The possibility to tune the functional properties ofnanomaterialsis key to their technological applications. Superlattices, i.e., periodicrepetitions of two or more materials in one or more dimensions, arebeing explored for their potential as materials with tailor-made properties.Meanwhile, nanowires offer a myriad of possibilities to engineer systemsat the nanoscale, as well as to combine materials that cannot be puttogether in conventional heterostructures due to the lattice mismatch.In this work, we investigate GaAs/GaP superlattices embedded in GaPnanowires and demonstrate the tunability of their phononic and optoelectronicproperties by inelastic light scattering experiments corroboratedby ab initio calculations. We observe clear modifications in the dispersionrelation for both acoustic and optical phonons in the superlatticesnanowires. We find that by controlling the superlattice periodicity,we can achieve tunability of the phonon frequencies. We also performedwavelength-dependent Raman microscopy on GaAs/GaP superlattice nanowires,and our results indicate a reduction in the electronic bandgap inthe superlattice compared to the bulk counterpart. All of our experimentalresults are rationalized with the help of ab initio density functionalperturbation theory (DFPT) calculations. This work sheds fresh insightsinto how material engineering at the nanoscale can tailor phonon dispersionand open pathways for thermal engineering. Consequently, the capability to tune the thermal conductivitybecomes essential for effective thermal engineering. Depending onspecific applications, there is a necessity to engineer materialswith heightened thermal conductivities, such as in high-power electronics5 and computing devices, as well as materials withreduced thermal conductivities for use in thermoelectric applications,6 thermal barrier coatings,7 etc. In semiconducting and dielectric materials, phonons - the vibrationsof the atomic lattice - are responsible for heat and sound transport.8 From kinetic theory, the thermal conductivityin semiconductors depends on the phononic properties such as densityof states, phonon mean free path, group velocities, and phonon energies.10 Consequently, the deliberate manipulation of these phononic propertiesenables us to create materials with tailor-made thermal conductivity.The advancements in material growth techniques have enabled the growthof artificial material structures with tunable phonon spectra forthermal engineering.18 Among the various strategies, the utilization of superlattice (SL)structures emerges as a promising way to tune the thermal propertyof materials.20 SLs are compositionally modulated periodic structures and have beenshown to host a plethora of interesting physics.21 Since the first experimental observation of reduced thermal conductivityin AlAs/GaAs SLs,22 several theoreticaland experimental works have explored SL structures for their potentialapplications in thermoelectric devices. The theoretical work of Hyldgaardand Mahan23 describes a model to calculatethe SL thermal conductivity based on modifications to the SL phononspectrum. They predicted a reduction in the thermal conductivity ofSi/Ge SLs due to the decrease in the group velocity of the SL phononmodes. This model was further extended by Tamura et al.,24 who calculated phonon group velocities in bothSi/Ge and AlAs/GaAs SLs and showed their contributions to thermalconductivity.In the last few decades,technological miniaturization has ledto the creation of smaller and more efficient electronic devices.As devices get smaller, we increasingly face the need for efficientheat management at lower dimensions, typically at the nanoscale.25 Indeed, several studies have demonstrated that this crossover canbe obtained by controlling the SL periodicity, showing that a distinctiveminimum in the lattice thermal conductivity can be achieved.27 By taking advantage of wave interferencephenomena of phonons, SLs can also serve as an ideal platform forcreating phonon bandgap materials by selectively allowing (blocking)phonons with certain energies to propagate through them. Moreover,studies have shown that we can have control over coherent and incoherentphonon transport in SLs by means of band folding produced by the largerperiodicity of the SL and the related changes in the phonon densityof states and velocities.20 The understanding of particle-waveduality of fundamental excitations like electrons and photons hasrevolutionized modern electronics and optics. By extension, a similarunderstanding of phonons is highly desirable for designing new waysfor manipulating the heat flow in materials. However, the need fornanoscale periodicity and atomically smooth interfaces heavily constrainsthe design of the SL for coherent control of phonon transport.SLs with atomically clean interfaces have provento be ideal systemsfor studying the crossover from particle to wave nature of phonons.30 However, SLs can also be madeby periodic alternation of different crystal phases of the same material31 and by the periodic rotation of the crystallattice, the so-called twinning SLs.32 The growthof many of these superstructures with atomically abrupt interfacesor minimal interface mixing, however, is limited to thin films. Oneof the main issues is the lattice mismatch between the constituentlayers. Nanowires (NWs) are quasi-one-dimensional structures whichallow the growth of defect-free axial and radial heterostructuresotherwise difficult or even impossible to achieve in planar structuresbecause they can release the strain caused by the lattice mismatchin the radial direction.35 Advancements in the epitaxialgrowth of semiconductor NWs make it possible to grow SL NWs of differenttypes with atomic interface sharpness and minimal interface mixing.This makes SL NWs an ideal platform to envisage and study phonon engineeringat the nanoscale for controlled heat transport. In recent years, therehas been an increase in both the theoretical and experimental studiesof SL NWs with a focus on their thermal properties.38 Most of the work done in NW SLs from the perspectiveof phonon engineering explores twinning or crystal phase SLs. In thiswork, we study the phononic properties of SL NWs made of two differentconstituent materials: GaAs and GaP. The combination of materialswith different elastic constants creates an enhancement of phononwave interference effects such as phonon bandgaps.16 Both GaAs and GaP are highly relevant materials in therealm of photonic and optoelectronic devices with applications inphotovoltaics,41 light-emitting devices,42 transistors,43 etc. The possibility ofcombining these two materials at the nanoscale will create a versatilematerial system for photonic and phononic applications. However, thelattice mismatch between GaAs and GaP is approximately 3.7%, posinggrowth constraints for planar superlattices.21 The NW geometry enables the combination of GaP and GaAs epitaxiallywithout the formation of misfit dislocations at the interface.SL structures can take different forms depending on their constituentlayers. Conventional SL structures are formed by the periodic alternationof different materials.In this work, we investigate the phononic properties of GaAs/GaPSL NWs with periodicities ranging from 4.8 to 10 nm. We present theresults of inelastic light scattering experiments such as Raman microscopyand Brillouin light scattering interferometry of these SL NWs, andwe show that the phononic properties of GaAs/GaP SL NWs can be tunedby controlling the SL periodicity. We demonstrate that as the SL periodicityincreases, the number of phonon modes increases. Our experimentalresults together with the ab initio calculations indicate a reductionin the electronic bandgap in the SL structure compared to the bulkmaterials. Our study shows that NWs can serve as a template for combiningdifferent materials at the nanoscale for designing new material systemswith tunable phononic and optoelectronic properties.244LGaAs) and GaP (LGaP) segments, i.e., L = LGaAs + LGaP. LGaAs = 5.0 nm and LGaP = 5.0 nm). The detailedhigh-resolution TEM (HR-TEM) image of an SL NW with a 4.8 nm longperiod is found in the SI in Figure S1.The TEM image shows alternatingly spaced GaAs and GaP segments alongthe growth direction of the NW and from the HR-TEM in Figure S1, we measure L as 5.3 ± 0.6 nm,i.e., consistent with the nominal value, using DigitalMicrograph. L = 6.0 nm (LGaAs = 3.0 nm and LGaP = 3.0 nm) and 10.0 nm (LGaAs = 5.0 nm and LGaP = 5.0nm). A reference sample of NWs without SL, i.e., made of a 0.5 μmlong GaAs stem followed by 3 μm of GaP segment, was also grown.GaAs/GaP SLNWs with different periodicities are grown using Au-assistedchemical beam epitaxy (CBE) on GaAs (111) B substrates. The GaAs/GaPSL NW growth process is described in detail elsewhere.In order to probe the phonon spectra of GaAs/GaPSL NWs, we performedinelastic light scattering experiments such as Raman microscopy onsingle GaAs/GaP SL NWs with different period lengths and Brillouinlight scattering interferometry on the as-grown NW ensemble.x̅x scattering configuration in Porto notation, asdescribed in –1, the experimentaldata can be fitted with 4 peaks at frequencies 352.2, 362.2, 371.0,and 400.7 cm–1, which can be assigned to the E2H mode, the A1/E1 transversal optical (TO) mode, the surface optical (SO) mode,and the longitudinal optical (LO) mode, respectively.47 The calculated spectrum of bulk wurtzite (WZ) GaP for configuration x̅x is shown in –1 which correspondsto the TO mode of GaP in good agreement with the experimental observation.We observe a low-intensity LO mode in the experimental spectrum, inprinciple forbidden, and thus absent in the calculated spectrum. Thisobservation is due to the usage of a high numerical aperture (NA)objective and due to the partial relaxation of the selection rules,similar to what is observed and explained in De Luca et al.17 Similarly, we observe a peak around the frequencyof the E2H mode, a signature of the WZ crystal phase.The E2H mode is also forbidden in the x̅x configuration, andits observation can also be assigned to the use of a high NA objectiveas well as due to the small deviations in the selection rules. Itis worth noticing that, it has been shown that the E2H has a strongwavelength dependence.48 Also, we cannotexclude that the signal we observe is due to an asymmetric broadeningof the GaP TO mode because of the anharmonicity of the material.49 In Figure S2, wehave presented the results of the Raman spectroscopy done in the x̅x configuration for the reference NW where the presence of the E2H, which is allowed in this scattering geometry, can be better appreciated.51 The SO, on the other hand, isdue to finite size effects because of the NW geometry,52 and its frequency depends mainly on the dielectric constant of thesurrounding medium as well as on the diameter of the NW. Therefore,it is absent in the computed spectrum, as the calculations were performedin a bulk system. In –1 arising from the Si substrate beneath.53In x̅x configuration, probingthe region of the NW embedding the SL. In the spectral region of thephonon modes of GaP, we observe several modes between 340 and 400cm–1. The most intense peaks in this spectral rangeare at frequencies of 358.3, 352.8, and 388.2 cm–1 in the order of decreasing intensities. These new peaks appearingare assigned to modes arising from the SL. We can also see severalRaman peaks in the spectral region (between 240 and 300 cm–1) close to the phonon modes of GaAs, the most intense peak beingaround 276.4 cm–1. The other peaks are located at261.3 and 287.6 cm–1. In –1, since it is similar to the experimentallymeasured peak broadening. The theoretical spectrum of the SL structurecontains several peaks between 240 and 300 cm–1 aswell as between 340 and 400 cm–1 . Experimental and theoretical spectra obtained froman SL with a longer period  are shownin Figure S3 in the Supporting Information.In 54 The phonondispersion of the GaP/GaAs SL with a period of 6.39 nm obtained throughab initio calculations can be found in Figure S4 in the Supporting Information. There, the increased numberof phonon modes at the Γ-point can be appreciated, though itis worth noticing that not all of them are Raman-active (Table S1).These several phonon modes can be understood in terms of backfoldingof the phonon dispersion of the constituent materials of the SL or,equivalently, from the fact that the SL period dictates a much largerunit cell, containing many more atoms than the WZ primitive cellsof the constituent materials.–1), we then analyzed the corresponding eigen-displacements. Figure S5 in the SI shows the schematicfor two phonon modes at 288.1 and 367.2 cm–1, respectively,selected from Table S1. In the schematic,the blue, yellow, and green spheres represent Ga, As, and P atoms,respectively. The phonon mode at 288.1 cm–1 involvesvibrations of Ga and As atoms while the phonon mode at 367.2 cm–1 involves vibrations of the Ga and P atoms. Therefore,for the sake of simplicity, from now on, we will refer to SL modesin the low-frequency range as to GaAs-like SL mode and to more inthe high-frequency range as to GaP-like SL modes. For the sake ofgenerality, in Figure S6 in the SupportingInformation, we also show the eigen displacement of a Raman-inactive,low-frequency mode, whose vibrations involve atoms on both the GaPand the GaAs region.Furthermore, to prove the originof the phonon modes in the twodifferent frequency ranges , there are two modesat around 35 GHz and around 75 GHz. In our experiments, for the GaAs/GaPSL NW with L = 6 nm, we see peaks around 36 and 71GHz, in very good agreement with the calculation. Within our experimentaldetection window, i.e., for phonon frequencies between −120and 120 GHz, for q values close to 85 μm–1, we obtain a good agreement with calculation. However, we also observea few phonon modes which do not appear in the calculations. This deviationbetween calculation and experiment could be explained as due to acombination of several reasons, the first is the difference betweenexperimentally measured and calculated phonon frequencies leadingto calculated modes falling out of the experimental detection window.In our calculations of the dispersion relationship, we do not takeinto account the surface phonon modes arising from the surface ripplemechanism,59 which is often observed in Brillouininterferometry of metals and semiconductors. Our bulk calculationsalso do not take into account confined acoustic phonon modes reported,e.g., by Kargar and co-workers in GaAs NWs with diameters in 100–150nm range.57 We have tabulated the calculatedacoustic phonon modes with frequencies less than 1 THz for an SL withperiodicity of 6.3 nm in the SI in Table S2.The acoustic phonon modes were probed by Brillouinlight scattering(BLS) interferometry.L = 4.8 nmto test the effects of the excitation wavelength on the SL phononmodes. The results of wavelength-dependent measurements are summarizedin 2 as thereference material as it has a constant Raman tensor in the range1.8–3.8 eV.61 We first normalized all of themeasured spectra with the intensity of the CaF2. In L = 4.8 nm excited with 3 different wavelengths. The datain violet, green, orange, and red curves represent spectra obtainedwith excitation wavelengths 488, 514, 561, and 633 nm, respectively.One striking observation as we increase the excitation wavelengthis that the relative contribution of GaAs-like modes compared to GaP-likemodes increases. This is clearer in –1) to the intensity of the most intense GaAs-like mode(at around 276 cm–1). We see that the value of thisratio goes from around 3 to less than 0.5 as we increase the excitationwavelength from 488 to 561 nm, this value then slightly increasesto 0.7 at 633 nm. In –1 shows a significant increase in signal at 561 and 633 nm. For GaP-likephonon modes, the phonon mode around 356 cm–1 showscomparable intensities for 633, 561, and 488 nm and a lower intensityfor 514 nm. All other SL phonon modes presented comparable intensitiesat different excitation wavelengths. In 1(LO) mode showsresonances at 2.38 and 2.67 eV, and A1(LO) exhibits resonanceat 2.67 eV.62 The different responses ofthe SL and reference NW to different excitation wavelengths also area strong indication of the modification of the electronic band structurein an SL as compared to the constituent materials. In order to furtherunderstand the effect of SL periodicity on the electronic band structure,we performed density functional theory (DFT) calculations with theprojector augmented wave method63 and thelocal density approximation (LDA) of three GaAs/GaP SLs with differentperiods. Local and semilocal approximations to the exchange-correlationenergy, such as the LDA, are known to underestimate electronic bandgaps.However, in a previous work, Giorgi et al.64 performed G0W0 calculations, which provide bandgaps in good agreement with theexperiments, obtaining a correction of the DFT-LDA bandgap of WZ bulkGaAs and GaP of ∼1 eV (0.91 and 0.96 eV). Therefore, as a firstapproximation, we assume a similar correction for the bandgap of GaAs/GaPSLs as well. The results of our calculations along with the G0W0 correctionsare tabulated in 3In this work, we reportedthe phononic properties of GaAs/GaP SLNWs with different periods using inelastic light scattering experiments.Our results are corroborated by ab initio theoretical calculations.We were able to assign the phonon modes stemming from the SL, associatingtheir frequencies with the atomic species involved in the vibration.We also showed the tunability of the phononic spectrum by studyingthe dependence of both acoustic and optical phonon modes as a functionof the SL period. Namely, the number of phonon modes increases withthe SL period, which results from an increased number of atoms perunit cell. The investigation of the Raman response to different excitationwavelengths of SL compared to the reference system hints at a differentelectronic band structure, which is also expected to be SL-period-dependent.Hence, we demonstrated the possibility of obtaining metamaterialswith designed functional properties by controlling the SL period.Our results show that NW SLs allow the creation of materials withdifferent phonon dispersions, which in turn has implications in designingthermoelectric materials with reduced thermal conductivity. Our resultsalso have a significant impact on creating designed materials withtunable thermal, acoustic, and optoelectronic properties.44.1The GaAs/GaP SL NWs were grownon GaAs (111)B substrates by Au-assisted Chemical Beam Epitaxy (CBE)in a Riber Compact-21 system. The metal–organic (MO) precursorsused for the NW growth were triethylgallium (TEGa), tertiary butylarsine(TBAs), and tertiary butylphosphine (TBP). The GaAs (111)B substrateswere first coated with a 0.1 nm thick Au film at room temperaturein a thermal evaporator and then transferred to the CBE growth chamber.Prior to the start of the growth, the samples were annealed at 520± 5 °C under TBAs flux for 20 min in order to dewet theAu film into nanoparticles and to remove the surface oxide from theGaAs substrate. The NW growth protocol consisted of four steps. Instep I, the growth of a 0.5 μm long GaAs stem was performedfor 60 min at 510 ± 5 °C using MO line pressures of 0.7and 1 Torr for TEGa and TBAs, respectively. Afterward, the temperaturewas ramped up to 560 ± 5 °C in 5 min to initiate the growthof the GaP segment (step II) with a direct switch of the precursorfluxes without any growth interruption. The GaP segment was grownusing MO line pressures of 0.7 and 2 Torr for TEGa and TBP, respectively.In step III, the growth of GaAs and GaP alternating segments formingthe SL was performed at 560 ± 5 °C using the same MO linepressures. Finally, (step IV), a 1 μm long GaP top segment wasgrown by keeping the growth parameters (growth temperature and MOfluxes). The growth was terminated by switching off the TEGa fluxand cooling the sample under the TBP flux.4.2NW transparent to the electronbeam was a dispersed carbon holey grid. HR-TEM and EDX measurementswere performed using a JEOL JEM F220 microscope operated at 200 kVand equipped with an EDX spectrometer.4.3ikks to indicate the polarization configuration of our Raman measurements,where ik, εi, εs, and ks are thedirection of propagation of incident photon, direction of polarizationof incident photon, direction of polarization of scattered photon,and direction of propagation of scattered photon, respectively. Inthis work, since we use backscattering geometry, we assume the incidentand scattered photon wave vectors to be antiparallel and parallelto the x axis. Therefore, the polarization vectorswill lie in the plane perpendicular to the directions of propagation,i.e., the yz plane. In our experiments, we considerthe NW growth axis to lie along the z axis. For example,the configuration x̅x, which is the main scattering geometryused in this work, represents a measurement with excitation and detectionpolarizations along the NW growth axis. For the sake of comparison,we have used a reference NW sample consisting of a 500 nm long GaAssegment followed by 3 μm of GaP stem.For the μ-Ramanexperiments, we transferred single NWs onto a Si substrate with a525 nm silicon nitride coating using a micromanipulator. The polarization-resolvedRaman measurements were performed in backscattering geometry withthe help of a Horiba T64000 triple spectrometer in subtractive modewith a 1.800 g/mm grating and a liquid-nitrogen-cooled CCD detector.Whenever not specified otherwise, the presented spectra were collectedby using a 488 nm excitation wavelength. We used power below 120 μWto perform the Raman experiments. At room temperature, we used a 100×objective with a high NA of 0.95 for focusing the excitation laserand collecting the scattered light. We use the conventional Portonotation of the form 4.465 The measurements were performed on as-grown NWs on the GaAs substrateusing a 532 nm laser at room temperature. We used a 100x objectiveto excite and collect the scattered light to perform the BLS measurements.We used a6-pass tandem Fabry Perrot interferometer, to investigate the low-frequencyacoustic phonons.4.566 with the ABINIT code68 by computing the third derivative of the total energy . Weused the LDA for the exchange-correlation energy functional and norm-conservingpseudopotentials. We used a plane wave cutoff of 37 Ha, an energycutoff for the fine fast Fourier transform of 76 Ha, and a strictconvergence criterion of the wave function residual norm of 10–22.We studied SLs with periods of 1.28, 2.56, 3.83, 5.12, and 6,39 nm,constructed by piling up unit cells of wurtzite GaAs and GaP alongthe [0001] crystal axis. The Brillouin zone was sampled with a gridof 8 × 8 × Nk-points,decreasing N from 3 to 1 on going from the shorterperiod to the longer period. Prior to the calculation of the Ramanspectra, all systems were structurally relaxed, optimizing both theatomic positions and the cell lattice vectors, without applying anyadditional constraint. The calculations were performed in a bulk system.Further details can be found, e.g., in ref , in ref .


Infectious diseases are among the leading causes of death worldwide. This is concerning because of the increasing capacity of the pathogens to develop antibiotic resistance. Antibiotic overuse and misuse remain the main drivers of resistance development. In the USA and Europe, annual campaigns raise awareness of antibiotic misuse hazards and promote their judicial use. Similar efforts are lacking in Egypt. This study assessed the knowledge of the public in Alexandria, Egypt of antibiotic misuse risks and their habits towards antibiotic use, in addition to conducting a campaign to increase awareness of the safe use of antibiotics.A questionnaire assessing knowledge, attitudes and behaviour towards antibiotics was used to collect responses from study participants at various sports clubs in Alexandria in 2019. An awareness campaign to correct misconceptions and a post awareness survey followed.Most of the participants were well-educated (85%), in their middle age (51%) and took antibiotics last year (80%). 22% would take an antibiotic for common cold. This dropped to 7% following the awareness. There was a 1.6 time increase in participants who would start an antibiotic on a healthcare professional’s advice following the campaign. A 1.3 time increase in participants who would finish an antibiotic regimen was also observed. The campaign made all participants recognize that unwise antibiotic use is harmful to them or others; and 1.5 more participants would spread the word about antibiotic resistance. Despite learning of the risks of antibiotic use, there was no change in how often participants thought they should take antibiotics.Although awareness of antibiotic resistance is rising, some wrong perceptions hold fast. This highlights the need for patient and healthcare-tailored awareness sessions as part of a structured and national public health program directed to the Egyptian population.The online version contains supplementary material available at 10.1186/s13756-023-01249-5. Antimicrobial resistance (AMR) represents a serious problem described by the World Health Organization (WHO) as “a global public health concern” . AMR hasThe emergence of these resistant bacteria leads to a socioeconomic burden worldwide due to increased healthcare costs as a result of using more expensive antimicrobials and prolonged hospital stays, in addition to lost productivity. It is estimated that the annual health burden of the treatment of MDR bacterial infections in the USA is around $20 billion, with $35 billion lost due to reduced productivity [Research from around the globe indicates high rates of injudicious use of antibiotics by the public. Practices related to injudicious use in the literature include the use of left over antibiotics , 7 and aStaphylococcus aureus isolates were resistant to a wide range of antibiotic classes. Another study reported fluoroquinolone resistance among methicillin-resistant S. aureus (MRSA) isolates from Alexandria, Egypt to range between 78% and 96% [E. coli isolates were resistant to ampicillin [Acinetobacter baumannii isolates from Alexandria Main University Hospital were MDR [In Egypt, antibiotic misuse and overuse led to a high prevalence of MDR bacteria among the population (reviewed in ). Most s and 96% . Among Gpicillin  and upwawere MDR . Howeverwere MDR . In anotwere MDR . Moreovewere MDR .Patient pressure has been identified as an important driver for injudicious prescribing and dispensing of antibiotics, yet a lone campaign in Minya, Egypt promoted the appropriate use of antibiotics to treat respiratory tract infections among prescribers and the general public . The aimA questionnaire was used to collect responses from study participants who were the parents of children playing sports at different sports clubs in Alexandria, Egypt. The study was conducted over three months between July and September 2019. It was divided into three phases. Phase one consisted of a general survey about participant’s antibiotic use and knowledge of antibiotic resistance. Phase two consisted of an antibiotic awareness campaign to guide people against the misuse of antibiotics and its consequences on antibiotic resistance, and phase three consisted of a post awareness questionnaire to assess the effectiveness of the awareness sessions. The awareness sessions were delivered by Alexandria University clinical pharmacy students and took the form of informal chats with the participants. As part of the sessions, the participants were given some flyers  stressing the awareness messages. The students took turns delivering the messages and used the flyers as guiding points.Ethical approval for the study was obtained from the Faculty of Medicine and Health Sciences Research Ethics Committee, University of East Anglia , and The Research Ethics Committee at the Faculty of Pharmacy, Alexandria University prior to study commencement.Convenience sampling was used to recruit the participants. No specific sample size was designated before study commencement. The sample size was determined in light of the number of students contributing to the campaign. The students set up working stations on weekdays and weekends in each of the sports clubs they visited and approached all adults who came in contact with them. All potential study participants were provided with a participant information sheet prior to taking part in the study, and informed consent was obtained from all participants for the collection and use of their data before beginning the study. The participants were then given the paper-based questionnaire by the students. The participants returned the completed questionnaire back to the students when they were done.The questionnaire  covered the demographic and professional data of the participants and then was divided into two parts. The first part consisted of six questions collecting data about past antibiotic use. The second part contained 13 questions about knowledge and attitudes towards antibiotics and antibiotic resistance. The participants were asked to fill both parts of the questionnaire at phase one, and just the second part at phase three following the awareness campaign. The full questionnaire needed an average of five minutes to be completed. A pilot study covering over 500 participants had been carried out prior to current data collection.The questionnaire was anonymous, the demographic data collected can’t be used to determine the identity of the participants, and therefore the data from phase one and phase three can’t be linked to individuals.p value of ≤ 0.05. The Independent variable was the education, and the dependent variables were knowledge and attitudes towards antibiotic use and resistance. Categorical variable was classified to Zero (unexposed to education), 1 (exposed to education). Data showing significant differences were subsequently analysed by binary or multinomial logistic regression in SPSS (v. 28.0.1.1) to obtain odds ratios. For multinomial regression, the reference category was set as the largest category for each dataset.The data were tabulated and statistically analysed using Fisher’s exact test and Chi squared test, where the results were considered significant at a A total of 626 sports club attendees were approached and they all agreed to participate in the study making the response rate 100%. The majority of the participants (51%) were aged 31 to 50 years old, 76% of the participants were females and 85% were university graduates holding a bachelor or a higher degree.Surveying the history of antibiotic use showed that more than 80% of the participants took antibiotics last year at least once, with 46% taking antibiotics 2 to 3 times. Of those who had taken antibiotics, 80% took them on the advice of a healthcare professional , while 20% took them after advice from non-healthcare professional sources  (Table p = 0.036). A total of 78% of the participants thought that they should not take antibiotics for a common cold; this percentage increased to 93% after the campaign . Yet, almost half of the participants would start an antibiotic based on their own assessment of their symptoms versus 34% who would start an antibiotic following advice from a physician or pharmacist. These percentages changed to 20% and 55% following the awareness campaign . Nevertheless, 64% of the participants knew that they should complete the antibiotic regimen, which increased to 86% as a consequence of the awareness campaign  . While there was also a significant drop in the number of participants who would buy antibiotics to use even if a doctor hadn’t told them they needed them , there remained a substantial number of people who would still purchase antibiotics. This was further reflected in the fact that there was no significant difference in the number of participants who felt they should be able to buy antibiotics whenever they want them, with almost one in three participants wanting the freedom to do so . As for participant’ attitudes towards antibiotic resistance, 87% have now told others about antibiotic resistance versus just 59% before the campaign , yet the campaign does not seem to have changed how often people would take an antibiotic  used antibiotics throughout the last year, which is almost the same percentage (89%) described in a recent WHO report  that stuMoreover, one third of participants believed that the more expensive an antibiotic is, the more effective it is. This could be explained by the perception in general that any product with a higher price will be higher in quality, neglecting its actual properties . HoweverIn total 22% of the participants believed that antibiotics could be used to treat the common cold, which is much lower than found in the WHO’s report (76%)  and closThe final part of the survey assessed the participants’ knowledge about antibiotic resistance. We found that almost 70% of the participants had already heard about antibiotic resistance more than once and from different sources, mainly healthcare professionals and from media sources. This figure is almost 3 times higher than in the WHO report (22%)  and arouWhile the awareness campaign was quite effective at changing the views and understanding of participants (views were changed in 10 out of 13 questions) there is still clearly work to be done to improve public knowledge. For example, despite the awareness campaign, 1 in 5 participants still believed a more expensive antibiotic would be better for them, and would self-medicate, while 8% believed they should be taking more antibiotics rather than fewer. It is possible that these represent people who are more resistant to change. Our study population consisted largely of adults of an age at which their views and behaviours will have been embedded for some time, and which are harder to change than those of much younger people . When prThe findings of the current study are aligned with the TPB that explains all behaviours that people control and that has been used to explain many health behaviours. It consists of a number of key constructs: (a) attitudes, (b) subjective norms and (c) perceived behavioural control. These components determine the behavioural intention of a person . In the Finally, perceived behavioural control is exemplified here by the difficulty level of obtaining an antibiotic. The finding that following the awareness session participants were not more likely to embrace a restriction to their ability to obtain antibiotics on demand responds to the perceived behavioural control. In future campaigns this can be addressed by stressing the benefits of restricting antibiotic use in limiting antibiotic resistance development.In conclusion, the tested population had some good pre-existing knowledge and attitudes to antibiotics and antibiotic resistance, but this was still increased as a result of the awareness campaign, with some incorrect perceptions corrected. However, some misconceptions persisted in a small proportion of the population, and this proportion would likely be higher in a population with less pre-existing knowledge. Hence, we recommended increasing awareness campaigns for the public with customized engagement materials and activities that are more likely to enable individuals to identify changes they could make in their own behaviour.To the best of the authors’ knowledge this is the second published campaign to address the wise use of antibiotics among the general public in Egypt and the first in Alexandria.The main limitation of this study is that convenience sampling was used to enroll participants resulting in a relatively high level of education. Future studies might address this by replicating and expanding on this work with patients of lower educational levels. Selection bias resulting from potential differences between the groups before and after the awareness campaign is a potential limitation. Second, social desirability bias might have impacted the reported rates. Third, the study used a single approach to improve antibiotic use and that is raising public awareness and didn’t address other forms and/or levels of interventions. Finally, despite targeting a specific group so that we could reassess their knowledge at subsequent visits to the clubs, it was difficult to persuade participants to re-do the survey leading to a much smaller group number following the awareness campaign. We do not anticipate differences among the before and after awareness groups in relation to key study variables. In future work, we need to consider how to better incentivise this.Below is the link to the electronic supplementary material.Additional File 1. Examples of educational flyers used by the clinical pharmacy students in the awareness campaign.Additional File 2. The Arabic version of the questionnaire used to assess the participants’ knowledge, attitudes and behaviour towards antibiotic use and antibiotic resistance.Additional File 3. The English translation of the questionnaire used to assess the participants’ knowledge, attitudes and behaviour towards antibiotic use and antibiotic resistance.


However, bacteria rarely grow in these optimal conditions. Using a mathematical model of the pharmacodynamics of antibiotics, we make predictions about the nutrient dependency of bacterial growth in the presence of antibiotics. We test these predictions with experiments in broth and a glucose-limited minimal media with Escherichia coli and eight different antibiotics. Our experiments question the sufficiency of using MICs and simple pharmacodynamic functions as measures of the pharmacodynamics of antibiotics under the nutritional conditions of infected tissues. To an extent that varies among drugs: (i) the estimated MICs obtained in rich media are greater than those estimated in minimal media; (ii) exposure to these drugs increases the time before logarithmic growth starts, their lag; and (iii) the stationary-phase density of E. coli populations declines with greater sub-MIC antibiotic concentrations. We postulate a mechanism to account for the relationship between sub-MICs of antibiotics and these growth parameters. This study is limited to a single bacterial strain and two types of culture media with different nutritive content. These limitations aside, the results of our study clearly question the use of MIC as the unique pharmacodynamic parameter to develop therapeutically oriented protocols.The MIC of an antibiotic required to prevent replication is used both as a measure of the susceptibility/resistance of bacteria to that drug and as the single pharmacodynamic parameter for the rational design of antibiotic treatment regimes. MICs are experimentally estimated IMPORTANCE For studies of antibiotics and how they work, the most-often used measurement of drug efficacy is the MIC. The MIC is the concentration of an antibiotic needed to inhibit bacterial growth. This parameter is critical to the design and implementation of antibiotic therapy. We provide evidence that the use of MIC as the sole measurement for antibiotic efficacy ignores important aspects of bacterial growth dynamics. Before now, there has not been a nexus between bacteria, the conditions in which they grow, and the MIC. Most importantly, few studies have considered sub-MICs of antibiotics, despite their clinical importance. Here, we explore these concentrations in-depth, and we demonstrate MIC to be an incomplete measure of how an infection will interact with a specific antibiotic. Understanding the critiques of MIC is the first of many steps needed to improve infectious disease treatment. Fundamental to the rational, as opposed to purely empirical design of antibiotic treatment regimens are the bacterial-dependent pharmacodynamics (PD) –3, and h–in vitro, most commonly by two-times serial dilution of the antibiotic , we explore the fit of these models to the pharmacodynamics of antibiotics of eight different classes.It has been shown that the value of the MIC estimated for antibiotic and bacteria pairs are critically dependent on the density of bacteria exposed to the antibiotics when starting MIC estimation experiments . In thisThe results of our study show how different factors affect the MIC estimation as determined by standard procedures and question the sufficiency and validity of this pivotal parameter to provide a quantitatively accurate picture of the pharmacodynamics of antibiotics and bacteria . We demoFor our model of the pharmacodynamics of antibiotics and bacteria, we combine Hill functions  with a rMAXv is the maximum rate of growth per cell per hour of the bacteria in the absence of the antibiotic, where MAXv > 0. MINv is the minimum growth rate per cell per hour of the bacteria in the presence of the antibiotic, MINv < 0. MIC is the MIC in μg/mL of the antibiotic. A, r) function, the greater the value of r. The parameter k in μg/mL is the Monod constant which is the concentration of the resource when the growth rate in the absence of antibiotics is half of its maximum value, MAXv.The parameter To explore the relationship between antibiotic concentration, limiting resource concentration, and bacterial density, we present three coupled differential equations based on the Hill functions. is the Hill function designated rate of growth or death of the bacteria when the concentration of the antibiotic is A and the resource is r  medium with 1,000 μg/mL glucose, and Mueller-Hinton (MH)  .For ciprofloxacin (CIP), fosfomycin (FOF), chloramphenicol (CHL), rifampin (RIF), and ceftriaxone (CRO), the MICs in broth and minimal medium are equal or nearly so. For azithromycin (AZM), gentamicin (GEN), and tetracycline (TET), the MICs in broth are substantially greater than that in glucose-limited minimal medium. In the case of MH, all the MICs are the same as in LB with the exception of GEN and AZM which are notably higher in LB. In Table S1, we show the MICs with minimal medium with different carbon sources. Notably, the MICs of certain drugs such as azithromycin, fosfomycin, and ceftriaxone are lower in alternative carbon sources than they are in glucose. The values presented for the MICs of these drugs were chosen as the first concentration at which the optical density declined substantially approached that of the media. As shown in Fig. S1, sub-MICs in most antibiotics lead to a decrease in the optical density in proportion to the drug concentration, an effect we call MIC ooze, that is to say, there is not one clear MIC as the OD decreases stepwise across several wells, rather than precipitously.(ii) Growth dynamics at sub-MICs of eight antibiotics in LB and minimal media. In E. coli MG1655 exposed to different antibiotics in LB and minimal media, respectively. A detailed comparison of the parameters estimated from this analysis  are available in Fig. S2 and S5, Fig. S3 and S6, and Fig. S4 and S7, respectively.The dynamics of change in optical densities of MG1655 vary among the drugs in both broth and minimal medium. For all eight antibiotics, these dynamic data indicate concentration-dependent variation in the time before the populations start to grow, the rate of growth, and the density achieved at 24 h for LB and 48 h for the minimal medium.In Fig. S2 and S5, we plot the relationship between the estimated maximum growth rates as a function of sub-MIC of the antibiotics in LB  and minimal . With the exception of fosfomycin in both media, the max rate of growth increases with the declining concentration of antibiotic. The observation that higher concentrations of the antibiotics would be reducing the growth rate of the bacteria to an extent greater than at lower concentrations is anticipated and central to the use of the pharmacodynamic Hill functions.In Fig. S3 and S6, we plot the amount of time required before the optical density exceeds 0.020, the relative lag for different concentrations of the antibiotics in LB and minimal medium, respectively. In both media, there is a concentration dependent increase in the lag time, with higher concentrations of the drug leading to longer lag times.The optical density at 24 h in LB and 48 h in minimal DM are presented in Fig. S4 and S7, respectively. In both media, for all of the antibiotics, the maximum optical density increases with the decline in the concentration of the antibiotic. This decrease in the maximum optical density is associated with a decrease in the viable CFU of these cultures .Consistently across all three testing conditions, fosfomycin, gentamicin, and rifampin have high variability between replicates. This high variability can be explained by the emergence of resistance. For fosfomycin and rifampin resistances emerge independently across replicas as shown in Fig. S9 and S10. For fosfomycin an increase in MIC of over 11-fold was seen between pre- and post-antibiotic exposed cultures, while for rifampin an increase of 35 times was seen. This rapid selection for fosfomycin resistance is well known as it has been shown that there is a large inoculum density effect when performing MICs with this drug . When MG(iii) Consumption of a limited resource in sub-MIC treated cultures. The association between the concentration of the drug and the final optical density of each culture  Antibiotic dependent resource consumption. In accord with E. coli, the antibiotic increases the amount of resource necessary to produce a new cell (new cell . As suchnew cell . By modi(v) Rates of antibiotic-dependent growth and mortality. To explore the relationship between the concentration of the antibiotic and the rates of growth and death of E. coli MG1655, we performed time-kill experiments. Overnight cultures of the bacteria in LB  suppress growth of the bacteria at super-MICs. In both media, ciprofloxacin, gentamicin, and ceftriaxone appear highly bactericidal, although ceftriaxone does not kill at all in the first 8 h in minimal media. Rifampin and fosfomycin are both complicated by the emergence of genotypic resistance. Rifampin appears static for the first several hours in both media, but the bacteria end up growing to the level of the control by 24 h and 48 h, respectively. Fosfomycin kills the in vivo conditions, the local bacterial concentration at the site of infection, the replication rate, the available nutrients, the antibiotic concentration, and the effect of immune response are highly heterogeneous in time and space. In addition, under in vivo conditions within tissues, most bacteria are likely exposed to sub-MICs of drugs derived to an antibiotic gradient, and not to the drug concentration present in the serum  but recognize there are caveats to consider. First, that our study was performed with just one laboratory strain of in vitro conditions. In laboratory tests, the most used PD parameter, the MIC, certainly allows for the comparison of antibiotic susceptibility between two isolates of the same species under identical in vitro conditions. However, MIC is an insufficient PD marker for several reasons. First, the antibiotic effect at subinhibitory concentrations is not considered. Second, this parameter does not tell us anything about the susceptibility of a given organism at different cell densities. Third, it tells us nothing about changes in growth parameters such as the effect on lag, average growth rate, final density, or overall rate of drug-mediated killing. Lastly, MIC indicates nothing about postantibiotic effects, resistance, persistence, or heteroresistance. All these pharmacodynamic dimensions change the effect of antibiotics in vivo as the concentration of the drug changes over time, as predicted by the PK. Without understanding these effects, the operative linkage of PK/PD is insufficient to obtain robust predictions about antibiotic efficacy. When MIC is used as the sole PD parameter, this insufficiency is even more apparent. Most PK/PD approaches look at one of three PK parameters: either maximum concentration of the antibiotic to MIC, drug exposure to MIC (which is to say area under the curve to MIC), or the time that the drug concentration is above the MIC . Factors which are difficult or impossible to reproduce under  the MIC . Most imE. coli. Copies of the Berkeley Madonna program used for these simulations are available at www.eclf.net.For our numerical analysis of the equations presented –6, we usLB broth (244620) was obtained from BD. The DM  minimal base without dextrose (15758-500G-F) was obtained from Sigma-Aldrich . MH broth (M391-500g) was obtained from HiMedia. Glucose (41095-5000) was obtained from Acros, Succinic Acid (S-2378) was obtained from Sigma-Aldrich, Lactose (L3750) was obtained from Sigma-Aldrich, Maltose (M2250) was obtained from Sigma-Aldrich, Glycerol (G7757) was obtained from Honeywell and Fructose (161355000) was obtained from ACROS Organics. LB agar (244510) for plates was obtained from BD.E. coli MG1655 was obtained from the Levin Lab Bacterial collection. This Whole Genome Shotgun project has been deposited at DDBJ/ENA/GenBank under the accession JAQIDJ000000000. The version described in this paper is version JAQIDJ010000000.T17000) was obtained from Research Products International, Fosfomycin (P5396) was obtained from Sigma-Aldrich, Chloramphenicol (23660) was obtained from USB, Rifampin (BP2679-1) was obtained from Fisher BioReagents, Ceftriaxone (C5793) was obtained from Sigma-Aldrich, Azithromycin (3771) was obtained from TOCRIS and Gentamicin (BP918-1) was obtained from Fisher BioReagents.Ciprofloxacin (A4556) was obtained from AppliChem Panreac, Tetracycline  were made every 5 min for 24 h in LB and 48 h in glucose-limited medium. Normalization, replicate means and error, growth rate, lag and maximum OD were found using a novel R Bioscreen C analysis tool accessible at https://josheclf.shinyapps.io/bioscreen_app.Exponential growth rates were estimated from changes in optical density (OD600) in a Bioscreen C. For this, 24-h stationary-phase cultures were diluted in LB or glucose-limited liquid media to an initial density of approximately 10Bacterial DNA was extracted using Promega’s  Wizard Genomics DNA purification kit (Cat# A1120) using the manufacturer’s protocol. The extracted DNA was quantified on Thermo Fisher’s NanoDrop OneC microvolume spectrophotometer (Cat# ND-ONEW). Samples were sent to the Microbial Genome Sequencing Center in Pittsburgh, PA, USA, for whole-genome sequencing on the Illumina NextSeq 2000 platform. Analysis of FASTAq files received from the Microbial Genome Sequencing Center were analyzed using Geneious Prime version 2022.0.1.Antibiotic MICs were estimated using a 2-fold microdilution procedure as described in Jorgensen et al. .E. coli MG1655 were added to LB broth or DM 1,000 μg/mL glucose liquid media at an initial density of approximately 105 cells per mL, followed by 1 h of incubation at 37°C and shaken continuously. After incubation, antibiotics were added at the concentrations indicated in For these experiments, overnight cultures of Glucose concentration was measured by the dinitrosalicylic colorimetric method as described in Miller .All the data generated are available in this manuscript and its supporting supplemental material.


The Children’s Saving Inventory (CSI) is a measurement tool developed to assess hoarding behavior in children. This study aims to investigate the psychometric properties of the Turkish version of the CSI in a clinical sample of children and adolescents. The study sample consisted of 52 children and adolescents diagnosed with obsessive-compulsive disorder in the 8-17 age group and their families. As a structured diagnostic interview, the Development and Well-Being Assessment (DAWBA) was applied to all participants included in the research. Hoarding disorder (HD) diagnosis was made clinically by considering the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) diagnostic criteria. The Children’s Yale-Brown Obsessive–Compulsive Scale Symptom Checklist (CY-BOCS) was administered by an experienced clinician. The parents and children filled out the Obsessive-Compulsive Inventory—Child Version (OCI-CV) and CSI scales independently. The 20-item CSI Turkish version demonstrated good internal consistency. This 4-factor structure of the scale was confirmed by confirmatory factor analysis. Children’s Saving Inventory showed convergent and discriminant validity with the OCI-CV and CY-BOCS subscales, and the higher CSI total scores in children and adolescents diagnosed with HD confirmed the construct validity. These findings support the use of the CSI Turkish version as a valid and reliable scale to investigate the hoarding behavior of children and adolescents in a clinical sample. In addition, the CSI Turkish version is currently the only validated instrument to evaluate hoarding behavior in children and adolescents, as rated by parents in Türkiye. This is the first and only study to test the validity and reliability of the Children’s Saving Inventory (CSI) in another culture.The CSI Turkish version demonstrated good internal consistency.This four-factor structure of the scale was confirmed by confirmatory factor analysis.The CSI Turkish version was found to be a valid and reliable scale for use in a clinical sample.1 While hoarding was previously considered a symptom of obsessive-compulsive disorder (OCD), HD is now recognized as a separate disorder within the OCD and Related Disorders category in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5).2 Research indicates that HD typically emerges between the ages of 11 and 15,3 although there is limited data available for childhood and adolescence in the scientific literature. However, the number of studies on this age group has been increasing since the inclusion of HD in the DSM-5. The estimated prevalence of HD in children and adolescents is 0.98%.4Hoarding disorder (HD) is a condition where individuals experience difficulties getting rid of possessions and have strong attachments to them, leading to distress when faced with the prospect of discarding them.5 Evidence-based assessments encourage the routine use of standard tools for the screening, diagnosis, and follow-up of psychiatric disorders in young people.6 Self-report questionnaires are widely used as an important source of information in daily practice since they help children and adolescents report their feelings, thoughts, and behaviors. Because hoarding is a subset of OCD, hoarding behavior is assessed using 2 items related to hoarding obsessions/compulsions on the Children’s Yale-Brown Obsessive–Compulsive Scale Symptom Checklist (CY-BOCS)7 and several items on the Obsessive-Compulsive Inventory—Child Version (OCI-CV).8 Hoarding disorder being recognized as a separate disorder and the limited ability of OCD scales to measure hoarding behaviors have led to the development of a specific scale for measuring hoarding in children and adolescents. Storch et al9 (2011) created the Children’s Saving Inventory (CSI), which is a parent-rated measure of a child’s level of hoarding behavior. The CSI is the first and only tool designed to assess hoarding behavior in children.It is emphasized that the early diagnosis and treatment of HD is important in terms of preventing the future recurrence of problems as well as increasing functionality in adult life.10 The items of the SI-R were revised to be appropriate for children and to be completed by parents. The psychometric properties of the CSI were tested on American9 and Canadian11 children and adolescents diagnosed with OCD. While the scale developers assessed the psychometric characteristics of the original 4-factor 23-item scale in the American context, the Canadian team assessed the revised 3-factor 15-item version, which excluded the factor assessing clutter. However, no validity or reliability study has yet been conducted for this tool in any language other than English. The lack of valid and reliable tools in non-English-speaking countries limits the ability to screen, diagnose, treat, and follow up on psychiatric disorders. Regardless of being shown to be sufficient in 1 culture, it is not guaranteed that these diagnostic instruments will be valid or reliable in another culture.12 There are differences between different cultures in the demographic characteristics, severity of symptoms, and comorbid psychiatric disorders of hoarding.13 Therefore, it is critical to translate the CSI parent version into a language other than English and to test it in a non-English-speaking culture.The CSI is based on the Saving Inventory-Revised (SI-R), a well-established adult self-report scale with strong psychometric properties.This study aims to investigate the psychometric characteristics of the Turkish CSI rated by parents in a clinical sample of children and adolescents in the 8-17 age group. We hypothesized that the results of the study would support the validity and reliability of the original 4-factor CSI in Turkish society.Necessary written permission and ethical approval for the study were obtained from the Ethics Committee of Atatürk University (B.30.2.0.01.00/50-01/29). In addition, permission was obtained electronically from the authors of the scale. After obtaining the necessary permissions, the items in the CSI were translated into Turkish separately by the present authors (fluent English speakers); then, the differences in the translated questionnaire were checked at a meeting. The inconsistencies were then examined by another researcher (a native English speaker) who was blind to the original items. The final version was accepted by all team members. The Turkish translation was translated back into English by a clinician who was fluent in both languages, and the translation was submitted to the author, who granted permission to use the original CSI. The participants included 52 children and adolescents aged 8-17 and their families. The children and adolescents were admitted to our outpatient clinic, where they were diagnosed with OCD for the first time. Those who read the informed consent form, volunteered to participate in the research, and signed the written consent form were included in the study. As a structured diagnostic interview, the Development and Well-Being Assessment (DAWBA) was applied to all participants included in the research. Obsessive-compulsive disorder diagnoses and comorbid psychiatric diagnoses were made using the DAWBA. Children and adolescents with a primary diagnosis of OCD were included in the study. The primary diagnosis was determined by the clinicians based on psychiatric interviews and the tools used according to the clinical manifestation that caused the most distress and deterioration in functionality. In addition, clinical interviews were conducted to assess the DSM-5 diagnostic criteria. The DSM-5 diagnostic criteria were endorsed. The findings and materials obtained as a result of the psychiatric interview were reviewed by an experienced child and adolescent psychiatrist. Each criterion and specifier of HD has been endorsed. Whether it is appropriate to use the C diagnostic criterion in children and adolescents and whether it should be adapted due to the strictness of this criterion remain controversial issues. Therefore, we neither waived this criterion nor disregarded parental intervention when confirming criterion C. Hence, criterion C was validated based on the verbal statement of the parent. At the end of all procedures, HD in children and adolescents was diagnosed based on the DSM-5 diagnostic criteria. Participants who had received or were already receiving treatment were excluded from the research due to their potential effects on the diagnosis and clinical presentation of both HD and OCD. The CY-BOCS was applied by an experienced clinician. The parents, children, and adolescents completed the OCI-CV and CSI scales independently.The form prepared within the scope of the study was used to collect demographic information  about the children and their parents.14 The Turkish version of DAWBA was developed by Dursun et al15 in 2013.This is a diagnostic tool used to assess psychiatric disorders in children and adolescents aged 2-17 years. It uses both the 10th edition of the International Classification of Diseases (ICD-10) and the DSM IV-V classifications. The DAWBA is composed of 3 parts: a structured interview for parents, a structured interview for young people aged 11-17, and a questionnaire for teachers. The interviews can be conducted through a written interview text or a computer application and can also be completed by parents, young people, and teachers themselves without the need for an interviewer. Unlike other interviewer-based formats, DAWBA includes open-ended questions in each section. This allows for a more accurate evaluation of symptoms and loss of functionality.9 to measure the frequency and severity of hoarding symptoms in children aged 8-17 years with OCD. The scale ranges from 0 to 4, with higher scores indicating more severe hoarding symptoms. The original scale consisted of 23 items, which were tested on 123 children and adolescents with OCD and their parents. Three items were removed from the scale due to low correlations and factor loadings. The final 23-item scale was found to be valid and reliable in the United States, with an internal consistency coefficient of r = .84-.96. In this study, the original 23-item version of the scale was used to assess the suitability of the scale for use in the Turkish population.The CSI is a parent-rated tool developed by Storch et al7 Obsessions and compulsions are scored in 5 subscales (scored from 0 to 4 points per item) to calculate the CY-BOCS obsession score (0-20 points), the CY-BOCS compulsion score (0-20 points), and the CY-BOCS total score (0-40 points). The Turkish reliability study of the scale was conducted in 2006 by Yücelen et al.16This is a semi-structured interview form used to assess the reported severity of obsessive-compulsive symptoms.8 The scale consists of 6 subscales: doubt/checking, obsessions, neutralizing, washing, ordering, and hoarding. Each item of the 21-item scale is scored from 0 to 4 points, with increasing scores in each subscale indicating more prominent OCD symptoms. The Turkish validity and reliability study of the scale was carried out in 2014 by Seçer.17This is a self-reported Likert-type instrument used to measure the level of obsessive-compulsive symptoms in children and adolescents.t-test was used for between-gender and between-group (HD/non-HD) comparisons. Continuous variables were presented using means and standard deviations (mean ± SD), and the categorical variables were presented as numbers and percentages .The Statistical Package for the Social Sciences version 24.0  program was used to analyze the data obtained in the study. The Kolmogorov–Smirnov test was used to test the normality of the distribution of continuous variables. An independent sample 19 One method to assess whether the items need to be removed from a scale to improve its alpha coefficient is to calculate the adjusted item-total correlation and remove items with a low (≤0.30) correlation.20 To achieve adequate item-total correlation values for the Turkish CSI scale, we used a cut-off value of 0.30, which is the accepted general cut-off value for the item removal criterion.The internal consistency of the CSI total and subscale scores was evaluated by examining Cronbach’s alpha coefficients, item-total correlations, and Cronbach’s alpha if the item was deleted. For acceptable reliability, alpha values should be in the range of 0.70-0.95.χ2, df, and P values, the root mean square error (RMSEA) of approximation ,21 the Comparative Fit Index , and Tucker–Lewis Index .22 In addition to examining model fit indices to obtain the most appropriate model, item factor loadings were also examined to identify items with poor fitness. A threshold value of 0.40 was used to include items on the scale.23 As a result, items with low factor loadings and low item-total correlations were removed.Confirmatory factor analysis (CFA) was performed using AMOS 24.0 software to test the model fitness of the original 23-item CSI and the 20-item Turkish CSI, which were developed by removing items that did not meet the criteria. To assess fitness, various fit indices were investigated, including model P < .05 was used to indicate statistical significance.The validity of the Turkish version of the CSI was evaluated using Pearson’s correlation analysis for continuous variables. The correlations between the CSI total and its subscales  and between the CSI total, CY-BOCS , and OCI-CV  were examined. In addition, the differences between the CSI total and subscale scores of the participants with and without HD diagnoses in the clinical interview were compared to test the construct validity of the CSI. A significance level of P > .05). In addition, there was no significant correlation between the ages of children and adolescents and CSI total and subscale scores (P > .05).The sociodemographic characteristics and psychiatric comorbidities of the participants are summarized in How much control does your child have over his/her urges to acquire possessions that s/he does not need?; Item 3, How much time do you spend dealing with your child’s possessions ?; and Item 4, How much control does your child have over his/her urges to save possessions that s/he does not need? The item-total correlations for Items 2, 3, and 4 were lower than 0.30 ; they also showed low factor loadings in CFA (see CFA). After removing these items, the analysis was repeated. The internal consistency of the Turkish 20-item CSI was excellent for the total score (Cronbach’s α = 0.93) and the subscales of discarding (α = 0.89), clutter (α = 0.78), acquisition (α = 0.83), and distress/impairment (α = 0.80). Item-total correlations ranged from 0.44 to 0.78 for the total scale, 0.57-0.85 for the discarding subscale, 0.43-0.76 for the clutter subscale, 0.43-0.74 for the acquisition subscale, and 0.51-0.73 for the distress/impairment subscale.The Cronbach’s alpha reliability of the 23-item original CSI was 0.91. Three items were removed from the scale: Item 2, P < .001). The factor loads of Item 2 (regression weight = 0.05), Item 3 (regression weight = 0.27), and Item 4 (regression weight = 0.14) were not significant . These 3 items were removed from the scale due to low item-total correlations in the reliability analysis and low factor loads in the CFA. Once removed, the analysis was repeated. The 20-item Turkish CSI was found to have an acceptable goodness of fit for the model . The chi-square test results and fit statistics are shown in The model fit of the original 23-item CSI data was somewhat good . All factor loadings, except for 3 items, were positive and significant (P < .001).Descriptive statistics and correlations for the CSI total and subscale scores are presented in r = 0.648, P < .001).Correlations between CSI scores and the hoarding subscale scores on the other scales used suggest acceptable convergent validity. The CSI total score was strongly correlated with the hoarding subscale of the OCI-CV , and between the CSI total score and the OCI-CV total score . In addition, there was no significant relationship between the CSI total score and the CY-BOCS and OCI-CV subscales . The correlations between the CSI total score and the OCD scales are shown in Low and moderate correlations were found between the CSI total score and the CY-BOCS total score (P < .001). A statistically significant difference was also found between the groups with and without HD diagnosis in terms of CSI discarding (17.29 vs. 6.22), CSI clutter (7.29 vs. 2.16), CSI acquisition (11.71 vs. 6.33), and CSI distress/impairment (10.14 vs. 6.18) subscales (P < .05).To test construct validity, the CSI total and subscale scores of the participants with (n = 7) and without (n = 45) HD diagnoses, according to clinical interviews, were compared. A statistically significant difference was found between the groups with and without HD diagnosis in CSI total scores  and Item 4 (How much control does your child have over his/her urges to save possessions that s/he does not need?) were removed from the scale due to low item-total correlations and low factor loads in CFA. However, Item 11 , which did not apply to the US population, was left on the scale since it had good fitness in the Turkish population. On the contrary, Item 3 ?), which applies to the US population, was removed from the scale due to insufficient fitness in the Turkish population. Thus, the 20-item Turkish CSI was obtained. The 4-factor Turkish CSI-20 was found to have an acceptable goodness of fit for the model. This result confirmed the 4-factor structure of the Turkish population. Compared to the original 23-item CSI, although we do not argue that the original CSI does not fit, the Turkish CSI-20 fits Turkish society better. When these findings are considered together, they offer a good example of how scale items translated into other languages and tested in different cultures may not have similar fitness.The scale developers excluded 2 items (Item 2 and Item 4) from the original 23-item CSI from their analysis due to their low item-total correlation and 1 item (Item 11) due to insufficient factor loading in the explanatory factor analysis.24 One method of measuring a scale’s internal consistency is the calculation of Cronbach’s alpha coefficient.18 The Cronbach’s alpha value in the study was found to be 0.93. Acceptable and good internal consistency was found for each of the 4 factors . Moreover, it was observed that all the scale items had positive correlations among themselves and with the total score of the scale. This shows that each item on the scale contributes to the total score. Our findings show that the 20-item CSI Turkish version has excellent reliability. In addition, the calculated Cronbach’s alpha values appear to be close to the values of the original scale .9Determining the internal consistency of the scale is one of the most important steps in determining whether a scale is reliable by evaluating item-total correlations.In addition to the reliability analyses, validity analyses show that the Turkish CSI-20 has adequate validity. First, the mutual correlations of the CSI total and subscale scores were examined for face validity. All CSI scores  had moderate to high correlations with each other. Second, the strong correlation between the CSI total score and the OCI-CV hoarding subscale supports acceptable convergent validity. Third, low and medium correlations were found between the CSI total score and the CY-BOCS and OCI-CV total scores. Since the sample of the study included children with OCD, this finding is expected. No significant correlations were found between the CSI total score and the other CY-BOCS subscales (obsession and compulsion) and the OCI-CV subscales . This, in turn, indicates the discriminant validity of the CSI-20. Finally, to test construct validity, the CSI total and subscale scores of participants with and without HD diagnoses were compared. In this study, HD diagnostic evaluation was based on a combined evaluation of data collected through clinical interviews with both the children and their parents. A statistically significant difference in the CSI total and 4 subscale scores  was found between the groups with and without an HD diagnosis. This result provides evidence that CSI can be used to distinguish between those with and without hoarding behavior.This study has some limitations despite its strengths. One of the limitations is that, similar to the original CSI, the generalizability of the results may be restricted because the study only focused on children and adolescents with OCD. Therefore, testing the applicability of community sampling and a clinical sample of young people diagnosed with HD would be useful for future studies. Second, the relatively small sample size (n = 52) might be considered a limitation. Third, since the CSI is a parent-rated scale, there is a need for a child version to compare parent–child self-reports. It is unclear how effective the child version of the questionnaire would be for this age group because children and adolescents have limited control and resources in their home environment, and parental involvement in their living spaces could impact the nature, features, and consequences of hoarding behavior. These potential effects will be explored in future studies. Fourth, the authors did not conduct test-retest analyses by repeating questionnaire administration a few weeks after filling out the first questionnaires, which might also be listed among the limitations of this study.In conclusion, this study investigated the psychometric properties of the Turkish version of a parent-rated scale for the hoarding behavior of children and adolescents in a clinical sample. The 20-item CSI Turkish version demonstrated good internal consistency for both the total score and the factor scores. This 4-factor structure of the scale was confirmed by CFA. Children’s Saving Inventory showed convergent and discriminant validity with the OCI-CV and CY-BOCS subscales, and the higher CSI total scores in children and adolescents diagnosed with HD confirmed the construct validity. As a result, our findings support the idea that the Turkish version of the CSI can be used as a valid and reliable measurement tool to assess the hoarding symptoms of children and adolescents in a clinical sample. We also believe that this study will lead to further validity and reliability studies of the CSI in cultures and languages other than English.


Publications are an important measure of scientific and technological progress. The quantitative examination of the number of publications in a certain research topic is known as bibliometrics. Bibliographic studies are widely used to analyse the condition of research, future potential, and current growth patterns in a certain topic. It can serve as a basis for making decisions and implementing strategies to achieve long-term development goals. To our knowledge, no research has been conducted in these domains; so, this work aims to employ bibliometric analysis to provide comprehensive data on publications related to anticoccidial drugs. As a result, the current study uses bibliometric analysis to track the evolution of anticoccidial drugs and its consequences in the academic and public worlds via a survey of relevant scientific and popular publications. The Dimensions database was used to retrieve the bibliographical statistics, which were then cleaned and analyzed. The data was also loaded into the VOS viewer, which generated a network visualization of the authors with the most joint articles. The investigation discovered three stages of publications and citations since the first article on anticoccidial drugs in 1949. The first stage, which ran from 1920 to 1968, was characterized by a scarcity of research articles on anticoccidial drugs. From 1969 to 2000, the second stage was marked by a stable and marginally increased number of articles. The scientific field was characterized by an increasing trend in the number of publications and their citations from 2002 to 2021. The study gave a complete list of the top anticoccidial drugs funding agents, countries, research institutes, most cited publications, and important co-authorship and partnerships. The outcomes of the study will help veterinary practitioners and researchers understand the trends and best sources of knowledge in the field of anticoccidial medications. Examples of anticoccidial drug subgroups include Ionophores, Sulphonamides, Vitamin Antagonists, Nicarbazin, Quinolones, and others . AnticocCoccidiostat failure has also been observed in several publications. Some of the causes identified include more than average oocysts exposure in the host. Besides, some of the drug subgroups may not be effective when treating or preventing all the Eimeria species –9. BesidThe study will employ prior literature as datasets holding information such as authors, titles of publications, years of publication, funding agents, the source institutes and countries. As a result, these data be used to establish a quantitative intellectual framework for anticoccidial medication research. However, due to the enormous number of publications on the subject, manually gathering and compiling all data is impractical, thanks to internet databases and software-based techniques that can easily enable effective data accessibility. As a result, the study seeks to give a bibliometric and visual analysis of anticoccidial drugs by studying the intellectual domain and the time evolution of anticoccidial drug research.The objectives of this study are 1) Analyze the trend in anticoccidial drugs publications in terms of the volume of documentation and citations in the field, 2) Analyze the most frequently cited research to contribute to the knowledge in the field of anticoccidial drugs, 3) Create awareness of the topmost recognized publishers, the most active country, the most active institutions and the top most funding agents in the field of anticoccidial drugs, and 4) Highlight the topmost authors with the highest number of jointly authored publications on anticoccidial drugs. To the best of our knowledge, no research has been done on these areas of thought, hence the goal of this paper is to use bibliometric analysis to give full data on anticoccidial drug publications.2.2.1.The questions raised in this study include 1) What is the trend in the volume of publications and documentation citation of the anticoccidial drugs over the past century? 2) What are the topmost countries that researchers prefer for their works on anticoccidial drugs? 3) What are the topmost researchers, research institutes, and frequent funding agents in the field of anticoccidial drugs? 4) What is the intellectual structure of the joint authorship on anticoccidial drug publications?2.2.The research employs bibliometric analysis and science mapping to perform the quantitative and visual analysis of anticoccidial drugs. Bibliometrics was first created by Otlet in 1934 . Later, For this study, data collection involves collecting relevant literature published and collected in different databases for further analysis. The data collection was achieved by first identifying the databases and choosing appropriate search strategy techniques, data retrieval techniques, and cleaning the data before feeding them into different tools for analysis and visualization.2.3.Science.gov, Crossref API, Microsoft Academic Search, and JSTOR Data for Research. For this research, DimensionsNowadays, several databases exist that offer bibliometric data. Examples of such databases include Web of Science, Scopus, PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), Google Scholar, Dimensions, CORE, BASE, In this study, the “dimensions database” was used to retrieve bibliometric data owing to 1) Dimensions covers a wider range of research outputs beyond scholarly articles and conference proceedings, including grants, datasets, clinical trials, patents, and policy documents, 2) citation analysis tools that allow users to identify highly cited articles and authors, track citation trends over time, and measure the impact of research, and 3) Dimensions has a more modern and intuitive user interface that allows users to filter and sort search results more easily. It also offers more visualization tools and interactive features, such as citation maps and co-author networks.2.4.The study used “anticoccidial drug” as the keyword to search relevant publications. The data retrieved comprised all the publications with the term “anticoccidial drug” in either their title, abstract or the main document. The study did not exclude any of the parameters provided in the dimensions database since the study intended to explore all the publications stored on anticoccidial drugs. The documents retrieved included articles, book chapters, editorial materials, and reviews. The search strategy retrieved a total of 5,000 publications. However, using a single dataset was limiting since some critical publications may not have been included in the Dimensions Database. Besides, the database also does not provide some bibliometric features such as keywords and references compared to other Databases. Since only English words were employed to search for relevant publications, the search may have left out some critical articles published in other languages such as French, Spanish, and Chinese. Therefore, the results may not be generalized to other researchers published in non-English speaking countries. Although the analysis may not include all the crucial publications on anticoccidial drugs, this study’s results offer a reliable insight into the trends and patterns in the publications that have been made on anticoccidial drugs.2.5.The study employed PRISMA in identifying, screening, and selecting the studies to be included in various analyses. The criteria were inclusive of all the years since the trend analysis was crucial in determining the progress made in terms of publications. Although the criteria did not specify a particular type of study, the database selection generated articles, chapters, edited books, and reprinted publications only. Upon retrieving the publications’ data, the data was cleaned by removing duplicates. The study also excluded publications that were not relevant to the study. Only the publications with the most recent citations were included in the risk of bias assessment. Details of the screening process and selection of the studies are shown in 2.6.Two independent researchers assessed the selected publications to determine their eligibility for the study. The majority of the selected articles were considered to be of high quality in terms of the methodology used and the relevance of the abstract to the study’s issue. During the screening stage for each study, the researchers were keen to determine the method of study participant selection, the strategy to reporting used, the methodologies used to measure the outcomes, the presence of detection bias, and attrition bias. Depending on the information given in the publications, each component was classified as uncertain, low, or high. Summary of quality assessment outcomes is provided in 3.3.1.The bibliometric study on anticoccidial drugs from 1920 to 2021 revealed three stages of development based on the total publication in each of the years, as shown in 3.2.The study revealed that publications on anticoccidial drugs originated from 102 countries. The United States was identified as the leading country of publications, followed by China and the United Kingdom. 3.3.The publications on anticoccidial drugs were investigated by the contribution of research institutes. The leading research institutions with more than 30 publications evaluating the anticoccidial drug are provided in 3.4.The most frequent funding agents are displayed in 3.5.In terms of the most widely recently cited publications on anticoccidial drugs, Johnson & Reid  lead bot3.6.The study used the VOS viewer to visualize the authors with the highest collaboration in anticoccidial drugs. Based on the network visualization provided in 3.7.Eimeria acervulina, Eimeria brunetti, Eimeria maxima, Eimeria mitis, Eimeria necatrix, Eimeria praecox, and Eimeria tenella. Each species of Eimeria affects a different part of the chicken’s digestive tract, and can cause a range of symptoms including diarrhea, decreased appetite, weight loss, and even death .The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


Antimicrobial resistance is an important problem resulting in part from a lack of antibiotic stewardship, which needs coordinated interventions designed to promote an optimal use of antimicrobial agents. Optimal use includes choosing appropriate drug regimens, optimal dosing, appropriate duration of treatment, and route of administration . AntibioThe concept of the antibiotic resistome has been used to understand how resistance of bacteria, both pathological and nonpathological, emerges and evolves at the genetic level . It inclStaphylococcus aureus from 2 regions in India [S. aureus is high in the regions studied, with many of the clinical isolates being multidrug resistant. They concluded that adopting “appropriate community-based preventive measures and establishing antimicrobial stewardship” is highly recommended to minimize the dissemination in antibiotic resistance.In this issue, Loganathan and Nachimuthu report antibiotic resistance, biofilm forming ability, and clonal profiling of clinical isolates of in India . They fo“Appropriate community-based preventive measures” implies antimicrobial stewardship both in clinical and agricultural settings. This approach is crucial in addressing antibiotic resistance problems. The antibiotic resistance problem can reach a crisis when new antimicrobial medications have not kept pace with the rate of bacterial resistance. An additional approach, the global collection of resistance genes in clinical and environmental samples, or the antibiotic “resistome,” is a welcomed addition to antibiotic stewardship in clinical and environmental settings. Through bioinformatic analyses of modern-day sequencing, the antibiotic “resistome” approach may improve our understanding and control of antibiotic resistance genes or their transmission. Using a One Health approach in the collection and analysis of samples of specimens, the antibiotic “resistome” may help identify selective pressures affecting the emergence, transmission, and evolution of antibiotic resistance genes and antibiotic resistance. Meanwhile, management of patients with suspected or proven bacterial infection through empirical therapy, and tailoring them to the most specific antibiotics with appropriate dosing and duration, is needed. Strict antimicrobial oversight through prospective audit and feedback and/or preauthorization can be implemented based on facility-specific clinical practice guidelines for common infections .