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Go travel... But let the experts of AMR Time Travel take care of you! Travel Expert Yessy will make sure you get the Best Price out there. AMR Time Travel really cares... The entire experience was Perfect, starting from planning, paying, parking, great tips, vessel knowledge. They booked my last trip and everything went smoothly. You want to have a Stress Free Wonderful Vacation? I highly recommend you call them first. I'm definitely going to call them every time I need a Getaway. They are by far, the Best Travel Agency to handle your next Adventure! Ivonne Orlando, Florida
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Is Time Travel Possible?
We all travel in time! We travel one year in time between birthdays, for example. And we are all traveling in time at approximately the same speed: 1 second per second.
We typically experience time at one second per second. Credit: NASA/JPL-Caltech
NASA's space telescopes also give us a way to look back in time. Telescopes help us see stars and galaxies that are very far away . It takes a long time for the light from faraway galaxies to reach us. So, when we look into the sky with a telescope, we are seeing what those stars and galaxies looked like a very long time ago.
However, when we think of the phrase "time travel," we are usually thinking of traveling faster than 1 second per second. That kind of time travel sounds like something you'd only see in movies or science fiction books. Could it be real? Science says yes!
This image from the Hubble Space Telescope shows galaxies that are very far away as they existed a very long time ago. Credit: NASA, ESA and R. Thompson (Univ. Arizona)
How do we know that time travel is possible?
More than 100 years ago, a famous scientist named Albert Einstein came up with an idea about how time works. He called it relativity. This theory says that time and space are linked together. Einstein also said our universe has a speed limit: nothing can travel faster than the speed of light (186,000 miles per second).
Einstein's theory of relativity says that space and time are linked together. Credit: NASA/JPL-Caltech
What does this mean for time travel? Well, according to this theory, the faster you travel, the slower you experience time. Scientists have done some experiments to show that this is true.
For example, there was an experiment that used two clocks set to the exact same time. One clock stayed on Earth, while the other flew in an airplane (going in the same direction Earth rotates).
After the airplane flew around the world, scientists compared the two clocks. The clock on the fast-moving airplane was slightly behind the clock on the ground. So, the clock on the airplane was traveling slightly slower in time than 1 second per second.
Credit: NASA/JPL-Caltech
Can we use time travel in everyday life?
We can't use a time machine to travel hundreds of years into the past or future. That kind of time travel only happens in books and movies. But the math of time travel does affect the things we use every day.
For example, we use GPS satellites to help us figure out how to get to new places. (Check out our video about how GPS satellites work .) NASA scientists also use a high-accuracy version of GPS to keep track of where satellites are in space. But did you know that GPS relies on time-travel calculations to help you get around town?
GPS satellites orbit around Earth very quickly at about 8,700 miles (14,000 kilometers) per hour. This slows down GPS satellite clocks by a small fraction of a second (similar to the airplane example above).
GPS satellites orbit around Earth at about 8,700 miles (14,000 kilometers) per hour. Credit: GPS.gov
However, the satellites are also orbiting Earth about 12,550 miles (20,200 km) above the surface. This actually speeds up GPS satellite clocks by a slighter larger fraction of a second.
Here's how: Einstein's theory also says that gravity curves space and time, causing the passage of time to slow down. High up where the satellites orbit, Earth's gravity is much weaker. This causes the clocks on GPS satellites to run faster than clocks on the ground.
The combined result is that the clocks on GPS satellites experience time at a rate slightly faster than 1 second per second. Luckily, scientists can use math to correct these differences in time.
If scientists didn't correct the GPS clocks, there would be big problems. GPS satellites wouldn't be able to correctly calculate their position or yours. The errors would add up to a few miles each day, which is a big deal. GPS maps might think your home is nowhere near where it actually is!
In Summary:
Yes, time travel is indeed a real thing. But it's not quite what you've probably seen in the movies. Under certain conditions, it is possible to experience time passing at a different rate than 1 second per second. And there are important reasons why we need to understand this real-world form of time travel.
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What physics says about time travel
Posted: February 6, 2024 | Last updated: February 6, 2024
The concept of time travel has captivated readers and moviegoers for many decades now. But while people have been fascinated by the idea, no one has managed to make the notion of time travel any more of a reality than before. It seems like a dream that's just a bit too far from reach. But in an age where science continues to push the boundaries of what's possible, do we even know—in theory—what the physics of time travel might involve?
Curious? Click on to discover what we know so far about the prospect of journeying through time.
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How time works
It might surprise you to learn that exactly how time works is still a bit of a mystery to physicists. For now, travel into the future seems possible (as we hurtle toward it each day).
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But when it comes to potentially meeting our great-great-great grandparents by traveling into the past, it seems either extremely difficult, or almost completely impossible.
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Albert Einstein
Albert Einstein was instrumental in our current understanding of time travel. His theory of relativity set out a description of space, time, mass, and gravity.
Theory of relativity
For Einstein, time was relative. A key outcome of relativity is that the flow of time isn't constant. Time can speed up or slow down, depending on the circumstances.
Time is relative
The fact that it can speed up or slow down is where the concept of time travel enters as a possibility, with real-world repercussions.
Speed of light
Time moves faster at speed, but for the effect to be noticeable, you would have to travel at the speed of light.
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Gravitational pull
Likewise, time passes more slowly in an intense gravitational field, for example in a black hole.
The Earth's gravitational pull is stronger at your feet, so your feet are actually aging at a slower rate than your head!
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GPS satellites
For us, day-to-day, the relativistic effects of time are too subtle to notice. But they actually do affect the satellites used for global positioning system (GPS).
Clock adjustment
The clocks in the sky click faster than the clocks on Earth. Because of this, the ones in the sky must be constantly readjusted to ensure accuracy. If not, your map app could be inaccurate by about six miles (10 km) per day!
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Future travel
Relativity means it's possible to travel into the future. Whether traveling at the speed of light or spending time in an intense gravitational field, you would experience a relatively short amount of subjective time.
In contrast, in the rest of the universe, decades or centuries would pass by. So when you return, you would be further into the future than the time you experienced.
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Backwards travel
Relativity does open some doors for backwards time travel, but right now these haven't evolved past the theoretical stage.
Closed-circle loop theory
One 1949 study published by Kurt Gödel proposed a closed time-like curve, a path where space and time loops back on itself, could make past time travel possible.
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However, a major problem with this theory is that there is no existing closed-circle loop anywhere in the universe. It's pure theory.
Without evidence for the existence of a closed-circle loop, there is no way to recreate it. A philosopher at Chapman University in California, Emily Adlam, says, "Even if we had much greater technological powers than we currently do, it seems unlikely that we would be able to create closed time-like curves on purpose."
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Cosmic strings
In 1991, a physicist named Richard Gott put forward the theory that such a closed-circle loop would be possible if there were two "cosmic strings" that moved past each other in opposite directions.
Which is great... if cosmic strings existed! These strings are still hypothetical, being thought to have formed the very early universe by some theories.
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Another phenomenon that's seemingly allowed by relativity is wormholes. Theoretically, it's possible for space-time to be folded like a piece of paper, allowing a tunnel to be punched through to create a shortcut between two widely-separated points, AKA a wormhole.
Again, the problem with wormholes is that although it's been shown in theory that they could exist, as a mathematical possibility, whether they exist physically is a different matter altogether.
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Intense gravitational field
If wormholes did exist, they wouldn't have a very long lifespan. In fact, if they are two black holes that have joined together as is theorized, their intense gravitational field would collapse under its own gravity.
Size problems
There's more bad news for aspiring time travelers; these wormholes would be microscopically tiny, too small for a bacterium, let alone for a person to pass through.
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Negative energy
In order to solve the size and gravity problems, a large amount of negative energy would be required inside the atom. The energy of the atom field must have more positive energy overall, however, so even if tiny pockets of negative energy expanded inside, it's not a very realistic proposal.
Quantum mechanics
While relativity describes the behavior of large objects like humans and galaxies, quantum mechanics explains the very small: smaller than atoms, i.e. electrons and photons.
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Non-locality
Strange observations have emerged from quantum mechanics, notably non-locality. This is where a change in a particle's state in one location can instantaneously influence another "entangled" particle somewhere else.
Einstein called this "spooky action at a distance." It's been shown experimentally many times, but many physicists are unhappy with the possibility of non-locality.
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This is because in order for the effect to be instantaneous, the information would have to move faster than the speed of light. This is supposed to be impossible.
Retrocausality
In response, some physicists have come up with an alternative way to interpret the experiments. Some propose that when something looks instantaneous, it has actually traveled to the future and back again. This introduces retrocausality, i.e. events that take place in the future having an effect on the past.
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If this is the case, our linear concept of time isn't necessarily correct. In fact, it means information from the future is always spiraling back to influence the past. It's worth bearing in mind that this theory is not universally accepted either, with some seeing it as more outrageous than non-locality.
In conclusion, we don't have a complete answer. Relativity and quantum physics aren't compatible with one another, but they work to explain certain aspects of our universe. Perhaps there is an overarching, unifying theory that links them; but it hasn't been discovered yet. For now, time travel remains out of reach—just like the more mysterious workings of the universe.
Sources: (BBC) (Scientific American) (Space.com) (USA Today)
See also: The biggest myths about space
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What is Ramadan and how do Muslims observe the Islamic holy month?
FILE - Officials are silhouetted as they use a telescope to scan the horizon for a crescent moon that will determine the beginning of the holy fasting month of Ramadan in Jakarta, Indonesia, Wednesday, March. 22, 2023. (AP Photo/Achmad Ibrahim, File)
FILE - Worshippers attend Friday prayers during the Muslim holy fasting month of Ramadan, at Al-Azhar mosque, the Sunni Muslim world’s premier Islamic institution, in Cairo, Egypt, Friday, April 7, 2023. (AP Photo/Amr Nabil, File)
FILE - Worshippers pray during Friday prayers at Al-Azhar mosque, the Sunni Muslim world’s premier Islamic institution, during Ramadan in Cairo, Egypt, Friday, April 7, 2023. (AP Photo/Amr Nabil, File)
FILE - A man looks at members of the Malaysian Islamic authority as they perform the “Rukyah Hilal Ramadan,” the sighting of the new moon to determine the start of the holy fasting month of Ramadan in Kuala Lumpur, Malaysia, Wednesday, March 22, 2023. (AP Photo/Vincent Thian, File)
FILE - Worshippers perform a night prayer called ‘Tarawih’ during the eve of the first day of the Muslim holy fasting month of Ramadan in Turkey at the Hagia Sophia mosque in Istanbul, Turkey, Wednesday, March 22, 2023. (AP Photo/Emrah Gurel, File)
FILE - A volunteer distributes free juice ahead of Iftar, the evening meal breaking the Ramadan fast, at El-Gamaliyya district in Cairo, Egypt Friday, April 14, 2023. (AP Photo/Amr Nabil, File)
FILE - A butcher serves a customer at a market in Jakarta, Indonesia, Wednesday, March 22, 2023, during preparations to welcome the holy month of Ramadan, expected to start the following day. (AP Photo/ Ahmad Ibrahim, File)
FILE - Worshippers break their fast during the Muslim holy month of Ramadan, at a free meal distribution point in Al-Azhar mosque, the Sunni Muslim world’s premier Islamic institution, in Cairo, Egypt, Saturday, March 25, 2023. (AP Photo/Amr Nabil, File)
FILE - A youth jumps into the Cisadane River, ahead the holy fasting month of Ramadan in Tangerang, Indonesia, Tuesday, March 21, 2023. Muslims follow local tradition to symbolically cleanse their soul in the river, prior to the holiest month in Islamic calendar. (AP Photo/Tatan Syuflana, File)
FILE - Men are reflected in a window at the women’s section during Eid Al-Fitr prayers in Bucharest, Romania, Friday, April 21, 2023, at the end of the holy fasting month of Ramadan, at the Dinamo stadium in the Romanian capital, in the largest Muslim public gathering of the year in Romania. (AP Photo/Andreea Alexandru, File)
FILE - Faithful break their fast at the Imam Ali shrine in Najaf, Iraq, Wednesday, April 5, 2023, during the Islamic holy month of Ramadan. (AP Photo/Anmar Khalil, File)
FILE - Shiites observe the crescent moon to determine the start of the tenth Islamic month of Shawwal, which marks the end of a month-long fasting of Ramadan and the beginning of the Eid al-Fitr festival in Najaf, Iraq, Thursday, April 20, 2023. (AP Photo/Anmar Khalil, File)
FILE - Mohammed El-Dahshan, 38-year-old “mesaharati,” or dawn caller, accompanies his donkey wrapped with colored led lights to wake Muslims up for a meal before sunrise, during the Islamic holy month of Ramadan, in the Delta city of Dikernis, Egypt, about 93 miles (150 kilometers) north of Cairo, early Wednesday, April 12, 2023. Each night, El-Dahshan, sets out after midnight with his donkey banging his drum, chanting traditional religious phrases and calling out on residents by name to wake them in time for the vital pre-dawn meal known as “suhoor”. (AP Photo/Amr Nabil, File)
FILE - Muslims perform an Eid al-Fitr prayer marking the end of the holy fasting month of Ramadan on Ampera Bridge in Palembang, South Sumatra, Indonesia, Saturday, April 22, 2023. (AP Photo/Binsar Bakkara, File)
FILE - People ride on horses during a Durbar festival to celebrate Eid al-Fitr and the end of Ramadan in Zazzau , Nigeria, Saturday, May 15, 2021. (AP Photo/Fati Abubakar, File)
FILE - Boys light smoke bombs as they celebrate the eve of Eid al-Fitr, the holiday marking the end of the holy fasting month of Ramadan, in Jakarta, Indonesia, Sunday, May 1, 2022. (AP Photo/Dita Alangkara, File)
FILE - Muslim girls carry torches during a parade to celebrate the eve of Eid al-Fitr, the holiday marking the end of the holy fasting month of Ramadan, in Polewali Mandar, West Sulawesi, Indonesia, Friday, April 21, 2023. (AP Photo/Yusuf Wahil, File)
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CAIRO (AP) — Observant Muslims the world over will soon be united in a ritual of daily fasting from dawn to sunset as the Islamic holy month of Ramadan starts. For Muslims, it’s a time of increased worship, charity and good deeds. Socially, it often brings families and friends together in festive gatherings around meals to break their fast. Ramadan is followed by the Islamic holiday of Eid al-Fitr.
This year, Ramadan comes as the latest Israel-Hamas war has killed thousands of Palestinians , left much of Gaza in ruins and created a humanitarian catastrophe , with many Palestinians there, especially in the devastated northern region , scrambling for food to survive. Some Muslims have been brainstorming how to remain mindful of the Palestinians’ plight during Ramadan, including through making donations, saying prayers or incorporating Palestinian traditional symbols in how they mark the holy month.
WHEN IS RAMADAN?
Ramadan is the ninth month of the Islamic lunar calendar; the month cycles through the seasons.
The start of the month traditionally depends on the sighting of the crescent moon; this year, the first day is expected to be on or around March 11.
Muslim communities may start Ramadan on different days, due to declarations by multiple Islamic authorities around the globe on whether the crescent has been sighted or different methodologies used to determine the start of the month.
WHY AND HOW DO MUSLIMS FAST?
Fasting is one of the Five Pillars of Islam, along with the profession of faith, prayer, almsgiving, and pilgrimage.
Muslims see various meanings and lessons in observing the fast.
It’s regarded as an act of worship to attain God-conscious piety and one of submission to God. The devout see benefits including practicing self-restraint, cultivating gratitude, growing closer to God, and feeling for the poor and hungry.
The daily fast in Ramadan includes abstaining from all food and drink; not even a sip of water is allowed from dawn to sunset before breaking the fast in a meal known as “iftar” in Arabic. Those fasting are expected to also refrain from bad deeds, such as gossiping, and increase good deeds.
Muslims typically stream into mosques for congregational prayers and dedicate more time for religious contemplation and the reading of the Quran, the Muslim holy book.
Charity is a hallmark of Ramadan. Among other ways of giving, many seek to provide iftar for the needy, distributing Ramadan boxes filled with pantry staples, handing out warm meals alongside such things as dates and juice or helping hold free communal meals.
Muslims eat a pre-dawn meal, called “suhoor,” to hydrate and nurture their bodies ahead of the daily fast.
ARE THERE EXEMPTIONS FROM FASTING?
Yes. There are certain exemptions from fasting, such as for those who are unable to because of illness or travel. Those unable to fast due to being temporarily ill or traveling need to make up for the missed days of fasting later.
WHAT ARE SOME CULTURAL AND SOCIAL TRADITIONS ASSOCIATED WITH RAMADAN?
Muslims are ethnically and racially diverse and not all Ramadan traditions are rooted in religion. Some customs may transcend borders, while others can differ across cultures.
Many social rituals center on gathering and socializing after the daily fast. Some Muslims decorate their homes, put out Ramadan-themed tableware and centerpieces or throng to markets and Ramadan bazaars.
In Egypt, the Arab world’s most populous country, Ramadan is typically a festive time.
Colorful lanterns, in different shapes and sizes, dangle from children’s hands and adorn homes or the entrances of buildings and stores. Ramadan songs may be played to welcome the month. So-called Ramadan tents, featuring food and entertainment, pop up to cater to gatherings.
Ramadan’s soundscape in Egypt has traditionally included the pre-dawn banging on drums by a “mesaharati” who roams neighborhoods, calling out to the faithful, sometimes by name, to awake them for the suhoor meal.
NEW TV SHOWS, COMMUNAL MEALS
A line-up of new television shows is another fixture of the month in some countries, and advertisers compete for the attention of viewers.
In various regions, some Muslims worry that the month is being commercialized, and that an emphasis on decorations, TV shows, outings or lavish iftar banquets, especially in the social media era, can detract from Ramadan’s religious essence. Others feel that a balance can be struck and that, done in moderation, such rituals are part of the month’s festive spirit.
In Indonesia, the most populous Muslim-majority country, Ramadan rituals vary across regions, with some influenced by local cultures or other faith traditions.
Thousands of villagers who live on the slopes of Mount Merapi in Central Java welcome Ramadan with Nyadran, a Javanese ritual influenced by Hinduism and Buddhism that includes visiting, cleaning and decorating ancestors’ graves.
People in Indonesia’s deeply conservative Aceh province slaughter animals during Meugang festivities. The meat is cooked and shared in a communal feast with family, friends, the poor and orphans.
Hundreds of residents in Tangerang, a city just outside the capital of Jakarta, flock to the Cisadane River to wash their hair with rice straw shampoo and welcome the fasting month with a symbolic spiritual cleansing.
After evening prayers, many boys and girls across Sumatra island parade through the streets. They carry torches and play Islamic songs.
In India, home to more than 200 million Muslims making up a large minority group in the country, stalls lining many streets sell such things as dates, sweets and freshly cooked food. At night, some New Delhi neighborhoods become lively as Muslims head to mosques to attend prayers.
Some Indian Muslims also visit holy shrines dedicated to Sufi saints, which are decorated with lights and colorful flowers.
In the United States, home to a diverse, small but growing Muslim population, gathering at mosques and Islamic centers when possible for iftar meals and prayers provides many Muslim families with a sense of community. Some Muslims also organize or attend interfaith iftar meals.
Some big U.S. retailers have started catering to Ramadan shoppers, selling such things as Ramadan-themed decor.
Associated Press writers Niniek Karmini in Jakarta, Indonesia, and Sheikh Saaliq in New Delhi contributed to this report.
Associated Press religion coverage receives support through the AP’s collaboration with The Conversation US, with funding from Lilly Endowment Inc. The AP is solely responsible for this content.
The Trinity Challenge on Antimicrobial Resistance
OpenCAST: Digital solutions for Community AMR Surveillance & Treatment
Dr Akaninyene Otu
Solution name:, short solution summary:.
OpenMRS will be used to capture community and patient-level data on common infections and antimicrobial consumption in Nigeria. Portable real-time DNA/RNA sequencing devices will be used for targeted antimicrobial prescribing. Electronic clinical decision support (eCDS) systems/real-time dashboards will be introduced for better decision-making to improve antimicrobial stewardship and patient outcomes.
In what city, town, or region is your solution team based?
Who is the team lead for your solution.
Dr Akaninyene Otu. Executive Director Foundation for Healthcare Innovation and Development (FHIND) Nigeria. He has >10 years experience of implementing electronic health (eHealth) training in low- and middle-income communities (LMICs)
Which Challenge Objective does your solution most closely address?
- Integration
- Implementation
What specific problem are you solving?
Antimicrobial resistance (AMR) rates are untenably high in Nigeria and AMR awareness is low among communities and healthcare workers (HCW). A survey in Cross River State (CRS) showed that for 56% of children with symptoms of a respiratory tract infection, carers sought treatment in public health facilities, but 37% bought antibiotics over-the-counter without a prescription. The 4 million people in CRS are served by 1,028 publicly-owned health facilities where medical records are currently paper-based. AMR surveillance is hampered by a lack of laboratory capacity, insufficient data collection/analysis.
OpenCAST will introduce OpenMRS in sentinel site health facilities in CRS to capture community and patient-level data on common infections and antimicrobial consumption. Genomics will be used for rapid pathogen identification and focused antimicrobial prescribing. Digital education on AMR will be provided to communities and HCW.
By demonstrating a viable working solution in CRS we can leverage the already deployed base of OpenMRS in over 1300 health facilities across Nigeria. We have a route to global dissemination through the academic support of University of Leeds (UoL) and Brown University (with technical lead of OpenMRS Ian Bacher, and co-founder Hamish Fraser), and a route to global implementation through open source and the OpenMRS community.
Who does your solution serve, and what needs of theirs does it address?
Our target audience will be communities in CRS which is a coastal state in South Eastern Nigeria spanning 20,156 square kilometres. The state’s healthcare challenges are exacerbated by a shortage of doctors with only 25 doctors employed by the state to work in secondary health facilities (16 general hospitals). In CRS, ~70% of clients, predominantly peri-urban and rural poor who are often vulnerable, access public facilities, where antibiotics are prescribed by HCW who are inadequately trained on antimicrobial stewardship (AMS) or AMR. Antibiotics can be purchased without prescriptions from unregulated drug shops and patent medicine vendors following self-diagnosis.
In the OpenCAST project, we aim to provide educational material on AMS for communities and HCW in CRS using digital platforms. This will promote a greater understanding of rational antimicrobial use and ways of reducing AMR. As part of our ongoing THET Partnerships for Antimicrobial Stewardship 2 project (grant ID Cw2 C.12) which is currently in its 7th month in CRS, we have conducted Point Prevalence Surveys on antimicrobial consumption. Additionally, we have conducted community surveys in CRS to better understand the key drivers of antimicrobial mis(use). We are constantly engaging communities in CRS to contribute to AMS strategies to guarantee sustainability.
What is your solution’s stage of development?
Please select all the technologies currently used in your solution:.
- Artificial Intelligence / Machine Learning
- Internet of Things
- Software and Mobile Applications
What “public good” does your solution provide?
Impoverished individuals and populations are especially vulnerable to harm from AMR. About 63% of Nigerians (133 million people) are projected to be experiencing poverty based on the 2022 Multidimensional Poverty Index (MPI). In the OpenCAST project, we will develop new features for the OpenMRS system that will be globally accessible under the existing free, open source licences. In line with a key strategy of the WHO’s Global Action Plan to contain AMR, we will prioritise public and HCW enlightenment initiatives using android-facing interfaces. We will introduce OpenMRS in health facilities in CRS to facilitate the longitudinal collection of health information about individual patients and the population including genomics data on AMR.
OpenMRS has the capacity to improve communication, health worker compliance with best practices, patient safety, quality of care and health outcomes while reducing medical errors. To complement OpenMRS, the android-facing user interface will be made available to the public to provide them with access to their medical records on mobile devices. We project that the benefits of this project will extend beyond AMR for Nigerian communities (since OpenMRS is a full clinic and patient record management system). This feasible and sustainable solution could ultimately be scaled up beyond Nigeria.
How will your solution create tangible impact, and for whom?
OpenCAST will target the underserved/vulnerable populations in CRS who are disproportionately affected by AMR. HCW in CRS use poorly written and grossly inadequate ‘Standing Orders’ for the care of sick children and adults. Antibiotics are prescribed unnecessarily contributing to AMR. We’ll revise the Standing Orders and provide training on rational use of antibiotics/AMR through online continuing professional development (CPD) on smartphones.
We will collaborate with local stakeholders to co-create, pilot and upscale OpenMRS in all General Hospitals (initially) then primary healthcare centres in CRS. Community-level data on common infections and antimicrobial consumption will be captured and used to develop a smartphone-based eCDS tool/real-time dashboard to provide evidence-based support to HCW. The prescribing algorithms will initially be guideline-based progressing to machine learning-based once 1+ year of clinical data has been collected. The eCDS tool will provide personalized recommendations for antibiotic prescribing.
FHIND and UoL have previously worked with a Nigerian health informatics company to upscale online CPD training for frontline HCW on Ebola ( https://doi.org/10.1186/s12960-016-0100-4 ), COVID ( https://doi.org/10.1177/20499361211040704 ), noncommunicable diseases ( https://bmjopen.bmj.com/content/12/8/e060304.in ) and sepsis ( https://doi.org/10.1177/20499361241233816 ).
Sustaining impact is an issue in Nigeria and elsewhere in LMICs. FHIND and UoL have a long-term presence through a series of projects in CRS.
How will you scale your impact over the next year and the next 3 years?
We'll introduce OpenMRS into 2 General Hospitals per district (6 facilities in total) in the first year. Over the next 2 years, OpenMRS will be deployed to the remaining 10 General Hospitals in CRS and some PHCs.
Five work packages will be aimed at:
1) Producing a tailored version of OpenMRS for CRS and AMR with the promised additional integration (to laboratories, to DNA sequences, to each other and a big database) that will use HL7 FHIR as an integration standard.
2) Political and health service negotiation to ensure all stakeholders are supportive of a move from paper to OpenMRS and the funding of any additional costs not covered by Trinity Challenge.
3) Deployment of OpenMRS into facilities in CRS - notably travel, training, hardware, software set-up, data take-on and hand-holding.
4) Development of CPD educational material and a smartphone-based eCDS tool/real-time dashboard for HCW. The tool will utilize guideline-based CDSS progressing to machine learning augmented algorithms/CDSS once 1+ year of clinical data has been collected.
5) Development of a community-facing tool to promote rational use of antibiotics among the public.
A "back office" system will be created to manage role-based access (RBAC) for users, other administration tasks and reporting.
How are you measuring success against your impact goals?
A monitoring/evaluation framework will be used to articulate measurable objectives and define relationships among inputs, activities, outputs, outcomes and impacts
Measurable indicators will include:
Number of health facilities in CRS with OpenMRS.
Number of community members in CRS educated on AMR
Number of HCW educated on AMS/AMR
Number of HCW who have access to the eCDS tool
Percentage reduction in antibiotic prescribing in health facilities
Expected outcomes will be:
Strengthened HIS in CRS with improved interoperability and data exchange capabilities.
Enhanced clinical decision-making and AMS practices through use of the eCDS tool.
Reduction in unnecessary antibiotic prescribing and AMR rates in CRS.
Empowerment of communities and HCW with knowledge on AMS/AMR via digital platforms.
An observational study will be carried out to measure antibiotic prescribing rates for key diagnoses (1) before implementation of OpenCAST, (2) after the OpenMRS EHR has been implemented and is in regular use, and (3) after implementation of the eCDS component of OpenCAST. The level of prescribing and dispensing will be measured through routine data collected in OpenMRS. As sites will be implementing at different times we'll be able to use difference of difference or step wedge study designs to obtain data to refine our solution.
In which countries do you currently operate?
- United Kingdom
- United States
In which countries do you plan to deploy your solution within the next 3 years?
What barriers currently exist for you to accomplish your goals in the next year and the next 3 years how do you plan to overcome these barriers.
Specific barriers to the OpenCAST project include:
1) Poor digital literacy: We will bring our extensive experience of providing digital training for HCW and communities at-scale to bear for the purpose of tackling AMR in Nigeria.
2) Lack of commitment by government and stakeholders: Advocacy will be done before and during the OpenCAST project to ensure buy-in from the main actors.
3) Lack of finances to sustain OpenMRS beyond the Trinity Challenge: We will embed the Open CAST project into the existing realities in the CRS health service while promoting public-private partnerships to promote local ownership and sustainability.
4) The diverse geography and uneven distribution of resources in CRS could pose obstacles. The Trinity Challenge will facilitate the deployment of digital transformative strategies for AMR to those hardest to reach (the so-called last mile challenge).
5) Limited access to stable internet connections and electricity in some parts of CRS. However, OpenMRS provides offline data capture capability, and is widely used in countries with limited electrical power, network connectivity and technical support.
6) Lack of regulatory frameworks for EMR: We will advocate for the establishment of clear regulatory guidelines for digital health technologies to foster a conducive environment for innovation
https://openmrs.org
What type of organization is your solution team?
Why are you applying to the trinity challenge.
Some barriers to AMS in CRS (and indeed Nigeria) include poor knowledge of AMS/AMR among HCW and communities, indiscriminate and unregulated use of antibiotics and lack of laboratory capacity. OpenMRS is already in use in 1365 facilities in Nigeria and the move to cascade this to PHCs across the country is ongoing. Open MRS can be used in very resource-poor environments and can be modified with the addition of new data items, forms, and reports. Thus extending this to capture community-level data on common infections and antimicrobial consumption, design eCDS systems and train communities and HCW on AMR should be feasible.
The Trinity Challenge affords us the opportunity to solve the big challenge of AMR in Nigeria by driving innovation in the form of upscaling OpenMRS. This intervention could potentially be replicated across Nigeria and similar contexts thus meaningfully impacting millions of lives.
A major challenge would be to design and deploy simple enough solutions that can be self-sustaining in the long term without donor funding. Also how to get the benefits of advanced technologies without the cost. However, cloud, artificial intelligence, and smartphone integration can all be done very cheaply if the right skillset and approach are adopted.
What organization(s) would you like to collaborate with to initiate, accelerate, or scale your solution?
- CRS Ministry of Health
- Federal Ministry of Health Nigeria
- National Primary Health Care Development Agency (NPHCDA) Nigeria
- Nigeria Centre for Disease Control (NCDC) Nigeria
- OpenMRS community
- British Society of Antimicrobial Chemotherapy (BSAC)
We believe that by working collaboratively with most/all of the above-named organizations, we will successfully initiate, accelerate and scale OpenCAST across the 36 states in Nigeria. Our project in CRS will be a use case to demonstrate that OpenMRS can be established at secondary care facilities in an LMIC setting. We aim to demonstrate the feasibility of obtaining streamlined EMR via OpenMRS and creating a purpose-built inventory management and requirement forecasting for antibiotics and other drugs. We believe that the interoperability in OpenCAST will have major impacts on the delivery and quality of care in CRS and result in gains in efficient use of resources. The learning from this project will enable use refine our approach for scale-up across Nigeria and similar LMIC settings.
OpenCAST is from the outset designed for scale-up. Therefore the resulting package of care will be feasible within the context and will address local priorities. We have almost 30 years experience of utilising the embedded approach which we will adopt for OpenCAST
https://health-policy-systems....
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