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First two decades of the twenty-first century are characterised by epidemics of non-communicable diseases such as many hundreds of millions of patients diagnosed with cardiovascular diseases and the type 2 diabetes mellitus, breast, lung, liver and prostate malignancies, neurological, sleep, mood and eye disorders, amongst others. Consequent socio-economic burden is tremendous. Unprecedented decrease in age of maladaptive individuals has been reported. The absolute majority of expanding non-communicable disorders carry a chronic character, over a couple of years progressing from reversible suboptimal health conditions to irreversible severe pathologies and cascading collateral complications. The time-frame between onset of SHS and clinical manifestation of associated disorders is the operational area for an application of reliable risk assessment tools and predictive diagnostics followed by the cost-effective targeted prevention and treatments tailored to the person.This article demonstrates advanced strategies in bio/medical sciences and healthcare focused on suboptimal health conditions in the frame-work of Predictive, Preventive and Personalised Medicine (3PM/PPPM). Potential benefits in healthcare systems and for society at large include but are not restricted to an improved life-quality of major populations and socio-economical groups, advanced professionalism of healthcare-givers and sustainable healthcare economy. Amongst others, following medical areas are proposed to strongly benefit from PPPM strategies applied to the identification and treatment of suboptimal health conditions:Stress overload associated pathologiesMale and female healthPlanned pregnanciesPeriodontal healthEye disordersInflammatory disorders, wound healing and pain management with associated complicationsMetabolic disorders and suboptimal body weightCardiovascular pathologiesCancersStroke, particularly of unknown aetiology and in young individualsSleep medicineSports medicineImproved individual outcomes under pandemic conditions such as COVID-19.

European pharmaceutical companies have a legal requirement to provide non-promotional Medical Information (MI) services to support healthcare professionals (HCPs) who are using their medicinal products. While the industry has self-regulating bodies with established Codes of Practice, these mainly focus on promotional messaging and commercial activities. In the absence of similar frameworks for MI, such services struggle to understand how to meet HCP digital expectations, often in fear of breaching the promotional codes. This is limiting access to the wealth of non-promotional patient-focussed information held within the industry. Meanwhile, a large volume of unregulated, low-quality information can be readily found on the internet. To understand the current status, the Medical Information Leaders in Europe (MILE) industry association performed a benchmarking survey which explored the online MI service provision of 13 mid-large pharmaceutical companies across Europe. This highlighted a great diversity in approach in terms of geographical coverage and content. Visibility and access for HCPs is complex, compromising online engagement and website utilisation. This MILE position paper highlights the critical need to establish a clear governance model, which empowers pharmaceutical company MI functions to provide unbranded, non-promotional, medicinal product information sources to support HCP online information needs. It is essential to build confidence, transparency and trust by establishing a practical quality framework with principles and standards for online MI services for HCPs.

PURPOSE: Main insight of the study was to evaluate the potential of Perionyx excavatus, an indigenous earthworm of India towards bioconversion of toxic paper mill wastes. The study had considered a comprehensive study over succession of different enzymes and microbial biomasses alongside removal of heavy metals to reflect the qualitative enrichment of the toxic waste through valorisation procedure. METHODS: The process of vermicomposting was performed using ratio of paper mill sludge: cow dung: straw as 5:4:1 and Perionyx excavatus for a period of 60 days. Qualitative enrichment was considered through detailed evaluation of physicochemical parameters and succession of 19 enzymes using API ZYM technology. Heavy metal loads in terms of Zn, Cr, Cu, Pb along with bioaccumulation factor (BAF) were considered to establish functional role of earthworm in bioremediation. Microbial succession was measured in terms of PLFA biomarkers. RESULTS: Enzymatic enrichment of different isozymes of esterase, aminopeptidase and glycosyl hydrolase were found in the vermicompost. A significant reduction of heavy metals was noticed in vermicomposting of primary sludge as Zn > Pb > Cr > Cu and secondary sludge as Zn > Pb > Cu > Cr. An increase in density of Gram positive bacterial and fungal populations was found at the end phase of vermicomposting process which supports maturity of vermicompost. CONCLUSION: Presence of different enzyme activities, reduction of heavy metal loads along with rise of eukaryotic PLFA markers, had illustrated the efficiency of vermicomposting as a valorisation procedure in the qualitative enrichment of toxic organic paper mill sludge.

Analysis of roll products at the final stage of production is the main stage for identifying defects, disrupted integrity or homogeneity, etc. Paper production is a typical example of such an operation in an industrial setting. It is proposed to use the results of the assessment for opacity, described by several standardized and statistical estimates, as the main characteristic for the quality of paper products. Studies of the dependence of the quality of the paper web on the production conditions and the properties of raw materials produce considerable variance, so that it is impossible to make accurate predictions. For this reason, we used a neural network modeling technology to develop an intelligent system for monitoring the quality of the paper web. Online quality control allows to assess the efficiency of the paper machine and rapidly adjust the manufacturing execution system. Special technologies such as computer vision systems can be introduced for this purpose, making it possible to make a transition from subjective assessment of the structure and defects of the paper web to obtaining objective quantitative estimates of these indicators. We considered a procedure for determining the estimates of structural heterogeneity of the paper web at the final stage of its production. We suggest to expand the classification of finished product samples by using neural fuzzy interpolation of linguistic values of such indicators. The approach introduced is aimed at improving the efficiency of the production process.

Pulp and Paper Companies collaborate to monitor and monetize waste and create value from their by-products. This process of Industrial Symbiosis requires the creation and maintenance of trusted and transparent relationships between all entities participating in these networks, which is a constant challenge. In this context, a blockchain-based system can help in establishing and maintaining these networks, serving as a ground truth between companies operating at a national or a global scale. This paper proposes a scalable and modular blockchain architecture design using smart contracts to enhance the industrial symbiosis process of the Pulp, Paper, and Cardboard Production Sector companies in Portugal. This design comprehends all entities participating in the network. The implementation of this design assumes the use of a permissioned ledger built using Hyperledger Fabric to provide the required trust and transparency between all entities.

With the upgrade of ICT infrastructure at a rocketed pace, diversification of applications and involvement of the Internet have increased. This evolution has led to the production, development, and implementation of various smart software/hardware solutions in multiple dimensions to make the process faster, smooth, accessible, and inclusive. The story of IoT (Internet of things) is a game-changer in several fields at different levels, starting from an office to home and industries. The term IoT was coined in 1999 by Kevin Ashton, since then it has seen an exponential growth, and now it has become ubiquitous. IoT may be summarized as the group of interrelated/interconnected devices embedded with sensors, software, actuator, and technology over the network for exchanging the data over the Internet without human involvement. Like any other technology, IoT has its pros and cons. In the last decade, cyber criminals have exploited many attack vectors, several of which can be used to exploit and launch attacks on IoT devices too. IoT attacks have increased substantially over the years, and there has been a jump of 900% in such attacks in 2019. Due to various constraints, IoT solutions don’t possess traditional security solutions or mechanisms to identify anomalies. Multiple security issues in IoT devices are persistent because of the limitation of computational power, hardware, and storage. These limitations make IoT devices more prone to cyber-attacks. IoT cyber-attacks are ranging from DDoS, MITM, brute-forcing, eavesdropping, privilege scaling to more sophisticated ransomware attacks and many more. This chapter will discuss multiple cyber-attacks, their mechanisms and TTPs, along with their impact on IoT infrastructure. This will also include security flaws that were exploited and related challenges in a holistic way at a single place. Statistical data leading to trend analysis along with shares of various attack campaigns shall also be highlighted in this study to give the readers more insight. In order to overcome these issues, remedial measures and mitigation policies will also be discussed.

The white paper first outlines the state of inequity in food security/sovereignty in our area of focus, taking into account historical context as well as emerging and ongoing effects of the COVID-19 pandemic and community and policy responses to it. We then discuss a food acquisition intervention, structured as a longitudinal, collaborative research, and service-learning effort known as Everybody Eats. The white paper provides detailed discussion of competing understandings of agriculture, horticulture, and the social problem of food insecurity; the preliminary data that has led to a current collaborative effort to enhance the skillset of people previously not understood as food producers and provisioners, but only as end-user consumers; and the new iteration of the project wherein specific sets of expertise from diverse disciplines are deployed both to offer a more robust intervention, and bring new methodologies to bear in assessing the ecology of a local foodshed. We propose mobilizing existing resources and expertise of the Land Grant/Cooperative Extension system to act as a regional hub for facilitating full community food security (caloric and nutritional adequacy) and food sovereignty (participatory decision-making regarding living spaces and culturally appropriate foodways). Finally, we illustrate how a nexus of faculty, working from a service-learning advocacy perspective and embedded in a participatory action framework, provides a mechanism for bringing together and sustaining a community of intellectually diverse researchers and stakeholders.

This article examines the impact of COVID-19 on the livelihoods of widows and other single women farmers from the most backward districts of Maharashtra, a state in western India. COVID-19 led to food insecurity, loss of farm incomes, decline in employment opportunities and increased debt traps for single women farmers. The paper highlights how agrarian distress and pre-existing inequalities of class, caste and gender in access to food, incomes, credit, land, markets, and decision making, were exacerbated during the pandemic, further impoverishing these women farmers. To trace these effects, the paper draws on two types of evidence gathered in Maharashtra by MAKAAM, an informal all-India women farmer’s forum: observations during multiple rounds of interactions with over a hundred women farmers during the COVID-support work of providing ration and seeds undertaken by MAKAAM during India’s national lockdown in 2020, and a subsequent large-scale survey covering about a thousand women. The paper also focuses on the inadequacy of state response, both in terms of providing relief and in its ability to partner with women’s collectives and grassroots organisations for better outcomes. The article makes a case for strengthening social security measures for women farmers and enhancing their access to productive resources, agricultural programmes and decision-making spaces in relevant institutions.

The Covid-19 crisis has radically changed the game for world and EU-economies, and urged for a reappraisal of the guidelines for a healthy management of public expenditure. This requires a deep rethinking of the role of public debt in modern capitalistic economies and of efficient, equitable and politically viable ways of financing it. This paper outlines the main operating framework of a Debt Agency tasked with the management of the Eurozone sovereign debts and the creation of a truly European safe asset. The framework leverages on the potential irredeemable nature of sovereign debts in order to build a common bond. By structurally filtering liquidity risk, the Debt Agency can price the Member States’ funding costs by referring only to their credit risk, as defined by EU agreed rules. The common bond issued by the Debt Agency thus avoids mutualisation by design; hence, it can be directly bought by the ECB. Due to its structural intertemporal sustainability, the Debt Agency’s framework delineated in this paper can serve as a benchmark for institutional and political decisions. In this perspective, a counterfactual exercise has been conducted in order to evaluate the future potential impact of the Debt Agency as well as the past distortions in market pricing of Member States’ fundamental risk due to market mispricing of the liquidity risk.

In this paper, we examine the relationship between the volatilities of the energy index, crude oil, gas prices, and financial assets (Gold, Bitcoin, and G7 stock indexes), especially during the coronavirus crisis. The study tests the presence of regime changes in the GARCH volatility dynamics of the G7 stock indexes, Bitcoin, Gold, and energy assets (energy index, oil, and gas) by using the Markov–Switching GARCH model. It estimates the dynamic correlation and volatility spillover between energy and financial assets, by using the multivariate MSGARCH models. The estimation results of the Markov-Switching-BEKK-GARCH prove the volatility spillover from energy assets to financial assets. For the high regime, the results indicate a high level of dynamic correlation between energy assets and stock indexes which proves the contagion effect of the COVID-19. On the contrary, the dynamic conditional correlation between energy assets and Gold prices decreased during the COVID-19 crisis. This paper makes an original contribution in identifying the contagion between energy and financial assets and indicates that Gold is a safe haven for all energy and financial assets during the COVID-19 crisis. However, Bitcoin cannot be considered as a safe haven during the COVID-19 pandemic when investing in energy assets (crude oil and gas).

The Brazilian economy entered a deep recession in 2015–2016 and since then has shown a sluggish recovery. In this paper, we offer an interpretation for the slow growth based on Minsky’s financial instability hypothesis and recent literature on financialization and growth. We analyze the balance sheet of large non-financial companies over the period 2012–2019, a period that comprises the positive investment cycle—initiated during the commodities boom which lasted from the second half of the 2000s until 2014—the 2015–2016 recession, and the period preceding the shock of the COVID-19 pandemic. Based on Minsky’s taxonomy of financial profiles, we map a proxy for financial instability at the firm level based on Davis et al. (2019). We also propose an aggregate financial stability index. We conclude that after the 2015–2016 recession, companies have been restructuring their debt profile and adopting a defensive behavior, increasing their liquidity preference. Our analysis supports the interpretation that, even with the sharp fall in domestic real interest rates, the degree of confidence on expectations to recover investment in productive assets is low. This corroborates with the thesis that agents’ decisions do not respond only to supply stimulus, but are guided by expectations of future returns, which fundamentally depend on the performance of aggregate demand. Since 2015, Brazilian economic policy has been driven by fiscal consolidation, which has proven ineffective in increasing economic growth.

The objective of this paper is to evaluate the attitudes of patients with various dermatologic diseases towards coronavirus disease (COVID-19) vaccines. The present questionnaire-based study was conducted on patients admitted to the outpatient clinic of the Department of Dermatology and Venereology, Ufuk University Hospital, between January 1 and 31, 2021. The study population was divided into two groups based on their ages: (1)

A reconfigurable hearing aid is a generic type that can be used for various hearing disabilities without modifying the device hardware. This requires several trials to identify the best matching with the impaired person’s audiogram. The objective of this paper is to propose a novel reconfigurable hearing aid of low complexity with auto-adapting capability which makes it suitable for different types of hearing disabilities ranging from mild to severe intensities. The audio spectrum is divided into three regions and for each region, four different schemes are proposed. An automatic selection of the optimum scheme is proposed for all the regions based on hearing thresholds. Octave and fractional interpolation techniques are performed on a Parks-McClellan based prototype filter to generate the various sub-bands in the reconfigurable filter bank structure. The proposed structure uses only 18 coefficient multipliers which save up to 92% of multipliers when compared to other designs. The delay and matching errors are within the globally accepted limits. The hardware implementation executed on Xilinx Kintex-7 FPGA development board has reaffirmed that the structure is compact and power-efficient. The proposed auto-reconfigurable structure can be used for various types of hearing impairments and can avoid the manual interventions for the selection of schemes in audiogram matching. This in turn minimizes the time to establish the best match with the audiogram. Since the proposed structure has minimal complexity, cost-effective implementation of the device is also possible.

Trichoderma spp. is one of the most popular genus of fungi commercially available as a plant growth promoting fungus (PGPF) and biological control agent. More than 80 species of Trichoderma are reported in the literature. However T. asperellum, T. harzianum, T. viride, and T. virens are most commonly utilized as biocontrol agents. Studies were initiated to explore the potential of biocontrol agents in order to develop a cost effective and practical management strategy. Analysis of large number of soil samples collected from western parts of the region led to isolation of native biocontrol agents viz., Trichoderma harzianum, Aspergillus versicolor, and Bacillus firmus from different agricultural systems. These biocontrol agents have proved their antagonistic ability in laboratory tests and field trials. In India, two species of Trichoderma i.e., T. viride and T. harzianum are commercially registered for usage against soil borne plant pathogens mostly as a seed treatment or soil application. There are published scientific papers on the efficacy of T. asperellum and T. virens in India for suppressing pathogens but these are not yet registered under Central Insecticide Board and Registration Committee (CIB & RC). This review article focuses on the uses, commercialization and adoption issues of various fungal and bacterial consortium products in sustainable disease management.

This study aims at embedding sustainability practices by exploring sustainable actions of individuals consisting the educated workforce of Greece. A tailored questionnaire was created and sent via e-mails to 500 respondents, to identify a snapshot of participants daily buying and consuming actions. 483 responses received and analyzed using statistical tools. They respond to recommendations for enhancing sustainability consciousness at individual level, inspiring people to buy sustainable, creating new consumption attitudes that are key factors for moving towards a sustainable citizenship. The findings will further provide information for a second paper on developing the ‘Go Sustainable Living’ digital application to be uploaded in individuals’ mobile phones, for rewarding users with points that correspond to each sustainable action and can later be used for discounts in all participating stores. The analysis showed that

Liangping district, which is located in both the Three Gorges Reservoir area of Northeast Chongqing and Chengdu-Chongqing economic circle, is acting as a bridge and pivot between the “Belt and Road” and the “Yangtze River Economic Zone.” High-quality business districts play a vital role in gathering popularity, developing the economy and improving residents’ living standards. Therefore, Liangping district should make a comprehensive consideration of the development situation of business, overall planning of the whole region, construction requirements from Chengdu-Chongqing economic zone and the Three Gorges Reservoir area. From the commercial area positioning, dislocation development, intelligent promotion, mode innovation, cultural construction and other aspects, the implementation of “environmental engineering,” strengthen the overall layout, improve the supporting facilities, enrich the commercial format, strengthen comprehensive services, improve the commercial area operating soft and hard environment, realize the commercial area upgrade.

Sail Training has emerged from the work and leisure sailing traditions as a particular sector focused on ‘training through the sea’, or personal and social development. This paper is focused on those drawn to work in this sector as either volunteer or paid workers. It explores the socio historical context from which sail training emerged to account for the character and diversity of the contemporary sector, the variety of routes into the sector and the particular challenges associated with it including the dangers of burnout and drop out. Subsequently we consider the various 'careers' or development trajectories implicated in working in the sector including 'occupational', 'serious leisure', 'sailing', 'lifecourse' and 'community working'. A small scale empirical study is presented to provide accounts from workers in the sector to support this socio-historical analysis. Finally, some consideration is given to the kinds of support needed by the sector.

Today’s European wine policy is centered on a system of appellations, implemented as geographical indications (GIs), that entail significant technological regulations—restricting the varieties that may be grown, while imposing maximum yields per hectare and other rules regarding grape production and winemaking practice. This paper outlines the historical development of European wine policy under the CAP, and presents a more detailed analysis of the economic consequences of the rules and regulations under the appellation system. The introduction of these rules and regulations was probably beneficial initially, both for their didactive effect on wine producers and consumers and as a way of overcoming a significant “lemons” problem in the market. However, those same rules and regulations are much less valuable today, given (1) the potential for alternative sources of information to solve the lemons problem, and (2) evidence that the appellation system per se might not be effectively serving that purpose as well as it once did, while some of the regulations impose significant social costs. Yield restrictions, in particular, are economically inefficient as a way of enhancing and signaling quality (their ostensible purpose) and as a way of restricting total supply to support market prices and thus producer incomes (a significant motivation). The inherent weaknesses of the policy design are compounded by failures of governance. A less heavy-handed approach to policy would allow more scope for the market mechanism to match supply and demand for this signature product from European agriculture.

The COVID-19 pandemic had a devastating impact on the human health and global economy. The food and agriculture sectors have also felt these effects. In many countries, the measures taken to curb the spread of the virus were initiated to hinder the supply of agricultural products to markets and consumers inside and outside the borders. How this impacts the food safety, nutrition, and the livelihoods of farmers, fishermen, and others working in the food supply chain depends mainly on short-, medium-, and long-term policy responses. Epidemics pose severe challenges to the food system in the short term, but they also offer an opportunity to face challenges and accelerate the transformation of the food and agricultural sectors to increase resilience. The aim of the review was to highlight the valuable insight on the impact of COVID-19 on the Indian agricultural system and rural economy, as well as potential strategies for post-pandemic recovery.

Objectives The COVID-19 pandemic posed many challenges to human services organizations serving persons with pre-existing conditions and health concerns. Study objectives were to assess organizational responsiveness to the pandemic through training, safety, and risk mitigation initiatives at community-based group homes for adults with intellectual disability (ID) and acquired brain injury (ABI). Method This was a two-phase mixed methods study with human services care providers. In phase 1, 54 focus group participants responded to standardized interviews about leadership actions in the early months of the COVID-19 pandemic and discussed implementation effectiveness. These qualitative findings informed the design and distribution of a multi-item questionnaire in phase 2 that quantified acceptance and approval of leadership actions among 498 participants. Results Both focus group and questionnaire participants identified several consistent leadership actions that had a positive impact on risk mitigation, health promotion, and participant satisfaction. Participants also converged on priority needs and recommendations for performance improvement. Conclusions The study supports previous research on the effects of pandemic health crises among frontline healthcare workers and more definitively the impact on direct care providers of adults with ID and ABI during COVID-19. Care providers were able to judge organizational effectiveness and provide feedback to aide strategic planning. Mixed methods research provides an approach to large-scale program evaluation through integrated qualitative and quantitative analyses.

To investigate the characteristic findings between laboratory-confirmed and clinically suspected patients with COVID-19. In this retrospective study, we included patients admitted to the Xiangya Hospital from Jan 24 to Feb 10, 2020. Two researchers separately collected and sorted out the patients' epidemiological, demographic, clinical, laboratory, and radiologic findings. SPSS was performed to analyze the collected data. 241 patients were admitted, including 28 (45.5; IQR, 34.0-52.5) confirmed and 213 (42.0; IQR, 30.0-57.0) suspected patients. The prevalence of COVID-19 disease in males was significantly higher than in females (64.3% vs. 35.7%, P = 0.033). Before admission of the confirmed and suspected undiagnosed cases, the onset of symptoms is often manifested as respiratory symptoms such as fever (35.7% vs. 27.7%) and cough (30.7% vs. 32.1%). Twenty patients (71.4%) had an exposure history to high-risk areas, and 14 patients (50.0%) traveled or lived in a high-risk area in the confirmed group, which was significantly different from the suspected group. The pulmonary imaging of the patients in the confirmed group was primarily manifested as ground-glass opacity (89.3%). A total of 499 nucleic acid testing (NAT) was performed to determine the 28 COVID-19 positive throat swabs among the 241 patients. Whether there is a history of high-risk area exposure in the epidemiological investigation is essential in distinguishing the suspected patients from the confirmed patients. Multiple nucleic acid tests were used as the basis for the diagnosis of COVID-19, and during CT examination, ground-glass opacity was used as a COVID-19 indicator. Trail registration Trail registration number. 202012195, Date of registration: 2020.12.22 "retrospectively registered""."

COVID-19 is an infectious disease, which has adversely affected public health and the economy across the world. On account of the highly infectious nature of the disease, rapid automated diagnosis of COVID-19 is urgently needed. A few recent findings suggest that chest X-rays and CT scans can be used by machine learning for the diagnosis of COVID-19. Herein, we employed semi-supervised learning (SSL) approaches to detect COVID-19 cases accurately by analyzing digital chest X-rays and CT scans. On a relatively small COVID-19 radiography dataset, which contains only 219 COVID-19 positive images, 1341 normal and 1345 viral pneumonia images, our algorithm, COVIDCon, which takes advantage of data augmentation, consistency regularization, and multicontrastive learning, attains 97.07% average class prediction accuracy, with 1000 labeled images, which is 7.65% better than the next best SSL method, virtual adversarial training. COVIDCon performs even better on a larger COVID-19 CT Scan dataset that contains 82,767 images. It achieved an excellent accuracy of 99.13%, at 20,000 labels, which is 6.45% better than the next best pseudo-labeling approach. COVIDCon outperforms other state-of-the-art algorithms at every label that we have investigated. These results demonstrate COVIDCon as the benchmark SSL algorithm for potential diagnosis of COVID-19 from chest X-rays and CT-Scans. Furthermore, COVIDCon performs exceptionally well in identifying COVID-19 positive cases from a completely unseen repository with a confirmed COVID-19 case history. COVIDCon, may provide a fast, accurate, and reliable method for screening COVID-19 patients.

In 2018, 22,000,000 Brazilian women experienced some type of violence (either physical or psychological), and 42% of these episodes occurred in the domestic environment. Therefore, government strategies have been developed to solve this problem. This study aimed to (a) carry out a survey of Brazilian government strategies for the protection of women after the creation of the Maria da Penha Law (Law No. 11.340, 2006) and (b) discuss these strategies from the concept of cultural design. Sixteen laws, five decrees, and two ordinances were found and analyzed. In a general way, the analysis suggests that they are not effective cultural plans because most do not show long-term results, and some of the laws that typify crimes and those that relate to the aggressor’s behavior do not specify the target behaviors, so there is no explicit contingency. Despite this, such strategies are relevant, as they end up providing the protective context for women from a social, legal, and political point of view. Finally, it is expected that the discussions raised in the present work can help prepare interventions that favor socially beneficial cultural practices.

People suffering from non-communicable diseases (NCDs) are at an increased risk for severe Covid-19. The aim was to determine the burden of common NCDs at a population level, assess Covid-19 impact while exploring whether a syndemic approach is merited to deal with NCDs and Covid-19. Baseline data from a Malta national representative survey. Individuals with type 2 diabetes (T2DM), hypertension, cardiovascular disease, dyslipidaemia and overweight-obese status were considered. Prevalence for single disease and multimorbidity were used to estimate population burden. Covid-19 impact at a population level was estimated through local Covid-19 infectivity rates. Years of life lost (YLL) and mortality rate were calculated using Covid-19 data and compared to corresponding NCDs data reported by global burden of disease (GBD) study. Half the study population (n = 3947) had a single NCD while a third had multimorbidity. Of these, 6.55% were estimated to be at risk of Covid-19 and require admission. Covid-19 YLL over 12 months was 5228.54 years, which is higher than the estimated YLL for hypertension and T2DM by GBD study for Malta. Health systems and policies should be re-focused to accommodate both Covid-19 and NCDs simultaneously through a targeted syndemic approach with primary healthcare playing a central role. Supplementary Information The online version contains supplementary material available at 10.1007/s42399-021-01064-2.

Machine learning has been widely used in the characterization of tumors recently. This article aims to explore the feasibility of the whole tumor fat-suppressed (FS) T2WI and ADC features-based least absolute shrinkage and selection operator (LASSO)-logistic predictive models in the differentiation of soft tissue neoplasms (STN). The clinical and MR findings of 160 cases with 161 histologically proven STN were reviewed, retrospectively, 75 with diffusion-weighted imaging (DWI with b values of 50, 400, and 800 s/mm2). They were divided into benign and malignant groups and further divided into training (70%) and validation (30%) cohorts. The MR FS T2WI and ADC features-based LASSO-logistic models were built and compared. The AUC of the FS T2WI features-based LASSO-logistic regression model for benign and malignant prediction was 0.65 and 0.75 for the training and validation cohorts. The model’s sensitivity, specificity, and accuracy of the validation cohort were 55%, 96%, and 76.6%. While the AUC of the ADC features-based model was 0.932 and 0.955 for the training and validation cohorts. The model’s sensitivity, specificity, and accuracy were 83.3%, 100%, and 91.7%. The performances of these models were also validated by decision curve analysis (DCA). The AUC of the whole tumor ADC features-based LASSO-logistic regression predictive model was larger than that of FS T2WI features (p = 0.017). The whole tumor fat-suppressed T2WI and ADC features-based LASSO-logistic predictive models both can serve as useful tools in the differentiation of STN. ADC features-based LASSO-logistic regression predictive model did better than that of FS T2WI features.

The COVID-19 pandemic has emphasized disasters related to environmental topics, human health, social lifestyles, and economic systems around the world. COVID-19 may further spread through municipal solid waste (MSW), if it is collected, handled, transported, or disposed in an improper way. The current paper provides an overview of the multiple challenges that COVID-19 has introduced to the various tasks of MSW management including the impact of the implemented precautionary measures on MSW management, priorities and hierarchy of MSW, direct impact on the constitution, and characterization of MSW in Makkah, Saudi Arabia, based on waste management characterization guidance. In addition, specific and alternative guidance plans for the potential critical points of the infection were suggested to protect public health during the pandemic. The results of the current study revealed that the hierarchical system of MSW was modified under pandemic conditions. Implementation of control measures in Makkah has led to a change of lifestyle, which resulted in a physical change of the MSW constitution in Makkah, with the following average rates: organic matter, 57%; plastics, 31%; paper and cardboard, 9%; metals, 1%; glass, 1%; and wood, 1%. In conclusion, a specific guidance plan for MSW management during the COVID-19 pandemic was developed, aimed at handlers, pickers, collection, transportation, transfer stations, and MSW disposal. Such a guidance plan may play a vital role in controlling the pandemic, especially in the outdoor environment. The suggested guidance plan describes and specifies structured and ordered practices of MSW management in Makkah during COVID-19 and other pandemics.

User-generated online reviews have become essential sources of information for potential consumers. Given the increasing importance of online reviews on consumer purchases, some traders try to publish or promote fake reviews on online platforms to improve the reputation of their goods or services, or to damage the reputation of their competitors. This paper aims (1) to analyse whether and how fake reviews violate the main legal and ethical principles of advertising, according to the legislations of the US, UK and EU as well as the International Advertising and Marketing Communications Code; (2) to assess how the EU, the UK and the US are dealing with them, and find out which approaches and actions are working best; and (3) to offer normative recommendations for effective prosecution of fake reviews. The paper uses a combination of theoretical and sociological approaches (section 1), black letter analysis of law (sections 2 and 3) and a comparative approach (sections 2 and 3). Among others, the article observes (1) that fake reviews are a form of illegal advertising and (2) that the European regulatory instruments provide more protection against fake reviews than the US and argues (3) that an effective fight against fake reviews requires strong administrative bodies, endowed with sufficient resources.

Background Accurate and rapid diagnosis of Clostridium difficile infection (CDI) is critical for effective patient management and implementation of infection control measures to prevent transmission. Objectives We updated our previous meta-analysis to provide a more reliable evidence base for the clinical diagnosis of Xpert C. difficile (Xpert C. difficile) assay. Methods We searched PubMed, EMBASE, Cochrane Library, Chinese National Knowledge Infrastructure (CNKI), and the Chinese Biomedical Literature Database (CBM) databases to identify studies according to predetermined criteria. STATA 13.0 software was used to analyze the tests for sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio, and area under the summary receiver operating characteristic curves (AUC). QUADAS-2 was used to assess the quality of included studies with RevMan 5.2. Heterogeneity in accuracy measures was tested with Spearman correlation coefficient and chi-square. Meta-regressions and subgroup analyses were performed to figure out the potential sources of heterogeneity. Model diagnostics were used to evaluate the veracity of the data. Results A total of 26 studies were included in the meta-analysis. The pooled sensitivity (95% confidence intervals [CI]) for diagnosis was 0.97(0.95–0.98), and specificity was 0.96(0.95–0.97). The AUC was 0.99 (0.98–1.00). Model diagnostics confirmed the robustness of our meta-analysis’s results. Significant heterogeneity was still observed when we pooled most of the accuracy measures of selected studies. Meta-regression and subgroup analyses showed that the sample size and type, ethnicity, and disease prevalence might be the conspicuous sources of heterogeneity. Conclusions The up-to-date meta-analysis showed the Xpert CD assay had good accuracy for detecting CDI. However, the diagnosis of CDI must combine clinical presentation with diagnostic testing to better answer the question of whether the patient actually has CDI in the future, and inclusion of preanalytical parameters and clinical outcomes in study design would provide a more objective evidence base.

Objective Junctional proteins are the most important component of the blood-testis barrier and maintaining the integrity of this barrier is essential for spermatogenesis and male fertility. The present study elucidated the effect of SARS-CoV-2 infection on the blood–testis barrier (BTB) in patients who died from severe acute respiratory syndrome coronavirus 2 (COVID-19) complications. Methods In this study, lung and testis tissue was collected from autopsies of COVID-19 positive (n = 10) and negative men (n = 10) and was taken for stereology, immunocytochemistry, and RNA extraction. Results Evaluation of the lung tissue showed that the SARS-CoV-2 infection caused extensive damage to the lung tissue and also increases inflammation in testicular tissue and destruction of the testicular blood barrier. Autopsied testicular specimens of COVID-19 showed that COVID-19 infection significantly changes the spatial arrangement of testicular cells and notably decreased the number of Sertoli cells. Moreover, the immunohistochemistry results showed a significant reduction in the protein expression of occluding, claudin-11, and connexin-43 in the COVID-19 group. In addition, we also observed a remarkable enhancement in protein expression of CD68 in the testes of the COVID-19 group in comparison with the control group. Furthermore, the result showed that the expression of TNF-α, IL1β, and IL6 was significantly increased in COVID-19 cases as well as the expression of occludin, claudin-11, and connexin-43 was decreased in COVID-19 cases. Conclusions Overall, the present study demonstrated that SARS-CoV-2 could induce the up-regulation of the pro-inflammatory cytokine and down-regulation of junctional proteins of the BTB, which can disrupt BTB and ultimately impair spermatogenesis.

Portugal and Spain share five large river basins. The human activities carried out in the rivers or in the river basin area generate mutual interferences and impacts on the quality and quantity of water and on the ecologic conditions of the rivers and surrounding ecosystems. Furthermore, the effects of climate change on river ecosystems in the Mediterranean region—namely drought, water scarcity, desertification, flooding, heat waves, soil salinization, invasive species—are leading to larger water stress periods and an overall reduction of ecosystem services. In this context, the main ethic challenges regarding joint management of shared river basins in the Iberian Peninsula are: territorial equity, geomorphologic equity, demographic equity, interspecies equity, development equity, intergenerational equity and cultural equity. To address these challenges, a set of principles of international environmental law are briefly analysed. These principles govern the relations between States, regulate the access to the rivers, preserve the ecologic equilibrium of the rivers, and influence risk management. The principles also limit State discretionarily towards possible river uses and shape international agreements to be adopted in the future.

Pure water will become a golden resource in the context of the rising pollution, climate change and the recycling economy, calling for advanced purification methods such as the use of nanostructured adsorbents. However, coming up with an ideal nanoadsorbent for micropollutant removal is a real challenge because nanoadsorbents, which demonstrate very good performances at laboratory scale, do not necessarily have suitable properties in in full-scale water purification and wastewater treatment systems. Here, magnetic nanoadsorbents appear promising because they can be easily separated from the slurry phase into a denser sludge phase by applying a magnetic field. Yet, there are only few examples of large-scale use of magnetic adsorbents for water purification and wastewater treatment. Here, we review magnetic nanoadsorbents for the removal of micropollutants, and we explain the integration of magnetic separation in the existing treatment plants. We found that the use of magnetic nanoadsorbents is an effective option in water treatment, but lacks maturity in full-scale water treatment facilities. The concentrations of magnetic nanoadsorbents in final effluents can be controlled by using magnetic separation, thus minimizing the ecotoxicicological impact. Academia and the water industry should better collaborate to integrate magnetic separation in full-scale water purification and wastewater treatment plants.

Purpose The etiology of young-onset breast cancer (BC) is poorly understood, despite its greater likelihood of being hormone receptor-negative with a worse prognosis and persistent racial and socioeconomic inequities. We conducted a population-based case–control study of BC among young Black and White women and here discuss the theory that informed our study, exposures collected, study methods, and operational results. Methods Cases were non-Hispanic Black (NHB) and White (NHW) women age 20–49 years with invasive BC in metropolitan Detroit and Los Angeles County SEER registries 2010–2015. Controls were identified through area-based sampling from the U.S. census and frequency matched to cases on study site, race, and age. An eco-social theory of health informed life-course exposures collected from in-person interviews, including socioeconomic, reproductive, and energy balance factors. Measured anthropometry, blood (or saliva), and among cases SEER tumor characteristics and tumor tissue (from a subset of cases) were also collected. Results Of 5,309 identified potentially eligible cases, 2,720 sampled participants were screened and 1,812 completed interviews (682 NHB, 1140 NHW; response rate (RR): 60%). Of 24,612 sampled control households 18,612 were rostered, 2,716 participants were sampled and screened, and 1,381 completed interviews (665 NHB, 716 NHW; RR: 53%). Ninety-nine% of participants completed the main interview, 82% provided blood or saliva (75% blood only), and SEER tumor characteristics (including ER, PR and HER2 status) were obtained from 96% of cases. Conclusions Results from the successfully established YWHHS should expand our understanding of young-onset BC etiology overall and by tumor type and identify sources of racial and socioeconomic inequities in BC.

The major industrial companies located in the Kwinana Industrial Area (KIA) produce many industrial, agricultural and mining chemicals and refined materials, for national and international markets. With over 150 documented product and by-product exchanges, Kwinana is considered to be one of the best examples of industrial symbiosis (IS) in the world. A new model of IS comprised of four dimensions is under development, whereby whilst each dimension is unique, collectively, they interact to characterise an industrial estate, thus contributing to the evolutionary understanding of IS. We investigate the basis for this model through an analysis of two water circular economy examples as they relate to Western Australia's premier industrial area, the KIA. Case studies will consider a managed aquifer recharge (MAR) project that failed and the process water interconnectedness of enterprises operating successfully as a sub-ecology within the industrial cluster. Apart from the traditional product and by-product dimension of IS, three additional dimensions seem to be playing a crucial role in the KIA, these being the skilled workforce, support industry and governance dimensions. We provide additional context for the water-related examples of the circular economy at Kwinana by exploring a new four-dimensional model for IS.

We analyze the task-content of occupations operating in about 600 sectors of the economy with a focus on the dimensions that expose workers to contagion risks during the COVID-19 epidemic. We do so in the Italian context, leveraging extremely detailed and granular information from ICP, the Italian equivalent of O*Net (the survey that describes the task content of US occupations). We find that several sectors need physical proximity to operate, mainly in services and retail trade. Workers at risk of complications from COVID-19 (mainly males above the age of 50) are concentrated in sectors characterized by little physical proximity or where working from home is feasible. We then study the sectoral lockdowns put in place by the Italian Government in March 2020. We find that governmental restrictions hit the sectors where the risk of contagion in the workplace was more widespread: the effect is stronger for proximity to the public than that with co-workers. The share of workers who have the possibility to work from home is higher in sectors that were not forced to close. The evidence we provide is useful to identify which activities pose larger risks for contagion among workers in the workplace and where to reinforce safety measures. Supplementary Information The online version contains supplementary material available at 10.1007/s40797-021-00164-1.

Purpose The neutrophil-to-lymphocyte ratio (NLR) is a marker of systemic inflammation that has been reported to be associated with survival after chronic disease diagnoses, including lung cancer. We hypothesized that the inflammatory profile reflected by pre-diagnosis NLR, rather than the well-studied pre-treatment NLR at diagnosis, may be associated with increased mortality after lung cancer is diagnosed in high-risk heavy smokers. Methods We examined associations between pre-diagnosis methylation-derived NLR (mdNLR) and lung cancer-specific and all-cause mortality in 279 non-small lung cancer (NSCLC) and 81 small cell lung cancer (SCLC) cases from the β-Carotene and Retinol Efficacy Trial (CARET). Cox proportional hazards models were adjusted for age, sex, smoking status, pack years, and time between blood draw and diagnosis, and stratified by stage of disease. Models were run separately by histotype. Results Among SCLC cases, those with pre-diagnosis mdNLR in the highest quartile had 2.5-fold increased mortality compared to those in the lowest quartile. For each unit increase in pre-diagnosis mdNLR, we observed 22–23% increased mortality (SCLC-specific hazard ratio [HR] = 1.23, 95% confidence interval [CI]: 1.02, 1.48; all-cause HR = 1.22, 95% CI 1.01, 1.46). SCLC associations were strongest for current smokers at blood draw (Interaction Ps = 0.03). Increasing mdNLR was not associated with mortality among NSCLC overall, nor within adenocarcinoma (N = 148) or squamous cell carcinoma (N = 115) case groups. Conclusion Our findings suggest that increased mdNLR, representing a systemic inflammatory profile on average 4.5 years before a SCLC diagnosis, may be associated with mortality in heavy smokers who go on to develop SCLC but not NSCLC.

Key summary points Aim The objective of this study is to describe the baseline characteristics of oldest-old patients admitted with COVID-19 to an acute geriatric unit and to determine the factors associated with in-hospital mortality. Findings Dementia, incident delirium, and the CURB-65 score ≥ 3 are independent mortality risk factors. The concurrent use of angiotensin-converting enzyme inhibitors is a protective factor. Message Recognition of geriatric syndromes may be useful to help clinicians establish the prognosis of oldest-old patients admitted to hospital with COVID-19., Purpose To determine predictors of in-hospital mortality related to COVID-19 in oldest-old patients. Design Single-center observational study. Setting and participants Patients ≥ 75 years admitted to an Acute Geriatric Unit with COVID-19. Methods Data from hospital admission were retrieved from the electronic medical records: demographics, geriatric syndromes (delirium, falls, polypharmacy, functional and cognitive status) co-morbidities, previous treatments, clinical, laboratory, and radiographic characteristics. Cox proportional hazard models were used to evaluate in-hospital mortality. Results Three hundred patients were consecutively included (62.7% females, mean age of 86.3 ± 6.6 years). Barthel Index (BI) was

Purpose To assess the change in mammography screening attendance in Sweden—overall and in sociodemographic groups at risk of low attendance—after removal of the out-of-pocket fee in 2016. Methods Individual-level data on all screening invitations and attendance between 2014 and 2018 were linked to sociodemographic data from Statistics Sweden. Odds ratios and 95% confidence intervals (CIs) for attendance by time period and sociodemographic factor were computed using mixed logistic regression to account for repeated measures within women. The study sample included 1.4 million women, aged 40–75, who had a mammography screening appointment in 2014–2015 and/or 2017–2018 in 14 of Sweden’s 21 health care regions. Results Overall screening attendance was 83.8% in 2014–2015 and 84.1% in 2017–2018 (+ 0.3 percentage points, 95% CI 0.2–0.4). The greatest increase in attendance was observed in non-Nordic women with the lowest income, where attendance rose from 62.9 to 65.8% (+ 2.9 points, 95% CI 2.3–3.6), and among women with four or more risk factors for low attendance, where attendance rose from 59.2 to 62.0% (+ 2.8 points, 95% CI 2.2–3.4). Conclusion Screening attendance did not undergo any important increase after implementing free screening, although attendance among some sociodemographic groups increased by almost three percentage points after the policy change.

Background Human papillomavirus (HPV) vaccination rates among adolescents are increasing in Minnesota (MN) but remain below the Healthy People 2020 goal of 80% completion of the series. The goal of this study was to identify messaging and interventions impacting HPV vaccine uptake in MN through interviews with clinicians and key stakeholders. Methods We conducted semi-structured key participant interviews with providers and stakeholders involved in HPV vaccination efforts in MN between 2018 and 2019. Provider interview questions focused on messaging around the HPV vaccine and clinic-based strategies to impact HPV vaccine uptake. Stakeholder interview questions focused on barriers and facilitators at the organizational or state level, as well as initiatives and collaborations to increase HPV vaccination. Responses to interviews were recorded and transcribed. Thematic content analysis was used to identify themes from interviews. Results 14 clinicians and 13 stakeholders were interviewed. Identified themes were grouped into 2 major categories that dealt with messaging around the HPV vaccine, direct patient–clinician interactions and external messaging, and a third thematic category involving healthcare system-related factors and interventions. The messaging strategy identified as most useful was promoting the HPV vaccine for cancer prevention. The need for stakeholders to prioritize HPV vaccination uptake was identified as a key factor to increasing HPV vaccination rates. Multiple providers and stakeholders identified misinformation spread through social media as a barrier to HPV vaccine uptake. Conclusion Emphasizing the HPV vaccine’s cancer prevention benefits and prioritizing it among healthcare stakeholders were the most consistently cited strategies for promoting HPV vaccine uptake. Methods to combat the negative influence of misinformation about HPV vaccines in social media are an urgent priority.

Key summary points Aim To compare functional, cognitive, and nutritional status before and after COVID-19 pandemic among institutionalized older adults. Findings High frequencies of functional, cognitive, emotional, and nutritional decline were found after the first wave of COVID19 pandemic independently of the infection. Message Health workers and managers should take measures to prevent this decline in institutionalized elderly and its potential adverse effects., Purpose Many institutionalized older people have died during the first wave of COVID-19. Other related consequences have not yet been described objectively. The aim of this study was to compare functional, cognitive, and nutritional status before and after the first wave among nursing home residents, in both COVID-19 and non-COVID-19 patients. Methods Older adults institutionalized in four nursing homes were assessed from May to June 2020, by a geriatric multidisciplinary team in collaboration with the nursing homes staff. Comprehensive geriatric assessment was performed including functional, cognitive, and nutritional variables before and after the first wave of the pandemic. Data from residents with positive results for microbiological testing for SARS-CoV-2 were compared with those who did not. Results 435 nursing home residents were included. The median age was 86.77 ± 8.5 years, 78.4% were women. 190 (43.9%) tested positive for coronavirus. Functional decline after the first wave was detected in 20.2% according to the Barthel Index and in 18.5% according to functional ambulation categories, p

This article examines political empowerment related to voting. The profession of social work requires practitioners to consider the social political roots of problems and to work to remediate them through micro and macro interventions, informed by political empowerment. Political empowerment involves having the power, ability, critical awareness, and sense of group identity to take action in order to create change in a political system. Findings from a qualitative study are presented to explore how recipients of food assistance benefits, enrolled in community college make decisions about voting. Data collected provides rich and contextual insight into how the decision to vote or not vote corresponds with an academic understanding of political empowerment and suggests that choosing not to vote may represent a type of political empowerment. Social work interventions related to voting for this population could include reducing stigma around government assistance, voter engagement, and work with systems to recognize the political power of those who are often left out of the process.

Key Summary points Aim RCT to evaluate the efficacy of multi-component interventions for prevention of hospital-acquired pneumonia in hospitalized older patients. Findings The multi-component interventions did not reduce hospital-acquired pneumonia but increased the mean time to next hospitalisation due to respiratory infection (11.5 months vs. 9.5 months; P = 0.049), and reduced the risk of hospitalisation in 1 year (18.6% vs. 34.4%; P = 0.049). This was likely due to the increased recognition of oropharyngeal dysphagia (35.6% vs. 20.3%; P < 0.001) and improved influenza (54.5% vs 17.2%; P < 0.001) and pneumococcal vaccination rates (52.5% vs. 20.3%; P < 0.001). Message A multi-component intervention for nosocomial pneumonia may not significantly reduce the incidence of hospital-acquired pneumonia but significantly increases the frequency of diagnosis of oropharyngeal dysphagia, improves vaccination rates and can reduce future hospitalisations for respiratory infections in older adults., Aims To evaluate the efficacy of multi-component interventions for prevention of hospital-acquired pneumonia in older patients hospitalized in geriatric wards. Methods A randomized, parallel-group, controlled trial was undertaken in patients aged 65 and above who were admitted to a tertiary hospital geriatric unit from January 1, 2016 to June 30, 2018 for an acute non-respiratory illness. Participants were randomized by to receive either a multi-component intervention (consisting of reverse Trendelenburg position, dysphagia screening, oral care and vaccinations), or usual care. The outcome measures were the proportion of patients who developed hospital-acquired pneumonia during hospitalisation, and mean time from randomization to the next hospitalisation due to respiratory infections in 1 year. Results A total of 123 participants (median age, 85; 43.1% male) were randomized, (n = 59) to intervention group and (n = 64) to control group. The multi-component interventions did not significantly reduce the incidence of hospital-acquired pneumonia but did increase the mean time to next hospitalisation due to respiratory infection (11.5 months vs. 9.5 months; P = 0.049), and reduced the risk of hospitalisation in 1 year (18.6% vs. 34.4%; P = 0.049). Implementation of multi-component interventions increased diagnoses of oropharyngeal dysphagia (35.6% vs. 20.3%; P

Significant racial and ethnic disparities in health care and service access exist. In the present article, we reviewed qualitative studies investigating the racism-related experiences of Black caregivers of children with autism spectrum disorder (ASD) in the U.S. health care system. Specifically, we examined institutional racism (i.e., systemic racism) and individual racism directed toward Black families when they seek diagnoses and services for their children with ASD. Additionally, we summarized culturally responsive and context-specific practice guidelines to work collaboratively with Black caregivers of children with ASD for applied behavior analysis practitioners.

The analysis regards the simulation of conversion of the durum wheat cultivation into hazelnut. This research is based on a case study in the province of Viterbo (Italy), where the durum wheat production and the hazelnuts represent the primary cultures adopted in this area. The purpose of this study is to analyse the number of people employed in the production of hazelnuts and durum wheat to understand if the intensification of hazelnut production has a positive impact on social sustainability and if the conversion process from durum wheat to hazelnuts is socially sustainable, in order to fill a gap in the existing literature. The social impact analysis shows that the hypothesis would be positive for the agricultural occupation of the Municipalities of the Province of Viterbo considered. The results showed as the conversion from the cultivation of durum wheat in hazelnut has brought to a considerable increase in agricultural occupation. Finally, I analysed the effects of the pandemic’s crisis on the COVID-19 virus in the choices related to the conversion between durum wheat and hazelnuts.