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It has long been debated as to whether higher education (HE) is a site of social mobility that promotes meritocracy or social reproduction that creates and exacerbates inequalities in societies. In this paper, I will argue that HE, even when democratised and provided free to everyone, reproduces inequalities unless coupled with an inclusive sectoral design, an expansion of funding, and a wider strategy to reduce socio-economic inequalities. To do so, I studied the case of Syria, which has always claimed to have a meritocratic HE system that is designed to achieve equality in society by providing free HE for all since the 1970s. I analysed the database of the Ministry of Higher Education (MoHE) for 15 academic years from 2001 to 2015. This database included data on students' access and graduation rate divided by the type of education (public, private, higher institutes, and technical institutes), level of education (undergraduate and postgraduate), gender (male and female), city, faculty, and specialisations. This analysis unpacked four types of inequalities, namely education type-based inequalities, specialisation-based inequalities, city-based inequalities, and gender-based inequalities. Finally, I show how gender dynamics and roles are changing in the HE sector as a result of the Syrian conflict.

Research on health systems resilience during the Coronavirus Disease-2019 pandemic frequently used the Global Health Security Index (GHSI), a composite index scoring countries' health security and related capabilities. Conflicting results raised questions regarding the validity of the GHSI as a reliable index. This study attempted to better characterize when and to what extent countries' progress towards Global Health Security (GHS) augments health systems resilience. We used longitudinal data from 191 countries and a difference-in-difference (DiD) causal inference strategy to quantify the effect of countries' GHS capacity as measured by the GHSI on their coverage rates for essential childhood immunizations, a previously established proxy for health systems resilience. Using a sliding scale of cutoff values with step increments of one, we divided countries into treatment and control groups and determined the lowest GHSI score at which a safeguarding effect was observed. All analyses were adjusted for potential confounders. World Bank governance indicators were employed for robustness tests. While countries with overall GHSI scores of 57 and above prevented declines in childhood immunization coverage rates from 2020-2022 (coef: 0.91; 95% CI: 0.41-1.41), this safeguarding effect was strongest in 2021 (coef: 1.23; 95% CI: 0.05-2.41). Coefficient sizes for overall GHSI scores were smaller compared to several GHSI sub-components, including countries' environmental risks (coef: 4.28; 95% CI: 2.56-5.99) and emergency preparedness and response planning (coef: 1.82; 95% CI: 0.54-3.11). Our findings indicate that GHS was positively associated with health systems resilience during the pandemic (2020) and the following two years (2021-2022), that GHS may have had the most significant protective effects in 2021 as compared with 2020 and 2022, and that countries' underlying characteristics, including governance quality, bolstered health systems resilience during the pandemic.

Objectives This study aims to assess both socioeconomic and climatic factors of cholera morbidity in Mozambique considering both spatial and temporal dimensions.Design An ecological longitudinal retrospective study using monthly provincial cholera cases from Mozambican Ministry of Health between 2000 and 2018. The cholera cases were linked to socioeconomic data from Mozambique Demographic and Health Surveys conducted in the period 2000–2018 and climatic data; relative humidity (RH), mean temperature, precipitation and Normalised Difference Vegetation Index (NDVI). A negative binomial regression model in a Bayesian framework was used to model cholera incidence while adjusting for the spatiotemporal covariance, lagged effect of environmental factors and the socioeconomic indicators.Setting Eleven provinces in Mozambique.Results Over the 19-year period, a total of 153 941 cholera cases were notified to the surveillance system in Mozambique. Risk of cholera increased with higher monthly mean temperatures above 24°C in comparison to the reference mean temperature of 23°C. At mean temperature of 19°C, cholera risk was higher at a lag of 5–6 months. At a shorter lag of 1 month, precipitation of 223.3 mm resulted in an 57% increase in cholera risk (relative risk, RR 1.57 (95% CI 1.06 to 2.31)). Cholera risk was greatest at 3 lag months with monthly NDVI of 0.137 (RR 1.220 (95% CI 1.042 to 1.430)), compared with the reference value of 0.2. At an RH of 54%, cholera RR was increased by 62% (RR 1.620 (95% CI 1.124 to 2.342)) at a lag of 4 months. We found that ownership of radio RR 0.29, (95% CI 0.109 to 0.776) and mobile phones RR 0.262 (95% CI 0.097 to 0.711) were significantly associated with low cholera risk.Conclusion The derived lagged patterns can provide appropriate lead times in a climate-driven cholera early warning system that could contribute to the prevention and management of outbreaks.

The efficient use of municipal waste is becoming increasingly important for sustainable environmental quality. An integral part of the process of recycling waste material is its quality sorting. Nowadays, both manual and automated sorting methods, especially optical sorting, are used worldwide for sorting mixed waste. This article presents the application of the NIR/VIS optical sorting system through a description of this processing equipment integrated into a specific plastic waste processing line. The aim of the article was to select the optimal mode of operation generally applicable to mixed waste, and, specifically, to compare the quality of sorting of plastic waste in automated and manual sorting modes. In order to compare the efficiency of the sorting system, significant parameters of the sorting process were proposed. The measurement of the plastic waste sorting purity parameter was based on data obtained by weighing selected control samples, and the evaluation of the results of these measurements showed, in particular, the dependence of the concerned parameter not only on the sorting mode, i.e., automated and manual, but also on the conveyor belt speed/waste material flow, on the pre-sorting methods and, in the case of manual sorting, on the operating shift. The subsequent economic assessment of both sorting processes clearly declared the investment in automated sorting systems in the optical system operation mode not only as profitable, but also as extremely advantageous both for the production economy and the environment.

Residual current devices are vital as they are used to protect humans from electric shocks and fire hazards. These devices detect the residual current in the grid, open the mechanism, and leave the grid without voltage. In this study, the time response of a newly designed hybrid system consisting of an electronic switch system and a residual current device to protect humans from hazards has been analyzed. A model consisting of capacitors and resistors has been used to simulate the human body. In the designed system, the average response time was found to be 1.37 ms, which operates with an average of 6.43 times faster than a conventional residual current device. The results of the study illustrated that the designed system leaves the circuit voltage-free much faster than a conventional residual current device and is more effective in protecting human life.

Comprehensive literature has been published on the development of digital health applications using machine learning methods in cardiovascular surgery. Many machine learning methods have been applied in clinical decision-making processes, particularly for risk estimation models. This review of the literature shares an update on machine learning applications for cardiovascular intervention (CVI) risk assessment. This study selected peer-reviewed scientific publications providing sufficient detail about machine learning methods and outcomes predicting short-term CVI risk in cardiac surgery. Thirteen articles fulfilling pre-set criteria were reviewed and tables were created presenting the relevant characteristics of the studies. The review demonstrates the usefulness of machine learning methods in high-risk CVI applications, identifies the need for improvement, and provides efficient support for future prediction models for the healthcare system.

Abstract Durgama Anchalare Malaria Nirakaran (DAMaN) is a multi-component malaria intervention for hard-to-reach villages in Odisha, India. The main component, malaria camps (MCs), consists of mass screening, treatment, education, and intensified vector control. We evaluated MC effectiveness using a quasi-experimental cluster-assigned stepped-wedge study with a pretest–posttest control group in 15 villages: six immediate (Arm A), six delayed (Arm B), and three previous interventions (Arm C). The primary outcome was PCR + Plasmodium infection prevalence. The time (i.e., baseline vs. follow-up 3) x study arm interaction term shows that there were statistically significant lower odds of PCR + Plasmodium infection in Arm A (AOR = 0.36, 95% CI = 0.17, 0.74) but not Arm C as compared to Arm B at the third follow-up. The cost per person ranged between US$3–8, the cost per tested US$4–9, and the cost per treated US$82–1,614, per camp round. These results suggest that the DAMaN intervention is a promising and financially feasible approach for malaria control.

Geographical depictions in ancient texts are often personal, biased, subjective, and sometimes imaginative. Therefore, the concept of geosophy coined by J. Kirtland Wright is important in terms of examining the geographical narratives and expressions in historical texts. According to him, geosophy is the study of geographical information in all respects and covers both true and false geographical ideas of all manner of people. Hence, Wright emphasizes that intuitive, imaginative and subjective thoughts are also valuable in geographical perception and should be taken into consideration. Examining all kinds of information related to the geographical perception in the texts from past to present brings the concept of geosophy closer to history as a discipline. In this study, physiognomic and geographical definitions of Aelius Aristeides, an orator and sophist of the 2nd century CE, about Pergamon, which is the most important ancient settlement of Kaikos Valley, and its surroundings are examined in terms of geosophical subjectivity and imagining categories. Thus, it is revealed that the examination of the narratives of ancient texts on terrestrial space from the geosophical point of view can offer new perspectives in studies on ancient history and historical geography.

In Tanzania, the One by One: Target COVID-19 campaign was launched nationally in July 2022 to address the prevalent vaccine hesitancy and lack of confidence in COVID-19 vaccines. The campaign mobilized social media influencers and viral content with the ultimate goal of increasing COVID-19 vaccine uptake in the country. The objective of this study was to empirically assess the impact of the campaign on three outcomes: vaccine confidence, vaccine hesitancy, and vaccination status. Using programmatic data collected through an online survey before and after the campaign, we conducted a difference-in-difference (DiD) analysis and performed a crude, adjusted, and propensity score-matched analysis for each study outcome. Lastly, to observe whether there was any differential impact of the campaign across age groups, we repeated the analyses on age-stratified subgroups. Data included 5,804 survey responses, with 3,442 and 2,362 responses collected before and after the campaign, respectively. Although there was only weak evidence of increased COVID-19 vaccine confidence in the campaign-exposed group compared to the control group across all age groups, we observed a differential impact among different age groups. While no significant change was observed among young adults aged 18-24 years, the campaign exposure led to a statistically significant increase in vaccine confidence (weighted/adjusted DiD coefficient = 0.76; 95% CI: 0.06, 1.5; p-value = 0.034) and vaccination uptake (weighted/adjusted DiD coefficient = 1.69.; 95% CI: 1.02, 2.81; p-value = 0.023) among young adults aged 25-34 years. Among adults aged 35 years and above, the campaign exposure led to a significant decrease in vaccine hesitancy (weighted/adjusted DiD coefficient = -15; 95% CI: -21, -8.3; p-value

Abstract Background Tackling infodemics with flooding misinformation is key to managing the COVID-19 pandemic. Yet only a few studies have attempted to understand the characteristics of the people who believe in misinformation. Methods Data was used from an online survey that was administered in April 2020 to 6518 English-speaking adult participants in the United States. We created binary variables to represent four misinformation categories related to COVID-19: general COVID-19-related, vaccine/anti-vaccine, COVID-19 as an act of bioterrorism, and mode of transmission. Using binary logistic regression and the LASSO regularization, we then identified the important predictors of belief in each type of misinformation. Nested vector bootstrapping approach was used to estimate the standard error of the LASSO coefficients. Results About 30% of our sample reported believing in at least one type of COVID-19-related misinformation. Belief in one type of misinformation was not strongly associated with belief in other types. We also identified 58 demographic and socioeconomic factors that predicted people’s susceptibility to at least one type of COVID-19 misinformation. Different groups, characterized by distinct sets of predictors, were susceptible to different types of misinformation. There were 25 predictors for general COVID-19 misinformation, 42 for COVID-19 vaccine, 36 for COVID-19 as an act of bioterrorism, and 27 for mode of COVID-transmission. Conclusion Our findings confirm the existence of groups with unique characteristics that believe in different types of COVID-19 misinformation. Findings are readily applicable by policymakers to inform careful targeting of misinformation mitigation strategies.

Abstract Background Smoking rates remain high in Vietnam, particularly among people living with HIV/AIDS (PLWH), but tobacco cessation services are not available in outpatient HIV clinics (OPCs). The research team is conducting a type II hybrid randomized controlled trial (RCT) comparing the cost-effectiveness of three tobacco cessation interventions among PLWH receiving care in HIV clinics in Vietnam. The study is simultaneously evaluating the implementation processes and outcomes of strategies aimed at increasing the implementation of tobacco dependence treatment (TDT) in the context of HIV care. This paper describes the systematic, theory-driven process of adapting intervention components and implementation strategies with demonstrated effectiveness in high-income countries, and more recently in Vietnam, to a new population (i.e., PLWH) and new clinical setting, prior to launching the trial. Methods Data collection and analyses were guided by two implementation science frameworks and the socio-ecological model. Qualitative interviews were conducted with 13 health care providers and 24 patients in three OPCs. Workflow analyses were conducted in each OPC. Qualitative data were analyzed using rapid qualitative analysis procedures. Based on findings, components of the intervention and implementation strategies were adapted, followed by a 3-month pilot study in one OPC with 16 patients randomized to one of two intervention arms. Results The primary adaptations included modifying the TDT intervention counseling content to address barriers to quitting among PLWH and Vietnamese sociocultural norms that support smoking cessation. Implementation strategies (i.e., training and system changes) were adapted to respond to provider- and clinic-level determinants of implementation effectiveness (e.g., knowledge gaps, OPC resource constraints, staffing structure, compatibility). Conclusions Adaptations were facilitated through a mixed method, stakeholder (patient and health care provider, district health leader)-engaged evaluation of context-specific influences on intervention and implementation effectiveness. This data-driven approach to refining and adapting components aimed to optimize intervention effectiveness and implementation in the context of HIV care. Balancing pragmatism with rigor through the use of rapid analysis procedures and multiple methods increased the feasibility of the adaptation process. Trial registration ClinicalTrials.gov NCT05162911 . Registered on December 16, 2021.

Küresel ısınma neticesinde tüm uluslar birtakım önlemler almak üzere harekete geçmişlerdir. Bu önlemler çerçevesinde ülkeler elektrikli araçların üretimi ve satışı üzerine yoğunlaşmışlardır. Ülkemizde de son yıllarda bu araçların kullanımı giderek yaygın hale gelmektedir. Bu çalışma, piyasada mevcut araçların performanslarını değerlendirerek alıcılara karar verme süreçlerinde destek olmayı amaçlamaktadır. Literatürde elektrikli sportif çok amaçlı araçların (Electric Sports Utility Vehicles, e-SUV) verimliliğini bütünleşik Kriterler Arası Korelasyon Yoluyla Kriterlerin Önemi (CRiteria Importance Through Intercriteria Correlation-CRITIC) ve Girdi-Çıktıların Tatminine Dayalı Etkinlik Analizi Tekniği (Efficiency Analysis Technique with Input Output Satisficing-EATWIOS) yöntemlerini kullanarak değerlendiren bir araştırmaya rastlanmamıştır. Bu çalışma bu boşluğu doldurarak, e-SUV’ların verimliliklerini değerlendirmektedir. CRITIC yönteminden elde edilen ağırlıklar EATWIOS yönteminde kullanılarak e-SUV’ların verimlilikleri değerlendirilmiştir. Belirlenen yedi tane girdi ve dört tane çıktı faktörüne göre Türkiye’de satılan beş farklı markaya ait e-SUV’lar performans açısından değerlendirilmiştir. e-SUV satın alma sürecinde enerji tüketiminin, fiyatın ve araç ağırlığının önemli faktörler olduğu sonucuna varılmıştır. Sonuç olarak İngilizler tarafından üretilen e-SUV’un en iyisi olduğu sonucuna ulaşılmış ancak verimliliğin çok yüksek olmadığı, verimliliğin arttırılması için çalışmalar yapılması gerektiği vurgulanmıştır.

Residual stresses are defined as the stresses that occur in the material without the application of an external load. Their occurrence is related to the technology of production and treatment of the material. This article proposes the identification of residual stresses in a steel material for bearing production, specifically 100Cr6 (1.3505) material. The identification consists in measuring the material by X-ray diffraction method, for which the Proto iXRD mobile diffractometer was chosen. The first measurement was carried out on turned bearing rings and a subsequent second measurement was carried out on the same rings after heat treatment, namely quenching and tempering. This article also proposes a measurement methodology for the bearing rings, where each ring is measured in 6 positions rotated 60° with respect to each other. The measurement results are compared with the individual manufacturing operations, i.e. turning and heat treatment. The results clearly show the expected increase in residual stresses after turning and subsequent decrease after heat treatment. The technological parameters of turning fundamentally influence the residual stresses and thus also affect the quality of the product in subsequent production operations.

BackgroundTemperature, precipitation, relative humidity (RH), and Normalized Different Vegetation Index (NDVI), influence malaria transmission dynamics. However, an understanding of interactions between socioeconomic indicators, environmental factors and malaria incidence can help design interventions to alleviate the high burden of malaria infections on vulnerable populations. Our study thus aimed to investigate the socioeconomic and climatological factors influencing spatial and temporal variability of malaria infections in Mozambique.MethodsWe used monthly malaria cases from 2016 to 2018 at the district level. We developed an hierarchical spatial–temporal model in a Bayesian framework. Monthly malaria cases were assumed to follow a negative binomial distribution. We used integrated nested Laplace approximation (INLA) in R for Bayesian inference and distributed lag nonlinear modeling (DLNM) framework to explore exposure-response relationships between climate variables and risk of malaria infection in Mozambique, while adjusting for socioeconomic factors.ResultsA total of 19,948,295 malaria cases were reported between 2016 and 2018 in Mozambique. Malaria risk increased with higher monthly mean temperatures between 20 and 29°C, at mean temperature of 25°C, the risk of malaria was 3.45 times higher (RR 3.45 [95%CI: 2.37–5.03]). Malaria risk was greatest for NDVI above 0.22. The risk of malaria was 1.34 times higher (1.34 [1.01–1.79]) at monthly RH of 55%. Malaria risk reduced by 26.1%, for total monthly precipitation of 480 mm (0.739 [95%CI: 0.61–0.90]) at lag 2 months, while for lower total monthly precipitation of 10 mm, the risk of malaria was 1.87 times higher (1.87 [1.30–2.69]). After adjusting for climate variables, having lower level of education significantly increased malaria risk (1.034 [1.014–1.054]) and having electricity (0.979 [0.967–0.992]) and sharing toilet facilities (0.957 [0.924–0.991]) significantly reduced malaria risk.ConclusionOur current study identified lag patterns and association between climate variables and malaria incidence in Mozambique. Extremes in climate variables were associated with an increased risk of malaria transmission, peaks in transmission were varied. Our findings provide insights for designing early warning, prevention, and control strategies to minimize seasonal malaria surges and associated infections in Mozambique a region where Malaria causes substantial burden from illness and deaths.

Abstract Background Dengue is a major public health problem in Sri Lanka. Aedes vector surveillance and monitoring of larval indices are routine, long-established public health practices in the country. However, the association between Aedes larval indices and dengue incidence is poorly understood. It is crucial to evaluate lagged effects and threshold values of Aedes larval indices to set pragmatic targets for sustainable vector control interventions. Methods Monthly Aedes larval indices and dengue cases in all 10 Medical Officer of Health (MOH) divisions in Kalutara district were obtained from 2010 to 2019. Using a novel statistical approach, a distributed lag non-linear model and a two-staged hierarchical meta-analysis, we estimated the overall non-linear and delayed effects of the Premise Index (PI), Breteau Index (BI) and Container Index (CI) on dengue incidence in Kalutara district. A set of MOH division-specific variables were evaluated within the same meta-analytical framework to determine their moderator effects on dengue risk. Using generalized additive models, we assessed the utility of Aedes larval indices in predicting dengue incidence. Results We found that all three larval indices were associated with dengue risk at a lag of 1 to 2 months. The relationship between PI and dengue was homogeneous across MOH divisions, whereas that with BI and CI was heterogeneous. The threshold values of BI, PI and CI associated with dengue risk were 2, 15 and 45, respectively. All three indices showed a low to moderate accuracy in predicting dengue risk in Kalutara district. Conclusions This study showed the potential of vector surveillance information in Kalutara district in developing a threshold-based, location-specific early warning system with a lead time of 2 months. The estimated thresholds are nonetheless time-bound and may not be universally applicable. Whenever longitudinal vector surveillance data areavailable, the methodological framework we propose here can be used to estimate location-specific Aedes larval index thresholds in any other dengue-endemic setting. Graphical Abstract

Son yıllarda, sağlık sistemlerinde, hastaların artan beklenti ve ihtiyaçları doğrultusunda hızla gelişmekte olan bağımsız ve tarafsız performans değerlendirme kavramı, denetlenebilir, hasta odaklı, hesap verebilirliği fazla olan, verimli, iyileştirilebilir, sürdürülebilir ve erişilebilir sistemler meydana getirebilmek açısından büyük bir önem taşımaktadır. Performans değerlendirme sürecinin ana aktörlerinden biri, belirli performans göstergelerinin tanımlanabileceği ve sağlık sisteminde gereken alanlarda düzenli olarak kullanılabilecek bir yapının sunulması olmakla beraber, bu sürece netlik kazandırmak amacıyla performansın bütünsel bir görünümünü oluşturabilmek için konuyu odak noktası alan araştırmacılar tarafından, sağlık sisteminin çeşitli yapıtaşlarında farklı araç ve yöntemler kullanılarak çalışmalara devam edilmektedir. Sağlık hizmetlerinde performans değerlendirme, her ne kadar zor ve karmaşık bir süreç olsa da sistemin iyileştirilebilmesi-geliştirilebilmesi adına kritik bir önem taşımaktadır. Bu derleme çalışmasında, sağlık alanında 2011-2021 yılları arasında gerçekleştirilen çeşitli performans değerlendirme çalışmalarında kullanılan araç ve yöntemler incelenerek özetlenmiş, çalışmalarda öne çıkan kavramlar sınıflandırılmıştır. Çalışmanın sonucunda literatürdeki eksikliklerin gözlemlenmesiyle, gerçekleştirilen çalışmanın, mevcut literatüre katkı sağlaması amaçlanmıştır.

Abstract Background Children in low-and-middle-income countries (LMICs) are facing tremendous mental health challenges. Numerous evidence-based interventions (EBIs) have been adapted to LMICs and shown effectiveness in addressing the needs, but most EBIs have not been adopted widely using scalable and sustainable implementation models that leverage and strengthen existing structures. There is a need to apply implementation science methodology to study strategies to effectively scale-up EBIs and sustain the practices in LMICs. Through a cross-sector collaboration, we are carrying out a second-generation investigation of implementation and effectiveness of a school-based mental health EBI, ParentCorps Professional Development (PD), to scale-up and sustain the EBI in Uganda to promote early childhood students’ mental health. Our previous studies in Uganda supported that culturally adapted PD resulted in short-term benefits for classrooms, children, and families. However, our previous implementation of PD was relied on mental health professionals (MHPs) to provide PD to teachers. Because of the shortage of MHPs in Uganda, a new scalable implementation model is needed to provide PD at scale. Objectives This study tests a new scalable and sustainable PD implementation model and simultaneously studies the effectiveness. This paper describes use of collaboration, task-shifting, and Train-the-Trainer strategies for scaling-up PD, and protocol for studying the effectiveness-implementation of ParentCorps-PD for teachers in urban and rural Ugandan schools. We will examine whether the new scale-up implementation approach will yield anticipated impacts and investigate the underlying effectiveness-implementation mechanisms that contribute to success. In addition, considering the effects of PD on teachers and students will influence by teacher wellness. This study also examines the added value (i.e. impact and costs) of a brief wellness intervention for teachers and students. Methods Using a hybrid-type II effectiveness-implementation cluster randomized controlled trial (cRCT), we will randomize 36 schools (18 urban and 18 rural) with 540 teachers and nearly 2000 families to one of three conditions: PD + Teacher-Wellness (PDT), PD alone (PD), and Control. Primary effectiveness outcomes are teachers’ use of mental health promoting strategies, teacher stress management, and child mental health. The implementation fidelity/quality for the scale-up model will be monitored. Mixed methods will be employed to examine underlying mechanisms of implementation and impact as well as cost-effectiveness. Discussion This research will generate important knowledge regarding the value of an EBI in urban and rural communities in a LMIC, and efforts toward supporting teachers to prevent and manage early signs of children’s mental health issues as a potentially cost-effective strategy to promote child population mental health in low resource settings. Trial Registration: This trial was registered with ClinicalTrials.gov (registration number: NCT04383327; https://clinicaltrials.gov/ct2/show/NCT04383327 ) on May13, 2020.

Objective: Young Latinas and Black women drink less than women of other racial/ethnic groups but experience more alcohol-related problems in midlife. This study aims to identify modifiable factors to prevent adult onset of alcohol use disorder (AUD) in this population. Methods: Data were collected at six time points as part of the Harlem Longitudinal Development Study from 365 Latinas (47%) and Black (53%) women (mean age at time 1 = 14, standard deviation 1.3). Structural equation modeling was used to test hypothesized pathways from childhood physical and sexual abuse to AUD via depressive mood, anxiety disorders, and somatic complaints in the 20s. We also tested the moderation effect of the high school academic environment by including in the structural equation model two latent variable interaction terms between the school environment and each of the abuse variables. Results: Childhood physical and sexual abuse was positively associated with depressive mood, anxiety disorders, and somatic complaints when participants were in the 20s. Depressive mood mediated childhood abuse and AUD when women were in the 30s. The high school academic environment attenuated the effect of physical, but not sexual abuse, on depressive mood (β = −0.59, B = −9.38, 95% CI [−14.00, −4.76]), anxiety symptoms (β = −0.61, B = −14.19, 95% CI [−21.76, −6.61]), appetite loss (β = −0.41, B = −10.52, 95% CI [−15.61, −5.42]), and sleeplessness (β = −0.50, B = −9.56, 95% CI [−13.95, −5.17]) in the early 20s. Conclusions: Our findings underscore the need to invest in early violence prevention interventions and in education to ensure equitable access to quality, academically oriented, and safe schools. [ABSTRACT FROM AUTHOR]

Abstract Background The COVID-19 pandemic has disproportionately impacted economically-disadvantaged populations in the United States (US). Precarious employment conditions may contribute to these disparities by impeding workers in such conditions from adopting COVID-19 mitigation measures to reduce infection risk. This study investigated the relationship between employment and economic conditions and the adoption of COVID-19 protective behaviors among US workers during the initial phase of the COVID-19 pandemic. Methods Employing a social media advertisement campaign, an online, self-administered survey was used to collect data from 2,845 working adults in April 2020. Hierarchical generalized linear models were performed to assess the differences in engagement with recommended protective behaviors based on employment and economic conditions, while controlling for knowledge and perceived threat of COVID-19, as would be predicted by the Health Belief Model (HBM). Results Essential workers had more precarious employment and economic conditions than non-essential workers: 67% had variable income; 30% did not have paid sick leave; 42% had lost income due to COVID-19, and 15% were food insecure. The adoption of protective behaviors was high in the sample: 77% of participants avoided leaving home, and 93% increased hand hygiene. Consistent with the HBM, COVID-19 knowledge scores and perceived threat were positively associated with engaging in all protective behaviors. However, after controlling for these, essential workers were 60% and 70% less likely than non-essential workers, who by the nature of their jobs cannot stay at home, to stay at home and increase hand hygiene, respectively. Similarly, participants who could not afford to quarantine were 50% less likely to avoid leaving home (AOR: 0.5; 95% CI: 0.4, 0.6) than those who could, whereas there were no significant differences concerning hand hygiene. Conclusions Our findings are consistent with the accumulating evidence that the employment conditions of essential workers and other low-income earners are precarious, that they have experienced disproportionately higher rates of income loss during the initial phase of the COVID-19 pandemic and face significant barriers to adopting protective measures. Our findings underscore the importance and need of policy responses focusing on expanding social protection and benefits to prevent the further deepening of existing health disparities in the US.

Abstract Background The global HIV burden remains a public health concern. Women engaged in sex work (WESW) are at higher risk of acquiring HIV compared to the general adult population. Uganda reports high rates of HIV prevalence among WESW. While WESW in Uganda have long been the subject of surveillance studies, they have not been targeted by theory-informed HIV prevention intervention approaches. In this study, we explored the perceived benefits of an evidence-based HIV risk reduction intervention that was implemented as part of a combination intervention tested in a clinical trial in Uganda. Methods As part of a larger randomized clinical trial, we conducted semi-structured in-depth interviews with 20 WESW selected using a stratified purposive sampling. All interviews were conducted in Luganda, language spoken in the study area, and audio-recorded. They were transcribed verbatim and translated to English. Thematic analysis was used to analyze the data. Results WESW’s narratives focused on: (1) condom use; (2) alcohol/drug consumption; (3) PrEP use; (4) “handling” customers; and (5) "massaging” customers. WESW agreed that male condom was one of the important learning points for them and planned to continue using them while female condoms were received with mixed reactions. Many women appreciated receiving information about the risks of consuming alcohol and drugs, and discussed how they reduced/ eliminated their consumption. PrEP information was appreciated though identified by fewer WESW. Handling a client was discussed as a helpful strategy for safer sex through improved ability to convince customers to use condoms or avoiding sex. Massaging was also beneficial to avoid penetrative sex, but similar to female condom, massaging also yielded mixed perceptions. Conclusion WESW found the intervention beneficial and described ways in which it improved their ability to engage in safer sex and stay healthy. The fact that WESW identified other strategies beyond condom use as helpful underlines the importance of adopting a comprehensive approach to behavioral interventions targeting HIV prevention even when combined with other interventions. Additionally, WESW’s narratives suggest that incorporating the tenets of social cognitive theory and harm reduction approaches in HIV prevention among this population can result in risk behavior change.

Abstract Optimal technology selection of wastewater treatment plants (WWTPs) necessitates the adoption of data-driven scientific approaches that satisfy the sustainability requirements of the urban ecosystem. Such approaches should be able to provide actionable insights to decision makers constrained by factors such as population growth, land scarcity, and loss of functionality of wastewater treatment plants. The framework in this study proposes a hybrid fuzzy multi-criteria decision making (MCDM) model consisting of the analytical hierarchy process (AHP) and the TODIM (an acronym in Portuguese of interactive and multi-criteria decision-making) by using alpha cut series which takes into account the risk aversion of decision makers (DMs) to overcome uncertainties of environmental conditions. The literature to date indicates that the study is the first to presents how a systematic decision-making process is approached by interpreting the interaction of criteria for the selection of wastewater treatment technology through the membership function of Prospect Theory. The proposed methodology reveals that the prominent reference criterion manipulates other sub-criteria according to the function of risk-aversion behavior. The fuzzy sets based on alpha cut series are employed to evaluate both the criteria weight and the rank of the alternatives in the decision-making process to obtain compromise solutions under uncertainty. The dominance degrees of the alternatives are achieved by fuzzy TODIM integrated with the fuzzy analytic hierarchy process (FAHP) which deals with the uncertainty of human judgements. According to the ranking results determined by the dominance degree of alternatives, anaerobic–anoxic–oxic (A2O) without pre-clarification was the most effective process in relation to the sludge disposal cost (C25) calculated as reference criteria. The ranking of four full-scale WWTPs in a metropolitan city of an EMEA country based on 24 sub-criteria listed under the four main criteria, namely the dimensions of sustainability, is used as a case study to verify the usefulness of the fuzzy approach. Motivated by the literature gap related to the failure to consider the psychological behavior of DMs in technology selection problem for wastewater treatment, it is discussed how the proposed hybrid MCDM model can be utilized by reflecting human risk perception in wastewater treatment technology selection for developing urban areas.

At present, there are several types of propellers in the field of the use of Unmanned Aerial Vehicles (UAVs) with unknown parameters, where it is necessary to provide information about their thrust, current consumption and maximal rotational speed (RPM). Commonly used methods for measurement of a propeller's thrust are mostly based on the usage of a single purpose system, on short measurements without data storage or on inaccurate sensors. The goal of this article is to develop a universal experimental measuring system for more accurate measurement of propeller's parameters (thrust, current consumption, maximal RPM). For more accurate measurement, the battery voltage, temperature and humidity of the environment were also measured. To acquire, measure and store the data safely on a micro SD card, a processing circuit based on an ATmega2560 microcontroller was developed. This innovative approach allowed to analyse the behaviour of the propeller and to measure the dependencies of the RPM on pulse width, of the current on RPM and of the thrust on RPM at different input conditions. The measurements have shown that the dependencies can be approximated by cubic functions. The mathematical description allows predicting the behaviour of the propeller in unmeasurable conditions.

In spite of continuous progress in technical advancement, the conventional machining process became unsatisfactory in the healthcare field due to its disadvantages. This inadequacy lead researchers to consider using the application of nontraditional machining that can machine extremely hard and brittle materials into complicated shapes such as medical devices and implants in healthcare. In this study, the three most popular nontraditional machining process technologies: Laser Beam Machining, Water Jet Machining, and Electrocautery are evaluated to determine the most appropriate technology using the Health Technology Assessment based Multi-criteria Decision-Making framework. HTA is organized evaluation of effects and properties of health technology that enables the application of systematic skills to solve a health problem. HTA's main goal is to raise awareness of new health technologies among decision makers. For these reasons, the HTA core model that enables the production of HTA-related information was utilized.The comparison of selected technologies was carried out via integrating the HTA core model, Best Worst, and Evaluation Based on Distance from Average Solution methods. Finally, a comparison was made to find the most suitable technology to create the necessary infrastructure. As a result, evaluation scores were computed as 0,673; 0,538 and 0,500 for WJM, LBM, and EC, respectively.

Background The HIV burden remains a critical public health concern and women engaged in sex work [WESW] are at significantly higher risk compared to the general adult population. Similar to other sub-Saharan African countries, Uganda reports high rates of HIV prevalence among WESW. Yet, they have not been targeted by theory-informed HIV prevention intervention approaches. Methods We conducted semi-structured in-depth interviews with 20 WESW upon intervention completion to explore their experiences with an evidence-based HIV risk reduction intervention that was implemented as part of a combination intervention tested in a clinical trial in Uganda (2018–2023. Specifically, we explored their initial motivations and concerns for participating in the intervention, barriers and facilitators to attendance, and their feedback on specific intervention characteristics. Results The main expectations revolved around access to health-related information, including information on STIs, HIV, and PrEP as well as on how one can protect themselves while engaging in sex work. Initial concerns were around potential breach of confidentiality and fear of arrest. The main facilitators for session attendance were the motivation to learn health-related information, the attitude of facilitators, and the incentives received for participation, whereas main challenges were related to family commitments and work schedules. WESW appreciated the group format of the intervention and found the location and times of the intervention delivery acceptable. Discussion and conclusions Overall, our findings suggest that the HIV risk reduction intervention was appropriate and acceptable to WESW. Yet, WESW experience unique concerns and barriers that need to be accounted for when designing interventions targeting this population, especially in resource-limited settings where sex work is illegal and highly stigmatized. Clinical trial registration NCT03583541.

BackgroundHIV stigma remains a formidable barrier to HIV treatment adherence among school-attending adolescents living with HIV, owing to high levels of HIV stigma within schools, rigid school structures and routines, lack of adherence support, and food insecurity. Thus, this protocol paper presents an evidence-informed multilevel intervention that will simultaneously address family- and school-related barriers to HIV treatment adherence and care engagement among adolescents living with HIV attending boarding schools in Uganda. ObjectiveThe proposed intervention—Multilevel Suubi (MSuubi)—has the following objectives: examine the impact of M-Suubi on HIV viral suppression (primary outcome) and adherence to HIV treatment, including keeping appointments, pharmacy refills, pill counts, and retention in care; examine the effect of M-Suubi on HIV stigma (internalized, anticipated, and enacted), with secondary analyses to explore hypothesized mechanisms of change (eg, depression) and intervention mediation; assess the cost and cost-effectiveness of each intervention condition; and qualitatively examine participants’ experiences with HIV stigma, HIV treatment adherence, and intervention and educators’ attitudes toward adolescents living with HIV and experiences with group-based HIV stigma reduction for educators, and program or policy implementation after training. MethodsMSuubi is a 5-year multilevel mixed methods randomized controlled trial targeting adolescents living with HIV aged 10 to 17 years enrolled in a primary or secondary school with a boarding section. This longitudinal study will use a 3-arm cluster randomized design across 42 HIV clinics in southwestern Uganda. Participants will be randomized at the clinic level to 1 of the 3 study conditions (n=14 schools; n=280 students per study arm). These include the bolstered usual care (consisting of the literature on antiretroviral therapy adherence promotion and stigma reduction), multiple family groups for HIV stigma reduction plus family economic empowerment (MFG-HIVSR plus FEE), and Group-based HIV stigma reduction for educators (GED-HIVSR). Adolescents randomized to the GED-HIVSR treatment arm will also receive the MFG-HIVSR plus FEE treatment. MSuubi will be provided for 20 months, with assessments at baseline and 12, 24, and 36 months. ResultsThis study was funded in September 2021. Participant screening and recruitment began in April 2022, with 158 dyads enrolled as of May 2022. Dissemination of the main study findings is anticipated in 2025. ConclusionsMSuubi will assess the effects of a combined intervention (family-based economic empowerment, financial literacy education, and school-based HIV stigma) on HIV stigma among adolescents living with HIV in Uganda. The results will expand our understanding of effective intervention strategies for reducing stigma among HIV-infected and noninfected populations in Uganda and improving HIV treatment outcomes among adolescents living with HIV in sub-Saharan Africa. Trial RegistrationClinicalTrials.gov NCT05307250; https://clinicaltrials.gov/ct2/show/NCT05307250 International Registered Report Identifier (IRRID)PRR1-10.2196/40101

Abstract Background In the United States, approximately 11% of households were food insecure prior to the COVID-19 pandemic. The present study aims to describe the prevalence of food insecurity among adults and households with children living in the United States during the pandemic. Methods This study utilized social media as a recruitment platform to administer an original online survey on demographics and COVID-related food insecurity. The survey was disseminated through an advertisement campaign on Facebook and affiliated platforms. Food insecurity was assessed with a validated six-item United States Department of Agriculture (USDA) Household Food Security Survey Module, which was used to create a six-point numerical food security score, where a higher score indicates lower food security. Individual-level participant demographic information was also collected. Logistic regressions (low/very-low compared with high/marginal food security) were performed to generate adjusted odds ratios (AOR) and 95%CIs for food insecurity and select demographic characteristics. Results Advertisements reached 250,701 individuals and resulted in 5,606 complete surveys. Overall, 14.7% of participants self-identified as having low or very low food security in their households, with higher prevalence (17.5%) among households with children. Unemployment (AOR:1.76, 95%CI:1.09–2.80), high school or lower education (AOR:2.25, 95%CI:1.29–3.90), and low income (AOR[$30,000-$50,000]:5.87, 95%CI:3.35–10.37; AOR[

A systematic interdisciplinary approach based on the socio-ecological model of the Vienna school has been adopted to achieve a more nuanced and multifaceted understanding of the ancient metropolis of Pergamon (western Anatolia) and its micro-region. The city of Pergamon ranks among the 'guiding fossils' of urban culture in antiquity. We describe how the socio-ecological model is subject to adaptation and discussion to fit the needs and circumstances of archaeology. In focussing on geomorphodynamics, we use several approaches to conceptualise and model selected aspects of human-environment interactions, integrating data from physical geography, archaeology, building archaeology (Bauforschung) and ancient history. The model includes several dimensions of the social metabolism of Pergamon, first and foremost the carrying capacity of the environment and demographics, comprising population increase and labour as an active investment in nature. Geomorphodynamics are regarded as major 'events' in the model, related to the social metabolism (e.g. increased erosion/deposition in the micro-region in relation to urban sprawl). With the social-ecological model, it is possible – and becomes imperative – to include the perception and representation of human-environment interactions manifested in, for example, administrative patterns and religious practices or architecture and built infrastructure (such as terraces, riverbank stabilisation, substraction terraces and substraction bridges). Geomorphodynamics also involve various aspects of the perception of the environment, though these are not recorded in ancient texts on Pergamon known to date. Concurrently, the importance of the model in organising, structuring, and communicating interdisciplinary collaboration and discourse is highlighted. [ABSTRACT FROM AUTHOR]

It has long been debated as to whether higher education (HE) is a site of social mobility that promotes meritocracy or social reproduction that creates and exacerbates inequalities in societies. In this paper, I will argue that HE, even when democratised and provided free to everyone, reproduces inequalities unless coupled with an inclusive sectoral design, an expansion of funding, and a wider strategy to reduce socio-economic inequalities. To do so, I studied the case of Syria, which has always claimed to have a meritocratic HE system that is designed to achieve equality in society by providing free HE for all since the 1970s. I analysed the database of the Ministry of Higher Education (MoHE) for 15 academic years from 2001 to 2015. This database included data on students' access and graduation rate divided by the type of education (public, private, higher institutes, and technical institutes), level of education (undergraduate and postgraduate), gender (male and female), city, faculty, and specialisations. This analysis unpacked four types of inequalities, namely education type-based inequalities, specialisation-based inequalities, city-based inequalities, and gender-based inequalities. Finally, I show how gender dynamics and roles are changing in the HE sector as a result of the Syrian conflict. [ABSTRACT FROM AUTHOR]

BackgroundSeveral studies have indicated that universal health coverage (UHC) improves health service utilization and outcomes in countries. These studies, however, have primarily assessed UHC's peacetime impact, limiting our understanding of UHC's potential protective effects during public health crises such as the Coronavirus Disease 2019 (COVID-19) pandemic. We empirically explored whether countries' progress toward UHC is associated with differential COVID-19 impacts on childhood immunization coverage.Methods and findingsUsing a quasi-experimental difference-in-difference (DiD) methodology, we quantified the relationship between UHC and childhood immunization coverage before and during the COVID-19 pandemic. The analysis considered 195 World Health Organization (WHO) member states and their ability to provision 12 out of 14 childhood vaccines between 2010 and 2020 as an outcome. We used the 2019 UHC Service Coverage Index (UHC SCI) to divide countries into a "high UHC index" group (UHC SCI ≥80) and the rest. All analyses included potential confounders including the calendar year, countries' income group per the World Bank classification, countries' geographical region as defined by WHO, and countries' preparedness for an epidemic/pandemic as represented by the Global Health Security Index 2019. For robustness, we replicated the analysis using a lower cutoff value of 50 for the UHC index. A total of 20,230 country-year observations were included in the study. The DiD estimators indicated that countries with a high UHC index (UHC SCI ≥80, n = 35) had a 2.70% smaller reduction in childhood immunization coverage during the pandemic year of 2020 as compared to the countries with UHC index less than 80 (DiD coefficient 2.70; 95% CI: 0.75, 4.65; p-value = 0.007). This relationship, however, became statistically nonsignificant at the lower cutoff value of UHC SCI ConclusionsWe observed that countries with greater progress toward UHC were associated with significantly smaller declines in childhood immunization coverage during the pandemic. This identified association may potentially provide support for the importance of UHC in building health system resilience. Our findings strongly suggest that policymakers should continue to advocate for achieving UHC in coming years.