Global Burden of Disease 2021 Health Financing Collaborator Network. Global investments in pandemic preparedness and COVID-19: development assistance and domestic spending on health between 1990 and 2026

How feasible is it to mobilize $31 billion a year for pandemic preparedness and response? An economic growth modelling analysis

BACKGROUND

Covid-19 has reinforced health and economic cases for investing in pandemic preparedness and response (PPR). The World Bank and World Health Organization (WHO) propose that low- and middle-income governments and donor countries should invest $31.1 billion each year for PPR. We analyse, based on the projected economic growth of countries between 2022 and 2027, how likely it is that low- and middle-income country governments and donors can mobilize the estimated funding.

METHODS

We modelled trends in economic growth to project domestic health spending by low- and middle-income governments and official development assistance (ODA) by donors for years 2022 to 2027. We modelled two scenarios for countries and donors - a constant and an optimistic scenario. Under the constant scenario we assume that countries and donors continue to dedicate the same proportion of their health spending and ODA as a share of gross domestic product (GDP) and gross national income (GNI), respectively, as they did during baseline (the latest year for which data are available). In the optimistic scenario, we assume a yearly increase of 2.5% in health spending as a share of GDP for countries and ODA as a share of GNI for donors.

FINDINGS

Our analysis shows that low-income countries would need to invest on average 37%, lower-middle income countries 9%, and upper-middle income countries 1%, of their total health spending on PPR each year under the constant scenario to meet the World Bank WHO targets. Donors would need to allocate on average 8% of their total ODA across all sectors to PPR each year to meet their target.

CONCLUSIONS

The World Bank WHO targets for PPR will not be met unless low- and middle-income governments and donors spend a much higher share of their funding on PPR. Even under optimistic growth scenarios, low-income and lower-middle income countries will require increased support from global health donors. The donor target cannot be met using the yearly increase in ODA under any scenario. If the country and donor targets are not met, the highest-impact health security measures need to be prioritized for funding. Alternative sources of PPR financing could include global taxation (e.g., on financial transactions, carbon, or airline flights), cancelling debt, and addressing illicit financial flows. There is also a need for continued work on estimating current PPR costs and funding requirements in order to arrive at more enduring and reliable estimates.

Non-typhoidal Salmonella in Nigeria: do outcomes of 'multisectoral' surveillance, treatment and control justify the intervention costs?

Non-typhoidal salmonellosis (NTS) is significant and an economic burden in Nigeria. To determine whether investment in NTS control is economically justifiable, Outbreak Costing Tool (OCT) was used to estimate the robust funding of public and animal health systems for epidemio-surveillance and control of multisectoral NTS outbreaks in Nigeria. Health, production, and economic data were collected and used to populate the tool for evaluation. The multisectoral NTS burden for the year 2020 in Nigeria was US$ 930,887,379.00. Approximately 4,835 technical officers, and 3,700 non-technical staff (n = 8,535) were needed with an investment of >2.2 million work hours. The investment cost for NTS control was US$ 53,854,660.87. The non-labour-related cost was 89.21% of the total intervention costs. The overall intervention's investment was 374.15% of the estimated national and subnational systems' annual budget for diarrhoeal diseases, and the outbreak response period attracted the highest costs (53%) of the total intervention. In conclusion, intervention against NTS was beneficial (benefit - cost ratio: 17.29), hence justifying the need for multisectoral surveillance-response against NTS in Nigeria. Complex sectoral silos must give way to coordinated collaborations to optimize benefits; and over-centralization of health interventions' associated delays must be removed through decentralized sub-national-focused framework that empowers rapid investigation, response, control, data collection, and analyses. It should assist anticipatory planning, and outbreak investigation and reduce critical response time. Anticipatory planning tools, when applied pre-emptively, can benefit budgeting, identify gaps, and assist in the delivery of cost-saving and effective measures against infectious disease.

Examining geographical inequalities for malaria outcomes and spending on malaria in 40 malaria-endemic countries, 2010-2020

BACKGROUND

While substantial gains have been made in the fight against malaria over the past 20 years, malaria morbidity and mortality are marked by inequality. The equitable elimination of malaria within countries will be determined in part by greater spending on malaria interventions, and how those investments are allocated. This study aims to identify potential drivers of malaria outcome inequality and to demonstrate how spending through different mechanisms might lead to greater health equity.

METHODS

Using the Gini index, subnational estimates of malaria incidence and mortality rates from 2010 to 2020 were used to quantify the degree of inequality in malaria burden within countries with incidence rates above 5000 cases per 100,000 people in 2020. Estimates of Gini indices represent within-country distributions of disease burden, with high values corresponding to inequitable distributions of malaria burden within a country. Time series analyses were used to quantify associations of malaria inequality with malaria spending, controlling for country socioeconomic and population characteristics.

RESULTS

Between 2010 and 2020, varying levels of inequality in malaria burden within malaria-endemic countries was found. In 2020, values of the Gini index ranged from 0.06 to 0.73 for incidence, 0.07 to 0.73 for mortality, and 0.00 to 0.36 for case fatality. Greater total malaria spending, spending on health systems strengthening for malaria, healthcare access and quality, and national malaria incidence were associated with reductions in malaria outcomes inequality within countries. In addition, government expenditure on malaria, aggregated government and donor spending on treatment, and maternal educational attainment were also associated with changes in malaria outcome inequality among countries with the greatest malaria burden.

CONCLUSIONS

The findings from this study suggest that prioritizing health systems strengthening in malaria spending and malaria spending in general especially from governments will help to reduce inequality of the malaria burden within countries. Given heterogeneity in outcomes in countries currently fighting to control malaria, and the challenges in increasing both domestic and international funding allocated to control and eliminate malaria, the efficient targeting of limited resources is critical to attain global malaria eradication goals.

Conflict, COVID-19, and crisis response: shifting from 'pivoting' to preparedness

This paper assesses the extent to which the COVID-19 (Coronavirus disease 2019) pandemic directed the attention and resources of the international community away from peacebuilding, and the potential impact of this on conflict-affected environments. It draws from a global survey, interviews, and conversations with peacebuilding practitioners, publicly available information on peacebuilding funding, and real-time data on conflict events from the Armed Conflict Location & Event Data Project. The paper argues that resources and attention have 'pivoted' away from peacebuilding to tackle the threat presented by COVID-19, and that this can-but does not always-adversely affect conflict dynamics. It contends that this pivoting belies the interconnectedness of crises, leads to 'forgotten crises' and escalating threats, and exposes deficiencies in peacebuilding funding and, more broadly, preparedness and crisis response. Crises do, however, provide opportunities for reflection and change, including how to address these deficiencies and, in so doing, advance more efficient, effective, and ethical practice.

Post-pandemic paradigm shift toward telemedicine and tele-education; an updated survey of the impact of Covid-19 pandemic on neurosurgery residents in United States

Background

Several strategies were implemented during the Covid-19 pandemic to enhance residency training and patient care.

Objective

This study aims to assess the post-pandemic landscape of neurosurgical training and practice.

Method

A survey consisting of 28 questions examining the challenges faced in neurosurgery and the adaptive measures was conducted among US neurosurgery residents from May 2022 to May 2023.

Results

This study encompassed 59 neurosurgical residents, predominantly male (72.9%) and in later years of training (66.1%) and were distributed across 25 states. Telemedicine and tele-education were pivotal during the pandemic, with virtual lecture series, standalone lectures, and virtual discussions highly favored. Remote didactic learning increased for nearly half of the residents, while 54.2% resumed in-person instruction. Telemedicine was deemed effective by 86.4% for evaluating neurosurgical patients. Access to teaching environments was restricted for 61.0% of residents, impacting their training. The pandemic significantly influenced elective surgeries, with complete cancellations reported by 42.4%. Reduced faculty engagement was noted by 35.6% of residents, while 47.5% reported a negative impact on the overall resident experience. The majority (76.3%) considered changes to their training reasonable given the global health situation.

Conclusions

Strategies implemented during the peak of the pandemic remain crucial in shaping neurosurgery training. Telemedicine has become indispensable, with widespread adoption. Tele-education has also expanded, providing additional learning opportunities. However, traditional didactic courses and hands-on experiences remain essential for comprehensive training. Balancing technology-driven methods with established approaches is crucial for optimizing neurosurgical education and maintaining high-quality patient care.

Clay-polymer nanocomposites for effective water treatment: opportunities, challenges, and future prospects

The metal intoxication and its associated adverse effects to humans have led to the research for development of water treatment technologies from pollution hazards. Therefore, development of cheaper water remediation technologies is more urgent than ever. Clays and clay minerals are naturally occurring, inexpensive, non-toxic materials possessing interesting chemical and physical properties. As a result of interesting surface properties, these have been developed as efficient absorbent in water remediation. Recently, clay-polymer nanocomposites have provided a cost-effective technological platform for removing contaminants from water. Covering research advancements from past 25 years, this review highlights the developments in clay-polymer nanocomposites and their advanced technical applications are evaluated with respect to the background and issues in remediation of toxic metals and organic compounds from water. The extensive analysis of literature survey of more than two decades suggests that future work need to highlight on advancement of green and cost-effective technologies. The development of understanding of the interaction and exchange between toxin and clay-polymer composites would provide new assembly methods of nanocomposites with functional molecules or nanomaterials need to be extended to increase the detection and extraction limit to parts per trillion.

Analyzing psychological resilience in college students: A decision tree model

In the evolving landscape of higher education, particularly in the post-pandemic era, it is crucial for college students to face societal challenges and achieve success by understanding and predicting psychological resilience. To deepen our understanding of psychological resilience, this study used a decision tree model to explore influencing factors. We surveyed 776 college students and collected data on demographic information, self-esteem, sense of school belonging, pro-environmental behavior, subjective well-being, internet game addiction, life autonomy, and academic procrastination using several scales. The decision tree model identified eight key predictors of psychological resilience, which are as follows in order of importance: self-esteem, sense of school belonging, pro-environmental behavior, subjective well-being, academic procrastination, life autonomy, internet game addiction, and academic achievement. This model's accuracy reached 73.985 %, emphasizing its potential utility in educational settings. The findings not only provide a novel and data-driven perspective to understand psychological resilience in college students compared to existing research but also provide practical guidance for educational practitioners and policymakers on how to develop psychological resilience in college students.

Pandemic preparedness improves national-level SARS-CoV-2 infection and mortality data completeness: a cross-country ecologic analysis

BACKGROUND

Heterogeneity in national SARS-CoV-2 infection surveillance capabilities may compromise global enumeration and tracking of COVID-19 cases and deaths and bias analyses of the pandemic's tolls. Taking account of heterogeneity in data completeness may thus help clarify analyses of the relationship between COVID-19 outcomes and standard preparedness measures.

METHODS

We examined country-level associations of pandemic preparedness capacities inventories, from the Global Health Security (GHS) Index and Joint External Evaluation (JEE), on SARS-CoV-2 infection and COVID-19 death data completion rates adjusted for income. Analyses were stratified by 100, 100-300, 300-500, and 500-700 days after the first reported case in each country. We subsequently reevaluated the relationship of pandemic preparedness on SARS-CoV-2 infection and age-standardized COVID-19 death rates adjusted for cross-country differentials in data completeness during the pre-vaccine era.

RESULTS

Every 10% increase in the GHS Index was associated with a 14.9% (95% confidence interval 8.34-21.8%) increase in SARS-CoV-2 infection completion rate and a 10.6% (5.91-15.4%) increase in the death completion rate during the entire observation period. Disease prevention (infections: β = 1.08 [1.05-1.10], deaths: β = 1.05 [1.04-1.07]), detection (infections: β = 1.04 [1.01-1.06], deaths: β = 1.03 [1.01-1.05]), response (infections: β = 1.06 [1.00-1.13], deaths: β = 1.05 [1.00-1.10]), health system (infections: β = 1.06 [1.03-1.10], deaths: β = 1.05 [1.03-1.07]), and risk environment (infections: β = 1.27 [1.15-1.41], deaths: β = 1.15 [1.08-1.23]) were associated with both data completeness outcomes. Effect sizes of GHS Index on infection completion (Low income: β = 1.18 [1.04-1.34], Lower Middle income: β = 1.41 [1.16-1.71]) and death completion rates (Low income: β = 1.19 [1.09-1.31], Lower Middle income: β = 1.25 [1.10-1.43]) were largest in LMICs. After adjustment for cross-country differences in data completeness, each 10% increase in the GHS Index was associated with a 13.5% (4.80-21.4%) decrease in SARS-CoV-2 infection rate at 100 days and a 9.10 (1.07-16.5%) decrease at 300 days. For age-standardized COVID-19 death rates, each 10% increase in the GHS Index was with a 15.7% (5.19-25.0%) decrease at 100 days and a 10.3% (- 0.00-19.5%) decrease at 300 days.

CONCLUSIONS

Results support the pre-pandemic hypothesis that countries with greater pandemic preparedness capacities have larger SARS-CoV-2 infection and mortality data completeness rates and lower COVID-19 disease burdens. More high-quality data of COVID-19 impact based on direct measurement are needed.

Follow the money: a global analysis of funding dynamics for global health security

Global financing for health security was dramatically impacted by COVID-19. Here, we provide an empirical analysis of how that funding changed. Using data from Global Health Security (GHS) Tracking (tracking.ghscosting.org), we analyzed disbursements of direct financial assistance for GHS from 2016 to 2022 to compare pre-pandemic funding (2016-2019) to post-pandemic funding (2020-2022) for preparedness and response during each of the seven World Health Organization-declared public health emergencies of international concern (PHEICs) from 2009 to 2022. Over $165B was disbursed for capacity-building and preparedness activities between January 2016 and December 2022, and over $76B was provided for PHEIC response. Preparedness funding remained evenly distributed since 2016 across regions, with the African region receiving about 70% of total preparedness funding. Indeed, how capacity-building and preparedness funding is distributed has changed remarkably little since 2016, despite unprecedented changes to the funding environment-including markedly increased spending-in response to COVID-19. This suggests we now have a unique opportunity to restructure how funds are tracked for accountability and assessing return on investment moving forward.

Global pattern, trend, and cross-country inequality of early musculoskeletal disorders from 1990 to 2019, with projection from 2020 to 2050

BACKGROUND

This study aims to estimate the burden, trends, forecasts, and disparities of early musculoskeletal (MSK) disorders among individuals ages 15 to 39 years.

METHODS

The global prevalence, years lived with disabilities (YLDs), disability-adjusted life years (DALYs), projection, and inequality were estimated for early MSK diseases, including rheumatoid arthritis (RA), osteoarthritis (OA), low back pain (LBP), neck pain (NP), gout, and other MSK diseases (OMSKDs).

FINDINGS

More adolescents and young adults were expected to develop MSK disorders by 2050. Across five age groups, the rates of prevalence, YLDs, and DALYs for RA, NP, LBP, gout, and OMSKDs sharply increased from ages 15-19 to 35-39; however, these were negligible for OA before age 30 but increased notably at ages 30-34, rising at least 6-fold by 35-39. The disease burden of gout, LBP, and OA attributable to high BMI and gout attributable to kidney dysfunction increased, while the contribution of smoking to LBP and RA and occupational ergonomic factors to LBP decreased. Between 1990 and 2019, the slope index of inequality increased for six MSK disorders, and the relative concentration index increased for gout, NP, OA, and OMSKDs but decreased for LBP and RA.

CONCLUSIONS

Multilevel interventions should be initiated to prevent disease burden related to RA, NP, LBP, gout, and OMSKDs among individuals ages 15-19 and to OA among individuals ages 30-34 to tightly control high BMI and kidney dysfunction.

FUNDING

The Global Burden of Disease study is funded by the Bill and Melinda Gates Foundation. The project is funded by the Scientific Research Fund of Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital (2022QN38).

Medical expenses and its determinants in female patients with urological disorder

BACKGROUND

The rising older adult population has led to an increase in the prevalence of chronic diseases and medical expenses. Women tend to have a longer healthy life expectancy than men and are more likely to be exposed to urological disorders around the age of 50, resulting in substantial healthcare expenses throughout their lifetime. Urological disorders often require continuous treatment owing to their high risk of recurrence, contributing to an increased financial burden from medical costs. This study aimed to identify factors influencing medical expense in female patients with urological disorders and propose strategies to alleviate the associated financial burden.

METHODS

We used data from the Korea Health Panel Survey conducted from 2011 to 2016. The final sample comprised 2,932 patients who visited hospitals for urological disorders. To identify the factors influencing medical expense among female patients with urological disorders, we employed a generalized estimating equation model.

RESULTS

The results indicated that younger people and patients with middle-income levels tended to incur higher medical expenses. Furthermore, patients receiving treatment at tertiary hospitals and those enrolled in National Health Insurance also incurred higher health expenses.

CONCLUSIONS

This study suggests that effective management of medical expenses related to urological disorders in women requires improvements in healthcare accessibility to facilitate early detection and continuous disease management. In addition, the findings highlight the potential benefits of digital health and non-face-to-face treatments in addressing these needs.

Assessing Evidence-Based Practice in Operating Room Nursing Students: A Cross-Sectional Study in the Southwest of Iran

Evidence-based practice (EBP) is a clinical decision-making process that is grounded in the utilization of the most reliable and up-to-date evidence. It involves utilizing resources and evidence to enhance patient management. The application of evidence-based decisions in patient care and education is of utmost importance in the performance of health sciences students. However, the emphasis on this concept among operating room nursing students has been lacking. Hence, the objective of this research is to assess the implementation of evidence-based practice among operating room nursing students studying in the operating room department at the Shiraz University of Medical Sciences in Iran. The study follows a descriptive, cross-sectional design, with a sample of 148 operating room nursing students selected through census sampling based on the student list. After obtaining informed consent, participants completed a demographic information form and the Rubin-Parrish evidence-based practice questionnaire. The data that were gathered underwent analysis through the utilization of SPSS version 22 software, employing descriptive statistics, T-tests, and Pearson correlation coefficient tests. The results revealed that the overall average score of evidence-based practice among the students exceeded the standard scores (172.66 ± 14.74). There was a significant association between the evidence-based practice score and prior familiarity with evidence-based practice, interest in the field of study, research experience, intention to participate in the Master's exam, and the participants' grade point average (GPA) (p < 0.05). These findings indicate that operating room nursing students displayed an average level of evidence-based practice, emphasizing the need for effective plans and strategies to improve their performance. Addressing the identified factors from this study becomes crucial in this regard.

Financing for pandemic preparedness and response measures: a systematic scoping review

Objective

To obtain insights into reducing the shortfall in financing for pandemic preparedness and response measures, and reducing the risk of another pandemic with social and economic costs comparable to those of the coronavirus disease.

Methods

We conducted a systematic scoping review using the databases ScienceDirect, Scopus, JSTOR, PubMed® and EconLit. We included articles published in any language until 1 August 2023, and excluded grey literature and publications on epidemics. We categorized eligible studies according to the elements of a framework proposed by the World Health Organization Council on the Economy of Health for All: (i) root/structural causes; (ii) social position/foundations; (iii) infrastructure and systems; and (iv) communities, households and individuals.

Findings

Of the 188 initially identified articles, we included 60 in our review. Most (53/60) were published after 2020, when academic interest had shifted towards global financing mechanisms. Most (37/60) addressed two or more of the council framework elements. The most frequently addressed element was infrastructure and systems (54/60), discussing topics such as health systems, financial markets and innovation ecosystems. The roots/structural causes were discussed in 25 articles; communities, households and individuals in 22 articles; and social positions/foundations in 11.

Conclusion

Our review identified three important gaps: a formal definition of pandemic preparedness and response, impeding the accurate quantification of the financing shortfall; research on the extent to which financing for pandemic preparedness and response has been targeted at the most vulnerable households; and an analysis of specific financial instruments and an evaluation of the feasibility of their implementation.

Research on the path of local colleges participating in community education of affordable rental housing in industrial parks

The affordable rental housing community in industrial parks has become a large-scale community, but little attention has been paid to this type of community education. Therefore, based on the concept of educational equality, this project aims to explore the path of local colleges participating in community education for affordable rental housing in industrial parks. With convenient samples, empirical research is conducted on the current situation and residents' needs of affordable rental housing community education in the Qianwan New Area Industrial Park. And it has been found that community residents have a high willingness to learn on one hand, however, on the other hand, there are few types of community education to meet their demand; Although there are many public space resources, the utilization of scene spaces is far from sufficient. Based on these findings, this research explores and proposes the paths for local colleges to participate in community education for affordable rental housing in industrial parks through resource sharing models, in-depth community services for all-age residential groups, the cultivation of application-oriented talents to promote the integration of industry and education and enriching spiritual connotation of community education content. By enhancing the quality of all-age residents, namely, the new citizens including industrial workers and their relatives, it can promote the construction of a learning-oriented society and contribute to the realization of common prosperity. This study has certain theoretical and practical significance in enriching the research field of community education, promoting social integration of new citizens, and helping to achieve common prosperity.

Did aid to the Ebola crisis divert aid for reproductive, maternal, and newborn health? An analysis of donor-reported data in Sierra Leone

BACKGROUND

Infectious disease outbreaks like Ebola and Covid-19 are increasing in frequency. They may harm reproductive, maternal and newborn health (RMNH) directly and indirectly. Sierra Leone experienced a sharp deterioration of RMNH during the 2014-16 Ebola epidemic. One possible explanation is that donor funding may have been diverted away from RMNH to the Ebola response.

METHODS

We analysed donor-reported data from the Organisation for Economic Cooperation and Development (OECD)'s Creditor Reported System (CRS) data for Sierra Leone before, during and after the 2014-16 Ebola epidemic to understand whether aid flows for Ebola displaced aid for RMNH. We estimated aid for Ebola using key term searches and manual review of CRS records. We estimated aid for RMNH by applying the Muskoka-2 algorithm to the CRS and analysing CRS purpose codes.

RESULTS

We find substantial increases in aid to Sierra Leone (from $484 million in 2013 to $1 billion at the height of the epidemic in 2015), most of which was earmarked for the Ebola response. Overall, Ebola aid was additional to RMNH funding. RMNH aid was sustained during the epidemic (at $42 m per year) and peaked immediately after (at $77 m in 2016). There is some evidence of a small displacement of RMNH aid from the UK during the period when its Ebola funding increased.

CONCLUSIONS

Modest changes to RMNH donor aid patterns are insufficient to explain the severe decline in RMNH indicators recorded during the outbreak. Our findings therefore suggest the need for substantial increases in routine aid to ensure that basic RMNH services and infrastructure are strong before an epidemic occurs, as well as increased aid for RMNH during epidemics like Ebola and Covid-19, if reproductive, maternal and newborn healthcare is to be maintained at pre-epidemic levels.

Negative effects of high public debt on health systems facing pandemic crisis: Lessons from COVID-19 in Europe to prepare for future emergencies

The investigation goal here was to analyze how the level of public debt affects preparedness of health systems to face emergencies. In particular, this study examined the negative effects of high public debt on health systems of European countries in the presence of the COVID-19 pandemic crisis. Empirical evidence revealed that European countries with a lower level of government debt as a percentage of GDP both in 2009 and 2019 (the period before the arrival of the pandemic) had lower COVID-19 fatality rates compared to countries with higher levels of public debt. The explanation is that high levels of public debt in countries trigger budget constraints that limit their ability to allocate resources to healthcare systems (e.g., health expenditures and investments), weakening health system performance and causing systemic vulnerability and lower preparedness during emergencies, such as with the COVID-19 pandemic. Implications of health policies are suggested to improve strategies of crisis management.

Health care expenses impact on the disability-adjusted life years in non-communicable diseases in the European Union

Background

Non-communicable diseases are a global health problem. The metric Disability-Adjusted Life Years was developed to measure its impact on health systems. This metric makes it possible to understand a disease's burden, towards defining healthcare policies. This research analysed the effect of healthcare expenditures in the evolution of disability-adjusted life years for non-communicable diseases in the European Union between 2000 and 2019.

Methods

Data were collected for all 27 European Union countries from Global Burden of Disease 2019, Global Health Expenditure, and EUROSTAT databases. Econometric panel data models were used to assess the impact of healthcare expenses on the disability-adjusted life years. Only models with a coefficient of determination equal to or higher than 10% were analysed.

Results

There was a decrease in the non-communicable diseases with the highest disability-adjusted life years: cardiovascular diseases (- 2,952 years/105 inhabitants) and neoplasms (- 618 years/105 inhabitants). Health expenditure significantly decreased disability-adjusted life years for all analysed diseases (p < 0.01) unless for musculoskeletal disorders. Private health expenditure did not show a significant effect on neurological and musculoskeletal disorders (p > 0.05) whereas public health expenditure did not significantly influence skin and subcutaneous diseases (p > 0.05).

Conclusion

Health expenditure have proved to be effective in the reduction of several diseases. However, some categories such as musculoskeletal and mental disorders must be a priority for health policies in the future since, despite their low mortality, they can present high morbidity and disability.

The Impact of Economic Corridor and Tourism on Local Community's Quality of Life under One Belt One Road Context

Economic corridors unlock new economic opportunities and tourism development in the region to achieve sustainable development goals. Green economic growth is conducive to environmental sustainability. Economic mega-projects of CPEC promote tourism that leads to communities' well-being and better quality of life. Modern infrastructure development contributes significantly to economic growth and tourism activities. This study's objectives emphasize exploring tourism and sustainable development pursuits under OBOR economic projects that open doors to improving residents' quality of life. The growing world is an eyewitness to a continuous rise in emissions and its severe consequences for humankind. It is necessary to show off the leading factors that result in tourism and economic activities causing environmental pollution rather than blame policymakers. Undoubtedly, many studies previously focused on demonstrating the influence of socio-economic factors that lead to better environmental quality. However, the empirical literature on tourism, social well-being, foreign direct investment, and the Environment in Belt and Road developed economies needed improvement. This research applied a series of advanced estimators that help demonstrate the study's probable results. This study explores the role of Social well-being (HDI), tourism development, FDI, renewable energy, information & communication technology (ICT), and urbanization on CO2 emissions in Belt and Road (BRI) developed economies.Estimated results exhibited the significant contribution of ICT and renewable energy to sustainability. Besides, FDI contributes to emissions reduction after its threshold level. Conversely, urbanization and tourism activities contribute to environmental pollution. The study outcomes stated inverted/EKC U-shaped hypotheses related to specified economies. Finally, the analysis based on the D-H panel causality test constructs exciting results.The present study concludes that economic corridor plays a vital role in tourism development, the community's well-being, and SDGs goals (sustainable development) impact on environmental safety. The findings suggest essential and applicable policies to attain the desired sustainability level. Findings contribute to the literature on tourism, well-being, and sustainability. Further studies can use insights using this methodology.

Formulation of precise exercise intervention strategy for adolescent depression

The high incidence of adolescent depression has become the focus of social and academic attention. Exercise is an important method to improve adolescent depression, but its intervention effect is still controversial. This study first compares and analyzes the relevant studies at home and abroad and finds that exercise prescription in adolescent depression intervention is not accurate enough. A meta-analysis was conducted to develop a precise exercise intervention strategy for adolescent depression. Firstly, this thesis identified how to optimize five elements (exercise intensity, exercise frequency, exercise time, exercise cycle, and exercise type) of exercise prescription to improve depression in adolescents. This is the problem. Furthermore, the concept of "precision exercise" was proposed, and a precision exercise intervention strategy (moderate-intensity aerobic exercise for 8-10 weeks, 3 times/week, 45-50 min/time) was constructed to improve adolescent depression. This paper also presents research that strengthens the cross-sectional research and empirical research on adolescent depression and establishes a precision exercise prescription database for adolescent depression in China. In conclusion, this study not only puts forward the concept of "precision exercise" but also constructs a precision exercise intervention strategy for adolescent depression, which has important theoretical and practical significance for improving the high incidence of adolescent depression.

Integration of Pakistan's stock market with the stock markets of top ten developed economies

This study examines the integration of Pakistan's Stock Market with the stock markets of the top ten largest economies in the world-USA, China, Japan, Germany, the UK, India, France, Italy, Brazil, and Canada-from January 2015 to October 2020. To examine long- and short run integration, this study employed Johansen and Juselius co-integration and pair-wise Granger causality tests. In the long run, the results indicated that Pakistan's Stock Market is not integrated with these markets. This implies that the market is more attractive in portfolio diversification for international investors, and vice versa. In the short run, the results revealed that, except for China, Pakistan's stock market integrates with the remaining nine markets. However, Pakistan's stock market exhibits a bidirectional relationship with the USA, Japan, Germany, the UK, and France in the lead-lag relationship. However, its relationship with India, Italy, Brazil, and Canada is unidirectional, with Pakistan's stock market leading, while these markets are following. For Pakistani investors, China is the optimal market, and vice versa. Importantly, our findings help policymakers to comprehend Pakistan's dynamic relationship with its trading partners. To the best of our knowledge, no prior study has employed advanced techniques to address the time-varying correlation among the selected markets. By determining Pakistan's stock market integration with its trading partners, this study aimed to fill this empirical literature gap.

The economics of nature's healing touch: A systematic review and conceptual framework of green space, pharmaceutical prescriptions, and healthcare expenditure associations

Green spaces play a crucial role in promoting sustainable and healthy lives. Recent evidence shows that green space also may reduce the need for healthcare, prescription medications, and associated costs. This systematic review provides the first comprehensive assessment of the available literature examining green space exposure and its associations with healthcare prescriptions and expenditures. We applied Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines to search MEDLINE, Scopus, and Web of Science for observational studies published in English through May 6, 2023. A quality assessment of the included studies was conducted using the Office of Health Assessment and Translation (OHAT) tool, and the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) assessment was used to evaluate the overall quality of evidence. Our search retrieved 26 studies that met the inclusion criteria and were included in our review. Among these, 20 studies (77 % of the total) showed beneficial associations of green space exposure with healthcare prescriptions or expenditures. However, most studies had risks of bias, and the overall strength of evidence for both outcomes was limited. Based on our findings and related bodies of literature, we present a conceptual framework to explain the possible associations and complex mechanisms underlying green space and healthcare outcomes. The framework differs from existing green space and health models by including upstream factors related to healthcare access (i.e., rurality and socioeconomic status), which may flip the direction of associations. Additional research with lower risks of bias is necessary to validate this framework and better understand the potential for green space to reduce healthcare prescriptions and expenditures.

Fine simulation of PM2.5 combined with NPP-VIIRS night light remote sensing and mobile monitoring data

Human activity plays a crucial role in influencing PM2.5 concentration and can be assessed through nighttime light remote sensing. Therefore, it is important to investigate whether the nighttime light brightness can enhance the accuracy of PM2.5 simulation in different stages. Utilizing PM2.5 mobile monitoring data, this study introduces nighttime lighting brightness as an additional factor in the PM2.5 simulation model across various time periods. It compares the differences in simulation accuracy, explores the impact of nocturnal human activities on PM2.5 concentrations at different periods of the following day, and analyzes the spatial and temporal pollution pattern of PM2.5 in urban functional areas. The results show that (1) the incorporation of nighttime lighting brightness effectively enhances the model's accuracy (R2), with an improvement ranging from 0.04 to 0.12 for different periods ranges. (2) the model's accuracy improves more prominently during 8:00-12:00 on the following day, and less so during 12:00-18:00, as the PM2.5 from human activities during the night experiences a strong aggregation effect in the morning of the next day, with the effect on PM2.5 concentration declining after diffusion until the afternoon. (3) PM2.5 is primarily concentrated in urban functional areas including construction sites, roads, and industrial areas during each period. But in the period of 8:00-12:00, there is a significant level of PM2.5 pollution observed in commercial and residential areas, due to the human activities that occurred the previous night.

Health care satisfaction and medical literacy habits among caregivers of individuals with Down syndrome

Patients with Down syndrome have significant specialized health care needs. Our objective was to understand the needs, satisfaction, and online habits of caregivers as they care for persons with Down syndrome. A mixed-method survey was distributed through REDCap from April 2022 to June 2022 in the United States; a Spanish-translated version was distributed through SurveyMonkey from August 2022 to March 2023 in Mexico. We received 290 completed responses from the United States and 58 from caregivers in Mexico. We found that current health care options are not meeting the needs of many individuals with DS in both the United States (39.7%) and Mexico (46.6%). Caregivers expressed frustrations with the inaccessibility and inapplicability of health care information. In particular, they often found the volume of information overwhelming, given their limited medical background. Additionally, health care recommendations were not customized and lacked practical recommendations. Most caregivers in both the United States (72.1%) and Mexico (82.8%) believe it is not easy to find answers to medical questions about their loved ones with DS. Online platforms with customized, specific health information related to DS could offer innovative solutions to these unmet needs for families and primary care providers.

Possibilities and limits of modelling of long-range economic consequences of air pollution - A case study

Air pollution is the biggest environmental problem in modern societies, causing considerable health damage and requiring substantial financial resources for health care. The goal of the study is to demonstrate the adverse economic consequences of air pollution on example of a small, open Central European country, Hungary, and to provide quantified financial arguments for macroeconomic decision-making for the development of a long-term energy strategy. On the basis of the Cobb-Douglas production function and Solow-Swann model of dynamic economic systems a simple and robust model was constructed to estimate and predict economic losses, caused by the pollution. On base of results it is obvious, that on base of macroeconomic theory and combination of various, publicly available, quality-controlled statistical resources quantifiable models can be constructed to characterise the economic consequences of air pollution, but it should be taken into consideration, that the reliability of economic models considerably depends on their initial parameters and practical validity of assumptions, based on which the underlying economic theories were built. The most important economic burden of air pollution is caused by the loss of working-age population, resulting in a decrease of 4.1-9.4 % a year in Gross Domestic Product (GDP) in the next fifty years. The additional burden of health care costs amounts to 0.1 % of GDP. Reducing air pollution is not only a quality of life improvement but also an investment into the economic development. Notwithstanding of statistical biases it could be proven the importance of combination health economic and econometric methods in preparation of more efficient environmental-related socio-economic decisions.

Ecotoxicological effects of cypermethrin on indigenous climbing perch (Anabas testudineus)

Pesticides including cypermethrin (10% EC) are commonly used pesticide in tea gardens of Bangladesh possess distinct harmful effects on an aquatic community. The experiment was carried out to assess the ecotoxicological effects of cypermethrin (10%) concentrate on indigenous Climbing Perch (Anabas testudineus). A total of 120 A. testudineus (mean length 16 ± 2.67 cm and mean weight 31.6 ± 3.56 g) were exposed to the acute toxicity test when the lethal concentration 50 value (LC50) for 96 h was maintained at 1.00 ppm. Three different sub-lethal concentrations of 0.05 ppm (5%), 0.10 ppm (10%), and 0.20 ppm (20%) were used respectively as three treatments and a control of 0 ppm with three replicates each. Restlessness, erratic movement, increased opercular activities, loss of equilibrium, and irregular response to feeding were observed in all the treatments compared to control one. Concerning histopathological alterations, all the analyzed organs showed highest changes in the T3 (cypermethrin conc. 20%) compared to other treatments while T0 (0 ppm) had normal structure. The major changes in the gill were epithelial cell hyperplasia, necrosis, severe lamellar fusion and epithelial lifting; while necrotic proximal tubules, glomerular shrinkage, disrupted renal corpuscle of the kidney and nuclear pyknosis, degenerated hepatic cells and vacuolation were observed in the liver. Severe melanomacrophage centre (MMC), haemosiderosis and vacuolation were found in spleen. The effect of cypermethrin on the hematological parameters of experimental fish was also studied. Red blood cells, hemoglobin and hematocrit were decreased in the experimental groups and lowest value was in T3 while values of white blood cells were increased in the experimental groups compared to control one. Hence, the present observation revealed that pesticides even at low concentrations can cause harmful effects on A. testudineus.

Computer vision based deep learning approach for toxic and harmful substances detection in fruits

Formaldehyde (CH₂O) is one of the significant chemicals mixed with different perishable fruits in Bangladesh. The fruits are artificially preserved for extended periods by dishonest vendors using this dangerous chemical. Such substances are complicated to detect in appearance. Hence, a reliable and robust detection technique is required. To overcome this challenge and address the issue, we introduce comprehensive deep learning-based techniques for detecting toxic substances. Four different types of fruits, both in fresh and chemically mixed conditions, are used in this experiment. We have applied diverse data augmentation techniques to enlarge the dataset. The performance of four different pre-trained deep learning models was then assessed, and a brand-new model named "DurbeenNet," created especially for this task, was presented. The primary objective was to gauge the efficacy of our proposed model compared to well-established deep learning architectures. Our assessment centered on the models' accuracy in detecting toxic substances. According to our research, GoogleNet detected toxic substances with an accuracy rate of 85.53 %, VGG-16 with an accuracy rate of 87.44 %, DenseNet with an impressive accuracy rate of 90.37 %, and ResNet50 with an accuracy rate of 91.66 %. Notably, the proposed model, DurbeenNet, outshone all other models, boasting an impressive accuracy rate of 96.71 % in detecting toxic substances among the sample fruits.

Corporate capital structure effects on corporate performance pursuing a strategy of innovation in manufacturing companies

Within the sphere of finance, the concept of capital structure has long been a subject of intense debate, serving as a quantitative depiction of the balance between debt, preference shares, and common stock within a company. This structure serves a crucial role in optimizing the utilization of a company's existing resources while simultaneously elevating the revenue streams for stakeholders. This particular study delves into the intricate relationship between corporate performance and capital structure, focusing on 78 publicly listed firms within the Dhaka Stock Exchange (DSE). Bangladesh holds the 29th position globally in terms of purchasing power, lending significant weight to this investigation. To comprehensively analyze this correlation, panel data encompassing the span from 2017 to 2021 was collected for these 78 sample companies operating within the DSE. Several key determinants of capital structure were considered in this analysis, namely the debt-to-equity ratio, short-term leverage ratio, long-term leverage ratio, and total debt ratio. Meanwhile, the performance of these firms was gauged using key metrics such as Return on Assets (ROA), Return on Equity (ROE), and Earnings Per Share (EPS). To ensure a robust analysis, factors such as inflation, liquidity, growth rate, tax rate, and firm size were meticulously controlled for. The findings unveiled a compelling narrative: all forms of debt ratios-be it short-term, long-term, or the total debt ratio-exhibited a substantial negative impact on ROA at a significant level of 1 %. Conversely, specific debt ratios, like the short-term total debt and the total debt-to-total asset ratio, displayed a notable positive correlation with ROE at a 1 % significance level. Intriguingly, the long-term total debt ratio yielded a negative and insignificant effect on ROE. Moreover, within the spectrum of predictors influencing a firm's performance, the liquidity ratio emerged as a non-significant factor-a notable discovery that highlights the nuanced nature of the interplay between capital structure and performance within these companies.

Does education influence COVID-19 vaccination? A global view

After the recent hard attempts felt on a global scale, notably in the health sector, the steady efforts of scientists have been materialized in maybe one of the most expected findings of the last decades, i.e. the launching of the COVID-19 vaccines. Although it is not our goal to plead for vaccination, as the decision in this regard is a matter of individual choice, we believe it is necessary and enlightening to analyze how one's educational status interferes with COVID-19 vaccination. There are discrepancies between world states vis-à-vis their well-being and their feedback to crises, and from the collection of features that can segregate the states in handling vaccination, in this paper, the spotlight is on education. We are referring to this topic because, generally, researches converge rather on the linkage between economic issues and COVID-19 vaccination, while education levels are less tackled in relation to this. To notice the weight of each type of education (primary, secondary, tertiary) in this process, we employ an assortment of statistical methods, for three clusters: 45 low-income countries (LICs), 72 middle-income countries (MICs) and 53 high-income countries (HICs). The estimates suggest that education counts in the COVID-19 vaccination, the tertiary one having the greatest meaning in accepting it. It is also illustrated that the imprint of education on vaccination fluctuates across the country groups scrutinized, with HICs recording the upper rates. The heterogeneity of COVID-19 vaccination-related behaviors should determine health authorities to treat this subject differently. To expand the COVID-19 vaccines uptake, they should be in an ongoing dialogue with all population categories and, remarkably, with those belonging to vulnerable communities, originated mostly in LICs. Education is imperative for vaccination, and it would ought to be on the schedule of any state, for being assimilated into health strategies and policies.

Examining factors influencing public knowledge and practice of proper face mask usage during the COVID-19 pandemic: a cross-sectional study

Background

The COVID-19 pandemic had an enormous impact on people's quality of life worldwide. Appropriate use of facemasks is an important checkpoint in containing the spread of infection, which was believed to provide the desired level of protection and preserve the community. Given the relative novelty of facemask use in the general population, it is imperative to prioritize the promotion of appropriate facemask utilization and identify factors that may contribute to poor adherence.

Aim

This study assessed the factors that determined facemask use among the public.

Methods

A cross-sectional questionnaire-based study was conducted among the residents of the Kingdom of Saudi Arabia between November 2020 and January 2021. The current study explored the factors such as demographic characteristics influencing the knowledge and practice of proper use of facemasks. The study included a total of 198 participants. The results were derived through binomial logistic regression analysis to determine the relationship between the demographic characteristics and responses.

Results

The key findings of the study which are crucial in developing targeted intervention strategies to enhance the responsible use and disposal of facemasks are gender, income and employment. A significant difference was found between male and female participants regarding a positive approach to using facemasks, such as washing their hands (P = 0.042). In addition, homemakers differed significantly from students, regarding the correct usage of facemasks (P = 0.026). The study participants were aware that hand hygiene is essential when putting on and removing facemasks. Despite wearing facemasks properly, adult participants possessed less knowledge about the hazards of reusing facemasks and appropriate disposal (OR = 0.202, 95% CI [0.032-1.298]).

Conclusion

The present research identified gender, income, and employment as the primary attributes that play a pivotal role in the formulation of focused intervention tactics aimed at improving the cautious use and appropriate disposal of facemasks. It is essential to implement nationwide awareness activities, such as information campaigns, to enhance knowledge. Health authorities should establish a functional infrastructure for the collection and disposal of used facemasks by the general public, starting with the dissemination of knowledge. Moreover, the results of the present study have significant implications for health preventive programs aimed at preparing for future pandemics, since they highlight the specific demographic groups that should be prioritized in the development of such policies. Furthermore, it is advisable to integrate these interventional initiatives with national health polices to promote preparedness for handling future pandemics.

PM2.5 exposure exacerbates seizure symptoms and cognitive dysfunction by disrupting iron metabolism and the Nrf2-mediated ferroptosis pathway

In recent years, air pollution has garnered global attention due to its ability to traverse borders and regions, thereby impacting areas far removed from the emission sources. While prior studies predominantly focused on the deleterious effects of PM2.5 on the respiratory and cardiovascular systems, emerging evidence has highlighted the potential risks of PM2.5 exposure to the central nervous system. Nonetheless, research elucidating the potential influences of PM2.5 exposure on seizures, specifically in relation to neuronal ferroptosis, remains limited. In this study, we investigated the potential effects of PM2.5 exposure on seizure symptoms and seizures-induced hippocampal neuronal ferroptosis. Our findings suggest that seizure patients residing in regions with high PM2.5 levels are more likely to disturb iron homeostasis and the Nrf2 dependent ferroptosis pathway compared to those living in areas with lower PM2.5 levels. The Morris Water Maze test, Racine scores, and EEG recordings in epileptic mice suggest that PM2.5 exposure can exacerbate seizure symptoms and cognitive dysfunction. Neurotoxic effects of PM2.5 exposure were demonstrated via Nissl staining and CCK-8 assays. Direct evidence of PM2.5-induced hippocampal neuronal ferroptosis was provided through TEM images. Additionally, increased Fe2+ and lipid ROS levels indirectly supported the notion of PM2.5-induced hippocampal ferroptosis. Therefore, our study underscores the necessity of preventing and controlling PM2.5 levels, particularly for patients with seizures.

Exploration on terrorism, ecological footprint and environmental sustainability in countries with the most terrorism antecedent: Accessing evidence from panel fourier analysis

Amidst increased concerns for global security and ecological balance, the intricate interconnectedness between terrorism and environmental sustainability has attracted significant attention in the existing literature. To this end, the present study explores the interaction among environmental degradation, terrorism, and foreign direct investments in 17 countries with the most terrorism antecedents over the 2002-2018 period through the Panel Fourier cointegration test and the Panel Fourier Toda-Yamamoto causality test. The present study also leverages recent and robust panel analysis for evidence-based results and inferences for policy formulation. The panel Fourier cointegration test presents the cointegration relationship between the outline variables under review. Empirical findings highlight that terrorism does not have a significant influence on the ecological footprint. However, foreign direct investment has a positive influence on the ecological footprint. These findings have implications for environmental sustainability and foreign direct investment inflows in the bloc investigated. More insights are discussed in the concluding section with policy caveats.

Long- and short-term health benefits attributable to PM2.5 constituents reductions from 2013 to 2021: A spatiotemporal analysis in China

Long- and short-term exposure to constituents of fine particulate matter (PM2.5) substantially affects human health. However, assessments of the health and economic benefits of reducing PM2.5 constituents are scarce. This study estimates the number of premature deaths from all-cause, cardiovascular (CVD), and respiratory diseases avoided due to reductions in daily and annual average concentrations of PM2.5 constituents. The Environmental Benefits Mapping and Analysis Program was used for two scenarios: we used yearly concentrations of PM2.5 constituents from 2013 to 2020 as the baseline concentration surface (Scenario I), and 2021 as the baseline year (Scenario II). With reductions in daily and annual average concentrations of PM2.5 constituents, 309,099 (95 % confidence interval [CI]: 37,265-571,485) and 195,297 (95 % CI: 178,192-211,914) premature deaths were avoided in Scenario I, respectively; meanwhile, 347,296 (95 % CI: 79,258-604,758) and 201,567 (95 % CI: 185,038-217,530) premature deaths were avoided in Scenario II, respectively. Moreover, economic benefits associated with the prevention of premature deaths were estimated using the willingness to pay (WTP) and modified human capital (AHC) methods. The total estimated economic benefits amounted to 563.32 billion RMB (WTP) and 322.03 billion RMB (AHC) in Scenario I. In Scenario II, the associated economic benefits were 751.48 billion RMB (WTP) and 427.56 billion RMB (AHC), accounting for 0.657 and 0.374 % of China's gross domestic product in 2021, respectively. Additionally, we analyzed the sensitivity of CVD-related premature deaths to the concentrations of PM2.5 constituents, and found that CVD-related premature deaths were more sensitive to black carbon.

Polysaccharide nanocomposites in wastewater treatment: A review

In modern times, wastewater treatment is vital due to increased water contamination arising from pollutants such as nutrients, pathogens, heavy metals, and pharmaceutical residues. Polysaccharides (PSAs) are natural, renewable, and non-toxic biopolymers used in wastewater treatment in the field of gas separation, liquid filtration, adsorption processes, pervaporation, and proton exchange membranes. Since addition of nanoparticles to PSAs improves their sustainability and strength, nanocomposite PSAs has gained significant attention for wastewater treatment in the past decade. This review presents a comprehensive analysis of PSA-based nanocomposites used for efficient wastewater treatment, focusing on adsorption, photocatalysis, and membrane-based methods. It also discusses potential future applications, challenges, and opportunities in adsorption, filtration, and photocatalysis. Recently, PSAs have shown promise as adsorbents in biological-based systems, effectively removing heavy metals that could hinder microbial activity. Cellulose-mediated adsorbents have successfully removed various pollutants from wastewater, including heavy metals, dyes, oil, organic solvents, pesticides, and pharmaceutical residues. Thus, PSA nanocomposites would support biological processes in wastewater treatment plants. A major concern is the discharge of antibiotic wastes from pharmaceutical industries, posing significant environmental and health risks. PSA-mediated bio-adsorbents, like clay polymeric nanocomposite hydrogel beads, efficiently remove antibiotics from wastewater, ensuring water quality and ecosystem balance. The successful use of PSA-mediated bio-adsorbents in wastewater treatment depends on ongoing research to optimize their application and evaluate their potential environmental impacts. Implementing these eco-friendly adsorbents on a large scale holds great promise in significantly reducing water pollution, safeguarding ecosystems, and protecting human health.

Spatio-temporal distribution and dynamics of antibiotic resistance genes in a water-diversion lake, China

The distribution and dynamics of antibiotic resistance genes (ARGs) in water-diversion lakes are poorly understood. In this study, two comparative in situ investigations of ARG profiles targeting water diversion (DP) and non-diversion periods (NDP) were conducted in Luoma Lake, a vital transfer node for the eastern route of the South-to-North Water Diversion Project in China. The results demonstrated significant spatiotemporal variations in ARG contamination and notable differences in the co-occurrence patterns of ARGs and bacterial communities between DP and NDP. Correlations among ARGs with the 16 S rRNA, and mobile genetic elements indicate that horizontal gene transfer (HGT) and vertical gene transfer (VGT) in NDP, but only HGT in DP, were the primary mechanisms of ARG proliferation and spread, implying that water diversion could be an essential control of the transfer pattern of ARGs in a lake environment. The null model analysis indicated that stochastic processes, with predominant driver of ecological drift in the lake mainly drove the assembly of ARGs. Partial least squares structural equation modeling was developed to analyze the causal effects of the factors in shaping ARG dynamics and identify the major driving forces in the DP and NDP.

The interaction of obesity with susceptible gene polymorphisms in the relationship with mild cognitive impairment

Mild cognitive impairment (MCI) in the elderly is threatening the mental health of the elderly, and the interaction of some factors is worth exploring. This study aims to explore the interactions of obesity and gene polymorphisms in the relationship with MCI. A total of 2555 community resident dwellings include 444 participants who met MCI criteria recruited from the Ningxia province of China. Fourteen MCI-susceptible single nucleotide polymorphisms were detected using a high-throughput mass spectrometer. The interaction was examined by performing the multifactor dimensionality reduction model and unconditional logistic regression model. Logistic regression showed that obesity (OR = 1.42, 95%CI: 1.04-1.94), rs2075650G allele carrying (OR = 17.95, 95%CI: 1.32-244.95), rs11556505T allele carrying (OR = 0.06, 95%CI: 0.01-0.87) were statistically associated with MCI. Multifactor dimensionality reduction analysis showed a strong antagonistic effect between obesity and rs4402960 (Interaction dendrogram between obesity and rs4402960 is red) and a weak synergy effect on rs7901695 (Interaction dendrogram between obesity and rs7901695 is green). The hierarchical analysis showed obesity is a risk factor for MCI in the non-rs4402960T allele carrier group (OR = 1.55, 95%CI: 1.02-2.35). This study found that obesity is an independent risk factor for MCI, and the interactions with MCI-susceptible gene polymorphisms suggest a possible precision preventive intervention program should be developed to reduce the risk of MCI among individuals with obesity in the community.

Diabetes Care in Humanitarian Settings

Despite the increasing prevalence of diabetes in populations experiencing humanitarian crisis, along with evidence that people living with diabetes are at higher risk for poor outcomes in a crisis, diabetes care is not routinely included in humanitarian health interventions. We here describe 4 factors that have contributed to the inequities and lack of diabetes inclusion in humanitarian programmes: (1) evolving paradigms in humanitarian health care, (2) complexities of diabetes service provision in humanitarian settings, (3) social and cultural challenges, and (4) lack of financing. We also outline opportunities and possible interventions to address these challenges and improve diabetes care among crisis-affected populations.

Effect of the characteristic town policy on sewage treatment in mountainous areas: Evidence from Chongqing

The report to the 20th National Congress of the Communist Party of China highlighted the necessity of advancing a new type of urbanization with people at the core. Characteristic towns as an essential link between new urbanization and rural revitalization attach great importance to creating a beautiful environment. Sewage treatment is an indispensable foundation for a town's high-quality economic and social development; however, it may be hard to achieve through urban construction. Therefore, using data from 584 organic towns in Chongqing, a typical mountainous city in western China, this study empirically analyzes the effect of the characteristic town policy in China on mountainous sewage treatment and its mechanisms from 2014 to 2020. The results indicate that (1) the characteristic town policy helps enhance sewage treatment in small towns, which remains valid after a series of robustness tests. (2) Investment and human resource effects are mediators for the characteristic town policy to boost sewage treatment in small towns. Further analyses reveal that the boosting effect of the characteristic town policy on small-town sewage treatment is more significant for small towns with higher economic development levels suffering ecological and environmental pressures. These findings provide a basis for a broad recognition of the effect of the characteristic town policy and its impact. They also theoretically enrich the awareness of the Chinese government's urbanization policy concerning the economy and society.

Immunomodulatory biomaterials against bacterial infections: Progress, challenges, and future perspectives

Bacterial infectious diseases are one of the leading causes of death worldwide. Even with the use of multiple antibiotic treatment strategies, 4.95 million people died from drug-resistant bacterial infections in 2019. By 2050, the number of deaths will reach 10 million annually. The increasing mortality may be partly due to bacterial heterogeneity in the infection microenvironment, such as drug-resistant bacteria, biofilms, persister cells, intracellular bacteria, and small colony variants. In addition, the complexity of the immune microenvironment at different stages of infection makes biomaterials with direct antimicrobial activity unsatisfactory for the long-term treatment of chronic bacterial infections. The increasing mortality may be partly attributed to the biomaterials failing to modulate the active antimicrobial action of immune cells. Therefore, there is an urgent need for effective alternatives to treat bacterial infections. Accordingly, the development of immunomodulatory antimicrobial biomaterials has recently received considerable interest; however, a comprehensive review of their research progress is lacking. In this review, we focus mainly on the research progress and future perspectives of immunomodulatory antimicrobial biomaterials used at different stages of infection. First, we describe the characteristics of the immune microenvironment in the acute and chronic phases of bacterial infections. Then, we highlight the immunomodulatory strategies for antimicrobial biomaterials at different stages of infection and their corresponding advantages and disadvantages. Moreover, we discuss biomaterial-mediated bacterial vaccines' potential applications and challenges for activating innate and adaptive immune memory. This review will serve as a reference for future studies to develop next-generation immunomodulatory biomaterials and accelerate their translation into clinical practice.

Development of an automated optimal distance feature-based decision system for diagnosing knee osteoarthritis using segmented X-ray images

Knee Osteoarthritis (KOA) is a leading cause of disability and physical inactivity. It is a degenerative joint disease that affects the cartilage, cushions the bones, and protects them from rubbing against each other during motion. If not treated early, it may lead to knee replacement. In this regard, early diagnosis of KOA is necessary for better treatment. Nevertheless, manual KOA detection is time-consuming and error-prone for large data hubs. In contrast, an automated detection system aids the specialist in diagnosing KOA grades accurately and quickly. So, the main objective of this study is to create an automated decision system that can analyze KOA and classify the severity grades, utilizing the extracted features from segmented X-ray images. In this study, two different datasets were collected from the Mendeley and Kaggle database and combined to generate a large data hub containing five classes: Grade 0 (Healthy), Grade 1 (Doubtful), Grade 2 (Minimal), Grade 3 (Moderate), and Grade 4 (Severe). Several image processing techniques were employed to segment the region of interest (ROI). These included Gradient-weighted Class Activation Mapping (Grad-Cam) to detect the ROI, cropping the ROI portion, applying histogram equalization (HE) to improve contrast, brightness, and image quality, and noise reduction (using Otsu thresholding, inverting the image, and morphological closing). Besides, the focus filtering method was utilized to eliminate unwanted images. Then, six feature sets (morphological, GLCM, statistical, texture, LBP, and proposed features) were generated from segmented ROIs. After evaluating the statistical significance of the features and selection methods, the optimal feature set (prominent six distance features) was selected, and five machine learning (ML) models were employed. Additionally, a decision-making strategy based on the six optimal features is proposed. The XGB model outperformed other models with a 99.46 % accuracy, using six distance features, and the proposed decision-making strategy was validated by testing 30 images.

Knowledge structure and emerging trends of cognitive impairment induced by sleep deprivation: A bibliometric analysis based on CiteSpace and VOSviewer from 2000 to 2022

This paper implements a bibliometric approach to investigate the research hotspots and future research directions in the relevant field literature. It also offers research ideas and methods for preventing and treating cognitive impairment induced by sleep deprivation in the clinical setting. The evolution of various clusters in the field is summarized through Citespace's projection function for keywords in the literature. CiteSpace and Vosviewer are utilized to analyze and visualize the attributes of the articles, including number of publications, citation frequency, country/region, institution, journal, authors, keywords, and references, from the 2280 publications obtained. A total of 2280 publications were collected, with the number of papers and citations in the field continuously increasing year by year. The most influential country in this field is the United States, and the University of Washington is the most influential institution. The most authoritative journal in the field is identified as SLEEP. Sleep deprivation, prefrontal cortex, and performance are the current topics of interest. The article with the strongest citation burst, lasting from 2015 to 2018, is "Sleep Drives Metabolite Clearance from the Adult Brain." The most influential article and co-cited reference, "Neurocognitive Consequences of Sleep Deprivation," highlights that sleep deprivation from various causes may lead to cognitive impairment. Future research should investigate all forms of cognitive impairment resulting from sleep deprivation. The findings of this study will assist researchers in improving their knowledge structure, identifying research hotspots, and revealing future directions in the field.

Improvement in health perception but not quality of life with an antiseizure medication intervention in people with epilepsy in Guinea: A cohort study

BACKGROUND

This study assesses perceptions of quality of life (QOL) and overall health in people with epilepsy (PWE) in Guinea after a clinical intervention providing modified and new antiseizure medicine (ASM) regimens.

METHODS

Participants 12 years and older diagnosed with active epilepsy were prospectively and consecutively enrolled at two health centers in the Republic of Guinea (one urban, one rural) in 2022. 95% of participants were prescribed new/increased ASM doses, and interviewed for QOL and overall health perceptions at enrollment and three- and six-month follow ups. Univariate and linear mixed models were used to evaluate effects on QOL and overall health over time.

RESULTS

The mean QOLIE-31 score (±SD) among 148 Guinean PWE (82 male, 66 female; mean age 27.3; 137 with >1 seizure in prior year) was 51.7 ± 12.8 at enrollment, 57.6 ± 16.0 after three months (n = 116), and 52.2 ± 9.9 after six months (n = 87). Overall health scores were 53.1 ± 26.9, 72.6 ± 21.5, and 65.7 ± 20.2 respectively. After three months, PWE had improved overall health and QOLIE-31 scores (p<0.0001, p = 0.003), but these improvements persisted for overall health and not QOLIE-31 after six months (p = 0.001, p = 0.63). Seizure freedom (prior 30 days) was 26% initially, and 62 (42%) of the remaining PWE experiencing seizures achieved seizure freedom at either the first or second follow-ups.

CONCLUSIONS

A noticeable discrepancy exists between Guinean PWE's self-rated perceptions of QOL and overall health. Purely clinical interventions may not be sufficient to improve QOL, especially in people that experience severe, previously-untreated epilepsy in lower income settings.

The impact of UN high-level meetings on non-communicable disease funding and policy implementation

Since the original UN General Assembly 'special session' for HIV/AIDS, there has been a proliferation of health-related high-level meetings (HLMs), including three for non-communicable diseases (NCDs) and a 2019 HLM on universal health coverage that was closely aligned to the NCD framework. This paper attempts to assess the impact of these meetings in terms of funding allocations, domestic NCD policy implementation, as well as the level of international engagement with the HLMs by reviewing attendance data and records of statements ('interventions') made by country delegations. In contrast to HIV/AIDS, whilst NCDs have enjoyed a marked rise in international political exposure and high-level political commitments, these have not always translated into national policy implementation or greater funding allocations. This is true even for countries that have engaged most deeply with HLMs. These findings should give pause to NCD advocacy groups that expend substantial energy in calling for further high-level political commitments and highlight the need to focus support on the translation of commitments into sustainably funded action.

Does healthy city construction facilitate green growth in China? Evidence from 279 cities

In the face of the challenge of balancing urban economic development and environmental protection, the concept of a healthy city has emerged as a promising model for sustainable urban development. This study empirically investigates the impact of healthy city construction on green growth by utilizing a difference-in-difference model estimation on a panel dataset of 279 Chinese prefecture-level cities from 2007 to 2019. The findings reveal that healthy city construction significantly contributes to green growth, particularly in pilot cities, and this effect is observed across cities of different sizes and economic bases. Additionally, we identify two channels through which healthy city construction promotes green growth: enhancing innovation capacity and enriching human resources. These findings have implications not only for Chinese cities navigating the path towards green growth but also for other developing nations striving for economic transformation and environmentally sustainable development.

Utilizing waste compost to improve the atmospheric CO2 capturing in the rice-wheat cropping system and energy-cum‑carbon credit auditing for a circular economy

The study aimed to manage industrial wastes and create a module for using compost from waste for crops cultivation to conserve energy, reduce fertilizer use and Greenhouse gas (GHG) emissions, and improve the atmospheric CO2 capturing in agriculture for a green economy. In the main-plot, the experiment's results using NS3 found 50.1 and 41.8 % more grain yield and total carbon dioxide (CO2) sequestration in the wheat-rice cropping sequence, respectively, compared to the NS0. Moreover, the treatment CW + TV in the sub-plot observed 24.0 and 20.3 % higher grain yield and total CO2 sequestration than B + PS. Based on interaction, the NS3× CW + TV resulted in a maximum total CO2 sequestration and C credit of 47.5 Mg ha-1 and US$ 1899 ha-1, respectively. Further, it was 27.9 % lower in carbon footprints (CFs) than NS1 × B + PS. Regarding another parameter, the treatment NS3 observed a 42.4 % more total energy output in the main-plot than that of NS0. Further, in the sub-plot, the treatment CW + TV produced 21.3 % more total energy output than B + PS. Energy use efficiency (EUE) and net energy return in the interaction of NS3× CW + TV were 20.5 and 138.8 % greater than the NS0 × B + PS, respectively. In the main-plot, the treatment NS3 obtained a maximum of 585.0 MJ US$-1 and US$ 0.24 MJ-1 for energy intensity in economic terms (EIET) and eco-efficiency index in terms of energy (EEIe), respectively. While in the sub-plot, the CW + TV was observed at a maximum of 571.52 MJ US$-1 and US$ 0.23 MJ-1 EIET and EEIe, respectively. The correlation and regression study showed a perfect positive correlation between grain yield and total C output. Moreover, a high positive correlation (0.75 to 1) was found with all other energy parameters for grain energy use efficiency (GEUE). The variability in the wheat-rice cropping sequence's energy profitability (EPr) was 53.7 % for human energy profitability (HEP). Based on principal component analysis (PCA), the eigenvalues of the first two principal components (PCs) had been greater than two, explaining 78.4 and 13.7 % of the variability. The experiment hypothesis was to develop a reliable technology for safely using industrial waste compost, minimizing energy consumption and CO2 emissions by reducing chemical fertilizer input in agriculture soils.

E-learning enhancement through educational data mining with Covid-19 outbreak period in backdrop: A review

E-learning is fast becoming an integral part of the teaching- learning process, particularly after the outbreak of Covid-19 pandemic. Educational institutions across the globe are striving to enhance their e-learning instructional mechanism in accordance with the aspirations of present-day students who are widely using numerous technological tools - computers, tablets, mobiles, and Internet for educational purposes. In the wake of the evident incorporation of e-learning into the educational process, research related to the application of Educational Data Mining (EDM) techniques for enhancing e-learning systems has gained significance in recent times. The various data mining techniques applied by researchers to study hidden trends or patterns in educational data can provide valuable insights for educational institutions in terms of making the learning process adaptive to student needs. The insights can help the institutions achieve their ultimate goal of improving student academic performance in technology-assisted learning systems of the modern world. This review paper aims to comprehend EDM's role in enhancing e-learning environments with reference to commonly-used techniques, along with student performance prediction, the impact of Covid-19 pandemic on e-learning and priority e-learning focus areas in the future.

Green and Sustainable Membranes: A review

Membranes are ubiquitous tools for modern water treatment technology that critically eliminate hazardous materials such as organic, inorganic, heavy metals, and biomedical pollutants. Nowadays, nano-membranes are of particular interest for myriad applications such as water treatment, desalination, ion exchange, ion concentration control, and several kinds of biomedical applications. However, this state-of-the-art technology suffers from some drawbacks, e.g., toxicity and fouling of contaminants, which makes the synthesis of green and sustainable membranes indeed safety-threatening. Typically, sustainability, non-toxicity, performance optimization, and commercialization are concerns centered on manufacturing green synthesized membranes. Thus, critical issues related to toxicity, biosafety, and mechanistic aspects of green-synthesized nano-membranes have to be systematically and comprehensively reviewed and discussed. Herein we evaluate various aspects of green nano-membranes in terms of their synthesis, characterization, recycling, and commercialization aspects. Nanomaterials intended for nano-membrane development are classified in view of their chemistry/synthesis, advantages, and limitations. Indeed, attaining prominent adsorption capacity and selectivity in green-synthesized nano-membranes requires multi-objective optimization of a number of materials and manufacturing parameters. In addition, the efficacy and removal performance of green nano-membranes are analyzed theoretically and experimentally to provide researchers and manufacturers with a comprehensive image of green nano-membrane efficiency under real environmental conditions.

Comparison of Impressions of COVID-19 Vaccination and Influenza Vaccination in Japan by Analyzing Social Media Using Text Mining

The aim of this study was to compare impressions of COVID-19 vaccination and influenza vaccination in Japan by analyzing social media (Twitter®) using a text-mining method. We obtained 10,000 tweets using the keywords "corona vaccine" and "influenza vaccine" on 15 December 2022 and 19 February 2023. We then counted the number of times the words were used and listed frequency of these words by a text-mining method called KH Coder. We also investigated concepts in the data using groups of words that often appeared together or groups of documents that contained the same words using multi-dimensional scaling (MDS). "Death" in relation to corona vaccine and "severe disease" for influenza vaccine were frequently used on 15 December 2022. The number of times the word "death" was used decreased, "after effect" was newly recognized for corona vaccine, and "severe disease" was not used in relation to influenza vaccine. Through this comprehensive analysis of social media data, we observed distinct variations in public perceptions of corona vaccination and influenza vaccination in Japan. These findings provide valuable insights for public health authorities and policymakers to better understand public sentiment and tailor their communication strategies accordingly.