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Background & methods National protests in the summer of 2020 drew attention to the significant presence of police in marginalized communities. Recent social movements have called for substantial police reforms, including “defunding the police,” a phrase originating from a larger, historical abolition movement advocating that public investments be redirected away from the criminal justice system and into social services and health care. Although research has demonstrated the expansive role of police to respond a broad range of social problems and health emergencies, existing research has yet to fully explore the capacity for health insurance policy to influence rates of arrest in the population. To fill this gap, we examine the potential effect of Medicaid expansion under the Affordable Care Act (ACA) on arrests in 3,035 U.S. counties. We compare county-level arrests using FBI Uniform Crime Reporting (UCR) Program Data before and after Medicaid expansion in 2014–2016, relative to counties in non-expansion states. We use difference-in-differences (DID) models to estimate the change in arrests following Medicaid expansion for overall arrests, and violent, drug, and low-level arrests. Results Police arrests significantly declined following the expansion of Medicaid under the ACA. Medicaid expansion produced a 20–32% negative difference in overall arrests rates in the first three years. We observe the largest negative differences for drug arrests: we find a 25–41% negative difference in drug arrests in the three years following Medicaid expansion, compared to non-expansion counties. We observe a 19–29% negative difference in arrests for violence in the three years after Medicaid expansion, and a decrease in low-level arrests between 24–28% in expansion counties compared to non-expansion counties. Our main results for drug arrests are robust to multiple sensitivity analyses, including a state-level model. Conclusions Evidence in this paper suggests that expanded Medicaid insurance reduced police arrests, particularly drug-related arrests. Combined with research showing the harmful health consequences of chronic policing in disadvantaged communities, greater insurance coverage creates new avenues for individuals to seek care, receive treatment, and avoid criminalization. As police reform is high on the agenda at the local, state, and federal level, our paper supports the perspective that broad health policy reforms can meaningfully reduce contact with the criminal justice system under historic conditions of mass criminalization.

This study assesses the practices and views of Scottish dairy farmers relating to pasture-based and indoor systems. There are the debates about the environmental, economic and animal welfare implications of these systems. Indoor dairy farming is a contentious practice among the public. While this controversy is sometimes represented as a lack of public understanding, there is a need for more research on farmers’ views to facilitate discussion in the industry. A survey was posted to 909 dairy farmers in Scotland with questions about their grazing practices and attitudes to grazing and indoor systems. 254 surveys were completed, online and in paper form. There was a 26% response rate to the paper version of the survey. The results showed that 19% of respondents housed some or all the cows all year-round. 68% agreed or strongly agreed that cows should graze for part of the year and 51% agreed or strongly agreed that welfare was better if cows grazed for part of the year. These views coexisted with the view that management was more important than the type of system for determining profitability or welfare outcomes (83% and 82% strongly agree or agree respectively). Respondents whose system involved grazing and respondents who had spent longer in farming were moderately more likely to agree that cows should have access to pasture, and slightly less likely to agree that management was more important than system for determining welfare outcomes. The results indicate that the picture is more complicated than the public rejecting indoor dairy farming and those in the industry accepting it. The results showed that a majority preference for cows to graze co-existed with the view that management was more important than system. In terms of industry and policy recommendations, the research suggests that measures should be taken to safeguard farmers’ ability to graze through for instance research and advisory support on grazing; ensuring different systems are not penalised in the development of dairy sector environmental measures and recommendations; and potentially supply chains that financially rewards farmers for grazing.

Background Ward-Based Outreach Teams’ (WBOTs) use of mobile technologies can promote better quality and improved health services for populations in low- and middle-income countries. However, the implementation of such systems is fraught with threats to sustainability. Purpose The purpose of this study was to gain a deeper understanding of users’ views and experiences of the implementation of mHealth in a selected sub-district in North West Province, South Africa. Methods The study was qualitative, exploratory and descriptive. Data were collected from community health workers (CHWs) (n = 24) and outreach team leaders (OTLs) (n = 4) who used mobile devices loaded with the Mobenzi application through semi-structured focus group interviews, using an interview guide. Creswell’s stages of thematic analysis were used for data analysis, and codes, categories and themes were validated with the participants. Results Three themes emerged from the findings, namely the transition from a paper-based system to an electronic system; the use of the application; and reverting to paper-based documentation. The findings revealed that WBOTs considered the mHealth application as useful, easy to use, and supportive to their workflow. They experienced some technical challenges and lamented the inaccessibility of technicians. The mobile initiative’s termination caused distress among the participants, especially CHWs who had to revert to paper-based documentation to capture community health data. OTLs were concerned about the quality of health data being captured in the absence of the application. Conclusions The study concluded that community-based health care programmes that use WBOTs and mHealth technologies are essential in strengthening the health care system. WBOTs are facilitators for improving access to health care. Policy-makers and district managers will gain useful insights if they engage application users in discussions regarding future mobile health interventions for household and community-based care.

Background Coronavirus (COVID-19) has severely impacted lifestyles worldwide. Responses to COVID-19 have intentionally restricted the factors that encourage regular and frequent PA; opportunity, capability and motivation. However, the effects of these restrictions are likely to have differed by gender and age and different intensities of PA. This rapid review builds on previous evidence by synthesising the global impact of COVID-19 on adult PA through specific intensities and types of PA and evaluating this by gender and age. Methods A rapid systematic search of seven electronic databases (PubMed, MEDLINE, CINAHL, SPORTDiscus, Academic Search Complete, APA PsycInfo, and APA PsycArticles) was performed from December 2019 to January 2021. Studies investigating adult change in PA, exercise or sedentary behaviour due to COVID-19 were included. Results From an initial database search identifying 3,863 articles, 66 remained for synthesis after applying eligibility criteria. Results demonstrate decreases among all intensities and types of PA—walking (6 out of 7 papers), moderate-only (5 out of 6 papers), vigorous-only (5 out of 6 papers) and MVPA (4 out of 5 papers); as well as overall PA (14–72% participants reported a decrease). Reflecting that COVID-19 responses were designed to have universal effects, they also achieved whole-society decreases in PA behaviour, accented in older age groups. Conclusion There is a universal need to address the low levels of PA post-COVID-19. The consequences of decreased PA across all intensities has powerful, potentially recoverable, impacts. Universal declines have implications for public health officials and PA advocates for post-COVID-19 initiatives to promote PA.

The prevalence of dyslexia identification has increased significantly over the last two decades. Yet there is debate over whether there are distinct biological and cognitive differences between those with literacy difficulties and the subgroup of people identified as dyslexic. This is the first paper that provides evidence for this ongoing debate by investigating the socio-demographic factors, outside biology and cognition, that predict whether a child is identified as dyslexic in the UK. Using secondary data from the UK’s Millennium Cohort Study, this paper examines the socio-demographic factors that predict whether a child’s teacher identifies them as dyslexic at age 11. Gender, season of birth, socio-economic class and parental income are found to be significant predictors of the dyslexia label. Therefore, factors seemingly unrelated to the clinical aspects of dyslexia influence whether a child is identified as dyslexic in England and Wales. This suggests that label may not be evenly distributed across a population; furthermore, it may also indicate that resources for support may not be fairly allocated. The findings further support the argument that a ‘dyslexic sub-group’ within poor readers is created due to the impact of environmental factors. The results from this national-scale study thus questions the reliability, validity and moral integrity of the allocation of the dyslexia label across current education systems in the UK.

The objective of the paper is to diagnose organisational culture of selected universities and analyse its impact on the innovation processes within them. The subject matter of the study was organisational culture and innovation at universities. The subjects were four selected universities in Poland, Austria, Germany, and Ukraine. The paper provided a definition of organisational culture and its typology. It further discussed the organisational culture of universities and the relationships between organisational culture and innovativeness. The literature review provided foundations for building a model for the formation of a type of organisational culture at universities that is innovation-friendly, which is the added value of the paper. It offers actions worth taking to shape innovation-friendly culture at universities. It is particularly important during difficult time of changing labour market, when universities greatly impact the attitudes of young people. The knowledge of how to shape innovation-friendly organisational culture at universities is necessary for academia to profile future employees in times of continuous changes. To investigate the relationship between organisational culture and the innovativeness of universities, we designed an original survey questionnaire [S1 File]. Organisational culture was diagnosed with the Organizational Culture Assessment Instrument by K.S. Cameron and R.E. Quinn. The analyses were conducted in Dell Statistica v. 13.1 (StatSoft Polska). We normalised data from the Likert rating scale using Kaufman’s and Rousseeuw’s formula. We used Spearman’s correlation coefficient and Kendall’s W to calculate correlations. The research shows that the investigated Polish and Austrian universities are dominated by hierarchy and market cultures. On the other hand, the German and Ukrainian universities host all cultures, but clan and adhocracy dominate there. Moreover, the analyses demonstrated that although the adhocracy culture was the least visible in the investigated organisations, it contributes to university innovativeness the most. The conclusions were used to build a model for promoting innovation-friendly organisational culture at universities. The model contains answers to the research questions. In addition, it offers guidelines for shaping organisational culture to bolster innovation at universities. The research identified relationships between organisational culture and university innovativeness and components that create innovation opportunities at universities as its contribution to management theory. When applied in practice, the guidelines can help form the university’s organisational culture bottom-up.

The purpose of this paper is to analyse the global Sales and Operations Planning (S&OP) process and investigate the steps to support consolidated business planning in worldwide operations and large-scale supply chains. The paper conducts a case study at a multinational manufacturing company applying an abductive approach. It combines the deductive logic from theory and the inductive logic from field observation in an attempt to elaborate further on theory on global S&OP. The analysis is structured and guided by a novel framework for global S&OP, which is developed based on the theoretical background and the case study findings. The research findings characterise the S&OP process for global operations and identify challenges related to the need to synchronise the subsidiaries’ S&OP efforts worldwide to deal with different contingencies of these subsidiaries, and to manage and analyse a large amount of information gathered. The research reveals how the subsidiaries’ performance is analysed by top executives along the global S&OP process, feeding strategic initiatives in the organisation and identifying business opportunities like benchmarking among subsidiaries, synergies with other management practices, and global gains. This paper offers a novel investigation of the global steps on S&OP in a real-life setting, offering a well-documented characterisation of the process that goes beyond the traditional local approach. Moreover, it is the first study to reveal challenges and expected outcomes of such a global perspective for S&OP. The theoretical advancements of S&OP research offered herein aid scholars, opening avenues for middle-range theorising, highlighting the cross-disciplinary nature of the domain, and discussing the use of concepts from related disciplines like Economics, Psychology, and Information Systems. The research findings can also assist executives, especially from multinational manufacturers, in their efforts to consolidate global planning.

Eggs contain the essential cholesterol and protein for the human body, which plays an irreplaceable role in human survival, production and life. There are significant differences in the development of laying hens feeding in different regions. It is of great significance to improve egg production and reduce pollution emission for China’s laying hens industry. Based on the SBM model, this paper constructs MML index, considering unexpected output under common frontier, to comprehensively evaluate the green total factor productivity on Chinese laying hens (GTCL). The results show that: (1) GTCL shows a large spatial and temporal differentiation under both the common frontier and the regional frontier. Compared with the eastern region and central region, the western region has obvious advantages in GTCL. (2) GTCL overall shows a downward trend, however, it emerges an upward trend in recent years. (3) Compared with small-scale and large-scale, middle-scale GTCL has advantages. According to the above empirical results, combined with the China’s actual national situation, this paper finally puts forward some policy recommendations to improve GTCL.

This paper explores the potential of combining different isotope systems from different tissues to improve resolution when reconstructing breastfeeding and weaning practices (BWP) in archaeology. Additionally, we tested whether changes in diet can be detected in deciduous teeth. Rib collagen samples from 22 infants/children from the archaeological site of Bacuranao I (Mayabeque, Cuba) were processed for nitrogen (δ15N) and carbon (δ13Cco) stable isotopes and assessed using a Bayesian model (WARN). In addition, enamel of 48 teeth from 30 infants/children were analyzed for oxygen (δ18Oen) and carbon (δ13Cen) stable isotopes. Data revealed that the timing of weaning cannot be characterized precisely by analyzing either δ18O or δ15N. While a depletion in both δ15N and δ13Cco is only evident after one year, the WARN model suggested that the weaning process started at around 3 months and ended around 1.7 years. Most teeth were enriched in δ18Oen compared to deciduous incisors, suggesting a breastfeeding signal. However, a high variability in δ18O was found between similar teeth from the same individuals. Higher enrichment in δ18Oen, and variability, was observed in tissues formed during the first six months of life. A δ13C enrichment of 1.0‰ was observed among deciduous teeth and ribs. While most individuals enriched in δ15N showed enrichment in δ13C, the δ18O values were more variable. Our data suggests that stable isotopes of deciduous teeth, especially δ13Cen, can be used to detect changes in diet during the weaning process. It is also possible that the δ18O enrichment observed in M1 is influenced by the effects of cooking techniques on weaning foods. The combination of multiple isotope systems and tissues overcome some of the limitations posed by single tissue approaches.

Agriculture is a very important sector of the economy that has a great influence on rural areas. Almost sixty years of the Common Agricultural Policy (CAP) in the European Union (EU) may impose a question on the impact of this policy on job creation and economic growth in rural areas. By analyzing key indicators, one should note that although there are still many problems to tackle, the CAP has been successful to some extend in increasing employment rate and Gross Domestic Product (GDP) per capita as well as decreasing poverty rate in the EU rural areas. There are also more and more households connected to the next-generation broadband network and there is still a significant number of bed places in the EU rural areas. Although, the situation in specific EU Member States and their rural regions may be different, the overall performance of the EU is satisfactory and shows positive prognostics for the current EU financial perspective of 2021–2027. This paper also provides an empirical approach which checks whether there is a connection between the employment rate and the rural development measured in GDP per capita based on the data from the Baltic States: Estonia, Latvia and Lithuania in the period of 2000–2020. This research confirms that when increasing the level of rural employment, the economic growth rises in rural areas.

In the paper the costs of Polish county hospitals in 2015–2018 are studied using behavioral cost function. The set of variables combines hospitals’ characteristics which may determine their level of costs, such as the form of ownership, bed turnover rate, number of patient-days and share of beds in emergency department with environment characteristics which may influence both outsourcing costs and patients’ health. In 2017 the system of basic hospital service provision (hospital network) was introduced in Poland. Dummy variables included in the model represent the category of hospital in the system. The results show that the costs may be described using fixed effect panel model. Positive impact of percentage of emergency department patients transferred to other departments and of wages is found. Higher ratio of residents and interns to doctors is found to decrease costs. Dummy variable for the period after the introduction of hospital network assumed a negative sign with costs, but the parameter remained insignificant.

Higher education students’ mental health has been a growing concern in recent years even before the COVID-19 pandemic. The stresses and restrictions associated with the pandemic have put university students at greater risk of developing mental health issues, which may significantly impair their academic success, social interactions and their future career and personal opportunities. This paper aimed to understand the mental health status of University students at an early stage in the pandemic and to investigate factors associated with higher levels of distress. An online survey including demographics, lifestyle/living situations, brief mental well-being history, questions relating to COVID-19 and standardised measures of depression, anxiety, resilience and quality of life was completed by 1173 students at one University in the North of England. We found high levels of anxiety and depression, with more than 50% experiencing levels above the clinical cut offs, and females scoring significantly higher than males. The survey also suggested relatively low levels of resilience which we attribute to restrictions and isolation which reduced the opportunities to engage in helpful coping strategies and activities rather than enduring personality characteristics. Higher levels of distress were associated with lower levels of exercising, higher levels of tobacco use, and a number of life events associated with the pandemic and lockdown, such as cancelled events, worsening in personal relationships and financial concerns. We discuss the importance of longer-term monitoring and mental health support for university students.

Background mHealth innovations have been proposed as an effective solution to improving adolescent access to and use of Sexual and Reproductive Health (SRH) services; particularly in regions with deeply entrenched traditional social norms. However, research demonstrating the effectiveness and theoretical basis of the interventions is lacking. Aim Our aim was to describe mHealth intervention components, assesses their effectiveness, acceptability, and cost in improving adolescent’s uptake of SRH services in Sub-Saharan Africa (SSA). Methods This paper is based on a systematic review. Twenty bibliographic databases and repositories including MEDLINE, EMBASE, and CINAHL, were searched using pre-defined search terms. Of the 10, 990 records screened, only 10 studies met the inclusion criteria. The mERA checklist was used to critically assess the transparency and completeness in reporting of mHealth intervention studies. The behaviour change components of mHealth interventions were coded using the taxonomy of Behaviour Change Techniques (BCTs). The protocol was registered in the ‘International Prospective Register for Systematic Reviews’ (PROSPERO-CRD42020179051). Results The results showed that mHealth interventions were effective and improved adolescent’s uptake of SRH services across a wide range of services. The evidence was strongest for contraceptive use. Interventions with two-way interactive functions and more behaviour change techniques embedded in the interventions improved adolescent uptake of SRH services to greater extent. Findings suggest that mHealth interventions promoting prevention or treatment adherence for HIV for individuals at risk of or living with HIV are acceptable to adolescents, and are feasible to deliver in SSA. Limited data from two studies reported interventions were inexpensive, however, none of the studies evaluated cost-effectiveness. Conclusion There is a need to develop mHealth interventions tailored for adolescents which are theoretically informed and incorporate effective behaviour change techniques. Such interventions, if low cost, have the potential to be a cost-effective means to improve the sexual and reproductive health outcomes in SSA.

BackgroundThe hospitalization of children during the COVID-19 pandemic has affected their physical and mental health. Pediatric nurses have faced challenges in providing high-quality nursing care for children and their families. However, the pediatric nursing care recommendations for COVID-19 patients in the hospital setting remain unclear. The current scoping review provides recommendations for nursing interventions for pediatric COVID-19 patients in the hospital setting.Methods and findingsThe selected articles containing management and nursing recommendations for COVID-19 that have occurred in pediatric patients ages 0–19 years old. A search strategy was developed and implemented in seven databases. We included peer-reviewed articles that reported observational or interventional studies, as well as policy papers, guides or guidelines, letters and editorials, and web articles. A total of 134 articles and other documents relevant to this review were included. We categorized the results based on The Nursing Intervention Classification (NIC) taxonomy which consists of six domains (e.g., Physiological: Basic); eleven classes (e.g., Nutrition Support); and eighteen intervention themes (e.g., Positioning, Family Presence Facilitation, Family Support, and Discharge Planning).ConclusionApart from the intervention of physical problems, there is a need to promote patient- and family-centered care, play therapy, and discharge planning to help children and families cope with their new situation.

Background “Contracting Out” is a popular strategy to expand coverage and utilization of health services. Bangladesh began contracting out primary healthcare services to NGOs in urban areas through the Urban Primary Health Care Project (UPHCP) in 1998. Over the three phases of this project, retention of trained and skilled human resources, especially doctors, proved to be an intractable challenge. This paper highlights the issues influencing doctor’s retention both in managerial as well as service provision level in the contracted-out setting. Methodology In this qualitative study, 42 Key Informant Interviews were undertaken with individuals involved with UPHCP in various levels including relevant ministries, project personnel representing the City Corporations and municipalities, NGO managers and doctors. Verbatim transcripts were coded in ATLAS.ti and analyzed using the thematic analysis. Document review was done for data triangulation. Results The most cited problem was a low salary structure in contrast to public sector pay scale followed by a dearth of other financial incentives such as performance-based incentives, provident funds and gratuities. Lack of career ladder, for those in both managerial and service delivery roles, was also identified as a factor hindering staff retention. Other disincentives included inadequate opportunities for training to improve clinical skills, ineffective staffing arrangements, security issues during night shifts, abuse from community members in the context of critical patient management, and lack of job security after project completion. Conclusions An adequate, efficient and dedicated health workforce is a pre-requisite for quality service provision and patient utilization of these services. Improved career development opportunities, the provision of salaries and incentives, and a safer working environment are necessary actions to retain and motivate those serving in managerial and service delivery positions in contracting out arrangements.

Dietary adequacy and diversity during the lactation period are necessary to ensure good health and nutrition among women and children. Behavioral interventions pertaining to health and nutrition counselling during pregnancy and lactation are critical for awareness about dietary diversity. The issue assumes salience for marginalized communities because of the Covid-19 pandemic and associated economic and societal disruptions. This paper assesses the dietary patterns among 400 lactating mothers in the tribal-dominated district of Palghar in Maharashtra, India in 2020. The study is based on primary data regarding consumption of 10 food groups among women across 10 food groups based on 24-hour recall period. The primary outcome variable was binary information regarding Minimum Dietary Diversity defined as consumption from at least 5 food groups. Econometric analysis based on multilevel models and item-response theory is applied to identify food groups that were most difficult to be received by mothers during the early and late lactation period. We find that the daily diet of lactating mothers in Palghar primarily consists of grains, white roots, tubers, and pulses. In contrast, the intake of dairy, eggs, and non-vegetarian food items is much lower. Only Half of the lactating women (56.5 percent; 95% CI: 37.4; 73.8) have a minimum diversified diet (MDD). The prevalence of lactating women with MDD was higher among households with higher income (73.1 percent; 95% CI: 45.2; 89.9) than those in lower income group (50.7 percent; 95% CI: 42.3; 58.9). Lactating Women (in early phase) who received health and nutrition counseling services are more likely (OR: 2.37; 95% CI: 0.90; 6.26) to consume a diversified diet. Food groups such as fruits, meat, poultry, fish, nuts, and seeds were among the rare food items in daily diet. The dietary pattern lacking in fruits, nuts, and heme (iron) sources indicates more significant risks of micronutrient deficiencies. The findings call for improving dietary diversity among lactating mothers, particularly from the marginalized communities, and are driven by low consumption of dairy products or various fruits and vegetables. Among the different food items, the consumption of micronutrient-rich seeds and nuts is most difficult to be accessed by lactating mothers. Also, diet-centric counseling and informing lactating mothers of its benefits are necessary to increase dietary diversity for improving maternal and child nutrition.

Objective The Spanish health system is made up of seventeen regional health systems. Through the official reporting systems, some inconsistencies and differences in case fatality rates between Autonomous Communities (CC.AA.) have been observed. Therefore the objective of this paper is to compare COVID-19 case fatality rates across the Spanish CC.AA. Material and methods Observational descriptive study. The COVID-19 case fatality rate (CFR) was estimated according to the official records (CFR-PCR+), the daily mortality monitory system (MoMo) record (CFR-Mo), and the seroprevalence study ENE-COVID-19 (Estudio Nacional de sero Epidemiologia Covid-19) according to sex, age group and CC.AA. between March and June 2020. The main objective is to detect whether there are any differences in CFR between Spanish Regions using two different register systems, i. e., the official register of the Ministry of Health and the MoMo. Results Overall, the CFR-Mo was higher than the CFR-PCR+, 1.59% vs 0.98%. The differences in case fatality rate between both methods were significantly higher in Castilla La Mancha, Castilla y León, Cataluña, and Madrid. The difference between both methods was higher in persons over 74 years of age (CFR-PCR+ 7.5% vs 13.0% for the CFR-Mo) but without statistical significance. There was no correlation of the estimated prevalence of infection with CFR-PCR+, but there was with CFR-Mo (R2 = 0.33). Andalucía presented a SCFR below 1 with both methods, and Asturias had a SCFR higher than 1. Cataluña and Castilla La Mancha presented a SCFR greater than 1 in any scenario of SARS-CoV-2 infection calculated with SCFR-Mo. Conclusions The PCR+ case fatality rate underestimates the case fatality rate of the SARS-CoV- 2 virus pandemic. It is therefore preferable to consider the MoMo case fatality rate. Significant differences have been observed in the information and registration systems and in the severity of the pandemic between the Spanish CC.AA. Although the infection prevalence correlates with case fatality rate, other factors such as age, comorbidities, and the policies adopted to address the pandemic can explain the differences observed between CC.AA.

Motivated by the two-decade-long scientific debate over the existence of the ego-depletion effect, our paper contributes to exploring the scope conditions of ego-depletion theory. Specifically, in a randomized experiment, we depleted students’ self-control with a cognitively demanding task that required students’ effort. We measured the effect of depleted self-control on a subsequent task that required self-control to not engage in fraudulent cheating behavior—measured with an incentivized dice-roll task—and tested ego-depletion in a large-scale preregistered field experiment that was similar to real-life situations. We hypothesized that treated students would cheat more. The data confirms the hypothesis and provides causal evidence of the ego-depletion effect. Our results provide new insights into the scope conditions of ego-depletion theory, contribute methodological information for future research, and offer practical guidance for educational policy.

School closures due to the COVID-19 global pandemic are likely to have a range of negative consequences spanning the domains of child development, education and health, in addition to the widening of inequalities and inequities. Research is required to improve understanding of the impact of school closures on the education, health and wellbeing of pupils and school staff, the challenges posed during reopening and importantly to identify how countries can ensure a safe return to education and to inform policy. This qualitative study aimed to reflect on the experience of primary school staff (pupils aged 3-11) in Wales regarding school closures and the initial reopening of schools and to identify recommendations for the future. A total of 208 school staff completed a national online survey through the HAPPEN primary school network, consisting of questions about school closures, the phased reopening of schools and a return to full-time education. Thematic analysis of survey responses identified five recommendations; (i) prioritise the health and wellbeing of pupils and staff. This includes more focus on wellbeing activities and less focus on attainment/assessments and protecting staff breaks to promote workplace wellbeing; (ii) focus on enabling parental engagement and support. Introduce support sessions for parents and include regular check ins during periods of home learning; (iii) improve digital competence amongst pupils, teachers and parents. Ensure the provision of equipment and training in building digital skills. Offer a combination of paper-based and digital home learning activities; (iv) consider opportunities for smaller class sizes and additional staffing. Ensure support is directed to need whilst providing pastoral care; and (v) improve the mechanism of communication between schools and families, and between government and schools. Ensure that schools receive advance notice of local or national changes in guidance.

Background With the increase in elderly population, the risk of cardiovascular diseases (CVD) among Indian older adults is also increasing. The present paper tries to assess how different anthropometric measures of obesity and physical activity affects cardiovascular disease risk among older adults in India. Methods The data from Longitudinal Ageing Study in India (LASI) has been used. The total sample size for the present study is 31,464 older adults aged 60 years and above. Chi-square test and binary logistic regression has been used to measure the association of obesity measures and CVD prevalence. Results About 35.2% (n = 11,058) of the older adults suffered from CVD. Moreover, 22.2% (n = 6,217) of the older adults were obese/overweight, 23.7% (n = 6,651) had high risk waist circumference and 77.0% (n = 21,593) had high risk waist-Hip ratio. The likelihood of CVD was 60%, 50%, and 34% significantly higher among older adults who were obese/overweight [Adjusted odds ratio (AOR): 1.60; CI: 1.48–1.72], had high risk waist circumference [AOR: 1.50; CI: 1.39–1.62] and high risk waist-Hip ratio [AOR: 1.34; CI: 1.25–1.44], respectively compared to older adults with normal BMI and those who do not have a high risk waist circumference and high risk waist hip ratio. Moreover, older adults who never did physical activity had 22 per cent higher risk of CVD than those who did frequent [AOR: 1.22; CI: 1.13–1.32] physical activity. Conclusion The burden of overweight and obesity along with physical inactivity increases the risk of CVD in older adults. These findings highlight the urgent need for framing direct and indirect strategies to control obesity in order to reduce the burden of CVD among older adults in India.

This paper is based on qualitative research carried out in a diabetic retinopathy (DR) programme in three districts of Pakistan. It analyses the organisation and delivery of DR services and the extent to which the interventions resulted in a fully functioning integrated approach to DR care and treatment. Between January and April 2019, we conducted 14 focus group discussions and 37 in-depth interviews with 144 purposively selected participants: patients, lady health workers (LHWs) and health professionals. Findings suggest that integration of services was helpful in the prevention and management of DR. Through the efforts of LHWs and general practitioners, diabetic patients in the community became aware of the eye health issues related to uncontrolled diabetes. However, a number of systemic pressure points in the continuum of care seem to have limited the impact of the integration. Some components of the intervention, such as a patient tracking system and reinforced interdepartmental links, show great promise and need to be sustained. The results of this study point to the need for action to ensure inclusion of DR on the list of local health departments’ priority conditions, greater provision of closer-to-community services, such as mobile clinics. Future interventions will need to consider the complexity of adding diabetic retinopathy to an already heavy workload for the LHWs.

Antimicrobial resistance (AMR) is a global public health crisis that is now impacted by the COVID-19 pandemic. Little is known how COVID-19 risks influence people to consume antibiotics, particularly in contexts like Bangladesh where these pharmaceuticals can be purchased without a prescription. This paper identifies the social drivers of antibiotics use among home-based patients who have tested positive with SARS-CoV-2 or have COVID-19-like symptoms. Using qualitative telephone interviews, the research was conducted in two Bangladesh cities with 40 participants who reported that they had tested positive for coronavirus (n = 20) or had COVID-19-like symptoms (n = 20). Our analysis identified five themes in antibiotic use narratives: antibiotics as ‘big’ medicine; managing anxiety; dealing with social repercussions of COVID-19 infection; lack of access to COVID-19 testing and healthcare services; and informal sources of treatment advice. Antibiotics were seen to solve physical and social aspects of COVID-19 infection, with urgent ramifications for AMR in Bangladesh and more general implications for global efforts to mitigate AMR.

In this paper, we presentautopsych, a novel online tool that allows school assessment experts, test developers, and researchers to perform routine psychometric analyses and equating of student test data and to examine the effect of student demographic and group conditions on student test performance. The app extends current open-source software by providing (1) extensive embedded result narration and summaries for written reports, (2) improved handling of partial credit data via customizable item-person Wright maps, (3) customizable item- and person-flagging systems, (4) item-response theory model constraints and controls, (5) many-facets Rasch analysis to examine item bias, (6) Rasch fixed item equating for mapping student ability across test forms, (7) tabbed spreadsheet outputs and immediate options for secondary data analysis, (8) customizable graphical color schemes, (9) extended ANOVA analysis for examining group differences, and (10) inter-rater reliability analyses for the verifying the consistency of rater scoring systems. We present the app’s architecture and functionalities and test its performance with simulated and real-world small-, medium-, and large-scale assessment data. Implications and planned future developments are also discussed.

Microplastics are a global challenge and a frequently studied environmental issue. Hence, the knowledge body about microplastics within the scientific community is growing fast and challenges an elaborated knowledge transfer from science to the general public. Just as well-informed people are the basis for reducing microplastics' impact on the environment, knowledge of the audience's conceptions is the basis for an accurate and successful dissemination of scientific findings. However, insights into the publics' perceptions of microplastics are still rare. The present study aimed to capture students' conceptions about microplastics based on their individual experiences following qualitative inductive, exploratory research. Therefore, 267 students of a state university in Germany responded to a paper-and-pencil questionnaire containing open and closed questions on microplastic-related conceptual understanding, risk perception, information behavior, sources, and sinks. The inductive classifying of all responses by a qualitative content analysis revealed six basic concepts: 1) Microplastics are mainly understood as small plastic particles. 2) Microplastics are closely associated with its negative consequences. 3) The most labeled source in households is plastic packaging. 4) Compared to other water bodies, microplastics are rarely suspected in groundwater. 5) A high threat awareness exists in classifying microplastics as very dangerous and dangerous. 6) Media such as TV or the Internet are the most crucial information sources while the school has less importance in acquiring information. It is precisely this pattern that indicates the need for profound science communication to establish a joint and scientifically sound knowledge base in society. Knowledge about conceptions of potential "customers" allows tailor-made scientific knowledge transfers to shape public awareness, initiate changes in thoughts and prepare the field for collaborative behavior.

Maintaining the functional integrity of ecosystems as climate pressures exceed natural rates of adaptation requires new knowledge and new approaches to governance and management. However, research into management interventions to assist regional ecosystem adaptation has generated both scientific and ethical debate. This paper reviews experience to date in order to identify the challenges and opportunities for assisted regional ecosystem adaptation and reflect on the implications for ongoing adaptation research. The review was informed by a database and structured analysis of some 450 reports, peer-reviewed manuscripts and books on participation theory and experience with novel technology development and assisted ecosystem adaptation. We identified five classes of challenges to adaptation research: 1) scientific conflicts and debates over the “facts”, 2) social challenges, 3) governance challenges, 4) epistemic challenges, and 5) ontological conflicts. We argue that engagement strategies linked to the multiple objectives of adaptation research provide opportunities for ecosystem adaptation.

Data Availability: All relevant data are within the paper and its Supporting Information files: Self-employment intention questionnaire (available at: https://figshare.com/articles/journal_contribution/Self-employment_intention_questionnaire_/16612528); Data used in the study (available at Data used in the study). Copyright: © 2021 Al-Qadasi et al.. This study assesses whether final-year undergraduate students at Sana’a University, Yemen intend to start their own business. The study employs the theory of planned behaviour and two environmental factors to explore whether the theory’s behavioural factors and the contextual factors of Lüthje & Franke’s model have an impact on students’ intentions to start their own business. A questionnaire survey with a random sample of 335 final-year university students from the largest public university in Yemen has been conducted. Data has been analysed using descriptive statistics, Pearson’s correlation and structural equation modelling. The findings indicate that students’ perceptions of entrepreneurship have a strong, direct impact on self-employment intention, excluding social norms and entrepreneurial self-efficacy. Students’ self-employment intention is directly affected by perceived barriers and support factors in the entrepreneurship-related context. To increase their entrepreneurial abilities, university students require more training and education to be able to start new businesses. Developing entrepreneurial skills among citizens may improve the societal norms of business. The outcomes provide significant implications for policymakers, academic communities and international bodies. Jilin University

The huge amount of data made available by the massive usage of social media has opened up the unprecedented possibility to carry out a data-driven study of political processes. While particular attention has been paid to phenomena like elite and mass polarization during online debates and echo-chambers formation, the interplay between online partisanship and framing practices, jointly sustaining adversarial dynamics, still remains overlooked. With the present paper, we carry out a socio-semantic analysis of the debate about migration policies observed on the Italian Twittersphere, across the period May-November 2019. As regards the social analysis, our methodology allows us to extract relevant information about the political orientation of the communities of users—hereby calledpartisan communities—without resorting upon any external information. Remarkably, our community detection technique is sensitive enough to clearly highlight the dynamics characterizing the relationship among different political forces. As regards the semantic analysis, our networks of hashtags display a mesoscale structure organized in a core-periphery fashion, across the entire observation period. Taken altogether, our results point at different, yet overlapping, trajectories of conflict played out using migration issues as a backdrop. A first line opposes communities discussing substantively of migration to communities approaching this issue just to fuel hostility against political opponents; within the second line, a mechanism of distancing between partisan communities reflects shifting political alliances within the governmental coalition. Ultimately, our results contribute to shed light on the complexity of the Italian political context characterized by multiple poles of partisan alignment.

Real-world effectiveness studies are important for monitoring performance of COVID-19 vaccination programmes and informing COVID-19 prevention and control policies. We aimed to synthesise methodological approaches used in COVID-19 vaccine effectiveness studies, in order to evaluate which approaches are most appropriate to implement in low- and middle-income countries (LMICs). For this rapid systematic review, we searched PubMed and Scopus for articles published from inception to July 7, 2021, without language restrictions. We included any type of peer-reviewed observational study measuring COVID-19 vaccine effectiveness, for any population. We excluded randomised control trials and modelling studies. All data used in the analysis were extracted from included papers. We used a standardised data extraction form, modified from STrengthening the Reporting of OBservational studies in Epidemiology (STROBE). Study quality was assessed using the REal Life EVidence AssessmeNt Tool (RELEVANT) tool. This study is registered with PROSPERO, CRD42021264658. Our search identified 3,327 studies, of which 42 were eligible for analysis. Most studies (97.5%) were conducted in high-income countries and the majority assessed mRNA vaccines (78% mRNA only, 17% mRNA and viral vector, 2.5% viral vector, 2.5% inactivated vaccine). Thirty-five of the studies (83%) used a cohort study design. Across studies, short follow-up time and limited assessment and mitigation of potential confounders, including previous SARS-CoV-2 infection and healthcare seeking behaviour, were major limitations. This review summarises methodological approaches for evaluating real-world effectiveness of COVID-19 vaccines and highlights the lack of such studies in LMICs, as well as the importance of context-specific vaccine effectiveness data. Further research in LMICs will refine guidance for conducting real-world COVID-19 vaccine effectiveness studies in resource-constrained settings.

The use of contraceptives for family planning improves women’s lives and may prevent maternal deaths. However, many women in low and middle-income countries, including the Pacific region, still die from pregnancy-related complications. While most health centres offer family planning services with some basic contraceptive methods, many people do not access these services. More than 60% of women who would like to avoid or delay their pregnancies are unable to do so. This scoping review identifies and analyses evidence about family planning service provision in Pacific Island Countries and Territories (PICTs), with the aim of better informing family planning services for improved maternal health outcomes in the Pacific. We used Arksey and O’Malley’s scoping review guidelines, supported by Levac, Colquhoun and O’Brien to identify gaps in family planning service provision. Selected studies included peer-reviewed publications and grey literature that provided information about family planning services from 1994 to 2019. Publication data was charted in MS Excel. Data were thematically analysed and key issues and themes identified. A total of 45 papers (15 peer-reviewed and 30 grey literature publications) were critically reviewed. Five themes were identified: i) family planning services in the Pacific; ii) education, knowledge and attitudes; iii) geographical isolation and access; iv) socio-cultural beliefs, practices and influences; and v) potential enabling factors for improved family planning, such as appropriate family planning awareness by health care providers and services tailored to meet individual needs. While culture and religion were considered as the main barriers to accessing family planning services, evidence showed health services were also responsible for limiting access. Family planning services do not reach everyone. Making relevant and sustainable improvements in service delivery requires generation of local evidence. Further research is needed to understand availability, accessibility and acceptability of current family planning services for different age groups, genders, social and marital status to better inform family planning services in the Pacific.

Background Cardiorespiratory fitness (CRF) is the core element of health-related physical fitness evaluation. High pressure and low oxygen in Tibet (over 3,500 m above sea level) may negatively impact the residents’ CRF. The 20-m shuttle run test (20mSRT) is the most popular field-based assessment and estimate of CRF in children and adolescents worldwide. However, normative CRF data for the children and adolescents residing in China’s plateau region are unavailable, which prevents comparability among those living at high-altitudes around the world. Purpose To measure the CRF of Chinese children and adolescents aged 9–18 years living in Tibet at altitudes exceeding 3,500 m, and to identify correlations between this metric and demographic characteristics (age, sex, and ethnicity). These data were then compared with those generated in the lowland (Shanghai, China) and various global regions. Methods 20mSRT performance (number of completed laps) and predicted peak oxygen consumption (VO2peak) were used as indicators of CRF. We measured the CRF of 1,717 healthy children and adolescents aged 9–18 years living in Tibet. The CRF data from school-age subjects in Shanghai (2,437 boys and 2,396 girls) and worldwide (1,142,026 students from 50 countries/regions in Africa, Asia, Europe, Latin America, North America, and Oceania) were collated from published papers. Results The average CRF of the participants from Tibet was 39.8 mL/kg/min. The male subjects (n = 876; 41.1 ± 4.42 mL/kg/min) had a higher average CRF than their female counterparts (n = 841; 37.8 ± 5.40 mL/kg/min). CRF decreased with age in both sexes at statistical significance (F = 1249.9, p for trend 0.05). The indigenous Tibetans (n = 1289; 40.1 ± 3.71 mL/kg/min) had a significant higher average CRF than those of Han descent (n = 394; 38.9 ± 4.70 mL/kg/min) (p < 0.05). Conclusions Children and adolescents aged 7–18 years residing above 3,500 m in Tibet displayed lower CRF traits compared with their counterparts from the plains area and other high altitude places. CRF varied according to age, sex, and ethnic group. Given the importance of CRF in children and adolescents, effective intervention strategies should be implemented to improve CRF in children and adolescents on the plateau.

Vehicle-tree collisions are the most common type of road crash with fixed obstacle in Czech Republic. Based on the literature review and using real world in-depth crash data, this paper aims to define factors, which significantly influence the injury severity of single vehicle-tree crashes. In-depth data provide a comprehensive view to the failure on the system infrastructure—human—vehicle related to crash, the in-depth crash database include very detailed information related to infrastructure, vehicle, human failure and crash participants characteristics and their medical condition and also crash reconstruction. Multinomial logistic regression and generalized linear mixed model were used to determine the individual effect of each predictor. The statistically significant variables were the day period, trunk diameter and impact speed. Using multinomial logistic regression shows also vehicle age as statistically significant. Obtained results can help to efficiently direct countermeasures not only on the road infrastructure—e.g. speed reduction in selected locations with specified tree character. However, the emphasis should be also focused on driver behaviour.

Men are underrepresented in family planning (FP) research, and despite the widespread promotion of FP through mass media, there is no systematic evaluation on how mass media exposure influences their FP knowledge, attitudes and behavior. Using Demographic and Health Survey (DHS) data from 31 countries in Sub-Saharan Africa (SSA), collected between 2010 and 2019, this paper examines the associations between three types of traditional mass media (radio, television and print) with FP knowledge, attitudes and method choices among reproductive age men in SSA, relative to other socio-cultural factors. Estimates to quantify the relative contribution of each type of mass media, relative to other evidence-based socio-cultural influences on FP outcomes, were derived using the Shorrocks-Shapley decomposition. Radio exposure had the largest impact on FP knowledge, attitudes and method choice, accounting for 26.1% of the variance in FP knowledge, followed by Television (21.4%) and education attainment (20.7%). Mass media exposure had relatively minimal impact on FP method choice, and between the three types of mass media, television (8%) had the largest influence on FP method choice. Print media had comparatively lesser impact on FP knowledge (8%), attitudes (6.2%) and method choice (3.2%). Findings suggest that mass media exposure has positive influences on FP knowledge, attitudes and method choice but its influence on FP knowledge, attitudes and method choice is smaller relative to other socio-cultural factors such as education, household wealth and marital status. As such, efforts to increase FP uptake in Sub-Saharan Africa should take into consideration the impact of these socio-cultural economic factors.

International openness can affect regional innovation through more export opportunities, enhanced import competition and the spillover effects of foreign direct investment. Many studies have been conducted based on different countries for capturing the determinants of regional innovation, but very little literature is available with contradictory findings for the case of China. Based on 19 years’ panel data of 31 Chinese provinces, this paper analyzes the impact of international openness on regional innovation measured by the number of patent grants. The positive effects of overall trade and a higher proportion of exports and imports to GDP are significant and robust across different model specifications, indicating that an increase in international openness can promote regional innovating activities in China. The causal relationship of all the variables depicted by path analysis matches the results of the system GMM model. Higher intellectual property protection provides each region with the opportunity to obtain economic benefits from innovation and then make a higher investment in R&D activities. Besides, the lag effect of regional innovation capability can also explain a large part of local innovating activities. In our subsample regressions, the positive effect of trade openness on innovation is majorly manifested in developed areas like eastern provinces.

In the aftermath of shock events, policy responses tend to be crafted under significant time constraints and high levels of uncertainty. The extent to which individuals comply with different policy designs can further influence how effective the policy responses are and how equitably their impacts are distributed in the population. Tools which allow policymakers to model different crisis trajectories, policy responses, and behavioral scenariosex antecan provide crucial timely support in the decision-making process. Set in the context of COVID-19 shelter in place policies, in this paper we present the COVID-19 Policy Evaluation (CoPE) tool, which is an agent-based modeling framework that enables researchers and policymakers to anticipate the relative impacts of policy decisions. Specifically, this framework illuminates the extent to which policy design features and behavioral responsiveness influence the efficacy and equity of policy responses to shock events. We show that while an early policy response can be highly effective, the impact of the timing is moderated by other aspects of policy design such as duration and targeting of the policy, as well as societal aspects such as trust and compliance among the population. More importantly, we show that even policies that are more effective overall can have disproportionate impacts on vulnerable populations. By disaggregating the impact of different policy design elements on different population groups, we provide an additional tool for policymakers to use in the design of targeted strategies for disproportionately affected populations.

Containers have emerged as a more portable and efficient solution than virtual machines for cloud infrastructure providing both a flexible way to build and deploy applications. The quality of service, security, performance, energy consumption, among others, are essential aspects of their deployment, management, and orchestration. Inappropriate resource allocation can lead to resource contention, entailing reduced performance, poor energy efficiency, and other potentially damaging effects. In this paper, we present a set of online job allocation strategies to optimize quality of service, energy savings, and completion time, considering contention for shared on-chip resources. We consider the job allocation as the multilevel dynamic bin-packing problem that provides a lightweight runtime solution that minimizes contention and energy consumption while maximizing utilization. The proposed strategies are based on two and three levels of scheduling policies with container selection, capacity distribution, and contention-aware allocation. The energy model considers joint execution of applications of different types on shared resources generalized by the job concentration paradigm. We provide an experimental analysis of eighty-six scheduling heuristics with scientific workloads of memory and CPU-intensive jobs. The proposed techniques outperform classical solutions in terms of quality of service, energy savings, and completion time by 21.73–43.44%, 44.06–92.11%, and 16.38–24.17%, respectively, leading to a cost-efficient resource allocation for cloud infrastructures.

British supermarket-panel data suggest no increases in overall sales and purchases of alcohol following COVID-19 lockdowns, yet survey and mortality data suggest otherwise. This paper attempts to unravel the paradox. Based on purchase data of 79,417 British households from Kantar Worldpanel, we undertake controlled interrupted time series analysis of the impact of COVID-19 confinement introduced on 23rd March 2020, and variably applied during 2020, compared to purchases during 2015 to 2019 as controls. We also undertook Poisson regression analyses to estimate if changes in purchases differed by household socio-demographic and economic factors. Excess off-trade household alcohol purchases (expressed as grams of ethanol) following the introduction of confinement, were 29.2% higher (95% CI = 25.8% to 32.5%) for the post-confinement months of 2020, being larger until mid-July 2020 (37.5%, 95%CI = 33.9 to 41.26%) when pubs re-opened with restrictions, and smaller (24.6%, 95%CI = 21.6 to 27.7) thereafter. During the time of complete pub closures, and fully adjusting for no on-trade purchases, household purchases of alcohol did not change when compared with the same time period during 2015–2019 (coefficient = -0.9%, 95%CI = -5.6 to 3.8). Excess purchases from 23rd March to 31st December 2020 varied by region of Great Britain, being higher in the north of England, and lower in Scotland and Wales. Excess purchases were greater in the most deprived households, compared with the least deprived households. Excess purchases increased substantially as the amount of alcohol normally purchased by a household increased, with the top one fifth of households that normally bought the most alcohol increasing their purchases more than 17 times than the bottom one fifth of households that bought the least alcohol. That the heaviest buyers of alcohol increased their purchases the most, with some independent impact of socio-economic disadvantage, might explain why reported alcohol problems and recent alcohol-related death rates might have increased. A conclusion of this is that alcohol policy to reduce high consumption of alcohol, and the availability of help and treatment to reduce alcohol consumption become more important during extraordinary times, such as COVID lockdowns.

Introduction Quality antenatal care is a window of opportunity for improving maternal and neonatal outcomes. Numerous studies have shown a positive effect of women empowerment on improved coverage of maternal and reproductive health services, including antenatal care (ANC). However, there is scarce evidence on the association between women’s empowerment and improved ANC services both in terms of coverage and quality. Addressing this gap, this paper examines the relationship between multi-dimensional measures of women empowerment on utilization of quality ANC (service coverage and consultation) in Pakistan. Methods We used Pakistan Demographic and Health Survey 2017–18 (PDHS) data which comprises of 6,602 currently married women aged between 15–49 years who had a live birth in the past five years preceding the survey. Our exposure variables were three-dimensional measures of women empowerment (social independence, decision making, and attitude towards domestic violence), and our outcome variables were quality of antenatal coverage [i.e. a composite binary measure based on skilled ANC (trained professional), timeliness (1st ANC visit during first trimester), sufficiency of ANC visits (4 or more)] and quality of ANC consultation (i.e. receiving at least 7 or more essential antenatal components out of 8). Data were analysed in Stata 16.0 software. Descriptive statistics were used to describe sample characteristics and binary logistic regression was employed to assess the association between empowerment and quality of antenatal care. Results We found that 41.4% of the women received quality ANC coverage and 30.6% received quality ANC consultations during pregnancy. After controlling for a number of socio-economic and demographic factors, all three measures of women’s empowerment independently showed a positive relationship with both outcomes. Women with high autonomy (i.e. strongly opposed the notion of violence) in the domain of attitude to violence are 1.66 (95% CI 1.30–2.10) and 1.45 (95% CI 1.19–1.75) and times more likely to receive antenatal coverage and quality ANC consultations respectively, compared with women who ranked low on attitude to violence. Women who enjoy high social independence had 1.87 (95% CI 1.44–2.43) and 2.78 (95% CI 2.04–3.79) higher odds of quality antenatal coverage and consultations respectively, as compared with their counterparts. Similarly, women who had high autonomy in household decision making 1.98 (95% CI 1.60–2.44) and 1.56 (95% CI 2.17–1.91) were more likely to receive quality antenatal coverage and consultation respectively, as compared to women who possess low autonomy in household decision making. Conclusion The quality of ANC coverage and consultation with service provider is considerably low in Pakistan. Women’s empowerment related to social independence, gendered beliefs about violence, and decision-making have an independent positive association with the utilisation of quality antenatal care. Thus, efforts directed towards empowering women could be an effective strategy to improve utilisation of quality antenatal care in Pakistan.

This paper evaluates the performance of eight tests with null hypothesis of cointegration on basis of probabilities of type I and II errors using Monte Carlo simulations. This study uses a variety of 132 different data generations covering three cases of deterministic part and four sample sizes. The three cases of deterministic part considered are: absence of both intercept and linear time trend, presence of only the intercept and presence of both the intercept and linear time trend. It is found that all of tests have either larger or smaller probabilities of type I error and concluded that tests face either problems of over rejection or under rejection, when asymptotic critical values are used. It is also concluded that use of simulated critical values leads to controlled probability of type I error. So, the use of asymptotic critical values may be avoided, and the use of simulated critical values is highly recommended. It is found and concluded that the simple LM test based on KPSS statistic performs better than rest for all specifications of deterministic part and sample sizes. © 2022 Public Library of Science. All rights reserved.

Critical thinking is a requisite skill for college success, employability, and conducive active civic participation. Empirical studies have noted to the low achievement of Arab students on critical thinking assessments. Insufficient endeavors have attempted to propose effective interventions enhancing critical thinking abilities among Arab students. The current analysis provides a preliminary overview of a special course designed to improve critical thinking skills among Arab college students. Results indicated a great improvement in all areas of critical thinking including explanation of information, identification of strategies, implementing solutions, and formulating logical inferences. Students’ scores on a critical thinking assessment increased from sufficient to good as a result of participating in the program. The gains are consistent after controlling for gender, major, class seniority, and nationality. Notwithstanding these promising results, this paper is limited in several respects including the choice of critical thinking assessments represented by two questions, the highly contextualized setting making it difficult to be replicated, and the convenient sampling strategy used to recruit participants. This set of limitations, however, does not discourage proactive attempts like designing special courses to enhance students’ critical thinking acquisition in the Middle East.

Little is known in Aotearoa New Zealand about experiences of homelessness amongst Takatāpui/LGBTIQ+ identifying people, despite growing international literature regarding LGBTIQ+ homelessness. Using data from semi-structured interviews with eight people who identified as Takatāpui/LGBTIQ+ and had experienced homelessness, this paper explores their experiences prior to becoming homeless. These experiences are placed into the categories of: the pervasiveness of instability (especially in regards to family relationships, finances, and housing), having to grow up fast due to social and material conditions, experiences of looking for housing in stressed markets, and systems failures that resulted in a lack of autonomy. These results show that instability and systems failures are key contributors to Takatāpui/LGBTIQ+ people becoming homeless in Aotearoa New Zealand.

In low-and middle-income countries, many infants and children remain unregistered in both civil registration and healthcare records, limiting their access to essential rights-based services, including healthcare. A novel biometric registration prototype, applying a non-touch platform using smart phones and tablets to capture physical characteristics of infants and children for electronic registration, was tested in rural Mozambique. This study assessed acceptability and perceived barriers and facilitators to the usability of this biometric registration prototype in Manhiça district, southern Mozambique. The study followed a qualitative design consisting of 5 semi-structured interviews with healthcare providers, 7 focus group discussions with caregivers of infants aged between 0 and 5 years old, and 2 focus group discussions with data collectors involved in the implementation of the biometric registration pilot project. Data were thematically analysed. The results of this study show that there is wide acceptability of the biometric registration prototype among healthcare providers and caregivers. Participants were aware of the benefits of the biometric registration prototype. The perceived benefits included that the biometric registration prototype would solve the inefficiency of paper-based registration, and the perception of biometric registration as “healthcare norm”. Perceived potential barriers to the implementation of the biometric registration prototype included: myths and taboos, lack of information, lack of time, lack of father’s consent, and potential workload among healthcare providers. In conclusion, the biometric prototype was widely accepted due to its perceived usefulness. However, there is a need to address the perceived barriers, and involvement of children’s fathers and/or other relevant family members in the process of biometric registration.

The hog industry is the core industry in the field of agriculture and animal husbandry in China, which development is related to the improvement of people’s quality of life. The production of the hog industry has been restricted by environmental regulations, which needs to reduce costs and improve efficiency. Based on the data of 29 provinces from 2008 to 2019, this paper aims to use the stochastic frontier analysis method to calculate the cost efficiency of fattening pigs, sows, and piglets in three stages of pig production and focuses on the impact of environmental regulation policies on cost efficiency. The study found that the cost efficiency of fattening pigs, sows, and piglets in China were 0.77, 0.79, and 0.53, respectively, and the efficiency losses were 23%, 21%, and 47%, respectively. The impact of environmental regulation policies on the cost efficiency of fattening pigs showed an ’ N ’ trend, and the impact on the cost efficiency of sows and piglets showed an inverted ’ N ’ trend. For fattening pigs, increasing the intensity of environmental regulation, and exceeding the second inflection point of the ’ N ’ curve can achieve the dual goals of environmental governance and cost reduction and efficiency increase. For sows, reducing the intensity of environmental regulation appropriately can avoid cost-efficiency loss. For piglets, environmental regulation policies have not effectively incentives the cost efficiency of piglets. In addition, raising the level of technology investment in fattening pigs and sows can achieve cost efficiency gains, and can farmers use emerging financial product tools such as ’ insurance + futures ’ to avoid market risks and efficiency losses.

The importance of implementing new methodologies to study the ever-increasing amount of Covid-19 data is apparent. The aftermath analysis of these data could inform us on how specific political decisions influenced the dynamics of the pandemic outbreak. In this paper we use the Italian outbreak as a case study, to study six different Covid indicators collected in twenty Italian regions. We define a new object, the Covidome, to investigate the network of functional Covid interactions between regions. We analyzed the Italian Covidome over the course of 2020, and found that Covid connectivity between regions follows a sharp North-South community gradient. Furthermore, we explored the Covidome dynamics and individuated differences in regional Covid connectivity between the first and second waves of the pandemic. These differences can be associated to the two different lockdown strategies adopted for the first and the second wave from the Italian government. Finally, we explored to what extent Covid connectivity was associated with the Italian geographical network, and found that Central regions were more tied to the structural constraints than Northern or Southern regions in the spread of the virus. We hope that this approach will be useful in gaining new insights on how political choices shaped Covid dynamics across nations.

Earlier findings suggest that men with daughters make judgments and decisions somewhat in line with those made by women. In this paper, we attempt to extend those findings, by testing how gender and parenting daughters affect judgments of the appropriateness of investing in and working for morally controversial companies (“sin stocks”). To do so, in Study 1 (N = 634) we investigate whether women judge the prospect of investing in sin stocks more harshly than men do, and test the hypothesis that men with daughters judge such investments less favorably than other men. In Study 2 (N = 782), we investigate the willingness to work in morally controversial companies at a significant wage premium. Results show that—for men—parenting daughters yields harsher evaluations of sin stocks, but no evidence that it lowers the propensity to work in such companies. This contrasts to the effect of gender: women reliably judge both investment and employment in morally controversial companies more harshly than men do. We suggest that an aversion towards morally controversial companies might be a partial determinant of the gender gap in wages.

The COVID-19 pandemic has been particularly threatening to patients with end-stage kidney disease (ESKD) on intermittent hemodialysis and their care providers. Hemodialysis patients who receive life-sustaining medical therapy in healthcare settings, face unique challenges as they need to be at a dialysis unit three or more times a week, where they are confined to specific settings and tended to by dialysis nurses and staff with physical interaction and in close proximity. Despite the importance and critical situation of the dialysis units, modelling studies of the SARS-CoV-2 spread in these settings are very limited. In this paper, we have used a combination of discrete event and agent-based simulation models, to study the operations of a typical large dialysis unit and generate contact matrices to examine outbreak scenarios. We present the details of the contact matrix generation process and demonstrate how the simulation calculates a micro-scale contact matrix comprising the number and duration of contacts at a micro-scale time step. We have used the contacts matrix in an agent-based model to predict disease transmission under different scenarios. The results show that micro-simulation can be used to estimate contact matrices, which can be used effectively for disease modelling in dialysis and similar settings.

As a part of a larger qualitative study to understand HIV-risk factors and impacts on people living with HIV (PLHIV) (52 women and 40 men) in Belu and Yogyakarta, Indonesia, this paper reports the influences of cultural practices and religious beliefs on sexual relationships and behaviours of participants as contributors for HIV transmission. This study was conducted from June to December 2020. Data collection was conducted using one-one-one in-depth interviews. Participants were recruited using the snowball sampling technique. Data analysis was guided by a qualitative data analysis framework. The findings showed that cultural practices in Belu related to the use of bride wealth, managing spousal disputes, marriage, and condom use, influenced spousal relationships and sexual behaviours or practices which contributed to HIV transmission. Javanese cultural practices and expectation of an ‘ideal wife’, Islamic religious beliefs about expected husband-wife relationships, forbidden premarital sex, and the participants’ individual interpretation of their religious beliefs about condom use spousal sexual relations, also influenced spousal sexual relations and behaviours, which supported HIV transmission among the participants. The findings indicate the need for HIV education programs that address cultural practices and religious beliefs for community members and population groups to enhance their understanding about HIV, condom use, and how cultural practices and religious beliefs play a role in HIV transmission. The findings also indicate the need for involvement of religious leaders in HIV education programs to bring insights to people and help them interpret their religious beliefs in health promoting ways. Future studies that explore different aspects of culture and religion which may contribute to HIV transmission are recommended.

BackgroundIn the United States, underserved communities including Blacks and Latinx are disproportionately affected by COVID-19, and widespread vaccination is critical for curbing this pandemic. This study sought to estimate the prevalence of COVID-19 vaccine hesitancy, describe attitudes related to vaccination, and identify correlates among racial minority and marginalized populations across 9 counties in North Carolina.MethodsWe conducted a cross-sectional survey with a self-administered questionnaire distributed at free COVID-19 testing events in underserved rural and urban communities from August 27 – December 15, 2020. Vaccine hesitancy was defined as the response of “no” or “don’t know/not sure” to whether the participant would get the COVID-19 vaccine as soon as it became available.ResultsThe sample comprised 948 participants including 27.7% Whites, 59.6% Blacks, 12.7% Latinx, and 63% female. Thirty-two percent earned ConclusionsThis study reached underserved minority populations in a number of different locations to investigate COVID-19 vaccine hesitancy. We built on existing relationships and further engaged the community, stake holders and health department to provide free COVID-19 testing. This direct approach permitted assessment of vaccine hesitancy (which was much higher than national estimates), distrust, and safety concerns.HighlightsThis study surveyed 948 adults at COVID-19 testing sites in 9 counties of North Carolina between August 27 and December 15, 2020 where vaccine hesitancy was widespread including 74% in Blacks, 62.7% in Whites and 59.5% in Latinx.Vaccine hesitancy declined over time but remained high for Blacks.On-site surveys conducted in underserved areas that were paper-based and self-administered permitted reaching adults with no internet (17%), no cell phone (20%), no computer (40%) and yearly incomes less than 20K (31%).Widespread vaccine hesitancy in predominately minority communities of NC must be addressed to successfully implement mass COVID-19 vaccination programs.

IntroductionViolence against medical staff has been prevalent in China over the past two decades. Although Chinese authorities have released many laws and regulations to protect medical staff from violence since 2011, the legal approach alone is unlikely to resolve this complex issue. In particular, several cases of violence against medical staff in China have caused great media sensation.MethodThis paper proposes an integrated model that combines the environmental stimuli theory, broken windows theory, and rational choice theory. It adopts the fuzzy set qualitative comparative analysis (fsQCA) to untangle the causal relationship between violence against medical staff, media sensation, and judicial judgment. We examined reports of medical violence on media and news websites from January 1, 2010, to January 31, 2020, and selected 50 cases with detailed information for this study.ResultsThe results show that each condition is not sufficient for the absence ofjudicial judgment, but when combined, they are conducive to the outcome. The conditions ofhospital level,medical cost, andmedia sensationplay important roles. The providers, patients, and environmental factors are indicators of inadequate or lack ofjudicial judgment, which corresponds to previous expectations.ConclusionsThe integrated model greatly enriches the extant theories and literature, and also yields implications for preventing violence against medical staff in China. We suggest that sustainable and innovative healthcare reform should be initiated. For example, public hospitals should remain the cornerstone of national public health security. Medical staff in public hospitals must be regarded as “civil servants”. Therefore, the current legal system should be improved. The media should objectively report events concerning medical staff and improve public healthcare knowledge.

This paper examines the impact of rural e-commerce development on rural households’ digital credit behavior at the micro-level by using a multivariate Probit model and propensity score matching method with rural residents in the China Family Panel Studies (CFPS) database. Specifically, we examine the complementary or substitution relationship between digital credit and traditional bank credit and the impact of participation in e-commerce on the scale of digital credit of rural households. The empirical results show that there is a substitution relationship between digital credit and traditional bank credit. Participation in e-commerce has a positive impact on the scale of digital credit and the full scale of credit obtained by farmers, with an increase of $0.922 million and $37.49 million in the scale of digital credit and real credit received by farmers who participate in e-commerce, respectively, compared with those who do not participate in e-commerce. Further tests revealed that the difference in capital endowment was an essential reason for the disparity in the size of digital credit received among e-commerce farmers.

Data Availability: All relevant data are within the paper and its Supporting information files. Copyright: © 2021 Kueh et al. Background: This study examined the psychometric properties of the Korean and Malay version of the decisional balance (DB) for exercise (i.e. perceived benefits and perceived barriers) using a cross-sectional design. Also, this study assessed the measurement and structural invariance of the DB scale across countries. Methods: A cross sectional study was conducted in Malaysia and Korea. The study sample consisted of 574 Korean participants and 562 Malaysian participants. The mean age of the participants was 19.8 (SD = 1.29) for the Korean sample and 19.8 (SD = 1.22) for the Malaysian sample. Participants were invited to complete the DB scale with the 10-item and two factors (i.e., perceived benefit and perceived barriers). Confirmatory factor analysis (CFA) and invariance test were conducted on the data by using Mplus 8.3. Results: The CFA results based on the hypothesised measurement model of two factors and ten items showed sufficient construct validity after adding residual covariance between items within the same factor: CFI = 0.979, TLI = 0.970, SRMR = 0.036, RMSEA = 0.036 for the Korea sample, and CFI = 0.964, TLI = 0.949, SRMR = 0.055, RMSEA = 0.066 for the Malay sample. For the Korea sample, the construct reliability was 0.62 and 0.74 for perceived benefits and perceived barriers respectively. For the Malay sample, the construct reliability was 0.75 and 0.77 for perceived benefits and perceived barriers respectively. The findings presented evidence for measurement and structural invariance of the DB scale for the Korea and Malaysia samples. Conclusion: The DB scale was a valid and reliable measure for assessing exercise behaviour and for making comparisons between Korean and Malaysian samples. Ministry of Education of the Republic of Korea, the National Research Foundation of Korea (NRF-2020S1A5A2A03041894); Fundamental Research Grant Scheme of the Ministry of Higher Education, Malaysia (203.PPSP.6171274).