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The medical care sector is viewed as having a high level of risk, and the provision of health services is considered particularly dangerous. Aim: The purpose of this study was to evaluate how patients perceive the elements that contribute to accessing quality medical services. Material and methods: To assess the attitude and knowledge of the population regarding infection control in dental clinics, we initiated a questionnaire-based study with 25 questions involving 75 patients who presented for dental treatments at two private clinics in Iași. The response rate was 96%. Results: 27% of patients discussed with the dentist about the risk of illness through blood-borne diseases during dental treatments. 65.5% of the subjects affirm that a dentist infected with HIV can provide dental treatments under the conditions of using protective equipment. All consider gloves, masks, and caps to be indispensable for the doctor when providing treatment. 87.6% of them consider that the nurse can be involved in the transmission of diseases.The main practices considered important by patients in preventing illness are the sterilization of instruments (100%) and the doctor washing their hands (86.2%), and to a lesser extent, waste handling (47.5%) and surface disinfection (100%). Conclusion: Patients have a relatively good perception regarding the factors that can influence the safety of the medical act in dental practice. The medical team has the responsibility to inform the patient in order to reduce the risk of unpleasant events occurring in the dental office.

Changing old habits and adopting new behaviors can be challenging and requires perseverance and motivation. For this reason, the study aimed to determine oral health behaviors among young adults. MATERIALS AND METHODS: The study group consisted of 129 students from “Grigore T. Popa” University in Iași, during the period of February 2023 to March 2023. The questionnaire method was used, specifically the Health-Promoting Lifestyle Profile II – HPLP II and the Generalized Self-Efficacy Scale. RESULTS: The students showed a moderate tendency to change in almost all areas assessed by the HPLP II questionnaire. For the “interpersonal relationships” domain, the average score of 2.74 indicated a strong desire for change. The GSE score α is 28.47, indicating a moderate to high confidence in dealing with challenging situations. CONCLUSIONS: The message of promoting health-promoting behavior is perceived positively, thus reducing behavioral barriers and promoting the prompt adoption of correct behavior.

Fire incidents are a problem of major importance for cities, as they affect the lives of a large population and produce significant material damages. Assessing the temporal and spatial distribution of fires is an important stage in order to efficiently manage this issue. Using a comprehensive database for a five year period, the present study tries to identify certain patterns and specificities by analyzing the occurrence of urban fires, grouped by their main causes and damages, at different time scale and integrating the information from street level to urban district and, finally, at city level. The spatial distribution of the number of fires follows the center-periphery model, overlapping the neighborhoods with multiple functions (residential, administrative and cultural). The industrial area also concentrates a bigger number of fires, these brownfields being used by homeless population which make use of garbage as fire material. Applying the location quotient was an opportunity to highlight cross-scale the concentration of fires and revealed that the neighborhoods located at the periphery are more vulnerable to fires. The results can be used for further, more comprehensive studies of urban fire risk assessment and can also became the basis for (re)configuring the emergency services, in particular, and urban planning, in general.

Leather is one of the most globally spread biomaterial which is obtained by the processing of different animal skins. It encompasses a wide palette of applications, from footwear and clothing to upholsteries and different types of furniture [1], [2], [3]. The main constituent of animal skins is collagen, a supramolecular fibrillar protein in the form of a triple helix. This form endows leather with elasticity, good mechanical properties and softness. A major disadvantage resides in the inapplicability of raw animal hides, due to their microbiological instability and decay through rotting. Microbiological stability is obtained through the tanning process, characterized by protein crosslinking and drying afterwards. After tanning the leather exhibits the required properties for the desired specific applications in terms of aspect, availability and sustainability [4], [5]. The study aims to elucidate the thermal decomposition process of chrome-free tanned bovine hide (wet-white) using a new product based on titanium and aluminium salts compared with the same hide tanned by chromium salts (wet-blue). The thermal behavior was studied by dynamic thermogravimetry in nitrogen atmosphere, up to 700 oC. A comparative thermal decomposition study between the different tanned bovine leathers was undertaken.

Leather is a high tech material with different application fields, such as automotive, manufacturing of leatherwear articles or clothing and footwear. Leather is a biomaterial obtained by processing animal skins. Unfortunately, raw animal hides are practically inutilizable, due to their microbiological instability and are affected by rotting. Microbiological stability is achieved by tanning, when the protein is crosslinked, followed by drying. After crosslinking and drying, the new material shows the required properties of sustainability, availability and an esthetically pleasing aspect to the touch, making it available across its entire range of applications. From a structural point of view the animal skins are constituted of collagen, which is a fibrilar protein with a high degree of supramolecular organization in triple helix form that endows softness, elasticity and mechanical strength. High quality standards and lack of toxicity are required in all cases. Leather colour changes during exposure to light radiations are considered a consequence of the presence of some products with weak photochemical resistance during fabrication. The study aims to compare changes in properties of leathers obtained using mineral tanning agents such as Cr III salts and those obtained with the more environment-friendly technology using acid hydrolysis. Accelerated aging studies were conducted on tanned leathers by exposing the samples to UV radiation with different irradiation doses and two wavelengths (254 and 365 nm) under controlled humidity and temperature conditions. Structural changes caused by irradiation were studied by FTIR. Colour changes on the sample surfaces were assessed during irradiation with the CIEL a*b* system. The colour parameters variation (L*, a*, b*) and colour differences have been discussed in correlation with structural changes, tanning method and irradiation conditions.

Reactive dyes are synthetic organic compounds used on a wide scale in textile industry, for painting materials of different types and compositions (e.g. 100% cotton, wool, natural satin, viscose, synthetic fibres). Reactive dyes are solid compounds (powders) completely water soluble at normal temperature and pressure conditions. Their structures contain chromophore groups, which generate colour, and auxochrome groups, which determine the compounds water solubility and the capacity to fix to the textile fiber. Such organic compounds absorb UV-Vis radiations at specific wavelengths, corresponding to maximum absorbtion peaks, in both solution and dyed fiber. The human organism, through the dyed clothing, comes in direct contact with those dyes which can undergo modifications once exposed to UV radiations, having the posibility to reach the organism via cutanated transport. As it is known, the provoked negative effects are stronger during summer when UV radiations are more intense and in order to reduce their intensity dark coloured clothing is avoided. Dyes can be transformed in compounds which are easily absorbed into the skin. Some of these metabolites can be less toxic than the original corresponding dye, whilst others, such as free radicals, are potentially cancerous. Knowledge of the biological effects of the organic dyes, reactive dyes in particular, correlated with their structural and physical characteristics, permanently consists an issue of high scientific and practical interest and its solution may contribute in the diminishing of risk factors and improving of population health. UV radiation influence on the structural and colour modifications of textile materials were studied. Colour modifications are due to structural changes in aromatic and carbonil groups. In most cases photo-oxidative processes were identified in the dye structure. Dyeing was performed using non-irradiated and irradiated cotton painted with reactive blue dye 204.

In today's move to "sustainable production" the leather industry, as well as many other industries is recognized as a polluting one. Traditional chemical operations are polluting because of the levels of inorganic chemical waste. Process chemicals which are not consumed within the reactions necessary to convert collagen to leather are currently discharged to waste. These are usually applied during bulk production, such as inorganic agents from beam house and tanning processes, e.g. lime, sulphide, ammonium salts, sulphuric acid and sodium chloride, mineral tanning agents – mainly Cr(III) and the less common Al(III), Zr(III), Ti(III), Fe(III) salts -, whereas depending on the tanning process and the leather article produced organic chemical waste discharged comprises aldehydic and polyphenolic tanning products, bating enzymes, organic carboxylic acids and excess electrolyte stable synthetic fat liquors. It is rare for chemicals and water to be recovered for re-use from several of these process steps. Moreover, tanners worldwide are required to operate within strict legislative boundaries. Serious drawbacks continuously arise concerning the chrome–tanning process in leather industry and the environmental hazardous consequences of chromium containing effluents. In order to overcome this impediment, a great deal of research has been focused on developing chrome–free tanning methods in the past years, such as titanium tanning. In the present study, Ti–Al tanned bovine leather was characterized by means of SEM microscopy, EDAX elemental analysis, ATR–FTIR spectroscopy, thermogravimetry TGA, and differential scanning calorimetry DSC techniques.

Textile dyes have been reported of causing various stages of contact dermatitis. Reactive dyes are widely applied in dyeing cellulose fiber based textiles (100% cotton), skin fibers (hemp, flax), regenerated cellulose (cellulose acetate, viscose), protein fibers (natural silk, wool). The human body comes in contact daily with such compounds. This aspect is important for elucidating their biological effects on the human body, in correlation with physico-chemical properties. Dyes are chemical compounds containing chromophore and auxochrome groups. Authors herein report results concerning the influence of UV irradiation with λ > 300 nm on the structure and properties of different colored textiles. Subjects to study were textiles painted with four azo-triazine based dyes which were exposed to 100 h UV irradiation time and irradiation dose values up to 3500 J cm-2. The five azo dyes were: reactive orange 13, reactive red 183, reactive yellow 143, reactive blue 204 and reactive red 2. Structural modifications as a result of irradiation were undertaken by UV-Vis spectroscopy. It was observed that during UV exposure there occurred partial dyes detachment from the textiles, accompanied by glucosidic units and dye photodecomposition by C–N bond scission and degradation of aromatic entities and azo based chromophores. Color modifications were also investigated. Color differences significantly increased with the irradiation dose for all the studied samples.

The uneven spatial distribution of basic facilities within urban areas is a major problem for developing countries like Senegal due to the emphasis of accessibility disparities and the use of this services. The efforts to quantify the problem and its consequences on people are constrained by the lack of satisfactory data and methods. The study seeks to examine the spatial accessibility to basic services (access to water, health, education, economic infrastructure and transportation services) in a very heterogeneous urban system and to highlight inequalities in access for improving the geographical accessibility and to ensure equity. The article explore the use of spatial analysis method (Closest Facility) to measure the potential accessibility to services and facilities in the city of Mbour. The analyses uses all the inhabited houses of the city as the potential demand. Results emphasis unequal access to basic urban services in the city and a center-periphery model with a high concentration of services around the city. The study demonstrates the utility of this method for the identification of disadvantaged areas, decision making and planning of basic services. It also provides paths for improving accessibility in urban areas with a high density of population.

Environmental issues and the reduction of fossil fuel resources will lead to the partial or total substitution of petroleum-based materials with natural, raw, renewable ones. One expanding domain is the obtaining of engineering materials from vegetable oils for sustainable, eco-friendly polymers for different applications. Herein, the authors propose a simplified and green synthesis pathway for a thermally curable, acrylated and epoxidized soybean oil matrix formulation containing only epoxidized soybean oil, acrylic acid, a reactive diluent (5%) and just 0.15 mL of catalyst. The small amount of reactive diluent significantly reduced the initial system viscosity while eliminating the need for adding solvent, hardener, activator, etc. Both the thermally cured composite with a 2% TiO 2 microparticle filler and its pristine matrix were comparably characterized in terms of structural, thermal, morphological, dielectric and wettability by Fourier transform infrared spectroscopy, differential scanning calorimetry, thermogravimetry, scanning electron microscopy, broadband dielectric spectrometry and contact angle measurements. The 2% filler in the composite generated superior thermal stability via lower mass loss (48.89% vs. 57.14%) and higher degradation temperatures (395 °C vs. 387 °C), increased the glass transition temperature from -20 °C to -10 °C, rendered the microcomposite hydrophobic by increasing the contact angle from 88° to 96° and enhanced dielectric properties compared to the pristine matrix. All investigations recommend the microcomposite for protective coatings, capacitors, sensors and electronic circuits. This study brings new contributions to green chemistry and sustainable materials., Competing Interests: The authors claim no conflicts of interest.

Background: The disability-adjusted life year (DALY), a key metric for health resource allocation, encompasses morbidity through disability weights. Widely used in tuberculosis cost-effectiveness analysis (CEAs), DALYs play a significant role in informing intervention adopt/reject decisions. This study reviews the values and consistency of disability weights applied in tuberculosis-related CEAs., Methods: We conducted a systematic review using the Tufts CEA database, updated to July 2023 with searches in Embase, Scopus and PubMed. Eligible studies needed to have included a cost-per-DALY ratio, and additionally either evaluated a tuberculosis (TB) intervention or included tuberculosis-related weights. We considered all tuberculosis health states: with/without human immunodeficiency virus (HIV) coinfection, TB treatments and treatment side effects. Data were screened and extracted independently by combinations of two authors., Findings: A total of 105 studies spanning 2002-2023 across 50 countries (mainly low- and middle-income countries) were extracted. Disability weights were sourced primarily from the Global Burden of Disease (GBD; 100/165; 61%), with 17 non-GBD studies additionally referenced, along with primary derivation. Inconsistencies in the utilisation of weights were evident: of the 100 usages of GBD-sourced weights, only in 47 instances (47%) had the weight value been explicitly specified with an appropriate up-to-date reference cited (constituting 28% of all weight usages, 47/165). Sensitivity analyses on weight values had been conducted in 30% of studies (31/105). Twelve studies did not clearly specify weights or their sources; nine further calculated DALYs without morbidity. The review suggests methodological gaps in current approaches for representing important aspects of TB, including TB-HIV coinfection, treatment, drug-resistance, extrapulmonary TB and psychological impacts. We propose a set of best practice recommendations., Interpretation: There is a need for increased rigour in the application, sensitivity testing and reporting of TB disability weights. Furthermore, there appears a desire among researchers to reflect elements of the tuberculosis experience beyond those allowed for by GBD disability weights., (© 2024. The Author(s).)

Background: The prevalence of multimorbidity (the presence of two or more chronic health conditions) is rapidly increasing in sub-Saharan Africa. Hospital care pathways that focus on single presenting complaints do not address this pressing problem. This has the potential to precipitate frequent hospital readmissions, increase health system and out-of-pocket expenses, and may lead to premature disability and death. We aim to present a description of inpatient multimorbidity in a multicentre prospective cohort study in Malawi and Tanzania., Primary Objectives: Clinical: Determine prevalence of multimorbid disease among adult medical admissions and measure patient outcomes. Health Economic: Measure economic costs incurred and changes in health-related quality of life (HRQoL) at 90 days post-admission. Situation analysis: Qualitatively describe pathways of patients with multimorbidity through the health system., Secondary Objectives: Clinical: Determine hospital readmission free survival and markers of disease control 90 days after admission. Health Economic: Present economic costs from patient and health system perspective, sub-analyse costs and HRQoL according to presence of different diseases. Situation analysis: Understand health literacy related to their own diseases and experience of care for patients with multimorbidity and their caregivers., Methods: This is a prospective longitudinal cohort study of adult (≥18 years) acute medical hospital admissions with nested health economic and situation analysis in four hospitals: 1) Queen Elizabeth Central Hospital, Blantyre, Malawi; 2) Chiradzulu District Hospital, Malawi; 3) Hai District Hospital, Boma Ng'ombe, Tanzania; 4) Muhimbili National Hospital, Dar-es-Salaam, Tanzania. Follow-up duration will be 90 days from hospital admission. We will use consecutive recruitment within 24 hours of emergency presentation and stratified recruitment across four sites. We will use point-of-care tests to refine estimates of disease pathology. We will conduct qualitative interviews with patients, caregivers, healthcare providers and policymakers; focus group discussions with patients and caregivers, and observations of hospital care pathways., Competing Interests: No competing interests were disclosed., (Copyright: © 2024 Spencer SA et al.)

In this study, the effects of three diamine curing agents (aromatic, cycloaliphatic, aliphatic) on the photochemical behavior of bisphenol A diglycidyl ether networks were comparatively examined. In order to monitor structural changes and study the curing agents' action mode, the cured epoxy resins were characterized before and after photoirradiation by means of Fourier-transform infrared spectroscopy, contact angle, differential scanning calorimetry, scanning electron microscopy, and energy-dispersive X-ray analysis, mass loss, and color modification measurements. Water absorption tests were also conducted. The cured epoxy resins are to be used in different multicomponent polymer materials for outdoor protection. The presence of the cycloaliphatic hardener led to reduced water absorption, and after UV irradiation, an increase in the glass transition temperature and lowest mass loss of the corresponding cured epoxy resin compared to the ones cured with aromatic and aliphatic hardener.

Background: In 2017, the WHO recommended the use of digital technologies, such as medication monitors and video observed treatment (VOT), for directly observed treatment (DOT) of drug-susceptible TB. The WHO's 2020 guidelines extended these recommendations to multidrug-resistant tuberculosis (MDR-TB), based on low evidence. The impact of COVID on health systems and patients underscored the need to use digital technologies in the management of MDR-TB., Methods: A decision-tree model was developed to explore the costs of several potential DOT alternatives: VOT, 99DOTS (Directly-observed Treatment, Short-course) and family-observed DOT. Assuming a 9-month, all-oral regimen (as evaluated within the STREAM trial), we constructed base-case cost models for the standard-of-care DOTs in Ethiopia, India, and Uganda, as well as for the three alternative DOT approaches. The models were populated with STREAM Stage 2 clinical trial outcome and cost data, supplemented with market prices data for the digital DOT strategies. Sensitivity analyses were conducted on key parameters., Results: Modelling suggested that the standard-of-care DOT approach is the most expensive DOT strategy from a societal perspective in all three countries evaluated (Ethiopia, India, Uganda), with considerable direct- and indirect-costs incurred by patients. The second most expensive DOT approach is VOT, with high health-system costs, largely caused by up-front technology expenditure. Each of VOT, 99DOTS and family-observed DOT would reduce by more than 90% patients' direct and indirect costs compared to standard of care DOT. Results were robust to the sensitivity analyses., Conclusions: While data on the costs and efficacy of alternative DOT approaches in the context of shorter MDR-TB treatment is limited, our modelling suggests alternative DOT approaches can significantly reduce patient costs in all three countries. Health system costs are higher for VOT and lower for 99DOTS and family-observed therapy when compared to standard of care DOT, as low smartphone penetration and internet availability requires the VOT health system to fund the cost of making them available to patients., (© 2023. The Author(s).)

Background: Larval Source Management (LSM) is an important tool for malaria vector control and is recommended by WHO as a supplementary vector control measure. LSM has contributed in many successful attempts to eliminate the disease across the Globe. However, this approach is typically labour-intensive, largely due to the difficulties in locating and mapping potential malarial mosquito breeding sites. Previous studies have demonstrated the potential for drone imaging technology to map malaria vector breeding sites. However, key questions remain unanswered related to the use and cost of this technology within operational vector control., Methods: Using Zanzibar (United Republic of Tanzania) as a demonstration site, a protocol was collaboratively designed that employs drones and smartphones for supporting operational LSM, termed the Spatial Intelligence System (SIS). SIS was evaluated over a four-month LSM programme by comparing key mapping accuracy indicators and relative costs (both mapping costs and intervention costs) against conventional ground-based methods. Additionally, malaria case incidence was compared between the SIS and conventional study areas, including an estimation of the incremental cost-effectiveness of switching from conventional to SIS larviciding., Results: The results demonstrate that the SIS approach is significantly more accurate than a conventional approach for mapping potential breeding sites: mean % correct per site: SIS = 60% (95% CI 32-88%, p = 0.02), conventional = 18% (95% CI - 3-39%). Whilst SIS cost more in the start-up phase, overall annualized costs were similar to the conventional approach, with a simulated cost per person protected per year of $3.69 ($0.32 to $15.12) for conventional and $3.94 ($0.342 to $16.27) for SIS larviciding. The main economic benefits were reduced labour costs associated with SIS in the pre-intervention baseline mapping of habitats. There was no difference in malaria case incidence between the three arms. Cost effectiveness analysis showed that SIS is likely to provide similar health benefits at similar costs compared to the conventional arm., Conclusions: The use of drones and smartphones provides an improved means of mapping breeding sites for use in operational LSM. Furthermore, deploying this technology does not appear to be more costly than a conventional ground-based approach and, as such, may represent an important tool for Malaria Control Programmes that plan to implement LSM., (© 2023. The Author(s).)

Background: Patient and health system costs for treating multidrug-resistant tuberculosis (MDR-TB) remain high even after treatment duration was shortened. Many patients do not finish treatment, contributing to increased transmission and antimicrobial resistance. A restructure of health services, that is more patient-centred has the potential to reduce costs and increase trust and patient satisfaction. The aim of the study is to investigate how costs would change in the delivery of MDR-TB care in Ethiopia under patient-centred and hybrid approaches compared to the current standard-of-care., Methods: We used published data, collected from 2017 to 2020 as part of the Standard Treatment Regimen of Anti-Tuberculosis Drugs for Patients with MDR-TB (STREAM) trial, to populate a discrete event simulation (DES) model. The model was developed to represent the key characteristics of patients' clinical pathways following each of the three treatment delivery strategies. To the pathways of 1000 patients generated by the DES model we applied relevant patient cost data derived from the STREAM trial. Costs are calculated for treating patients using a 9-month MDR-TB treatment and are presented in 2021 United States dollars (USD)., Results: The patient-centred and hybrid strategies are less costly than the standard-of-care, from both a health system (by USD 219 for patient-centred and USD 276 for the hybrid strategy) and patient perspective when patients do not have a guardian (by USD 389 for patient-centred and USD 152 for the hybrid strategy). Changes in indirect costs, staff costs, transport costs, inpatient stay costs or changes in directly-observed-treatment frequency or hospitalisation duration for standard-of-care did not change our results., Conclusion: Our findings show that patient-centred and hybrid strategies for delivering MDR-TB treatment cost less than standard-of-care and provide critical evidence that there is scope for such strategies to be implemented in routine care. These results should be used inform country-level decisions on how MDR-TB is delivered and also the design of future implementation trials., (© 2023. The Author(s).)

Background: The STREAM stage 2 trial assessed two bedaquiline-containing regimens for rifampicin-resistant tuberculosis: a 9-month all-oral regimen and a 6-month regimen containing an injectable drug for the first 2 months. We did a within-trial economic evaluation of these regimens., Methods: STREAM stage 2 was an international, phase 3, non-inferiority randomised trial in which participants with rifampicin-resistant tuberculosis were randomly assigned (1:2:2:2) to the 2011 WHO regimen (terminated early), a 9-month injectable-containing regimen (control regimen), a 9-month all-oral regimen with bedaquiline (oral regimen), or a 6-month regimen with bedaquiline and an injectable for the first 2 months (6-month regimen). We prospectively collected direct and indirect costs and health-related quality of life data from trial participants until week 76 of follow-up. Cost-effectiveness of the oral and 6-month regimens versus control was estimated in four countries (oral regimen) and two countries (6-month regimen), using health-related quality of life for cost-utility analysis and trial efficacy for cost-effectiveness analysis. This trial is registered with ISRCTN, ISRCTN18148631., Findings: 300 participants were included in the economic analyses (Ethiopia, 61; India, 142; Moldova, 51; Uganda, 46). In the cost-utility analysis, the oral regimen was not cost-effective in Ethiopia, India, Moldova, and Uganda from either a provider or societal perspective. In Moldova, the oral regimen was dominant from a societal perspective. In the cost-effectiveness analysis, the oral regimen was likely to be cost-effective from a provider perspective at willingness-to-pay thresholds per additional favourable outcome of more than US$4500 in Ethiopia, $1900 in India, $3950 in Moldova, and $7900 in Uganda, and from a societal perspective at thresholds of more than $15 900 in Ethiopia, $3150 in India, and $4350 in Uganda, while in Moldova the oral regimen was dominant. In Ethiopia and India, the 6-month regimen would cost tuberculosis programmes and participants less than the control regimen and was highly likely to be cost-effective in both cost-utility analysis and cost-effectiveness analysis. Reducing the bedaquiline price from $1·81 to $1·00 per tablet made the oral regimen cost-effective in the provider-perspective cost-utility analysis in India and Moldova and dominate over the control regimen in the provider-perspective cost-effectiveness analysis in India., Interpretation: At current costs, the oral bedaquiline-containing regimen for rifampicin-resistant tuberculosis is unlikely to be cost-effective in many low-income and middle-income countries. The 6-month regimen represents a cost-effective alternative if injectable use for 2 months is acceptable., Funding: USAID and Janssen Research & Development., Competing Interests: Declaration of interests LR reports consulting fees from GSK (paid to institution) and support for attending trial-related meetings from Janssen Research & Development and the US Agency for International Development (USAID; paid to institution). JJM reports support for attending meetings or travel from the Liverpool School of Tropical Medicine. EMT reports consulting fees from GSK (paid to institution) and support for attending meetings from USAID (paid to institution). MM, PB, RD, GN, AKBh, BK, SKM, AJN, GB, IDR, and EW report support for attending trial-related meetings from Janssen Research & Development and USAID (paid to institution). ET reports support for attending meetings from USAID (paid to institution). SBS reports a research grant on tuberculosis research (paid to institution) from the UK Foreign & Commonwealth Development Office, support for attending trial-related meetings from Janssen Research & Development and USAID (paid to institution), and is co-chair of the Scientific Working Group on Implementation Research for the Tropical Disease Research Foundation (unpaid). All other authors declare no competing interests., (Copyright © 2023 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

Background: The growing urban population imposes additional challenges for health systems in low- and middle-income countries (LMICs). We explored the economic burden and inequities in healthcare utilisation across slum, non-slum and levels of wealth among urban residents in LMICs., Methods: This scoping review presents a narrative synthesis and descriptive analysis of studies conducted in urban areas of LMICs. We categorised studies as conducted only in slums, city-wide studies with measures of wealth and conducted in both slums and non-slums settlements. We estimated the mean costs of accessing healthcare, the incidence of catastrophic health expenditures (CHE) and the progressiveness and equity of health expenditures. The definitions of slums used in the studies were mapped against the 2018 UN-Habitat definition. We developed an evidence map to identify research gaps on the economics of healthcare access in LMICs., Results: We identified 64 studies for inclusion, the majority of which were from South-East Asia (59%) and classified as city-wide (58%). We found severe economic burden across health conditions, wealth quintiles and study types. Compared with city-wide studies, slum studies reported higher direct costs of accessing health care for acute conditions and lower costs for chronic and unspecified health conditions. Healthcare expenditures for chronic conditions were highest amongst the richest wealth quintiles for slum studies and more equally distributed across all wealth quintiles for city-wide studies. The incidence of CHE was similar across all wealth quintiles in slum studies and concentrated among the poorest residents in city-wide studies. None of the definitions of slums used covered all characteristics proposed by UN-Habitat. The evidence map showed that city-wide studies, studies conducted in India and studies on unspecified health conditions dominated the current evidence on the economics of healthcare access. Most of the evidence was classified as poor quality., Conclusions: Our findings indicated that city-wide and slums residents have different expenditure patterns when accessing healthcare. Financial protection schemes must consider the complexity of healthcare provision in the urban context. Further research is needed to understand the causes of inequities in healthcare expenditure in rapidly expanding and evolving cities in LMICs., (© 2022. The Author(s).)

Due to their highly reactive character and multiple crosslinking capacity, epoxy resins are one of the worldwide market-dominating classes of thermosetting polymers and are present in a wide range of technical applications, including structural adhesives, coatings and polymer matrices for composite materials. Despite their excellent features, epoxy resins are known to be highly flammable and possess low thermal stability and a brittle character and crack easily under impact forces. An efficient approach towards eliminating such drawbacks resides in obtaining epoxy-based semi-interpenetrating polymer networks, which possess excellent control over the morphology. The article describes the comparative effect of three hardeners (aromatic, cycloaliphatic and aliphatic) in the presence of an oligophosphonate (-R-O-PO(C 6 H 5 )-O-) (2 wt.% phosphorus) on the photochemical, fire and antifungal performance of bisphenol A diglycidyl ether semi-interpenetrating polymer networks. The networks are designed as future potential outdoor protective coatings for different substrates. The fire resistance capacity of the networks was undertaken with microscale combustion calorimetry before and after photochemical aging. Structural changes during photoirradiation were monitored via color modification studies, Fourier-transform infrared spectroscopy, differential scanning calorimetry, morphological assessment through scanning electron microscopy and mass loss measurements in order to propose the action mode of the hardeners and the oligophosphonate on the material properties. Microbiological testing was also undertaken with the aid of three specific wood decaying fungi as a first substrate.

Background: There is growing awareness of the burden of post-TB morbidity, and its impact on the lives and livelihoods of TB affected households. However little work has been done to determine how post-TB care might be delivered in a feasible and sustainable way, within existing National TB Programmes (NTPs) and health systems, in low-resource, high TB-burden settings. In this programme of stakeholder engagement around post-TB care, we identified actors with influence and interest in TB care in Kenya and Malawi, including TB-survivors, healthcare providers, policy-makers, researchers and funders, and explored their perspectives on post-TB morbidity and care., Methods: Stakeholder mapping was completed to identify actors with interest and influence in TB care services in each country, informed by the study team's local, regional and international networks. Key international TB organisations were included to provide a global perspective. In person or online one-to-one interviews were completed with purposively selected stakeholders. Snowballing was used to expand the network. Data were recorded, transcribed and translated, and a coding frame was derived. Data were coded using NVivo 12 software and were analysed using thematic content analysis. Online workshops were held with stakeholders from Kenya and Malawi to explore areas of uncertainty and validate findings., Results: The importance of holistic care for TB patients, which addresses both TB comorbidities and sequelae, was widely recognised by stakeholders. Key challenges to implementation include uncertainty around the burden of post-TB morbidity, leadership of post-TB services, funding constraints, staff and equipment limitations, and the need for improved integration between national TB and non-communicable disease (NCD) programmes for care provision and oversight. There is a need for local data on the burden and distribution of morbidity, evidence-informed clinical guidelines, and pilot data on models of care. Opportunities to learn from existing HIV-NCD services were emphasised., Discussion: This work addresses important questions about the practical implementation of post-TB services in two African countries, exploring if, how, where, and for whom these services should be provided, according to a broad range of stakeholders. We have identified strong interest in the provision of holistic care for TB patients in Kenya and Malawi, and key evidence gaps which must be addressed to inform decision making by policy makers, TB programmes, and funders around investment in post-TB services. There is a need for pilot studies of models of integrated TB care, and for cross-learning between countries and from HIV-NCD services., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2022 Karanja et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: The potential of drones to support public health interventions, such as malaria vector control, is beginning to be realised. Although permissions from civil aviation authorities are often needed for drone operations, the communities over which they fly tend to be ignored: How do affected communities perceive drones? Is drone deployment accepted by communities? How should communities be engaged?, Methods: An initiative in Zanzibar, United Republic of Tanzania is using drones to map malarial mosqutio breeding sites for targeting larval source management interventions. A community engagement framework was developed, based on participatory research, across three communities where drones will be deployed, to map local perceptions of drone use. Costs associated with this exercise were collated., Results: A total of 778 participants took part in the study spanning a range of community and stakeholder groups. Overall there was a high level of acceptance and trust in drone use for public health research purposes. Despite this level of trust for drone operations this support was conditional: There was a strong desire for pre-deployment information across all stakeholder groups and regular updates of this information to be given about drone activities, as well as consent from community level governance. The cost of the perception study and resulting engagement strategy was US$24,411., Conclusions: Mapping and responding to community perceptions should be a pre-requisite for drone activity in all public health applications and requires funding. The findings made in this study were used to design a community engagement plan providing a simple but effective means of building and maintaining trust and acceptability. We recommend this an essential investment., Competing Interests: The authors have no competing interests to declare., (© 2022 The Authors.)

The paper describes the photochemical stability of a commercial triphenodioxazine dye (Reactive Blue_204) linked onto a cotton fabric. Preliminary studies have shown that as a result of irradiation, the dye and its photodegradation products can pass directly onto the skin under conditions that mimic human perspiration and cause side-effects. The cotton dyed fabric was photo irradiated at different time intervals. Standard methods were employed to evaluate the color strength at various levels of pH, temperature, dyeing contact time, and salt concentration. The influence of UV radiation at different doses (λ > 300 nm) on the structural and color modifications of the dyed cotton fabrics was studied. Structural modifications before and after irradiation were compared by applying FTIR, UV-Vis, and near infrared chemical imaging (NIR-CI) techniques. Color modifications were investigated with the CIELAB system. Color differences significantly increased with the irradiation dose. High irradiation doses caused changes in the dye structure.

The aim of this study consists of monitoring the effect of thermal aging on the physico-chemical and optical properties of poly(ester urethane) elastomers designed as damping materials for railways. The materials were obtained by polyaddition in two stages in melt, resulting in regular structures. The structural modifications during the thermal aging of the samples were monitored using FTIR, color changes, TGA in non-isothermal and isothermal conditions, DSC and physico-mechanical measurements. The structural regularity of the rigid and flexible segments maintained the good mechanical properties of the structures up to 200 h of thermal aging at the elevated temperatures of 40 °C, 70 °C, 100 °C and 130 °C. It was observed that at 40 °C and low exposure times, changes occur mainly to the carbonyl groups of the soft segments. At higher temperatures and longer exposure times urethane groups were affected. Extended thermal aging led to significant changes in thermo-mechanical and optical properties.

Introduction: A December 2019 WHO rapid communication recommended the use of 9-month all-oral regimens for treating multidrug-resistant tuberculosis (MDR-TB). Besides the clinical benefits, they are thought to be less costly than the injectable-containing regimens, for both the patient and the health system. STREAM is the first randomised controlled trial with an economical evaluation to compare all-oral and injectable-containing 9-11-month MDR-TB treatment regimens., Methods and Analysis: Health system costs of delivering a 9-month injectable-containing regimen and a 9-month all-oral bedaquiline-containing regimen will be collected in Ethiopia, India, Moldova and Uganda, using 'bottom-up' and 'top-down' costing approaches. Patient costs will be collected using questionnaires that have been developed based on the STOP-TB questionnaire. The primary objective of the study is to estimate the cost utility of the two regimens, from a health system perspective. Secondary objectives include estimating the cost utility from a societal perspective as well as evaluating the cost-effectiveness of the regimens, using both health system and societal perspectives. The effect measure for the cost-utility analysis will be the quality-adjusted life years (QALY), while the effect measure for the cost-effectiveness analysis will be the efficacy outcome from the clinical trial., Ethics and Dissemination: The study has been evaluated and approved by the Ethics Advisory Group of the International Union Against Tuberculosis and Lung Disease and also approved by ethics committees in all participating countries. All participants have provided written informed consent. The results of the economic evaluation will be published in a peer-reviewed journal., Trial Registration Number: ISRCTN18148631., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY. Published by BMJ.)

Objective: To investigate cost changes for health systems and participants, resulting from switching to short treatment regimens for multidrug-resistant (MDR) tuberculosis., Methods: We compared the costs to health systems and participants of long (20 to 22 months) and short (9 to 11 months) MDR tuberculosis regimens in Ethiopia and South Africa. Cost data were collected from participants in the STREAM phase-III randomized controlled trial and we estimated health-system costs using bottom-up and top-down approaches. A cost-effectiveness analysis was performed by calculating the incremental cost per unfavourable outcome avoided., Findings: Health-care costs per participant in South Africa were 8340.7 United States dollars (US$) with the long and US$ 6618.0 with the short regimen; in Ethiopia, they were US$ 6096.6 and US$ 4552.3, respectively. The largest component of the saving was medication costs in South Africa (67%; US$ 1157.0 of total US$ 1722.8) and social support costs in Ethiopia (35%, US$ 545.2 of total US$ 1544.3). In Ethiopia, trial participants on the short regimen reported lower expenditure for supplementary food (mean reduction per participant: US$ 225.5) and increased working hours (i.e. 667 additional hours over 132 weeks). The probability that the short regimen was cost-effective was greater than 95% when the value placed on avoiding an unfavourable outcome was less than US$ 19 000 in Ethiopia and less than US$ 14 500 in South Africa., Conclusion: The short MDR tuberculosis treatment regimen was associated with a substantial reduction in health-system costs and a lower financial burden for participants., ((c) 2020 The authors; licensee World Health Organization.)

The study describes the curing and thermal behavior of a new castor oil maleic anhydride adduct/epoxy oils/5-Bromosalicylic acid coatings and their composites with wood. The epoxidized oils were flax and hemp. The kinetic parameters of the curing and thermal degradation processes were calculated. The resistance of the coated wood surfaces against Cladosporium cladosporioides , Aspergillus brasiliensis , and Penicillium chrysogenum was tested. Color changes, FT-IR and SEM were conducted before and after fungal attack. The decay resistance and color change of raw wood and wood treated samples against fungi was tested. Based on the color changes and according to ASTM D 2017, the decay resistance rating for covered samples was considered as "highly resistant". Chemical resistance and coating performance tests were also undertaken. The obtained results recommend the described materials for applications in wood protective coatings.

Studies highlight cumulative life stress as a significant predictor of accelerated cognitive aging. This study paired electrophysiological with behavioral measures to explore how cumulative stress affects attentional and maintenance processes underpinning working memory retention. We collected electroencephalographic recordings from 60 individuals (30 older, 30 younger) reporting high or low levels of cumulative stress during the performance of a spatial Sternberg task. We measured mid-occipital alpha (8-12 Hz) and frontal-midline theta (4-6 Hz) as indicators of attentional and maintenance processes. Older, high-stress participants' behavioral performance lay significantly below than that of younger adults and low-stress older individuals. Impaired task performance coincided with reduced event-related synchronization in alpha and theta frequency ranges during memory maintenance. Electrophysiological findings suggest that older adults' reduced performance results from a stress-related impact on their ability to retain a stimulus in working memory and inhibit extraneous information from interfering with maintenance. Our results demonstrate the wide-ranging impact of cumulative stress on cognitive health and provide insight into the functional mechanisms disrupted by its influence., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Surgical site infections (SSIs) determine an increase in hospitalization time and antibiotic therapy costs. The aim of this study was to identify the germs involved in SSIs in patients from the Clinical Emergency County Hospital of Craiova (SCJUC) and to assess their resistance to antimicrobials, with comparisons between surgical wards and the intensive care unit (ICU). The biological samples were subjected to classical bacteriological diagnostics. Antibiotic resistance was tested by disc diffusion. We used hierarchical clustering as a method to group the isolates based upon the antibiotic resistance profile. The most prevalent bacterial species isolated were Staphylococcus aureus (S. aureus; 50.72%), followed by Escherichia coli (E. coli; 17.22%) and Pseudomonas aeruginosa; 10.05%). In addition, at lower percentages, we isolated glucose-non-fermenting, Gram-negative bacteria and other Enterobacteriaceae. The antibiotic resistance varied greatly between species; the most resistant were the non-fermenting Gram‑negative rods. E. coli exhibited lower resistance to third generation cephalosporins, quinolones and carbapenems. By contrast, Klebsiella was resistant to many cephalosporins and penicillins, and to a certain extent to carbapenems due to carbapenemase production. The non-fermenting bacteria were highly resistant to antibiotics, but were generally sensitive to colistin. S. aureus was resistant to ceftriaxone (100%), penicillin (91.36%), amoxicillin/clavulanate (87.50%), amikacin (80.00%) and was sensitive to levofloxacin, doxycycline, gentamycin, tigecycline and teicoplanin. The Enterobacteriaceae resistance was only slightly higher in the ICU, particularly to carbapenems (imipenem, 31.20% in the ICU vs. 14.30% in the surgical wards; risk ratio = 2.182). As regards Staphylococcus species, but for non-fermenting bacteria, even if the median was almost the same, the antibiotic resistance index values were confined to the upper limit in the ICU. The data gathered from this study may help infection control teams to establish effective guidelines for antibiotic therapies in various surgical procedures, in order to minimize the risk of developing SSIs by the efficient application of the anti-infection armamentarium.

The effect of UV-visible light irradiation on the changes in color and chemical composition of the surfaces of Abies alba L. (fir, a softwood), non-modified and chemically modified, was studied. Chemical modification of the wood was performed by reaction with succinic anhydride in xylene at different concentration values. The wood samples were irradiated in air using a rotative device equipped with a middle pressure mercury lamp. Analysis of the color changes in wood surfaces during photo-degradation was carried out by measuring CIELAB parameters. Fourier transform infrared spectroscopy was used to study chemical changes caused by light irradiation. Irradiation modified physical and chemical characteristics of wood surfaces and resulted in rapid color changes, degradation of lignin and increased content of chromophoric groups on the wood surfaces. Color changes (DeltaE(ab)) correlate well with degradation of lignin., (2010 Elsevier B.V. All rights reserved.)

By using CBA/J mice as a source of effector cells and Yac-1 lymphoma line as "target" cells, the natural killer (NK) cell activity was assayed following both in vivo and in vitro immunomodulation [beta-interferon (IF), interleukin-1 (IL-1), indomethacin (IND), prostaglandin-E2 (PGE)]. Only IF/IND and IL-1/IND mixed in vivo led to a significant augmentation of NK cell activity. If exposed in vitro to IF or to IL-1, control group-derived spleen NK cells exhibited increased cytotoxic activity whereas PGE-exposure only was followed by a lower cytotoxic level as expressed both in % cytotoxicity curves and in lytic units 20%/10(7) effector cells. On the other hand, PGE seemed to activate the "nonspecific suppressor" (NSS) cell subset in its inhibitory effect about NK cells as tested in vitro in several NK/NSS cell mixtures at different ratios. IF, but not IL-1 diminished the NSS-cell-induced suppressive activity. Pre-exposure of NK/NSS cell mixtures to IF followed by PGE exposure, did not prevent PGE-dependent NSS cell activation.

By using CBA/J mice as responders and a murine fibroblast-like cell line spontaneously transformed in vitro (Swiss-12) as the material to be implanted, the development of tumours and the natural killer (NK) cell activity levels in the spleen were tested, respectively, in relation to the in vivo administration of several immunomodulators; i.e., beta-interferon (beta-IF), macrophage-derived interleukin-1 (IL-1), or indomethacin (IND), as a prostaglandin inhibitor. For each immunomodulating agent, two separate schemes of administration were used as follows: for 14 days, on alternate days, preceding the tumour cell implantation, or for 14 days, on alternate days, after tumour cell implantation. In both schemes, beta-IF was able to reduce the tumour size as well as to stimulate the NK cell cytotoxicity. On the other hand, only pre-treatment with IL-1 and only post-treatment with IND exhibited such an effect.