Building conceptual and methodological bridges between SSE's diversity, equity, and inclusion statement and educational actions in evolutionary biology

The field of evolutionary biology must bridge the gap between its diversity, equity, and inclusion (DEI) commitments and data-driven educational actions in the nation's undergraduate classrooms and degree programs. In this article, we discuss the urgent need for the adoption of equity frameworks and why they are centrally important to data-driven DEI efforts in evolutionary biology. We describe why equity indicators (e.g., measures) must be anchored in and aligned with equity frameworks. We introduce a specific equity framework for learning (the enhanced educational debt framework) and illustrate how it may be leveraged to document, interpret, and improve outcomes in evolutionary biology. We apply the equity framework and associated indicators to >3,500 students' first college-level experience with evolutionary biology at a public, 4-year institution in the Northeastern United States to demonstrate how these conceptual tools and empirical perspectives may be used by faculty, departments, and degree programs to better understand their roles in mitigating or perpetuating inequities. We end by discussing how this framework may be applied to a range of evolution concepts and courses in the educational hierarchy and used to help evolutionary biologists better understand the extent to which a core aspect of SSE's diversity statement is being realized.

Healthcare workforce equity for health equity: An overview of its importance for the level of primary health care

BACKGROUND

Healthcare workforce crises often stem from healthcare workers' inequities. This study provides an overview of the main PHC workforce policy questions related to health equity, offering examples of evidence necessary to support the implementation of policies and strategies that increase equity in the health workforce and access to the PHC workforce and services.

METHODS

The equity-related policies in PHC and workforce were linked with the indicators listed in the Global Health Workforce Network Data and Evidence Hub and guidelines for health workforce management.

RESULTS

The policy-relevant questions in PHC cover many workforce issues such as the optimal size, equitable distribution, relevant competencies to ensure equitable healthcare access, and equitable approaches for retention, training, recruitment, benefits and incentive schemes and governance. This will require intersectionality evidence of the optimised staffing to PHC workload, that PHC practitioners' training demonstrates evidence-based knowledge aligned with locally relevant expertise.

CONCLUSION

Critical for equitable PHC access and health equity is the establishment of efficient measurement of PHC workforce equity and its implications for population health. Using indicators that measure health and workforce equity in research, policy, and practices may improve recruitment and retention, and respond more effectively to the PHC workforce crises.

Length of Hospitalization and Mortality among Stroke Patients before and after the Implementation of a Specialized Unit: A Retrospective Cohort Study Using Real-World Data from One Reference Hospital in Southern Brazil

Stroke constitutes a significant global cause of mortality and disability. The implementation of stroke units influences hospital quality indicators, guiding care management. We aimed to compare hospital length of stay (LOS), in-hospital mortality, and post-discharge mortality between stroke patients admitted in the pre- and post-implementation periods of a stroke unit in a public hospital in southern Brazil. This retrospective cohort study used real-world data from one reference hospital, focusing on the intervention (stroke unit) and comparing it to the general ward (control). We analyzed the electronic medical records of 674 patients admitted from 2009 to 2012 in the general ward and 766 patients from 2013 to 2018 in the stroke unit. Admission to the stroke unit was associated with a 43% reduction in the likelihood of prolonged hospitalization. However, there was no significant difference in the risk of in-hospital mortality between the groups (Hazard ratio = 0.90; Interquartile range = 0.58 to 1.39). The incidence of death at three, six and twelve months post-discharge did not differ between the groups. Our study results indicate significant improvements in care processes for SU patients, including shorter LOS and better adherence to treatment protocols. However, our observations revealed no significant difference in mortality rates, either during hospitalization or after discharge, between the SU and GW groups. While SU implementation enhances efficiency in stroke care, further research is needed to explore long-term outcomes and optimize management strategies.

What makes a city 'breastfeeding-friendly'? A scoping review of indicators of a breastfeeding-friendly city

A breastfeeding-friendly city is one where there is an enabling environment to support breastfeeding throughout the first 2 years or more of a child's life. Indicators of a breastfeeding-friendly city have yet to be identified. What are the indicators or criteria used to define breastfeeding friendliness in a geographic area such as a city and the settings within, which we have classified as community, healthcare and workplace? Three major databases and grey literature were searched. Records were screened to identify publications describing criteria such as indicators or descriptions of a breastfeeding-friendly setting, defined as 'criteria-sets'. These criteria-sets were then categorized and summarized by settings. The search up to 2 September 2021 found 119 criteria-sets from a range of settings: geographic locations (n = 33), community entities (n = 24), healthcare facilities (n = 28), workplaces (n = 28) and others (n = 6). Overall, 15 community, 22 healthcare and 9 workplace related criteria were extracted from the criteria-sets. Criteria that were consistently present in all settings were policy, training & education, skilled breastfeeding support and physical infrastructure. Some criteria-sets of geographic locations contained criteria only from a single setting (e.g., the presence of breastfeeding-friendly cafes). Criteria-sets were present for all settings as defined in this review, but few were actual indicators. Specifically, there were no existing indicators of a breastfeeding-friendly city. Several common components of the criteria-sets were identified, and these could be used in developing indicators of a breastfeeding-friendly city. Future studies should determine which of these are important and how each can be measured.

A Scoping Review on Adverse Childhood Experiences Studies Using Latent Class Analysis: Strengths and Challenges

Adverse childhood experiences (ACEs) studies reveal the profound impacts of experiencing trauma and hardships in childhood. However, the cumulative risk approach of treating ACEs obscures the heterogeneity of ACEs and their consequences, making actionable interventions impossible. latent class analysis (LCA) has increasingly been used to address these concerns by identifying underlying subgroups of people who experience distinctive patterns of co-occurring ACEs. Though LCA has its strengths, the existing research produces few comparable findings because LCA results are dependent on ACEs measures and indicators, which vary widely by study. Therefore, a scoping review of ACEs studies using LCA that focuses on ACEs measures, indicators, and findings is needed to inform the field. Following Arksey and O'Malley's five-stage scoping review methodological framework, we first identified 211 articles from databases of EBSCOhost, PubMed, and Scopus using "adverse childhood experiences" for title search and "latent class analysis" for abstract search. Based on the inclusion criteria of peer-reviewed articles written in English published from 2012 to 2022 and the exclusion criteria of nonempirical studies and the LCA not analyzing ACEs, we finally selected 58 articles in this scoping review. Results showed LCA has been increasingly endorsed in the ACEs research community to examine the associations between ACEs and human health and well-being across culturally diverse populations. LCA overcame the limitations of the traditional methods by revealing specific ACEs clusters that exert potent effects on certain outcomes. However, the arbitrary nature of selecting ACEs indicators, measures, and the limited use of theory impedes the field from moving forward.

Towards circular economy indicators: Evidence from the European Union

The European Union (EU) is moving towards sustainable development, and a key role is played by circular economy (CE) models geared towards reducing pressure on natural resources, generating jobs and fostering economic opportunities. Indicators are able to aggregate a variety of information and their use, through the use of multi-criteria decision analysis (MCDA), allows the performance of alternatives to be monitored. This work aims to calculate the performance of the EU27 in the years 2019 and 2020 according to 15 CE indicators available on Eurostat. The results of the Analytic Hierarchy process show that the greatest impact on circularity is determined by the category 'competitiveness and innovation', which together with the category 'global sustainability and resilience' accounts for two thirds of the overall weight. The MCDA results show that Belgium prevails in both the baseline and alternative scenarios, ahead of Italy and the Netherlands respectively. In general, circular policies see western European countries excel, while the performance of eastern European countries is weaker. The implications of this work highlight the three main barriers to the development of CE models: (i) illegal waste management; (ii) lack of knowledge and low level of investment in circular technologies and (iii) low distribution of value among stakeholders. In this way, resource management based on circularity will enable Europe to meet the challenges of sustainability with less dependence on imported raw materials.

Correlates of childhood caries: A study in Qatar

BACKGROUND

The prevalance of dental caries in children in Qatar is high, which necessitates preventive efforts.

AIM

To identify the sociodemographic and behavioural correlates of dental caries in the primary dentition of children 4- to 8-year-olds in Qatar.

DESIGN

Weighted data from the Qatar Child Oral Health Survey 2017 were analysed for caries prevalence (dmft>0) and experience (dmft). Sociodemographic and behavioural variables were also drawn from the survey.

RESULTS AND CONCLUSION

Among the 1154 children, caries prevalence was 69.3% (95%CI [63.4, 74.5]) and experience at 3.8 dmft (95%CI [3.3, 4.2]). The prevalence ratio (PR) 0.82 (0.72, 0.94) was lower among younger than in older children; those for non-Qatari nationality Arabic PR 0.91 (0.82, 1.00) and Other PR 0.75 (0.57, 0.99) than for Qatari nationality; those attending international kindergartens/schools PR 0.89 (0.80, 0.99) than independent schools; and whose parents had university-level education PR 0.85 (0.75,0.95) than did not. Caries prevalence was lower among those toothbrushing by age 3 years PR 0.88 (0.80,0.99) than later; children with low/intermediate sugar exposures PR 0.85 (0.74,0.97) and 0.89 (0.79,1.00) than those with high exposures; children with a dental check-up PR 0.68 (0.53,0.87) than those without; and children who drank bottled water with some fluoride PR 0.89 (0.80,0.99) than those who did not. Findings were similar for dmft. In conclusion caries prevalence varied but was high across sociodemographic correlates indicating vulnerablity. Interventions focusing on behaviours - such as toothbrushing, reducing sugar intake, check-up and encouraging intake of water with fluoride - are needed.

Toxicity Risk Assessment Due to Particulate Matter Pollution from Regional Health Data: Case Study from Central Romania

Air pollution poses one of the greatest dangers to public well-being. This article outlines a study conducted in the Central Romania Region regarding the health risks associated with particulate matter (PM) of two sizes, viz., PM10 and PM2.5. The methodology used consists of the following: (i) an analysis of the effects of PM pollutants, (ii) an analysis of total mortality and cardiovascular-related mortality, and (iii) a general health risk assessment. The Central Region of Romania is situated in the Carpathian Mountains' inner arch (consisting of six counties). The total population of the region under investigation is about 2.6 million inhabitants. Health risk assessment is calculated based on the relative risk (RR) formula. During the study period, our simulations show that reducing these pollutants' concentrations below the new WHO guidelines (2021) will prevent over 172 total fatalities in Brasov alone, as an example. Furthermore, the potential benefit of reducing annual PM2.5 levels on total cardiovascular mortality is around 188 persons in Brasov. Although health benefits may also depend upon other physiological parameters, all general health indicators point towards a significant improvement in overall health by a general reduction in particulate matter, as is shown by the toxicity assessment of the particulate matter in the region of interest. The modality can be applied to other locations for similar studies.

Somatic Coliphages as an Operational Tool to Assess Loss of Bathing Water Quality after Heavy Rain Events

Rapid population growth and coastal development has led to increased fecal contamination of coastal surface waters worldwide, enhancing the potential risk of waterborne human pathogens in bathing areas. More frequent heavy rainfall events, attributed to global warming, have further exacerbated the problem by causing sometimes sewer overflows into recreational waters. As traditional bacterial indicators have limited accuracy for predicting health risks associated with waterborne viruses, the additional use of viral indicators such as coliphages is recommended. In this study, we compared the behavior of bacterial and viral indicators of water quality at 10 Barcelona beaches during three bathing seasons, in dry conditions, and after four rainstorms that caused specific pollution events due to rain runoff with combined sewer overflows (CSO). Levels of all target indicators increased after the rainstorms, but compared to Escherichia coli and intestinal enterococci, somatic coliphages exhibited a slower decline and higher environmental persistence following a rain event. Daily continuous sampling carried out during the days following a rainstorm allowed not only the determination of the decay kinetics of each target indicator but also the day when the water quality recovered the values established in the current European regulation in approximately 2 -3 days after each CSO. These observations indicate that the combined use of bacterial and viral indicators can enhance the surveillance of microbial quality of bathing waters. Moreover, coliphages can swiftly provide insights into transient fecal pollution linked to rainfall episodes, thanks to available analytical techniques that enable same-day recommendations. The management of urban wastewater and recreational water regulations should consistently employ microbial indicators to address rainwater runoff or sewer overflows resulting from heavy rainfall.

The missing middle of childhood

Middle childhood, between six and twelve years, is a critical bridge between earlier childhood and adolescence with rapid physical and psychological transitions. Most of the world's 2.6 billion young people, of which the middle childhood age group is a significant portion, live in low- and middle-income countries. Many live in environments that place them at high and growing risk for mental ill-health, injuries, and adoption of risky behaviours that often lead to non-communicable diseases in later years. Still, middle childhood, the 'missing middle,' is omitted from global health information systems, targeted policies, and strategies. The dearth of internationally comparable and standardised indicators on middle childhood in major international development agency databases hampers age-appropriate policy and programme development. Better understanding of the needs of this increasingly vulnerable population is critical. Middle childhood needs to be an explicit focus within child-focused research and implementation. Standardised, comprehensive, and relevant indicators are required to quantify the contribution of middle childhood to the global burden of disease and to facilitate interventions, monitoring, and evaluation, to ensure that all children flourish and thrive.

Advanced materials foresight: research and innovation indicators related to advanced and smart nanomaterials

Background: Advanced materials are most likely to bring future economic, environmental and social benefits. At the same time, they may pose challenges regarding their safety and sustainability along the entire lifecycle. This needs to be timely addressed by the stakeholders (industry, research, policy, funding and regulatory bodies). As part of a larger foresight project, this study aimed to identify areas of scientific research and technological development related to advanced materials, in particular advanced nanomaterials and the sub-group of smart nanomaterials. The study identified and collected data to build relevant research and innovation indicators and analyse trends, impact and other implications. Methods: This study consisted of an iterative process including a documentation phase followed by the identification, description and development of a set of core research and innovation indicators regarding scientific publications, EU projects and patents. The data was extracted mainly from SCOPUS, CORDIS and PATSTAT databases using a predefined search string that included representative keywords. The trends, distributions and other aspects reflected in the final version of the indicators were analysed, e.g. the number of items in a period of time, geographical distribution, organisations involved, categories of journals, funding programmes, costs and technology areas. Results: Generally, for smart nanomaterials the data used represent around 3.5% of the advanced nanomaterials data, while for each field analysed, they represent 4.4% for publications, 13% for projects and 1.1% for patents. The study shows current trends for advanced nanomaterials at a top-level information that can be further extended with sub-indicators. Generally, the results indicated a significant growth in research into advanced nanomaterials, including smart nanomaterials, in the last decade, leading to an increased availability of information. Conclusion: These indicators identify trends regarding scientific and technological achievements and represent an important element when examining possible impacts on society and policy implications associated to these areas.

Identifying indicators for the evaluation of community interventions and initiatives in a multi-site public health programme

INTRODUCTION

Measuring success of community-level programmes and interventions is important, and indicators can provide valuable information to achieve this. However, identifying appropriate indicators can be challenging. Indicators can be identified by official local stakeholders such as local authorities, but involving communities can add value and trust to the project, with community involvement likely to improve programme sustainability.

METHODS

As part of the evaluation of multi-site community initiatives, we used local health profiles to identify core indicators that overlapped sites. In addition, we engaged with members of the community during a pilot data collection training day to identify issues they identified as important for measuring health and well-being locally.

RESULTS

A total of 313 indicators were identified from local profiles, with 31 indicators meeting inclusion criteria. The community identified 26 issues, collated into eight categories, only three of which were identified in core indicators. Tools were sourced or created for the other community-identified categories.

DISCUSSION

The methodology identified validated indicators comparable across all sites, based on local health profiles. It also identified tools for measuring issues identified by members of the community. The exercise demonstrated disconnect between priorities of official bodies, researchers and communities, indicating multiple approaches should be considered when evaluating community initiatives.

Development and Validation of an Indicator for Oncofertility Care in Ontario, Canada, for Adolescents and Young Adults with Cancer

Introduction: There is a lack of metrics to monitor and evaluate fertility care in adolescents and young adults with cancer. This study evaluated the indicator "proportion of cases attending a fertility consult visit ≤30 days from diagnosis of cancer" using the National Quality Forum (NQF) criteria. Methods: This was a retrospective cohort study using administrative data available through the Institute of Clinical Evaluative Sciences in Ontario, Canada. Cases were included if they were diagnosed with a cancer between January 2005 and December 2019, and aged 15-39 years. Fertility consultations were identified by Ontario Health Insurance Plan Claims Database (OHIP) diagnostic codes 628 and 606.Validity was assessed by examining expected differences in the proportion of fertility consults within clinical and demographic factors using chi-square tests. Reliability was assessed by comparing fertility consult visits identified using OHIP diagnostic codes with consults identified using visits to physicians in a registered specialty, using Pearson's correlation coefficient. Results: The population was composed of 39,977 cases, with 6524 (16.3%) having attended a fertility consult. For diagnostic years 2016-2019, differences in the proportion of cases receiving their first fertility consult within 30 days of diagnosis were observed for sex, age, cancer type, hospital type, Local Health Integration Unit, and region (p < 0.001). There was no correlation between the time from diagnosis to fertility consult and time from diagnosis to the first visit to a fertility-related specialty (r = 0.11; p = 0.002). Conclusion: The indicator examined in this article adhered to the criteria described by the NQF, providing a possible metric for reporting on oncofertility care.

Evaluation of Radon Action Plans: Searching for a Systematic and Standardised Method

Radon, a carcinogenic radioactive gas, is a leading cause of lung cancer according to the World Health Organization. European Member States are required to develop and implement National Radon Action Plans (RAPs) to address its dangerous health effects. However, assessing the effectiveness of these RAPs presents challenges for authorities. This study aims to explore the possibility of a systematic and standardised assessment method to evaluate the effectiveness of RAP strategies and its implementation. The method involved analysing the strategies of 27 EU Member States and the UK, conducting legal document analysis and group interviews with responsible authorities. Additionally, four regional workshops and one final European workshop were held. The research took place from March 2021 to May 2023. Findings indicate that evaluating RAP effectiveness is challenging due to limited existing common criteria or indicators. To address this, the study proposes guiding questions for each element required by the EU Directive, as well as additional questions related to education and training. This contribution benefits RAP owners and European regulatory authorities, supporting the development of effectiveness indicators for RAPs. By improving assessment methods, we can enhance the effectiveness of strategies in mitigating the risks associated with radon exposure.

Development of novel parameters for pathogen identification in clinical metagenomic next-generation sequencing

Introduction: Metagenomic next-generation sequencing (mNGS) has emerged as a powerful tool for rapid pathogen identification in clinical practice. However, the parameters used to interpret mNGS data, such as read count, genus rank, and coverage, lack explicit performance evaluation. In this study, the developed indicators as well as novel parameters were assessed for their performance in bacterium detection. Methods: We developed several relevant parameters, including 10M normalized reads, double-discard reads, Genus Rank Ratio, King Genus Rank Ratio, Genus Rank Ratio*Genus Rank, and King Genus Rank Ratio*Genus Rank. These parameters, together with frequently used read indicators including raw reads, reads per million mapped reads (RPM), transcript per kilobase per million mapped reads (TPM), Genus Rank, and coverage were analyzed for their diagnostic efficiency in bronchoalveolar lavage fluid (BALF), a common source for detecting eight bacterium pathogens: Acinetobacter baumannii, Klebsiella pneumoniae, Streptococcus pneumoniae, Staphylococcus aureus, Hemophilus influenzae, Stenotrophomonas maltophilia, Pseudomonas aeruginosa, and Aspergillus fumigatus. Results: The results demonstrated that these indicators exhibited good diagnostic efficacy for the eight pathogens. The AUC values of all indicators were almost greater than 0.9, and the corresponding sensitivity and specificity values were almost greater than 0.8, excepted coverage. The negative predictive value of all indicators was greater than 0.9. The results showed that the use of double-discarded reads, Genus Rank Ratio*Genus Rank, and King Genus Rank Ratio*Genus Rank exhibited better diagnostic efficiency than that of raw reads, RPM, TPM, and in Genus Rank. These parameters can serve as a reference for interpreting mNGS data of BALF. Moreover, precision filters integrating our novel parameters were built to detect the eight bacterium pathogens in BALF samples through machine learning. Summary: In this study, we developed a set of novel parameters for pathogen identification in clinical mNGS based on reads and ranking. These parameters were found to be more effective in diagnosing pathogens than traditional approaches. The findings provide valuable insights for improving the interpretation of mNGS reports in clinical settings, specifically in BALF analysis.

Developing and Evaluating Data Infrastructure and Implementation Tools to Support Cardiometabolic Disease Indicator Data Collection

Background

Assessment of aerobic exercise (AE) and lipid profiles among individuals with spinal cord injury or disease (SCI/D) is critical for cardiometabolic disease (CMD) risk estimation.

Objectives

To utilize an artificial intelligence (AI) tool for extracting indicator data and education tools to enable routine CMD indicator data collection in inpatient/outpatient settings, and to describe and evaluate the recall of AE levels and lipid profile assessment completion rates across care settings among adults with subacute and chronic SCI/D.

Methods

A cross-sectional convenience sample of patients affiliated with University Health Network's SCI/D rehabilitation program and outpatients affiliated with SCI Ontario participated. The SCI-HIGH CMD intermediary outcome (IO) and final outcome (FO) indicator surveys were administered, using an AI tool to extract responses. Practice gaps were prospectively identified, and implementation tools were created to address gaps. Univariate and bivariate descriptive analyses were used.

Results

The AI tool had <2% error rate for data extraction. Adults with SCI/D (n = 251; 124 IO, mean age 61; 127 FO, mean age 55; p = .004) completed the surveys. Fourteen percent of inpatients versus 48% of outpatients reported being taught AE. Fifteen percent of inpatients and 51% of outpatients recalled a lipid assessment (p < .01). Algorithms and education tools were developed to address identified knowledge gaps in patient AE and lipid assessments.

Conclusion

Compelling CMD health service gaps warrant immediate attention to achieve AE and lipid assessment guideline adherence. AI indicator extraction paired with implementation tools may facilitate indicator deployment and modify CMD risk.

Solid waste management and Aedes aegypti infestation interconnections: A regression tree application

Public health is at the core of all environmental and anthropic impacts. Urban and territorial planners should include public health concerns in their plans. Basic sanitation infrastructure is essential to maintaining public health and social and economic development. This infrastructure deficiency causes diseases, death and economic losses in developing countries. Framing interconnections among health, sanitation, urbanization and circular economy will assist sustainable development goal achievements. This study aims to identify the relationships between solid waste management indicators in Brazil and the Aedes aegypti mosquito infestation index. Regression trees were employed for modelling due to the complexity and characteristics of the data. The analyses were performed separately from data collected from 3501 municipalities and 42 indicators from the country's five regions. Results show that expenses and personnel indicators were the most critical indicators (in the mid-western, southeastern and southern regions), operational (northeastern (NE) region) and management (northern region). The mean absolute errors ranged from 0.803 (southern region) to 2.507 (NE region). Regional analyses indicate that the municipalities with better SWM results display lower infestation rates in buildings and residences. This research is innovative as it analyses infestation rates rather than dengue prevalence, using a machine learning method, in a multidisciplinary research field that needs further study.

Proposal of a sustainability index for intermunicipal cooperation on waste management

The management of solid waste is one of the biggest challenges for sustainability. Aiming at gains of scale, guaranteeing universal access and the technical and economic viability of the services, intermunicipal cooperation has been implemented in several countries, and in Brazil, it presents itself as one of the main instruments of public policies in the sector of sanitation. The main objective of this article is to propose a set of indicators and the construction of an index to evaluate the performance of regionalized management of urban solid waste, applying them to intermunicipal public consortia operating in Brazil. Based on the Delphi methodology, a total of 15 indicators were defined, divided into 5 sustainability dimensions, used for the construction of the Regionalized Urban Solid Waste Management Performance Index (IDGRSU). In Brazil, the performance of regionalized management was classified as Regular for most of the operating consortia analysed. The adequacy of the final disposal in regional sanitary landfills is the common practice among the municipalities, and consequently, the reduction of the areas of dumps represents the main advance in the management. The index developed proved to be an important instrument to support municipalities and consortia for waste management, contributing to the implementation of sustainable strategies and to the development of policies, and its application in other countries is feasible, regardless of the size of the municipalities.

Missed Opportunities to Diagnose Common Variable Immunodeficiency: a Population-Based Case-Control Study Identifying Indicator Diseases for Common Variable Immunodeficiency

PURPOSE

Delayed diagnosis of common variable immunodeficiency (CVID) remains a serious problem. We investigated whether some diseases diagnosed during out-patient visits or admission to hospitals could act as indicator conditions for CVID diagnosis.

METHODS

In this nested case-control study, we identified 128 cases diagnosed with CVID in Denmark (1999-2013) and 640 age-, gender-, and region-matched controls. We obtained data on diseases diagnosed at hospitals in the five years before CVID diagnosis from The National Hospital Registry. We grouped hospital diagnoses in 33 major disease categories and 210 subcategories. We used conditional logistic regression to calculate the odds ratios (OR) and 95% confidence intervals (CI) to estimate associations between disease exposure and subsequent CVID.

RESULTS

During the five years preceding a CVID diagnosis, cases had four times as many hospital contacts as the controls (p < 0.001). A diagnosis in 18 major disease categories showed a significant OR for subsequent diagnosis of CVID. The most substantial association with a subsequent CVID diagnosis was a diagnosis of lower respiratory tract infections (OR: 29.9; 95% CI: 14.2-63.2) and lung diseases (35.1; 15.0-82.5). We observed a similar association when we removed the last year before diagnosis from analysis and overall, in the years < 1, ≥ 1-3, and ≥ 3-5 before diagnosis, although the absolute number of exposures was small. Twenty-eight specific diseases displayed an at least 3-fold risk of subsequent CVID diagnosis.

CONCLUSION

Targeted screening for antibody deficiency in patients diagnosed with specific diseases associated with CVID may lead to earlier CVID diagnosis and treatment and thereby potentially reduced morbidity and mortality.

Evaluating Drug Prescription Patterns in Undiagnosed Common Variable Immunodeficiency Patients

OBJECTIVE

To compare the consumption of antibiotics (AB), systemic steroids, and inhaled bronchodilators/glucocorticoids in the 3 years preceding the diagnosis of common variable immunodeficiency (CVID) among CVID patients and matched controls and to estimate whether the level of consumption was associated with the risk of a subsequent CVID diagnosis.

METHODS

We conducted a nested case-control study, identifying all individuals (n=130 cases) diagnosed with CVID in Denmark (1994-2014) and 45 age- and sex-matched population controls per case (n=5850 controls) from national registers. Drug consumption was estimated as defined daily doses per person-year. We used conditional logistic regression to compute odds ratios and 95% confidence intervals.

RESULTS

In the 3 years preceding a CVID diagnosis, we observed more frequent and higher consumption of all three drug classes. The association between consumption and risk of subsequent CVID diagnosis was statistically significant for all drug classes. The association was stronger with higher consumption and shorter time to CVID diagnosis. The fraction of cases compared to the controls redeeming ≥1 prescription of the included drugs during the study period was higher for AB (97% vs 52%), systemic steroids (35% vs 7.4%), and inhaled bronchodilators/glucocorticoids (46% vs 11.7%) (p<0.001).

CONCLUSION

CVID patients have significantly higher use of AB, systemic steroids, and inhaled bronchodilators/glucocorticoids in the 3 years preceding CVID diagnosis than controls. Prescribing these drugs in primary healthcare could be an opportunity to consider (proactive) screening for CVID. Further studies are needed to identify optimal prescription cutoffs that could endorse its inclusion in public health policies.

Defining the Zero Dose Child: A Comparative Analysis of Two Approaches and Their Impact on Assessing the Zero Dose Burden and Vulnerability Profiles across 82 Low- and Middle-Income Countries

While there is a coordinated effort around reaching zero dose children and closing existing equity gaps in immunization delivery, it is important that there is agreement and clarity around how 'zero dose status' is defined and what is gained and lost by using different indicators for zero dose status. There are two popular approaches used in research, program design, and advocacy to define zero dose status: one uses a single vaccine to serve as a proxy for zero dose status, while another uses a subset of vaccines to identify children who have missed all routine vaccines. We provide a global analysis utilizing the most recent publicly available DHS and MICS data from 2010 to 2020 to compare the number, proportion, and profile of children aged 12 to 23 months who are 'penta-zero dose' (have not received the pentavalent vaccine), 'truly' zero dose (have not received any dose of BCG, polio, pentavalent, or measles vaccines), and 'misclassified' zero dose children (those who are penta-zero dose but have received at least one other vaccine). Our analysis includes 194,829 observations from 82 low- and middle-income countries. Globally, 14.2% of children are penta-zero dose and 7.5% are truly zero dose, suggesting that 46.5% of penta-zero dose children have had at least one contact with the immunization system. While there are similarities in the profile of children that are penta-zero dose and truly zero dose, there are key differences between the proportion of key characteristics among truly zero dose and misclassified zero dose children, including access to maternal and child health services. By understanding the extent of the connection zero dose children may have with the health and immunization system and contrasting it with how much the use of a more feasible definition of zero dose may underestimate the level of vulnerability in the zero dose population, we provide insights that can help immunization programs design strategies that better target the most disadvantaged populations. If the vulnerability profiles of the truly zero dose children are qualitatively different from that of the penta-zero dose children, then failing to distinguish the truly zero dose populations, and how to optimally reach them, may lead to the development of misguided or inefficient strategies for vaccinating the most disadvantaged population of children.

The effectiveness of trauma-informed youth justice: a discussion and review

Youth justice services around the world are under increasing pressure to find new and more effective ways of working with young people. One way forward is to implement a more compassionate approach to service delivery that embraces the idea of 'trauma-informed practice'. And yet, substantial variation has been observed in how a trauma-informed approach has been defined and understood by practitioners, with idiosyncratic implementation evident across different systems and only limited evidence that this results in reductions in subsequent re-offending. In this paper we argue that the success of efforts to work in more trauma-informed ways cannot be judged using recidivism data alone and that there is a need to identify key indicators of the effectiveness of any trauma- informed approach. We present the case for implementing trauma-informed youth justice and outline key features of the approach. We then present a logic model that articulates key components and identifies short- and longer-term outcomes that can be measured to assess the overall performance of a service. The article concludes with a discussion of the current evidential status of trauma-informed youth justice, identifying areas of current strength and those where further work is needed to develop the evidence base, including the need to demonstrate the hypothesized association between short-term trauma-informed practice outcomes and the longer-term goal of preventing re-offending.

Early initiation of breastfeeding, bottle feeding, and experiencing feeding challenges are associated with malnutrition

Malnutrition remains a public health concern amidst low proportions of the core infant and young child feeding (IYCF) practices, yet, data on specific child feeding practices that are associated with undernutrition are rare. Hence, this study sought to assess child feeding practices and their association with undernutrition among young children. An analytical cross-sectional design was used among mothers/caregivers with children aged 6-23 months, attending child welfare clinics in Techiman municipality, Ghana. Simple random sampling was used to select 8 health facilities, and 403 participants were selected from those facilities using proportional stratification. A 24-h dietary recall based on seven food groups was used to collect data on children's dietary intake and used to derive WHO child feeding indicators. The length, weight, and age of children were taken and used to compute anthropometric z-scores. The proportions of children who met their minimum dietary diversity (MDD), minimum meal frequency (MMF), and minimum acceptable diet (MAD) were 44%, 56%, and 36% respectively. Children 6-8 months [AOR=2.24, CI (1.037-4.841); p = .04] and 9-11 months [AOR=2.47, CI (1.096-5.573); p = .029], those who were not breastfed within the first hour of delivery [AOR = 3.56, CI (1.833-6.912), p < .001], and those who were bottle fed [AOR = 2.87, CI (1.374-5.973); p = .005] were more likely to be wasted. Children 6-8 months [AOR = 0.29, CI (0.126-0.672); p = .004] and 9-11 months [AOR = 0.24, CI (0.104-0.544); p = .001] and those who experienced feeding challenges [AOR = 0.52, CI (0.301-0.905); p = 0.021] were protected against stunting. The percentages of children who met their MDD, MMF, and MAD were low and not associated with undernutrition. Early initiation of breastfeeding and bottle feeding were associated with acute malnutrition and experiencing feeding challenges was associated with chronic malnutrition. Promoting appropriate child feeding practices can reduce the risk of undernutrition.

Electrospun Nanofibers for Functional Food Packaging Application

With the strengthening of the public awareness of food safety and environmental protection, functional food packaging materials have received widespread attention. Nanofibers are considered as promising packaging materials due to their unique one-dimensional structure (high aspect ratio, large specific surface area) and functional advantages. Electrospinning, as a commonly used simple and efficient method for preparing nanofibers, can obtain nanofibers with different structures such as aligned, core-shell, and porous structures by modifying the devices and adjusting the process parameters. The selection of raw materials and structural design of nanofibers can endow food packaging with different functions, including antimicrobial activity, antioxidation, ultraviolet protection, and response to pH. This paper aims to provide a comprehensive review of the application of electrospun nanofibers in functional food packaging. Advances in electrospinning technology and electrospun materials used for food packaging are introduced. Moreover, the progress and development prospects of electrospun nanofibers in functional food packaging are highlighted. Meanwhile, the application of functional packaging based on nanofibers in different foods is discussed in detail.

Global indicators framework for socially responsible research and innovation (RRI): Aligning standards to monitor public and researcher perspectives with the UNESCO Recommendation on Science and Scientific Researchers

As calls for more socially responsible research and innovation (RRI) policies and practices grow more insistent, the need for high-quality indicators that can be used to evaluate progress is becoming increasingly important. Given the global nature of science, such indicators need to be relevant to countries across all world regions. Moreover, the methodological quality of indicators is critical to provide a strong foundation for long-term comparative measurement of the impacts of different kinds of policy intervention. There is a practical challenge here, given the uneven mechanisms for data collection and analysis available in different countries. There is also a geopolitical challenge in gaining buy-in from countries with very different, and sometimes competing, agendas. Here, the 2017 UNESCO-led Recommendation on Science and Scientific Researchers is highlighted as an existing vehicle that can enable cooperation on globally comparative measurement of socially responsible research and innovation. In particular, the quadrennial monitoring of the implementation of this wide-ranging global policy instrument that has been ratified by 195 countries affords a unique opportunity to add value for these countries by linking RRI to the 2017 Recommendation while establishing benchmark indicators for RRI more generally. As a practical and methodological contribution to the global community of science and innovation policymakers, researchers and research and innovation stakeholders committed to socially responsible research, this report contains detailed survey questions and response options focusing on public opinion and individual researchers' level of measurement. It provides details of sources of benchmark survey data that have readily available open data that can be used to benchmark the development of socially responsible research and innovation over time from the vantage points of the public and researchers around the world. The aim of this kind of science ecosystem-level indicators framework is to enable evidence-based practice in socially responsible research and innovation.

Global indicators framework for socially responsible research and innovation (RRI): Aligning standards to monitor public and researcher perspectives with the UNESCO Recommendation on Science and Scientific Researchers

As calls for more socially responsible research and innovation (RRI) policies and practices grow more insistent, the need for high-quality indicators that can be used to evaluate progress is becoming increasingly important. Given the global nature of science, such indicators need to be relevant to countries across all world regions. Moreover, the methodological quality of indicators is critical to provide a strong foundation for long-term comparative measurement of the impacts of different kinds of policy intervention. There is a practical challenge here, given the uneven mechanisms for data collection and analysis available in different countries. There is also a geopolitical challenge in gaining buy-in from countries with very different, and sometimes competing, agendas. Here, the 2017 UNESCO-led Recommendation on Science and Scientific Researchers is highlighted as an existing vehicle that can enable cooperation on globally comparative measurement of socially responsible research and innovation. In particular, the quadrennial monitoring of the implementation of this wide-ranging global policy instrument that has been ratified by 195 countries affords a unique opportunity to add value for these countries by linking RRI to the 2017 Recommendation while establishing benchmark indicators for RRI more generally. As a practical and methodological contribution to the global community of science and innovation policymakers, researchers and research and innovation stakeholders committed to socially responsible research, this report contains detailed survey questions and response options focusing on public opinion and individual researchers' level of measurement. It provides details of sources of benchmark survey data that have readily available open data that can be used to benchmark the development of socially responsible research and innovation over time from the vantage points of the public and researchers around the world. The aim of this kind of science ecosystem-level indicators framework is to enable evidence-based practice in socially responsible research and innovation.

Framing socioecological complexity: The long-term evolution of multiple dimensions of desertification risk in Italy

Desertification risk depends on the interplay of biophysical and socioeconomic drivers, among which climate change, soil depletion, landscape modifications, and biodiversity decline are key factors of change in Southern Europe. The present study introduces a diachronic analysis of desertification risk in Italy adopting a multidimensional approach based on four dimensions (ecological, economic, demographic, and administrative) assessed at three dates (1961, 1991, and 2011). These risk components were evaluated separately in Southern Italy, a formerly affected region (sensu United Nations Convention to Combat Desertification), and Northern/Central Italy, a nonaffected region in the country. All risk measures document how the divide between affected and nonaffected regions in Italy has gradually reduced. Because of local warming and rising human pressure, Northern Italy has recently displayed a level of desertification risk close to those observed in Southern Italy over the last 30 years. These results suggest a thorough revision of the national classification of risky areas, that may inform more specific mitigation and adaptation policies responding effectively to recent socioenvironmental trends and local (economic) dynamics. The intrinsic system's evolution observed at both regional and national level in Italy may be generalized to a broader European context. Our work finally documents the appropriateness of a multidimensional definition of desertification risk grounded on the joint analysis of ecological, demographic, economic, and administrative indicators. A comprehensive knowledge of socioeconomic patterns and processes of change contributes to more precise scenario modeling and design of integrated strategies mitigating desertification risk.

Linking policy and practice in monitoring socially responsible research and innovation (RRI): A conceptual framework to evaluate progress through the UNESCO-led Recommendation on Science and Scientific Researchers

This paper sets out a high-level conceptual framework for monitoring the development of socially responsible research and innovation (RRI) systems linked to the global policy instrument called 'the Recommendation on Science and Scientific Researchers' (RSSR). RRI is an umbrella concept, rooted in EU policy and research, that encompasses a range of topics that overlap directly with the RSSR. These topics include social inclusion in scientific research, improved scientific transparency and governance and expanded public engagement with science. The RSSR is an international accord ratified by 195 United Nations Educational Scientific and Cultural Organization (UNESCO) Member States in 2017, updating an earlier version of the instrument. This UNESCO-led initiative offers a globally inclusive and agreed structure for advancing RRI-related principles. A key feature of the RSSR initiative is its permanent structure of quadrennial monitoring to assess implementation of its principles. Here, a conceptual framework is presented to clarify the specific dimensions of RRI embedded in the 10 key priority areas for this quadrennial monitoring process. The paper explicates these dimensions and the underpinning policy language from the 2017 recommendation with the aim of supporting UNESCO Member States and research stakeholders globally to design appropriate evaluation methods. This conceptual framework is intended to support development of globally aligned measurement of RRI policy and practice that allows research and policy stakeholders from each world region to learn from each other. Fostering mutual learning on a global scale will help to enable evidence-based practice in the context of RRI to improve outcomes and mitigate the limitations of well-meaning but ineffective policies and practices.

Linking policy and practice in monitoring socially responsible research and innovation (RRI): A conceptual framework to evaluate progress through the UNESCO-led Recommendation on Science and Scientific Researchers

This paper sets out a high-level conceptual framework for monitoring the development of socially responsible research and innovation (RRI) systems linked to the global policy instrument called 'the Recommendation on Science and Scientific Researchers' (RSSR). RRI is an umbrella concept, rooted in EU policy and research, that encompasses a range of topics that overlap directly with the RSSR. These topics include social inclusion in scientific research, improved scientific transparency and governance and expanded public engagement with science. The RSSR is an international accord ratified by 195 United Nations Educational Scientific and Cultural Organization (UNESCO) Member States in 2017, updating an earlier version of the instrument. This UNESCO-led initiative offers a globally inclusive and agreed structure for advancing RRI-related principles. A key feature of the RSSR initiative is its permanent structure of quadrennial monitoring to assess implementation of its principles. Here, a conceptual framework is presented to clarify the specific dimensions of RRI embedded in the 10 key priority areas for this quadrennial monitoring process. The paper explicates these dimensions and the underpinning policy language from the 2017 recommendation with the aim of supporting UNESCO Member States and research stakeholders globally to design appropriate evaluation methods. This conceptual framework is intended to support development of globally aligned measurement of RRI policy and practice that allows research and policy stakeholders from each world region to learn from each other. Fostering mutual learning on a global scale will help to enable evidence-based practice in the context of RRI to improve outcomes and mitigate the limitations of well-meaning but ineffective policies and practices.

Development of Quality Indicators for Geriatric Home Enteral Nutrition (HEN) Services

The evidence on the safety, efficacy and patient centeredness of Home Enteral Nutrition (HEN) services is scarce. In 2015, we carried out a search of the literature to identify specific indicators for HEN services as tools to be used to assess the quality of INRCA HEN services. No specific indicators for HEN services were found. Through a subsequent search of the literature, we have identified the appropriate methodology to define quality indicators and developed eight (8) specific indicators to track the quality of our HEN service for geriatric patients. Following Donabiedan's classification, we have defined two structure indicators, two process indicators and four outcome indicators that are presented in this manuscript. Though they may be used to make a comparison of HEN services for geriatric patients and to monitor the quality of therapy provided at patients' homes, the definition of quality system indicators for HEN services requires the additional joint efforts of experts in the field of nutrition and the scientific community for their validation.

The Need to Set up a Biobank Dedicated to Lymphoid Malignancies: Experience of a Single Center (Laboratory of Clinical and Experimental Pathology, University Côte d'Azur, Nice, France)

Several therapies to improve the management of lymphoma are currently being investigated, necessitating the development of new biomarkers. However, this requires high-quality and clinically annotated biological material. Therefore, we established a lymphoma biobank including all available biological material (tissue specimens and matched biological resources) along with associated clinical data for lymphoma patients diagnosed, according to the WHO classification, between 2005 and 2022 in the Laboratory of Clinical and Experimental Pathology, Nice, France. We retrospectively included selected cases in a new collection at the Côte d'Azur Biobank, which contains 2150 samples from 363 cases (351 patients). The male/female ratio was 1.3, and the median age at diagnosis was 58 years. The most common lymphoma types were classical Hodgkin lymphoma, diffuse large B-cell lymphoma, and extra-nodal marginal zone lymphoma of MALT tissue. The main sites of lymphoma were the mediastinum, lymph node, Waldeyer's ring, and lung. The Côte d'Azur Biobank is ISO 9001 and ISO 20387 certified and aims to provide high quality and diverse biological material to support translational research projects into lymphoma. The clinico-pathological data generated by this collection should aid the development of new biomarkers to enhance the survival of patients with lymphoid malignancies.

Coelenterazine Indicators for the Specific Imaging of Human and Bovine Serum Albumins

Albumin assays in serum are important for the prognostic assessment of many life-threatening diseases, such as heart failure, liver disease, malnutrition, inflammatory bowel disease, infections, and kidney disease. In this study, synthetic coelenterazine (CTZ) indicators are developed to quantitatively illuminate human and bovine serum albumins (HSA and BSA) with high specificity. Their functional groups were chemically modified to specifically emit luminescence with HSA and BSA. The CTZ indicators were characterized by assaying the most abundant serum proteins and found that the CTZ indicators S6 and S6h were highly specific to HSA and BSA, respectively. Their colors were dramatically converted from blue, peaked at 480 nm, to yellowish green, peaked at 535 nm, according to the HSA-BSA mixing ratios, wherein the origins and mixing levels of the albumins can be easily determined by their colors and peak positions. The kinetic properties of HSA and BSA were investigated in detail, confirming that the serum albumins catalyze the CTZ indicators, which act as pseudo-luciferases. The catalytic reactions were efficiently inhibited by specific inhibitors, blocking the drug-binding sites I and II of HSA and BSA. Finally, the utility of the CTZ indicators was demonstrated through a quantitative imaging of the real fetal bovine serum (FBS). This study is the first example to show that the CTZ indicators specify HSA and BSA with different colors. This study contributes to the expansion of the toolbox of optical indicators, which efficiently assays serum proteins in physiological samples. Considering that these CTZ indicators immediately report quantitative optical signals with high specificity, they provide solutions to conventional technical hurdles on point-of-care assays of serum albumins.

Toward One Health: a spatial indicator system to model the facilitation of the spread of zoonotic diseases

Recurrent outbreaks of zoonotic infectious diseases highlight the importance of considering the interconnections between human, animal, and environmental health in disease prevention and control. This has given rise to the concept of One Health, which recognizes the interconnectedness of between human and animal health within their ecosystems. As a contribution to the One Health approach, this study aims to develop an indicator system to model the facilitation of the spread of zoonotic diseases. Initially, a literature review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement to identify relevant indicators related to One Health. The selected indicators focused on demographics, socioeconomic aspects, interactions between animal and human populations and water bodies, as well as environmental conditions related to air quality and climate. These indicators were characterized using values obtained from the literature or calculated through distance analysis, geoprocessing tasks, and other methods. Subsequently, Multi-Criteria Decision-Making (MCDM) techniques, specifically the Entropy and Technique for Order of Preference by Similarity to Ideal Solution (TOPSIS) methods, were utilized to combine the indicators and create a composite metric for assessing the spread of zoonotic diseases. The final indicators selected were then tested against recorded zoonoses in the Valencian Community (Spain) for 2021, and a strong positive correlation was identified. Therefore, the proposed indicator system can be valuable in guiding the development of planning strategies that align with the One Health principles. Based on the results achieved, such strategies may prioritize the preservation of natural landscape features to mitigate habitat encroachment, protect land and water resources, and attenuate extreme atmospheric conditions.

Developing Biodiversity Baselines to Develop and Implement Future Conservation Targets

With the recent launch of the Kunming-Montreal global biodiversity framework (GBF), and the associated monitoring framework, understanding the framework and data needed to support it is crucial. Unfortunately, whilst the monitoring framework was meant to provide key data to monitor progress towards goals and targets, most indicators are too unclear for detection or marking progress. The most common datasets for this task, such as the IUCN redlist of species, have major spatial inaccuracies, and lack the temporal resolution to track progress, whilst point-based datasets lack data from many regions, in addition to species coverage. Utilising existing data will require the careful use of existing data, such as the use of inventories and projecting richness patterns, or filling data gaps before developing species-level models and assessments. As high-resolution data fall outside the scope of explicit indicators within the monitoring framework, using essential biodiversity variables within GEOBON (which are noted in the prelude of the monitoring framework) as a vehicle for data aggregation provides a mechanism for collating the necessary high-resolution data. Ultimately developing effective targets for conservation will require better species data, for which National Biodiversity Strategic Action Plans (NBSAPs) and novel mechanisms for data mobilisation will be necessary. Furthermore, capitalising on climate targets and climate biodiversity synergies within the GBF provides an additional means for developing meaningful targets, trying to develop urgently needed data to monitor biodiversity trends, prioritising meaningful tasks, and tracking our progress towards biodiversity targets.

Ecological integrity of tropical secondary forests: concepts and indicators

Naturally regenerating forests or secondary forests (SFs) are a promising strategy for restoring large expanses of tropical forests at low cost and with high environmental benefits. This expectation is supported by the high resilience of tropical forests after natural disturbances, yet this resilience can be severely reduced by human impacts. Assessing the characteristics of SFs and their ecological integrity (EI) is essential to evaluating their role for conservation, restoration, and provisioning of ecosystem services. In this study, we aim to propose a concept and indicators that allow the assessment and classification of the EI of SFs. To this end, we review the literature to assess how EI has been addressed in different ecosystems and which indicators of EI are most commonly used for tropical forests. Building upon this knowledge we propose a modification of the concept of EI to embrace SFs and suggest indicators of EI that can be applied to different successional stages or stand ages. Additionally, we relate these indicators to ecosystem service provision in order to support the practical application of the theory. EI is generally defined as the ability of ecosystems to support and maintain composition, structure and function similar to the reference conditions of an undisturbed ecosystem. This definition does not consider the temporal dynamics of recovering ecosystems, such as SFs. Therefore, we suggest incorporation of an optimal successional trajectory as a reference in addition to the old-growth forest reference. The optimal successional trajectory represents the maximum EI that can be attained at each successional stage in a given region and enables the evaluation of EI at any given age class. We further suggest a list of indicators, the main ones being: compositional indicators (species diversity/richness and indicator species); structural indicators (basal area, heterogeneity of basal area and canopy cover); function indicators (tree growth and mortality); and landscape proxies (landscape heterogeneity, landscape connectivity). Finally, we discuss how this approach can assist in defining the value of SF patches to provide ecosystem services, restore forests and contribute to ecosystem conservation.

Main social vulnerability indicators in the COVID-19 pandemic in Iran

Background

Social factors play the main role in the vulnerability of exposed countries to disasters. The COVID-19 pandemic as a disaster is not an exception to this fact. This study aimed to determine the main social vulnerability indicators in the COVID-19 pandemic in Iran.

Methods

This study was conducted during the period of 2021-2022 in three phases, including a systematic review, a virtual panel expert, and the Analytical Hierarchy Process. First, the draft of social vulnerability indicators in COVID-19 was extracted through a systematic review. Then, the extracted indicators were finalized and prioritized by the expert panel and the AHP, respectively.

Results

Initially, the literature review found five domains and 38 indicators of social vulnerability in COVID-19. The outcome of the expert panel increased the related domains to six but decreased the indicators to 31. The three prioritized social vulnerability indicators that were determined by the AHP were population density, accessibility to healthcare facilities, and relevant services and vulnerable groups.

Conclusion

Measuring social vulnerability with the identified indicators is valuable for addressing high COVID-19 incidence among socially vulnerable hotspot areas. Regarding the result of this study, further research should be conducted to validate the identified indicators.

Conditional Forest Models Built Using Metagenomic Data Accurately Predicted Salmonella Contamination in Northeastern Streams

The use of water contaminated with Salmonella for produce production contributes to foodborne disease burden. To reduce human health risks, there is a need for novel, targeted approaches for assessing the pathogen status of agricultural water. We investigated the utility of water microbiome data for predicting Salmonella contamination of streams used to source water for produce production. Grab samples were collected from 60 New York streams in 2018 and tested for Salmonella. Separately, DNA was extracted from the samples and used for Illumina shotgun metagenomic sequencing. Reads were trimmed and used to assign taxonomy with Kraken2. Conditional forest (CF), regularized random forest (RRF), and support vector machine (SVM) models were implemented to predict Salmonella contamination. Model performance was assessed using 10-fold cross-validation repeated 10 times to quantify area under the curve (AUC) and Kappa score. CF models outperformed the other two algorithms based on AUC (0.86, CF; 0.81, RRF; 0.65, SVM) and Kappa score (0.53, CF; 0.41, RRF; 0.12, SVM). The taxa that were most informative for accurately predicting Salmonella contamination based on CF were compared to taxa identified by ALDEx2 as being differentially abundant between Salmonella-positive and -negative samples. CF and differential abundance tests both identified Aeromonas salmonicida (variable importance [VI] = 0.012) and Aeromonas sp. strain CA23 (VI = 0.025) as the two most informative taxa for predicting Salmonella contamination. Our findings suggest that microbiome-based models may provide an alternative to or complement existing water monitoring strategies. Similarly, the informative taxa identified in this study warrant further investigation as potential indicators of Salmonella contamination of agricultural water. IMPORTANCE Understanding the associations between surface water microbiome composition and the presence of foodborne pathogens, such as Salmonella, can facilitate the identification of novel indicators of Salmonella contamination. This study assessed the utility of microbiome data and three machine learning algorithms for predicting Salmonella contamination of Northeastern streams. The research reported here both expanded the knowledge on the microbiome composition of surface waters and identified putative novel indicators (i.e., Aeromonas species) for Salmonella in Northeastern streams. These putative indicators warrant further research to assess whether they are consistent indicators of Salmonella contamination across regions, waterways, and years not represented in the data set used in this study. Validated indicators identified using microbiome data may be used as targets in the development of rapid (e.g., PCR-based) detection assays for the assessment of microbial safety of agricultural surface waters.

A Framework for Evaluating the Implementation of Biosimilar Drugs

Background

The introduction of biosimilar drugs has significant effects on health care systems, and a variety of approaches are required to support acceptance, adoption, and use of these drugs. Literature exists on the enablers of, and barriers to, biosimilar implementation, but frameworks that support the evaluation of biosimilar implementation strategies are currently lacking.

Objective

To develop an evaluation framework for assessing the effects of biosimilar implementation strategies on patients, clinicians, and publicly funded drug programs.

Methods

The scope of the evaluation was determined by a pan-Canadian working group through the creation of a logic model of activities and expected outcomes associated with biosimilar implementation. Each component of the logic model was considered under the RE-AIM framework, which led to a set of evaluation questions and indicators. Feedback to inform the final framework was sought from stakeholders through focus group sessions and written responses.

Results

An evaluation framework was created that articulates evaluation questions and indicators across 5 priority areas: stakeholder engagement, patient experience, patient outcomes, clinician experience, and system sustainability and affordability. Stakeholder feedback was obtained through 9 focus group sessions with a total of 87 participants. Feedback was used to refine the framework on the basis of stakeholder priorities and feasibility.

Conclusions

Through extensive stakeholder consultation, an evaluation framework was developed to measure and monitor the effects of biosimilar implementation on the 5 identified priority areas, as well as to inform future biosimilar implementations. This framework can be used as a starting point for evaluating the implementation of biosimilars across health care systems.

Application of smart packaging for seafood: A comprehensive review

Nowadays, due to the changes in lifestyle and great interest of consumers in a healthy life, people have started increasing their seafood consumption. But due to their short shelf life, experts are looking for a new packaging called smart packaging (SMP) for seafood. There are different indicators/sensors in SMP; one of the effective indices is time-temperature, which can show consumers the best time of using seafood based on their shelf life and experienced temperature. Another one is radio-frequency identification (RFID) that is a transmission device that represents a separate form of the electronic information-based SMP systems. RFID does not belong to any of the categories of markers or sensors; it is an auto recognition system that applies cordless sensors to indicate segments and collect real-time information without manual interposition. This review covers the use of SMP in all marine foods, including fish, due to its high consumption and high content of polyunsaturated fatty acids, eicosapentaenoic acid (C20:5n-3) and docosahexaenoic acid (C22:6n-3), which are the considerable factors of n-3 polyunsaturated fatty acids for human.

Indicators, Goals, and Assessment of the Water Sustainability in China: A Provincial and City-Level Study

The United Nations and scholars called for more attention and efforts for cleaner water and water sustainability. This study established a water sustainability evaluating method framework, including indicators, goals, and methods and performs provincial and city-level assessments as case studies. The framework involves six fields, surface water quality, marine environmental quality, water-soil-agriculture, water infrastructure, water conservation, aquatic ecology, water-efficient use, and pollutant emission reduction. The methods innovatively integrate multi fields and concerns of water sustainability while providing a goal-oriented evaluation and implementing the United Nations' call for the refinement and clarification of SDGs. China's overall water sustainability was evaluated as 0.821 in 2021, and have performed well in surface water quality, sea quality, water conservation, and aquatic ecology fields while performing poorly in the water-soil-agriculture field. The overall strategy, policy, and action for water sustainability could be developed based on the evaluation. The water sustainability evaluation presented the regional and field/indicator differentiations. It is necessary to implement regionally classified policies and differentiated management for sustainable water development. The correlation analysis with socioeconomic factors implies the complicated and intimate interaction between socioeconomic development and water sustainability while revealing that development stages and the inherent conditions of natural ecology and water sources bring about the differentiations. A comprehensive evaluation of water sustainability may be three-dimensional, involving water quality and ecology, development related to water, and water resources and utilization.

Delineating the Intrinsic, Long-Term Path of Land Degradation: A Spatially Explicit Transition Matrix for Italy, 1960-2010

Vulnerability to land degradation in southern Europe has increased substantially in the last decades because of climate and land-use change, soil deterioration, and rising human pressure. The present work focuses on a quantitative evaluation of changes over time in the level of vulnerability to land degradation of a Mediterranean country (Italy) using a composite indicator, the environmentally sensitive area index (ESAI), which is the final outcome of a complex model conceived to assess land vulnerability on the basis of climate, soil, vegetation, and human pressure. Considering four different levels of vulnerability to land degradation (not affected, potentially affected, fragile, and critical), the main trajectories of this index were highlighted in a long-time perspective (1960-2010), discriminating dynamics over two sub-periods (1960-1990 and 1990-2010). The empirical results at a very detailed spatial scale (1 km² grid) reflect spatial consolidation of degradation hot-spots over time. However, aggregated trajectories of change indicate an overall improvement in the environmental conditions between 1990 and 2010 compared with what is observed during the first period (1960-1990). Worse environmental conditions concerned southern Italian regions with a dry climate and poor soil conditions in the first time interval, large parts of northern Italy, traditionally recognized as a wet and affluent agricultural region, experienced increasing levels of land vulnerability in the second time interval. Being classified as an unaffected region according with the Italian national action plan (NAP), the expansion of (originally sparse) degradation hot-spots in northern Italy, reflective of an overall increase in critical areas, suggests a substantial re-thinking of the Italian NAP. This may lead to a redesign of individual regional action plans (RAPs) implementing place-specific approaches and comprehensive measures to be adopted to mitigate land degradation.

Adherence to Good Pharmacy Practices by Community Pharmacies in Lebanon and Opportunities for Quality Improvement: It is Time to Act

Purpose

Good pharmacy practice is an important standard that highlight the quality of services in community pharmacies. In 2018, The Order of Pharmacists in Lebanon (OPL) published their own good pharmacy practices (GPP) guidelines. The need exists for investigational studies to assess GPP implementation status and the professional conduct of on-site staff towards these standards.

Methods

Data collection was carried out between February and August 2020 using a questionnaire covering: Socio-demographic variables; Indicator A (Attitude of the Community Pharmacists); Indicator B (Services and Facilities); Indicator C (Dispensing); Indicator D (Storage). Data analysis were performed on SPSS version 25, T-Test and ANOVA were used. A significant p value of <0.001, 95% confidence interval and variables with missing data counting less than 10% were considered.

Results

A total of 211 staffers from pharmacies were enrolled in the study, each representing one community pharmacy. The mean percent of adherence to GPP standards by community pharmacies in the South of Lebanon was below the recommended threshold of 75%. Only 65.09% adhered to all tested indicators (27% to Indicator A, 56.91% to Indicator B, 68.61% to Indicator C, 66.31% to Indicator D). Higher indicators were seen among providers who were aware of OPL standards (OR = 4.021), female (OR= 2.011) and being a licensed pharmacist (OR=3.506). Cronbach alpha of the overall score was 0.615.

Conclusion

Further steps shall be taken to improve the compliance to GPP standards. Steps shall include, identification of the core standards, such as dispensing, provision of adequate information, monitoring of storage conditions, and ensuring the presence of a licensed pharmacist. It is highly recommended that the OPL and the Ministry of Public Health develop a "Self-assessment tool" and an efficient training program to increase community Pharmacists' awareness status. Regular assessment shall be carried to monitor the progress overtime.

Clinical Trial Authorisation: A Final Look Back to Better Appraise the New European Regulation

The implementation of the new European Clinical Trial Regulation on 31 January 2022, is a major step to promote clinical research in Europe. The French National Agency for Medicines and Health Products Safety (ANSM) proposes to share some key aspects of the preparation for the application of the Regulation initiated in 2017 and to discuss shared indicators that should be considered to monitor clinical trials opportunities on a territory with regards to access to innovation for patients and attractiveness for sponsors. New criteria based on the time from the first request for authorisation to the first inclusion could be of particular interest to appraise the implementation of the European Clinical Trial Regulation.

[The EASY-NET research programme: background, structure, and methodology]

This is the first contribution of a series of interventions describing the EASY-NET research program (Bando Ricerca Finalizzata 2016, funds 2014-2015; NET-2016-02364191). Here, the objective is to illustrate the background and the research question, the structure and organization, the methodologies and the expected results of the programme. The main theme is audit&feedback (A&F), a proven and widespread technique for improving the quality of health care. EASY-NET, funded by the Italian Ministry of Health and by the governments of the participating Italian Regions, starts its research activities in 2019 with the aim of evaluating the effectiveness of A&F in improving care for different clinical conditions in various organizational and legislative contexts. The research network involves seven Italian Regions, each conducting specific research activities described by as many work packages (WP): Lazio (the leading Region, coordinator of the research activities), Friuli Venezia Giulia, Piedmont, Lombardy, Emilia-Romagna, Calabria, and Sicily. The involved clinical areas include the management of chronic diseases, emergency care for acute conditions, surgery in the oncological area, the treatment of heart disease, obstetrics, and the use of caesarean section and post-acute rehabilitation. The involved settings concern the community, the hospital, the emergency room, and the rehabilitation facilities. Different experimental or quasi-experimental study designs are applied in each WP to achieve specific objectives of the specific clinical and organizational context. In all WPs, the process and outcome indicators are calculated on the basis of the Health Information Systems (HIS) and, in some cases, they are integrated with measures obtained from ad hoc data collections. The programme aims to contribute to the scientific evidence on A&F also exploring the obstacles and favourable factors for its effectiveness and to promote its implementation in the health service, with the ultimate aim of improving the access to healthcare and the health outcomes for citizens.

The prognostic effect of sixteen malnutrition/inflammation-based indicators on the overall survival of chemotherapy patients

Background

Studies have confirmed the validity of malnutrition/inflammation-based indicators among cancer patients compared to chemotherapy patients. Moreover, it is necessary to identify which indicator is the best prognostic predictor for chemotherapy patients. This study attempted to determine the best nutrition/inflammation-based indicator of overall survival (OS) for chemotherapy patients.

Methods

In this prospective cohort study, we collected 16 nutrition/inflammation-based indicators among 3,833 chemotherapy patients. The maximally selected rank statistics were used to calculate the optimal values of cutoffs for continuous indicators. OS was evaluated using the Kaplan-Meier method. The associations of 16 indicators with survival were evaluated using Cox proportional hazard models. The predictive ability of 16 indicators was assessed via time-dependent receiver operating characteristic curves (time-ROC) and the C-index.

Results

All indicators were significantly associated with worse OS of chemotherapy patients in the multivariate analyses (all P < 0.05). Time-AUC and C-index analyses indicated that the lymphocyte-to-CRP (LCR) ratio (C-index: 0.658) had the best predictive ability for OS in chemotherapy patients. The tumor stage significantly modified the association between inflammatory status and worse survival outcomes (P for interaction < 0.05). Compared to patients with high LCR and I/II tumor stages, patients with low LCR and III/IV tumor stages had a 6-fold higher risk of death.

Conclusions

The LCR has the best predictive value in chemotherapy patients compared with other nutrition/inflammation-based indicators.

Clinical trial registration

http://www.chictr.org.cn, identifier ChiCTR1800020329.

Measurement of Progress in the Environmental Area: Poland against the Countries of the European Union

The initiatives taken by the European Union (EU) and the strategies it adopts aim to achieve sustainable development in a long-term perspective. This, however, requires continuous and consistent efforts to minimise the pressure on the natural environment. By obliging and encouraging Member States to take action in the environmental area, the EU wants to be a leader in conducting the green energy transformation. The main aim of the article is to assess the level of advancement of the EU countries (taking into account their division into two groups: EU-13 and EU-15) in making efforts to preserve the natural environment, with a particular emphasis on the position of Poland among the EU countries. An environmental index (EI) was used to make comparisons between EU countries. This index was designed on the basis of selected indicators during a statistical analysis. The Principal Component Analysis and the cluster analysis are employed in the article. This analysis puts forward a claim that it was mainly the countries of the EU-15 (Denmark and Sweden, in particular) that ranked highest in the environmental area in the period analysed and thus are the most advanced in terms of taking action for environmental protection-they took leaders' positions. Romania and Bulgaria took the lowest positions in these comparisons. Poland's score was low for the EI in the period analysed compared to the EU-28 countries. Establishing a more effective environmental policy in Member States with the lowest results is most crucial. The consistency of ordering countries according to the EI was noticeable in the period investigated. This proves the stability of the positions occupied by the EU-13 and the EU-15 group. Even though the European Union has made great progress with regard to the protection of the natural environment and green transformation, there is still much more to be done to increase the efficiency of resource use, waste recycling, energy efficiency or RES sharing in energy mixes.

A scoping review of the social dimensions in food insecurity and poverty assessments

Food poverty is a phenomenon that is currently receiving increasing social attention in both the Global South and the Global North. It is often equated with food insecurity, for which numerous assessment tools and reports exist. However, only limited specific data can be found on food poverty. Starting from a theoretical concept of food poverty, this article examines in a scoping review which dimensions of food poverty are captured by indices and indicators of food insecurity and general poverty assessments. The review focuses particularly on the social dimension of food poverty and points out that it is under-reported and that no adequate assessment tools exist so far. Existing indices and indicators of food insecurity and general poverty assessments are critically reviewed and suggestions for the assessment of social food poverty for policy and practice derived.

Circular Economy trifft urban-regionale Resilienz – Synergien für eine nachhaltig-anpassungsfähige Stadtentwicklung

Um der Circular Economy bessere Möglichkeiten zur Integration in stadtregionale Strategien zu verschaffen, bietet sich die Verknüpfung mit weiter gefassten Zielen der Resilienz an. Die Konzepte der Urbanen und Regionalen Resilienz werden auch in Deutschland zunehmend als Ansatz für Zukunftsfähigkeit diskutiert. Sie sollen die Robustheit, Anpassungs- und Erholungsfähigkeit von Städten bzw. Regionen im Angesicht vielfältiger Krisen stärken, verknüpft mit Zielen der nachhaltigen Entwicklung. Der Beitrag zeigt einerseits auf, in welcher Hinsicht die kombinierte Sicht auf urban-regionale Resilienz einen geeigneten Rahmen für die effektive Einbettung systemischer Ansätze der Circular Economy ins stadträumliche Gefüge schafft. Andererseits wird erläutert, wie im Gegenzug auch die resiliente Abfederung umwelt- und wirtschaftsbezogener Risiken besser gelingen kann, wenn kreislaufwirtschaftliche Elemente integriert werden. Nach konzeptionellen Überlegungen zu synergetischen Wechselwirkungen dieser Prozessfelder dient das Beispiel der Stadt Aachen zur Illustration der zweckmäßigen Kombination von „Circular City“ und resilienzbezogenen Zielen. Dies macht deutlich, wie bedeutsam ein Fokus auf Innovationen für solche Strategieansätze ist. Am Ende werden Empfehlungen zur Gestaltung einer resilient-zirkulären Stadtökonomie formuliert.