RATIONALE Rising antimicrobial resistance (AMR) is a threat to modern medicine and increasing international mobility facilitates the spread of AMR. Infections with resistant organisms have higher morbidity and mortality, are costlier to treat, result in longer hospital stays, and place a greater burden on health systems than infections caused by susceptible organisms. Here we review the role of travel in the international dissemination of antimicrobial resistance and consider actions at the levels of travelers, travel medicine practitioners, and policymakers that would mitigate this threat. FINDINGS Resistant pathogens do not recognize international borders; travelers to areas with high AMR prevalence are likely to be exposed to resistant bacteria and return to their home countries colonized. Medical tourists go between health facilities with drastically different rates of AMR, potentially transmitting highly resistant strains.Drug-resistant bacteria have been found in every continent, however, differences between countries in the prevalence of AMR depend on multiple factors. These include levels of antibiotic consumption (including inappropriate use), access to clean water, adequate sanitation, vaccination coverage, the availability of quality healthcare, and access to high quality medical products. CONCLUSIONS Travelers to areas with high levels of AMR should have vaccines up to date, be aware of ways of treating and preventing travelers' diarrhea (other than antibiotic use) and be informed on safe sexual practices. The healthcare systems of low- and middle-income countries require investment to reduce the transmission of resistant strains by improving access to clean water, sanitation facilities and vaccines. Efforts are needed to curb inappropriate antibiotic use worldwide. In addition, more surveillance is needed to understand the role of the movement of humans, livestock and food products in resistance transmission. The travel medicine community has a key role to play in advocating for the recognition of AMR as a priority on the international health agenda. KEY POLICY RECOMMENDATIONS Antimicrobial resistance is a threat to modern medicine and international travel plays a key role in the spread of highly resistant strains. It is essential that this is addressed at multiple levels: Individual travelers can reduce antibiotic consumption and the likelihood of infection. Travelers should have up to date vaccines and be informed on methods of preventing and treating travelers' diarrhea, other than use of antibiotics, and on safe sexual practices, such as condom use. Healthcare facilities need to be aware of the travel history of patients to provide appropriate treatment to those who are at high risk of exposure and to prevent further spread. Internationally, in countries without reliable and universal access to clean water, sanitation and hygiene, investment is needed to reduce the emergence and spread of resistance and ensure the antimicrobials available are of assured quality. High-income countries must ensure their use of antimicrobials is appropriate to reduce selection for AMR. Surveillance across all countries is needed to monitor and respond to this emerging threat.
Christian Rutzer, Dragan Filimonovic, Jeffrey T. Macher
et al.
The CD index is a widely used measure of disruptive inventions. Most studies compute it using USPTO data. This creates a puzzle because the US appears less disruptive than European and Asian countries. We show that this largely stems from missing international citations. Using a global citation network, we quantify and correct this bias. The disruptiveness advantage of non-US inventors drops by 64% to 148% of the US baseline mean. The US emerges as a disruption leader over Europe, with Asia's advantage substantially reduced. Globally integrated citation data are essential for credible measurement of disruptive innovation in international contexts.
The transition toward a low-carbon maritime transportation requires understanding lifecycle carbon intensity (CI) of marine fuels. While well-to-tank emissions significantly contribute to total greenhouse gas emissions, many studies lack global perspective in accounting for upstream operations, transportation, refining, and distribution. This study evaluates well-to-tank CI of High Sulphur Fuel Oil (HSFO) and well-to-refinery exit CI of Liquefied Petroleum Gas (LPG) worldwide at asset level. HSFO represents traditional marine fuel, while LPG serves as potential transition fuel due to lower tank-to-wake emissions and compatibility with low-carbon fuels. Using OPGEE and PRELIM tools with R-based geospatial methods, we derive country-level CI values for 72 countries (HSFO) and 74 countries (LPG), covering 98% of global production. Results show significant variation in climate impacts globally. HSFO upstream CI ranges 1-22.7 gCO2e/MJ, refining CI 1.2-12.6 gCO2e/MJ, with global volume-weighted-average well-to-tank CI of 12.4 gCO2e/MJ. Upstream and refining account for 55% and 32% of HSFO well-to-tank CI, with large exporters and intensive refining practices showing higher emissions. For LPG, upstream CI ranges 0.9-22.7 gCO2e/MJ, refining CI 2.8-13.9 gCO2e/MJ, with volume-weighted-average well-to-refinery CI of 15.6 gCO2e/MJ. Refining comprises 49% of LPG well-to-refinery CI, while upstream and transport represent 44% and 6%. Major players include China, United States and Russia. These findings reveal significant CI variability across countries and supply chains, offering opportunities for targeted emission reduction policies.
Classifier-free guidance (CFG) is a key technique for improving conditional generation in diffusion models, enabling more accurate control while enhancing sample quality. It is natural to extend this technique to video diffusion, which generates video conditioned on a variable number of context frames, collectively referred to as history. However, we find two key challenges to guiding with variable-length history: architectures that only support fixed-size conditioning, and the empirical observation that CFG-style history dropout performs poorly. To address this, we propose the Diffusion Forcing Transformer (DFoT), a video diffusion architecture and theoretically grounded training objective that jointly enable conditioning on a flexible number of history frames. We then introduce History Guidance, a family of guidance methods uniquely enabled by DFoT. We show that its simplest form, vanilla history guidance, already significantly improves video generation quality and temporal consistency. A more advanced method, history guidance across time and frequency further enhances motion dynamics, enables compositional generalization to out-of-distribution history, and can stably roll out extremely long videos. Project website: https://boyuan.space/history-guidance
Matteo Busso, Andrea Bontempelli, Leonardo Javier Malcotti
et al.
Understanding everyday life behavior of young adults through personal devices, e.g., smartphones and smartwatches, is key for various applications, from enhancing the user experience in mobile apps to enabling appropriate interventions in digital health apps. Towards this goal, previous studies have relied on datasets combining passive sensor data with human-provided annotations or self-reports. However, many existing datasets are limited in scope, often focusing on specific countries primarily in the Global North, involving a small number of participants, or using a limited range of pre-processed sensors. These limitations restrict the ability to capture cross-country variations of human behavior, including the possibility of studying model generalization, and robustness. To address this gap, we introduce DiversityOne, a dataset which spans eight countries (China, Denmark, India, Italy, Mexico, Mongolia, Paraguay, and the United Kingdom) and includes data from 782 college students over four weeks. DiversityOne contains data from 26 smartphone sensor modalities and 350K+ self-reports. As of today, it is one of the largest and most diverse publicly available datasets, while featuring extensive demographic and psychosocial survey data. DiversityOne opens the possibility of studying important research problems in ubiquitous computing, particularly in domain adaptation and generalization across countries, all research areas so far largely underexplored because of the lack of adequate datasets.
Not all nations on earth have previously been surveyed accurately enough to know for certain which peak is the national highpoint, the highest peak in the country. Knowledge of these peaks is important for understanding the physical geography of these countries in terms of natural resource availability, watershed management, and tourism potential. For this study, ground surveys were conducted between 2018-2025 with modern professional surveying equipment, including differential GPS units and Abney levels, to accurately determine the national highpoints in five African and Asian countries where uncertainty existed. New national highpoints were determined for Saudi Arabia (Jabal Ferwa), Uzbekistan (Alpomish), Gambia (Sare Firasu Hill), Guinea-Bissau (Mt Ronde), and Togo (Mt Atilakoutse). Elevations were measured with sub-meter vertical accuracy for candidate peaks in Saudi Arabia, Gambia, Guinea-Bissau, and Togo. Relative elevations were measured between contender peaks in Uzbekistan with sufficient accuracy to determine the highpoint.
OBJECTIVES Influenza vaccination is an effective method for preventing influenza virus infection. Herein, we performed a meta-analysis to quantify global influenza vaccination rates (IVRs) and the factors influencing its uptake in the general population, individuals with chronic diseases, pregnant women, and healthcare workers. METHODS Related articles were obtained from online databases and screened according to the inclusion criteria. The pooled IVRs were calculated using the random effects model. Subgroup analyses and multivariate meta-regression were performed to determine the factors associated with influenza vaccine uptake. RESULTS We included 522 studies from 68 countries/regions. Most studies were conducted in the European region (247 studies), followed by the Western Pacific (135 studies) and American regions (100 studies). The IVRs in the general population were lower (24.96%, 23.45-26.50%) than in individuals with chronic diseases (41.65%, 40.08-43.23%), healthcare workers (36.57%, 33.74-39.44%), and pregnant women (25.92%, 23.18-28.75%). The IVRs were significantly higher in high-income countries/regions than that in middle-income countries/regions. Countries/regions with free vaccine policy, perception of influenza vaccine efficacy and disease severity, a recommendation from healthcare workers, and having a history of influenza vaccination were positive factors for vaccine uptake (P < 0.01). CONCLUSIONS Overall, global IVRs were low, especially in the general population. The studies on the IVRs, especially for priority populations, should be strengthened in Eastern Mediterranean, South-East Asian, and African regions. Free vaccine policies and the dissemination of continuous awareness campaigns are effective measures to enhance vaccination uptake.
Based on the assumption that printing privileges were meant to protect printer-publishers from market competition locally, scholars have primarily studied such privileges in individual states. This article is the first attempt to study printing privileges transnationally, by focusing on the phenomenon of cross-border printing privileges in the seventeenth-century Habsburg Netherlands and the Dutch Republic. I examine both the foreign printers requesting a privilege in the Low Countries and local printers requesting a privilege from a foreign authority. In doing so, this essay analyses why printers were requesting privileges for their books from more than one authority across political borders. Rather than seeing these cross-border privileges solely as a way for printers to expand the reach and commercial viability of their published works, this article demonstrates that, by securing privileges from multiple authorities, printers showed they were able to navigate the market for institutions and complex networks of power. By analysing diplomatic correspondence alongside privilege requests, I demonstrate the crucial role of ambassadors in favouring certain printers and their project. Throughout the seventeenth century, the state and its representatives became involved in securing such privileges from other authorities. This hitherto hidden role of diplomatic agents alerts us both to the fierce competition in a certain segment of the international book market and the importance of managing a state’s international reputation.
The overconsumption of consumers under today's increasingly scarce natural resources has overwhelmed the textile industry in middle-income countries, such as Romania. It is becoming more and more essential to encourage sustainable clothing consumption behaviors, such as purchasing recyclable clothes. Notwithstanding there is a limited number of studies trying to understand the intrinsic factors that motivate consumers' purchase intention toward sustainable clothes in middle-income countries. Moreover, the effect of consumers' environmental knowledge on determining their purchase intention of sustainable clothes remains understudied. Consequently, the purpose of this paper is to make a significant contribution to the sustainable consumption literature by providing a consolidated framework that explores the behavioral factors inclining Romanian consumers' purchase intention towards sustainable clothes. The foundation of this study combines consumers' social value orientation and the theory of planned behavior. the partial least square path modelling procedure was used to analyze the data of 1,018 Romanian respondents. The findings of this study show that altruistic value orientation, subjective norms, and sustainable attitudes have a positive effect on Romanian consumers' purchase intention of sustainable clothing. Thus, these insights provide essential practical implications of advocating for the consumption of sustainable clothes along with useful guidelines for practitioners in the textile industry among middle-income countries, especially in Romania, to reduce overconsumption.
Language endangerment is a phenomenon in which approximately 40% of languages spoken worldwide are predicted to disappear within the next few decades, resulting in the loss of cultures associated with these languages. To take effective measures against language endangerment, it is essential to quantitatively understand its characteristics because it is a phenomenon in which historical, geographical, and economic factors are intricately intertwined. In this study, multilayer language-country bipartite networks are constructed using information about which countries each language is spoken in and two types of linguistic features, namely the existence of a writing system and the function within a country. In addition, percolation simulations are conducted to measure how language and country networks break down according to the extinction of languages and to identify vulnerable connections in them. In the language network of officially used languages with their writing system, the community analysis indicated that there were communities composed of languages spoken over geographically separated distances. The strength of languages revealed that the official languages in the former colonial nations, namely English, French, Spanish, Dutch, Portuguese, and Russian, still played significant roles in the formation of these communities. In the language and country networks of unofficially used languages without their writing system, the percolation simulation revealed that languages were likely to severely disappear in the Americas, and that linguistic diversity was vulnerable in affluent countries. The findings show that the analysis of multilayer language-country bipartite networks has enabled a quantitative understanding of the language endangerment occurring worldwide from historical, geographical, and economic perspectives.
K. Ormond, Laura Hayward, Tina‐Marié Wessels
et al.
We conducted an exploratory survey of genetic counselors internationally to assess similarities and differences in reported practice activities. Between November 2018 and January 2020 we conducted a mass emailing to an estimated 5600 genetic counselors in different countries and regions. We obtained 189 useable responses representing 22 countries, which are included in an aggregate manner. Data from countries with 10 or more responses, comprising 82% of the total (N = 156), are the primary focus of this report: Australia (13), Canada (26), USA (59), UK (17), France (12), Japan (19) and India (10). Twenty activities were identified as common (≥74%) across these countries, encompassing most subcategories of genetic counseling activity. Activities with most frequent endorsement include: reviewing referrals and medical records and identifying genetic testing options as part of case preparation; taking family and medical histories; performing and sharing risk assessment; and educating clients about basic genetic information, test options, outcomes and implications, including management recommendations on the basis of the test results. Genetic counselors also consistently establish rapport, tailor the educational process, facilitate informed decision making and recognize factors that may impact the counseling interaction. The least endorsed activities were in the Medical History category. Notable differences between countries were observed in the endorsement of 33 activities, primarily in the Contracting and Establishing Rapport, Family History, Medical History, Assessing Patients Psychosocially and Providing Psychosocial Support categories. Generalizations about international practice patterns are limited by the low response rate. However, this study is, to our knowledge, the first to systematically compare the clinical practice and specific activities of genetic counselors working in different countries.
Isidora Tourni, Georgios Grigorakis, Isidoros Marougkas
et al.
The advances of Generative AI models with interactive capabilities over the past few years offer unique opportunities for socioeconomic mobility. Their potential for scalability, accessibility, affordability, personalizing and convenience sets a first-class opportunity for poverty-stricken countries to adapt and modernize their educational order. As a result, this position paper makes the case for an educational policy framework that would succeed in this transformation by prioritizing vocational and technical training over academic education in sub-Saharan African countries. We highlight substantial applications of Large Language Models, tailor-made to their respective cultural background(s) and needs, that would reinforce their systemic decolonization. Lastly, we provide specific historical examples of diverse states successfully implementing such policies in the elementary steps of their socioeconomic transformation, in order to corroborate our proposal to sub-Saharan African countries to follow their lead.
Prostate cancer (PCa) is the most frequent type of cancer in the male population in 112 countries. PCa represents 14.1% of the incidence and 6.8% of the mortality by cancer worldwide, which represents 1.4 million new cases and 375.000 deaths in 2020 (1). In the same year, the age-standardized incidence rate of PCa was 65.5, whereas the mortality was 13.6 per 100.000 individuals in South America (1). According to the Instituto Nacional de Câncer José Alencar Gomes da Silva (INCA), one of the main Brazilian cancer institutes, PCa accounts for 29.2% of all cancers in males in Brazil (2). This represents 65.840 new cases of PCa in each year in the period 2020-2022 (2). The etiology of PCa is still poorly understood and the most well-known risk factors are older age, genetic mutations, and a family history of this type of cancer (3). Smoking, excessive body weight and diet are some environmental factors that may be related to this cancer, but further studies are still necessary to confirm this (1, 3). The guidelines for managing localized PCa depend on the severity of the tumor and on the risk group to which the patient belongs, according to the American Society of Clinical Oncology (4). The main approaches are surgical procedures (prostatectomies), radiotherapy, and androgen deprivation therapies. They can be applied alone or in combination. For low and very low risk localized prostate tumors in patients who have a high probability of progression, physicians may offer surgical procedures as a definitive treatment. In cases of intermediate and high risk localized PCa, prostatectomy or radiotherapy with androgen deprivation therapy should be recommended (4). In Brazil, citizens have access to the Sistema Único de Saúde (SUS, the Brazilian Unified National Health System) which is responsible for undertaking preventive exams and treating numerous disorders and diseases, including cancer. Information regarding the number of hospitalizations, procedures, costs, number of deaths, mortality rates and other factors related to the treatment of PCa by SUS are available in the public database DATASUS. Furthermore, INCA is responsible for the Atlas On-line da Mortalidade (here referred to as the Online Atlas of Cancer Mortality), a database presenting information specifically on deaths and mortality rates related to cancer in Brazil (5). The main focus of this study is to present a description of data concerning PCa mortality, diagnosed cases, and the costs of prostate surgical procedures in the SUS based on these two public databases.
Omran Alamayreh, Giovanna Maria Dimitri, Jun Wang
et al.
Recognizing the country where a picture has been taken has many potential applications, such as identification of fake news and prevention of disinformation campaigns. Previous works focused on the estimation of the geo-coordinates where a picture has been taken. Yet, recognizing in which country an image was taken could be more critical, from a semantic and forensic point of view, than estimating its spatial coordinates. In the above framework, this paper provides two contributions. First, we introduce the VIPPGeo dataset, containing 3.8 million geo-tagged images. Secondly, we used the dataset to train a model casting the country recognition problem as a classification problem. The experiments show that our model provides better results than the current state of the art. Notably, we found that asking the network to identify the country provides better results than estimating the geo-coordinates and then tracing them back to the country where the picture was taken.
In recent years end-to-end verifiable voting (E2EVV) has emerged as a promising new paradigm to conduct evidence-based elections. However, E2EVV systems thus far have primarily been designed for the developed world and the fundamental assumptions underlying the design of these systems do not readily translate to the developing world, and may even act as potential barriers to adoption of these systems. This is unfortunate because developing countries account for 80\% of the global population, and given their economic and socio-political dilemmas and their track record of contentious elections, these countries arguably stand to benefit most from this exciting new paradigm. In this paper, we highlight various limitations and challenges in adapting E2EVV systems to these environments, broadly classed across social, political, technical, operational, and human dimensions. We articulate corresponding research questions and identify significant literature gaps in these categories. We also suggest relevant strategies to aid researchers, practitioners, and policymakers in visualizing and exploring solutions that align with the context and unique ground realities in these environments. Our goal is to outline a broader research agenda for the community to successfully adapt E2EVV voting systems to developing countries.
This article analyses how the alternative food movement in the Low Countries successfully promoted the ideal of small-scale production and consumption since the 1970s. This history highlights an interpretation of sustainability which addressed global problems by a return to the local. Operating on a small scale enabled the alternative food movement to bridge the gap between social and environmental concerns. Although alternative food remained marginal within the quickly expanding agricultural sector of both Belgium and the Netherlands, the movement enlarged its reach through eco-labels and cooperation with large retail chains. As a result, small-scale practices could not be maintained. In the Netherlands, the alternative food movement subsequently emphasised the environment, whereas the social dimension was more pronounced in Belgium. Small-scale production and consumption became firmly entrenched as ideals, but, in practice, the balance between social, environmental, and economic concerns that activists had hoped for, moved out of reach. Dit artikel analyseert hoe de alternatieve voedselbeweging in de Lage Landen succesvol het ideaal van kleinschalige productie en consumptie op de kaart zette sinds de jaren zeventig van de vorige eeuw. Het artikel gaat dieper in op een variant van duurzaamheid waarin mondiale problemen werden geadresseerd door een terugkeer naar het lokale. Kleinschaligheid bood de alternatieve voedselbeweging een kans om ecologische en sociale bekommernissen te verbinden. Hoewel alternatieve voeding marginaal bleef in de snel intensiverende landbouwsector in België en Nederland, vergrootte de alternatieve voedselbeweging haar bereik door middel van eco-keurmerken en samenwerkingen met grote winkelketens. Hierdoor kwam kleinschaligheid echter onder druk te staan. Terwijl de beweging in Nederland het milieu vooropstelde, lag in België meer nadruk op het sociale belang van lokale productie. Hoewel kleinschaligheid als ideaal stevig verankerd bleef, raakte de verhoopte balans tussen aandacht voor het milieu, sociale verhoudingen en economische belangen in de praktijk buiten bereik.
Background Suicide ideation and attempt are more highly prevalent among medical students compared to the general population. Suicidal thought negatively impacts the quality of life, physical, and mental well-being of the students. However, research into suicide ideation and attempt among medical students in low- and middle-income countries is limited. Therefore, this study aimed to explore suicide ideation and attempt and their determinants among medical students in Ethiopia have a crucial role for further intervention. Methods An institution-based cross-sectional study was conducted on 393 medical students from March to June 2019 at the University of Gondar (UoG) in Ethiopia. Simple random sampling technique was used to select study participants. Suicide ideation and attempt were assessed using the World Health Organization Composite International Diagnostic Interview (CIDI) to assess lifetime suicide ideation and attempts during medical school. Data were collected using a self-administered questionnaire. Binary logistic regression analyses were used to identify factors associated with suicide ideation and attempt. An odds ratio (OR) with a 95% confidence interval (CI) was computed to assess the strength of the association. Results A total of 393 participants took part with a response rate of 92.9%. The prevalence of suicide ideation and attempt among study participants was found to be 14% and 7.4%, respectively, with 95% CI (10.9–18.1) and (5.1–10.2). Being female (AOR: 5.21, 95% CI 3.42–7.20), co-morbid depression symptoms (AOR: 10.12, 95% CI 6.80–15.52), current khat chewing (AOR: 4.46, 95% CI 3.32–10.02), and poor social support (AOR: 4.46, 95% CI 3.43–9.87) were factors significantly associated with suicide ideation; whereas, female sex (AOR: 8.08, 95% CI 6.04–12.39), depression (AOR: 10.66, 95% CI 8.01–19.01 ) and history of mental illness (AOR: 5.53, 95% CI 5.20–15.50) were factors significantly associated with suicide attempt. Conclusions In the current study, the prevalence of suicide ideation among medical students was low compared to other studies, but the suicide attempt was high. Ministry of Health should develop a guideline on how to screen and manage suicide ideation and attempt among medical students.
Abstract:Readers can access open access articles for free, but authors or research funders pay article-processing charges to publish them. This requirement may deter authors in low-income countries from publishing in open access. This study investigates the choices that authors make among three types of open access journal and closed (subscription) journals in history, economics, science, and technology based on their countries’ income level. The sample comprises research articles published in journals in English in 2020 and indexed in Scopus. The results show that authors in low-income countries publish more in gold open access than do authors in lower-middle- and upper-middle-income countries, who tend not to publish in hybrid open access and to favour closed journals. Authors from high-income countries publish more in hybrid open access than do authors in the other groups of countries. Although major publishers waive their article-processing charges for authors in low-income countries, these authors amount to less than 1 per cent of the total. Improving the effectiveness of publishers’ waiver policies is necessary.
Aragaw Tesfaw, S. Demis, Tigabu Munye Aytenew
et al.
Background Unlike developed countries, there is high mortality of breast cancer in low- and middle-income countries associated with prolonged patient delays and advanced stage presentations. However, evidence-based information about patient delay in presentation and contributing factors to diagnosis of breast cancer in Ethiopia is scarce. Methods Institution-based cross-sectional study was conducted at oncology units of the University of Gondar and Felege Hiwot specialized hospitals. A total of 371 female breast cancer patients who were newly diagnosed from September 2019 to April 30, 2020 were included. Data were entered using EPI info version 7.2 and analyzed in SPSS version 23. Descriptive statistics was used to summarize socio-demographic and clinical characteristic of the patients. Multivariable logistic regression at a P-value<0.05 significance level was used to identify predictors of patient delay. Results A total of 281 (75.7%) patients had long patient delay of ≥90 days (3 months) with the average patient delay time of 8 months, and advanced stage diagnosis was found on 264 (71.2%) of patients. The median age of patients was 40 years. Rural residence (AOR=3.72; 95% CI=1.82–7.61), illiterate (AOR=3.8; 95% CI=1.71–8.64), having a painless wound (AOR=3.32; 95% CI=1.93, 5.72), travel distance ≥5 km (AOR=1.66; 95% CI=1.09–3.00), having no lump/swelling in the armpit (AOR=6.16; 95% CI=2.80–13.54), and no history of any breast problem before (AOR=2.46; 95% CI=(1.43–4.22) were predictors for long patient delay. Conclusion Long patient delay and advanced stage diagnosis of breast cancer are higher in our study. Travel distance ≥5 km, rural residence, no history of any breast problem before, having no lump/swelling in the arm pit, a painless lump in the breast, and being illiterate were important predictors for patient delay. Therefore, public awareness programs about breast cancer should be designed to prevent patient delay in presentation and to promote early detection of cases before advancement.