Sylvester Kyei-Gyamfi, Frank Kyei-Arthur, Joseph Kwatsenu
et al.
Abstract Background The phenomenon of child begging has emerged as a visible and deeply troubling aspect of urban poverty worldwide, particularly in low- and middle-income countries. Rooted in chronic child poverty and economic insecurity, this practice disproportionately affects vulnerable children. Although several studies have examined child begging in Ghana, few have examined children’s perspectives, and even fewer have focused exclusively on children’s perceptions of street begging. This study examines the experiences of child street beggars in inner-city Accra, Ghana, focusing on their living and sleeping arrangements, daily activities, and future aspirations. Methods This study used secondary qualitative data of 46 child street beggars in Accra. Data were analysed using thematic analysis to capture children’s narratives and experiences. Results Findings reveal that some child street beggars lived with their parents, while others lived with peers, siblings, or alone. Child street beggars living conditions were characterised by housing insecurity, poor sanitation, and heightened exposure to abuse. Despite these challenges, many child street beggars expressed aspirations to return to school, acquire vocational skills, or achieve economic self-reliance. Conclusions The study underscores the need for comprehensive, child-centred interventions that address structural poverty, strengthen child protection systems, and expand access to education and vocational training. Incorporating children’s voices is essential for developing effective and humane policy responses to child begging in urban Ghana.
Ayodeji Ogunleye, Deborah Olude, Ayodeji Kehinde
et al.
The prevalence of credit constraints has a significant effect on the adoption of biofortified cassava; hence, low productivity on farms. This research, therefore, investigates the effect of credit constraints on the adoption of biofortified cassava (BC) among farming households. A multistage sampling procedure is employed to select 300 cassava farming households for this study. Data is analyzed using descriptive statistics, seemingly unrelated regression, and endogenous switching regression model. The results show that most of the household heads (78%) are not constrained by credit while 22% of respondents are constrained by credit. Out of the 22% that are constrained by credit, 7% are ‘quantity’ constrained (they receive partial credit) while 7.5% are both ‘risk’ (they choose not to submit their applications due to concerns about losing their collateral) and ‘price’ (they do not apply because of high interest rate) constrained. The seemingly unrelated regression model reveals that marital status, household size, years of education and farming experience significantly influenced quantity constraint status; while age, relationship with household head, farming experience and access to information are factors that contribute to the risk constraint status of farming households. The conditional treatment effect (ATT), which assesses the effect of credit constraints on the adoption of BC among farming households, is approximately -11.4 and is statistically significant at 1 %. The study finds that credit constraint has a negative impact on the adoption of BC among farming households in Nigeria after adjusting for both observable and unobserved factors. Therefore, the study recommends that innovative financing mechanisms should be leveraged to help promote the adoption of agricultural technologies such as BC. This will help to improve the nutrition, food security and income of farming households.
Freshta Amiry, Narges Neyazi, Ali Mirzazadeh
et al.
Abstract Introduction Community health workers (CHWs) played a vital role in providing diverse essential health services to their communities during the pandemic. Using CHWs perspective, this study investigates barriers to seeking and delivery of essential health services in the nine Afghan communities during the COVID-19 pandemic. Method In this cross-sectional study, 107 primary health care clinics from 9 provinces were selected, in which around 45% of the total country population reside. We used the validated questionnaire “Community Needs, Perceptions and Demand, Community Assessment Tool” which was contextualized by WHO headquarters and the WHO Afghanistan office. Data was exported into Excel, cleaned, and then exported into and analyzed using STATA version 17. Result Most CHWs were men (80.9%), from rural areas (87.2%), and volunteers (58.1%). About 66.3% reported that lack of information about available services was a main barrier. Other reported barriers were a lack of transportation to health facilities (47.2%), their home were too far from health facilities (40.9%), and a perceived lack of medicines at facilities (23.6%). More than half of CHWs reported that they received some training on how COVID-19 spreads (67.2%), COVID-19 vaccine (65.4%), and how to use a mask properly while working (56.3%), while 27.2% said that they had not enough mask available to use. Conclusion Our research demonstrated that most barriers and concerns related to using critical services during a pandemic may be addressed by providing information about available services, providing transportation to facilities, and providing masks to personnel and individuals. CHWs could play critical role in managing and responding to emergencies and pandemics if the government invest on their capacity and motivation. Revision of training curriculum for CHWs and their job description to include the emergency and pandemic management at community level, and providing them monetary incentives are highly recommended.
Kabupaten Mempawah merupakan salah satu wilayah di Provinsi Kalimantan Barat yang telah mengadopsi konsep smart city dan smart village sejak tahun 2020 melalui program digitalisasi. Program ini dirancang sebagai terobosan percepatan kreativitas dan inovasi pembangunan desa menuju desa mandiri. Salah satu dimensi smart village yang perlu dikaji secara ilmiah adalah smart community dengan melihat peran masyarakat dalam pengambilan keputusan dan perumusan kebijakan pembangunan desa. Penelitian ini bertujuan untuk menganalisis penerapan smart community pada desa mandiri di Kabupaten Mempawah agar dapat mendukung keberlanjutan dan peningkatan desa mandiri, serta memberi masukan bagi pemerintah daerah dalam mengimplementasikan smart village sesuai karakteristik wilayah. Penelitian ini menggunakan pendekatan deduktif dengan teknik pengumpulan data primer dan sekunder. Analisis yang digunakan yaitu distribusi frekuensi dan analisis indeks komposit dengan indikator demokrasi masyarakat, kreativitas masyarakat, edukasi masyarakat, dan ekonomi masyarakat. Berdasarkan hasil analisis smart community, maka dapat disimpulkan bahwa lokasi pengamatan yang difokuskan pada 7 kecamatan yang mencakup 31 mandiri di Kabupaten Mempawah termasuk kategori cukup tinggi dengan indeks sebesar 2,93.
As a systematic and complex strategic project, the realization of marine ecological product value is still in the early stage of practice. It is important to identify the key influencing factors to establish the mechanism of realizing the value of marine ecological products. This paper identified the influencing factors based on the process of realizing the value of marine ecological products, and constructed the indicator system of influencing factors. The DEMATEL-ISM method was used to construct the model and analyze the degree of mutual influence, the causal nature of each factor, and the multi-layer structure of the influencing factors. The MICMAC method was also used to classify the attributes of each influencing factor. Finally, according to the results of the model, this paper provided comprehensive suggestions for promoting the realization of marine ecological product value. The results show that the cognition of marine ecological product value, capital investment, ecological industrialization, consumption intention, market trading platform construction, incentive mechanism and policy support, stakeholder participation and ecological protection compensation mechanism are the key factors. The ISM model divides the influencing factors into four levels, among which the cognition of marine ecological product value and the ecological protection compensation mechanism as independent factors are located at the deepest level L4, and the market trading platform construction as dependent factors are located at the central level L2.
Thorsten Winkelmann, Julia Zimmermann, Erik Vollmann
Abstract Background Traffic and transport infrastructure is a vital prerequisite for social and economic development as well as the socio-spatial integration of countries and regions’ societal strata. It sets the course for the future of mobility and transport-related social and economic development and is thus inherently political. Deficiencies in traffic infrastructure provision, such as delays in project deployment and exceeding costs, increase the potential for public discontent. It is the mission of public audits to identify, diminish and remedy infrastructure deployment problems—and to encourage best practice models and policy learning. Despite their importance, shortcomings that audit offices identify as well as the reactions and follow-up measures of the addressees to official problem statements remain vastly under-researched. As the transport area is one of the core emitters of CO2 and at the heart of many transition policies to tackle climate change, lack of knowledge regarding transformative change opportunities in the mobility sector is detrimental to the success of these adaptations. One major policy issue in this respect are reform strategies regarding transport and traffic infrastructure planning and project implementation. Our systematic analysis of public audit reports in Germany on traffic and transport infrastructure project deployment contributes to a better understanding of this issue. Results We detect patterns of compliance and resistance to audit office assessments by the executing administrations in traffic infrastructure project deployment. While we witness at least the partial compliance and announcement of corrections in 51% of the cases, in about 19% of the cases, the responsible authorities acknowledge the audit’s critique (partially), but do not signal concrete willingness for further corrections. In more than 20% of the identified audit statements, the audit’s assessments are even rejected without corrections to the further projects’ execution. Conclusion We analyze the extents and limits of organizational learning and institutional adaptation of public control strategies in mobility and transport-related infrastructure provision. Our contribution discusses possible reasons for sustainable transport and traffic infrastructure development deficits as well as shortcomings in infrastructure planning and project deployment. We thus try to open new avenues for debate on improved sustainable infrastructure policy and planning.
Renewable energy sources, Energy industries. Energy policy. Fuel trade
Gerashchenko Igor Germanovich, Gerashchenko Natalya Vladimirovna
The paper analyses the specificity of modern patriotic education in Russia in the information society conditions. The patriotic education is shown in the context of globalism challenges. The necessity of a systematic approach to patriotic education is substantiated. Such aspects as military-patriotic, heroic-patriotic, spiritual-patriotic, ecological-patriotic, civil-patriotic, historical-local and sports-patriotic education are analysed.
History of scholarship and learning. The humanities
Marine hydrodynamic environment, the critical component of marine ecological habitat, provides fundamental conditions for the evolution of marine ecological differentiation pattern and basic guarantee for the realization of ecological functions and services. The Philippine Sea is one of the important centers and origins of global marine biodiversity. Based on the analysis of three-dimensional tempo-spatial characteristics of marine hydrodynamic environment in the Philippine Sea, and combined with the current situation of marine ecological zoning, this paper put forward some enlightening research suggestions. The results showed that the core marine hydrological elements of the Philippine Sea presented the distinct modes of horizontal "five zones differentiation" and vertical "three lines and one circle", which could be used as a basic reference for marine ecological comprehensive zoning. Marine ecological zoning was the strategic basis for sustainable marine development. In the future, China should strengthen marine observation networking and basic data fusion, scientifically divide the boundaries of marine biodiversity protection and resource space management, build a theoretical system of comprehensive zoning scheme and a technical system of comprehensive zoning of classified zoning, innovate a composite classification zoning algorithm, and improve the service capacity of marine ecosystem.
Ambulatory blood pressure (BP) monitoring (ABPM) is vital for screening cardiovascular activity. The American College of Cardiology/American Heart Association guideline for the prevention, detection, evaluation, and management of BP in adults recommends measuring BP outside the office setting using daytime ABPM. The recommendation to use night–day BP measurements to confirm hypertension is consistent with the recommendation of several other guidelines. In recent studies, ABPM was used to measure BP at regular intervals, and it reduces the effect of the environment on BP. Out-of-office measurements are highly recommended by almost all hypertension organizations. However, traditional ABPM devices based on the oscillometric technique usually interrupt sleep. For all-day ABPM purposes, a photoplethysmography (PPG)-based wrist-type device has been developed as a convenient tool. This optical, noninvasive device estimates BP using morphological characteristics from PPG waveforms. As measurement can be affected by multiple variables, calibration is necessary to ensure that the calculated BP values are accurate. However, few studies focused on adaptive calibration. A novel adaptive calibration model, which is data-driven and embedded in a wearable device, was proposed. The features from a 15 s PPG waveform and personal information were input for estimation of BP values and our data-driven calibration model. The model had a feedback calibration process using the exponential Gaussian process regression method to calibrate BP values and avoid inter- and intra-subject variability, ensuring accuracy in long-term ABPM. The estimation error of BP (ΔBP = actual BP—estimated BP) of systolic BP was −0.1776 ± 4.7361 mmHg; ≤15 mmHg, 99.225%, and of diastolic BP was −0.3846 ± 6.3688 mmHg; ≤15 mmHg, 98.191%. The success rate was improved, and the results corresponded to the Association for the Advancement of Medical Instrumentation standard and British Hypertension Society Grading criteria for medical regulation. Using machine learning with a feedback calibration model could be used to assess ABPM for clinical purposes.
Stephanie Bonn, Gabriella Licitra, Rino Bellocco
et al.
BackgroundThere is a need to find new methods that can enhance the individuals’ engagement in self-care and increase compliance to a healthy lifestyle for the prevention of noncommunicable diseases and improved quality of life. Mobile health (mHealth) apps could provide large-scale, cost-efficient digital solutions to implement lifestyle change, which as a corollary may enhance quality of life.
ObjectiveHere we evaluate if the use of a smartphone-based self-management system, the Health Integrator app, with or without telephone counseling by a health coach, had an effect on clinical variables (secondary outcomes) of importance for noncommunicable diseases.
MethodsThe study was a 3-armed parallel randomized controlled trial. Participants were randomized to a control group or to 1 of 2 intervention groups using the Health Integrator app with or without additional telephone counseling for 3 months. Clinical variables were assessed before the start of the intervention (baseline) and after 3 months. Due to the nature of the intervention, targeting lifestyle changes, participants were not blinded to their allocation. Robust linear regression with complete case analysis was performed to study the intervention effect among the intervention groups, both in the entire sample and stratifying by type of work (office worker vs bus driver) and sex.
ResultsComplete data at baseline and follow-up were obtained from 205 and 191 participants, respectively. The mean age of participants was 48.3 (SD 10) years; 61.5% (126/205) were men and 52.2% (107/205) were bus drivers. Improvements were observed at follow-up among participants in the intervention arms. There was a small statistically significant effect on waist circumference (β=–0.97, 95% CI –1.84 to –0.10) in the group receiving the app and additional coach support compared to the control group, but no other statistically significant differences were seen. However, participants receiving only the app had statistically significantly lower BMI (β=–0.35, 95% CI –0.61 to –0.09), body weight (β=–1.08, 95% CI –1.92 to –0.26), waist circumference (β=–1.35, 95% CI –2.24 to –0.45), and body fat percentage (β=–0.83, 95% CI –1.65 to –0.02) at follow-up compared to the controls. There was a statistically significant difference in systolic blood pressure between the two intervention groups at follow-up (β=–3.74, 95% CI –7.32 to –0.16); no other statistically significant differences in outcome variables were seen.
ConclusionsParticipants randomized to use the Health Integrator smartphone app showed small but statistically significant differences in body weight, BMI, waist circumference, and body fat percentage compared to controls after a 3-month intervention. The effect of additional coaching together with use of the app is unclear.
Trial RegistrationClinicalTrials.gov NCT03579342; https://clinicaltrials.gov/ct2/show/NCT03579342
International Registered Report Identifier (IRRID)RR2-10.1186/s12889-019-6595-6
Computer applications to medicine. Medical informatics, Public aspects of medicine
Christine Sudre, Hélène Duplan, John Bukasakakamba
et al.
IntroductionFrench Guiana is a multicultural overseas territory in the Amazon, where precariousness and difficulties in access to care are widespread. The prevalence of diabetes is double that of other French departments, and cardiovascular morbidity and mortality is high. The objective of the study was to analyze the biological, clinical and therapeutic follow-up of patients with diabetes mellitus using exhaustive data and to correlate it with national and European recommendations.Material and MethodsUsing the national health insurance data, 9079 and 10075 patients with diabetes mellitus were analyzed in 2018 and 2019, respectively. We analyzed antidiabetic treatments, medical, dental, and podiatric consultations, examinations prescribed as part of the annual follow-up, and home nursing care.ResultsThere was a significant increase over one year in the number of patients (+10%) with diabetes, mainly women (60%), and 31% were under 54 years of age, with a disparity depending on the area of the territory, the most isolated having less access to screening. Less than 56% of patients had HbA1c measurements twice a year, less than 43% had an annual renal check-up, only 19% had an ophthalmic check-up at least every two years, less than 25% had an annual dental check-up, and less than 4% had an annual follow-up with the podiatrist.ConclusionsSubstandard diabetes monitoring is a major problem likely to increase morbidity and mortality. Adapting health care to the specificities of the territory is crucial, notably by formalizing the delegation of care to advanced practice nurse and non-healthcare professionals in precarious or geographically isolated areas.
Diseases of the endocrine glands. Clinical endocrinology
Nicholas Van Hise, Russell M. Petrak, Nathan C. Skorodin
et al.
Abstract Background Eravacycline is a novel fluorocycline approved for treatment of intraabdominal infections, with a broad spectrum of activity against a range of pathogens including multidrug-resistant species, including ESBL- or KPC-producing isolates. It is approved for twice-daily dosing with no need for adjustment in renal dysfunction. In the concomitant administration with CYP 3A4-inducing drugs, eravacycline dosing should be modified. Objective To evaluate the efficacy and safety of eravacycline in a range of infections such as intraabdominal infections, pneumonia and diabetic foot infections in seriously ill patients. Methods A retrospective observational cohort study using electronic patient records of 50 consecutive patients administered eravacycline during inpatient acute care admission or as part of outpatient antibiotic therapy (OPAT). Results Therapy of 1.5 mg/kg q24h was initiated in the hospital in most patients, although some of the less sick were managed in the office or OPAT setting. All patients concluded their management outside of the hospital. Of the 50 patients, 47 (94%) achieved clinical resolution of their infection and 3 (6%) clinical failures occurred. Only three (6%) patients did not have comorbidities, three had a single comorbidity (6%), and the majority (88%) of patients had two or more comorbidities. Most common infections were intraabdominal (36%), pneumonia (18%), diabetic foot (12%), spontaneous bacterial peritonitis (8%) and empyema (8%). Almost half of infections had more than one pathogen isolated, and resistant isolates were frequent. The drug was well tolerated with only two reports of nausea, which did not result in treatment discontinuation, and in 30 days of post-eravacycline therapy only one case of Clostridiodes difficile. Conclusions In this real-world setting, eravacycline demonstrated a similar high level of clinical efficacy as seen in clinical trials, 94%, in a variety of infections, including against multidrug-resistant bacteria, and was well tolerated.
Alla Marchenko, Alenka Temeljotov-Salaj, Victor Rizzardi
et al.
In the time of climate change, as heat waves become a more regular occurrence, indoor thermal comfort is an important factor in day to day life. Due to such circumstances, many researchers have focused their studies on finding an effective solution that will not only enable thermal comfort, but also increase satisfaction within the indoor environment and, as a result, productivity. The fast development of the biometrical field encouraged the study focused on the investigation of how bio-markers, in combination with artificial intelligence algorithms, can be collected within an experimental setting to create a new approach for non-invasive thermal discomfort detection. The developed experimental design provides synergy between automatic facial coding, pulse, and galvanic skin response measurements via iMotions software in a controlled environment. The iMotions software has built-in machine vision algorithms, and with Shimmer sensors and a post-processing tool through Affectiva AFFDEX, is able to collect facial action data through detection of the facial muscle movements and various bio-markers. The Zero Emission Building (ZEB) Test Cell laboratory was used as the control environment and transformed to imitate an office space for the data collection campaign at NTNU in Trondheim. The given experimental design provides an opportunity to create an immense database with bio-markers that are linked to the subcortical level of the brain, indoor parameters, and direct feedback on the comfort level of occupants within an office-like environment. In total, 111 data collection sessions were registered with iMotions. The discomfort button was pressed 240 times and 1080 planned indoor comfort evaluation surveys were held during experiment. The discomfort button was pressed 49 times to indicate that participant felt discomfort due to low temperature and 52 due to high temperature. Collected data revealed a big deviation in the discomfort temperature values for experiment participants with respect to performed temperature ramps. While it is common to use the same predefined temperature range for facility management, it became clear that the complexity of the task is greater and should not be approached on a human computational level. Implementation of AI can potentially provide higher value accuracy within thermal discomfort detection and enable unique personal user experience at the workplace.
The role of the nurse in improving hypertension control has expanded over the past 50 years, complementing and supplementing that of the physician. Nurses' involvement began with measuring and monitoring blood pressure (BP) and patient education and has expanded to become one of the most effective strategies to improve BP control. Today the roles of nurses and nurse practitioners (NPs) in hypertension management involve all aspects of care, including (1) detection, referral, and follow up; (2) diagnostics and medication management; (3) patient education, counseling, and skill building; (4) coordination of care; (5) clinic or office management; (6) population health management; and (7) performance measurement and quality improvement. The patient-centered, multidisciplinary team is a key feature of effective care models that have been found to improve care processes and control rates. In addition to their clinical roles, nurses lead clinic and community-based research to improve the hypertension quality gap and ethnic disparities by holistically examining social, cultural, economic, and behavioral determinants of hypertension outcomes and designing culturally sensitive interventions to address these determinants.
Sung‐Chun Tang, Jiu‐Haw Yin, Chung‐Hsiang Liu
et al.
BackgroundPulse pressure (PP) is related to cardiac function, arterial stiffness, fluid status, and vascular events. This study aimed to explore the prognostic role of PP upon admission in patients with acute ischemic stroke (AIS) based on a nation‐wide stroke registry. Methods and ResultsWe evaluated the association between PP upon admission and outcomes 3 months after a stroke in patients who had an AIS registered in the Taiwan Stroke Registry, including 56 academic and community hospitals between 2006 and 2013. Three months after the stroke, unfavorable outcomes were defined using a modified Rankin scale of 3 to 6. Of 33 530 patients (female, 40.6%; mean age, 68.8±13.3 years) who had an AIS, PP upon admission had a reverse J‐curve association with an unfavorable outcome. After adjusting for clinical variables, including AIS subtypes, initial National Institutes of Health Stroke Scale, and systolic and diastolic blood pressure upon admission, a PP of <50 mm Hg was associated with unfavorable outcomes (P<0.0001). Compared with patients with a PP of 50 to 69 mm Hg, the odds ratios for unfavorable outcomes were 1.24 (95% CI, 1.14–1.36) with a PP of 30 to 49 mm Hg and 1.85 (95% CI, 1.50–2.28) with a PP of <30 mm Hg. Moreover, the prognostic impact of PP upon admission was similar across all AIS subtypes. ConclusionsLow PP upon admission was associated with unfavorable patient outcomes in AIS.
Diseases of the circulatory (Cardiovascular) system
Charlotte Klinga, Johan Hansson, Henna Hasson
et al.
<p class="p1"><strong>Introduction: </strong>Co-leadership has been identified as one approach to meet the managerial challenges of integrated services, but research on the topic is limited. In the present study, co-leadership, practised by pairs of managers – each manager representing one of the two principal organizations in integrated health and social care services – was explored. <p class="p2"><strong>Aim: </strong>To investigate co-leadership in integrated health and social care, identify essential preconditions in fulfilling the management assignment, its operationalization and impact on provision of sustainable integration of health and social care. <p class="p2"><strong>Method: </strong>Interviews with eight managers exercising co-leadership were analysed using directed content analysis. Respondent validation was conducted through additional interviews with the same managers. <p class="p2"><strong>Results: </strong>Key contextual preconditions were an organization-wide model supporting co-leadership and co-location of services. Perception of the management role as a collective activity, continuous communication and lack of prestige were essential personal and interpersonal preconditions. In daily practice, office sharing, being able to give and take and support each other contributed to provision of sustainable integration of health and social care. <p class="p2"><strong>Conclusion and discussion: </strong>Co-leadership promoted robust management by providing broader competence, continuous learning and joint responsibility for services. Integrated health and social care services should consider employing co-leadership as a managerial solution to achieve sustainability.
The nonlinear behavior of organizations in development projects is considered. The nonlinear behavior is initiated in the growth of organizations and requires a restructuring of governance in identifying dysfunctions. Such a restructuring is needed in the area of soft components, determining the organizational levels of competence in the management of projects, programs, portfolios and heads of the Project Management Office. An important component of the strategic development of the organization is the proposed concept for formation and management of development programs in the context according to their life cycle. It should take into account the non-linear behavior of the soft components of the system and violation of functional processes of the organization. The specific management syndromes of projects and programs are considered. Such as syndromes time management project linked to the singular points of the project. These syndromes are "shift to the right", "point of no return", "braking at the end of the project" and others.