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1.
Biomaterials ; 313: 122794, 2025 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-39241552

RESUMO

Complex tissue damage accompanying with bacterial infection challenges healthcare systems globally. Conventional tissue engineering scaffolds normally generate secondary implantation trauma, mismatched regeneration and infection risks. Herein, we developed an easily implanted scaffold with multistep shape memory and photothermal-chemodynamic properties to exactly match repair requirements of each part from the tissue defect by adjusting its morphology as needed meanwhile inhibiting bacterial infection on demand. Specifically, a thermal-induced shape memory scaffold was prepared using hydroxyethyl methacrylate and polyethylene glycol diacrylate, which was further combined with the photothermal agent iron tannate (FeTA) to produce NIR light-induced shape memory property. By varying ingredients ratios in each segment, this scaffold could perform a stepwise recovery under different NIR periods. This process facilitated implantation after shape fixing to avoid trauma caused by conventional methods and gradually filled irregular defects under NIR to perform suitable tissue regeneration. Moreover, FeTA also catalyzed Fenton reaction at bacterial infections with abundant H2O2, which produced excess ROS for chemodynamic antibacterial therapy. As expected, bacteriostatic rate was further enhanced by additional photothermal therapy under NIR. The in vitro and vivo results showed that our scaffold was able to perform high efficacy in both antibiosis, inflammation reduction and wound healing acceleration, indicating a promising candidate for the regeneration of complex tissue damage with bacterial infection.


Assuntos
Antibacterianos , Alicerces Teciduais , Cicatrização , Antibacterianos/farmacologia , Antibacterianos/química , Antibacterianos/uso terapêutico , Animais , Alicerces Teciduais/química , Camundongos , Cicatrização/efeitos dos fármacos , Raios Infravermelhos , Terapia Fototérmica , Engenharia Tecidual/métodos , Taninos/química , Taninos/farmacologia , Materiais Inteligentes/química , Staphylococcus aureus/efeitos dos fármacos , Masculino , Polietilenoglicóis/química
2.
Data Brief ; 57: 110917, 2024 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-39386326

RESUMO

This article presents the data used in the paper "Vehicle-to-home operation and multi-location charging of electric vehicles for energy cost optimisation of households with photovoltaic system and battery energy storage" [1]. The datasets reported in this paper include the probability distributions of arrival and departure times of privately used vehicles at both home and workplace. The datasets relate to two types of privately used vehicles, namely, those commuting to and from the workplace, and those used for all other activities except attending the workplace. These two vehicle types are referred to as work vehicles and casual vehicles respectively. The datasets consider different daily travel frequencies, where the term travel frequency refers to the number of times a vehicle arrives at home each day. The raw data of vehicle usage is sourced from the Victorian Integrated Survey of Travel & Activity (VISTA) [2], which is an ongoing survey that has collected data from 32,000 households and 82,000 people since 2012. This dataset is filtered to obtain the arrival-departure times of privately-used work vehicles. For the casual vehicles, the filtered data is categorised based on daily travel frequency to obtain the arrival-departure times. Using the filtered and categorised data, the probability distributions of the arrival-departure times for work and casual vehicles are extracted. Microsoft Excel and MATLAB software are used to perform the required processing. The experimental methods used to obtain the required data, from downloading the raw datasets to extracting the probability distributions, are described in this paper.

3.
BMC Health Serv Res ; 24(1): 1172, 2024 Oct 03.
Artigo em Inglês | MEDLINE | ID: mdl-39363337

RESUMO

BACKGROUND: Efforts to engage boys and young men in sexual and reproductive health (SRH) services in Sweden remain limited, with only a small proportion accessing youth clinics, the primary providers of such services. Existing initiatives are often ad-hoc and lack institutionalization within public policy and practice. This study aims to identify feasible and effective interventions to improve boys' and young men's access to youth clinics in Sweden. METHODS: Employing a mixed-methods approach, this study investigates interventions, strategies, and factors influencing access to SRH services for boys and young men in Sweden. Firstly, a systematic literature review will be conducted to identify evaluated interventions globally. Secondly, strategies to attracts boys and young men in youth clinics in Sweden will be mapped. Thirdly, case studies in two regions in Sweden - chosen for their demographic and geographic diversity - will be conducted interviewing healthcare providers, managers, policymakers, and boys and young men. Lastly, Q-methodology will be used to rank all identified strategies. Healthcare providers and managers will rank these strategies based on their perceived effectiveness and feasibility while boys and young men will rank the interventions based on perceived effectiveness. DISCUSSION: The added value of this project is generating robust evidence regarding boys and young men's involvement in SRH services, especially their access to youth clinics. This is crucial for (1) developing gender-sensitive services and service delivery models that effectively promote young men's SRH; (2) informing future young men's health policies ensuring that their unique SRH concerns are addressed; and (3) improving young men's participation in SRH provision. This will ultimately foster a culture of shared responsibilities and advance gender equality.


Assuntos
Acessibilidade aos Serviços de Saúde , Humanos , Suécia , Masculino , Adolescente , Serviços de Saúde Reprodutiva/organização & administração , Adulto Jovem
4.
Biomater Transl ; 5(2): 144-156, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-39351167

RESUMO

Understanding the in vivo transport process provides guidelines for designing ideal nanoparticles (NPs) with higher efficacy and fewer off-target effects. Many factors, such as particle size, morphology, surface potential, structural stability, and etc., may influence the delivering process of NPs due to the existence of various physiological barriers within the body. Herein, we summarise the distinct influences of NP physicochemical properties on the four consecutive in vivo transport steps: (1) navigating with bloodstream within blood vessels, (2) transport across vasculature walls into tumour tissues, (3) intratumoural transport through the interstitial space, and (4) cellular uptake & intracellular delivery by cancerous cells. We found that the philosophy behind the current consensus for NP design has certain similarities to the "Yin-Yang" theory in traditional Chinese culture. Almost all physicochemical properties, regardless of big or small sizes, long or short length, positive or negative zeta potentials, are double-edged swords. The balance of potential benefits and side effects, drug selectivity and accessibility should be fully considered when optimising particle design, similar to the "Yin-Yang harmony". This paper presents a comprehensive review of the advancements in NPs research, focusing on their distinct features in tumour targeting, drug delivery, and cell uptake. Additionally, it deliberates on future developmental trends and potential obstacles, thereby aiming to uncover the ways these characteristics influence the NPs' biological activity and provide theoretical guidance for the targeted delivery of NPs.

5.
Physiol Rep ; 12(19): e70068, 2024 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-39358859

RESUMO

We sought to determine the repeatability of EFL in healthy adults during incremental cycle exercise. We hypothesized that the repeatability of EFL would be "strong" when assessed as a binary variable (i.e., absent or present) but "poor" when assessed as a continuous variable (i.e., % tidal volume overlap). Thirty-two healthy adults performed spirometry and an incremental cycle exercise test to exhaustion on two occasions. Standard cardiorespiratory variables were measured at rest and throughout exercise, and EFL was assessed by overlaying tidal expiratory flow-volume and maximal expiratory flow-volume curves. The repeatability of EFL was determined using Cohen's κ for binary assessments of EFL and intraclass correlation (ICC) for continuous measures of EFL. During exercise, n = 12 participants (38%) experienced EFL. At peak exercise, the repeatability of EFL was "minimal" (κ = 0.337, p = 0.145) when assessed as a binary variable and "poor" when measured as a continuous variable (ICC = 0.338, p = 0.025). At matched levels of minute ventilation during high-intensity exercise (i.e., >75% of peak oxygen uptake), the repeatability of EFL was "weak" when measured as a binary variable (κ = 0.474, p = 0.001) and "moderate" when measured as a continuous variable (ICC = 0.603, p < 0.001). Our results highlight the day-to-day variability associated with assessing EFL during exercise in healthy adults.


Assuntos
Teste de Esforço , Exercício Físico , Humanos , Masculino , Feminino , Adulto , Exercício Físico/fisiologia , Teste de Esforço/métodos , Teste de Esforço/normas , Reprodutibilidade dos Testes , Volume de Ventilação Pulmonar/fisiologia , Espirometria/métodos , Adulto Jovem , Consumo de Oxigênio/fisiologia
6.
Sci Rep ; 14(1): 23041, 2024 Oct 04.
Artigo em Inglês | MEDLINE | ID: mdl-39362938

RESUMO

The integration of renewable energy sources into smart distribution grids poses substantial challenges in maintaining grid stability, efficiency, and reliability due to their inherent variability and intermittency. This study addresses these challenges by proposing a novel two-level optimization model aimed at enhancing operational efficiency and robustness in smart distribution grids. The model synergistically integrates renewable energy sources, energy storage systems, electric vehicles, and demand-side management through a dynamic reconfiguration approach. It employs a robust optimization framework combined with a two-stage second-order cone optimization model to manage real-time operations and strategic grid reconfiguration. Key findings from simulations on the IEEE 33 and 69-bus networks underscore the model's effectiveness. In the 33-bus system, implementing the demand response program led to a significant reduction in power losses, from 0.64 MW to 0.52 MW, and improved voltage stability, with the minimum voltage increasing from 0.970 to 0.980 p.u. Similarly, in the 69-bus system, power losses decreased from 0.85 MW to 0.79 MW, and voltage stability improved, with the minimum voltage rising from 0.962 to 0.972 p.u. The model also demonstrated reduced energy procurement needs, showcasing its impact on enhancing grid efficiency and reliability. These results highlight the model's potential for advancing smart grid management strategies, offering significant improvements in operational performance and stability under varying demand conditions.

7.
Health Serv Res ; 2024 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-39351857

RESUMO

OBJECTIVE: To explore variation in rates of acute care utilization for mental health conditions, including hospitalizations and emergency department (ED) visits, across high-income countries before and during the COVID-19 pandemic. DATA SOURCES AND STUDY SETTING: Administrative patient-level data between 2017 and 2020 of eight high-income countries: Canada, England, Finland, France, New Zealand, Spain, Switzerland, and the United States (US). STUDY DESIGN: Multi-country retrospective observational study using a federated data approach that evaluated age-sex standardized rates of hospitalizations and ED visits for mental health conditions. PRINCIPAL FINDINGS: There was significant variation in rates of acute mental health care utilization across countries. Among the subset of four countries with both hospitalization and ED data, the US had the highest pre-COVID-19 combined average annual acute care rate of 1613 episodes/100,000 people (95% CI: 1428, 1797). Finland had the lowest rate of 776 (686, 866). When examining hospitalization rates only, France had the highest rate of inpatient hospitalizations of 988/100,000 (95% CI 858, 1118) while Spain had the lowest at 87/100,000 (95% CI 76, 99). For ED rates for mental health conditions, the US had the highest rate of 958/100,000 (95% CI 861, 1055) while France had the lowest rate with 241/100,000 (95% CI 216, 265). Notable shifts coinciding with the onset of the COVID-19 pandemic were observed including a substitution of care setting in the US from ED to inpatient care, and overall declines in acute care utilization in Canada and France. CONCLUSION: The study underscores the importance of understanding and addressing variation in acute care utilization for mental health conditions, including the differential effect of COVID-19, across different health care systems. Further research is needed to elucidate the extent to which factors such as workforce capacity, access barriers, financial incentives, COVID-19 preparedness, and community-based care may contribute to these variations. WHAT IS KNOWN ON THIS TOPIC: Approximately one billion people globally live with a mental health condition, with significant consequences for individuals and societies. Rates of mental health diagnoses vary across high-income countries, with substantial differences in access to effective care. The COVID-19 pandemic has exacerbated mental health challenges globally, with varying impacts across countries. WHAT THIS STUDY ADDS: This study provides a comprehensive international comparison of hospitalization and emergency department visit rates for mental health conditions across eight high-income countries. It highlights significant variations in acute care utilization patterns, particularly in countries that are more likely to care for people with mental health conditions in emergency departments rather than inpatient facilities The study identifies temporal and cross-country differences in acute care management of mental health conditions coinciding with the onset of the COVID-19 pandemic.

8.
Neurosci Biobehav Rev ; : 105916, 2024 Oct 05.
Artigo em Inglês | MEDLINE | ID: mdl-39374679

RESUMO

Cardiovascular diseases (CVDs) are a leading cause of morbidity and mortality, with disparities observed between males and females. Psychosocial work exposures (PWE), including workload, job control, reward and long working hours, are associated with CVD development. Despite higher prevalence among females, the association with CVD is consistently observed in males, with limited explanations for these differences. This study aimed to examine the consideration of sex and gender in prospective studies within systematic reviews on PWE - specifically, the demand-control model, the effort-reward imbalance model, and long working hours - and CVD. Conducting a systematic review, we assessed sex and gender considerations using criteria from the Sex and Gender Equity in Research (SAGER) guidelines. While most studies recognized potential sex and gender differences in the associations between PWE and CVD, only about half of the 28 studies that included both sexes (15 studies) analyzed females and males separately. Moreover, few studies included criteria for sex- and gender-based analyses. Less than half of the studies (23 studies) incorporated a sex and/or gender perspective to discuss observed differences and similarities between men and women. Although there is a rising trend in integrating sex and gender considerations, significant gaps persist in methodologies and reporting, highlighting the need for comprehensive incorporation of sex and gender considerations to bolster CVD prevention strategies and policies.

9.
JMIR Med Educ ; 10: e57157, 2024 Oct 10.
Artigo em Inglês | MEDLINE | ID: mdl-39388702

RESUMO

Background: The 2024 Nephrology fellowship match data show the declining interest in nephrology in the United States, with an 11% drop in candidates and a mere 66% (321/488) of positions filled. Objective: The study aims to discern the factors influencing this trend using ChatGPT, a leading chatbot model, for insights into the comparative appeal of nephrology versus other internal medicine specialties. Methods: Using the GPT-4 model, the study compared nephrology with 13 other internal medicine specialties, evaluating each on 7 criteria including intellectual complexity, work-life balance, procedural involvement, research opportunities, patient relationships, career demand, and financial compensation. Each criterion was assigned scores from 1 to 10, with the cumulative score determining the ranking. The approach included counteracting potential bias by instructing GPT-4 to favor other specialties over nephrology in reverse scenarios. Results: GPT-4 ranked nephrology only above sleep medicine. While nephrology scored higher than hospice and palliative medicine, it fell short in key criteria such as work-life balance, patient relationships, and career demand. When examining the percentage of filled positions in the 2024 appointment year match, nephrology's filled rate was 66%, only higher than the 45% (155/348) filled rate of geriatric medicine. Nephrology's score decreased by 4%-14% in 5 criteria including intellectual challenge and complexity, procedural involvement, career opportunity and demand, research and academic opportunities, and financial compensation. Conclusions: ChatGPT does not favor nephrology over most internal medicine specialties, highlighting its diminishing appeal as a career choice. This trend raises significant concerns, especially considering the overall physician shortage, and prompts a reevaluation of factors affecting specialty choice among medical residents.


Assuntos
Escolha da Profissão , Medicina Interna , Nefrologia , Pesquisa Qualitativa , Estados Unidos , Humanos , Nefrologia/educação , Medicina Interna/educação , Internato e Residência/estatística & dados numéricos
10.
Waste Manag ; 190: 306-317, 2024 Oct 07.
Artigo em Inglês | MEDLINE | ID: mdl-39378637

RESUMO

The long-term effectiveness of stabilized/solidified sediments (S/S sediments) is increasingly attracting attention. This study investigated the long-term leaching characteristics and mechanisms of S/S sediment through an 841-day tank leaching test, considering the influence of cement content, curing time, and zeolite. The results indicate significant correlations among pH, heavy metals, TN, NH3-N, and COD. The specimens with 6 % cement cured for 30 days (C6(30)) demonstrated considerable heavy metal stabilization, with stabilization rates for Cr, Ni, Cu, Zn, As, and Pb reaching 99.81 %, 99.06 %, 98.93 %, 99.61 %, 97.58 %, and 99.97 %, respectively. Compared to C6(30), partial replacement of cement with 10 % zeolite (C5 + Z0.5(30)) not only more effectively stabilized heavy metals except As, but also reduced the release of COD and NH3-N by 4.23 % and 10.04 %, respectively. However, there was a risk of TN, NH3-N, and COD exceeding permissible limits during long-term leaching. Microscopic analysis results suggested that hydration products and low porosity contributed to stabilization of heavy metals. Leaching mechanisms was revealed that surface wash-off controls the leaching of Cr and Pb, while diffusion controls the leaching of Ni, Cu, Zn, As, COD, TN, and NH3-N. Considering stabilization performance, cost and carbon emissions, C5 + Z0.5(30) is an effective strategy for reducing long-term environmental risks of S/S sediments.

11.
ISA Trans ; : 1-17, 2024 Sep 12.
Artigo em Inglês | MEDLINE | ID: mdl-39379251

RESUMO

The energy optimization in smart power grids (SPGs) is crucial for ensuring efficient, sustainable, and cost-effective energy management. However, the uncertainty and stochastic nature of distributed generations (DGs) and loads pose significant challenges to optimization models. In this study, we propose a novel optimization model that addresses these challenges by employing a probabilistic method to model the uncertain behavior of DGs and loads. Our model utilizes the multi-objective wind-driven optimization (MOWDO) technique with fuzzy mechanism to simultaneously address economic, environmental, and comfort concerns in SPGs. Unlike existing models, our approach incorporates a hybrid demand response (HDR), combining price-based and incentive-based DR to mitigate rebound peaks and ensure stable and efficient energy usage. The model also introduces battery energy storage systems (BESS) as environmentally friendly backup sources, reducing reliance on fossil fuels and promoting sustainability. We assess the developed model across various distinct configurations: optimizing operational costs and pollution emissions independently with/without DR, optimizing both operational costs and pollution emissions concurrently with/without DR, and optimizing operational costs, user comfort, and pollution emissions simultaneously with/without DR. The experimental findings reveal that the developed model performs better than the multi-objective bird swarm optimization (MOBSO) algorithm across metrics, including operational cost, user comfort, and pollution emissions.

12.
J Formos Med Assoc ; 2024 Oct 07.
Artigo em Inglês | MEDLINE | ID: mdl-39379263

RESUMO

BACKGROUND: Certain patient subpopulations requiring dialysis initiation show varied survival rates and chances of ending renal replacement therapy (RRT). Consensus clustering can help identify these subgroups and their dialysis outcomes. METHODS: The study included patients who were over 18 years old with urine output above 400 ml per day and an estimated glomerular filtration rate over 15 ml/min/1.73 m2. They underwent acute RRT because of systemic demand-capacity imbalance. Using consensus clustering with 33 clinical variables and urea:creatinine ratio (UCR) to the variables to investigate the catabolic demand. Endpoints were all-cause mortality and being dialysis-free at 180-day follow-up after RRT initiation. RESULTS: Of 946 patients (mean 63 ± 17 years and 649 men, 68.6 %) three distinct phenotypes were identified. 509 (53.8%) patients died and 364 (38.5%) patients were weaned off dialysis. Cluster 2 showed better survival (60.23% vs. 53.18% [cluster 1] vs. 45.85% [cluster 3], P < 0.01) and higher possibility to be weaned off RRT (45.24% vs. 38.44% [cluster 1] vs. 31.62% [cluster 3], P < 0.01). High UCR had increased mortality (59.16% vs. 47.75%, P < 0.01) and a lower weaning rates (33.27%; 45.72%, P < .01). UCR with the clustering phenotype improved risk stratification. CONCLUSIONS: Among critical patients undergoing RRT due to systemic demand-capacity imbalance, more than half of the patients died. We identified distinct phenotypes in demand-capacity imbalance in a heterogeneous cohort of patients initializing RRT. Additionally, we found that pre-dialysis UCR as a novel predictor for mortality and the likelihood of being dialysis-free.

13.
J Gen Intern Med ; 2024 Oct 07.
Artigo em Inglês | MEDLINE | ID: mdl-39375316

RESUMO

BACKGROUND: Millions of US adults continue to experience symptoms of post COVID-19 condition (PCC). More data on health service utilization patterns and barriers to care in this population are needed to understand how to care for people with PCC. OBJECTIVE: To evaluate health service utilization and barriers to medical care among individuals with a history of PCC compared with other US adults. DESIGN: Data were analyzed from the 2022 National Health Interview Survey (NHIS), a nationally representative, cross-sectional survey of the US population. PARTICIPANTS: US adults. MAIN MEASURES: Health service utilization and the presence of financial and nonfinancial barriers to care in the preceding 12 months. KEY RESULTS: There were 24,905 individuals included in the analysis, representing approximately 230 million US adults. The weighted prevalence of those with a history of PCC was 6.9% (95%CI, 6.5-7.3). Compared to other US adults, participants with a history of PCC were more likely to have had an urgent care visit (adjusted odds ratio (aOR) 1.52 [95%CI, 1.34-1.72]), emergency room visit (aOR 1.94 [95%CI 1.71-2.21]), hospitalization (aOR 1.48 [95%CI, 1.24-1.77]), rehabilitation services (aOR 1.35 [95%CI, 1.14-1.60]), home care (aOR 1.55 [95%CI, 1.66-2.26]), mental health counseling (aOR 1.39 [95%CI, 1.17-1.65]), and complementary and integrative medicine services (aOR 1.29 [95%CI, 1.13-1.49]). Furthermore, respondents with a history of PCC were more likely to report at least one financial barrier to care (aOR 1.71 [95%CI, 1.48-1.97]) and at least one nonfinancial barrier (aOR 1.77 [95%CI, 1.56-2.00]). A greater proportion of participants with a history of PCC reported a financial barrier and nonfinancial barrier than adults with most other chronic conditions captured by NHIS. CONCLUSIONS: Individuals with a history of PCC were more likely to use a variety of health services and report barriers to medical care. Health systems should consider developing accessible, multidisciplinary care pathways for this population.

14.
Sci Rep ; 14(1): 23336, 2024 Oct 07.
Artigo em Inglês | MEDLINE | ID: mdl-39375411

RESUMO

Benthic (seafloor) remineralization of organic material determines the fate of carbon in the ocean and its sequestration. Bottom water temperature and labile carbon supply to the seafloor are expected to increase in a warming Arctic and correspondingly, benthic remineralization rates. We provide some of the first experimental data on the response of sediment oxygen demand (SOD), an established proxy for benthic remineralization, to increased temperature and/or food supply across a range of Arctic conditions and regimes. Each factor significantly increased SOD rates (with different degrees of variability); however the largest increases were seen with both factors combined (50% to ten-fold increases), consistently across the four seasons and the spatial gradient covering shelf to deep basin included in our study. This ability of the Arctic benthos to process increased pulses of carbon suggests that increased sedimented carbon under warming conditions is likely to be utilized and processed, not accumulated, impacting carbon storage and decreasing the Arctic's role as a global carbon sink.

15.
Adv Healthc Mater ; : e2402363, 2024 Oct 10.
Artigo em Inglês | MEDLINE | ID: mdl-39390845

RESUMO

The treatment of infected pressure ulcers (IUPs) requires addressing diverse microenvironments. A pressing challenge is to effectively enhance the regenerative microenvironment at different stages of the healing process, tailoring interventions as needed. Here, a dual enzyme mimetic and bacterial responsive self-activating antimicrobial hydrogel designed to enhance IPUs healing is introduced. This hydrogel incorporates pH-responsive dual enzyme-active nanoplatforms (HNTs-Fe-Ag) encapsulated within a methacrylate-modified silk fibroin (SFMA) and dopamine methacrylamide (DMA) matrix. This composite hydrogel exhibits adaptive microenvironment regulation capabilities. Under the low pH microenvironment of bacterial infection, it has excellent antimicrobial activity by self-activating the •OH generation in conjunction with photothermal effects. Under the neutral and alkaline microenvironment of chronic inflammation, it catalyzes the decomposition of hydrogen peroxide (H2O2) to produce oxygen (O2), thereby alleviating hypoxia and scavenging reactive oxygen species (ROS), which in turn remodulates the phenotype of macrophages. The composite hydrogel demonstrates on-demand therapeutic effects in the microenvironment of infected wounds, significantly enhancing the regenerative microenvironment of IUPs by promoting wound closure, inflammation regulation, and collagen deposition through self-activated antimicrobial action during infection and adaptive hypoxia relief during recovery. This approach offers a novel strategy for developing smart wound dressings.

16.
Glob Health Action ; 17(1): 2411742, 2024 Dec 31.
Artigo em Inglês | MEDLINE | ID: mdl-39390974

RESUMO

BACKGROUND: The doctoral dissertation examines how local response efforts were integrated into overall emergency management. OBJECTIVES: It seeks to understand the role and effectiveness of community-based actors in addressing collective action problems. METHODS: Sixty-seven semi-structured interviews were conducted from January to July 2017 in Liberia and Sierra Leone. Key informants include healthcare workers, traditional leaders, and community stakeholders, such as non-governmental organization representatives and volunteers. RESULTS: Findings show that traditional and community leaders responded to the public health emergency via rulemaking, quarantine, travel limitation, healthcare referrals, health sensitization, and door-to-door contact tracing. These actions by local leaders helped to change behaviors and improve cooperation. Sierra Leone had 32.3% more Ebola cases than Liberia but 18% fewer deaths. Sierra Leone had integrated traditional and community leaders before the scale up of international aid resources. CONCLUSION: This suggests that actions taken by traditional and community leaders improved overall efforts, and in some areas, before scaled-up humanitarian interventions. Bilateral engagement with local community actors should be integrated in every public health response to improve cooperation, and it should be done before an intervention is conceived and executed.


Main findings: Bottom-up legislation and community-led action were significant in containing the EVD spread in Liberia and Sierra Leone.Contribution to knowledge: Theoretical contribution centers on the governance patterns of Traditional Local Institutions. Evidence-based contribution was the observation of polycentric governance patterns of demand and supply-side barriers between traditional, state, and aid institutions.Global health impact for policy and action: Policymakers should contextualize soft factors such as trust, which can hamper technical advice. Any intervention should include bilateral engagement with local community leaders.


Assuntos
Epidemias , Doença pelo Vírus Ebola , Humanos , Doença pelo Vírus Ebola/prevenção & controle , Doença pelo Vírus Ebola/epidemiologia , Libéria , Serra Leoa/epidemiologia , Epidemias/prevenção & controle , Governo Local , Entrevistas como Assunto , Saúde Pública , Liderança , Quarentena , Cooperação Internacional
17.
Exp Brain Res ; 2024 Oct 12.
Artigo em Inglês | MEDLINE | ID: mdl-39395059

RESUMO

A vexing characteristic of motor disability after stroke is that many individuals fail to use their affected arm effectively despite having the capacity to do so, a phenomenon termed arm nonuse. Based on the hypothesis that nonuse is influenced by the competing cognitive demands of many daily activities, we examined the effects of cognitive load on arm choice and motor performance in individuals with stroke using a novel virtual reality paradigm that mimics the demands of real-life visual search, object selection, and reaching to targets. Twenty individuals with single left or right hemispheric chronic stroke (11 left cerebrovascular accident; 9 right cerebrovascular accident) and 10 age-matched neurotypical participants completed the Virtual Reality Arm Choice task, in which they reached for target objects in an array under varied cognitive demand. To manipulate cognitive demand, we varied the semantic similarity of objects in the reaching space and the presence or absence of a secondary task. The results showed reduced use of the paretic arm under increased demand. Under cognitive load, participants with stroke also showed slower reach initiation, slower movements, increased reach curvature, and increased performance differences between the paretic and non-paretic arms. The arm choice of neurotypical individuals was also modulated under cognitive load. These data indicate that cognitive factors influence arm choice and motor performance in naturalistic reaching tasks in individuals with chronic stroke. Performance decrements under cognitive load may in turn influence reduced paretic arm use during daily activities.

18.
Environ Monit Assess ; 196(11): 1047, 2024 Oct 12.
Artigo em Inglês | MEDLINE | ID: mdl-39395072

RESUMO

Evaluation of vital water-quality indicators, especially biological and chemical demand of oxygen (BOD and COD), is important for environmental factors, human health, and agricultural output. In the recent past, data-driven techniques (DDT) offer the ability to automate water quality assessment with more reliable and rapid evaluation. The present study thus aims to utilize various DDTs: random forest (RF), model tree (MT), and non-linear-regression (NLR) to predict vital water quality indicators such as BOD and COD for the three stretches of Mula-Mutha River, Pune, India. Since the river has three stretches: Mutha, Mula, and Mula-Mutha respectively, BOD-COD models have been developed separately for each using MT, RF, and NLR. Data analysis using a violin diagram is done to understand the data characteristics. Further, the models developed were developed using the appropriate input parameters for predicting BOD and COD. Error measures including coefficient of correlation (R), mean absolute error (MAE), and root mean square error (RMSE) were used to evaluate the constructed models. The Taylor diagram, scatter plot, and hydrograph were also used for visual performance analysis. The findings suggest that the MT and RF techniques exhibit a stronger connection between the actual and anticipated levels of BOD and COD, with NLR following closely behind. Practical acceptance of these approaches is increased by RF in the form of trees, MT with an output in the form of a sequence of equations, and NLR with a single equation. These findings help us gain insight into DDT's water quality assessment model, which will also help future researchers and water quality professionals make decisions.


Assuntos
Monitoramento Ambiental , Rios , Qualidade da Água , Índia , Rios/química , Monitoramento Ambiental/métodos , Poluentes Químicos da Água/análise , Análise da Demanda Biológica de Oxigênio , Dinâmica não Linear , Modelos Teóricos , Algoritmo Florestas Aleatórias
19.
J Environ Manage ; 370: 122722, 2024 Oct 11.
Artigo em Inglês | MEDLINE | ID: mdl-39395288

RESUMO

Rainwater Harvesting Systems (RHS) are widely implemented to mitigate urban water shortages, yet the impacts of compatibility between rainwater availability and water demand on their performance are often overlooked. This study introduces novel rainwater deficit and surplus indices to quantitatively assess the impacts of compatibility between rainwater availability and water demand on the performance of RHS across 16 cities in different climate zones and under 3 daily water demand scenarios. The rainwater deficit and surplus indices, and the water saving efficiency and reliability of RHS are calculated based on long-term (1991-2020) continuous simulations using a daily water balance model. Results show the rainwater deficit index effectively quantifies water supply pressure on RHS, while the rainwater surplus index quantitatively evaluates their water saving potential. Both of water saving efficiency and reliability of RHS significantly linearly decrease with the rainwater deficit index (P < 0.05), and the coefficients of determination (R2) decrease from 0.96 to 0.80 as tank size increases from 1 to 300 m3. Both of water saving efficiency and reliability increase along sigmoid curves with the rainwater surplus index (P < 0.05), and R2 values increase from 0.91 to 0.99 with tank size. The results indicate that tank size optimization enhances water saving performance of RHS through reducing deficits and surpluses. However, the performance enhancement by tank size optimization could be limited by the compatibility between rainwater availability and water demand. Taken Kashgar (arid climate) as an example, the thresholds of water saving efficiency under all water demand scenarios are below 15% due to high rainwater deficit and low surplus. This study emphasizes that the compatibility between rainwater availability and water demand should be considered in planning and design of RHS.

20.
Ecotoxicol Environ Saf ; 286: 117153, 2024 Oct 11.
Artigo em Inglês | MEDLINE | ID: mdl-39395375

RESUMO

Safe drinking water requires sound monitoring and maintenance of residual chlorine within drinking water distribution networks (DWDNs) to suppress possible microbial regrowth. However, in the developing world, DWDNs face unique challenges, including aging infrastructure, water pipes laid near or even aboveground thus exposing water to high temperature fluctuations, and relatively high organic loads. Therefore, safely maintaining sustainable residual chlorine levels and restricting the problems of hazardous disinfection by-products (DBPs) formation and of antimicrobial resistance (AMR), both tracing back to extensive chlorination, is a difficult exercise in those settings. Here, the temperature dependent bulk chlorine decay, i.e., the rate at which chlorine residual is consumed, was estimated for a typical DWDN system in South Africa. To this end, experimental assays were performed and a mathematical model was developed to predict chlorine levels within the DWDN under study. A direct relationship (R2 = 0.99) between bulk chlorine decay and initial chlorine dosage was identified, with bulk chlorine decay following the first-order decay model. The bulk chlorine decay rate coefficient (Kb) and the reaction constant with the pipe walls (Kw) were experimentally estimated, with the first being the main chlorine consumer and the latter only slightly contributing to chlorine decay. EPANET was used to simulate the chlorine concentrations within the examined DWDN, while residual chlorine concentrations were modelled using COMSOL. The software programs were calibrated and validated using experimental results. The optimum liquid chlorine dosage was 5 mg L-1, and this could maintain residual levels at 0.5 mg L-1 for 3500 min in the water distribution tanks. Yet, the residual chlorine levels at the distal end of the DWDN were below the recommended safety limits, suggesting the need for chlorine booster stations to supplement residual chlorine rather than further increasing chlorine initial dosages which will lead to unsafe chlorine levels at the proximal points and inevitably will increase DBPs in drinking water. This relatively high chlorine dosage reflects the overall poor quality of the raw water that feeds the drinking water treatment plant under study, which is consistent with the poor water quality of surface water in South Africa. Overall, this methodology can be replicated in DWDNs in South Africa and across the developing world, where similar challenges persist and ensure safe drinking water but not at the expense of DBPs formation and possibly AMR spreading.

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