bluuebunny/crossref_metadata_2025 huggingface dataset:
Social Force Model-Based Safety Evaluation of Intersections in Arterials Considering the Pedestrian Yield Rule
Authors: Yao Jiao , Li Yuhang , He Jiaping
Published: November 2021

To enhance the safety of pedestrians crossing the street, a series of new regulations regarding pedestrian yield has been proposed and widely implemented across cities. In this study, we first made some improvements to the social force model, in which pedestrian crossing at the intersection, drivers’ psychology of giving way, vehicle yield to pedestrians, vehicle yield in different directions, the influence of pedestrians crossing boundaries, and signal lamp groups on pedestrian behavior were considered. Furthermore, pedestrian crossing and vehicle yield safety models were established, based on which the comprehensive safety evaluation model of intersections in arterials was established, in which two indices—(1) the safety degree of pedestrian crossings and (2) vehicle acceleration interference—were combined with the entropy weight method. Finally, four types of intersections in arterials were studied using a simulation: the intersections between different levels of arterials, and intersections with one-time and two-times pedestrian crossings. Moreover, safety evaluation and analysis of those intersections, considering the rule of pedestrian yield, were conducted combined with the trajectory data from the VISSIM simulation. The relevant results showed that for pedestrians crossing the street, the pedestrian safety of two-time crossing is significantly higher than that of one-time crossing, and compared with the arterial, the pedestrian crossing distance of the sub-arterial is shorter, and the pedestrian perception is safer. Moreover, due to the herd psychology effect, the increase in pedestrian flow volume improves the safety perception of pedestrians at the intersection.
Quality of Life, Insomnia and Coping Strategies during COVID-19 Pandemic in Hospital Workers. A Cross-Sectional Study
Authors: Italia Sebastiano , Costa Chiara , Briguglio Giusi , Mento Carmela , Muscatello Maria Rosaria Anna , Alibrandi Angela , Larese Filon Francesca , Spatari Giovanna , Teodoro Michele , Fenga Concettina
Published: November 2021

COVID-19 became a pandemic in a few months, leading to adverse health outcomes, reducing the quality of life, affecting the sleep/wake cycle, and altering coping strategies, especially among hospital personnel. Life quality, insomnia, and coping strategies were thus assessed among hospital personnel during the first wave of the COVID-19 pandemic in Italy. This cross-sectional study was conducted from May to November 2020 through an online survey. There were 558 participants (28.5% males and 71.5% females) enrolled in two different metropolitan areas (in North and South of Italy, respectively). Three standardized questionnaires were administered: European Quality of life–5 Dimensions (EQ-5D), Athens Insomnia Scale (AIS), and Brief COPE. Differences in sociodemographic characteristics and work-related factors were also investigated in order to identify possible predictors through a generalized linear model and logistic regression analysis. Results showed good perceived life quality and high insomnia prevalence. After sample stratification, the statistical analysis highlighted that personal (gender, age, educational level) and work-related factors (employment in COVID wards, remote working) played different roles in predicting quality of life, insomnia, and coping attitude. Active, Planning, and Acceptance were the most frequently adopted coping strategies. Despite women confirming their attitude in reacting to the difficulties, adopting emotion-focused coping strategies, they showed a higher probability to develop insomnia, so a gender perspective should be considered in the health protection of this working category. An integrated approach should be implemented at individual, interpersonal and organizational levels aiming to monitor psychological distress, favor regular sharing and communication between peers, and also allow conciliation of work with family life. At the organizational level, preventive and protective measures adequate to work-related risk to COVID-19 should be adopted.
Liver-Based Probabilistic Risk Assessment of Exposure to Organophosphate Esters via Dust Ingestion Using a Physiologically Based Toxicokinetic (PBTK) Model
Authors: Ding Jiaqi , Liu Wenxin , Zhang Hong , Zhu Lingyan , Zhu Lin , Feng Jianfeng
Published: November 2021

Organophosphate esters (OPEs) are widely used and harmful to organisms and human health. Dust ingestion is an important exposure route for OPEs to humans. In this study, by integrating ToxCast high-throughput in vitro assays with in vitro to in vivo extrapolation (IVIVE) via physiologically based Toxicokinetic (PBTK) modeling, we assessed the hepatocyte-based health risk for humans around the world due to exposure to two typical OPEs (TPHP and TDCPP) through the dust ingestion exposure route. Results showed that the health guidance value of TPHP and TCDPP obtained in this study was lower than the value obtained through animal experiments. In addition, probabilistic risk assessment results indicate that populations worldwide are at low risk of exposure to TPHP and TDCPP through dust ingestion due to low estimated daily intakes (EDIs) which are much lower than the reference dose (RfDs) published by the US EPA, except in some regional cases. Most margin of exposure (MOE) ranges of TDCPP for children are less than 100, which indicates a moderately high risk. Researchers should be concerned about exposure to TDCPP in this area. The method proposed in this study is expected to be applied to the health risk assessment of other chemicals.
Design Optimization of a HAZMAT Multimodal Hub-and-Spoke Network with Detour
Authors: Li Shuxia , Zu Yuedan , Fang Huimin , Liu Liping , Fan Tijun
Published: November 2021

The growing transportation risk of hazardous materials (hazmat) is an important threat to public safety. As an efficient and reliable mode of transportation, the multimodal hub-and-spoke transport network helps to achieve economies of scale and reduce costs. Considering the dual goals of risk and cost management of hazmat transportation, a novel optimization model of a multimodal hub-and-spoke network with detour (MHSNWD) for hazmat on the strategic level is designed. It integrates the planning of hub location and route selection based on the risk quantification for different transportation modes. Additionally, a detour strategy is applied, which allows for more than two hub nodes to be selected to form an optimal path between any supply and demand nodes in a hub-and-spoke network. Then, the risk is taken as the main objective and the cost is converted into a budget constraint to solve the model by using CPLEX. Additionally, a numerical study is conducted based on a CAB dataset to find the influence of the number of hubs and budget constraints on the optimization results. In addition, a counterpart model of the multimodal hub-and-spoke network without detour (MHSNOD) is tested to validate the advantages of the proposed model of MHSNWD. The numerical experiment shows that an appropriate increase in the number of hubs and the cost budget can remarkably reduce network risk. Compared with MHSNOD, the optimal result of MHSNWD can achieve a marginal improvement in risk reduction. This work may provide an informative decision-making reference for planning a hazmat transportation network.
Effects of Human Activities on the Spatial Distribution, Ecological Risk and Sources of PTEs in Coastal Sediments
Authors: Wang Weili , Lin Cai , Wang Lingqing , Jiang Ronggen , Liu Yang , Lin Hui , Chen Jinmin
Published: November 2021

Potentially toxic elements (PTEs) have attracted substantial attention because of their widespread sources, long residue time and easy accumulation. PTEs in the surface sediments of inshore waters are strongly affected by human activities because these waters are a zone of interaction between the ocean and land. In the present study, to explore the environmental geochemical behaviour and source of PTEs in the surface sediments of coastal waters, the contents and spatial distributions of copper (Cu), lead (Pb), zinc (Zn), cadmium (Cd), chromium (Cr), mercury (Hg) and arsenic (As) in different regions of Xiamen Bay were investigated. The data were processed by multivariate statistical methods, and the distribution characteristics of PTEs in the surface sediments of Xiamen Bay were analysed. In addition, the pollution load index (PLI), geo-accumulation index (Igeo) and potential ecological index(RI) were used to evaluate the pollution degree and potential risk in the surface sediments of Xiamen Bay, and the positive matrix factorisation (PMF) model was used to analyse the source. The results show that Zn had the highest mean concentration, followed by Pb, Cr, Cu, As, Cd and Hg, among the seven PTEs. The mean contents of Pb, Zn, Cd, Cu and Hg, and especially Hg and Cd, were higher than the corresponding environmental background values. The average PLI value indicated that the Xiamen Bay sediment was moderately contaminated by PTEs. The Igeo results showed that Xiamen Bay was moderately to strongly polluted by Cd and Hg. The proportions of samples with low, medium and strong risk levels were 11.63%, 74.42%, and 13.95% in surface sediments, respectively. PMF models showed that the input of chemical fertilizer and medication, anthropogenic atmospheric components and terrestrial detritus were the main sources of PTEs in the surface sediment of Xiamen Bay.
Spatial Characteristics and Regional Transmission Analysis of PM2.5 Pollution in Northeast China, 2016–2020
Authors: Fang Chunsheng , Wang Liyuan , Li Zhuoqiong , Wang Ju
Published: November 2021

Northeast China is an essential industrial development base in China and the regional air quality is severely affected by PM2.5 pollution. In this paper, spatial autocorrelation, trajectory clustering, hotspot analysis, PSCF and CWT analysis are used to explore the spatial pollution characteristics of PM2.5 and determine the atmospheric regional transmission pattern for 40 cities in Northeast China from 2016 to 2020. Analysis of PM2.5 concentration characteristics in the northeast indicates that the annual average value and total exceedance days of PM2.5 concentration in Northeast China showed a U-shaped change, with the lowest annual average PM2.5 concentration (31 μg/m3) in 2018, decreasing by 12.1% year-on-year, and the hourly PM2.5 concentration exploding during the epidemic lockdown period in 2020. A stable PM2.5 pollution band emerges spatially from the southwest to Northeast China. Spatially, the PM2.5 in Northeast China has a high degree of autocorrelation and a south-hot–north-cool characteristic, with all hotspots concentrated in the most polluted Liaoning province, which exhibits the H–H cluster pattern and hotspot per year. Analysis of the air mass trajectories, potential source contributions and concentration weight trajectories in Northeast China indicates that more than 74% of the air mass trajectories were transmitted to each other between the three heavily polluted cities, with the highest mean value of PM2.5 pollution trajectories reaching 222.4 μg/m3, and the contribution of daily average PM2.5 concentrations exceeding 60 μg/m3 within Northeast China. Pollution of PM2.5 throughout the Northeast is mainly influenced by short-range intra-regional transport, with long-range transport between regions also being an essential factor; organized integration is the only fundamental solution to air pollution.
Urban–Rural Partnership Framework to Enhance Food–Energy–Water Security in the Post-COVID-19 Era
Authors: Mitra Priyanka , Shaw Rajib , Sukhwani Vibhas , Mitra Bijon Kumer , Rahman Md Abiar , Deshkar Sameer , Sharma Devesh
Published: November 2021

Food, energy, and water (collectively referred to as ‘FEW’) security forms the key to human survival as well as socioeconomic development. However, the security of these basic resources is increasingly threatened due to growing demand. Beyond the widespread implications on public health, Coronavirus disease (COVID-19) has further raised additional challenges for FEW security, particularly for urban populations, as they mainly outsource their FEW demands from rural areas outside their physical boundaries. In light of that, this study reviews existing literature on FEW security to highlight the growing relevance of urban–rural linkages for realizing FEW security, especially against the backdrop of the COVID-19 pandemic. To achieve this, relevant research documents have been identified through Elsevier’s Scopus database and other sources (by applying search equations). The authors have accordingly underlined the necessity of shifting the conventional urban-centric approach to city region-centric development planning for the post-COVID-19 era. To this end, a framework has been suggested for translating physical urban–rural linkages to a partnership enhancing a collective response. The major elements of this framework are the conceptualization of national-level policies to support urban–rural linkages. The framework can play the role of a science–policy–action interface to redesign the FEW system in city regions.
Motor Learning of Complex Tasks with Augmented Feedback: Modality-Dependent Effectiveness
Authors: Jaszczur-Nowicki Jarosław , Romero-Ramos Oscar , Rydzik Łukasz , Ambroży Tadeusz , Biegajło Michał , Nogal Marta , Wiśniowski Waldemar , Kruczkowski Dariusz , Łuszczewska-Sierakowska Iwona , Niźnikowski Tomasz
Published: November 2021

Background: This paper aims to evaluate the effectiveness of feedback modalities in the motor learning of complex tasks. Methods: This study examined sixty-one male university students randomised to three groups: group Verbal (VER) = 20 (body height 178.6 ± 4.3 cm, body mass 81.3 ± 3.7 kg, age 20.3 ± 1.2 years), group Visual (VIS) = 21 (body height 179 ± 4.6 cm, body mass 82 ± 3.4 kg, age 20.3 ± 1.2 years), and group Verbal–Visual (VER&VIS) = 20 (body height 178.6 ± 4.3 cm, body mass 81.3 ± 3.7 kg, age 20.3 ± 1.2 years). The duration of the experiment was 6 months. Training sessions were performed three times per week (on Mondays, Wednesdays, and Fridays). The participants were instructed to perform a vertical jump with an arm swing (with forward and upward motion). During the jump, the participants pulled their knees up to their chests and grabbed their lower legs. The jump was completed with a half-squat landing, with arms positioned sideward. The jumping performance was rated by three gymnastic judges on a scale from 1 to 10. Results: A Tukey post hoc test revealed that in the post-test, a significant difference in the quality of performance was found between the Verbal group concerning errors combined with visual feedback on how to correct them (VER&VIS), the Verbal group concerning errors (VER), and the Visual group with visual feedback on the correctness of task performance (VIS). The ratings observed in the post-test were significantly higher in group VER&VIS than in groups VER and VIS (9%; p < 0.01 and 15%; p < 0.001, respectively). All judges’ ratings observed in group VER&VIS and VIS decreased insignificantly, but in group VER the ratings improved insignificantly. Conclusion: Providing verbal feedback combined with visual feedback on how to correct errors made in performing vertical jumps proved more effective than the provision of verbal feedback only or visual feedback only.
Developing a Stacked Ensemble-Based Classification Scheme to Predict Second Primary Cancers in Head and Neck Cancer Survivors
Authors: Chang Chi-Chang , Huang Tse-Hung , Shueng Pei-Wei , Chen Ssu-Han , Chen Chun-Chia , Lu Chi-Jie , Tseng Yi-Ju
Published: November 2021

Despite a considerable expansion in the present therapeutic repertoire for other malignancy managements, mortality from head and neck cancer (HNC) has not significantly improved in recent decades. Moreover, the second primary cancer (SPC) diagnoses increased in patients with HNC, but studies providing evidence to support SPCs prediction in HNC are lacking. Several base classifiers are integrated forming an ensemble meta-classifier using a stacked ensemble method to predict SPCs and find out relevant risk features in patients with HNC. The balanced accuracy and area under the curve (AUC) are over 0.761 and 0.847, with an approximately 2% and 3% increase, respectively, compared to the best individual base classifier. Our study found the top six ensemble risk features, such as body mass index, primary site of HNC, clinical nodal (N) status, primary site surgical margins, sex, and pathologic nodal (N) status. This will help clinicians screen HNC survivors before SPCs occur.
Exploring the Potential of Implementing Managed Alcohol Programmes to Reduce Risk of COVID-19 Infection and Transmission, and Wider Harms, for People Experiencing Alcohol Dependency and Homelessness in Scotland
Authors: Parkes Tessa , Carver Hannah , Masterton Wendy , Booth Hazel , Ball Lee , Murdoch Helen , Falzon Danilo , Pauly Bernie M. , Matheson Catriona
Published: November 2021

People who experience homelessness and alcohol dependency are more vulnerable than the general population to risks/harms relating to COVID-19. This mixed methods study explored stakeholder perspectives concerning the impact of COVID-19 and the potential utility of introducing managed alcohol programmes (MAPs) in Scotland as part of a wider health/social care response for this group. Data sources included: 12 case record reviews; 40 semi-structured qualitative interviews; and meeting notes from a practitioner-researcher group exploring implementation of MAPs within a third sector/not-for-profit organisation. A series of paintings were curated as a novel part of the research process to support knowledge translation. The case note review highlighted the complexity of health problems experienced, in addition to alcohol dependency, including polysubstance use, challenges related to alcohol access/use during lockdown, and complying with stay-at-home rules. Qualitative analysis generated five subthemes under the theme of ‘MAPs as a response to COVID-19′: changes to alcohol supply/use including polysubstance use; COVID-19-related changes to substance use/homelessness services; negative changes to services for people with alcohol problems; the potential for MAPs in the context of COVID-19; and fears and concerns about providing MAPs as a COVID-19 response. We conclude that MAPs have the potential to reduce a range of harms for this group, including COVID-19-related harms.
A Lower CD4 Count Predicts Most Causes of Death except Cardiovascular Deaths. The Austrian HIV Cohort Study
Authors: Leierer Gisela , Rieger Armin , Schmied Brigitte , Sarcletti Mario , Öllinger Angela , Wallner Elmar , Egle Alexander , Kanatschnig Manfred , Zoufaly Alexander , Atzl Michele , Rappold Michaela , El-Khatib Ziad , Ledergerber Bruno , Zangerle Robert ,   on behalf of the Austrian HIV Cohort Study Group
Published: November 2021

(1) Objective: To investigate changes in mortality rates and predictors of all-cause mortality as well as specific causes of death over time among HIV-positive individuals in the combination antiretroviral therapy (cART) era. (2) Methods: We analyzed all-cause as well as cause-specific mortality among the Austrian HIV Cohort Study between 1997 and 2014. Observation time was divided into five periods: Period 1: 1997–2000; period 2: 2001–2004; period 3: 2005–2008; period 4: 2009–2011; and period 5: 2012–2014. Mortality rates are presented as deaths per 100 person-years (d/100py). Potential risk factors associated with all-cause mortality and specific causes of death were identified by using multivariable Cox proportional hazard models. Models were adjusted for time-updated CD4, age and cART, HIV transmission category, population size of residence area and country of birth. To assess potential nonlinear associations, we fitted all CD4 counts per patient using restricted cubic splines with truncation at 1000 cells/mm3. Vital status of patients was cross-checked with death registry data. (3) Results: Of 6848 patients (59,704 person-years of observation), 1192 died: 380 (31.9%) from AIDS-related diseases. All-cause mortality rates decreased continuously from 3.49 d/100py in period 1 to 1.40 d/100py in period 5. Death due to AIDS-related diseases, liver-related diseases and non-AIDS infections declined, whereas cardiovascular diseases as cause of death remained stable (0.27 d/100py in period 1, 0.10 d/100py in period 2, 0.16 d/100py in period 3, 0.09 d/100py in period 4 and 0.14 d/100py in period 5) and deaths due to non-AIDS-defining malignancies increased. Compared to latest CD4 counts of 500 cells/mm3, lower CD4 counts conferred a higher risk of deaths due to AIDS-related diseases, liver-related diseases, non-AIDS infections and non-AIDS-defining malignancies, whereas no significant association was observed for cardiovascular mortality. Results were similar in sensitivity analyses where observation time was divided into two periods: 1997–2004 and 2005–2014. (4) Conclusions: Since the introduction of cART, risk of death decreased and causes of death changed. We do not find evidence that HIV-positive individuals with a low CD4 count are more likely to die from cardiovascular diseases.
Investigating the Effect of School Bus Stopping Process on Driver Behavior of Surrounding Vehicles Based on a Driving Simulator Experiment
Authors: Chen Yanyan , Guo Yinjia , Gu Xin , Zhou Yuntong , Tong Yao , Cao Bingxin
Published: November 2021

School bus safety has attracted widespread attention with economic development and the improvement of overall quality of the population. However, violations of school bus regulations and school bus-related crashes often occur. Limited research has been conducted on the impact of the school bus stopping process on surrounding drivers’ behavior. This study provides a driving simulator experiment to explore drivers’ behaviors during the school bus stopping process under different traffic law awareness status, traffic volume status, and initial location status. Eight variables about behavior decision and kinetic parameters were assessed for analysis by a logistic regression model and multivariate analysis of variance (MANOVA). Results show that the mean speed decreases and the number of people complying with the regulations increases after publicizing the regulations. The proportion of surrounding vehicles in the acceleration state increases, especially under the scenario that the traffic volume is large and the initial distance is far. This indicates that the enforcement of the regulations may stimulate unsafe driving behavior. The findings of this study could help policy makers to better understand the prevalence and compliance of current school bus stopping regulations among drivers and support improvements in the practical application of the regulations.
Exploring Mental Health during the Initial COVID-19 Lockdown in Mumbai: Serendipity for Some Women
Authors: Roberts Lisa R. , Solomon Shreeletha , Renati Solomon J. , Montgomery Susanne
Published: November 2021

Background: This study explored how low-income women already distressed by reproductive challenges were affected during the initial lockdown conditions of the COVID-19 pandemic in Mumbai, India. Methods: Women with reproductive challenges and living in established slums participated in a longitudinal mixed-methods study comparing their mental health over time, at pre-COVID-19 and at one and four-months into India’s COVID-19 lockdown. Results: Participants (n = 98) who presented with elevated mental health symptoms at baseline had significantly reduced symptoms during the initial lockdown. Improvements were associated with income, socioeconomic status, perceived stress, social support, coping strategies, and life satisfaction. Life satisfaction explained 37% of the variance in mental health change, which was qualitatively linked with greater family time (social support) and less worry about necessities, which were subsidized by the government. Conclusions: As the pandemic continues and government support wanes, original mental health issues are likely to resurface and possibly worsen, if unaddressed. Our research points to the health benefits experienced by the poor in India when basic needs are at least partially met with government assistance. Moreover, our findings point to the critical role of social support for women suffering reproductive challenges, who often grieve alone. Future interventions to serve these women should take this into account.
The Use of mHealth in Orthopedic Surgery: A Scoping Review
Authors: Dionisi Sara , Giannetta Noemi , Di Simone Emanuele , Ricciardi Francesco , Liquori Gloria , De Leo Aurora , Moretti Lorenzo , Napoli Christian , Di Muzio Marco , Orsi Giovanni Battista
Published: November 2021

(1) Background: It is well known that the success of surgical procedures is related to optimal postoperative management and follow-up. In this regard, mHealth technologies could potentially improve perioperative care. Based on these considerations, the objective of this scoping review is to evaluate the current status and use of mHealth interventions designed to provide perioperative care in orthopedic surgery. (2) Methods: This scoping review was conducted in accordance with the PRISMA statement (Extension for Scoping Review) and follows the framework of Arskey and O’Malley. (3) Results: The use of mHealth in the surgical setting is mainly oriented towards the development of applications for monitoring post-operative pain and optimizing communication between the various health professionals involved in patient care. (4) Conclusions: The mHealth systems can have a positive impact both on patient participation in the therapeutic process and on the communication between health professionals, increasing the quality of care.
Validation of Spanish Erasmus-Modified Nottingham Sensory Assessment Stereognosis Scale in Acquired Brain Damage
Authors: Zamarro-Rodríguez Belén Dolores , Gómez-Martínez Miguel , Cuesta-García César
Published: November 2021

Acquired brain injury (ABI) is the third leading cause of death in Spain. The disability derived from ABI can include considerable difficulties in upper-limb use due to somatosensory deficits. One of the assessments most commonly used to evaluate ABI is the Nottingham Sensory Assessment (NSA); however, there is no complete psychometric analysis or standardized version in Spanish. We aimed to develop and validate a Spanish version of the stereognosis component of the NSA for evaluating Spanish adults with ABI via a single-center, observational, cross-sectional study. The Spanish version of the NSA was developed in two steps. The first was based on the standardization and collection of normative data in 120 asymptomatic participants. For the second, we recruited 25 participants with ABI to establish concurrent criterion-related validity, internal consistency, and floor/ceiling effects. Criterion validity was assessed against two-point discrimination and tactile-localization tests. Our normative data showed significant differences among the various age groups (p < 0.05), supporting the validity of the Spanish-version assessment. For the ABI sample, we also found further evidence of validity with Spearman’s rho coefficient between the total scores and the two-point discrimination and tactile-localization tests, which showed low and moderate correlations (rho = 0.50–0.75, p < 0.05). Internal consistency was excellent, with a Cronbach’s alpha of 0.91. No ceiling or floor effects were found. We conclude that the stereognosis component of the NSA in its Spanish version is a valid scale that can be used to comprehensively and accurately assess stereognosis capacity in adults with ABI. As a low-cost evaluation, this assessment has great potential to be widely used in clinical practice and research settings.
Mobility in Blue-Green Spaces Does Not Predict COVID-19 Transmission: A Global Analysis
Authors: Venter Zander S. , Sadilek Adam , Stanton Charlotte , Barton David N. , Aunan Kristin , Chowdhury Sourangsu , Schneider Aaron , Iacus Stefano Maria
Published: November 2021

Mobility restrictions during the COVID-19 pandemic ostensibly prevented the public from transmitting the disease in public places, but they also hampered outdoor recreation, despite the importance of blue-green spaces (e.g., parks and natural areas) for physical and mental health. We assess whether restrictions on human movement, particularly in blue-green spaces, affected the transmission of COVID-19. Our assessment uses a spatially resolved dataset of COVID-19 case numbers for 848 administrative units across 153 countries during the first year of the pandemic (February 2020 to February 2021). We measure mobility in blue-green spaces with planetary-scale aggregate and anonymized mobility flows derived from mobile phone tracking data. We then use machine learning forecast models and linear mixed-effects models to explore predictors of COVID-19 growth rates. After controlling for a number of environmental factors, we find no evidence that increased visits to blue-green space increase COVID-19 transmission. By contrast, increases in the total mobility and relaxation of other non-pharmaceutical interventions such as containment and closure policies predict greater transmission. Ultraviolet radiation stands out as the strongest environmental mitigant of COVID-19 spread, while temperature, humidity, wind speed, and ambient air pollution have little to no effect. Taken together, our analyses produce little evidence to support public health policies that restrict citizens from outdoor mobility in blue-green spaces, which corroborates experimental studies showing low risk of outdoor COVID-19 transmission. However, we acknowledge and discuss some of the challenges of big data approaches to ecological regression analyses such as this, and outline promising directions and opportunities for future research.
Entonox® versus Pethidine in Labor Pain Relief: A Randomized Controlled Trial
Authors: Chantrasiri Rasrawee , Wanapirak Chanane , Tongsong Theera
Published: November 2021

Background: Pain relief during labor is a part of standard care in modern obstetrics. Several modalities used for pain relief have their own disadvantages and benefits in terms of side effects, effectiveness, availability, and satisfaction. The objectives of this study are primarily to compare the effectiveness and patients’ satisfaction for pain relief during labor between pethidine and inhaled 50% nitrous oxide (Entonox®). Methods: Laboring women at 37–41 + 6 weeks of gestation were randomly allocated to receive pethidine (50 mg intravenously) or Entonox® for reducing labor pain. Pain scores were evaluated at 0, (baseline), 30, 60, 90, and 120 min after initiation, using the visual analog scale (VAS) and also satisfaction score after delivery using the verbal rating scale (VRS). The secondary outcomes were also assessed, including APGAR scores, labor course, side effects, and cesarean section rate. Results: A total of 136 laboring women underwent randomization into two groups, but only 58 and 65 in the pethidine group and the Entonox® group were available for analysis. The median pain scores at baseline, 30, 60, and 90 min were comparable between both groups (p-value > 0.05); however, pain score at 120 min in the pethidine group was significantly higher (p-value: 0.038). The median of satisfaction score was significantly higher in the Entonox® group (4 vs. 3; p-value 0.043). All of the secondary outcomes were comparable between the two groups. Conclusions: Both have comparable effectiveness, but Entonox® has a higher satisfaction score. Entonox® could be an alternative to pethidine for reducing labor pain, because of its efficacy, ease for self-adjustment for satisfaction, and no serious effects on the labor course and newborns.
Distribution and Location Stability of the Australian Ophthalmology Workforce: 2014–2019
Authors: Allen Penny , Jessup Belinda , Khanal Santosh , Baker-Smith Victoria , Obamiro Kehinde , Barnett Tony
Published: November 2021

Objective: To investigate the ophthalmology workforce distribution and location stability using Modified Monash Model category of remoteness. Methods: Whole of ophthalmologist workforce analysis using Australian Health Practitioner Registration Agency (AHPRA) data. Modified Monash Model (MMM) category was mapped to postcode of primary work location over a six-year period (2014 to 2019). MMM stability was investigated using survival analysis and competing risks regression. Design: Retrospective cohort study. Setting: Australia. Participants: Ophthalmologists registered with AHPRA. Main outcome measures: Retention within MMM category of primary work location. Results: A total of 948 ophthalmologists were identified (767 males, 181 females). Survival estimates indicate 84% of ophthalmologists remained working in MMM1, while 79% of ophthalmologists working in MMM2–MMM7remained in these regions during the six-year period. Conclusion: The Australian ophthalmology workforce shows a high level of location stability and is concentrated in metropolitan areas of Australia. Investment in policy initiatives designed to train, recruit and retain ophthalmologists in regional, rural and remote areas is needed to improve workforce distribution outside of metropolitan areas.
Interaction Preference Differences between Elderly and Younger Exergame Users
Authors: Wang Ying , Huang Yuanyuan , Xu Junjie , Bao Defu
Published: November 2021

Existing motion capture technology can efficiently track whole-body motion and be applied to many areas of the body. This whole-body interaction design has gained the attention of many researchers. However, few scholars have studied its suitability for elderly users. We were interested in exercise-based whole-body interactive games, which can provide mental and physical exercise for elderly users. We used heuristic evaluation to measure participants’ actions during exergame tasks and analyzed preference differences between elderly and younger users through the distribution of actions in four dimensions. We found that age affected the actions performed by users in exergame tasks. We discuss the mental model of elderly users during the process of performing these tasks and put forward some suggestions for interactive actions. This model and these suggestions theoretically have guiding significance for the research and application of exergame design for elderly users and may help designers develop more effective exergames or other whole-body interaction interfaces suitable for elderly users.
Resource Threat versus Resource Loss and Emotional Well-Being of Ethnic Minorities during the COVID-19 Pandemic
Authors: Youngmann Rafael , Kushnirovich Nonna
Published: November 2021

This paper used Hobfoll’s conservation of resources theory as a theoretical framework to investigate which kinds of resource loss predicted the emotional well-being (EWB) of ethnic minorities and majority populations during a period of crisis. Data were collected from a national representative survey conducted by the Israel Central Bureau of Statistics during the COVID-19 pandemic. The sample included 1157 respondents, including 174 Israeli Palestinian citizens (ethnic minority) and 983 Israeli Jews (majority population). Measures of EWB, actual losses and threats of losses of economic, social, and health resources were examined. The results showed that the losses of economic, social, and health resources reduced the EWB of individuals. Negative effects of the actual losses of resources on EWB were greater than those of the perceived threats of loss. The largest effect was for economic resources. There were differences in effects between the ethnic minorities and the majority populations. The study revealed that for the ethnic minorities, who are less powerful and more disadvantaged than ethnic majorities, the depletion of already deficient resources during time of crisis is more important for predicting their EWB than for the majority populations.
Fidelity and Adherence to a Liquefied Petroleum Gas Stove and Fuel Intervention during Gestation: The Multi-Country Household Air Pollution Intervention Network (HAPIN) Randomized Controlled Trial
Authors: Quinn Ashlinn K. , Williams Kendra N. , Thompson Lisa M. , Harvey Steven A. , Piedrahita Ricardo , Wang Jiantong , Quinn Casey , Pillarisetti Ajay , McCracken John P. , Rosenthal Joshua P. , Kirby Miles A. , Diaz Artiga Anaité , Thangavel Gurusamy , Rosa Ghislaine , Miranda J. Jaime , Checkley William , Peel Jennifer L. , Clasen Thomas F.
Published: November 2021

Background: Clean cookstove interventions can theoretically reduce exposure to household air pollution and benefit health, but this requires near-exclusive use of these types of stoves with the simultaneous disuse of traditional stoves. Previous cookstove trials have reported low adoption of new stoves and/or extensive continued traditional stove use. Methods: The Household Air Pollution Intervention Network (HAPIN) trial randomized 3195 pregnant women in Guatemala, India, Peru, and Rwanda to either a liquefied petroleum gas (LPG) stove and fuel intervention (n = 1590) or to a control (n = 1605). The intervention consisted of an LPG stove and two initial cylinders of LPG, free fuel refills delivered to the home, and regular behavioral messaging. We assessed intervention fidelity (delivery of the intervention as intended) and adherence (intervention use) through to the end of gestation, as relevant to the first primary health outcome of the trial: infant birth weight. Fidelity and adherence were evaluated using stove and fuel delivery records, questionnaires, visual observations, and temperature-logging stove use monitors (SUMs). Results: 1585 women received the intervention at a median (interquartile range) of 8.0 (5.0–15.0) days post-randomization and had a gestational age of 17.9 (15.4–20.6) weeks. Over 96% reported cooking exclusively with LPG at two follow-up visits during pregnancy. Less than 4% reported ever running out of LPG. Complete abandonment of traditional stove cooking was observed in over 67% of the intervention households. Of the intervention households, 31.4% removed their traditional stoves upon receipt of the intervention; among those who retained traditional stoves, the majority did not use them: traditional stove use was detected via SUMs on a median (interquartile range) of 0.0% (0.0%, 1.6%) of follow-up days (median follow-up = 134 days). Conclusions: The fidelity of the HAPIN intervention, as measured by stove installation, timely ongoing fuel deliveries, and behavioral reinforcement as needed, was high. Exclusive use of the intervention during pregnancy was also high.
When in Doubt … Career Indecision, Mental Wellbeing, and Consultation-Seeking Behaviour—A Qualitative Interview Study among Students and Counsellors
Authors: Heinrichs Katherina , Hermülheim Victoria , Pilz González Laura , Loerbroks Adrian
Published: November 2021

University dropout is often preceded by a phase of doubt whether to continue studying, either in general or just the given subject. Mental health problems might be interrelated with this phase of doubt. Counselling services at German universities could provide help, but do not seem to reach students in need. To explore the phase of doubt and possible (inter-)relationships with mental wellbeing among university students in Germany as well as their consultation-seeking behaviour, a qualitative interview study was conducted (2017–2018). Participants were students casting doubts on their studies (n = 14) and counsellors (n = 16) working with this target group. Examples of reasons for doubts were insufficient information, unfulfilled expectations concerning the subject, subjectively poor study conditions, performance problems, and lacking future perspectives. Mental health problems were subjectively intertwined with doubts, considered as both cause and effect. Counselling services were evaluated as hardly helpful by students and as being in need of improvement by counsellors. Suggestions as how to improve such services comprise a more specific and proactive way to approach students. By considering the phase of doubt before dropout, German universities can improve their support services to be more responsive to students and, thus, prevent dropout and mental health problems.
Familiarity, Attitude, and Confidence of Health Literacy Practice among Community Healthcare Providers in Taiwan
Authors: Chang Mei-Chuan , Hsieh Jyh-Gang , Wei Mi-Hsiu , Tsai Chuan-Hsiu , Yu Jui-Hung , Wang Ying-Wei
Published: November 2021

Health literacy (HL), which is a determinant of individuals’ health as well as a personal and public asset, can be improved by community healthcare providers (CHPs) with the capability of providing HL services. The purpose of this study was to explore CHPs’ familiarity with and attitudes toward HL and their confidence in implementing HL practices. A cross-sectional online survey was conducted involving a total of 104 CHPs from 20 public health centers in Taiwan. It was based on a structured questionnaire involving self-evaluation by participants. The scores for familiarity, attitudes, and confidence in implementing HL practices were mean = 4.36, SD = 1.99; mean = 7.45, SD = 1.93; and mean = 6.10, SD = 1.77 (out of 10 points), respectively. The results of the multiple regression analysis showed that the two independent variables of familiarity and attitude could predict confidence in implementing HL practices (R2 = 0.57, F(2101) = 58.96, p < 0.001). The CHPs surveyed were not especially familiar with HL; thus, they recognized its importance, but they lacked confidence in implementing HL practices. Increasing practitioners’ familiarity with HL may therefore boost their confidence in implementation. The research results can serve as a reference when planning HL education and training.
Heavy Metal in Rice and Vegetable and Human Exposure near a Large Pb/Zn Smelter in Central China
Authors: Hu Yanxin , Wang Chuan , Song Zhengcheng , Chen Min , Ding Li , Liang Xingyu , Bi Xiangyang , Li Zhonggen , Li Ping , Zheng Wei
Published: November 2021

Non-ferrous metal smelting is a significant source of anthropogenic heavy metal emission and has led to severe environmental pollution that ultimately threatens the health of local residents. In this study, we determined concentrations of copper (Cu), zinc (Zn), cadmium (Cd) and lead (Pb), as well as Pb isotopic compositions in rice, vegetables and human hair in areas surrounding the Zhuzhou Pb/Zn smelter in Hunan, China and we assessed the health risks associated with rice and vegetable consumption for local residents. Results showed that rice and vegetable samples were significantly contaminated by Cd and Pb. Age and source of rice were important factors for the enrichment of heavy metal concentrations in human hair. The ratios of Pb isotopes in human hair (1.164–1.170 for 206Pb/207Pb and 2.102–2.110 for208Pb/206Pb) were comparable to those in rice (1.162–1.172 for 206Pb/207Pb and 2.098–2.114 for208Pb/206Pb) and were slightly lower than those in vegetables (1.168–1.172 for 206Pb/207Pb and 2.109–2.111 for208Pb/206Pb), indicating that Pb in human hair mainly originated from food ingestion. A non-carcinogenic risk assessment showed that Cd exposure was the dominant health risk for local residents. This study suggested that crops planted surrounding the smelter were seriously contaminated with Cd and human exposure was related to dietary intake.
The Preliminary Study on the Proapoptotic Effect of Reduced Graphene Oxide in Breast Cancer Cell Lines
Authors: Krętowski Rafał , Jabłońska-Trypuć Agata , Cechowska-Pasko Marzanna
Published: November 2021

Breast cancer is the most common cancer diagnosed in women, however traditional therapies have several side effects. This has led to an urgent need to explore novel drug approaches to treatment strategies such as graphene-based nanomaterials such as reduced graphene oxide (rGO). It was noticed as a potential drug due to its target selectivity, easy functionalisation, chemisensitisation, and high drug-loading capacity. rGO is widely used in many fields, including biological and biomedical, due to its unique physicochemical properties. However, the possible mechanisms of rGO toxicity remain unclear. In this paper, we present findings on the cytotoxic and antiproliferative effects of rGO and its ability to induce oxidative stress and apoptosis of breast cancer cell lines. We indicate that rGO induced time- and dose-dependent cytotoxicity in MDA-MB-231 and ZR-75-1 cell lines, but not in T-47D, MCF-7, Hs 578T cell lines. In rGO-treated MDA-MB-231 and ZR-75-1 cell lines, we noticed increased induction of apoptosis and necrosis. In addition, rGO has been found to cause oxidative stress, reduce proliferation, and induce structural changes in breast cancer cells. Taken together, these studies provide new insight into the mechanism of oxidative stress and apoptosis in breast cancer cells.
Epigenetics of Myotonic Dystrophies: A Minireview
Authors: Visconti Virginia Veronica , Centofanti Federica , Fittipaldi Simona , Macrì Elisa , Novelli Giuseppe , Botta Annalisa
Published: November 2021

Myotonic dystrophy type 1 and 2 (DM1 and DM2) are two multisystemic autosomal dominant disorders with clinical and genetic similarities. The prevailing paradigm for DMs is that they are mediated by an in trans toxic RNA mechanism, triggered by untranslated CTG and CCTG repeat expansions in the DMPK and CNBP genes for DM1 and DM2, respectively. Nevertheless, increasing evidences suggest that epigenetics can also play a role in the pathogenesis of both diseases. In this review, we discuss the available information on epigenetic mechanisms that could contribute to the DMs outcome and progression. Changes in DNA cytosine methylation, chromatin remodeling and expression of regulatory noncoding RNAs are described, with the intent of depicting an epigenetic signature of DMs. Epigenetic biomarkers have a strong potential for clinical application since they could be used as targets for therapeutic interventions avoiding changes in DNA sequences. Moreover, understanding their clinical significance may serve as a diagnostic indicator in genetic counselling in order to improve genotype–phenotype correlations in DM patients.
Analgesic Mechanisms of Steroid Ointment against Oral Ulcerative Mucositis in a Rat Model
Authors: Naniwa Mako , Nakatomi Chihiro , Hitomi Suzuro , Matsuda Kazunari , Tabuchi Takuya , Sugiyama Daijiro , Kubo Sayaka , Miyamura Yuichi , Yoshino Kenichi , Akifusa Sumio , Ono Kentaro
Published: November 2021

Despite the long history of use of steroid ointments for oral mucositis, the analgesic mechanism has not been fully elucidated. In this study, we examined the effects of triamcinolone acetonide (Tmc) on oral ulcerative mucositis-induced pain in conscious rats by our proprietary assay system. Based on evaluations of the physical properties and retention periods in the oral mucosa of human volunteers and rats, we selected TRAFUL® ointment as a long-lasting base. In oral ulcerative mucositis model rats, TRAFUL® with Tmc suppressed cyclooxygenase-dependent inflammatory responses with upregulations of glucocorticoid receptor-induced anti-inflammatory genes and inhibited spontaneous nociceptive behavior. When an ointment with a shorter residual period was used, the effects of Tmc were not elicited or were induced to a lesser extent. Importantly, TRAFUL® with Tmc also improved oral ulcerative mucositis-induced mechanical allodynia, which has been reported to be independent of cyclooxygenase. Ca2+ imaging in dissociated trigeminal ganglion neurons showed that long-term preincubation with Tmc inhibited the hypertonic stimulation-induced Ca2+ response. These results suggest that the representative steroid Tmc suppresses oral ulcerative mucositis-induced pain by general anti-inflammatory actions and inhibits mechanical sensitivity in peripheral nerves. For drug delivery, long-lasting ointments such as TRAFUL® are needed to sufficiently induce the therapeutic effects.