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Tropospheric ozone (O 3 ) is a major component of photochemical smog and is a known human health hazard, as well as a damaging factor for vegetation. Its precursor compounds, nitrogen oxides (NO x ) and volatile organic compounds (VOCs), have a variety of anthropogenic and biogenic sources and exhibit non-linear effects on ozone production. As an update to previous studies on ground-level ozone in the Greater Toronto Area (GTA), we present an analysis of NO 2 , VOC and O 3 data from federal and provincial governmental monitoring sites in the GTA from 2000 to 2012. We show that, over the study period, summertime 24 h VOC reactivity and NO 2 midday (11:00–15:00) concentrations at all sites decreased significantly; since 2000, all sites experienced a decrease in NO 2 of 28–62% and in measured VOC reactivity of at least 53–71%. Comparing 2002–2003 to 2011–2012, the summed reactivity of OH towards NO 2 and a suite of measured VOCs decreased from 8.6 to 4.6 s −1 . Ratios of reactive VOC pairs indicate that the effective OH concentration experienced by primary pollutants in the GTA has increased significantly over the study period. Despite the continuous decrease in precursor levels, ozone concentrations are not following the same pattern at all stations; it was found that the Canada-wide Standard for ozone continues to be exceeded at all monitoring stations. Additionally, while the years 2008–2011 had consistently lower ozone levels than previous years, 2012 experienced one of the highest recorded summertime ozone concentrations and a large number of smog episodes. We demonstrate that these high ozone observations in 2012 may be a result of the number of days with high solar radiation, the number of stagnant periods and the transport of high ozone levels from upwind regions.

The transport sector has an important contribution to the economy, employment and to the citizens' mobility. However, it is also a major contributor to greenhouse gas (GHG) emissions, representing almost a quarter of Europe's GHG emissions, and air pollution, which reduces air quality in cities with direct effects on public health. In particular, road transport is responsible for almost a fifth of total EU emissions and 73% of emissions from transport (European Commission, 2017). Intelligent Transport Systems (ITS) is the application of sensing, analysis, control and communications technologies for the management of the transport process to improve safety, mobility and efficiency, increase security and reduce environment impact. The use of ITS tools in transport has brought significant improvement in transport systems performance and it is a key element in reducing carbon footprint, as well as increasing the sustainability on an urban scale. The increasing road transport volumes in the EU are the primary cause of growing congestion and energy consumption, as well as a source of environmental and social problems (Tafidis & Bandeira, 2017). According to EC, ITS can contribute to the main transport policy objectives by reducing environmental impacts and save energy through better demand management. Therefore, the primary goals for urban transport should be the promotion of cleaner cars and fuels and the reduction of road accidents and traffic congestion. ITS tools can have a significant role to a cleaner, safer and more efficient transport system. EC with the ITS Directive (2010/40/EU) gave the necessary legal framework to their member states to accelerate the implementation of smart technologies in transport sector, giving each country freedom to decide their priorities (Urban ITS Expert Group, 2013). Regarding the mobility sector, there is a clear lack of well-structured policy guidelines that leverage the use of Information and Communication Technologies (ICT), sensing systems and big data to promote a more ...

Anemia is a reduced levels of Hemoglobin ( Hb ) in the blood. Anemia is one of the most common disorder that occurs during pregnancy, with the condition of Hb levels below 11 gr%.Supplementation iron or granting tablet. Fe is an attempt important in prevent and handle Anemia , especially iron deficiency Anemia. Compliance consume iron tablets in measuring instrument from accuracy of the total tablets which was consumed , the accuracy of consuming manner iron tablets , the frequency of consumption each day. Objective: To identify relations factors predisposing , compliance in consum iron tablet and levels hemoglobin of pregnant mothers in Puskesmas Mangli Kabupaten Jember.Methods: The study ofobservationalanalytic. Research instruments to collect database by giving questionnaire and examination levels hemoglobin. Respondents are 32 pregnant women. Data were analyzed by univariate, bivariate and multivariate. Results: Analysis using spearmen correlation rank showed the relationship between age to compliance mother in consume iron tablet( p = 0,015 ), there was a correlation between mothers education pregnant with compliance pregnant mothers in consume iron tablet ( p = 0,001 ), there was a correlation between a capital work impregnate with compliance pregnant mothers in consume iron tablet ( p = 0,001 ), there was a correlation between knowledge pregnant mothers with compliance pregnant mothers in consume iron tablet ( p = 0,001 ), there was a correlation between a pregnant mothers with compliance pregnant mothers in consume iron tablet ( p = 0,003 ), there was a correlation between compliance pregnant mothers in consume iron tableton the hemoglobin pregnant mothers ( p = 0,000 ). The most dominant factor which affect the compliancy consumingiron tablet during the pregnancy was pregnant mother's attitude with the score odds ratio (OR) 4,328.Conclusion: There was a connection between the predisposing with compliance pregnantmothersin consume iron tablet and there wasa link between compliance in consume iron tabletto the pregnant mother's hemoglobin and the most predisposition dominant factor which affect the compliancy consumingiron tablet during the pregnancy was pregnant mother's attitude.

NPS NRP Executive Summary ; Report Type: Final Report ; Project Summary: Women comprise approximately 8% of the active component in the Marine Corps, a number less than half of female representation in other military services. While the Department of Defense's (DoD's) recent mandate to fully integrate women is not the focus of this project, the policy dramatically increases the set of opportunities the Marine Corps can offer to women. This project seeks to provide a foundation to ultimately help determine the "optimal" number of women in the Marine Corps. In particular, we determine what a feasible level of gender integration could look like by creating an empirically justified upper bound of female representation across Marine Corps occupations. To establish this, we develop a mapping of Marine Military Occupational Specialties (MOS) to its civilian equivalents using detailed job descriptors. We find previously male-only Marine MOS are equivalent to primarily male-dominated civilian jobs, where the proportions of women still sit at or below five percent. There is substantial variation in female representation across Marine jobs; however, for example, women comprise more than 25 percent in the Manpower/Admin Occupational Field (OCCFLD). The analysis reveals the occupational segregation in the Marine Corps closely mirrors that of the civilian labor market. Because some Marine jobs do not map well to civilian equivalents, we also examine determinants of success at infantry training. Finding that physical ability is the dominant predictor of success, we use physical fitness data of male and female civilian youth to further estimate the proportions of women we may expect in the infantry OCCFLD. Finally, we develop an analytical framework that can address the costs and benefits of increasing the proportion of women in the Marine Corps. ; HQMC Manpower & Reserve Affairs (M&RA) ; NPS-18-M222-A ; Approved for public release; distribution is unlimited.

Background: Advance care planning (ACP) involves important decision making about future medical needs. The high-volume and disparate nature of ACP research makes it difficult to grasp the evidence and derive clear policy lessons for policymakers and clinicians. Aim: The aim of this study was to synthesize ACP research evidence and identify relevant contextual elements, program features, implementation principles, and impacted outcomes to inform policy and practice. Design: An overview of systematic reviews using the Cochrane Handbook of Systematic Reviews of Interventions was performed. Study quality was assessed using a modified version of the AMSTAR (A MeaSurement Tool to Assess Reviews) tool. Data Sources: MEDLINE, EBM Reviews, Cochrane Reviews, CINAHL, Global Health, PsycINFO, and EMBASE were searched for ACP-related research from inception of each database to April 2017. Searches were supplemented with gray literature and manual searches. Eighty systematic reviews, covering over 1660 original articles, were included in the analysis. Results: Legislations, institutional policies, and cultural factors influence ACP development. Positive perceptions toward ACP do not necessarily translate into more end-of-life conversations. Many factors related to patients' and providers' attitudes, and perceptions toward life and mortality influence ACP implementation, decision making, and completion. Limited, low-quality evidence points to several ACP benefits, such as improved end-of-life communication, documentation of care preferences, dying in preferred place, and health care savings. Recurring features that make ACP programs effective include repeated and interactive discussion sessions, decision aids, and interventions targeting multiple stakeholders. Conclusions: Preliminary evidence highlights several elements that influence the ACP process and provides a variety of features that could support successful, effective, and sustainable ACP implementation. However, this evidence is compartmentalized and limited. Further studies evaluating ACP as a unified program and assessing the impact of ACP for different populations, settings, and contexts are needed to develop programs that are able to unleash ACP's full potential. ; MOH (Min. of Health, S'pore) ; Published version

Формирование конкурентоспособной экономики России невозможно без устойчивого роста промышленного производства. Все действия Правительства РФ по государственной поддержке производственного комплекса ориентированы на реализацию приоритетной цели российской экономики, которая заключается в обеспечении его конкурентоспособности на основе инновационного развития. Металлургическая промышленность как одна из важнейших для России – не исключение. Целью исследования является выполнение анализа инновационной активности металлургических предприятий РФ, выявление тенденций и формулирование проблем инновационного развития металлургического производства. В ходе исследования автором использовались общенаучные методы: сравнительный и логический анализ, системный подход, а также графический и табличный методы исследования. В работе рассматриваются вопросы инновационной деятельности металлургических предприятий РФ. На основании статистических данных Федеральной службы государственной статистики РФ выполнен анализ динамики основных показателей инновационной активности металлургического производства России за 2015 2017 гг. На основе результатов выполненного исследования автором сформулированы положительные и отрицательные тенденции инновационного развития металлургических предприятий РФ. Выделены проблемы реализации инновационных решений в металлургическом производстве. ; The formation of a competitive Russian economy is impossible without sustainable growth in industrial production. The government's actions to support the Russian industry focus on ensuring competitiveness of a production complex based on innovative development, and the metallurgical industry is no exception. This article aims to analyze the innovative activity of Russian metallurgical enterprises, identify trends, and formulate problems of innovative development of metallurgical production. Using comparative and logical analysis and systematic approach, as well as graphical and tabular research methods, the author studies the issues of innovative activity of Russian metallurgical enterprises. Using the statistical data of the RF Federal State Statistics Service, she analyzes the dynamics of the main indicators of innovative activity of Russian metallurgical production for 2015-2017. The results show positive and negative trends of innovative development of Russian metallurgical enterprises, highlighting the problems of implementation of innovative solutions in metallurgical production.

Building construction requires a wide range specialty subcontractor for accomplishing project objectives. The stakeholder in public building construction of Addis Ababa includes clients, contractors, government consultants and micro and small enterprises firms working as sub-contractors. Despite their contribution to economic development and job opportunity creation micro and small enterprises contractors face a number of problems caused by stakeholders of the construction industry. This study aimed to assess the practice, challenges and develop approach for selection of MSEs (micro and small enterprises) contractors who are working as subcontractors in Addis Ababa public building construction industry. The data collection method used was made by integrated questionnaire survey and case studies. Samples for the study have been randomly selected from a clustered group of stakeholders who are actively participating in construction industry. In the analysis, the "Mean Score" method is adopted to establish the relative importance of the challenges and a theory of multi-parameter approach model incorporating a number of selection criteria was developed based on the challenges faced. The SPSS (Statistical Package for the Social Sciences) was used to analyze the questioner and Microsoft Excel was used to present the results and develop a selection evaluation model for MSEs contractors. In the public construction industry a significant portion of the project work are given to MSEs in different trade even though they don"t have a certain specialization by using both fixed price and tender system with a unique contractual relationship of stakeholders to that of other countries practice. The main challenges faced in the public building construction include MSEs attitude of dependency syndrome, unrealistic low contract price, lack of work quality, main contractor lack of managerial skill, lack of direct contract between main contract and government consultant fixing unrealistic contract time which consider all micro and small enterprises. Taking the challenge faced in the industry in to consideration a selection criteria model is developed for the technical evaluate of MSEs contractors.

Publisher's version (útgefin grein) ; Recent studies indicate that lifestyle factors in early life affect breast cancer risk. We therefore explored the association of high consumption of meat, milk, and whole grain products in adolescence and midlife, on breast cancer risk. We used data from the population based AGES-Reykjavik cohort (2002–2006), where 3,326 women with a mean age of 77 years (SD 6.0) participated. For food items and principal component derived dietary patterns we used Cox proportional models to calculate multivariate hazard ratios (HR) with 95% confidence intervals (95% CI). During a mean follow-up of 8.8 years, 97 women were diagnosed with breast cancer. For both adolescence and midlife, daily consumption of rye bread was positively associated with breast cancer (HR 1.7, 95% CI 1.1–2.6 and HR 1.8, 95% CI 1.1–2.9, respectively). In contrast, persistent high consumption of oatmeal was negatively associated with breast cancer (0.4, 95% CI 0.2–0.9). No association was found for other food items or dietary patterns that included rye bread. High rye bread consumption in adolescence and midlife may increase risk of late-life breast cancer whilst persistent consumption of oatmeal may reduce the risk. ; The AGES-Reykjavik Study was funded by NIH contract N01-AG-12100, the Intramural Research Program of the National Institute on Aging, by the Icelandic Heart Association and the Icelandic Parliament. This work was supported by the The Icelandic Centre for Research, RANNIS grant number: 152495051, (http://en.rannis.is/) (A. Haraldsdottir) and the Public Health Fund of the Icelandic Directorate of Health (A. Haraldsdottir). The funding agencies (National Institute on Aging, Icelandic Heart Association and Icelandic Parlament,) for the AGES-Reykjavik Study, RANNIS, or Directorate of Health had no role in the design, analysis or writing of this article. ; Peer Reviewed

BACKGROUND: The reading skills of 16% of children fall below the mean range for their age, and 5% of children have significant and severe reading problems. Phonics training is one of the most common reading treatments used with poor readers, particularly children. OBJECTIVES: To measure the effect of phonics training and explore the impact of various factors, such as training duration and training group size, that might moderate the effect of phonics training on literacy‐related skills in English‐speaking poor readers. SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase, 12 other databases, and three trials registers up to May 2018. We also searched reference lists of included studies and contacted experts in the field to identify additional studies. SELECTION CRITERIA: We included studies that used randomisation, quasi‐randomisation, or minimisation to allocate participants to a phonics intervention group (phonics training only or phonics training plus one other literacy‐related skill) or a control group (no training or non‐literacy training). Participants were English‐speaking poor readers with word reading one standard deviation below the appropriate level for their age (children, adolescents, and adults) or one grade or year below the appropriate level (children only), for no known reason. Participants had no known comorbid developmental disorder, or physical, neurological, or emotional problem. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by Cochrane. MAIN RESULTS: We included 14 studies with 923 participants in this review. Studies took place in Australia, Canada, the UK, and the USA. Six of the 14 included studies were funded by government agencies and one was funded by a university grant. The rest were funded by charitable foundations or trusts. Each study compared phonics training alone, or in conjunction with one other reading‐related skill, to either no training (i.e. treatment as usual) or alterative training (e.g. maths). Participants were English‐speaking ...

BACKGROUND: In the United States, reported rates of syphilis continue to increase. Co-occurring epidemics of syphilis among men who have sex with men (MSM) and heterosexual populations create challenges for the prioritization of resources and the implementation of context-specific interventions. METHODS: State was the unit of analysis and was restricted to the 44 states with the most complete data of sex or sex partners for their reported adult syphilis cases. States were classified as high, medium, or low for reported congenital syphilis (CS) and MSM primary and secondary (P&S) syphilis rates. Average values of a range of ecologic state level variables were examined among the 9 categories created through the cross-tabulation of CS and MSM P&S syphilis rates. Patterns among ecologic factors were assessed across the 9 categories of states' syphilis rates. RESULTS: Among the 44 states categorized, 4 states had high rates of both CS and MSM P&S syphilis in 2015, whereas 12 states fell into the medium/medium category and 7 into the low category. Six states had high CS and medium MSM syphilis and 4 states had medium CS but high MSM syphilis. Several area-level factors, including violent crime, poverty, insurance status, household structure and income, showed qualitative patterns with higher rates of CS and MSM P&S syphilis. Higher proportions of urban population were found among states with higher CS rates; no trend was seen with respect to urbanity and MSM P&S syphilis. CONCLUSIONS: Several area-level factors were associated with CS and MSM P&S syphilis in similar ways, whereas other ecologic factors functioned differently with respect to the 2 epidemics. Explorations of community and area-level factors may shed light on novel opportunities for population specific prevention of syphilis.

BACKGROUND: Sub-Saharan Africa is experiencing a rising burden of hypertension. Antihypertensive medications and salt-restriction diet are the cornerstone of effective hypertension control. PURPOSE: We therefore, assessed adherence to medication and salt restriction in 12 sub-Saharan countries and studied their relationship with blood pressure (BP) control among hypertensive patients. MATERIAL AND METHODS: We conducted a cross-sectional survey in urban clinics of 12 sub-Saharan countries (Benin, Democratic Republic of Congo, Guinea, Mozambique, Niger, Togo, Cameroon, Congo (Brazzaville), Gabon, Côte d'Ivoire, Mauritania, Senegal). Data collected on demographics, treatment and standardised BP measures were made among the hypertensive patients attending the clinics. BP control was defined as BP <140/90 mmHg and hypertension grades were defined according to European Society of Cardiology guidelines. Poor adherence was defined as a score <8 on the validated 8-Item Morisky Medication Adherence Scale (MMAS 8) completed by the patients. We developed a scale (ranging from 0 to 9) to assess salt consumption: poor adherence to salt restriction was defined as a score ≥2. The association between adherence to medication and salt restriction and BP control was investigated using multilevel logistic regression analysis adjusting for age, sex and countries. RESULTS: A total of 2198 hypertensive patients (mean age 58.4±11.8 years; 39.9% male) were included. Among these patients, 77.4% had uncontrolled BP, 34.0% were poorly adherent to salt restriction, 64.4% were poorly adherent to medication and 24.6% had poor adherence to both. Poor adherence to salt restriction (OR: 1.33, 95% CI: 1.03 to 1.72), medication (OR: 1.56, 95% CI: 1.25 to 1.93) or both (OR: 1.91, 95% CI: 1.39 to 2.66) was related to uncontrolled BP. Moreover, poor adherence to both medication and salt restriction was related to 1.52 fold (95% CI: 1.04 to 2.22), 1.8 fold (95% CI: 1.22 to 2.65) and 3.08 fold (95% CI: 2.02 to 4.69) increased the likelihood of ...

BACKGROUND: Drug misuse is a serious public health problem. Evidence from previous epidemiological studies show that GPs are recording drug misuse in electronic patient records (EPR). However, although the recording trends are similar to national surveys, recording rates are much lower. AIM: To explore the factors that influence GPs to record drug misuse in the EPR, and to gain a clearer understanding of the gap between the amount of drug misuse recorded in primary care and that in national surveys and other studies. DESIGN AND SETTING: A semi-structured qualitative interview study of GPs working in general practices across England. METHOD: Purposive sampling was employed to recruit 12 GPs, both with and without a special interest in drug misuse, from across England. Semi-structured face-to-face interviews were conducted to consider whether and why GPs record drug misuse, which methods GPs use for recording, GPs' actions if a patient asks for the information not to be recorded, and GPs' actions if they think a patient misuses drugs but does not disclose the information. Resulting data were analysed using a combination of inductive and deductive thematic analysis. RESULTS: The complexity of asking about drug misuse preceded GPs' decision to record. They described how the context of the general practice protocols, interaction between GP and patient, and the questioning process affected whether, how, and in which circumstances they asked about drug use. This led to GPs making a clinical decision on whether, who, and how to record in the EPR. CONCLUSION: When making decisions about whether or not to record drug misuse, GPs face complex choices. Aside from their own views, they reported feelings of pressure from the general practice environment in which they worked and their clinical commissioning group, as well as government policies.

Bovine Tuberculosis (BTB) is a serious cause of economic losses and public health threat, especially in developing countries. Humans acquire BTB through consumption of raw or undercooked meat, inhalation of aerosol and occupational exposure. A cross-disciplinary approach to study diseases connecting society and biology helps to understand the ways in which social, cultural, behavioral, and economic circumstances influence a healthy life. The objective of this study was to assess the risk perceptions and protective behaviors toward BTB among abattoir and butcher workers in central Ethiopia. A health belief model was used to generate the desired data following health belief model constructs. A total of 300 meat handlers working in local abattoirs, export abattoirs and butcher houses in Bishoftu, Modjo, Dukem, and Akaki towns of central Ethiopia were selected using a systematic random sampling method. Univariate and multivariable logistic regression analysis were used to assess factors associated with risk of exposure to BTB through the consumption of raw meat. The results showed that among the study participants, 95% heard about BTB and 93% knew that eating raw meat could be a source of BTB for humans. More than 62.7% of the respondents in the high risk group strongly agreed that contracting BTB would prevent them from coming to work, keep them in bed for an extended period of time and cause death. The majority of the respondents believed that free provision of personal protective clothing, compensation with test and slaughter campaigns, television and radio advertisements, educational programs and government-imposed penalties would help in prevention of BTB. Despite the high perceived severity and risk perception, the multivarable logistic regression model showed low-risk protective behavior among male (OR: 2.3, 95% CI: 1.2–4.3) and older age (>30) individuals (OR: 14.4 95% CI: 2.1–125.8). The study also noted the importance of media for health education as means for prevention of BTB. The authors strongly ...

OBJECTIVE: To assess whether Massachusetts legislation directed at intensive care unit (ICU) nurse staffing was associated with improvements in patient outcomes. DESIGN: Retrospective cohort study; difference-in-difference design to compare outcomes in Massachusetts with outcomes of other states (before and after the March 31, 2016 compliance deadline). SETTING: Administrative claims data collected from medical centers across the United States (Vizient, Inc). PATIENTS: Adults between ages 18-99 years old who were admitted to ICUs for ≥1 day. INTERVENTIONS: Massachusetts General Law c. 111, § 231, which established (1) maximum patient-to-nurse assignments of 2:1 in the ICU, and (2) that this determination should be based on a patient acuity tool and by the staff nurses in the unit. MEASUREMENTS AND MAIN RESULTS: Nurse staffing increased similarly in Massachusetts (N = 11 ICUs, Baseline patient-to-nurse ratio 1.38±0.16 to Post-mandate 1.28±0.15, p = 0.006) and other states (N = 88 ICUs, Baseline 1.35±0.19 to Post-mandate 1.31±0.17, p = 0.002); difference-in-difference p = 0.20. Massachusetts ICU nurse staffing regulations were not associated with changes in hospital mortality within Massachusetts (Baseline N=29754, standardized mortality ratio 1.20±0.04 to Post-mandate N=30058, 1.15±0.04, p=0.11) or when compared to changes in hospital mortality in other states (Baseline N=572,952, 1.15±0.01 to Post-mandate N=567,608,1.09±0.01; difference-in-difference p = 0.69). Complications (Massachusetts: Baseline 0.68% to Post-mandate 0.67%; other states: Baseline 0.72% to Post-mandate 0.72%; difference-in-difference p = 0.92) and do-not-resuscitate orders (Massachusetts: Baseline 13.5% to Post-mandate 15.4%; other states: Baseline 12.3% to Post-mandate 14.5%; difference-in-difference p = 0.07] also remained unchanged relative to secular trends. Results were similar in interrupted time series analysis, as well as in subgroups of community hospitals and workload intensive patients receiving mechanical ventilation. CONCLUSIONS: ...

With the rapid development of urbanization, industrialization, and motorization, a large number of Chinese cities have been affected by heavy air pollution. In order to promote the development quality of Chinese cities, mixed regulations to control air pollution have been implemented under the lead of government. The principal component analysis and efficacy coefficient method are used to estimate urban development quality, according to the panel data of 285 prefecture-level cities in China over the period 2003–2016. On this basis, the paper uses the spatial Durbin model to study the direct impact and the spatial spillover effect of air pollution control on urban development quality in China. Results show that the control of smoke and dust has improved urban development quality in China, however, the control of sulfur dioxide has led to the decline of urban development quality in China. Furthermore, the impact of air pollution control on urban development quality in the eastern region is of great significance in statistical tests, while the situation in the central and western regions has not passed the test, implying the spatial heterogeneity among different regions. The different effects of air pollution control on urban development quality in different regions also illustrate the consciousness and supervision of local governments' environment protection. Finally, the effects decomposition of the influencing factors based on spatial Durbin model (SDM) also supports the robust findings. Promoting the upgrading of energy consumption structure, raising awareness of environmental protection and supervision, and strengthening cooperation of different regions are suggested. Further recommendations are provided to improve the conceptual design and increase the credibility of our research. Our study not only provides new evidence on the impact of air pollution control on urban development quality in China, but also proposes a new perspective to promote urban development quality in China.