Changes In Public Policy Research Articles

Neighborhood Deprivation and DNA Methylation and Expression of Cancer Genes in Breast Tumors

The biological processes that underlie the association of neighborhood environment with chronic diseases, such as cancer, remain poorly understood. To determine whether differences in breast tissue DNA methylation are associated with neighborhood deprivation among Black and White women with breast cancer. This cross-sectional study collected breast tissue from women undergoing surgery for breast cancer between January 1, 1993, and December 31, 2003. Participants were recruited through the University of Maryland Medical Center, with additional collection sites at Baltimore-area hospitals. Data analysis was performed from March 1 through December 1, 2022. Year 2000 census tract-level socioeconomic deprivation measured via neighborhood deprivation index (NDI) as a standardized score, with Black and White race being ascertained through self-report. The primary outcome was tissue DNA methylation using genome-wide measurements. The secondary outcome was tissue gene expression. Participants included 185 women with breast cancer (110 Black [59.5%], 75 White [40.5%]). Mean (SD) age at surgery was 56.0 (14.1) years. Neighborhood deprivation was higher for Black women than for White women (Mean [SD] NDI, 2.96 [3.03] for Black women and -0.54 [1.91] for White women; difference, -3.50; 95% CI, -4.22 to -2.79; P < .001). In unstratified analysis, 8 hypomethylated CpG sites were identified as associated with the NDI, including sites in 2 tumor suppressor genes, LRIG1 and WWOX. Moreover, expression of the 2 genes inversely correlated with neighborhood deprivation. In the race-stratified analysis, the negative correlation between the LRIG1 gene body CpG site cg26131019 and the NDI remained significant in Black women. A neighborhood deprivation-associated decrease in gene expression was also observed for LRIG1 and WWOX in tumors from Black women. In this study, high neighborhood deprivation was associated with differences in tissue DNA methylation and gene expression among Black women. These findings suggest that continued investment in public health interventions and policy changes at the neighborhood level may help to remedy biological alterations that could make minoritized populations more susceptible to chronic diseases.

Socioeconomic Disadvantage Is Associated with Decreased Long-Term Survival in Adolescent and Young Adult Patients with Acute Lymphoblastic Leukemia

Background: The treatment of acute lymphoblastic leukemia (ALL) in the adolescent and young adult (AYA) population has dramatically improved over the past decade with the use of pediatric-inspired regimens increasing long-term survival rates to over 60%. Despite these advances, AYA patients with ALL have seen persistent disparities in survival by race and ethnic background. The primary objective of this study is to examine socioeconomic disadvantage as a driver of the racial and ethnic disparities that exist among AYAs with ALL using a nationally representative cancer registry. Methods: The cohort was identified using the SEER*Stat software, which utilizes Surveillance, Epidemiology, and End Results (SEER) data from the National Cancer Institute (NCI). All SEER patients diagnosed at age 15 to 39 years with ALL from January 1, 2005 to December 31, 2019 were included in the analysis. Patients were excluded from analysis if they had an unknown cause of death, were diagnosed with ALL only postmortem, had no survival time listed, or did not have a recorded age. We utilized the area deprivation index (ADI) as a measure of socioeconomic disadvantage, and patients were excluded if they were in a county that did not have a corresponding ADI score (0.3%). ADI scores were calculated by county using the ‘Sociome’ package in R software. Both the 2009 and 2019 county ADI scores were used based on patient diagnosis year. ADI quartiles were then assigned by decade (2000-2009 and 2010-2019). The quartiles were calculated by first identifying the median ADI score for each decade, and then assessing the median of the lower and upper half to determine the lower and upper quartile value. Analyses were also completed by state Medicaid expansion status. Both cause-specific and observed survival (OS) were calculated by five-year periods from 2005 to 2019. The net survival time was assessed at 12 to 60 months in 12-month increments for 2005-2014 with only an upper limit of 48 months survival able to be calculated for patients diagnosed between 2015-2019. The Kaplan-Meier Method was used for all survival calculations. Results: A total of 4,382 patients were found to meet criteria for inclusion. Specific characteristics of the analyzed population are listed in Table 1. OS for the entire group was 60.6% at 60 months (95% CI 58.9%-62.3%), with a cause-specific survival at 60 months of 64.3% (95% CI 62.7%-65.9%). For AYA ALL patients diagnosed from 2005 to 2009, cause-specific survival for the ADI quartiles diverged over time and at 48 months was significantly higher in patients residing in a county with an ADI value of 1 (least disadvantaged) than in those residing in a county with an ADI value of 4 (most disadvantaged) [66.6%, 95% CI 62.5-70.4% versus 51.2%, 95% CI 40.2-61.2% p&amp;lt;0.05], although this difference was not significant at 60 months. This difference was also seen in OS at 48 months and persisted at 60 months [62.0%, 95% CI 57.9-65.8% versus 45.7%, 95% CI 35.3-55.5% (48 mo.) and 59.7%, 95% CI 55.6-63.5% versus 45.7%, 95% CI 35.3-55.5% (60 mo.) p&amp;lt;0.05]. There was no significant difference in cause-specific or OS by ADI quartile for patients diagnosed from 2010-2014. However, this difference in survival reoccurred in the most recent data available (Figure 1). For AYA ALL patients diagnosed from 2015 to 2019, cause-specific survival at 36 and 48 months was significantly higher in patients residing in a county with an ADI value of 1 than in those residing in a county with an ADI value of 4 [79.7%, 95% CI 75.6-83.2% versus 65.8%, 95% CI 55.8-74.0% (36 mo.) and 78.6%, 95% CI 74.2-82.3% versus 62.4%, 95% CI 51.8-71.3% (48 mo.) all p&amp;lt;0.05]. This difference was also seen in OS for all survival intervals from 12 to 48 months [90.2%, 95% CI 87.6-92.3% versus 81.3%, 95% CI 74.4-86.5% (12 mo.); 82.9%, 95% CI 79.4-85.8% versus 72.9%, 95% CI 64.9-79.3% (24 mo.); 77.1%, 95% CI 72.9-80.7% versus 62.1%, 95% CI 52.4-70.3% (36 mo.); and 76.0%, 95% CI 71.6-79.8% versus 58.8%, 95% CI 48.6-67.7% (48 mo.) all p&amp;lt;0.05]. There were no statistically significant differences noted in cause-specific and observed survival between states that expanded Medicaid versus those that did not. Conclusions: Socioeconomic disadvantage was associated with significantly worse long-term survival in AYA patients with ALL. This gap reappears over time despite both treatment innovations and public policy changes. Urgent interventional approaches are needed to target this highly vulnerable population.

Securing lethal means for suicide: a focus group study exploring perceptions and barriers among practicing veterinarians.

Veterinarians are at higher risk for suicide than the general population, and 1 reason for this may be veterinarians' access to and knowledge of pentobarbital-a common suicide method in this population. One possible approach to reducing suicide risk is means safety. This study examined the acceptability and feasibility of means safety protocols in the veterinary workplace. 43 veterinarians from a mix of specialty areas aged 26 to 53 years, currently practicing in the United States, recruited via social media and listservs. Participants completed a 60- to 90-minute focus group with pre- and post-test surveys. Focus group content was qualitatively analyzed. Survey responses indicated that that 30% (n = 13) of veteriarians reported storing their pentobarbital unlocked at least part of the time. During focus group discussion, participants perceived work/life balance or being overwhelmed as the most common suicide risk factor in veterinarians, with normalizing mental health emerging as a primary way to improve mental health in veterinarians. Additionally, adding an extra lockbox for pentobarbital/firearms emerged as the most acceptable and feasible means safety method. Finally, at post-test, veterinarians increased in willingness to implement storage protocol changes (P = .02) and were more likely to endorse concern about a coworker's suicide risk than concern about their own suicide risk (P < .01) as a reason to change pentobarbital storage methods. Results from this study will inform public messaging campaigns and policy changes for pentobarbital storage and suicide prevention efforts in the veterinary workplace at the individual and organizational level.

Corneal blindness in the developing world: The role of prevention strategies

Corneal blindness is an important contributor to the burden of global blindness and has a greater prevalence in low-income countries of the developing world where resources and infrastructure are limited. The causes of corneal blindness too are different from high-income countries and include infectious keratitis, ocular trauma, and xerophthalmia. Persons with these indications tend to have unfavourable outcomes after corneal transplantation, limiting their chances of benefitting from this sight-saving procedure. However, most causes of corneal blindness in the developing world are preventable. This highlights the importance of understanding the unique challenges in these regions and the need for targeted interventions. This article discusses various prevention strategies, including primordial, primary, and secondary prevention, aimed at reducing the burden of corneal blindness in low-income countries. These include capacity building, training, and awareness campaigns to reduce the risk factors of ocular trauma, infectious keratitis, and improve access to first aid. It is also important to promote safe eye practices and tackle nutritional deficiencies through public health interventions and policy changes. Providing the required training to general ophthalmologists in the management of basic corneal surgeries and diseases and enhancing the accessibility of eye care services in rural areas will ensure early treatment and prevent sequelae. Current treatment modalities belong to the tertiary level of prevention and are largely limited to corneal transplantation. In developing nations, there is a scarcity of donor corneal tissue necessitating an urgent expansion of eye banking services. Alternative approaches to corneal transplantation such as 3D printed corneas, cultured stem cells, and biomaterials should also be explored to meet this demand. Thus, there is a need for collaborative efforts between healthcare professionals, policymakers, and communities to implement effective prevention strategies and reduce the prevalence of corneal blindness in the developing world.

Actitud de los fisioterapeutas acerca del acceso directo y su implementación a través de un cambio en la política pública en Puerto Rico

ObjectivesTo explore the attitudes of physiotherapists in Puerto Rico: (1) towards direct access (DA), (2) the implications for the profession, practice, and health services, and (3) the implementation of DA through a change in public policy. MethodsThe design was cross-sectional exploratory, non-experimental, and quantitative in nature. Participants were licensed physiotherapists, over 21 years old, with any academic degree in physiotherapy, currently practicing in Puerto Rico. Physiotherapists without clinical experience, those completing a transitional doctoral degree, or with experience practicing with DA were excluded. To address the research objectives, a questionnaire was constructed, whose content was validated by 4 expert physiotherapists using the Lawshe model modified by Tristán. ResultsOne hundred physiotherapists participated in this study. 96% of participants agreed with the implementation of DA in Puerto Rico. However, only 83% indicated being prepared to practice the profession through DA. 55% understood that physiotherapists with doctoral degrees were better prepared to practice through DA. 59% indicated that DA should be restricted based on educational level and/or experience. ConclusionThe attitude of physiotherapists in Puerto Rico towards DA was favorable regardless of academic degree. They are in favor of incorporating DA into physiotherapy, feel prepared to practice through DA, and consider it beneficial for patients, practice, and the profession.

Making the library of the future identifying the zone of proximal development for a Norwegian public library makerspace

ABSTRACT This article presents a cultural-historical analysis of what making becomes in the transition to a public library makerspace in Norway. We pursue this topic by applying the concept of expansive learning, and ethnographic notes, interviews, official documents, and video data comprise the data for analysis. We focus on historical changes in Norwegian public library policy, how systemic needs become visible in how making emerges, and how staff re-construct making for primary school children. Findings suggest a Zone of Proximal Development for children’s making that moves toward a pedagogy for real-world problem-finding and storytelling.

Promoting Staff Financial Well-Being in Human Service Organizations: The Role of Pay, Benefits, and Working Conditions

ABSTRACT Many U.S. workers struggle with financial challenges. Human service organizations (HSOs) can consider ways to better promote financial well-being among staff, especially lower-wage, frontline workers. In addition to raising pay, HSOs can improve benefits and working conditions in ways that will meaningfully affect staff's financial well-being, such as offering wage-tiered health insurance premiums, financial counseling, access to public benefits, and giving staff more control over their schedules. Doing so will help HSOs strengthen their commitments to social and economic justice, yet financial challenges among nonprofit HSOs – especially those that are minority-led and/or -serving – require changes in public policies.

Action anthropology and public policy change: Lead poisoning in Syracuse, NY

AbstractIn Syracuse, New York more than 10% of children are lead poisoned each year, a toxic exposure that lowers the children's ability to learn and increases risky behaviors in adolescence. African American children are affected at nearly twice the rate of White children. We describe a community‐university collaboration to reduce childhood lead poisoning in Syracuse, and the effects these efforts have had on public policy to date. This paper documents the effectiveness of the Community Action, Research, and Education model to deliver community‐based prevention strategies on child lead poisoning in Syracuse, New York. The community‐based strategies were successful for promoting legal and policy change, increasing the public awareness of this tragic problem, holding elected and appointed officials to their commitments in addressing this toxic injustice, and obtaining needed intervention and disability accommodations for lead‐poisoned children in the community and educational institutions.

Prevalence and Factors Associated With Vaping Cannabidiol Among US Adolescents

e-Cigarette use and vaping marijuana (cannabis) are popular among US adolescents. Cannabidiol (CBD) is a compound found in the cannabis plant that has recently increased in use. To examine the prevalence of and factors associated with youths vaping CBD. This cross-sectional study included a nationally representative sample of students from middle and high schools (typical age, 11-18 years) in the US from the 2022 National Youth Tobacco Survey, conducted from January to May 2022. Demographic characteristics, harm perception of tobacco use, and vaping behaviors. The main outcomes were weighted prevalence and population estimates of ever and current (past 30-day) vaping of CBD overall and by e-cigarette use status. Multivariable logistic regression analyses were conducted to estimate the association of currently vaping CBD with demographic factors and e-cigarette and tobacco use behaviors stratified by current e-cigarette use status. The study included 28 291 participants (51.1% male; mean [SD] age, 14.5 [2.0] years). Among 2448 current e-cigarette users, 21.3% (95% CI, 18.4%-24.1%) reported any past-month vaping of CBD and 6.3% (95% CI, 4.7%-7.8%) reported that they did not know whether they had vaped CBD. Hispanic e-cigarette users were more likely than their non-Hispanic White peers to report currently vaping CBD (adjusted odds ratio [AOR], 1.9; 95% CI, 1.3-2.8). Current e-cigarette users with higher frequency (≥20 days vs ≤5 days) and longer duration (2-3 years or >3 years vs <1 year) of use were more likely to report currently vaping CBD (frequency: AOR, 1.5 [95% CI, 1.1-1.9]; 2-3 years: AOR, 2.2 [95% CI, 1.2-3.9]; 3 years: AOR, 3.2 [95% CI, 1.7-6.1]). Among 25 091 noncurrent e-cigarette users, 1.2% (95% CI, 1.0%-1.5%) reported currently vaping CBD and 2.3% (95% CI, 2.1%-2.6%) reported that they did not know. High school students (vs middle school students; AOR, 4.2; 95% CI, 2.8-6.1) and gay or lesbian (AOR, 2.9; 95% CI, 1.6-5.4) or bisexual (AOR, 2.7; 95% CI, 1.8-4.0) (vs heterosexual) youths were more likely to report vaping CBD, while those who perceived tobacco as dangerous (vs not dangerous; AOR, 0.4; 95% CI, 0.3-0.6) had lower odds of reporting vaping CBD. In this cross-sectional study of US middle and high school students, the prevalence of youths vaping CBD was high, particularly among e-cigarette users and Hispanic and sexual minority populations. The findings suggest that evidence-based educational campaigns, interventions, and public policy changes are needed to reduce the harmful health outcomes possible with vaping CBD among developing youths.

News Coverage of Face Masks in Australia During the Early COVID-19 Pandemic: Topic Modeling Study.

During the COVID-19 pandemic, web-based media coverage of preventative strategies proliferated substantially. News media was constantly informing people about changes in public health policy and practices such as mask-wearing. Hence, exploring news media content on face mask use is useful to analyze dominant topics and their trends. The aim of the study was to examine news related to face masks as well as to identify related topics and temporal trends in Australian web-based news media during the early COVID-19 pandemic period. Following data collection from the Google News platform, a trend analysis on the mask-related news titles from Australian news publishers was conducted. Then, a latent Dirichlet allocation topic modeling algorithm was applied along with evaluation matrices (quantitative and qualitative measures). Afterward, topic trends were developed and analyzed in the context of mask use during the pandemic. A total of 2345 face mask-related eligible news titles were collected from January 25, 2020, to January 25, 2021. Mask-related news showed an increasing trend corresponding to increasing COVID-19 cases in Australia. The best-fitted latent Dirichlet allocation model discovered 8 different topics with a coherence score of 0.66 and a perplexity measure of -11.29. The major topics were T1 (mask-related international affairs), T2 (introducing mask mandate in places such as Melbourne and Sydney), and T4 (antimask sentiment). Topic trends revealed that T2 was the most frequent topic in January 2021 (77 news titles), corresponding to the mandatory mask-wearing policy in Sydney. This study demonstrated that Australian news media reflected a wide range of community concerns about face masks, peaking as COVID-19 incidence increased. Harnessing the news media platforms for understanding the media agenda and community concerns may assist in effective health communication during a pandemic response.

Policy change in socially embedded local policy processes in São Paulo, 1988–2020

ABSTRACT Policy transformation is a classic theme in policy analysis. Policy models have emphasized the role of actors, coalitions, leadership, and ideas in agenda-setting, the circulation of policy frameworks and solutions, and different mechanisms of gradual institutional change that accumulate in policy trajectories. We sustain that oscillating and incremental policy trajectories also produce policy change during policy implementation, triggered by political competition and partisan politics, the embeddedness of policy communities, and multilevel effects. This theorizing is built from the recent trajectories of social assistance and housing policies in São Paulo. Both trajectories followed incremental processes of expansion and diversification, although with sectoral specificities. These cases show that cumulative positive public policy change may happen even in the face of institutional conditions that the literature considers far from ideal – an extremely fragmented party system, decentralized federalism, and weak bureaucracies and state capacities. Competitive partisan politics reinforced the creation and reanimation of policy innovations under multilevel regulation. Networks of bureaucrats and civil society activists within the relevant policy communities enabled policy replication and reanimation by entering and exiting local administrations depending on their ideological colors.

User Profiles for the Integrated Family and Community Health Care Model in the Alto Hospicio, a commune of a northern region of Chile

The study presents comprehensive profiles of Primary Health Care Centers of the Alto Hospicio Commune users. To characterize users registered in the Health Centers of Alto Hospicio Commune from a comprehensive perspective, including satisfaction indicators and knowledge about the Comprehensive Family and Community Health Care Model (MAIS). A questionnaire of 8 dimensions and 73 items was designed and applied in 4 Primary Health Care Centers in the commune. Four simple random samplings were applied. In total, 1,124 users were surveyed. The confidence and significance levels were between 95%-93% and 5%-7%, respectively. The user profile highlights the diversity in each Health Care Center and reveals general problems such as the lack of information regarding the family care model and services provided by the Health Care Centers and the difficulty of facing mental health situations in the context of the COVID-19 pandemic. Those Health Centers that provide more information about MAIS show better indicators regarding knowledge of health services and user satisfaction. The changes in public health policies and the implementation of the Comprehensive Family and Community Health Care Model require clarifying user profiles according to the characteristics of each health center, its population, and the territory, as well as sharing best practices between health centers.

Theorizing reactive policy entrepreneurship: A case study of Swedish local emergency management

AbstractIn this article, we examine public policy change at the local level of governance in the aftermath of an extraordinary event. Using the case study of a Swedish municipality after the sweeping forest fire of 2014, we contend that policy entrepreneurship, like its market counterpart, may under certain conditions take on a wider range of behaviors that are not underpinned by the proactive quest for opportunities. Rather, a sense of urgency and necessity, professional norms, and some keen technical skills make for a different kind of entrepreneurship, which we label reactive policy entrepreneurship.

Commemorations and outreach: Shi‘i leaders of metro Detroit take on theCOVID‐19 pandemic

AbstractOn March 11, 2020, the World Health Organization declared the coronavirus (COVID‐19) outbreak a global pandemic, spurring dramatic changes in public health policies, travel between countries, and (trans)national economies, as well as in religious and political institutions. In the United States, in particular, the pandemic provoked and revealed an increasingly fraught relationship between scientific, religious, and political sources of information and leadership—an American “crisis of authority” wherein many Americans distrusted scientific and medical establishments. This article explores how Shi‘i Muslim institutions and leaders of metro Detroit navigated these competing authorities, even as their communities faced entrenched societal inequities, including anti‐Muslim racism (Islamophobia). Through interviews with Shi‘i religious leaders in Dearborn, Dearborn Heights, and Detroit, supplemented by digital and in‐person ethnographic research at five major Shi‘i mosques, we show how major Islamic centers and leaders argued for the efficacy, safety, religious value, and legality of COVID‐19 medical guidance and led extensive community outreach initiatives to help their struggling communities. Supported by religious scholars in Iran, Iraq, and Lebanon, their guidance offered messages of hope and resilience, as well as an emphasis on the community preservation and selflessness (caring for others) exemplified by the Family of the Prophet. They also emphasized how religious and scientific knowledge intersect, as per the sacred texts of Islam (the Qur'an and hadiths). Their approach compels us to better understand how sources of religious authority can tether vulnerable communities to forms of (legitimate) knowledge in times of upheaval, divisive politics, and misinformation.

Global leadership in paediatric and congenital cardiac care: education and empowerment to improve outcomes in low- and middle-income countries - an interview with Krishna Kumar, MD, DM FAHA.

Dr Krishna Kumar is the focus of our sixth in a series of interviews in Cardiology in the Young entitled, "Global Leadership in Paediatric and Congenital Cardiac Care." Dr Kumar was born in Raurkela, India. He attended medical school at Maulana Azad Medical College in New Delhi, graduating in 1984. Dr Kumar then went on to complete internal medicine, emergency medicine, and adult cardiology training at All India Institute of Medical Sciences in 1988, 1989, and 1990, respectively. He then pursued paediatric cardiology training at Harvard Medical School in Boston, MA, USA. Dr Kumar began his clinical position as a paediatric cardiologist at Amrita Institute of Medical Sciences in Kochi, Kerala, India.During his impressive career, Dr Kumar has made significant contributions to educational advancement, research and innovation, public health advocacy, and clinical care. Dr Kumar is credited for distinguishing paediatric cardiology as a distinct subspecialty in India. He was a founding member of the Pediatric Cardiology Society of India and the original editor of the society's academic journal. Recognising the deficit of paediatric cardiology-trained physicians in low- and middle-income countries, Dr Kumar helped establish formal structured training programmes for paediatric cardiology in India. More recently, he established the Children's HeartLink Fellowships in paediatric cardiac sciences at Amrita Institute of Medical Sciences in Kochi and Institut Jantung Negara in Malaysia. Through educational programmes, Dr Kumar has taught countless caregivers and paediatricians, in India and neighbouring countries, the early identification and management of children with CHD. Dr Kumar has established a premier paediatric heart programme at Amrita Institute of Medical Sciences. As department Chief, he emphasises the importance of teamwork, advocacy, and continuous quality improvement. He has developed numerous low-cost strategies for the management of CHD. He has established large community-based studies on rheumatic heart disease and CHD in South India. Dr Kumar's focus on advocacy and policy change in India has made a substantial impact on early identification and treatment of CHD in the subcontinent. He has made a global impact on the care of paediatric cardiology patients through his educational programmes, research and innovation, large-scale research registries, and advocacy for public health policy changes. He is an incredibly humble and generous leader, and his patients and community are the source of his unending motivation.

Optimizing patient outcomes: Health plans and pharmacists summit: Meeting proceedings

ObjectiveTo convene a group of experts to define the value pharmacists provide to health plans, barriers to covering pharmacists’ patient care services, and scalable solutions to cover pharmacists’ services, specifically in the medical benefit. MethodsThe American Pharmacists Association (APhA) convened 31 experts, including physicians and pharmacists representing health plans (HPs), and pharmacist practitioners (PP) or organizations representing PPs for a strategic summit on May 16 to May 17, 2022, in Washington DC and Arlington, VA. A presummit survey was conducted to identify participants’ perspectives on the value proposition of pharmacists and barriers to coverage for services. Day 1 of the summit featured a keynote presentation focused on the future of pharmacist-provided care. The second day included a framing session on the current state of coverage for pharmacists’ services and the results of the presummit survey; four panel presentations on innovative HP program coverage; three breakout sessions to gather participant feedback on their experiences; and a final session prioritizing action items into an initial timeline of goals. A postsummit survey was fielded to rank feasibility and importance of opportunities and next steps for advancing coverage of pharmacists’ services. ResultIn general, there appeared to be consensus throughout the summit on the need to expand payer programs covering patient care services provided by pharmacists and the importance of continued collaboration between PPs and HPs to increase patient access to care. Participants highlighted a need for legislative and regulatory changes at the state and federal level for the expansion of some programs; however, there were many opportunities to expand programs without the need for public policy changes. ConclusionThe summit was a groundbreaking meeting between PPs and HPs that provided the foundation for collaboration and expansion of programs covering pharmacists’ patient care services under the medical benefit. Key takeaways from the summit focused on the need for scaling programs; establishing mutually beneficial programs for patients, PPs, and HPs; and the need for partnership and flexibility from PPs and HPs as programs continue to establish and expand.

GHG Emission Accounting and Reduction Strategies in the Academic Sector: A Case Study in Mexico

The carbon footprint (CF) quantifies the greenhouse gas (GHG) emissions generated by human activities, expressed in carbon dioxide equivalent (CO2e) units. It is an instrument for monitoring and mitigating the effects of climate change, which particularly affects low- and middle-income countries such as Mexico. The Mexican government has established a goal of reducing GHG emissions by 22% from the levels in 2000 by 2030. Although most efforts to reduce GHG emissions have been focused on the energy and agriculture sectors, the academic sector is also important since it can advise changes in public policy. In this study, the 2019 CF of the Centro Roberto Garza Sada (CRGS), a design school at the Universidad de Monterrey, was estimated in an effort to develop measures for reducing GHG emissions. The GHG Protocol was employed to calculate the total CF of the CRGS and identify the greatest contributors, including commuting (50.2%), energy purchase (28.5%), business travel (19.6%), and energy generation, use of paper, refrigerants, and shipments (1.7%). Three progressive mitigation scenarios were developed to reduce the GHG emissions from commuting, energy consumption, collaborators and student mobility, and material resources. These strategies could reduce the GHG emissions of the CRGS by 63.5% of the baseline assessed.

Stunting and wasting in a growing economy: biological living standards in Portugal during the twentieth century

Portugal's real income per head grew by a factor of eight during the second half of the twentieth century, a period of fast convergence towards Western European living standards. We use a new sample of about 3,400 infants and children living in Lisbon to document trends in the prevalence of stunting and wasting between 1906 and 1994. We find that stunting and wasting fell quickly from around 1950, for both males and females. We additionally use a sample of more than 26,000 young adult males covering the entire country, which shows a consistent decrease in wasting and stunting with the expected time lag. We discuss these trends in relation to changes in income and public policy, which affected the ontogenetic environment of children. Sustained progress began well before the introduction of democracy.

Latin American migrants under the US New Political Economy: Public raids cost vs private sanctuary revival

This is a case study on migration management in the United States of America, according to the New Political Economy approach. Attention is paid to how Latin American immigrants are treated, given the change in public policies and their economic perception. There has been a shift from open-door immigration policies to raids and massive deportations, violating the founding principles of the United States and the key to its growth and development, since immigrants are not only a greater productive factor of work, but also bring knowledge, technologies and institutions that improve the competitiveness. Faced with this change in public powers, civil society has reacted, with a revitalization of the Sanctuary Movement. This study uses an explanatory methodology on the evolution of the academic disciplines and approaches dedicated to the research on religion-economics-migration relations, to focus its attention on the case study of the Sanctuary Movement.

Finite-time stability analysis and control of stochastic SIR epidemic model: A study of COVID-19

Finite-time stability analysis is a powerful tool for understanding the long-term behavior of epidemiological models and has been widely used to study the spread of infectious diseases such as COVID-19. In this paper, we present a finite-time stability analysis of a stochastic susceptible–infected–recovered (SIR) epidemic compartmental model with switching signals. The model includes a linear parameter variation (LPV) and switching system that represents the impact of external factors, such as changes in public health policies or seasonal variations, on the transmission rate of the disease. We use the Lyapunov stability theory to examine the long-term behavior of the model and determine conditions under which the disease is likely to die out or persist in the population. By taking advantage of the average dwell time method and Lyapunov functional (LF) method, and using novel inequality techniques the finite-time stability (FTS) criterion in linear matrix inequalities (LMIs) is developed. The finite-time stability of the resultant closed-loop system, with interval and linear parameter variation (LPV), is then guaranteed by state feedback controllers. By analyzing the modified SIR model with these interventions, we are able to examine the efficiency of different control measures and determine the most appropriate response to the COVID-19 pandemic and demonstrate the efficacy of the suggested strategy through simulation results.