Cost-effective Access Research Articles

Assessing student and patient perspectives on pharmacist-prescribed hormonal contraceptives

BackgroundIncreasing convenient, accessible, and cost effective contraceptive access is critically important. Two-thirds of U.S. states permit pharmacists to prescribe hormonal contraceptives. Community pharmacies are ideal settings for patients to be offered contraceptive therapeutic options, including hormonal contraceptives, emergency contraception (EC), and over-the-counter (OTC) oral contraception. ObjectiveThe objective of this study was to assess college student and community pharmacy patients’ perspectives on pharmacist-prescribed hormonal contraceptives, likelihood of accessing contraceptives from a pharmacist, and perspectives regarding EC and OTC oral contraception. MethodsThe researchers conducted an observational study distributed to college students and patients accessing care at community-based pharmacies from October 2022 to February 2023. The survey population included those who were 18 years or older, English speaking, and recruited both in person and online. Survey questions assessed barriers to contraception access, perspectives toward pharmacist-prescribed hormonal contraception, likelihood of receiving pharmacist-prescribed hormonal contraception, as well as EC and OTC oral contraception at the community pharmacy. Results from the pharmacist and clinician surveys were previously published, therefore this report will focus on the student and patient data. ResultsNinety-one percent of all respondents strongly agreed or agreed with pharmacist-prescribed hormonal contraception. Students and patients reported convenience, time-saving, and money saving as reasons for obtaining from their pharmacist. In regard to EC, 36% reported having ever purchased from a pharmacy and 58% were extremely or somewhat likely to purchase OTC oral contraception. ConclusionsThe majority of students and community pharmacy patients surveyed in Rhode Island support pharmacist-prescribed hormonal contraceptives. State-level policy advancements with reimbursement for services provide pharmacists an opportunity to provide contraceptive care for all people.

Late-Stage Desulfurization Enables Rapid and Efficient Solid-Phase Synthesis of Cathepsin-Cleavable Linkers for Antibody-Drug Conjugates.

The synthesis of linker-payloads is a critical step in developing antibody-drug conjugates (ADCs), a rapidly advancing therapeutic approach in oncology. The conventional method for synthesizing cathepsin B-labile dipeptide linkers, which are commonly used in ADC development, involves the solution-phase assembly of cathepsin B-sensitive dipeptides, followed by the installation of self-immolative para-aminobenzyl carbonate to facilitate the attachment of potent cytotoxic payloads. However, this approach is often low yield and laborious, especially when extending the peptide chain with components like glutamic acid to improve mouse serum stability or charged amino acids or poly(ethylene glycol) moieties to enhance linker hydrophilicity. Here, we introduce a novel approach utilizing late-stage desulfurization chemistry, enabling safe, facile, and cost-effective access to the cathepsin B-cleavable linker, Val-Ala-PABC-MMAE, on resin for the first time.

Low-energy Earth–Moon transfers via Theory of Functional Connections and homotopy

Numerous missions leverage the weak stability boundary in the Earth–Moon–Sun system to achieve a safe and cost-effective access to the lunar environment. These transfers are envisaged to play a significant role in upcoming missions. This paper proposes a novel method to design low-energy transfers by combining the recent Theory of Functional Connections with a homotopic continuation approach. Planar patched transfer legs within the Earth–Moon and Sun–Earth systems are continued into higher-fidelity models. Eventually, the full Earth–Moon transfer is adjusted to conform to the dynamics of the planar Earth–Moon Sun-perturbed, bi-circular restricted four-body problem. The novelty lies in the avoidance of any propagation during the continuation process and final convergence. This formulation is beneficial when an extensive grid search is performed, automatically generating over 2000 low-energy transfers. Subsequently, these are optimized through a standard direct transcription and multiple shooting algorithm. This work illustrates that two-impulse low-energy transfers modeled in chaotic dynamic environments can be effectively formulated in Theory of Functional Connections, hence simplifying their overall design process. Moreover, its synergy with a homotopic continuation approach is demonstrated.

Expanding Access to Patient Care in Community Pharmacies for Minor Illnesses in Washington State.

As the shortage of primary care providers widens nationwide, access to care utilizing non-physician providers is one strategy to ensure equitable access to care. This study aimed to compare community pharmacist-provided care for minor ailments to care provided at three traditional sites of care: primary care, urgent care, and emergency department, to determine if care provided by pharmacists improved access with comparable quality and reduced financial strain on the healthcare system. Pharmacy data was provided from 46 pharmacies and 175 pharmacists who participated across five pharmacy corporations over a 3-year period (2016-2019). Data for non-pharmacy sites of care was provided by a large health plan, matching episodes of care for conditions seen in the community pharmacy. Cost-of-care analysis was conducted using superiority study design and revisit data analysis was conducted using noninferiority study design. Median cost-of-care across traditional sites of care was $277.78 higher than care provided at the pharmacies, showing superiority. Noninferiority was demonstrated for revisit care when the initial visit was conducted by a pharmacist compared to traditional sites. The authors conclude community pharmacist-provided care for minor ailments improved cost-effective access for patients with comparable quality and reduced financial strains on the healthcare system.

Hydraulic Radial Drilling Using a Rotary Hydraulic Nozzle Aimed at Increasing the Exploitation of Deposits

The exploration and development of new hydrocarbon deposits face increasing challenges, primarily driven by the shift away from hydrocarbons towards renewable energy sources like shallow geothermal deposits, wind farms, and photovoltaics. This shift necessitates finding solutions that minimize environmental impact and enable increased energy extraction from existing or decommissioned fields and wells. This paper explores the possibility of excavating from potentially depleted fields, where a significant portion (up to 85%) of the reservoir’s resources remain unrecoverable due to low reservoir energy. To address this, secondary and tertiary exploitation methods are proposed involving the supply of external energy to increase the pressure in the reservoir layer, thereby enhancing resource exploitation. One of the suggested tertiary methods involves reaming the deposit with multiple small-diameter radial holes using a hydraulic drilling nozzle. The entire process comprises several key components, including the coiled tubing unit (CTU), high-pressure flexible hose, window drilling kit for casing pipe, kit for positioning the exit of the hydraulic drilling head from the casing pipe, anchor, and hydraulic drilling head attached to the end of the high-pressure flexible hose. This method aims to increase the contact between the reservoir layer and the wellbore, potentially leading to an increase in or initiation of exploitation in certain deposit scenarios. The described method presents an environmentally friendly approach, eliminating the need for drilling new boreholes and offering cost-effective access to resources in decommissioned deposits with insufficient reservoir energy for self-exploitation. The applicability of this method to extract methane from coalbed seams is also mentioned in this article. In a separate article, the authors detail the design of a hydraulic drilling nozzle specifically for reaming the reservoir layer.

Genome Survey and Chromosome-Level Draft Genome Assembly of Glycine max var. Dongfudou 3: Insights into Genome Characteristics and Protein Deficiencies.

Dongfudou 3 is a highly sought-after soybean variety due to its lack of beany flavor. To support molecular breeding efforts, we conducted a genomic survey using next-generation sequencing. We determined the genome size, complexity, and characteristics of Dongfudou 3. Furthermore, we constructed a chromosome-level draft genome and speculated on the molecular basis of protein deficiency in GmLOX1, GmLOX2, and GmLOX3. These findings set the stage for high-quality genome analysis using third-generation sequencing. The estimated genome size is approximately 1.07 Gb, with repetitive sequences accounting for 72.50%. The genome is homozygous and devoid of microbial contamination. The draft genome consists of 916.00 Mb anchored onto 20 chromosomes, with annotations of 46,446 genes and 77,391 transcripts, achieving Benchmarking Single-Copy Orthologue (BUSCO) completeness of 99.5% for genome completeness and 99.1% for annotation. Deletions and substitutions were identified in the three GmLox genes, and they also lack corresponding active proteins. Our proposed approach, involving k-mer analysis after filtering out organellar DNA sequences, is applicable to genome surveys of all plant species, allowing for accurate assessments of size and complexity. Moreover, the process of constructing chromosome-level draft genomes using closely related reference genomes offers cost-effective access to valuable information, maximizing data utilization.

The Role of Media Digital in Building Democracy in Indonesia

The rise of digitalization has transformed the media landscape, providing individuals with convenient, rapid, practical, and cost-effective access to diverse information and news. However, concerns have been raised about the tendency of digital media to prioritize sensationalism over factual reporting, driven by the pursuit of high ratings and clicks, often neglecting core journalistic principles. This scientific article aims to explore the concept of digital media, trace its evolution, and evaluate its role in promoting democracy. The research methodology primarily relies on an extensive literature review, incorporating a range of sources such as books, journals, articles, and relevant websites to gather comprehensive insights. The findings underscore the significant impact of digital media in shaping and reinforcing democratic systems. In the digital age, digital media empowers the public by facilitating active participation in political discussions and decision-making processes, thereby enhancing transparency and accountability within political systems.

Exploratory Qualitative Focus Group Analysis of School-based Health Center Policy Issues: Insights From State Leaders

School-based health centers (SBHCs) provide students with critical, cost-effective access to health care. The pandemic accelerated a shift in SBHC care delivery. From the viewpoint of SBHC state leadership, this study aimed to describe changes since the last national SBHC health policy survey in 2017 through the COVID-19 pandemic. Leaders from state offices funding SBHCs and of School-Based Health Alliance affiliates participated in semistructured virtual focus groups in early 2022. Qualitative researchers triangulated focus group data with open-ended survey questions and performed thematic content analysis. The results confirmed a priori themes of increased funding, challenges in alignment around the definition, standardization, and metrics of SBHCs, and pandemic-related changes. Emerging themes included: (1) increased mental health services, (2) a shift toward telehealth and increased access delivery models, and (3) workforce challenges. These themes drive further exploration to sustain positive change, overcome challenges, and guide future quantitative SBHC policy analysis.

Statistical learning and big data applications

Abstract The amount of data generated in the field of laboratory medicine has grown to an extent that conventional laboratory information systems (LISs) are struggling to manage and analyze this complex, entangled information (“Big Data”). Statistical learning, a generalized framework from machine learning (ML) and artificial intelligence (AI) is predestined for processing “Big Data” and holds the potential to revolutionize the field of laboratory medicine. Personalized medicine may in particular benefit from AI-based systems, especially when coupled with readily available wearables and smartphones which can collect health data from individual patients and offer new, cost-effective access routes to healthcare for patients worldwide. The amount of personal data collected, however, also raises concerns about patient-privacy and calls for clear ethical guidelines for “Big Data” research, including rigorous quality checks of data and algorithms to eliminate underlying bias and enable transparency. Likewise, novel federated privacy-preserving data processing approaches may reduce the need for centralized data storage. Generative AI-systems including large language models such as ChatGPT currently enter the stage to reshape clinical research, clinical decision-support systems, and healthcare delivery. In our opinion, AI-based systems have a tremendous potential to transform laboratory medicine, however, their opportunities should be weighed against the risks carefully. Despite all enthusiasm, we advocate for stringent added-value assessments, just as for any new drug or treatment. Human experts should carefully validate AI-based systems, including patient-privacy protection, to ensure quality, transparency, and public acceptance. In this opinion paper, data prerequisites, recent developments, chances, and limitations of statistical learning approaches are highlighted.

Spatial availability of federally qualified health centers and disparities in health services utilization in medically underserved areas

Federally qualified health centers (FQHCs) improve access to care for important health services (e.g., preventive care), particularly among marginalized and underserved communities. However, whether spatial availability of FQHCs influences care-seeking behavior for medically underserved residents is unclear. The objective of this study was to examine the relationships of present-day zip-code level availability of FQHCs, historic redlining, and health services utilization (i.e., at FQHCs and any health clinic/facility) in six large states. We further examined these associations by states, FQHC availability (i.e., 1, 2–4 and ≥5 FQHC sites per zip code) and geographic areas (i.e., urbanized vs. rural, redlined vs. non-redlined sections of urban areas). Using Poisson and multivariate regression models, we found that in medically underserved areas, having at least one FQHC site was associated with greater likelihood of patients seeking health services at FQHCs [rate ratio (RR) = 3.27, 95%CI: 2.27–4.70] than areas with no FQHCs available, varying across states (RRs = 1.12 to 6.33). Relationships were stronger in zip codes with ≥5 FQHC sites, small towns, metropolitan areas, and redlined sections of urban areas (HOLC D-grade vs. C-grade: RR = 1.24, 95%CI: 1.21–1.27). However, these relationships did not remain true for routine care visits at any health clinic or facility (β = −0.122; p = 0.008) or with worsening HOLC grades (β = −0.082; p = 0.750), potentially due to the contextual factors associated with FQHC locations. Findings suggest that efforts to expand FQHCs may be most impactful for medically underserved residents living in small towns, metropolitan areas and redlined sections of urban areas. Because FQHCs can provide high quality, culturally competent, cost-effective access to important primary care, behavioral health, and enabling services that uniquely benefit low-income and marginalized patient populations, particularly those who have been historically denied access to health care, improving availability of FQHCs may be an important mechanism for improving health care access and reducing subsequent inequities for these underserved groups.

The WALK HOP program: a French innovative multicentric home-based cardiac rehabilitation initiative

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Fonds pour l'innovation du système de santé (FISS) - France. Background Cardiac rehabilitation (CR) has demonstrated scientific benefits in terms of morbidity and mortality. In France, 2019 national data indicates that only 22,3% of coronary patients benefit from CR. The development of alternative programs to center-based cardiac rehabilitation (CBCR) must be considered as a public health priority and requires a reorganization of ambulatory care pathways. Purpose The objective of the "Walk Hop" program is to demonstrate that home-based cardiac tele-rehabilitation (HBCT) is a complementary and safe approach to CBCR, able to increase the proportion of patients benefiting from a rehabilitation program. Methods This feasibility study started begin of 2022. 3,200 coronary patients will be recruited in 8 participating cardiac rehabilitation centers (CRC). Total duration of the experiment is 42 months. The program is financially supported by the French authorities. The HBCT solution developed for the study is proposed to patients by the CRC cardiologist. A multidisciplinary platform consisting of a secure portal and an application allows bidirectional communication. Patients are equiped with a cycle ergometer and a validated heart rate monitor. The application presents aerobic and muscle strenghtening activities and therapeutic education and collects data from the sessions carried out, adherence to the program, symptoms and quality of life. Results By october 2022, 157 active patients have been included in the program with a large majority of men (86%). Mean age is 53,9 ± 9,0. Hypercholesterolemia is noted in 36,9% of the included patients, smoking in 31%, arterial hypertension in 30,6% and diabetes in 11,1%. Obesity/overweight affects 60% of the population. Mean time from angioplasty to initiation of the rehabilitation is 81 ± 90 days. Mean number of home rehabilitation sessions is 21 and a total of 3342 home sessions have been realized. No cardiovascular event or rehospitalization have been registered since the beginnng. Mean adherence to the prescribed sessions is 80 ± 20% and the mean power gain at the end of the program is 14,6 ± 9,9 %. 94% of the patients expressed satisfaction or high satisfaction at the end of the program. Conclusion(s) The Walk Hop program is evaluating the feasibility and acceptability of HBCT with remote monitoring and digital assistance by smartphone. The preliminary data are encouraging in view of the final expected impact: greater cost-effective access to rehabilitation programs by removing obstacles like distance or resumption of work. It is also expected that HBCT will provide an improvement in the long-term maintenance benefits.

Improving the lives of ethnically diverse family carers and people living with dementia using digital media resources - Protocol for the Draw-Care randomised controlled trial.

Ethnically diverse family carers of people living with dementia (hereafter carers and people with dementia) experience more psychological distress than other carers. To reduce this inequality, culturally adapted, multilingual, evidence-based practical assistance is needed. This paper details the Draw-Care study protocol including a randomised control trial (RCT) to test the effectiveness of a digital intervention comprising a multilingual website, virtual assistant, animated films, and information, on the lives of carers and people with dementia in Australia. The Draw-Care intervention will be evaluated in a 12-week active waitlist parallel design RCT with 194 carers from Arabic, Cantonese, Greek, Hindi, Italian, Mandarin, Spanish, Tamil, and Vietnamese-speaking language groups. Our intervention was based on the World Health Organization's (WHO) iSupport Lite online carer support messages and was co-designed with carers, people with dementia, service providers, and clinicians. Culturally adapted multilingual digital resources were created in nine languages and English. In Phase I (2022), six co-design workshops with stakeholders and interviews with people with dementia informed the development of the intervention which will be trialled and evaluated in Phases II and III (2023 and 2024). Digital media content is a novel approach to providing cost-effective access to health care information. This study protocol details the three study phases including the RCT of a co-designed, culturally adapted, multilingual, digital intervention for carers and people with dementia to advance the evidence in dementia and digital healthcare research and help meet the needs of carers and people with dementia in Australia and globally.

Biocatalytic Approaches to Building Blocks for Enzymatic and Chemical Glycan Synthesis.

While the field of biocatalysis has bloomed over the past 20-30 years, advances in the understanding and improvement of carbohydrate-active enzymes, in particular, the sugar nucleotides involved in glycan building block biosynthesis, have progressed relatively more slowly. This perspective highlights the need for further insight into substrate promiscuity and the use of biocatalysis fundamentals (rational design, directed evolution, immobilization) to expand substrate scopes toward such carbohydrate building block syntheses and/or to improve enzyme stability, kinetics, or turnover. Further, it explores the growing premise of using biocatalysis to provide simple, cost-effective access to stereochemically defined carbohydrate materials, which can undergo late-stage chemical functionalization or automated glycan synthesis/polymerization.

Motivational Interviewing Conversational Agent for Parents as Proxies for Their Children in Healthy Eating: Development and User Testing.

BackgroundIncreased adoption of off-the-shelf conversational agents (CAs) brings opportunities to integrate therapeutic interventions. Motivational Interviewing (MI) can then be integrated with CAs for cost-effective access to it. MI can be especially beneficial for parents who often have low motivation because of limited time and resources to eat healthy together with their children.ObjectiveWe developed a Motivational Interviewing Conversational Agent (MICA) to improve healthy eating in parents who serve as a proxy for health behavior change in their children. Proxy relationships involve a person serving as a catalyst for behavior change in another person. Parents, serving as proxies, can bring about behavior change in their children.MethodsWe conducted user test sessions of the MICA prototype to understand the perceived acceptability and usefulness of the MICA prototype by parents. A total of 24 parents of young children participated in 2 user test sessions with MICA, approximately 2 weeks apart. After parents’ interaction with the MICA prototype in each user test session, we used qualitative interviews to understand parents’ perceptions and suggestions for improvements in MICA.ResultsFindings showed participants’ perceived usefulness of MICAs for helping them self-reflect and motivating them to adopt healthier eating habits together with their children. Participants further suggested various ways in which MICA can help them safely manage their children’s eating behaviors and provide customized support for their proxy needs and goals.ConclusionsWe have discussed how the user experience of CAs can be improved to uniquely offer support to parents who serve as proxies in changing the behavior of their children. We have concluded with implications for a larger context of designing MI-based CAs for supporting proxy relationships for health behavior change.

Connecting real-world digital mobility assessment to clinical outcomes for regulatory and clinical endorsement-the Mobilise-D study protocol.

BackgroundThe development of optimal strategies to treat impaired mobility related to ageing and chronic disease requires better ways to detect and measure it. Digital health technology, including body worn sensors, has the potential to directly and accurately capture real-world mobility. Mobilise-D consists of 34 partners from 13 countries who are working together to jointly develop and implement a digital mobility assessment solution to demonstrate that real-world digital mobility outcomes have the potential to provide a better, safer, and quicker way to assess, monitor, and predict the efficacy of new interventions on impaired mobility. The overarching objective of the study is to establish the clinical validity of digital outcomes in patient populations impacted by mobility challenges, and to support engagement with regulatory and health technology agencies towards acceptance of digital mobility assessment in regulatory and health technology assessment decisions.Methods/designThe Mobilise-D clinical validation study is a longitudinal observational cohort study that will recruit 2400 participants from four clinical cohorts. The populations of the Innovative Medicine Initiative-Joint Undertaking represent neurodegenerative conditions (Parkinson’s Disease), respiratory disease (Chronic Obstructive Pulmonary Disease), neuro-inflammatory disorder (Multiple Sclerosis), fall-related injuries, osteoporosis, sarcopenia, and frailty (Proximal Femoral Fracture). In total, 17 clinical sites in ten countries will recruit participants who will be evaluated every six months over a period of two years. A wide range of core and cohort specific outcome measures will be collected, spanning patient-reported, observer-reported, and clinician-reported outcomes as well as performance-based outcomes (physical measures and cognitive/mental measures). Daily-living mobility and physical capacity will be assessed directly using a wearable device. These four clinical cohorts were chosen to obtain generalizable clinical findings, including diverse clinical, cultural, geographical, and age representation. The disease cohorts include a broad and heterogeneous range of subject characteristics with varying chronic care needs, and represent different trajectories of mobility disability.DiscussionThe results of Mobilise-D will provide longitudinal data on the use of digital mobility outcomes to identify, stratify, and monitor disability. This will support the development of widespread, cost-effective access to optimal clinical mobility management through personalised healthcare. Further, Mobilise-D will provide evidence-based, direct measures which can be endorsed by regulatory agencies and health technology assessment bodies to quantify the impact of disease-modifying interventions on mobility.Trial registrationISRCTN12051706.

Striped hyaena den site selection in Nilgiri Biosphere Reserve, India

AbstractThe den is a multi-purpose critical space of carnivores and provides a growth conducive refuge which ensures both substances and protection from interspecific predation and harsh climate. Selection of optimal den sites determined by various site-specific factors potentially reduces aversive interspecific interactions and provides cost-effective access to food sources. In this study, we have assessed the factors determining the den site selection by a small population of striped hyaena,Hyaena hyaenain a shared landscape dominated by large carnivores. We assessed den site selection as a function of vegetation patch characteristics, site-specific anthropogenic threats/activities and topographical variables using Bayesian algorithm through field collected binomial data on den use by the species. Our model suggested that hyaenas select rocky refugia surrounded by trees and tall grasses, situated on mountain slopes proximate to a water body. Our study consolidated the importance of undulating terrain in the species ecology and postulated the slope as an ‘energy-expensive’ terrain that refrains frequent movement of other carnivores, in turn providing more affordable denning space for the striped hyaena. This study provides critical information on denning ecology of last remaining major breeding population striped hyaena of southern India.

Canada’s oil sands in a carbon-constrained world

ABSTRACT The oil sands have dominated Canada’s domestic energy conversations for most of the last 50 years. More recently, the resource has become an important factor in Canada’s foreign relations, in particular with respect to Canada’s commitments on climate change. Environmental concerns are not new to the oil sands, with endangered species impacts and tailings pond mitigation presenting pressing domestic concerns. This paper argues that climate change presents a unique challenge, even as prices for oil rise dramatically. Domestic action threatens to increase the cost of production and to erode cost-effective access to markets, and policy uncertainty has made investments more challenging. More importantly, global action will change the market for oil itself and shape the willingness of investors to commit to the oil sands. This paper examines the state of the oil sands industry in the context of Canadian and global commitments to action on climate change and the potential for a global energy transition. The paper concludes with a discussion of potential solutions and pitfalls for Canada’s oil sands in a carbon-constrained world.

A review of telehealth during the COVID-19 emergency situation in the public health sector: challenges and opportunities

PurposeThe purpose of this study is to provide current state of knowledge on how the COVID-19 emergency situation necessitated the behaviour influencing use and acceptance of telehealth. This study interlinks the health belief model (HBM) and the unified theory of acceptance and use of technology (UTAUT) to highlight the challenges and opportunities as a result of the COVID-19 pandemic in the public health sector.Design/methodology/approachThis study used three online databases (Emerald publishing, Science Direct and Taylor and Francis) that enabled the authors to access electronic journal articles. Search strategy was used to extract articles based on the relevance of this study.FindingsThe key findings from this study suggested that the COVID-19 emergency forced health-care workers and their patients to rapidly use and rely on telehealth to reduce the rate of COVID-19 transmissions. The key benefits of telehealth use highlighted an expansive cost effective and convenient access to health-care services irrespective of geographical local and levels of physical impairment. Moreover, telehealth inhibited in person human interaction, which was perceived as impersonal and not ideal for new patient consultations. The barriers outweighed the benefits; as a result, it is unlikely that there will be a wide use of telehealth beyond the COVID-19 emergency situation.Practical implicationsThe research findings are limited to discussions drawn from available secondary data. The criteria within telehealth for policymakers to note the technology acceptance and use for both health-care and outpatient stakeholders and their health seeking behaviour. Health-care sectors (private and public) and government need to understand enablers of effective telehealth in policymaking to ease the barriers during an emergency situation like a pandemic.Originality/valueThis study contributes to the emerging literature on how COVID-19 pandemic has disrupted and accelerated telehealth by extending both the UTAUT and HBM theories. This study is expected to contribute and expand literature on telehealth during emergency situations, given the novice nature of COVID-19 and limited literature surrounding it.

Peracetic acid activation by mechanochemically sulfidated zero valent iron for micropollutants degradation: Enhancement mechanism and strategy for extending applicability

In this study, mechanically sulfidated microscale zero valent iron (S-ZVI) was found to effectively activate the peracetic acid (PAA) with a result of almost complete degradation of six micropollutants within 10 min under neutral conditions, and > 95% sulfamethoxazole (SMX) removal after six cycles. Reactive oxidized species (ROS) including HO•, carbon-centered radicals, and Fe(IV) were generated in the S-ZVI/PAA system, while HO• was the main contributor towards micropollutants degradation. This study clearly revealed that enhancement of the electron donating ability of ZVI by the formed conductive iron sulfides was crucial for promoted Fe(II) generation and subsequent PAA activation over several cycles, rather than the ability of sulfides to reduce Fe(III) for Fe(II) regeneration as reported previously. Interestingly, it's discovered that co-existence of Fe(III) would dramatically improve the contaminants removal efficiency of the S-ZVI/PAA system; transform the surfaced Fe(II) dominated ROS generation process to aqueous Fe(II) one; enhance the tolerance of the proposed system to water matrix. The promoting effect of predosed Fe(III) on PAA activation by S-ZVI should be mainly associated with: the greater ability of Fe(III) than H2O to accept electron from Fe0 for obtaining more active sites; slower Fe0 consumption and solid sulfur species release for elevated electron utilization efficiency and PAA activation. Considering the convenient and cost-effective access of Fe(III), the decrease of acute toxicity of treated SMX, excellent stability and good removal of various micropollutants fully demonstrate the superiority of S-ZVI/PAA system for practical application.

Reducing future climate impact on rural transport infrastructure in developing countries; the role of engineering geology

Hard-won development gains are under real threat due to climate change impacts on rural transport infrastructure (RTI) and it is a major challenge, within normally available budgets, to ensure that rural access is made sustainably climate resilient. The ability of engineers and engineering geologists to identify problems and to devise solutions that provide sustainable cost-effective access for the rural poor is a key factor in overarching aims of poverty reduction and socio-economic development in lower and middle-income countries (LMICs). Engineering geology, through its inherent wide-ranging and inclusive approach to earth science, has an important role to play in providing a holistic and cross-sectorial framework to meet this challenge in a sustainable manner. This paper firstly emphasizes the importance of RTI, then outlines the climate change risks to RTI and hence to socio-economic development in LMICs. The paper then describes the key contribution that engineering geology can make to combatting this challenge through cost-effective climate-strengthening measures aided by the practical application of sound earth-science principles in a budget-constrained environment. Illustrative examples are taken from recent and ongoing LMIC projects funded by the UKAID Department for International Development, the Word Bank, the Asian Development Bank and Kreditanstaltfür Wiederaufbau – the German Development Bank. Thematic collection: This article is part of the Climate change and resilience in Engineering Geology and Hydrogeology collection available at: https://www.lyellcollection.org/cc/climate-change-and-resilience-in-engineering-geology-and-hydrogeology