Investigating Growth-Energy-Emissions Trilemma in South Asia

This paper situates the 2030 United Nations Sustainable Development Goals (SDGs) 7, 8, and 13 to investigate the growth-energy-emissions trilemma. It uniquely contributes to the discourse by using carbon emissions per capita (emissions), GDP per capita (economic growth), energy use per capita (nonrenewable energy) and renewable energy from seven South Asian countries covering 1990 to 2019 to determine the effect of economic growth and energy use on emissions and if its interaction with either energy variant enhances or dims the effect of energy on emissions. Consistent findings from panel-corrected standard errors (PCSE), feasible generalized least squares (FGLS) and bootstrapping ordinary least squares (BOLS) reveal that: (1) Economic growth intensifies emissions, (2) renewable energy exhibit emissions-reducing properties; (3) nonrenewable energy intensifies emissions, (4) economic growth sustains the emissions-reducing impact of renewable energy; and (5) economic growth diminishes the harmful effect of nonrenewable energy. Given these, we submit that the interaction of economic growth enables the “good” effect of renewable energy. At the same time, it reduces the “bad” effect nonrenewable energy on carbon emissions. These outcomes engender a new line of argument that the extent of economic growth cuts carbon emissions level. Therefore, economic growth is an essential determinant of carbon emissions. Policy implications discussed

Addressing Implicit Bias to Improve the Engagement and Retention Rate of the Under-Represented Minorities in Substance Use Treatment.

Abstract Background: Racial and ethnic minorities\u27 care for substance use disorder is negatively affected by biases, prejudices, and stereotypes in healthcare. This has created a general mistrust of the healthcare system and has constituted a barrier preventing minority patients from seeking care. Implicit biases are harmful, and this project aimed to bring awareness to this issue through educational activities to empower nurses in recognizing the problem. Methods: Twelve nurse-care managers in an outpatient addictions treatment clinic volunteered to participate in an educational session on implicit bias and its impact on the healthcare environment. The training involved an interactive presentation utilizing an implicit bias test and case studies to guide the discussion. In addition, pre and post presentation surveys were used to determine the impact of the training on the perceptions, opinions, and attitudes of the project participants. Results: Despite most of the project participants stating that they did not have implicit biases, six agreed that awareness of biases could help improve healthcare outcomes for underrepresented minorities. Only one strongly disagreed that awareness of implicit biases could improve outcomes for patients from underrepresented minorities. Conclusion: There was a lack of awareness of implicit biases among participants, indicating the need to implement evidence-based practices to provide culturally appropriate care and services to diverse patients. Also, more education is needed in healthcare workplaces to make the care providers understand how implicit bias affects the health outcomes of marginalized groups

Examining the influence of ICT innovation in the finance-tourism nexus in Asia

This study adds a new perspective to the finance-tourism relation by examining the role of information and communication technology (ICT) in the dynamics. We interrogate the discourse with data on 44 Asian economies from 2010-2019. The approach entails the use of tourism receipts, domestic credit to the private sector, four ICT indicators (mobile phone subscriptions, fixed telephone subscription, fixed broadband subscription and secured Internet servers). For the most part, the results reveal that (1) finance and ICT independently boost tourism; (2) the interaction effect is negative, (3) negative interaction not sufficient to erase the enhancing-properties of finance on tourism; (4) positive net impact of finance; and (5) results are heterogeneous across the sub-samples. Our findings strengthen the argument for financial technology (FinTech) and calls for stronger integration of the financial system with ICT innovation in order to fully harness the potentials and gains from tourism

Improving access to breast cancer screening and treatment in Nigeria: The triple mobile assessment and patient navigation model (NCT05321823): A study protocol.

BackgroundIn Nigeria, breast cancer incidence is rising, late presentation is common, and outcomes are poor. Patient-related factors such as lack of awareness and misperceptions in addition to health system deficiencies such as lack of a clearly defined framework for breast cancer screening and referral are some of the major drivers of this poor outlook. Guidelines for breast cancer screening in high-income countries have limited applicability in low-middle-income countries, hence the need for innovative, resource-compatible strategies to combat the negative trend. This manuscript presents our study protocol which aims to evaluate the impact of a novel breast cancer early detection program developed to address delayed presentation and lack of access to diagnostic and treatment facilities in South-West Nigeria. This entails the use of mobile technology (innovative handheld iBreast Exam [iBE] device, mobile breast ultrasound, and mobile mammography) and patient navigation as interventions at the community level.MethodsThe study (ClinicalTrials.gov identifier: NCT05321823) will adopt a randomized two group clinical trial design with one local government area (LGA) serving as an intervention arm and another serving as the control. Both LGAs will receive breast cancer awareness education but only one will receive the interventions. In the intervention arm, asymptomatic (40-70 years) and symptomatic (30-70 years) women will be invited for breast evaluation which will be performed by trained Community Health Nurses using Clinical Breast Exam (CBE), and iBE. Those with positive findings will proceed to imaging using mobile mammography and ultrasound brought to the LGA every month. Symptomatic women with negative findings on CBE and iBE will be scheduled for repeat clinical evaluation on a short-term basis (one month). The Radiologist will obtain core needle biopsies as indicated and transfer them for prompt pathological assessment. Women presenting to the Primary Healthcare Centers in the control LGA will be referred directly to Obafemi Awolowo University Teaching Hospitals Complex as per the current standard of care. Records of all breast cancer cases seen in the two LGAs during the study period will be obtained. The program metrics will include screening participation rate, cancer detection rate, stage at diagnosis, and timeline from detection to initiation of treatment. The stage at diagnosis and timeline from detection to treatment compared between the two LGAs will be used to assess the impact of the intervention. The study is proposed for 2 years; however, a descriptive analysis will be carried out at 1.5 years to evaluate the retention of the study participants.Study significanceIt is anticipated that this study will provide vital data to support wider breast cancer screening efforts in Nigeria

Adaptation of the Wound Healing Questionnaire universal-reporter outcome measure for use in global surgery trials (TALON-1 study): mixed-methods study and Rasch analysis

BackgroundThe Bluebelle Wound Healing Questionnaire (WHQ) is a universal-reporter outcome measure developed in the UK for remote detection of surgical-site infection after abdominal surgery. This study aimed to explore cross-cultural equivalence, acceptability, and content validity of the WHQ for use across low- and middle-income countries, and to make recommendations for its adaptation.MethodsThis was a mixed-methods study within a trial (SWAT) embedded in an international randomized trial, conducted according to best practice guidelines, and co-produced with community and patient partners (TALON-1). Structured interviews and focus groups were used to gather data regarding cross-cultural, cross-contextual equivalence of the individual items and scale, and conduct a translatability assessment. Translation was completed into five languages in accordance with Mapi recommendations. Next, data from a prospective cohort (SWAT) were interpreted using Rasch analysis to explore scaling and measurement properties of the WHQ. Finally, qualitative and quantitative data were triangulated using a modified, exploratory, instrumental design model.ResultsIn the qualitative phase, 10 structured interviews and six focus groups took place with a total of 47 investigators across six countries. Themes related to comprehension, response mapping, retrieval, and judgement were identified with rich cross-cultural insights. In the quantitative phase, an exploratory Rasch model was fitted to data from 537 patients (369 excluding extremes). Owing to the number of extreme (floor) values, the overall level of power was low. The single WHQ scale satisfied tests of unidimensionality, indicating validity of the ordinal total WHQ score. There was significant overall model misfit of five items (5, 9, 14, 15, 16) and local dependency in 11 item pairs. The person separation index was estimated as 0.48 suggesting weak discrimination between classes, whereas Cronbach's α was high at 0.86. Triangulation of qualitative data with the Rasch analysis supported recommendations for cross-cultural adaptation of the WHQ items 1 (redness), 3 (clear fluid), 7 (deep wound opening), 10 (pain), 11 (fever), 15 (antibiotics), 16 (debridement), 18 (drainage), and 19 (reoperation). Changes to three item response categories (1, not at all; 2, a little; 3, a lot) were adopted for symptom items 1 to 10, and two categories (0, no; 1, yes) for item 11 (fever).ConclusionThis study made recommendations for cross-cultural adaptation of the WHQ for use in global surgical research and practice, using co-produced mixed-methods data from three continents. Translations are now available for implementation into remote wound assessment pathways

SARS-CoV-2 vaccination modelling for safe surgery to save lives: data from an international prospective cohort study

Background: Preoperative SARS-CoV-2 vaccination could support safer elective surgery. Vaccine numbers are limited so this study aimed to inform their prioritization by modelling. Methods: The primary outcome was the number needed to vaccinate (NNV) to prevent one COVID-19-related death in 1 year. NNVs were based on postoperative SARS-CoV-2 rates and mortality in an international cohort study (surgical patients), and community SARS-CoV-2 incidence and case fatality data (general population). NNV estimates were stratified by age (18-49, 50-69, 70 or more years) and type of surgery. Best- and worst-case scenarios were used to describe uncertainty. Results: NNVs were more favourable in surgical patients than the general population. The most favourable NNVs were in patients aged 70 years or more needing cancer surgery (351; best case 196, worst case 816) or non-cancer surgery (733; best case 407, worst case 1664). Both exceeded the NNV in the general population (1840; best case 1196, worst case 3066). NNVs for surgical patients remained favourable at a range of SARS-CoV-2 incidence rates in sensitivity analysis modelling. Globally, prioritizing preoperative vaccination of patients needing elective surgery ahead of the general population could prevent an additional 58 687 (best case 115 007, worst case 20 177) COVID-19-related deaths in 1 year. Conclusion: As global roll out of SARS-CoV-2 vaccination proceeds, patients needing elective surgery should be prioritized ahead of the general population