Siblings of Direct Sums of Chains

We prove that a countable direct sum of chains has either one, countably many or else continuum many isomorphism classes of siblings. This proves Thomass\'e's conjecture for such structures. Further, we show that a direct sum of chains of any cardinality has one or infinitely many siblings, up to isomorphism.Comment: 15 page

Decontamination of Red Pepper Using Cold Atmospheric Pressure Plasma as Alternative Technique

Background and objective: Non-thermal methods are suggested for decontamination of spices to preserve safety and quality of the products. In this study, effects of atmospheric pressure floating-electrode dielectric-barrier discharge plasma were investigated on red pepper powder, compared to gamma irradiation.Material and methods: To achieve the optimum time of treatment for decontamination, Escherichia coli, Bacillus cereus and Aspergillus flavus as microorganisms in red pepper were exposed to atmospheric pressure floating-electrode dielectric-barrier discharge plasma for 10, 20 and 30 min and the structural changes in microorganisms were investigated using scanning electron microscopy and DNA measurement following exposure. The red pepper was exposed to plasma for 20 min (optimum time) and 10 KGy gamma irradiation. Microbial count, color measurement and sensory evaluation of the samples were assessed before and after treatments.Results and conclusion: Results indicated that the density of surviving bacterial strains decreased when time of exposure increased and this decrease was significant after 10 min (P≤0.05). The complete decontamination was carried out within 20 min. The deformation of cells and destruction of cell wall structures were seen in bacteria and mold following exposure. Data revealed that cold floating-electrode dielectric-barrier discharge plasma for 20 min inactivated red pepper microorganisms as well as gamma irradiation. As a conclusion, floating-electrode dielectric-barrier discharge plasma is an appropriate method to decontaminate the red pepper powder (regardless of color change) and can replace traditional methods without changes in the product quality and taste.Conflict of interest: The authors declare no conflict of interest

Measuring universal health coverage based on an index of effective coverage of health services in 204 countries and territories, 1990–2019 : A systematic analysis for the Global Burden of Disease Study 2019

Background Achieving universal health coverage (UHC) involves all people receiving the health services they need, of high quality, without experiencing financial hardship. Making progress towards UHC is a policy priority for both countries and global institutions, as highlighted by the agenda of the UN Sustainable Development Goals (SDGs) and WHO's Thirteenth General Programme of Work (GPW13). Measuring effective coverage at the health-system level is important for understanding whether health services are aligned with countries' health profiles and are of sufficient quality to produce health gains for populations of all ages. Methods Based on the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, we assessed UHC effective coverage for 204 countries and territories from 1990 to 2019. Drawing from a measurement framework developed through WHO's GPW13 consultation, we mapped 23 effective coverage indicators to a matrix representing health service types (eg, promotion, prevention, and treatment) and five population-age groups spanning from reproductive and newborn to older adults (≥65 years). Effective coverage indicators were based on intervention coverage or outcome-based measures such as mortality-to-incidence ratios to approximate access to quality care; outcome-based measures were transformed to values on a scale of 0–100 based on the 2·5th and 97·5th percentile of location-year values. We constructed the UHC effective coverage index by weighting each effective coverage indicator relative to its associated potential health gains, as measured by disability-adjusted life-years for each location-year and population-age group. For three tests of validity (content, known-groups, and convergent), UHC effective coverage index performance was generally better than that of other UHC service coverage indices from WHO (ie, the current metric for SDG indicator 3.8.1 on UHC service coverage), the World Bank, and GBD 2017. We quantified frontiers of UHC effective coverage performance on the basis of pooled health spending per capita, representing UHC effective coverage index levels achieved in 2019 relative to country-level government health spending, prepaid private expenditures, and development assistance for health. To assess current trajectories towards the GPW13 UHC billion target—1 billion more people benefiting from UHC by 2023—we estimated additional population equivalents with UHC effective coverage from 2018 to 2023. Findings Globally, performance on the UHC effective coverage index improved from 45·8 (95% uncertainty interval 44·2–47·5) in 1990 to 60·3 (58·7–61·9) in 2019, yet country-level UHC effective coverage in 2019 still spanned from 95 or higher in Japan and Iceland to lower than 25 in Somalia and the Central African Republic. Since 2010, sub-Saharan Africa showed accelerated gains on the UHC effective coverage index (at an average increase of 2·6% [1·9–3·3] per year up to 2019); by contrast, most other GBD super-regions had slowed rates of progress in 2010–2019 relative to 1990–2010. Many countries showed lagging performance on effective coverage indicators for non-communicable diseases relative to those for communicable diseases and maternal and child health, despite non-communicable diseases accounting for a greater proportion of potential health gains in 2019, suggesting that many health systems are not keeping pace with the rising non-communicable disease burden and associated population health needs. In 2019, the UHC effective coverage index was associated with pooled health spending per capita (r=0·79), although countries across the development spectrum had much lower UHC effective coverage than is potentially achievable relative to their health spending. Under maximum efficiency of translating health spending into UHC effective coverage performance, countries would need to reach $1398 pooled health spending per capita (US$ adjusted for purchasing power parity) in order to achieve 80 on the UHC effective coverage index. From 2018 to 2023, an estimated 388·9 million (358·6–421·3) more population equivalents would have UHC effective coverage, falling well short of the GPW13 target of 1 billion more people benefiting from UHC during this time. Current projections point to an estimated 3·1 billion (3·0–3·2) population equivalents still lacking UHC effective coverage in 2023, with nearly a third (968·1 million [903·5–1040·3]) residing in south Asia. Interpretation The present study demonstrates the utility of measuring effective coverage and its role in supporting improved health outcomes for all people—the ultimate goal of UHC and its achievement. Global ambitions to accelerate progress on UHC service coverage are increasingly unlikely unless concerted action on non-communicable diseases occurs and countries can better translate health spending into improved performance. Focusing on effective coverage and accounting for the world's evolving health needs lays the groundwork for better understanding how close—or how far—all populations are in benefiting from UHC

Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

Background: In an era of shifting global agendas and expanded emphasis on non-communicable diseases and injuries along with communicable diseases, sound evidence on trends by cause at the national level is essential. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) provides a systematic scientific assessment of published, publicly available, and contributed data on incidence, prevalence, and mortality for a mutually exclusive and collectively exhaustive list of diseases and injuries. Methods: GBD estimates incidence, prevalence, mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) due to 369 diseases and injuries, for two sexes, and for 204 countries and territories. Input data were extracted from censuses, household surveys, civil registration and vital statistics, disease registries, health service use, air pollution monitors, satellite imaging, disease notifications, and other sources. Cause-specific death rates and cause fractions were calculated using the Cause of Death Ensemble model and spatiotemporal Gaussian process regression. Cause-specific deaths were adjusted to match the total all-cause deaths calculated as part of the GBD population, fertility, and mortality estimates. Deaths were multiplied by standard life expectancy at each age to calculate YLLs. A Bayesian meta-regression modelling tool, DisMod-MR 2.1, was used to ensure consistency between incidence, prevalence, remission, excess mortality, and cause-specific mortality for most causes. Prevalence estimates were multiplied by disability weights for mutually exclusive sequelae of diseases and injuries to calculate YLDs. We considered results in the context of the Socio-demographic Index (SDI), a composite indicator of income per capita, years of schooling, and fertility rate in females younger than 25 years. Uncertainty intervals (UIs) were generated for every metric using the 25th and 975th ordered 1000 draw values of the posterior distribution. Findings: Global health has steadily improved over the past 30 years as measured by age-standardised DALY rates. After taking into account population growth and ageing, the absolute number of DALYs has remained stable. Since 2010, the pace of decline in global age-standardised DALY rates has accelerated in age groups younger than 50 years compared with the 1990–2010 time period, with the greatest annualised rate of decline occurring in the 0–9-year age group. Six infectious diseases were among the top ten causes of DALYs in children younger than 10 years in 2019: lower respiratory infections (ranked second), diarrhoeal diseases (third), malaria (fifth), meningitis (sixth), whooping cough (ninth), and sexually transmitted infections (which, in this age group, is fully accounted for by congenital syphilis; ranked tenth). In adolescents aged 10–24 years, three injury causes were among the top causes of DALYs: road injuries (ranked first), self-harm (third), and interpersonal violence (fifth). Five of the causes that were in the top ten for ages 10–24 years were also in the top ten in the 25–49-year age group: road injuries (ranked first), HIV/AIDS (second), low back pain (fourth), headache disorders (fifth), and depressive disorders (sixth). In 2019, ischaemic heart disease and stroke were the top-ranked causes of DALYs in both the 50–74-year and 75-years-and-older age groups. Since 1990, there has been a marked shift towards a greater proportion of burden due to YLDs from non-communicable diseases and injuries. In 2019, there were 11 countries where non-communicable disease and injury YLDs constituted more than half of all disease burden. Decreases in age-standardised DALY rates have accelerated over the past decade in countries at the lower end of the SDI range, while improvements have started to stagnate or even reverse in countries with higher SDI. Interpretation: As disability becomes an increasingly large component of disease burden and a larger component of health expenditure, greater research and developm nt investment is needed to identify new, more effective intervention strategies. With a rapidly ageing global population, the demands on health services to deal with disabling outcomes, which increase with age, will require policy makers to anticipate these changes. The mix of universal and more geographically specific influences on health reinforces the need for regular reporting on population health in detail and by underlying cause to help decision makers to identify success stories of disease control to emulate, as well as opportunities to improve. Funding: Bill & Melinda Gates Foundation. © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licens

Measuring universal health coverage based on an index of effective coverage of health services in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

Background Achieving universal health coverage (UHC) involves all people receiving the health services they need, of high quality, without experiencing financial hardship. Making progress towards UHC is a policy priority for both countries and global institutions, as highlighted by the agenda of the UN Sustainable Development Goals (SDGs) and WHO's Thirteenth General Programme of Work (GPW13). Measuring effective coverage at the health-system level is important for understanding whether health services are aligned with countries' health profiles and are of sufficient quality to produce health gains for populations of all ages. Methods Based on the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, we assessed UHC effective coverage for 204 countries and territories from 1990 to 2019. Drawing from a measurement framework developed through WHO's GPW13 consultation, we mapped 23 effective coverage indicators to a matrix representing health service types (eg, promotion, prevention, and treatment) and five population-age groups spanning from reproductive and newborn to older adults (≥65 years). Effective coverage indicators were based on intervention coverage or outcome-based measures such as mortality-to-incidence ratios to approximate access to quality care; outcome-based measures were transformed to values on a scale of 0–100 based on the 2·5th and 97·5th percentile of location-year values. We constructed the UHC effective coverage index by weighting each effective coverage indicator relative to its associated potential health gains, as measured by disability-adjusted life-years for each location-year and population-age group. For three tests of validity (content, known-groups, and convergent), UHC effective coverage index performance was generally better than that of other UHC service coverage indices from WHO (ie, the current metric for SDG indicator 3.8.1 on UHC service coverage), the World Bank, and GBD 2017. We quantified frontiers of UHC effective coverage performance on the basis of pooled health spending per capita, representing UHC effective coverage index levels achieved in 2019 relative to country-level government health spending, prepaid private expenditures, and development assistance for health. To assess current trajectories towards the GPW13 UHC billion target—1 billion more people benefiting from UHC by 2023—we estimated additional population equivalents with UHC effective coverage from 2018 to 2023. Findings Globally, performance on the UHC effective coverage index improved from 45·8 (95% uncertainty interval 44·2–47·5) in 1990 to 60·3 (58·7–61·9) in 2019, yet country-level UHC effective coverage in 2019 still spanned from 95 or higher in Japan and Iceland to lower than 25 in Somalia and the Central African Republic. Since 2010, sub-Saharan Africa showed accelerated gains on the UHC effective coverage index (at an average increase of 2·6% [1·9–3·3] per year up to 2019); by contrast, most other GBD super-regions had slowed rates of progress in 2010–2019 relative to 1990–2010. Many countries showed lagging performance on effective coverage indicators for non-communicable diseases relative to those for communicable diseases and maternal and child health, despite non-communicable diseases accounting for a greater proportion of potential health gains in 2019, suggesting that many health systems are not keeping pace with the rising non-communicable disease burden and associated population health needs. In 2019, the UHC effective coverage index was associated with pooled health spending per capita (r=0·79), although countries across the development spectrum had much lower UHC effective coverage than is potentially achievable relative to their health spending. Under maximum efficiency of translating health spending into UHC effective coverage performance, countries would need to reach $1398 pooled health spending per capita (US$ adjusted for purchasing power parity) in order to achieve 80 on the UHC effective coverage index. From 2018 to 2023, an estimated 388·9 million (358·6–421·3) more population equivalents would have UHC effective coverage, falling well short of the GPW13 target of 1 billion more people benefiting from UHC during this time. Current projections point to an estimated 3·1 billion (3·0–3·2) population equivalents still lacking UHC effective coverage in 2023, with nearly a third (968·1 million [903·5–1040·3]) residing in south Asia. Interpretation The present study demonstrates the utility of measuring effective coverage and its role in supporting improved health outcomes for all people—the ultimate goal of UHC and its achievement. Global ambitions to accelerate progress on UHC service coverage are increasingly unlikely unless concerted action on non-communicable diseases occurs and countries can better translate health spending into improved performance. Focusing on effective coverage and accounting for the world's evolving health needs lays the groundwork for better understanding how close—or how far—all populations are in benefiting from UHC

Mapping local patterns of childhood overweight and wasting in low- and middle-income countries between 2000 and 2017

A double burden of malnutrition occurs when individuals, household members or communities experience both undernutrition and overweight. Here, we show geospatial estimates of overweight and wasting prevalence among children under 5 years of age in 105 low- and middle-income countries (LMICs) from 2000 to 2017 and aggregate these to policy-relevant administrative units. Wasting decreased overall across LMICs between 2000 and 2017, from 8.4% (62.3 (55.1–70.8) million) to 6.4% (58.3 (47.6–70.7) million), but is predicted to remain above the World Health Organization’s Global Nutrition Target of <5% in over half of LMICs by 2025. Prevalence of overweight increased from 5.2% (30 (22.8–38.5) million) in 2000 to 6.0% (55.5 (44.8–67.9) million) children aged under 5 years in 2017. Areas most affected by double burden of malnutrition were located in Indonesia, Thailand, southeastern China, Botswana, Cameroon and central Nigeria. Our estimates provide a new perspective to researchers, policy makers and public health agencies in their efforts to address this global childhood syndemic

Siblings of Binary Relations: The Case of Direct Sums of Chains, NE-Free Posets and Trees

Two structures are called siblings when they mutually embed in each other. This dissertation mainly discusses Thomasse's conjecture and its alternate form for some binary relations. Thomasse's conjecture states that a countable relation has either one, countably many or continuum many siblings, up to isomorphism and the alternate form says that a relation of any cardinality has one or infinitely many siblings, up to isomorphism. There is also a conjecture due to Bonato-Tardif stating that a tree has one or infinitely many siblings in the category of trees. For a tree which is not a sibling of the graph obtained by adding an isolated vertex to the tree, the Bonato-Tardif conjecture and the alternate Thomasse conjecture are equivalent. Abdi, Laflamme, Tateno, Woodrow verified the ideas of a counterexample to the Bonato-Tardif conjecture claimed by Tateno and they confirmed that the example also disproves Thomasse's conjecture. This is a major development in the program of understanding siblings of a given mathematical structure. The counterexample is not a subject of this dissertation, however, determining which structures exactly do satisfy the conjectures is of interest. Laflamme, Pouzet and Woodrow verified both Thomasse's conjecture and its alternate form for chains. Moreover, the alternate Thomasse conjecture was proved for countable cographs by Hahn, Pouzet and Woodrow. In order to tackle the conjectures towards posets, we verify both Thomasse's conjecture and its alternate version for direct sums of chains. We also show that the alternate Thomasse conjecture is true for countable NE-free posets which have strong connections to cographs. Moreover, making use of decomposition trees, we give a proof that each cograph is the comparability graph of some NE-free poset. In order to pose more restriction on trees related to the Bonato-Tardif conjecture, we give a positive answer to one of the open cases of a result due to Hamann. Tyomkyn conjectured that if a locally finite tree has a non-surjective embedding, then it has infinitely many siblings, unless the tree is a one-way infinite path. We prove that if a locally finite tree has a non-surjective embedding preserving precisely one end, then it has infinitely many siblings, unless the tree is a one-way infinite path. This establishes both conjectures of Bonato-Tardif and Tyomkyn for locally finite trees which do not have non-surjective embeddings preserving precisely two ends. Finally, we give a representation of trees obtained by a technique which is similar to the Cantor-Bendixson derivative of a topological space. This representation helps us to verify the Bonato-Tardif conjecture in some cases

Assessing the thermal comfort effects of green spaces: a systematic review of methods, parameters, and plants attributes

The expansion of urbanization leads to increases in urban populations and manmade constructions. Likewise, problems like changing local climates negatively affect urban heat islands and human outdoor thermal comfort. This paper is based on recent studies on the effects of green spaces and plants on the microclimate and thermal comfort of recent years. The topics studied included physical properties of plants, location and vegetation cover, planting densities and crown density, plant element, leaf type, planting patterns and arrangement, and Albedo. The results of the review revealed that several factors with effects on the cooling effect of plants have not received adequate attention in previous studies yet. These include the effects of patterns, arrangement of various plant species, different tree forms and shrubs, the distribution and connection of green space patches in the landscape, the direction of the planting rows in different wind conditions, among others. By the end of this review, suggestions could be made about what possible future studies could undertake to do by way of adopting more precise and comprehensive approaches to different characteristics of plants, different landscape patterns, and the effects of different arrangements of elements in terms of microclimate improvement

Explaining nutritional habits and behaviors of low socioeconomic status women in Sanandaj: a qualitative content analysis

Introduction: Health and behavior are closely related subjects because disease is typically rooted in individuals’ unhealthy behaviors and habits. This study aims to identify women’s nutritional habits and behaviors in order to design interventions to promote nutritional literacy. Methods: This qualitative research is part of a mixed method (quantitative-qualitative) study, conducted based on content analysis. Data were collected using semistructured interviews, group discussions, and in-depth interviews with married women, aged 18-50 years, who were referred to four health care centers in Sanandaj in 2013–2014. Results: Nutritional habits and behaviors of participants were classified into two categories: representation of nutritional behavior based on consumption pattern and representation of nutritional behavior based on consumption method. For the former, eight consumption pattern subcategories were formed: meat, dairy, fast food, local foods, fruits and vegetables, soft drinks, and oils. The latter (representation of nutritional behavior based on consumption method), included two subcategories: consumption method in line with health and consumption method inconsistent with health. Conclusion: Results of this qualitative study provide a solid foundation for development and designing interventions to nutritional literacy promotion based on needs. The designed intervention to healthy nutritional behavior should be based on empowering women and providing facilitator factors of a healthy diet. While designing this study, with a holistic perspective, individual and social aspects of a healthy diet should be taken into accoun

Early Jurassic Rifting of the Arabian Passive Continental Margin of the Neo-Tethys. Field Evidence From the Lurestan Region of the Zagros Fold-and-Thrust Belt, Iran

The Arabian passive margin formed at the southern margin of the Neo-Tethys ocean during the breakup of Pangea. In the Lurestan region of the Zagros mountain belt, the deformed Arabian continental paleo-margin can be reconstructed as originally consisting of distinct crustal domains, including a proximal sector and a distal continental ribbon, separated by a deep-water trough, known as the Radiolarite Basin. Such an architecture was shaped by the continental rifting process, thus reflecting timing and style of continent separation, which is generally assumed to have occurred during the Permo-Triassic interval. This study reports evidence of syn-sedimentary extensional faults, unconformities, and facies changes in the Mesozoic stratigraphic succession of the Lurestan region, which point to a major Jurassic extensional pulse. In detail, extension reached its climax at the end of the Early Jurassic, when tectonically driven drowning of the long-lived Triassic to Early Jurassic carbonate platform led to the transition from shallow- to deep-water environments in large areas of the inner margin, coevally with the development of the Radiolarite Basin. Our findings suggest a two-step continental rifting in this area, with the first Permo-Triassic phase predating an Early Jurassic one