Academic literature on the topic 'Low-risk activism'

This article presents a quantitative study of differential participation in low- and high-risk activism in the Danish refugee solidarity movement. Distinguishing between low- and high-risk activism, it shows the fruitfulness of combining what are often considered competing theoretical explanations related to (1) values, (2) microstructures, and (3) emotions. We analyze data from a unique survey of 1,856 respondents recruited via Facebook. The results show that low- and high-risk participation strongly correlate but are influenced by different factors. For low-risk activities, the most important factors are emotional reactions, structural availability, and predispositions in the form of basic human values. For high-risk activity, the important factors are prior history of activism and emotional reaction. Values, microstructures, and emotions interact in relation to participation in both kinds of activism, which points to promising avenues for integrating and developing the theoretical framework of differential participation and recruitment.

In this article, we describe the development and validation of a measure of orientation toward activism in and for the Black community—the Black Community Activism Orientation Scale (BCAOS)—in a sample of Black adolescents and emerging adults. An exploratory factor analysis ( n = 446) was conducted and the results were a 26-item measure with scores of three internally consistent factors: high-risk, low-risk, and formal political activism orientation. A confirmatory factor analysis was conducted ( n = 447) and strong model fit estimates confirmed the factor structure of the exploratory factor analysis. Convergent validity was established through bivariate correlations of the BCAOS factors with social responsibility beliefs and nationalist ideology. In light of increased participation in sociopolitical movements in support of Black lives, the BCAOS can contribute to investigations of the psychology of adolescent and emerging adult activism in and for the Black community. We recommend additional scale development research to further contribute to this growing field.

The prevalence of breast cancer in Venezuela is particularly alarming, which is attributed to healthcare inequalities, low health literacy, and lagging compliance with prevention methods (i.e., screening and mammography). While the right to health is acknowledged by the Venezuelan constitution, activism beyond governmental confines is required to increase women's breast cancer awareness and decrease mortality rates. Through the development of social support and strategic communicative methods enacted by healthcare providers, it may be possible to empower women with the tools necessary for breast cancer prevention. This paper discusses issues surrounding women's breast cancer, such as awareness of the disease and its risks, self-advocacy, and the roles of activists, healthcare providers, and society. Specifically, it describes a four-year action-oriented research project developed in Venezuela, which was a collaborative work among researchers, practitioners, NGOs, patients, journalists, and policymakers. The outcomes include higher levels of awareness and interest among community members and organizations to learn and seek more information about women's breast cancer, better understandings of the communicated messages, more media coverage and medical consultations, increasing positive patient treatments, expansion of networking of NGOs, as well as a widely supported declaration for a national response against breast cancer in Venezuela.

Personal reflections on radiation hormesis for the past 50 years are presented. The causes of ignoring and rejections of this phenomenon by international and national bodies and by radiation protection establishment are analyzed. The opposition against nuclear weapons and preparations for nuclear war was probably the main factor in inducing the concern for adverse effects of low doses of ionizing radiation, a byproduct of activism against the nuclear weapon tests. UNSCEAR was deeply involved in preparation of the scientific basis for cessation of nuclear test, and contributed to elaboration of the LNT assumption, which is in contradiction with the hormetic phenomenon. However, this authoritative body recognized also the existence of radiation hormesis, termed as ‘adaptive response.’ The political and vested interests behind exclusion of hormesis from the current risk assessment methodology are discussed.

Beginning with President Trump’s speech against the national anthem protestors in September 2017, the authors consider how external sociopolitical events interacted with the network structure of the 2017 National Football League (NFL) to alter the salience of member identities and the resultant patterns of protest activity within the league. Using group membership data on the full population of 2,453 football players, the analysis tracks protest participation by membership in race and status groups and by the network variables of degree, betweenness, and closeness centrality. Black and elite players are both overrepresented among protesters throughout the season. The margins of overrepresentation narrowed during an increase in demonstrations after Trump’s first criticisms but had widened by the end of the season. The mean centralities of the protesting groups varied from week to week because of an increase in the salience of the NFL player identity and its interaction with racial identities. In general, protesters had lower mean degree and closeness centralities and a higher mean betweenness centrality than players who abstained from protest. Those who participated in high-risk forms of activism also tended to have lower mean degree and closeness centralities and a higher mean betweenness centrality than those who opted for low-risk demonstrations. These findings indicate that sociopolitical events can implicate different identities, changing their salience in the decision to join or abstain from a social movement.

In socially responsible investment terms, Germany is a contradiction. The country is considered by many as one of the pioneers of post-war environmentalism and social reform. Yet, German financial institutions are amongst the European laggards in adopting environmentally and socially informed approaches to investment. This article identifies a variety of legal, institutional and attitudinal factors which hinder the growth of the German SRI market. Its paltry size does not reflect evidence of any specific disinterest among German investors in social and environmental issues. Rather, it arises from a combination of structural impediments, particularly the institutional arrangements for German pension schemes that hinder their participation in financial markets, regulations which encourage conservative investments, and investors' preference for low-risk assets and avoidance of shareholder activism. Legal and institutional reforms over the past decade have in theory created better opportunities for SRI in Germany, although they have yet to engender significant changes in the market.

Awareness of the risks posed by excess nitrogen is low beyond the scientific community. As public understanding of scientific issues is partly influenced by news reporting, this article is the first to study how the British press has discussed nitrogen pollution. A corpus-assisted frame analysis of newspaper articles (1984–2018) highlighted five frames: Activism, where environmental charities and organizations are portrayed as having an active role in fighting pollution; Government Responsibility, where privatization is presented as central and positioned as one of the main causes of pollution; Industry Responsibility, in which industries’ actions are depicted as causing pollution to increase; Pollutions as Politics, in which pollution is not discussed as a problem to be solved but rather as a means to increase votes; and Risk, where readers are warned about the possible effects of pollution on human health, flora and fauna. The analysis also points to the absence of named scientists and sources with the coverage being dominated by politicians.

A review of the scientific literature revealed a lack of information regarding the integrated daily activity levels of low-risk pregnant women in contemporary Western society. A prospective, longitudinal study was therefore undertaken to (i) assess the impact of low-risk pregnancy on the daily activity levels of healthy, British primigravid women and (ii) examine the relationship between total maternal daily activity level and pregnancy outcome. The best combination of methods to measure daily activity levels during pregnancy was considered to be a subjective self-report measure used in conjunction with an objective ambulatory activity monitor. These methods were developed and were demonstrated to be both reliable and valid in non-pregnant women. However, the study identified some unique problems in using activity monitors in pregnant women. These problems emanated both from women's reluctance to wear an activity monitor when pregnant and from a need to measure extremely low levels of activity in late gestation. Both data from the ambulatory monitor and the new activity questionnaire demonstrated a overall decrease in mean maternal daily activity levels between 25 & 38 weeks gestation (n=51; p<0.01). This decline masked different maternal responses in different activity domains. The mean occupational activity ratios of women working full-time declined steadily between 16 & 34 weeks gestation (n=25, p<0.01). Women's working hours and the more flexible elements of their work were reduced whilst the frequency of work breaks increased. Between 25 & 38 weeks gestation, mean recreational activity ratios also declined (n=50, p<0.05). Participation in structured sports and exercise ceased and increasing amounts of time were spent within the home. In contrast, mean overall domestic activity ratios were maintained. Between 16 & 38 weeks gestation mean nocturnal activity ratios increased steadily (n=47; p=0.01) To maintain waking activity during pregnancy, women actively engaged in a number of different balancing strategies. These strategies comprised monitoring, prioritising, pacing and forward planning. Despite the changes that occurred in maternal activity behaviour, one of the strongest and most consistent predictors of maternal activity behaviour during pregnancy was that of maternal activity behaviour prior to pregnancy. Occupational activity levels pre-pregnancy were independently associated with maternal daily activity levels at 12,16 & 25 weeks gestation (p=0.004-0.020). Self-efficacy was the only significant predictor of the change in maternal daily activity levels between 25 & 38 weeks gestation (p=0.013). The women who reduced their activity the most were likely to be those individuals who had more difficulty in overcoming perceived barriers to physical activity participation. Five main barriers to physical activity were identified: (i) the physical symptoms of pregnancy (ii) the effect of outside influences (iii) a lack of motivation (iv) a low maternal body image and (v) a lack of time and/or appropriate facilities. Findings suggested that maternal daily activity may impact significantly on pregnancy outcome. Higher maternal daily activity at 16 weeks gestation was independently associated with a lower incidence of emergency caesarean section (p<0.05). Higher maternal daily activity at 38 weeks gestation was independently associated with a higher incidence of an induction of labour (p<0.05). Total daily activity at 25 & 34 weeks gestation was independently and negatively associated with infant birthweight (p<0.05).

L'étendue et les causes des déficits de coordination visuo-manuelle des enfants nés prématurés à bas risque ne sont pas vraiment connus. L'objectif principal de la thèse présentée ici était d'étudier le développement de la coordination visuo-manuelle chez douze prématurés à bas risque, nés après 33-36 semaines de gestation et examinés entre 5 et 23 mois d'âge chronologique. Au cours de la thèse, nous avons mené une série d'études avec des objectifs spécifiques. Dans l'étude 1, nous avons observé le développement de la coordination visuo-manuelle, la prise d'objets, le contrôle de la motricité bimanuelle et la latéralité chez ces enfants prématurés vus entre 6 et 12 mois et comparés à des enfants nés à terme à âge gestationnel équivalent. La perception visuelle des enfants a également été testée à 5 mois et mise en relation avec la coordination visuo-manuelle. Les résultats montrent une perception visuelle globalement normale chez les prématurés qui ne différent des enfants à terme que par une fixation visuelle plus faible. Par contre les enfants prématurés présentent un développement plus lent pour l'intégration visuo-manuelle, la prise d'objet, la coordination bimanuelle et la latéralité. L'hypotonicité et l'âge gestationnel sont les principaux facteurs responsables de ce retard. Aucun retard n'est observé pour le développement postural et locomoteur. Dans l'étude 2 nous avons recherché l'effet de la prématurité sur le développement de la compréhension qu'un objet dont toutes les parties ne sont pas à portée de main peut être saisi par n'importe quelle partie (principe de cohésion). Nous avons présenté aux mêmes enfants prématurés une condition « objet composite » dans laquelle une balle colorée est attachée au bout d'un manche blanc, seul le manche étant à portée de main. Dans une deuxième condition (« déconnection invisible »), la balle paraissait connectée au manche mais ne l'était pas. Les résultats montrent que, en tant que groupe, les bébés prématurés ne présentent pas de retard dans leur prise d'un objet composite. Cependant les enfants prématurés hypotoniques ou nés après 33-34 semaines étaient significativement en retard par rapport aux enfants prématurés hypertoniques. Ces résultats des deux premières études montrent que les nourrissons prématurés, même à bas risque, présentent un retard de développement visuo-manuel dans leur première année de vie et on peut se demander si ce retard se prolonge au-delà de la première année. La réponse à cette question est présentée dans l'étude 3. Nous avons comparé le développement de l'utilisation d'un outil chez les enfants prématurés, âgés alors de 15 à 23 mois, avec celui d'enfants nés à terme d'âge gestationnel équivalent. Comprendre l'affordance d'un outil est une étape importante dans la période sensorimotrice. L'utilisation d'un outil pour prendre un objet hors de portée, par exemple, se développe normalement au cours de la deuxième année. Nous avons présenté aux enfants prématurés un jouet coloré hors de portée et un râteau blanc à portée de main dans cinq conditions de relations spatiales entre le jouet et le râteau. En tant que groupe, les enfants prématurés ont présenté un développement normal de l'utilisation de l'outil. Cependant, ce développement normal n'apparaît pas chez tous les enfants prématurés. Les enfants prématurés hypotoniques ou nés après 33-34 semaines de gestation ont montré un retard significatif dans leur acquisition de l'utilisation de l'outil. Ces résultats montrent que les enfants nés prématurés à faible risque peuvent être retardés dans leur développement de nouvelles compétences manuelles au-delà de la première année. En suivant ces enfants au-delà de deux ans, il devrait être possible de déterminer quels sont les tests les plus prédictifs de déficits neuropsychologiques persistants parmi ceux que nous avons utilisés. Ces résultats devraient néanmoins être confirmés dans une population plus large
The extent of and reasons for visual-manual coordination deficits in moderate and late low risk preterm born infants are not well known. The aim of the thesis presented here was to investigate the development of visual-manual coordination in twelve low risk preterm infants born after 33-36 weeks of gestation and examined from 5 to 23 months of age. We conducted a series of studies with specific goals. The goal of study 1 was to investigate the development of visual-manual and bimanual coordination as well as handedness in the preterm infants between the postnatal ages of 6 and 12 months, after having evaluated their visual functions at 5 months. Gross motor development was also evaluated every month. Preterm infants were compared to a control group of ten full-term infants according to corrected age. Results show that preterm infants had a visual perception close to normal, with only visual fixation being lower than in full-terms. Preterm infants had delayed development of visual-manual integration, grasping, bimanual coordination and handedness. Tonicity and gestational age at birth were the main variables associated to the delays. There was no delay for gross motor development. The goal of study 2 was to investigate at what age preterm infants integrate the notion of object cohesiveness into their action plan. The same preterm and full-term infants as in first study were presented with a composite object task at 6, 8, and 10 months in two conditions, "composite object" condition, in which a bright ball was attached to the end of a neutral handle, and "invisible disconnection" condition in which the ball seemed to be connected to the handle but was not. Only the handle was within reach. Corrected age comparisons between preterm infants and full-terms showed no significant difference between the two groups. However, the hypotonic preterm infants had a significantly lower performance than the hypertonic infants. Based on the results from studies 1 and 2 it seems that preterm infants, in particular the hypotonic infants, have a delayed development in their first year of life, and one can wonder if this delay remains at later stages. To answer this question, in study 3 we compared the development of tool use in the preterm infants, aged 15 to 23 months, with that of full-terms according to corrected age. Understanding the affordance of a tool is an important milestone in early sensorimotor period. Using a tool to bring within reach an out-of-reach object, for instance, has been shown to develop during the second year in full-term infants. Here we presented preterm infants with an attractive toy out of reach and with a rake-like tool within reach in five conditions of spatial relationships between the toy and the tool. As a group, preterm infants showed a normal development of tool use. However not all preterm infants developped tool use without delay. Hypotonic and moderate preterm infants were significantly delayed in their acquisition of tool use. These results, show that some low risk preterm infants can still be impaired for the development of new manual skills beyond the first year. By following these low risk preterm children, it should be possible to evaluate which of the delays observed in our studies are the best predictors of later neuropsychological deficits in childhood. These results should also be confirmed with a larger sample of preterm infants

Background: Low back pain (LBP) is the most common pain condition with a lifetime prevalence of 70 %. One of the most investigated risk factor for LBP is sedentary lifestyle. This is of great interest as sitting is the more dominant occupational activity in today’s society. Aim: The aim of this study was to prospectively investigate if the risk of chronic LBP is associated with time spent sitting, leisure time physical activity, and occupational activity. We also examined the combined effect of time spent sitting and physical activity and also for the combined effect of physical leisure activity and work activity on the risk of chronic LBP. Method: Logistic regression was used to calculate odds ratio (OR) of LBP associated with the various activity measures. The precision of the estimates was assessed by 95 % confidence interval (Cl). Results: There was some evidence of an inverse association between time spent sitting and risk of chronic LBP, with a OR of 0.83 (0.71-0.97) among persons sitting more than eleven hours a day compared to persons sitting less than five hours a day. Hard physical labour increased the odds of chronic LBP (OR 1.19, 1.02-1.40) when compared to an occupation mostly involving sitting, whereas high levels of leisure time activity was associated with a OR of 0.79 (0.64 - 0.96) compared to being inactive. Combined analysis showed high level of leisure time physical activity to decrease the risk of chronic LBP regardless of occupation. The largest modification of leisure time physical activity on the risk of chronic LBP was found for persons having hard physical work demands. Conclusion: In this population-based longitudinal study, time spent sitting and leisure time physical activity was inversely associated with chronic LBP, whereas heavy physical work, such as walking, lifting and heavy labour, increased the risk. Moreover, analyses of combined effects suggest that the lowest risk was among persons who reported high leisure time physical activity and much sitting.

Magister Artium (Sport, Recreation and Exercise Science) - MA(SRES)
The prevalence of non-communicable diseases (NCDs) are the rising cause of mortality globally. Physical inactivity, unhealthy diet, tobacco use, and excessive alcohol consumption are common NCDs risk factors contributing to premature death, related to NCDs worldwide. Youth’s lack of knowledge and misconception on physical activity (PA) and NCDs risk factors, aids the growing burden of NCDs globally. Thus, the purpose of this study is to explore the knowledge and perception of youth in a low-resourced community in the Western Cape Province. A qualitative methodological approach was adopted for data collection, using a qualitative exploratory study design. Convenience sampling was used to select the female youth participants, aged 18-35 years old from, Vrygrond in the Western Cape Province. Focus group discussions were steered by means of a semi-structured interview plan to guide the discussion about perceptions and knowledge of PA and NCDs risks factor. Trustworthiness was used to review information and to assess accuracy of findings. The discussions were analysed using Atlas.Ti8. Results indicated that the female youth were reasonably knowledgeable about the term PA. However, they lacked sufficient knowledge with regards to NCDs, indicating that participants are uninformed about NCDs and their risk factors in their community and local healthcare centres. Female youth’s socio-economic environment had an influence impact on their perceptions and decisions made with regards to PA and preventing them from engaging in NCDs risk factors. Furthermore, there were various barriers hindering the female youth from participating in PA and preventing them from engaging in NCDs risk factors. Results of this study will inform policy at the provincial, and national level, to provide cost effective and sustainable educative intervention programmes that address the youth misconception on physical activity and NCDs risks factor. Creation of awareness can positively influence beliefs and promote healthier practices, therefore making it crucial to understand NCDs risks factor implications on health, in lieu to combating the onset of NCDs.

Introducción. El objetivo del presente estudio es determinar si existe correlación entre los conocimientos sobre las consecuencias de la obesidad y el grado de actividad física de las personas. Métodos. Se realizó un estudio transversal analítico durante los años 2013 y 2014. Participaron 215 alumnos de pregrado seleccionados por conveniencia no relacionados a carreras del campo de la salud en una universidad de Lima, Perú. Se evaluó el grado de actividad física utilizando el International Physical Activity Questionnaire (IPAQ) y el nivel de conocimientos sobre consecuencias de la obesidad utilizando la escala Obesity Risk Knowledge-10 (ORK-10). También, se consignó las fuentes de información de donde obtuvieron el conocimiento para responder dicho cuestionario. Resultados. La mediana de edad fue 20 (rango intercuartílico=4) y 63% eran mujeres. De acuerdo al IPAQ, 53,9% realizaban actividad física alta, 35,4%, moderada y 10,7%, leve. Se encontró una correlación muy baja (rs=0,06) entre el puntaje del ORK-10 y la cantidad de equivalentes metabólicos/minuto consumidos por semana, pero no era significativa (p=0,38). Las personas informadas por medios de comunicación y por personal de salud obtuvieron mayores puntajes en el ORK- 10 que quienes se informaron por otras vías (p<0,05). Conclusiones. La correlación entre los conocimientos sobre consecuencias de la obesidad y el grado de actividad física es muy baja. Es necesario utilizar enfoques multidisciplinarios que incluyan todos los determinantes de la realización de actividad física para poder lograr cambios en la conducta de la población.

abstract: Despite the societal importance of activism, the understanding of activist intentions remained limited (Liebert, Leve, & Hu, 2011; Klar & Kasser, 2009). The current study used the Theory of Planned Behavior (TPB) to examine two structural models of low-risk activist intentions and high-risk activist intentions (Ajzen, 1991). The traditional TPB model was tested against a hybrid commitment model that also assessed past activist behaviors and activist identity. Participants (N = 383) were recruited through social media, professional list-serves, and word of mouth. Results indicated a good model fit for both the traditional TPB model (CFI = .98; RMSEA = .05; SRMR = .03; χ2(120) = 3760.62, p < .01) and the commitment model (CFI = .97; RMSEA = .05; SRMR = .04; χ2(325) = 7848.07, p < .01). The commitment model accounted for notably more variance in both low-risk activist intentions (78.9% in comparison to 26.5% for the traditional TPB model) and high-risk activist intentions (58.9% in comparison to 11.2% for the traditional TPB model). Despite this, the traditional TPB model was deemed the better model as the higher variance explained in the commitment model was almost entirely due to the inclusion of past low-risk activist behaviors and past high-risk activist behaviors. A post-hoc analysis that incorporated sexual orientation and religious affiliation as covariates into the traditional model also led to a good-fitting model (CFI = .98; RMSEA = .04; SRMR = .04; χ2(127) = 217.18, p < .01) and accounted for increased variance in low-risk activist intentions (29.7%) and high-risk activist intentions (18.7%) compared to the traditional model. The merits of each of the structural models and the practical implications for practice and research were discussed
Dissertation/Thesis
Doctoral Dissertation Counseling Psychology 2019

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School of Physical Education, Sport, and Exercise Science

The incidence of morbidity and mortality related to CVD is rather low in a paediatric population. Studies investigating the relationship between physical activity, physical fitness, and cardiovascular health in children and adolescents are therefore mostly limited to CVD risk factors as outcome measures. For this reason, this chapter will focus on the association of physical activity and physical fitness with CVD risk factors in children and adolescents. These risk factors can be divided into the so-called traditional CVD risk factors; that is, lipoproteins [total cholesterol, low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, triglycerides (TG)], blood pressure, body fatness, and diabetes, and ‘new’ CVD risk factors; that is, other lipoproteins [lipoprotein(a) (Lp(a)), apolipoprotein (apo)B, and apoA-1], coagulation and inflammation markers [fibrinogen, C-reactive protein (CRP)], homocysteine, and heart rate variability.

Obesity is a serious chronic disease of epidemic and global proportions. The incidence of cardiovascular diseases (CVD) is increased in obese people. Since overweight and obesity are associated with decreased lifespan, weight loss might be expected to improve long-term survival and to have beneficial effects on CVD risk. The therapeutic approaches for obesity are lifestyle changes, drugs, and bariatric surgery. Lifestyle modifications include modest weight loss and moderate-intensity physical activity. A low-fat (low saturated fat), low-sugar diet rich in fruit and vegetables, as well as legumes and whole grains, should be advised for its beneficial impact on weight and cardiovascular risk. Bariatric surgery represents an effective treatment in cases of severe obesity. Prevention of overweight and obesity at the population level will probably play a major role in combating the present obesity epidemic. Combining different intervention strategies is probably the best choice for maximizing the effects and minimizing the costs.

A physically active lifestyle and active participation in sports is important, for adults as well as for children. Reasons to participate in sports and physical activity are many: pleasure and relaxation, competition, socialization, maintenance and improvement of fitness and health, etc. In general, when compared to adults, the risk for sports injury resulting from participation in sports and free play is low in children.1 Despite this relatively low risk, sports injuries in children are a fact of life, which calls for preventive action. In order to set out effective prevention programmes, epidemiological studies need to be done on incidence, severity, and aetiology of sports injuries. Also the effect of preventive measures needs to be evaluated. In the following chapters various authors will describe these aspects of sports injuries in children, regarding specific sports. This chapter describes briefly some current concepts regarding the epidemiology and prevention of sports injuries as a means of introduction to these chapters.

This article examines global warming using the narrative genre model of risk evaluation. The narrative genre model of risk evaluation offers a systematic and comparative way of looking at the form and structure of storytelling and its consequences for human action. It is based on a number of claims, for example: uncertain events and real world facts are “clues”; we can see things as low mimetic, romantic, tragic, or apocalyptic; binary oppositions play a role as building blocks for wider storytelling activity. The article first provides a background on the issues of global warming, climate change, and greenhouse gas emissions before discussing the rise and growing acceptance of the apocalyptic genre as part of the discourse on global warming. It then considers the critique of apocalypticism, arguing that it is not only a bad genre guess that can be mocked, but also a hegemonic and anti-democratic force. It concludes with a commentary on how the narration of global warming is taking place at two levels.

According to some feminist critiques, gossip is merely a form of women’s talk and thus an activity that men do not participate in. Yet gossip may be an ideal strategy for both men and women to engage in when involved in mate competition, allowing the individual to covertly damage a competitor’s reputation while simultaneously preserving his or her own. This chapter investigates the role of gossip in mate competition, considering the influence of variables including sex and attraction context on both the usage and success of a gossip-based competition strategy. Evidence shows that, although sex differences do exist in reputation-based gossip, both men and women are willing to use gossip strategically in order to gain a mating advantage. Overall, it appears that gossip is an effective, low-risk, and non-sex-specific intrasexual competition strategy for individuals to employ in both traditional and poaching attraction contexts.

The social investment approach (SIA) with regard to gendered family arrangements might be defined as a dual defamilization: of women and children. This dual defamilization, however, presents risks, particularly for women, in so far it strongly delegitimizes family/mother’s caring as a valuable activity, with the additional risks of, on the one hand, undermining the trend towards more male caring and, on the other hand, of presenting low-educated mothers’ caring as a liability for their children. In order to be effective, the SIA should address in a systematic way both the issue of social inequality and that of non-paid work and activities as meaningful ones, deserving themselves time and social investment. It should also address the risk of creating a new dichotomy between people deserving (e.g. children, the young) and undeserving (e.g. the old, the severely disabled, the ‘inactivable’) of social investment.

Women and men with neurological disease more often suffer from depression in relation to pregnancy and delivery than other parents. Perinatal depression may harm the parent-child relationship as well as the health of the child. Postnatal psychosis, suicide, and infanticide are rare but severe consequences of the disorder. Symptoms of perinatal depression may overlap with symptoms of neurological disease. Both disorders may aggravate each other. Side effects from neurological treatment could mimic symptoms of depression, and antidepressive drugs could worsen neurological symptoms and interact with other treatment. Neurological patients should be evaluated for risk factors for perinatal depression before delivery. These include previous psychiatric disease, sexual or psychical abuse, sleep problems, high neurological disease activity, and low social support. Pregnant women with previous psychotic episodes or bipolar disease should be referred for psychiatric evaluation before delivery. All patients should be screened for depressive symptoms during follow-up using a 3-step method.

Biomarker testing in the evaluation of a patient with acute chest pain is best established for cardiac troponins that allow the diagnosis of myocardial infarction, risk estimation of short- and long-term risk of death and myocardial infarction, and guidance of pharmacological therapy, as well as the need and timing of invasive strategy. Newer, more sensitive troponin assays have become commercially available and have the capability to detect myocardial infarction earlier and more sensitively than standard assays, but they are hampered by a lack of clinical specificity, i.e. the ability to discriminate myocardial ischaemia from myocardial necrosis not related to ischaemia such as myocarditis, pulmonary embolism, or decompensated heart failure. Strategies to improve clinical specificity (including strict adherence to the universal myocardial infarction definition and the need for serial troponin measurements to detect an acute rise and/or fall of cardiac troponin) will improve the interpretation of the increasing number of positive results. Other biomarkers of inflammation, activated coagulation/fibrinolysis, and increased ventricular stress mirror different aspects of the underlying disease activity and may help to improve our understanding of the pathophysiological mechanisms of acute coronary syndromes. Among the flood of new biomarkers, there are several novel promising biomarkers, such as copeptin that allows an earlier rule-out of myocardial infarction in combination with cardiac troponin, whereas MR-proANP and MR-proADM appear to allow a refinement of cardiovascular risk. GDF-15 might help to identify candidates for an early invasive vs conservative strategy. A multi-marker approach to biomarkers becomes more and more attractive, as increasing evidence suggests that a combination of several biomarkers may help to predict individual risk and treatment benefits, particularly among troponin-negative subjects. Future goals include the acceleration of rule-in and rule-out of patients with suspected acute coronary syndrome, in order to shorten lengths of stay in the emergency department, and to optimize patient management and the use of health care resources. New algorithms using high-sensitivity cardiac troponin assays at low cut-offs alone, or in combination with additional biomarkers, allow to establish accelerated rule-out algorithms within 1 or 2 hours.

Biomarker testing in the evaluation of a patient with acute chest pain is best established for cardiac troponins that allow the diagnosis of myocardial infarction, risk estimation of short- and long-term risk of death and myocardial infarction, and guidance of pharmacological therapy, as well as the need and timing of invasive strategy. Newer, more sensitive troponin assays have become commercially available and have the capability to detect myocardial infarction earlier and more sensitively than standard assays, but they are hampered by a lack of clinical specificity, i.e. the ability to discriminate myocardial ischaemia from myocardial necrosis not related to ischaemia such as myocarditis, pulmonary embolism, or decompensated heart failure. Strategies to improve clinical specificity (including strict adherence to the universal myocardial infarction definition and the need for serial troponin measurements to detect an acute rise and/or fall of cardiac troponin) will improve the interpretation of the increasing number of positive results. Other biomarkers of inflammation, activated coagulation/fibrinolysis, and increased ventricular stress mirror different aspects of the underlying disease activity and may help to improve our understanding of the pathophysiological mechanisms of acute coronary syndromes. Among the flood of new biomarkers, there are several novel promising biomarkers, such as copeptin that allows an earlier rule-out of myocardial infarction in combination with cardiac troponin, whereas MR-proANP and MR-proADM appear to allow a refinement of cardiovascular risk. GDF-15 might help to identify candidates for an early invasive vs conservative strategy. A multi-marker approach to biomarkers becomes more and more attractive, as increasing evidence suggests that a combination of several biomarkers may help to predict individual risk and treatment benefits, particularly among normal-troponin subjects. Future goals include the acceleration of rule-in and rule-out of patients with suspected acute coronary syndrome, in order to shorten lengths of stay in the emergency department, and to optimize patient management and the use of health care resources. New algorithms using high-sensitivity cardiac troponin assays at low cut-offs alone, or in combination with additional biomarkers, allow to establish accelerated rule-out algorithms within 1 or 2 hours.

Biomarker testing in the evaluation of a patient with acute chest pain is best established for cardiac troponins that allow the diagnosis of myocardial infarction, risk estimation of short- and long-term risk of death and myocardial infarction, and guidance of pharmacological therapy, as well as the need and timing of invasive strategy. Newer, more sensitive troponin assays have become commercially available and have the capability to detect myocardial infarction earlier and more sensitively than standard assays, but they are hampered by a lack of clinical specificity, i.e. the ability to discriminate myocardial ischaemia from myocardial necrosis not related to ischaemia such as myocarditis, pulmonary embolism, or decompensated heart failure. Strategies to improve clinical specificity (including strict adherence to the universal myocardial infarction definition and the need for serial troponin measurements to detect an acute rise and/or fall of cardiac troponin) will improve the interpretation of the increasing number of positive results. Other biomarkers of inflammation, activated coagulation/fibrinolysis, and increased ventricular stress mirror different aspects of the underlying disease activity and may help to improve our understanding of the pathophysiological mechanisms of acute coronary syndromes. Among the flood of new biomarkers, there are several novel promising biomarkers, such as copeptin that allows an earlier rule-out of myocardial infarction in combination with cardiac troponin, whereas MR-proANP and MR-proADM appear to allow a refinement of cardiovascular risk. GDF-15 might help to identify candidates for an early invasive vs conservative strategy. A multi-marker approach to biomarkers becomes more and more attractive, as increasing evidence suggests that a combination of several biomarkers may help to predict individual risk and treatment benefits, particularly among normal-troponin subjects. Future goals include the acceleration of rule-in and rule-out of patients with suspected acute coronary syndrome, in order to shorten lengths of stay in the emergency department, and to optimize patient management and the use of health care resources. New algorithms using high-sensitivity cardiac troponin assays at low cut-offs alone, or in combination with additional biomarkers, allow to establish accelerated rule-out algorithms within 1 or 2 hours.

AbstractMaterial deprivation is a key aspect of social exclusion, and the domain of economic exclusion, for the older population. In this chapter we utilised cross-sectional data from Wave 5 (2013) of the Survey of Health and Retirement in Europe (SHARE) and logistic regression analysis to assess the variation in material deprivation of the population aged 50+ across four geographic clusters of welfare regimes in Europe. We used the SHARE-based Material Deprivation Index (MDI) to assess the associations between material deprivation and socio-demographic factors (age, gender, education, economic activity status, household type, number of children, residential area, chronic diseases and limitations of daily activities, and origin). We observed a pronounced variation in material deprivation among the older population across welfare clusters, with high levels of MDI in the Eastern and Southern clusters. Living alone, having a large number of children, low education, activity limitations, and being of immigrant origin significantly increase the risk of material deprivation in older age in all clusters. The study also identified subgroups of older persons that have an increased risk of material deprivation in some but not all clusters, such as those aged 80+ and rural residents in the Southern and Eastern clusters.

AbstractResilience is defined as “The ability to prepare and plan for, absorb, recover from and more successfully adapt to adverse events” (US National Academies). Resilience has four pillars: • Anticipate: the ability to anticipate and reduce the impact of shocks through preparedness and planning, • Absorb the ability to absorb and cope with the impacts of shocks and stresses. • Adapt: the ability to change in response to multiple, long-term and future risks, and to learn and adjust after a shock materializes. • Transform: the ability to take deliberate steps to change the systems that create risk, vulnerability and or inequality. How does insurance intervene in building resilience? The outcome of insurance is to restore property and livelihoods in case of an adverse effect. It does that by providing a cash infusion into the socio-economic system of the affected communities immediately after the event. The cash is used to restore property and avoid interruption of commercial and industrial activity. Insurance also intervenes in terms of reducing impact of stresses (which are the more extensive types of risk) since it enables a system of “maintenance” by providing funds for recovery under minor but more frequent events. For most developing countries, governments have been the insurer of last resort when it comes to catastrophe risk (referred to as Cat Risk in the insurance industry). The reason is that level of cat insurance penetration in most developing countries is very low, sometimes lower than 1%. The assurance of government intervention coupled with the lack of effectiveness of the financial transaction associated with a traditional insurance policy negate any incentive for individuals to acquire a cat insurance policy. The Turkish Compulsory Insurance Program or TCIP is one of the early experiment to change that paradigm and to provide a meaningful role for cat insurance in emerging economies. After a slow start, TCIP has now developed the financial capacity and the spread of coverage to play a significant role both in the financing of risk but also in supporting earthquake risk reduction in Turkey. New cat insurance products based on parametric indexing have since emerged. These insurance products could further improve the efficiency of TCIP and other cat insurance pools by making them more attractive to individuals, thereby scaling up their contribution to building resilience.

The prevalence of breast cancer in Venezuela is particularly alarming, which is attributed to healthcare inequalities, low health literacy, and lagging compliance with prevention methods (i.e., screening and mammography). While the right to health is acknowledged by the Venezuelan constitution, activism beyond governmental confines is required to increase women's breast cancer awareness and decrease mortality rates. Through the development of social support and strategic communicative methods enacted by healthcare providers, it may be possible to empower women with the tools necessary for breast cancer prevention. This paper discusses issues surrounding women's breast cancer, such as awareness of the disease and its risks, self-advocacy, and the roles of activists, healthcare providers, and society. Specifically, it describes a four-year action-oriented research project developed in Venezuela, which was a collaborative work among researchers, practitioners, NGOs, patients, journalists, and policymakers. The outcomes include higher levels of awareness and interest among community members and organizations to learn and seek more information about women's breast cancer, better understandings of the communicated messages, more media coverage and medical consultations, increasing positive patient treatments, expansion of networking of NGOs, as well as a widely supported declaration for a national response against breast cancer in Venezuela.

Low-risk cardiac patients should start exercise training (ET) as early as possible after the index event to maintain or improve their cardiorespiratory fitness, muscular strength, and prognosis. Ideally, ET is provided within a multidisciplinary cardiac rehabilitation (CR) programme. It can be delivered as an early outpatient or home-based (HB) programme or as a combination of the two approaches, based on patient preference and local facilities. ET should be prescribed on an individual basis after careful clinical and functional assessment, including risk stratification, evaluation of fitness level, behavioural characteristics, personal goals, and exercise preferences. Importantly, the programme should empower the patient for individual long-term physical activity and ET. Aerobic endurance training three to five times weekly should be prescribed, with a goal of at least 150 min of moderate to vigorous exercise per week. Resistance training (RT) twice to three times weekly should also be prescribed. The initial duration and intensity of ET should be adapted to the patient’s condition and gradually increased.

Chapter 6 explores the activity component of the BEAST model, and highlights several techniques for activities that can be used to lessen depression. This includes activity scheduling, with a particular focus on pleasant activities, identifying patterns associated with low moods, making the effort to change, and other action strategies (recovering lost activities, risk taking, graded tasks, social skills training) as well as relaxation techniques (progressive muscle relaxation (PMR), meditation, and patterned breathing).

Hyperlipidaemias, multifactorial conditions partly genetically and partly life habit induced, are the most important underlying risk factors for cardiovascular disease. They can lead to arterial lipid deposition with a consequent increased risk of coronary events. The primary effort in hypolipidaemic drug therapy is focused on the lowering of the primary carriers of cholesterol, the low-density lipoproteins (LDLs), but more recent efforts have been placed on the lowering of triglycerides. Reduced levels of the protective high-density lipoproteins (HDLs) are generally considered a primary risk factor, ‘dysfunctional’ HDL may probably be a more important factor. Among drugs primarily reducing LDL cholesterol the most important systemic agents are statins. Non-systemic agents, such as resins, have a lesser use, whereas ezetimibe is frequently given in combination with statins. A new series of systemic compounds, the inhibitors of proprotein convertase subtilisin/kexin type 9 (PCSK9), recently available, have a higher activity on LDL cholesterol. Drugs indicated for the treatment of the homozygous forms of hypercholesterolaemia are lomitapide, an inhibitor of the microsomal transfer protein, and the antisense nucleotide mipomersen, designed to inhibit synthesis of apolipoprotein B. Treatment of hypertriglyceridaemias mainly relies on fibrates, activating the peroxisomal proliferator-activated receptor-α‎. They treat particularly the atherogenic dyslipidaemias (elevated triglycerides with low HDL cholesterol). Nicotinic acid is less frequently used and the omega-3 fatty acids have an as yet unclear cardiovascular protective activity.

Hyperlipidaemias, multifactorial conditions partly genetically and partly life habit induced, are the most important underlying risk factors for cardiovascular disease. They can lead to arterial lipid deposition with a consequent increased risk of coronary events. The primary effort in hypolipidaemic drug therapy is focused on the lowering of the primary carriers of cholesterol, the low-density lipoproteins (LDLs), but more recent efforts have been placed on the lowering of triglycerides. Reduced levels of the protective high-density lipoproteins (HDLs) are generally considered a primary risk factor, ‘dysfunctional’ HDL may probably be a more important factor. Among drugs primarily reducing LDL cholesterol the most important systemic agents are statins. Non-systemic agents, such as resins, have a lesser use, whereas ezetimibe is frequently given in combination with statins. A new series of systemic compounds, the inhibitors of proprotein convertase subtilisin/kexin type 9 (PCSK9), recently available, have a higher activity on LDL cholesterol. Drugs indicated for the treatment of the homozygous forms of hypercholesterolaemia are lomitapide, an inhibitor of the microsomal transfer protein, and the antisense nucleotide mipomersen, designed to inhibit synthesis of apolipoprotein B. Treatment of hypertriglyceridaemias mainly relies on fibrates, activating the peroxisomal proliferator-activated receptor-α‎. They treat particularly the atherogenic dyslipidaemias (elevated triglycerides with low HDL cholesterol). Nicotinic acid is less frequently used and the omega-3 fatty acids have an as yet unclear cardiovascular protective activity.

Erectile dysfunction (ED) is common in subjects with cardiovascular risk factors and in patients with cardiovascular disease (CVD); it also confers an independent risk for future cardiovascular events. Thus, sexual function should be incorporated into CVD risk assessment for all men. Algorithms for the management of patients with ED have been proposed according to the risk for sexual activity and future cardiovascular events. This chapter recommends that initial cardiovascular risk stratification be based on the SCORE risk estimation tool or Framingham Risk Score. Management of men with ED who are at low risk for CVD should focus on risk factor control; men at high/very high risk, including those with CVD, should be referred to a cardiologist. Intermediate-risk men should undergo non-invasive evaluation for subclinical atherosclerosis and functional CVD status. This chapter provides practical algorithms for the evaluation and management of these patients. The clinical use of biomarkers has the ability to provide the clinician with a tool to gauge residual risk and chart a course for optimal management of the patient with ED. Testosterone and biomarkers of generalized vascular disease serve this purpose specifically in intermediate-risk ED patients even though most of them do not fulfil all the stringent criteria to adequately predict cardiovascular risk in this specific population.

The author builds an agent-based model wherein the societal corruption level is derived from individual corruption levels optimally chosen by heterogeneous agents with different risk aversion and human capital. The societal corruption level, in turn, affects the risk-return profile of corruption for the individual agents. Simulating a multi-generational economy with heterogeneous agents, the author shows that there are locally stable equilibrium corruption levels with certain socio-economic determinants. However, there are situations when corruption can rise until it stifles all economic activity. “You live in a society where everybody steals. Do you choose to steal? The probability that you will be caught is low ... and, even if you are caught, the chances of your being punished severely for a crime so common are low. Therefore you too steal. By contrast, if you live in a society where theft is rare, the chances of your being caught and punished are high, so you choose not to steal.” (Mauro, 1998, p. 12)

Honey has been considered as a very important and superior nutrient in human nutrition since ancient times due to its ability to be consumed by humans without processing, easy digestibility, nutritional properties and biological benefits. Although honey contains many desired bioactive and antibacterial substances, which may be sufficient for antimicrobial activity, it cannot be produced in sufficient quantities due to low water activity under normal conditions. This causes various food and bee-borne spores/non-spores pathogens going viral. Hence, it may cause the risk of parasitological and fungal agents to be found. In honey production, “Hazard Analysis Critical Control Point (HACCP)” must be applied meticulously and completely. Current technologies in honey production will be explained in this section.

Background: The increasing prevalence of obesity in female adolescents is a global health problem. It is may caused by the adoption of a Western lifestyle (decrease in physical activity and an increase in the consumption of energy-dense food, high in fats and refined sugar). The purpose of this study was to investigate effect of physical activity on the incidence of obesity in female adolescents. Subjects and Method: This was meta-analysis and systematic review. The study was conducted by collecting articles from Google Scholar, PubMed, and Science Direct databases, published from 2002 to 2020. Keywords were searched using the terms “physical activity” OR “physical fitness” AND obesity AND “cross sectional” AND girls OR adolescent. The study subject was female adolescents. The intervention was low physical activity with comparison high physical activity. The study outcome was obesity. Collected articles were screened using PRISMA flowchart. The quantitative data were analyzed by Revman 5.3. Results: 6 studies from China, New York, Netherlands, Korea, Taiwan, and United States, reported that low physical activity increased the risk of obesity in female adolescents (aOR= 1.74; 95% CI= 1.11 to 2.72; p= 0.010). Conclusion: Low physical activity increased the risk of obesity in female adolescents. Keywords: obesity, physical activity, female adolescents Correspondence: Putri Isriyatil Jannah. Masters Program in Public Health, Universitas Sebelas Maret. Jl. Ir. Sutami 36A, Surakarta 57126, Central Java. Email: putriisriyatil@gmail.com. Mobile: 089634956745.

The river valleys in the plains of Western Canada and the Northwestern United States are relatively young in a geological time scale and often have extensive landslide activity on the valley slopes. Depending on the geology, these landslides can have very low movement rates and show little or no visible signs of slope movement, but still be relevant for the integrity of pipelines. Pipelines installed in gradually moving landslide terrain are subject to some risk of damage, depending on the details of the installation and the level of activity of the slide. Directionally drilled pipeline installations can be particularly vulnerable to this type of slope movement relative to long term integrity. A number of case histories are reviewed that involved pipeline installations on slopes that were moving at slow but persistent rates. Measures were successfully implemented at several of the slopes to lower the risk to the pipelines. Many of these cases involved relatively low cost drainage measures that significantly reduced the risk of pipeline damage.

During decommissioning of nuclear facilities, it is generally thought that the risk is relatively low after high activity inventory such as the spent fuel is removed. However, dismantlement works may be carried out with non-multiple barriers with a non-regular process depending mainly on human activities. Moreover, fire or gas incidents caused by conventional industry methods may lead to accidents with radioactivity release. This means more attention is necessary for safer dismantlement especially for nuclear reactors with high activity. Therefore, utilization of risk information based on risk assessment of the decommissioning was proposed. A method of risk assessment for decommissioning was developed and applied for the dismantlement of typical reactor facilities and nuclear fuel facilities (a uranium enrichment plant and a reprocessing plant). The results show that the consequences of such troubles are low, but their occurrences are still not negligible. This fact is supported by past trouble cases. Taking into account of the risk assessment results, a methodology to secure the safety of decommissioning was proposed. It consists of four steps i.e. 1) risk-informed approach, 2) graded approach, 3) phased approach and 4) layered approach and the results can be reflected to the management and regulation. The regulation means are for example, review of the decommissioning plan or the fitness-for-safety, the periodic safety inspections and usual monitoring. The methodology can evaluate the risk level of decommissioning more objectively and enable reasonable regulation based on the risk level. This leads to the appropriate distribution of resources with safety enhancement.

Government and commercial decommissioning and remediation activities at nuclear sites and facilities often generate in large volumes and mass radioactive waste that is of low activity. In large part, the low activity radioactive waste generated from decommissioning and remediation activities are below regulatory limits for low level radioactive waste, while not meeting site specific dose and risk-based cleanup criteria. Policies and strategies for the remediation, management, and disposal of low activity radioactive waste in these circumstances often explore alternative options to fully licensed disposal. Primary goals in exploring alternative disposal options are protection of the public and the environment, while achieve a cost-effective solution. Vague regulations and arbitrary interpretation by federal and state regulators may enhance alternative disposal options or quash efforts by those conducting the remediation and decommissioning. Fundamental to the issues is the overriding concern of a lack of clarity and increased liability in the regulatory structure of the grey area that is low activity radioactive wastes. This paper explores the current efforts by the United States of America and International regulatory community to better define low activity radioactive waste and to provide effective and protective waste management and disposal policies and strategies.

Thrombotic graft occlusion occurs within a few hours after surgery, suggesting a benefit of preoperative start of antiplatelet treatment. We investigated the effectivity and risk of preoperatively started treatment with 100 mg/day acetyl salicylic acid (ASA) compared to anticoagu1 ation started 6 hours postoperatively (heparin followed by coumarin (AC)). The prospective randomized trial yielded the following results:Preoperative low dose ASA increased chest-tube blood loss. This indicates effective antiplatelet activity of low dose ASA. Perioperative platelet consumption and coagulation factors activity was not altered.It is concluded, that graft patency rates are similar with postoperative anticoagu1 ation or antiplatelet treatment with low dose acetylsalicylic acid.

ABSTRACT Background: Stress has been shown to have major effects on metabolic activity. Diabetes mellitus (DM) is a metabolic disease characterized by chronic hyperglycemia that results from an alteration of the secretion or action of insulin. This study aimed to investigate biopsychosocial determinants of diabetes mellitus type 2 Subjects and Method: A case control study was conducted in Surakarta, Centra Java, Indonesia, from November 2019 to January 2020. A sample of 200 patients with type 2 DM was selected by fixed disease sampling. The dependent variable was type 2 DM. The independent variables were family history of DM, dietary pattern, physical activity, body mass index (BMI), central obesity, stress, hypertension, and smoking. The data were collected by medical record and questionnaire. The data were analyzed by a multiple logistic regression run on Stata 13. Results: The risk of type 2 DM increased with family history of tipe 2 DM (OR= 12.88; 95% CI= 5.18 to 32.04; p<0.001), poor dietary pattern (OR= 2.92; 95% CI= 1.16 to 7.36; p= 0.023), and low physical activity (OR= 3.15; 95% CI= 1.22 to 8.18; p= 0.018), central obesity (OR= 4.55; 95% CI= 1.55 to 13.41; p= 0.006), stress (OR= 3.07; 95% CI= 1.21 to 7.79; p= 0.018), history of hypertension (OR= 3.83; 95% CI= 1.49 to 9.79; p= 0.005), and smoking behavior (OR= 3.86; 95% CI= 1.29 to 11.57; p= 0.016). The risk of type 2 DM decreased with normal BMI (OR= 0.37; 95% CI= 0.13 to 1.01; p= 0.053). Conclusion: The risk of type 2 DM increases with family history of tipe 2 DM, poor dietary pattern, and low physical activity, central obesity, stress, history of hypertension, and smoking behavior. The risk of type 2 DM decreases with normal BMI. Keywords: Determinan biopsikososial, DM tipe 2. Correspondence: Anggi Putri Aria Gita. Masters Program in Public Health, Universitas Sebelas Maret, Jl. Ir. Sutami 36A, Surakarta 57126, Central Java, Indonesia. Email: anggipag@gmail.com. Mobile: +628975406464. DOI: https://doi.org/10.26911/the7thicph.01.46

High pressure hydrogenation cracking unit is the core equipment system in the aromatic plant, which is subjected simultaneously to the action of hydrogen and high pressure and high temperature. In this paper, quantitative analysis method of RBI was carried out by Orbit-Onshore software, which was developed by DNV corporation. In API 581, the risk situation for a certain equipment unit were classified into four grades, such as low risk grade and medium risk grade and medium-high risk grade and high grade, which is expressed as risk matrix. The whole risk distribution of 553 equipment and piping items was obtained, and in which the hydrocracking reactors and the reactor effluent air coolers are belong to ‘medium-high risk’ grade. Based on the RBI results, an optimum inspection plan was developed by the author to reduce the risk level for the hydrogenation cracking unit. It is concluded that the optimum inspection plan was completely satisfied with the engineering specification of the aromatic plant, after the validation of the inspection activity in 2004.

The goal of this paper is to document the pedagogic impacts of the remote learning strategy used by an state department of education in Brazil during the pandemic. We found that dropout risk increased by 365% under remote learning. While risk increased with local disease activity, most of it can be attributed directly to the absence of in-person classes: we estimate that dropout risk increased by no less than 247% across the State, even at the low end of the distribution of per capita Covid-19 cases. Average standardized test scores decreased by 0.32 standard deviation, as if students had only learned 27.5% of the in-person equivalent under remote learning. Learning losses did not systematically increase with local disease activity, attesting that they are in fact the outcome of remote learning, rather than a consequence of other health or economic impacts of Covid-19. Authorizing schools to partially reopen for in-person classes increased high-school students test scores by 20% relative to the control group.

Objectives. To assess benefits and harms of nonpharmacological and pharmacological interventions for breathlessness in adults with advanced cancer. Data sources. We searched PubMed®, Embase®, CINAHL®, ISI Web of Science, and the Cochrane Central Register of Controlled Trials through early May 2020. Review methods. We included randomized controlled trials (RCTs) and observational studies with a comparison group evaluating benefits and/or harms, and cohort studies reporting harms. Two reviewers independently screened search results, serially abstracted data, assessed risk of bias, and graded strength of evidence (SOE) for key outcomes: breathlessness, anxiety, health-related quality of life, and exercise capacity. We performed meta-analyses when possible and calculated standardized mean differences (SMDs). Results. We included 48 RCTs and 2 retrospective cohort studies (4,029 patients). The most commonly reported cancer types were lung cancer and mesothelioma. The baseline level of breathlessness varied in severity. Several nonpharmacological interventions were effective for breathlessness, including fans (SMD -2.09 [95% confidence interval (CI) -3.81 to -0.37]) (SOE: moderate), bilevel ventilation (estimated slope difference -0.58 [95% CI -0.92 to -0.23]), acupressure/reflexology, and multicomponent nonpharmacological interventions (behavioral/psychoeducational combined with activity/rehabilitation and integrative medicine). For pharmacological interventions, opioids were not more effective than placebo (SOE: moderate) for improving breathlessness (SMD -0.14 [95% CI -0.47 to 0.18]) or exercise capacity (SOE: moderate); most studies were of exertional breathlessness. Different doses or routes of administration of opioids did not differ in effectiveness for breathlessness (SOE: low). Anxiolytics were not more effective than placebo for breathlessness (SOE: low). Evidence for other pharmacological interventions was limited. Opioids, bilevel ventilation, and activity/rehabilitation interventions had some harms compared to usual care. Conclusions. Some nonpharmacological interventions, including fans, acupressure/reflexology, multicomponent interventions, and bilevel ventilation, were effective for breathlessness in advanced cancer. Evidence did not support opioids or other pharmacological interventions within the limits of the identified studies. More research is needed on when the benefits of opioids may exceed harms for broader, longer term outcomes related to breathlessness in this population.

Several factors contribute to Surinames particular vulnerability to the effects of climate change. It is dependent on fossil fuels, has forests liable to decay, fragile ecosystems, and its low-lying coastal area accounts for 87% of the population and most of the countrys economic activity. Many sectors are at risk of suffering losses and damage caused by gradual changes and extreme events related to climate change. For Suriname to develop sustainably, it should incorporate climate change and its effects into its decision-making process based on scientific- evidence. The State of the Climate Report analyzes Surinames historical climate (1990-2014) and provides climate projections for three time horizons (2020-2044, 2045-2069, 2070-2094) through two emissions scenarios (intermediate/ SSP2-4.5 and severe/ SSP5-8.5). The analysis focuses on changes in sea level, temperature, precipitation, relative humidity, and winds for the seven subnational locations of Paramaribo, Albina, Bigi Pan MUMA, Brokopondo, Kwamalasamutu, Tafelberg Natural Reserve, and Upper Tapanahony. The Report also analyzes climate risk for the countrys ten districts by examining the factors which increase their exposure and vulnerability on the four most important sectors affected by climate change: infrastructure, agriculture, water, and forestry, as well as examining the effects across the sectors. The State of the Climate provides essential inputs for Suriname to develop and update its climate change policies and targets. These policies and targets should serve as enablers for an adequate mainstreaming of climate change adaptation and resilience enhancement into day-to-day government operations.

Suriname is highly vulnerable to the effects of climate change. Among the factors that exacerbate its vulnerability are its dependency on fossil fuels, the degradation of important ecosystems (e.g., mangroves), and the fact that 87% of the population, and most of the countrys economic activity is located within the low-lying coastal area. Many sectors are at risk of suffering losses and damage caused by gradual changes and extreme events related to climate change. For Suriname to develop sustainably, it should incorporate climate change and its effects into its decision-making process based on scientific- evidence. The State of the Climate Report analyzes Surinames historical climate (1990-2014) and provides climate projections for three time horizons (2020-2044, 2045-2069, 2070-2094) through two emissions scenarios (intermediate/ SSP2-4.5 and severe/ SSP5-8.5). The analysis focuses on changes in sea level, temperature, precipitation, relative humidity, and winds for the seven subnational locations of Paramaribo, Albina, Bigi Pan MUMA, Brokopondo, Kwamalasamutu, Tafelberg Natural Reserve, and Upper Tapanahony. The Report also analyzes climate risk for the countrys ten districts by examining the factors which increase their exposure and vulnerability on the four most important sectors affected by climate change: infrastructure, agriculture, water, and forestry, as well as examining the effects across the sectors. The State of the Climate Report provides essential inputs for Suriname to develop and update its climate change policies and targets. These policies and targets should enable an adequate mainstreaming of climate change adaptation and resilience enhancementinto day-to-day government operations. It is expected that the Report will catalyze similar efforts in the future to improve decision-making by providing science-based evidence.

1.1 Macroeconomic summary Economic recovery has consistently outperformed the technical staff’s expectations following a steep decline in activity in the second quarter of 2020. At the same time, total and core inflation rates have fallen and remain at low levels, suggesting that a significant element of the reactivation of Colombia’s economy has been related to recovery in potential GDP. This would support the technical staff’s diagnosis of weak aggregate demand and ample excess capacity. The most recently available data on 2020 growth suggests a contraction in economic activity of 6.8%, lower than estimates from January’s Monetary Policy Report (-7.2%). High-frequency indicators suggest that economic performance was significantly more dynamic than expected in January, despite mobility restrictions and quarantine measures. This has also come amid declines in total and core inflation, the latter of which was below January projections if controlling for certain relative price changes. This suggests that the unexpected strength of recent growth contains elements of demand, and that excess capacity, while significant, could be lower than previously estimated. Nevertheless, uncertainty over the measurement of excess capacity continues to be unusually high and marked both by variations in the way different economic sectors and spending components have been affected by the pandemic, and by uneven price behavior. The size of excess capacity, and in particular the evolution of the pandemic in forthcoming quarters, constitute substantial risks to the macroeconomic forecast presented in this report. Despite the unexpected strength of the recovery, the technical staff continues to project ample excess capacity that is expected to remain on the forecast horizon, alongside core inflation that will likely remain below the target. Domestic demand remains below 2019 levels amid unusually significant uncertainty over the size of excess capacity in the economy. High national unemployment (14.6% for February 2021) reflects a loose labor market, while observed total and core inflation continue to be below 2%. Inflationary pressures from the exchange rate are expected to continue to be low, with relatively little pass-through on inflation. This would be compatible with a negative output gap. Excess productive capacity and the expectation of core inflation below the 3% target on the forecast horizon provide a basis for an expansive monetary policy posture. The technical staff’s assessment of certain shocks and their expected effects on the economy, as well as the presence of several sources of uncertainty and related assumptions about their potential macroeconomic impacts, remain a feature of this report. The coronavirus pandemic, in particular, continues to affect the public health environment, and the reopening of Colombia’s economy remains incomplete. The technical staff’s assessment is that the COVID-19 shock has affected both aggregate demand and supply, but that the impact on demand has been deeper and more persistent. Given this persistence, the central forecast accounts for a gradual tightening of the output gap in the absence of new waves of contagion, and as vaccination campaigns progress. The central forecast continues to include an expected increase of total and core inflation rates in the second quarter of 2021, alongside the lapse of the temporary price relief measures put in place in 2020. Additional COVID-19 outbreaks (of uncertain duration and intensity) represent a significant risk factor that could affect these projections. Additionally, the forecast continues to include an upward trend in sovereign risk premiums, reflected by higher levels of public debt that in the wake of the pandemic are likely to persist on the forecast horizon, even in the context of a fiscal adjustment. At the same time, the projection accounts for the shortterm effects on private domestic demand from a fiscal adjustment along the lines of the one currently being proposed by the national government. This would be compatible with a gradual recovery of private domestic demand in 2022. The size and characteristics of the fiscal adjustment that is ultimately implemented, as well as the corresponding market response, represent another source of forecast uncertainty. Newly available information offers evidence of the potential for significant changes to the macroeconomic scenario, though without altering the general diagnosis described above. The most recent data on inflation, growth, fiscal policy, and international financial conditions suggests a more dynamic economy than previously expected. However, a third wave of the pandemic has delayed the re-opening of Colombia’s economy and brought with it a deceleration in economic activity. Detailed descriptions of these considerations and subsequent changes to the macroeconomic forecast are presented below. The expected annual decline in GDP (-0.3%) in the first quarter of 2021 appears to have been less pronounced than projected in January (-4.8%). Partial closures in January to address a second wave of COVID-19 appear to have had a less significant negative impact on the economy than previously estimated. This is reflected in figures related to mobility, energy demand, industry and retail sales, foreign trade, commercial transactions from selected banks, and the national statistics agency’s (DANE) economic tracking indicator (ISE). Output is now expected to have declined annually in the first quarter by 0.3%. Private consumption likely continued to recover, registering levels somewhat above those from the previous year, while public consumption likely increased significantly. While a recovery in investment in both housing and in other buildings and structures is expected, overall investment levels in this case likely continued to be low, and gross fixed capital formation is expected to continue to show significant annual declines. Imports likely recovered to again outpace exports, though both are expected to register significant annual declines. Economic activity that outpaced projections, an increase in oil prices and other export products, and an expected increase in public spending this year account for the upward revision to the 2021 growth forecast (from 4.6% with a range between 2% and 6% in January, to 6.0% with a range between 3% and 7% in April). As a result, the output gap is expected to be smaller and to tighten more rapidly than projected in the previous report, though it is still expected to remain in negative territory on the forecast horizon. Wide forecast intervals reflect the fact that the future evolution of the COVID-19 pandemic remains a significant source of uncertainty on these projections. The delay in the recovery of economic activity as a result of the resurgence of COVID-19 in the first quarter appears to have been less significant than projected in the January report. The central forecast scenario expects this improved performance to continue in 2021 alongside increased consumer and business confidence. Low real interest rates and an active credit supply would also support this dynamic, and the overall conditions would be expected to spur a recovery in consumption and investment. Increased growth in public spending and public works based on the national government’s spending plan (Plan Financiero del Gobierno) are other factors to consider. Additionally, an expected recovery in global demand and higher projected prices for oil and coffee would further contribute to improved external revenues and would favor investment, in particular in the oil sector. Given the above, the technical staff’s 2021 growth forecast has been revised upward from 4.6% in January (range from 2% to 6%) to 6.0% in April (range from 3% to 7%). These projections account for the potential for the third wave of COVID-19 to have a larger and more persistent effect on the economy than the previous wave, while also supposing that there will not be any additional significant waves of the pandemic and that mobility restrictions will be relaxed as a result. Economic growth in 2022 is expected to be 3%, with a range between 1% and 5%. This figure would be lower than projected in the January report (3.6% with a range between 2% and 6%), due to a higher base of comparison given the upward revision to expected GDP in 2021. This forecast also takes into account the likely effects on private demand of a fiscal adjustment of the size currently being proposed by the national government, and which would come into effect in 2022. Excess in productive capacity is now expected to be lower than estimated in January but continues to be significant and affected by high levels of uncertainty, as reflected in the wide forecast intervals. The possibility of new waves of the virus (of uncertain intensity and duration) represents a significant downward risk to projected GDP growth, and is signaled by the lower limits of the ranges provided in this report. Inflation (1.51%) and inflation excluding food and regulated items (0.94%) declined in March compared to December, continuing below the 3% target. The decline in inflation in this period was below projections, explained in large part by unanticipated increases in the costs of certain foods (3.92%) and regulated items (1.52%). An increase in international food and shipping prices, increased foreign demand for beef, and specific upward pressures on perishable food supplies appear to explain a lower-than-expected deceleration in the consumer price index (CPI) for foods. An unexpected increase in regulated items prices came amid unanticipated increases in international fuel prices, on some utilities rates, and for regulated education prices. The decline in annual inflation excluding food and regulated items between December and March was in line with projections from January, though this included downward pressure from a significant reduction in telecommunications rates due to the imminent entry of a new operator. When controlling for the effects of this relative price change, inflation excluding food and regulated items exceeds levels forecast in the previous report. Within this indicator of core inflation, the CPI for goods (1.05%) accelerated due to a reversion of the effects of the VAT-free day in November, which was largely accounted for in February, and possibly by the transmission of a recent depreciation of the peso on domestic prices for certain items (electric and household appliances). For their part, services prices decelerated and showed the lowest rate of annual growth (0.89%) among the large consumer baskets in the CPI. Within the services basket, the annual change in rental prices continued to decline, while those services that continue to experience the most significant restrictions on returning to normal operations (tourism, cinemas, nightlife, etc.) continued to register significant price declines. As previously mentioned, telephone rates also fell significantly due to increased competition in the market. Total inflation is expected to continue to be affected by ample excesses in productive capacity for the remainder of 2021 and 2022, though less so than projected in January. As a result, convergence to the inflation target is now expected to be somewhat faster than estimated in the previous report, assuming the absence of significant additional outbreaks of COVID-19. The technical staff’s year-end inflation projections for 2021 and 2022 have increased, suggesting figures around 3% due largely to variation in food and regulated items prices. The projection for inflation excluding food and regulated items also increased, but remains below 3%. Price relief measures on indirect taxes implemented in 2020 are expected to lapse in the second quarter of 2021, generating a one-off effect on prices and temporarily affecting inflation excluding food and regulated items. However, indexation to low levels of past inflation, weak demand, and ample excess productive capacity are expected to keep core inflation below the target, near 2.3% at the end of 2021 (previously 2.1%). The reversion in 2021 of the effects of some price relief measures on utility rates from 2020 should lead to an increase in the CPI for regulated items in the second half of this year. Annual price changes are now expected to be higher than estimated in the January report due to an increased expected path for fuel prices and unanticipated increases in regulated education prices. The projection for the CPI for foods has increased compared to the previous report, taking into account certain factors that were not anticipated in January (a less favorable agricultural cycle, increased pressure from international prices, and transport costs). Given the above, year-end annual inflation for 2021 and 2022 is now expected to be 3% and 2.8%, respectively, which would be above projections from January (2.3% and 2,7%). For its part, expected inflation based on analyst surveys suggests year-end inflation in 2021 and 2022 of 2.8% and 3.1%, respectively. There remains significant uncertainty surrounding the inflation forecasts included in this report due to several factors: 1) the evolution of the pandemic; 2) the difficulty in evaluating the size and persistence of excess productive capacity; 3) the timing and manner in which price relief measures will lapse; and 4) the future behavior of food prices. Projected 2021 growth in foreign demand (4.4% to 5.2%) and the supposed average oil price (USD 53 to USD 61 per Brent benchmark barrel) were both revised upward. An increase in long-term international interest rates has been reflected in a depreciation of the peso and could result in relatively tighter external financial conditions for emerging market economies, including Colombia. Average growth among Colombia’s trade partners was greater than expected in the fourth quarter of 2020. This, together with a sizable fiscal stimulus approved in the United States and the onset of a massive global vaccination campaign, largely explains the projected increase in foreign demand growth in 2021. The resilience of the goods market in the face of global crisis and an expected normalization in international trade are additional factors. These considerations and the expected continuation of a gradual reduction of mobility restrictions abroad suggest that Colombia’s trade partners could grow on average by 5.2% in 2021 and around 3.4% in 2022. The improved prospects for global economic growth have led to an increase in current and expected oil prices. Production interruptions due to a heavy winter, reduced inventories, and increased supply restrictions instituted by producing countries have also contributed to the increase. Meanwhile, market forecasts and recent Federal Reserve pronouncements suggest that the benchmark interest rate in the U.S. will remain stable for the next two years. Nevertheless, a significant increase in public spending in the country has fostered expectations for greater growth and inflation, as well as increased uncertainty over the moment in which a normalization of monetary policy might begin. This has been reflected in an increase in long-term interest rates. In this context, emerging market economies in the region, including Colombia, have registered increases in sovereign risk premiums and long-term domestic interest rates, and a depreciation of local currencies against the dollar. Recent outbreaks of COVID-19 in several of these economies; limits on vaccine supply and the slow pace of immunization campaigns in some countries; a significant increase in public debt; and tensions between the United States and China, among other factors, all add to a high level of uncertainty surrounding interest rate spreads, external financing conditions, and the future performance of risk premiums. The impact that this environment could have on the exchange rate and on domestic financing conditions represent risks to the macroeconomic and monetary policy forecasts. Domestic financial conditions continue to favor recovery in economic activity. The transmission of reductions to the policy interest rate on credit rates has been significant. The banking portfolio continues to recover amid circumstances that have affected both the supply and demand for loans, and in which some credit risks have materialized. Preferential and ordinary commercial interest rates have fallen to a similar degree as the benchmark interest rate. As is generally the case, this transmission has come at a slower pace for consumer credit rates, and has been further delayed in the case of mortgage rates. Commercial credit levels stabilized above pre-pandemic levels in March, following an increase resulting from significant liquidity requirements for businesses in the second quarter of 2020. The consumer credit portfolio continued to recover and has now surpassed February 2020 levels, though overall growth in the portfolio remains low. At the same time, portfolio projections and default indicators have increased, and credit establishment earnings have come down. Despite this, credit disbursements continue to recover and solvency indicators remain well above regulatory minimums. 1.2 Monetary policy decision In its meetings in March and April the BDBR left the benchmark interest rate unchanged at 1.75%.

Why research Palaeolithic and Mesolithic Scotland? Palaeolithic and Mesolithic archaeology sheds light on the first colonisation and subsequent early inhabitation of Scotland. It is a growing and exciting field where increasing Scottish evidence has been given wider significance in the context of European prehistory. It extends over a long period, which saw great changes, including substantial environmental transformations, and the impact of, and societal response to, climate change. The period as a whole provides the foundation for the human occupation of Scotland and is crucial for understanding prehistoric society, both for Scotland and across North-West Europe. Within the Palaeolithic and Mesolithic periods there are considerable opportunities for pioneering research. Individual projects can still have a substantial impact and there remain opportunities for pioneering discoveries including cemeteries, domestic and other structures, stratified sites, and for exploring the huge evidential potential of water-logged and underwater sites. Palaeolithic and Mesolithic archaeology also stimulates and draws upon exciting multi-disciplinary collaborations. Panel Task and Remit The panel remit was to review critically the current state of knowledge and consider promising areas of future research into the earliest prehistory of Scotland. This was undertaken with a view to improved understanding of all aspects of the colonization and inhabitation of the country by peoples practising a wholly hunter-fisher-gatherer way of life prior to the advent of farming. In so doing, it was recognised as particularly important that both environmental data (including vegetation, fauna, sea level, and landscape work) and cultural change during this period be evaluated. The resultant report, outlines the different areas of research in which archaeologists interested in early prehistory work, and highlights the research topics to which they aspire. The report is structured by theme: history of investigation; reconstruction of the environment; the nature of the archaeological record; methodologies for recreating the past; and finally, the lifestyles of past people – the latter representing both a statement of current knowledge and the ultimate aim for archaeologists; the goal of all the former sections. The document is reinforced by material on-line which provides further detail and resources. The Palaeolithic and Mesolithic panel report of ScARF is intended as a resource to be utilised, built upon, and kept updated, hopefully by those it has helped inspire and inform as well as those who follow in their footsteps. Future Research The main recommendations of the panel report can be summarized under four key headings:  Visibility: Due to the considerable length of time over which sites were formed, and the predominant mobility of the population, early prehistoric remains are to be found right across the landscape, although they often survive as ephemeral traces and in low densities. Therefore, all archaeological work should take into account the expectation of Palaeolithic and Mesolithic ScARF Panel Report iv encountering early prehistoric remains. This applies equally to both commercial and research archaeology, and to amateur activity which often makes the initial discovery. This should not be seen as an obstacle, but as a benefit, and not finding such remains should be cause for question. There is no doubt that important evidence of these periods remains unrecognised in private, public, and commercial collections and there is a strong need for backlog evaluation, proper curation and analysis. The inadequate representation of Palaeolithic and Mesolithic information in existing national and local databases must be addressed.  Collaboration: Multi-disciplinary, collaborative, and cross- sector approaches must be encouraged – site prospection, prediction, recognition, and contextualisation are key areas to this end. Reconstructing past environments and their chronological frameworks, and exploring submerged and buried landscapes offer existing examples of fruitful, cross-disciplinary work. Palaeolithic and Mesolithic archaeology has an important place within Quaternary science and the potential for deeply buried remains means that geoarchaeology should have a prominent role.  Innovation: Research-led projects are currently making a substantial impact across all aspects of Palaeolithic and Mesolithic archaeology; a funding policy that acknowledges risk and promotes the innovation that these periods demand should be encouraged. The exploration of lesser known areas, work on different types of site, new approaches to artefacts, and the application of novel methodologies should all be promoted when engaging with the challenges of early prehistory.  Tackling the ‘big questions’: Archaeologists should engage with the big questions of earliest prehistory in Scotland, including the colonisation of new land, how lifestyles in past societies were organized, the effects of and the responses to environmental change, and the transitions to new modes of life. This should be done through a holistic view of the available data, encompassing all the complexities of interpretation and developing competing and testable models. Scottish data can be used to address many of the currently topical research topics in archaeology, and will provide a springboard to a better understanding of early prehistoric life in Scotland and beyond.