Assessment of Jordanian physicians' knowledge about venous thromboembolism risk and management among COVID-19 patients

Objectives: The aim of this study was to assess Jordanian physicians' awareness about venous thromboembolism (VTE) risk among COVID-19 patients and its treatment protocol. Method(s): This was a cross-sectional-based survey that was conducted in Jordan in 2020. During the study period, a convenience sample of physicians working in various Jordanian hospitals were invited to participate in this study. Physicians' knowledge was evaluated and physicians gained one point for each correct answer. Then, a knowledge score out of 23 was calculated for each. Key Findings: In this study, 102 physicians were recruited. Results from this study showed that most of the physicians realize that all COVID-19 patients need VTE risk assessment (n = 69, 67.6%). Regarding VTE prophylaxis, the majority of physicians (n = 91, 89.2%) agreed that low molecular weight heparin (LMWH) is the best prophylactic option for mild-moderate COVID-19 patients with high VTE risk. Regarding severe/critically ill COVID-19 patients, 75.5% of physicians (n = 77) recognized that LMWH is the correct prophylactic option in this case, while 80.4% of them (n = 82) knew that mechanical prevention is the preferred prophylactic option for severe/critically ill COVID-19 patients with high bleeding risk. Moreover, 77.5% of physicians (n = 79) knew that LMWH is the treatment of choice for COVID-19 patients diagnosed with VTE. Finally, linear regression analysis showed that consultants had an overall higher knowledge score about VTE prevention and treatment in COVID-19 patients compared with residents (P = 0.009). Conclusion(s): All physicians knew about VTE risk factors for COVID-19 patients. However, consultants showed better awareness of VTE prophylaxis and treatment compared with residents. We recommend educational workshops be conducted to enhance physicians' knowledge and awareness about VTE thromboprophylaxis and management in COVID-19 patients.Copyright © 2022 The Author(s). Published by Oxford University Press on behalf of the Royal Pharmaceutical Society. All rights reserved.

Water Management Priorities in a Post-COVID World

This paper maintains that the growing crisis of water scarcity cannot be addressed from within the paradigm that created the problem. The extractive paradigm which prevails views high economic growth as the main goal of development to be achieved through the increasing extraction of natural resources. Approaches to water management that are based on this paradigm view water as a resource primarily meant for human consumption. In contrast, the paper proposes an ecosystem paradigm in which water is viewed as being embedded within the ecosystem as an essential part of it to be conserved and preserved for future generations. The author identifies five areas of action for water management in the post-COVID context: move away from water-intensive agriculture through crop diversification;sustainable and community-based groundwater management;protection of river systems and wetlands;ensuring water quality and drinking water security and the creation of strong legal frameworks for water governance. © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2023.

Achieving Zero Stunting: A Sustainable Development Goal Interlinkage Approach at District Level

The sustainable development goals (SDGs) provide an integrated framework of targets and indicators, including the elimination of stunting, to support better development planning. Indonesia faces a significant challenge as it ranks fourth globally in terms of stunting prevalence, exacerbated by disparities across regions, gender, and socioeconomic status, further compounded by the ongoing COVID-19 pandemic. Given the interlinked nature of SDGs, this study provides empirical support for the prioritization of SDG indicators, primarily in the context of stunting elimination at the district level in Indonesia. This study employed a combination of economic complexity and network theory, utilizing data from a comprehensive set of 54 indicators spanning 28 targets within 13 SDG goals in 514 districts. The analysis is based on network metrics, including revealed comparative advantage (RCA), proximity, centrality, and density to establish the SDG interlinkage network and identify key priority indicators. The findings highlight the importance of prioritizing indicators such as civil registration, health facilities and services, access to basic facilities and housing, and access to ICT in efforts to reduce stunting, particularly among disadvantaged households. Given the unique resources and capacities of each region, our analysis offers district-specific prioritization strategies for stunting elimination.

Coupling Machine Learning and Agent-Based Modeling to Characterize Contamination Sources in Water Distribution Systems for Changing Demand Regimes

Water distribution systems (WDSs) deliver clean, safe drinking water to consumers, providing an essential service to constituents. WDSs are increasingly at risk of contamination due to aging infrastructure and intentional acts that are possible through cyber-physical vulnerabilities. Identifying the source of a contamination event is challenging due to limited system-wide water quality monitoring and non-uniqueness present in solving inverse problems to identify source characteristics. In addition, changes in the expected demand patterns that are caused by, for example, social distancing during a pandemic, adoption of water conservation behaviors, or use of decentralized water sources can change the anticipated propagation of contaminant plumes in a network. This research develops a computational framework to characterize contamination sources using machine learning (ML) techniques and simulate water demands and human exposure to a contaminant using agent-based modeling (ABM). An ABM framework is developed to simulate demand changes during the COVID-19 pandemic. The ABM simulates population movement dynamics, transmission of COVID-19 within a community, decisions to social distance, and changes in demands that occur due to social distancing decisions. The ABM is coupled with a hydraulic simulation model, which calculates flows in the network to simulate the movement of a contaminant plume in the network for several contamination event scenarios. ML algorithms are applied to determine the location of source nodes. Research results demonstrate that ML using random forests can identify source nodes based on inline and mobile sensor data. Sensitivity analysis is conducted to explore the number of mobile sensors that are needed to accurately identify the source node. Rapidly identifying contamination source nodes can increase the speed of response to a contamination event, reducing the impact to the community and increasing the resiliency of WDSs during periods of changing demands. © World Environmental and Water Resources Congress 2023.All rights reserved

Emerging membrane technologies and disinfection methods for efficient removal of waterborne pathogens during the COVID-19 pandemic and post-pandemic

Viruses and other microorganisms can enter water sources from different routes and cause pollution and irreparable damage. So, cost-effective and efficient systems for providing safe water are necessary. Efficient filtration systems based on antimicrobial materials have received a lot of attention in this regard. A wide range of materials play an important role in the production of efficient water filtration systems. Metal and metal oxide particles with anti-viral and antimicrobial properties comprising Cu, Cu2O, Ag, TiO2, and ZnO play a valuable role in the preparation of water filtration systems. Biopolymers such as cellulose or carbon nanomaterials like graphene or its derivatives have been reported to provide safe water. In this review, we summarize the use of diverse materials in the preparation of efficient filtration-based systems like membranes and paper filters for water treatment. Pathogen-containing water samples were effectively disinfected using the prepared water disinfection systems.Copyright © 2023 The Royal Society of Chemistry.

Water Service Quality Networks against COVID-19

Within the framework of Sustainable Development, Social Work has established areas and fields of intervention around which social services have been developed, mainly those related to water care with respect to quality of life and subjective well-being, determinants of evaluation of public policies, environmental programs and attention strategies for migrant communities [4]. In this scheme, Environmental Social Work acts as a mediator of supply policies and civil demands considering the limitations of space, time and infrastructure, but the generality of its dimensions, categories and variables inhibit the analysis of the subjectivity inherent in the objective indicators. of sustainability. [...]it is necessary to delve into the psychological, cognitive and behavioral dimension, in order to be able to establish the needs, expectations, demands and individual or community capacities in the face of environmental crises and the shortage of water resources [5]. From This Nomenclature, It Is Possible To Notice That Sustainable Development Is A Central Issue Or Node That Involves Climate Change, Global Warming, The Greenhouse Effect And Carbon Emissions As Environmental Factors That Have A Direct Impact On The Quality Of The Environment. Air And Respiratory Health In Economically Developed Cities And Economies, But In Addition To Air Pollution, Water And Municipal Waste Problems Are Central Issues In The Economic And Urban Periphery Because The Natural Resources Of The Southern Hemisphere They Are Transformed Into Satisfiers For The Northern Hemisphere, As Is The Case Of Crude Oil And Its Derivatives [5].

Preventive Measures against Ebola and COVID-19 and Their Impact on Human Dirty-Hand Disease Mitigation in Côte d'Ivoire

Hygiene is the most useful public health measure for preventing infections of important endemic and emerging diseases of global significance. This study aimed to assess the impact of these public health preventive measures on dirty hand diseases. A retrospective survey was conducted in the rural general hospitals of Taabo (south-central Côte d'Ivoire) and Marcory (urban Abidjan) to collect clinical data on dirty hand diseases in the patients' records from 2013 to 2020. In addition, focus group discussions (N = 8) were conducted in the communities in both settings to identify the sociocultural and economic hindering or fostering factors that affected the adoption of and the compliance with handwashing and disinfection practices. A total of 3245 and 8154 patients' records were examined in the general hospitals of Taabo and Marcory, respectively. Compared with women, men were more affected by typhoid fever (OR, 0.68 [95%CI, 0.53–0.88]) and influenza (OR, 0.87 [95%CI, 0.75–1]). Hygiene measures promoted during Ebola and COVID-19 outbreaks had no impact on the prevalence of typhoid fever in both settings;however, a positive impact was observed regarding influenza infections. Populations were aware of the importance of handwashing for public health but had difficulties adhering due to financial constraints, access to drinking water, and the absence or scarcity of handwashing facilities.

MONITORING OF MICROBIOLOGY QUALITY RAW WATER AND REFILLED DRINKING WATER DURING COVID-19

Introduction: Riau province regency / city data for drinking water depots in 2020 show that the largest number of Pekanbaru City in Riau Province has refill drinking water depots, there are 440 depots consisting of 220 feasible depots while 227 depots are not feasible. This research was conducted in the Tampan sub-district which is the most densely populated city of Pekanbaru. The purpose of this study was to evaluate the microbiological quality standards (Coliform) for refill drinking water depot, raw water source quality standards and population well quality standards during Covid-19. Methods: This research is quantitative descriptive analytic with triangulation methods observation with laboratory tests, in-depth interviews with correspondents of depot officers and residents of drinking water wells. The test was carried out at the UPT health and environment laboratory of the Riau provincial health office. Result: Data analysis compared 7 samples with laboratory test results according to quality standards. The results of the analysis stated that there were no Coliform bacteria in the tested samples. The source of raw water from housing will have better standard of quality the deeper it is. Conclusion: There is no periodic supervision from the health office / Puskesmas to drinking water depot during the Covid-19 period which is usually routinely carried out every 3-6 months according to regulation of ministers of health no.736,2010 concerning supervision of drinking water quality. Housing developers are required to provide a clean water source from a proper borehole from the start of housing development. © 2022 IJPH.

Recycling of Anti-COVID-19 Filtering Facepiece Respirators for Use as Preliminary Water Filters.

Although the United Nations has set sustainable management of water as an important worldwide goal, methods to supply clean water to underdeveloped countries are generally lacking. The ongoing COVID-19 pandemic as increased the worldwide use of filtering facepiece respirators (FFRs), resulting in enormous amounts of plastic waste. The present study tested whether FFRs could be recycled for use as preliminary water filters. Filtering of contaminated water with FFRs significantly reduced its turbidity, as well as concentrations of total organic carbon and major pollutants such as P, K, Mg, and Fe. Most of the filtered samples satisfied the drinking water quality standards of the World Health Organization. The additional use of FFRs decontamination process with hydrogen peroxide or ultraviolet germicidal irradiation, and sterilization with water purification tablets can eliminate disease-causing microorganisms and further reduce turbidity that would make water suitable for drinking. Recycling anti-COVID-19 FFRs for use as preliminary water filters is an effective and sustainable method for solving both drinking water problems and waste due to FFRs. Supplementary Information: The online version contains supplementary material available at 10.1007/s41742-023-00526-w.

Global prospects to deliver safe drinking water services for 100 million rural people by 2030

The climate crisis and global pandemic have accelerated the urgency of providing safe drinking water services around the world. Global progress to safe drinking water is off-track with uncertain and limited data on the extent and performance of rural water service providers to inform policy and investment decisions. This report documents a global diagnostic survey to evaluate the status and prospects of rural water service providers from 68 countries. The service providers describe providing drinking water services to a population of around 15 million people through over 3 million waterpoints. The data provides information on the scale and sustainability of rural water services to examine: . The extent and type of professional water service provision in rural areas globally;. Self-reported metrics of operational and financial performance;and, . The size and scope of current rural service providers that could transition to resultsbased funding. Five major findings emerge. First, most service providers aim to repair broken infrastructure in three days or less. Second, almost all service providers reported at least one type of water safety activity. Third, most service providers collect payments for water services. Fourth, about one third of service providers reported major negative shocks to their operations from the COVID-19 pandemic. Fifth, non-governmental service providers in low income countries less often report receiving subsidies for operations, and more often report paying part of user fees to government, including through taxes. Most rural water service providers are working towards provision of affordable, safe and reliable drinking water services. Key barriers to progress include sustainable funding and delivery of services at scale. We propose four conditions to promote scale and sustainability based on policy alignment, public finance, professional service delivery, and verifiable data. To illustrate these conditions, we consider the differing context and service delivery approaches in the Central African Republic and Bangladesh. We conclude by identifying a group of 77 service providers delivering water services for about 5 million people in 28 countries. These 77 service providers report operational metrics consistent with a results-based contracting approach. Technical assistance might support many more to progress. We argue that government support and investment is needed to rapidly progress to the scale of 100 million people to provide evidence of pathways to universal drinking water services for billions more.

PREVENTIVNE MJERE KONTROLE Legionella U VODOOPSKRBNIM SUSTAVIMA TIJEKOM EPIDEMIJE

U ovom su članku opisane i sažete strategije i mjere koje bi se trebale primjenjivati u Hrvatskoj u svrhu sprječavanja kontaminacije vodoopskrbnih sustava pojedinih ustanova bakterijom Legionella tijekom pandemije COVID-19. Kolonizacija bakterije Legionella u vodovodnim instalacijama povećava rizik od zaraze ljudi, stoga je važno istaknuti da je ovaj problem javnog zdravstva još veći tijekom drugih epidemija. Legionella može uzrokovati vrlo ozbiljne vrste upale pluća, tzv. legionarsku bolest i manje opasnu pontijačku groznicu. Hrvatska će u svoje zakonodavstvo implementirati izmjenjenu EU Direktivu 2020/2184 o kvaliteti vode za ljudsku potrošnju koja po prvi put uključuje obvezu procjene rizika od bakterije Legionella. To bi trebalo pridonijeti u smanjenju zdravstvenih rizika ili komplikacija respiratornih infekcija (teške upale pluća) i smrtnosti tijekom drugih epidemija (COVID-19 ili sl.).Alternate abstract:This paper describes and summarizes the strategies and measures that should be applied in Croatia toprevent Legionella contamination in drinking water systems in buildings during the COVID-19 epidemic. Legionellacolonisation in drinking water installations increases the risk of infection for humans and it is important to pointout that this public health problem is even greater during other epidemics. Legionella can cause very severe typesof pneumonia called Legionnaires' disease and less serious illness Pontiac fever. Therefore, Croatia will implementthe new EU Directive 2020/2184 on the quality of water intended for human consumption into its legislation, whichfor the first time includes an obligation to assess the risk of Legionella.This should help reduce the health risk orcomplications of respiratory infections (severe pneumonia) and mortality during other epidemics (COVID-19 andsimilar).Alternate abstract:In diesem Beitrag werden die Strategien und Maßnahmen beschrieben undzusammengefasst, die in Kroatien angewendet werden sollen zum Zwecke der Vorbeugung der Kontamination vonWasserversorgungssystemen verschiedener Institutionen mit Legionella-Bakterien während der COVID-19-Pandemie.Die Ansiedlung von Legionella-Bakterien in Wasserinstallationen erhöht das Infektionsrisiko beim Menschen,deswegen ist es wichtig darauf hinzuweisen, dass dieses Problem des öffentlichen Gesundheitswesens noch größerwährend anderer Epidemien ist. Legionellen können sehr schwere Arten von Lungenentzündungen verursachen, diesgn. Legionärskrankheit und das weniger gefährliche Pontiac-Fieber. Kroatien wird durch seine Gesetze die Richtlinie(EU) 2020/2184 über die Qualität von Wasser für den menschlichen Gebrauch umsetzen, die zum ersten Mal dieAnforderung der Risikobewertung eines Versorgungssystems in Bezug auf Legionellen enthält. Das sollte helfen,die Gesundheitsrisiken oder Komplikationen von Atemweginfektionen (schwere Lungenentzündungen)sowie dieSterblichkeit während anderer Epidemien (COVID-19 und ähnliche) zu reduzieren.

Preventive measures for managing Legionella in drinking water systems during epidemics

This paper describes and summarizes the strategies and measures that should be applied in Croatia to prevent Legionella contamination in drinking water systems in buildings during the COVID-19 epidemic. Legionella colonisation in drinking water installations increases the risk of infection for humans and it is important to point out that this public health problem is even greater during other epidemics. Legionella can cause very severe types of pneumonia called Legionnaires' disease and less serious illness Pontiac fever. Therefore, Croatia will implement the new EU Directive 2020/2184 on the quality of water intended for human consumption into its legislation, which for the first time includes an obligation to assess the risk of Legionella. This should help reduce the health risk or complications of respiratory infections (severe pneumonia) and mortality during other epidemics (COVID-19 and similar).

Evaluation of Inosine-Acedoben-Dimepranol as an immunomodulator in broiler chicks vaccinated with Infectious bronchitis virus vaccine

Protecting livestock against diseases by enhancing its immunity is essential and required in poultry industry. Therefore, the aim of the present study was to evaluate the possible immunoenhancing effects of Inosine-Acedoben-Dimepranol (IAD) in broiler chicks. A total of 150 chicks were used in the present study, divided into 6 groups (25 for each) and subjected to different treatments. It has been found that IAD significantly (P 0.05) increased total leukocytic count, with increased granulocyte (neutrophils, eosinophils, basophils), lymphocyte and monocyte counts compared to control chicks. IAD significantly (P 0.05) increased total protein as a result of increased globulins in plasma when compared with those of control. IAD has been found to significantly (P 0.05) increase immune response of IB vaccine in IAD + IB vaccine-treated groups compared to control measured by ELISA. IAD exhibited antiviral effect indicated by increased survival percent of chicks challenged with virulent IB virus with survival 100% in the groups received IAD large dose plus vaccine. Data of the present study may indicate that supplying chicks with IAD in drinking water is a good recommendation in poultry industry based on its immune enhancing properties.

The effect of current infection control procedures and application times on the dimensional stability of dental impression materials

Aims: In this study, the effects of different disinfection and sterilization methods and their application duration on the dimensional stability of impression materials were evaluated. Methods: Two impression materials, condensation (CS) and addition silicone (VPS), disinfectants with 5.25% sodium hypochlorite (NaOCl) immersion, 3% hydrogen peroxide immersion and steam autoclave were selected. Disc-shaped samples (n=112) were obtained in 7 subgroups of each material (n=8). Sixteen untreated samples served as controls. Dimensional change was measured with a digital micrometer in the reference lines on the sample. Results: The highest mean percentage of dimensional change for the 50 min autoclave was 0.10±0.03% for CS and 0.10±0.02% for VPS. The dimensional change in CS did not differ for hydrogen peroxide. Compared with the controls, dimensional change was significant in 20 min NaOCl and 50 min autoclave (p<.05). Both impression materials in the autoclave showed statistically significant dimensional changes regardless of the time. The difference in application duration significantly affected the dimensional stability of the impression materials regardless of the procedure (p<.001). Extended application duration did not affect the dimensional stability in the hydrogen peroxide for CS, NaOCl and autoclave for VPS. Conclusions: Chemical disinfection and autoclave sterilization caused statistically significant but clinically acceptable dimensional changes in CS and VPS impression materials used in this study.

Photocatalytic Degradation of Paracetamol under Simulated Sunlight by Four TiO2 Commercial Powders: An Insight into the Performance of Two Sub-Micrometric Anatase and Rutile Powders and a Nanometric Brookite Powder

The photocatalytic degradation of the emerging contaminant paracetamol in aqueous solution has been studied under 1 SUN (~1000 W m−2) in the presence of four commercial TiO2 powders, namely sub-micrometric anatase and rutile, and nanometric brookite and P25 (the popular anatase/rutile mixture used as a benchmark in most papers). The rutile powder showed low activity, whereas, interestingly, the anatase and the brookite powders outperformed P25 in terms of total paracetamol conversion to carboxylic acids, which, according to the literature, are the final products of its degradation. To explain such results, the physicochemical properties of the powders were studied by applying a multi-technique approach. Among the physicochemical properties usually affecting the photocatalytic performance of TiO2, the presence of some surface impurities likely deriving from K3PO4 (used as crystallization agent) was found to significantly affect the percentage of paracetamol degradation obtained with the sub-micrometric anatase powder. To confirm the role of phosphate, a sample of anatase, obtained by a lab synthesis procedure and having a "clean” surface, was used as a control, though characterized by nanometric particles and higher surface area. The sample was less active than the commercial anatase, but it was more active after impregnation with K3PO4. Conversely, the presence of Cl at the surface of the rutile did not sizably affect the (overall poor) photocatalytic activity of the powder. The remarkable photocatalytic activity of the brookite nanometric powder was ascribed to a combination of several physicochemical properties, including its band structure and nanoparticles size.

Water safety management during the initial phase of the Covid-19 pandemic: challenges, responses and guidance

Water safety plans address both routine operations and incident responses to support risk management in drinking water utilities. Their use and relevance in facing the challenges of the Covid-19 crisis were investigated via a survey distributed to water utilities and health or environmental agencies across the globe. Responses from 86 respondents from 38 countries were analysed to identify the water safety challenges faced and responses. Water safety plans appear to provide some preparedness and organizational advantages to utilities in facing the Covid-19 crisis, including stronger communication links between utilities and governing agencies. Guidance for future water safety planning is provided.

Access to basic water, sanitation, and hygiene (WASH) facilities and associated factors in Ethiopia: evidence from demographics and health surveys

In low- and middle-income countries, ensuring water, sanitation, and hygiene (WASH) facilities for households remains a major public health concern. Therefore, this study aimed to assess households' access to WASH services and associated factors in Ethiopia. A cross-sectional study was conducted among 16,650 and 8,663 households in the 2016 Ethiopian Demographic Health Survey (EDHS) and 2019 Mini-EDHS, respectively. The households were selected using a stratified two-stage cluster sampling technique. Multivariable logistic regression analysis was performed to identify factors associated with basic WASH services. Households' access to basic water services was 65.2% (95% CI: 64.5–65.9%) and 68.7% (95% CI: 68.01–69.4%) in the 2016 EDHS and 2019 Mini-EDHS, respectively. Only 25.9% (95% CI: 25.2–26.62%) in the 2016 EDHS and 27.5% (95% CI: 26.34–28.3%) in the 2019 Mini-EDHS households had access to basic sanitation services. Moreover, only 38% (95% CI: 37.25–38.8%) of households had access to basic hygiene services in the 2016 EDHS. Female-headed households, urban residents, having education, family members ≥7, presence of soaps or detergents, and having a better wealth index were the most likely to have access to basic WASH services. The findings in general suggest the need for effective WASH interventions.

Thyroid outbreak during the pandemic of COVID-19: a report

Background : In the 19th Week of 2020, Integrated Disease Surveillance Programme (IDSP) noted an unusual increase in the number of fever cases in Routine Syndromic Surveillance. Objectives : The unusual increase of fever cases were investigated to identify the agent, the source of infection and to propose recommendations for control measures. Methods : Active surveillance of fever cases done, blood samples, stool samples and water samples were collected from the affected area. The secondary data of indoor and outdoor patient were collected from the nearest health facilities. Result : It was a single peak outbreak of typhoid, started from 1st May, 2020, had peaked during the 19th Week of May. 2020 and ended on 31st May, 2020. The epicentre of the outbreak was the residential colony of Industrial labour. The outbreak of Typhoid occurred due to conditions generated due to the pandemic of COVID -19. Two sources of active infection were found. First, contaminated supply of drinking water and second a food-handler, who was the carrier of Typhoid. Interpretation and Conclusion : It is a lesson to learn that the local communicable diseases should be monitor during the pandemic. Otherwise, that can cause the situation of co-epidemic.

Small Drinking Water Utilities' Resilience: The Case of the COVID-19 Pandemic

Extreme events can significantly disrupt the operation and maintenance (O&M) of drinking water utilities (DWUs), compromising community access to water in critical times. However, we posit that utility size can influence DWUs' resilience, as large DWUs may have a greater capacity to handle extreme and sudden changes characteristic of emergencies. Here, we explore the resilience of small DWUs by understanding how a global crisis (i.e., the COVID-19 pandemic) affected small DWUs and how these impacts statistically differ from those of large DWUs using statistical inferencing. We used two data sets that reflect the perspectives of 28 large and 26 small DWUs from 14 states. We found that small DWUs experienced issues involving supply chain, finances, and personnel management that pre-existing issues may have magnified. Additionally, small and large DWUs experienced statistically significant differences in personnel management, revenue change, increase in delinquent accounts, and emergency response plan activation. For example, large DWUs experienced more revenue loss than small DWUs due to economies of scale and larger changes from status quo operations. This study reveals areas of concern (and opportunities) regarding the resiliency of small DWUs in the face of emergencies that can allow policymakers to assist small DWUs. © 2023 American Chemical Society.