Differences in Associated Factors of Underweight and Overweight According to Rural-Urban Residence Strata among Ever-Married Non-Pregnant Women of Reproductive Age in Bangladesh.

Background: This study sought to compare the prevalence of underweight and overweight among ever-married, non-pregnant women of reproductive age in Bangladesh by urban or rural residency status. Methods: This study used Bangladesh Demographic and Health Survey (BDHS), 2017 data. Cross-sectional study design with two-stage stratified sampling method was employed. A sample of ever-married non-pregnant women of reproductive age was selected and multinomial logistic regression was utilised in analysis. Results: It was found that around half of rural women (45.0%, N = 4,934) and more than half of urban women (60.3%, n = 3,913) were overweight. Nearly one in seven rural women (14.0%, n = 1,537) and 1 in 12 urban women (9.0%, n = 564) were reported as underweight. Our analyses revealed that being overweight was substantially connected with age, husband's occupation, economic status, television access, and division for both urban and rural areas. Women from poor households were significantly more likely to be underweight than women from middle- income households for both urban (P < 0.05; OR: 1.41; 95% CI: 1.03, 1.94) and rural (P < 0.05; OR: 1.23; 95% CI: 1.04, 1.46) areas. Interestingly, women without television access both in urban (P < 0.001; OR = 0.78; 95% CI: 0.67, 0.91) and rural (P < 0.001; OR = 0.75; 95% CI: 0.68, 0.84) areas had an inverse association with overweight/obesity compared to women with television access. In both areas, women in Sylhet and Mymensingh had higher likelihood of being underweight than Barisal division. Additionally, in both residential zones, women in Sylhet had lower likelihood of being overweight than Barisal division. Conclusion: This study reveals that multiple characteristics are linked to both overweight and underweight among ever-married, non-pregnant women of reproductive age in Bangladesh. Addressing these variables should be a priority in public health efforts to combat the dual challenge of malnutrition in Bangladesh.

A game-theoretic approach to designing carbon regulations in a duopoly freight transportation market: Road and multimodal road-rail competitive systems.

Since the transportation industry produces remarkable carbon emissions worldwide, governments aim to curb these emissions by implementing different carbon regulations. However, little is known regarding how the heterogeneity of transportation systems should be exploited to design carbon regulations. To fill this research gap, the present article formulates carbon cap-and-trade and carbon offset regulations to reduce total carbon emissions produced by road and multimodal road-rail freight transportation systems (FTSs) in a duopoly market; the latter is regarded as a green, energy-efficient transportation mode. A novel procedure is suggested to allocate initial carbon caps that is a hybrid of both benchmark and grandfathering methods. The procedure allows the government to exploit the energy efficiency of the multimodal system, when targeting a reduction of total carbon. Then, a game-theoretic approach is adopted to implement the mentioned carbon regulations. A government, as a Stackelberg leader, maximizes a social welfare function containing economic, social, and environmental dimensions. Under the cap-and-trade regulation, a Nash bargaining process is proposed to trade carbon permits between the FTSs, as the followers, for updating their initial caps. The equilibrium outputs of the two mentioned carbon regulations and a carbon tax regulation are compared. The findings based on an experimental analysis suggest that the cap-and-trade (carbon offset) is the optimal and energy-efficient regulation from the social (economic or environmental) perspective. In terms of policy implications, our findings indicate that the development of a marketplace infrastructure for trading carbon permits is not justifiable under the economic and environmental perspectives of the government.

Supplementation with spinach-derived thylakoid augments the benefits of high intensity training on adipokines, insulin resistance and lipid profiles in males with obesity.

Introduction: This study investigated the effects of 12 weeks of high-intensity functional training (HIFT) combined with spinach-derived thylakoid supplementation on some selected Adipokines and insulin resistance in males with obesity. Method: Sixty-eight participants (mean age: 27.6 ± 8.4 yrs.; mean height: 168.4 ± 2.6 cm; mean weight: 95.7 ± 3.8 kg, mean BMI: 32.6 ± 2.6 kg/m2) were randomly divided into four groups of 17 per group: Control group (CG), Supplement group (SG), Training group (TG), and Training + supplement group (TSG). Following baseline measurements, the two training groups (TG and TSG) started the 12 weeks of exercise training program (3 sessions per week). A total of 36 sessions lasting up to 60 min were included in the HIFT program using the CrossFit program. The eligible participants received 5 g/day of thylakoid-rich spinach extract or matching placebo as 5 g/day of raw corn starch (one sachet, 30 min before lunch) for 12 weeks. Baseline assessments were obtained 48 hours before the start of the training protocols and 48 hours after the last training session in all groups. Results: There were significant interactions (p<0.001 for all) between exercise and time for adiponectin (ES:0.48), leptin (ES:0.46), resistin (ES:0.3), omentin (ES:0.65), vaspin (ES:0.46), visfatin (ES:0.62), apelin (ES:0.42), RBP4 (ES:0.63), chemrin (0.36) and semaphorin3c (ES: 0.5). Plasma levels of semaphorin3c were significantly correlated (p<0.05) with body weight (r= 0.57), BMI (r= 0.43), FFM (r= -0.612), FAT (r= 0.768), VO2peak (r=-0.53), insulin (r= 0.756), glucose (r= 0.623), and HOMA-IR (r= 0.727). There were also significant group differences in insulin (ES: 0.77), glucose (ES: 0.21), and HOM-IR (ES: 0.44) (p<0.05). Discussion: Our findings indicate that 12 weeks of HIFT supplemented with spinach-derived thylakoid reduced levels of leptin, resistin, vaspin, visfatin, apelin, RBP4, chemrin, semaphorin3c and insulin resistance while increasing adiponectin and omentin levels in men with obesity.

Matching medical staff to long term care facilities to respond to COVID-19 outbreak.

BACKGROUND: Staff shortage is a long-standing issue in long term care facilities (LTCFs) that worsened with the COVID-19 outbreak. Different states in the US have employed various tools to alleviate this issue in LTCFs. We describe the actions taken by the Commonwealth of Massachusetts to assist LTCFs in addressing the staff shortage issue and their outcomes. Therefore, the main question of this study is how to create a central mechanism to allocate severely limited medical staff to healthcare centers during emergencies. METHODS: For the Commonwealth of Massachusetts, we developed a mathematical programming model to match severely limited available staff with LTCF demand requests submitted through a designed portal. To find feasible matches and prioritize facility needs, we incorporated restrictions and preferences for both sides. For staff, we considered maximum mileage they are willing to travel, available by date, and short- or long-term work preferences. For LTCFs, we considered their demand quantities for different positions and the level of urgency for their demand. As a secondary goal of this study, by using the feedback entries data received from the LTCFs on their matches, we developed statistical models to determine the most salient features that induced the LTCFs to submit feedback. RESULTS: We used the developed portal to complete about 150 matching sessions in 14 months to match staff to LTCFs in Massachusetts. LTCFs provided feedback for 2,542 matches including 2,064 intentions to hire the matched staff during this time. Further analysis indicated that nursing homes and facilities that entered higher levels of demand to the portal were more likely to provide feedback on the matches and facilities that were prioritized in the matching process due to whole facility testing or low staffing levels were less likely to do so. On the staffing side, matches that involved more experienced staff and staff who can work afternoons, evenings, and overnight were more likely to generate feedback from the facility that they were matched to. CONCLUSION: Developing a central matching framework to match medical staff to LTCFs at the time of a public health emergency could be an efficient tool for responding to staffing shortages. Such central approaches that help allocate a severely limited resource efficiently during a public emergency can be developed and used for different resource types, as well as provide crucial demand and supply information in different regions and/or demographics.

Cooperation, coordination, or collaboration? A structured review of buyers' partnerships to support sustainable sourcing in supply chains.

The growing need of today's global supply chains for a paradigm shift to sustainability requires all supply chain members to establish partnership relationships. However, the existing literature fails to provide a comprehensive understanding of these partnerships. The present research contributes to understanding the nature and structure of the buyers' partnerships for enhancing sustainable sourcing. A structured review methodology is adopted to collect information about supply chain partnerships from the literature on sustainable sourcing. Then, a content analysis is conducted on the collected information using a comprehensive partnership framework, i.e., the McNamara framework. The framework suggests ten interconnected facets to characterize the structure of a partnership and classifies the nature of partnerships into three categories called cooperation, coordination, and collaboration. The findings indicate that cooperative partnerships are not effective for promoting sustainable sourcing as they lack the exchange of resources between the participating organizations. In contrast, coordinative partnerships are mainly effective for tactical and operational initiatives to address reactive, end-of-pipe solutions for sustainable sourcing. Finally, collaborative partnerships should be mainly initiated at the strategic level to design proactive solutions for sustainable sourcing. Some practical implications are provided to facilitate the transition of supply chains to sustainability. Some open questions for future research are also provided.

Impact of using a centralized matching process on nursing home staffing.

OBJECTIVE: To examine the effectiveness of adopting a novel centralized matching process for reducing staff shortages in Massachusetts nursing homes during the COVID-19 pandemic. METHODS: This study involved several datasets and 216 Massachusetts nursing homes that used a novel online portal to enter demand for nursing staff from May 2020 to April 2021. RESULTS: There were significant associations between the staff-to-resident ratio and demand entries lagged by three and four weeks, and no significant associations between the staff-to-resident ratio and demand entries lagged by one and two weeks. In contrast, we found significant associations between the staff-to-resident ratio and the number of generated staff matches lagged by one, two and three weeks, with larger impacts overall. CONCLUSION: This study shows how adopting a centralized matching process may expedite and increase improvement in the staff-to-resident ratio in nursing homes, compared with the setup in which nursing homes need to seek nurses on their own.

A game-theoretic approach to designing an optimal code of conduct program to promote supplier sustainability in a supply chain.

In recent years, suppliers in developing countries face the challenge of their low technological and knowledge-related capabilities to enhance sustainability. In addition, buying firms cannot optimize the performance of the whole supply chain because the supplier sustainability practices are unobservable to them and to the public. These two challenges lead to the occurrence of several environmental and social scandals. These scandals pose serious economic and reputational consequences to supply chain members, especially buying firms. Given these challenges and using a sequential game-theoretic methodology, our contribution to the literature on supplier sustainability is to address the effects of supplier code of conduct (SCC) programs on different performance indicators of supply chains. Our analyses indicated that (a) an SCC program can mitigate the supply chain performance deficiencies created by the lack of the integrated optimization of the whole supply chain. Moreover, an SCC program can be superior to some common auditing programs initiated by buying firms. (b) In cases that the supplier's capability is low or moderate, an SCC program provides a Pareto improvement in its sustainability level and the buying firm's profit. (c) High consumer awareness threatens the buying firm's survival in the market. Given this threat, an SCC program indirectly enhances the buying firm's potential to survive. (d) Buying firms should lower their suppliers' wholesale prices in exchange for a substantial investment in their suppliers' capabilities, irrespective of whether or not an SCC program is initiated.

Continuous exposure to ambient air pollution and chronic diseases: prevalence, burden, and economic costs.

Studies that assess the connection between the prevalence of chronic diseases and continuous exposure to air pollution are scarce in developing countries, mainly due to data limitations. Largely overcoming data limitations, this study aimed to investigate the association between the likelihood of reporting a set of chronic diseases (diabetes, cancer, stroke and myocardial infarction, asthma, and hypertension) and continuous exposure to carbon monoxide (CO), nitrogen dioxide (NO2), ozone (O3), and coarse particulate matter (PM10). Using the estimated associations, the disease burden and economic costs of continuous exposure to air pollutants were also approximated. A 2011 Health Equity Assessment and Response Tool survey from Tehran, Iran, was used in the main analyses. A sample of 67,049 individuals who had not changed their place of residence for at least 2 years before the survey and reported all relevant socioeconomic information was selected. The individuals were assigned with the average monthly air pollutant levels of the nearest of 16 air quality monitors during the 2 years leading to the survey. Both single- and multi-pollutant analyses were conducted. The country's annual household surveys from 2002 to 2011 were used to calculate the associated economic losses. The single-pollutant analysis showed that a one-unit increase in monthly CO (ppm), NO2 (ppb), O3 (ppb), and PM10 (µg/m3) during the 2 years was associated with 751 [confidence interval (CI): 512-990], 18 (CI: 12-24), 46 (CI: -27-120), and 24 (CI: 13-35) more reported chronic diseases in 100,000, respectively. The disease-specific analyses showed that a unit change in average monthly CO was associated with 329, 321, 232, and 129 more reported cases of diabetes, hypertension, stroke and myocardial infarction, and asthma in 100,000, respectively. The measured associations were greater in samples with older individuals. Also, a unit change in average monthly O3 was associated with 21 (in 100,000) more reported cases of asthma. The multi-pollutant analyses confirmed the results from single-pollutant analyses. The supplementary analyses showed that a one-unit decrease in monthly CO level could have been associated with about 208 (CI: 147-275) years of life gained or 15.195 (CI: 10.296-20.094) thousand US dollars (USD) in life-time labor market income gained per 100,000 30-plus-year-old Tehranis.

A mechanism design approach to a buyer's optimal auditing policy to induce responsible sourcing in a supply chain.

Responsible sourcing refers to the compliance of suppliers with environmental and social standards. In today's supply chains, buyers and external stakeholders use auditing mechanisms to induce responsible sourcing. For the first time, this paper investigates the effect of a buyer's audits on the tactical decisions of supply chains. We address a repeated game with one buyer and one critical supplier. At the strategic stage, the buyer chooses the optimal auditing efforts to induce responsible sourcing. At the tactical stages, the buyer and supplier compete with each other for their profit margins, while the buyer also determines the quantity of production. Moreover, the supplier chooses between responsible and irresponsible production. Two auditing mechanisms are defined for the buyer: strong incentive compatibility (SIC) and weak incentive compatibility (WIC). The effectiveness and backfiring conditions for these auditing mechanisms are identified. The former denotes that the mechanism can induce responsible sourcing, while the latter denotes the conflict between supply chain transparency and responsible sourcing. The results show that the supplier requires an efficiency wage for compliance with responsible sourcing standards. We find that auditing mechanisms in supply chains face an unintended consequence. Higher auditing efforts by the buyer reduce the supplier's wholesale price. This reduction may offset the greater potential for discovery obtained by higher auditing efforts. We also show that the effect of consumer awareness on responsible sourcing is not straightforward and depends strongly on the buyer's auditing mechanism. If the buyer chooses the SIC (WIC) auditing mechanism, consumer awareness always favors (threatens) responsible sourcing. Finally, this research suggests that coordination between buyers and external stakeholders contributes greatly to responsible sourcing.

Maxillofacial injuries in western Iran: a prospective study.

INTRODUCTION: Although the epidemiology of facial injuries has been studied in many populations, there is a paucity of information in the literature in this relation in the Middle East including Iran. The aim of this study was to assess the epidemiology and mode of treatment of facial injuries in western Iran. MATERIAL AND METHODS: We examined all patients with a maxillofacial injury who presented to the outpatient department or who were hospitalized in the Besat Hospital of Hamedan City, Iran, between 20 December 2007 and 20 December 2009. RESULTS: Of 2,450 patients (77% male, 23% female) with a facial injury, 90% sustained soft tissue injuries and 37% had bone fractures. Motor vehicle accidents (MVAs) were the most common cause of injuries (35%). The most frequent bone fracture occurred in the nasal bone (63.4%). The incidence of associated injuries was 8.3% (mostly orthopedic). Rigid internal fixation was the main treatment of facial fractures. Malpositioned zygomas and functional and aesthetic problems after reconstruction of nasal-orbital-ethmoid injuries were the most common postoperative complications. DISCUSSION: Although in many countries the rate of facial injuries due to traffic accidents is decreasing, MVA is still the major cause of facial trauma in Iran. This may be due to the lack of enforcement of traffic laws by police and insufficient compliance of the population in obeying traffic rules. Rigid internal fixation was the most common mode of treatment of facial fractures, and in spite of the severity of facial injuries, the rate of postoperative complications was relatively low.