The circulating pellet fluidized bed (CPFB) softening method is a highly efficient and environmentally friendly softening technology that can be used to reduce water hardness during the pretreatment process of circulating water in thermal power plants. The performance of chemical crystallization CPFB reactors was tested for increasing the concentration ratio and softening the circulating water in a thermal power plant in Dingzhou, Hebei. The results show that usage of CPFB reactors removed water hardness and Ca²⁺ ions with efficiencies exceeding 60% and 90%, respectively. The size of the particles discharged from the reactors was approximately 1–3 mm, and the content of CaO in these particles was found to be greater than 50%. All the discharged particles were reused in the desulfurization system in the power plant. The operational cost of the CPFB system is US$0.074 per cubic meter of water. After adopting the proposed CPFB softening method in the Dingzhou Power Plant, the concentration ratio of the circulation cooling water was increased from 4.5 to more than 9. In addition, the amount of replenished water and sewage discharge were both reduced by 150 m³/h, and the amount of scale inhibitor used in the system was reduced by more than 30%. These improvements contribute to approximately US$200,000 in annual savings in the power plant. In summary, the CPFB softening method demonstrated a high hardness removal rate, strong economic benefits, and remarkable environmental and social benefits. Therefore, this method seems ideal for softening replenished circulating cooling water, increasing the concentration ratio of the water and achieving zero liquid discharge (ZLD) in thermal power plants. Full article

Objectives: Exploring determinants underlying disparities in full vaccination coverage (FVC) can contribute to improved immunization interventions. FVC and its risk factors in Zhejiang province have been studied, yet the determinants explaining the rural–urban disparity in FVC have not been studied. This study aimed to disentangle the factors explaining rural–urban disparities in FVC of vaccine doses scheduled during the first year of life in Zhejiang province. Methods: We used data from a vaccination coverage survey among children aged 24–35 months conducted in 2016. The outcome measure was full vaccination status, and the grouping variable was the area of residence. Descriptive statistics were used to analyze the FVC and rural–urban residence across the exposure variables. The Fairlie decomposition technique was used to decompose factors contributing to explaining the FVC disparity. Results: There were 847 children included in this study, of which 49.6% lived in a rural area. FVC was 94% in rural areas and 85% in urban areas. A disparity of 9% to the advantage of the rural areas and the exposure variables explained 81.1% of the disparity. Maternal factors explained 49.7% of the explained disparity with education, occupation, and ethnicity being the significant contributors to the explained disparity. Children’s birth order and immigration status contributed somewhat to the explained inequality. Conclusion: There was a significant disparity in FVC in Zhejiang province, a disadvantage to the urban areas. Policy recommendations or health interventions to reduce the inequality should be focused on eliminating poverty and women’s illiteracy, targeted at migrant children or children from minority ethnicities. Full article

Background: Environmental tax has been implemented by the government in response to the demands of the residents to control environmental pollution. However, a tax has a wide effect on many interacting aspects of the society. It remains unknown whether enacting an environmental tax for the government can improve the residents’ happiness. This study aimed to examine the impact of air and water pollution on residents’ happiness and evaluate whether an environmental tax can alleviate the impact of air and water pollution on residents’ happiness. Methods: Based on the 2015 Chinese General Social Survey Data, 28 provinces in China were divided into two categories according to their environmental tax rates: baseline-tax areas (n = 13) and high-tax areas (n = 15). The ordered probit model was used to analyze the impact of air and water pollution on the residents’ happiness in baseline-tax areas and high-tax areas, respectively. The Chow Test was used to test whether the impact of environmental pollution on happiness was different between baseline-tax areas and high-tax areas. Results: The impact of air pollution on residents’ happiness was statistically significant in the baseline-tax areas (coefficient −0.162, 95% confidence interval (CI) −0.239, −0.086, p < 0.001), but the significance was weakened in the high-tax areas (coefficient −0.030, 95% CI −0.060, 0.000, p = 0.051). The Chow Test showed that the absolute value of the regression coefficient in the baseline-tax areas was significantly higher than the value in the high-tax areas (F = 12.712, p < 0.001). Similarly, the impact of water pollution on residents’ happiness was statistically significant (coefficient −0.264, 95% CI −0.353, −0.174, p < 0.001) in the baseline-tax areas and in the high-tax areas (coefficient −0.063, 95% CI −0.091, −0.035, p < 0.001), but the Chow Test showed that the absolute value of the regression coefficient in the baseline-tax areas was significantly higher than the value in the high-tax areas (F = 13.758, p < 0.001). Conclusions: Both air and water pollution impair residents’ happiness. The present study shows for the first time that enacting an environmental tax significantly alleviates the negative effect of air and water pollution on residents’ happiness. The findings of the present study provide empirical evidence for the government to levy environmental tax. Full article

The purpose of this study is to identify the willingness of pensioners to move from an apartment/house to an apartment/house located in a housing estate specifically designed for senior citizens. As such, this article forms part of the discussion of the housing needs of senior citizens, their preferences and willingness to change their place of residence. The research covers a group of post-working-age people residing in the region of Lower Silesia in south-western Poland. Various research methods were used in the study, including a written questionnaire and its statistical analysis. The research focuses on analysing both the preferences of potential buyers of apartments for seniors and seniors’ willingness to change their place of residence in order to purchase an apartment adapted to their mobility needs (free from architectural and technical barriers), taking into account the respondent’s age and housing situation. The research indicates that city residents are significantly more often willing to change their current place of residence for one adapted to the needs of persons with disabilities than residents of rural areas. In turn, those living with their husband or wife are significantly more likely to state that special offers for seniors do not need to be developed than those living alone or with other family members or in a social care home. No relationship was found between the age of a respondent and the desire to move to a new house. However, younger seniors are more open to moving to housing estates offering facilities for the elderly who require additional care. Full article

In May 2018, the non-governmental organization (NGO) Doctors with Africa CUAMM began to implement an intervention to strengthen Chiulo Hospital’s public health section to deliver immunization services in Mucope Comuna, Ombadja District. We aimed to evaluate the effect of this intervention. During the intervention period, actions such as staff training, improvement in the monitoring of vaccine stockpile, and the involvement of Community Health Workers were performed. The effects of the intervention on the number of vaccine doses administered were examined using negative binomial regression. Doses administered were 14,221 during the intervention period and 11,276 in the pre-intervention one. The number of administered doses was 26% higher (95% CI 9%–45%) in the intervention period than in the pre-intervention period. This was driven by vaccine doses administered during outreach sessions, where a statistically significant increase of 62% (95% CI 28%–107%) was observed. Regarding individual vaccines, statistically significant increases in the number of doses were observed for OPV2 (76%), OPV3 (100%), Penta3 (53%), PCV3 (53%), and Rota2 (43%). The NGO interventions led to improved delivery of immunization services in the study area. Greater increases were observed for vaccine doses that are more likely to be missed by children. Full article

In gymnastics, coaches are constantly searching for efficient training methods in order to improve the athletes’ performance. Therefore, in this study we aimed to investigate the effects of a novel, four-week, gymnastic-specific, eccentric–isokinetic (0.1 m/s) cluster training on a computer-controlled training device on the improvement of two static strength elements on rings (swallow and support scale). Nine elite male gymnasts participated in this study. Outcome parameters were maximum strength and strength endurance in maintaining the static position of both elements. After four weeks of training, specific maximum strength increased significantly (swallow: +4.1%; d = 0.85; p = 0.01; support scale: +3.6%; d = 2.47; p = 0.0002) and strength endurance tended to improve (swallow: +104.8%; d = 0.60; p = 0.07; support scale: +26.8%; d = 0.27; p = 0.19). Our results demonstrate that top athletes can considerably improve ring-specific strength and strength endurance in only four weeks. We assumed that the high specificity but also the unfamiliar stimulus of slow eccentric movements with very long times under maximal muscle tension led to these improvements. We suggest to use this type of training periodically and during phases in which the technical training load is low. Full article

In the European Union, the Environmental Impact Assessment (EIA) Directive (2014/52/EU) and Strategic Environmental Assessment (SEA) Directive (2011/92/EU) emphasise the assessment of population and human health. The directives require health to be considered within Environmental Impact Assessment (EIA) and Strategic Environmental Assessment (SEA). To date, health is mainly considered in connection with negative environmental factors and in terms of risk assessments. The integration of health in EIA as well as SEA has not been investigated in a Danish context, and this study aims to address the missing knowledge. There is a need for a more comprehensive health assessment within EIA and SEA to comply with the EIA and SEA directives. An integration of health into EIA and SEA will ensure a sound examination of health determinants which can improve decision making and thus comprehensively promote and protect health. To establish the status of the inclusion of the assessment of impacts on health into EIA and SEA, a literature review was performed. In addition, a survey addressed to researchers and practitioners was conducted and analysed through a comparative analysis. The survey examined the needs of practitioners and researchers, focusing on the Danish context, regarding the inclusion of health into EIA and SEA. Enhanced intersectoral cooperation of the health and environmental sectors, more specific guidance documents, and underlying this, stronger political support, were identified among needs for more comprehensive health assessments. Full article

Respiratory tract infection (RTI) is a major public health challenge during the Muslim pilgrimage to Makkah. This study aims to evaluate the knowledge, attitude, and practice of Malaysian Hajj and Umrah pilgrims towards the prevention of RTIs in 2018 and determine correlations among three domains. A cross-sectional study was conducted among 225 Umrah and Hajj pilgrims. Knowledge, attitude, and practice (KAP) towards RTI prevention was assessed by using a validated self-administered questionnaire among pilgrims attending a weekly orientation course organized by private Hajj/Umrah companies. Out of 225 participants, 65.9% of respondents were female with the mean (SD) age of 46.74 (13.38) years. The interquartile range (IQR) score for knowledge is 18.0 (6.0), the mean scores of attitude and practice are 32.65 (4.72) and 25.30 (4.9). respectively. Significant and negative linear correlations between knowledge and practice (r = −0.232, p < 0.001), and attitude and practice (r = 0.134, p = 0.045) were observed. Results from the current study showed good knowledge of RTIs among Malaysian pilgrims. However, a poor attitude was reflected in their preventive practice behaviors. This will further help in the prevention and management of RTIs during Hajj and Umrah. Therefore, an extensive educational health campaign should be provided to pilgrims to create awareness. Full article

Heatwave studies typically estimate heat-related mortality and morbidity risks at the city level; few have addressed the heterogeneous risks by socioeconomic status (SES) and location within a city. This study aimed to examine the impacts of heatwaves on mortality outcomes in Memphis, Tennessee, a Mid-South metropolitan area top-ranked in morbidity and poverty rates, and to investigate the effects of SES and urbanicity. Mortality data were retrieved from the death records in 2008–2017, and temperature data from the Applied Climate Information System. Heatwave days were defined based on four temperature metrics. Heatwave effects on daily total-cause, cardiovascular, and respiratory mortality were evaluated using Poisson regression, accounting for temporal trends, sociodemographic factors, urbanicity, and air pollution. We found higher cardiovascular mortality risk (cumulative RR (relative risk) = 1.25, 95% CI (confidence interval): 1.01–1.55) in heatwave days defined as those with maximum daily temperature >95th percentile for more than two consecutive days. The effects of heatwaves on mortality did not differ by SES, race, or urbanicity. The findings of this study provided evidence to support future heatwave planning and studies of heatwave and health impacts at a coarser geographic resolution. Full article

Saturation in hospital emergency departments is one of the main safety problems for the patient, which can generate negative consequences for their health. In response to this issue, triage systems are developed to organize the flow of patients in order to allow the most urgent ones to be treated first. The Emergency Severity Index (ESI) is the most used triage system in the USA and it has been implemented in the General Hospital of La Palma since 2010. The objective of this study is the validation of the ESI adapted to our hospital through the study of its degree of reliability, as well as the criterion validity. The sample consisted of 240 randomly selected cases, with proportional representation of emergencies attended in 2015 and their fraction of urgent ones (Levels 1 and 2). Criterion validity was estimated by sensitivity, specificity, and predictive result values. For reliability, the degree of agreement among the nurses was studied by means of the adapted kappa index k_c2. Criterion validity showed a sensitivity of 89% (85–93%) and a specificity of 97% (94–99%), with a positive predictive value of 68% (62–74%) and a negative predictive value of 99% (98–100%) for the discrimination of urgent cases. The reliability analysis showed a k_c2 = 0.94 (0.84–0.99) index, a very good agreement according to Landis-Koch criteria. The results of our study have shown adequate validity and reliability in the adaptation and implementation of an ESI triage system suited to the specific conditions of a hospital emergency service in Spain. Full article

This paper constructs a dual-channel value chain composed of one altruistic manufacturer and one altruistic retailer, where the manufacturer makes green innovation input for green products and sells its green products to its customers through both the direct channel and the traditional channel, the retailer provides channel service for customers and sells green products through the traditional channel. We consider two scenarios in which the manufacturer and the retailer make decentralized and centralized decisions, respectively. We develop two dynamic game models for the two scenarios and analyze the dynamic behaviors of the two dynamic game models using bifurcation diagram, LLE (largest Lyapunov exponent) and attraction of basin, etc. We find that the stability region in decentralized decision model is greater than that of centralized decision, and narrow with increase of service value, green innovation input. In the decentralized decision model, the stability of the system decreases with the altruistic behavior increasing. With the price adjustment speed increasing, the dual-channel green value chain system enters into chaotic state through flip bifurcation or N-S bifurcation. In the stable state, the manufacturer and the retailer can obtain the maximum utility with the appropriate value of green innovation input. In the chaotic state, the utilities of the manufacturer and retailer are greatly affected and significantly reduced. This study will provide good guidance for sustainable development decision-making of dual-channel green value chain. Full article

Home-based interventions targeting children’s sedentary behaviours have had limited and inconsistent effectiveness, possibly due to a mismatch between the behaviours targeted, the behaviours actually performed, and health-risk messages parents need to initiate change. Between October 2017–February 2018, 540 parents completed an online survey indicating their own and their child’s participation in 15 home-based sedentary behaviours (child mean age 11.1 ± 2.61 years, 52% male; parent mean age 40.7 ± 6.14, 93% female). Parents also indicated which home-based sedentary behaviours they and their child could reduce, and what health-risk messages would make them change their child’s behaviours. The most prevalent sedentary behaviours among children (particularly older children) and parents were screen-based leisure-time activities, specifically TV/video/DVD use (67.5 and 62.5 min/day, respectively) and using a tablet/smart phone for leisure (53.6 and 80.8 min/day, respectively). Importantly, these were also perceived as the most feasible behaviours parents and children could reduce. Parents reported that the following messages would help them reduce their child’s sedentary behaviour: sitting may increase the risk of poor mental health (85.2% of parents) and adversely impact future health as an adult (85.1%). These findings highlight feasible behavioural targets and intervention content for programs aiming to reduce sedentary behaviours in the home environment. Further research is needed to test these strategies. Full article

Despite abundant literature on antenatal and delivery care received by pregnant women, there is a wide knowledge gap on the prevalence of symptoms of discomfort or problems during the postpartum period and their relationship with the mode of delivery. This cross-sectional study, carried out with 3324 participants in Spain in 2017, aimed to investigate the association between the mode of delivery and self-reported postpartum symptoms of discomfort and maternal problems during the puerperium. An ad hoc online questionnaire was used to collect data on socio-demographic and obstetric variables, symptoms of discomfort, and maternal problems during the puerperium. The crude odds ratios (OR) and adjusted OR (aOR) and their 95% confidence intervals (95%CI) were calculated using binary logistic regression. In total, 3324 women participated. Compared to a normal vaginal delivery, having a cesarean section was associated with increased odds of an infected surgical wound (aOR: 11.62, 95%CI: 6.77–19.95), feeling sad (aOR: 1.31, 23 95%CI: 1.03–1.68), and symptoms of post-traumatic stress (aOR: 4.64, 95%CI: 2.94–7.32). Instrumental delivery vs. normal vaginal delivery was a risk factor for constipation (aOR: 1.35 95%CI: 25 1.10–1.66), hemorrhoids (aOR: 1.28, 95%CI: 1.04–1.57), urinary incontinence (aOR: 1.30, 95%CI: 26 1.05–1.61), and fecal incontinence (aOR: 1.94, 95%CI: 1.29–2.92) during the puerperium. Women who gave delivery via cesarean section or instrumental delivery had higher incidences of infection and psychological alterations than those who had a normal vaginal delivery. Identifying women at risk of giving birth by cesarean section and informing them about subsequent symptoms of discomfort and maternal problems during the puerperium must be included in pregnancy health program policies and protocols to allow women to make informed decisions regarding their birthing plan. Full article