The world in recent years has seen a pandemic of global scale. To counter the widespread loss of life and severe repercussions, researchers developed vaccinations at a fast pace to immunize the population. While the vaccines were developed and tested through extensive human trials, historically vaccines have been known to evoke mixed sentiments among the generic demographics. In the proposed study, we aim to reveal the impact of political and socio-economic factors on SARS-Cov-2 vaccination trends observed in two hundred and seventeen countries spread across the six continents.The study had hypothesized that the citizens who have lower trust in their government would be less inclined towards vaccination programs. To test this hypothesis, vaccination trends of nations under authoritarian rule were compared against democratic nations. Further, the study was synthesized with Cov-2 vaccination data which was sourced from Our World Data repository, which was sampled among 217 countries spread across the 6 continents. The study was analyzed with exploratory data analysis and proposed with relevance and impacting factor that was considered for vaccine dissemination in comparison with the literacy rate of the nations. Another impacting factor the study focused on for the vaccination dissemination trends was the health expenses of different nations. The study has been synthesized on political and socio-economic factors where the features were ardently study in retrospect of varied socio- economic features which may include country wise literacy rate, overall GDP rate, further we substantiated the work to address the political factors which are discussed as the country status of democratic or having other status.The comparison of trends showed that dissemination of SARS-Cov-2 vaccines had been comparable between the two-opposing types of governance. The major impact factor behind the wide acceptance of the SARS-Cov-2 vaccine was the expenditure done by a country on healthcare. These nations used a large number of vaccines to administer to their population and the trends showed positive growth. The overall percentage of vaccine utilized by countries in quantitative terms are Pfizer/BioNTech (17.55%), Sputnik V (7.08%), Sinovac (6.98%), Sinopharm/Beijing (10.04%), Oxford/AstraZeneca (19.56%), CanSino (2.85%), Moderna (12.05%), Covaxin (3.28%), JohnsonandJohnson (10.89%), Sputnik Light (3.07%), Novavax (3.49%). While the nations with the lowest healthcare expenses failed to keep up with the demand and depended on vaccines donated by other countries to protect their population.The analysis revealed strong indicators that the nations which spend more on healthcare were the ones that had the best SARS-Cov-2 vaccination rollout. To further support decision-making in the future, countries should address the trust and sentiment of their citizens towards vaccination. For this, expenses need to be made to develop and promote vaccines and project them as positive health tools. The global stance, in the current scenario of the pandemic, has imposed a substantial burden on healthcare practitioners. The ultimate aim of researchers and scientists worldwide is to fight the ongoing situation and discover significant vaccines which can reduce the mortality rate among society. As we know, the decisive way to overcome the ongoing situation is to immunize the population. Moreover, the existing circumstances infer that, if we need to prevent and control the spread of COVID-19, then immunization would play an imperative role.Certainly, COVID-19 has imprudently created several challenges among young researchers, scientists, and healthcare practitioners around the globe . To addrTo address the vital issues of real-world data complexity, several adoptive technologies such as computer vision, Tele health was need of time and assistive technologies implemented such as visualization-based models to assist the need of the patients also several communication modules were implemented to assist with the work from home and support the overall population to best fit the current scenario . Also, wWe can say that the healthcare organizations are explicitly searching for appropriate technology which can track the epidemiological synchronization or cofactors which can relate to pandemic spread , 10. HowFurther, the utilization of ML and AI has flourished their advances in the pandemic era, victoriously in several application domains which include military organizations, healthcare, business analytics, and other technological intervention while gaining momentum and success stories –13. For Further, considering the relative global impact of vaccination with vital features such as literacy rate, disabilities, older generation and many other factors in retrospect of the citizens and certain formulation suggested that users those have lower trust in their government were less inclined towards vaccination programs . In accoIn the proposed study, we aim to reveal the impact of political and socio-economic factors on SARS-Cov-2 vaccination trends in different countries. The study has been synthesized on political and socio-economic factors where the features were ardently study in retrospect of varied socio- economic features which may include country wise literacy rate, overall GDP rate, further we substantiated the work to address the political factors which are discussed as the country status of democratic or having other status which are discussed elaborated in methodology section.Data science can be discussed as a vibrant tool for developing and supporting vaccine dissemination. The major role is to discover the protein structure which can enable the clinicians and data scientists to discover the patterns for future research repositories and identification of drug discovery. We can say that vaccine is the only possibility that can control the dissemination of COVID 19 cases around the globe . HoweverThe concept of reverse vaccinology (RV) with ML tools was utilized to forecast and develop a vaccine for COVID -19. The RV was applied to discover the pathogen using genomes. The study prevailed to discover the proteins which were responsible for the virus which includes SARS-CoV, MERS-CoV, HCoV-229E, and others where were discovered from Uniprot proteins. Moreover, they have exploited the ML techniques Vaxign-ML to detect and discover the signal behavior of the proteome of the virus, to forecast the relevance of biological signals . FurtherIn similar, the control and spread of any communicable disease depend upon the vaccine instantiated. Certainly, the development of these vaccines is not an easy task, moreover, several challenges and barriers exist to determine the effective and efficient drug which can handle the generic data. In the past several studies are introduced by researchers and health care practitioners to study the overall effect of the vaccine –22. CompCOVID 19 has substantially worn the world upside down which has created several inhibitions to detect hidden patterns and information from large scale databases. However, the current study of approach focuses on vaccine dissemination patterns around the globe. The study was based on databases generated from public domain repository of United Nations World Population Prospect, where the datasets compromise of subnational locations such as England, Northern Ireland, Scotland, Wales and others . Also, tThe exploratory data analysis (EDA) is conducted among the databases to detect hidden patterns, information and knowledge from the data. The data investigated was preprocessed for null values, missing values and inconsistent values to measure the exploratory features summarization. The proposed study was implemented using python 3.9.0 version using NumPy package, Matplotlib library and pandas to explore the complex patterns among the data. Further, data was explored with graphs and distribution curves to synthesize and identify the potential outlines in the data. The analysis also included varied statistics such as mean, median, standard deviation for varied features in the datasets.Additionally, the study was categorized with relevance and impacting factor which were considered for vaccine dissemination in comparison with the literacy rate of the nations. Also. Target features were considered for the vaccination dissemination trends for calculating the health expenses of different nations. The study has been synthesized on political and socio-economic factors where the features were ardently study in retrospect of varied socio- economic features which may include country wise literacy rate, overall GDP rate, further we substantiated the work to address the political factors which are discussed as the country status of democratic or having other status.Vaccines have been one of the biggest preventive measures that were developed over the past century to tackle dreaded diseases. However, the major diseases which tends to cured with vaccination is smallpox and rinderpest which has substantially outcasted the population with their rendered threats. While Covid-19 vaccinations have once again raised the debate about a population's trust in various aspects of this process, studies were done before the pandemic also helped in understanding the factors that drive acceptance rates , 30.A study done by Larson et al. in 2016  had analAs can be seen from the rankings, European and Western Pacific nations were least confident of vaccinations. Developed nations like Japan and France were unexpected entries. The distrust of the population of France can be attributed to the vaccine-related controversies that plagued the nation in the past two decades . Japan iWhile the countries with positive sentiment towards vaccination are a mix of developed and developing nations, the latter were more accepting. It should also be noted that religious fundamentalism might impede vaccine acceptance, but it cannot be linked to a certain faith type, as shown by the presence of Saudi Arabia which has a majorly Muslim population .The SARS-Cov-2 vaccination data was sourced from Our World in Data repository hosted on Github . This daThe data repository also contained information on Covid vaccines that were administered till the time of this study. These were Oxford/AstraZeneca, Pfizer/BioNTech, Sinopharm/Beijing, Sinovac, SputnikV, JohnsonandJohnson, Moderna, Covaxin, CanSino, Sinopharm/Wuhan, Abdala, Soberana02, QazVac, Sinopharm/HayatVax, EpiVacCorona, RBD-Dimer . Their uOur analysis also aimed to discern the effect of a nation's political regime on the SARS-Cov2 vaccination dissemination. While Authoritarian governments are associated with strict implementation of policies among the residents, democracies offer a choice to its residents. The said choice may take stricter forms in case of emergencies like a pandemic. Therefore, some democracies also saw strict regulations regarding the SARS-Cov2 vaccination dissemination. Nonetheless, we combined the political regimes of different nations  for thisThe proposed analysis aimed to reveal the impact of political and socio-economic factors on SARS-Cov-2 vaccination trends in different countries. The political regimes of different nations were fetched from Our World in Data repository  to disceIn, Figs. The comparison of trends shows that dissemination of the SARS-Cov-2 vaccine has been done between the two opposing types of governance. Both types have used a combination of vaccines and the graphs show a rising trend thus marking extensive acceptance among the citizens.The next impacting factor that was considered for vaccine dissemination was the literacy of the nations. The WHO literacy rates from the year 2016  were useA country's literacy rate is an indicator of its economy and living standards. In agreement with this statement, the vaccination trends show that nations with the poorest literacy rates have extremely low and flat growth curves for vaccination numbers. On the other hand, the nations that have the highest literacy rates boast of good living conditions and better vaccination figures. These nations also used a combination of multiple vaccines for the faster safeguard of their population.Another impacting factor that this study focused on was the vaccination dissemination trends in comparison with the health expenses of different nations. Each nation sets aside a percentage of the GDP towards the betterment of healthcare and its implementation. The health expenditure data hosted by the World Bank for the year 2018  was usedThe human race has progressed through several inventions, and vaccines have been one of the most important of them all.While vaccines have been successful in improving the life expectancy of the masses, the technology is still riddled with distrust and negative sentiment among the masses. This sentiment gets further aggravated due to controversies and low confidence in scientific research. It is but evident that the difference in ideology can be attributed to the demographics that the persons with negative sentiment belong to. The ideology of a person is governed by their cultural background and the other conditions that prevail in their country. These may include political factors like the government regime, economic factors like GDP and generic economic status, and literacy rates.In this paper, we have analysed how vaccination dissemination and acceptance were affected by the political and socio-economic factors where the features were ardently study in retrospect of varied socio- economic features which may include country wise literacy rate, overall GDP rate and others. While, the world is battling with the global pandemic of SARS-Cov-2, sentiment towards vaccination has again come into the limelight. The authors have analyzed the confidence in vaccinations before the Covid pandemic happened and found that the European and Western Pacific nations were least confident. Japan, known to be a risk-averse nation also showed a major concern in vaccine safety to fully trust them. The countries with positive sentiment towards vaccination were a mix of developed and developing nations. In the post-Covid scenario, the analysis showed that the dissemination of the SARS-Cov-2 vaccine had been comparable between the authoritarian and democratic types of governance. The vaccination trends also showed that the nations with the poorest literacy rates had extremely low and flat growth curves for vaccination numbers. The nations that spent more on healthcare were the ones that had the best SARS-Cov-2 vaccination rollout. These nations used a large number of vaccines to administer to their population and the trends were positive growth. While the nations with the lowest healthcare expenses failed to keep up with the demand and depended on vaccines donated by other countries to protect their population. With this analysis, the authors hope that better vaccination strategies can be drafted as suited to the geopolitical factors of different countries.


The development of competencies in dentistry is a complicated process that calls for the development of not just cognitive and psychomotor abilities but also behaviors and attitudes that change as technical proficiency increases and meaningful patient encounters occur. This study examined the relationship between the number of clinical requirements completed by dental students and subsequent performance on tests of competence. The null hypothesis stated there would be no significant linear relationship different from zero between absolute clinical requirements and grades attained in various tests of clinical competence.Retrospective assessment data for 81 students were used in this analysis. Data included the amounts of clinical requirements completed for operative dentistry, endodontics, periodontics, and fixed prosthodontics together with data on the respective performance in tests of competence. Correlation was ascertained between grades for tests of competence and the corresponding clinical requirements using a non-parametric Spearman’s Rho test at an alpha level of 0.05.Fixed prosthodontics and posterior endodontics were the least common procedures completed by dental students. Statistically significant weak correlations were found between the amounts of clinical requirements performed for posterior endodontic(p = 0.005) and operative procedures (p = 0.006) and associated performance in tests of competence. A moderate correlation was found between the number of fixed prosthodontic procedures completed and associated performance in tests of competence. This latter correlation, however, was not statistically significant (p = 0.654). A significant weak correlation was found between requirements completed for periodontics and the associated test of competence (p = 0.04). A highly statistically significant moderate correlation was found between clinical requirements for anterior endodontics and the associated performance in the tests of competence (p < 0.001).The null hypothesis was rejected since a positive correlation was found between the absolute clinical requirements completed and grades in tests of competence. However, only a weak to moderate degree of correlation was found between the completion of clinical requirements and performance in tests of competence for common clinical procedures that new dental graduates should be able to perform. Competency-based curricula have been widely accepted as a framework in dental education . There aSynonymous with competency-based education in dentistry has been the shift that individual dental students must be responsible for the holistic and comprehensive management of patients under their care. Training programs must respond to such shifts by identifying what is crucial for safe and competent practice and design learning activities and experiences so that students may graduate as safe and qualified beginners . This deCentral to competency-based education, many dental schools have moved away from quota-based training and instead have described the minimum experience thresholds that students must fulfil, so-called minimal clinical requirements, in the development of competencies . ConversA school of dentistry in the English-speaking Caribbean adopted a competency-based curriculum in 2000 . StudentThe use of minimal clinical requirements takes a work-oriented approach to the development of competence. The attributes that dental learners have regarding the clinical management of patients serve as the starting point for proponents of a work-oriented approach in the development of competence. Work-oriented techniques start with the tasks that need to be completed that are then translated into learning activities and the subsequent development of attributes required to complete said learning activities .The purpose of this research, which used retrospective student assessment data explored the relationship between absolute clinical experiences and performance in tests of competence. The null hypothesis stated there would be no significant linear relationship different from zero between absolute clinical requirements and grades attained in various tests of clinical competence.Ethical approval for the study was granted by the university’s Ethics Committee [CREC-SA.1052/06/2021]. Retrospective student assessment data for all students in the graduating classes of 2017, 2018, and 2019 were included together with data on minimal clinical requirements  for students of these graduating classes. Data were de-identified and aggregated for statistical analysis. Clinical experiences for operative procedures, endodontics (single and multi-rooted teeth), fixed prosthodontics, and periodontics were included. Minimum clinical experiences were counted once a clinical procedure was deemed to be completed for those procedures requiring multiple visits.Despite an overall competency-based curriculum individual tests of competence are required for progression from year to year. A skilled clinical operative test (SCOT I) where students must demonstrate skill in the operative management of proximal caries serves as a pathway examination from the fourth to the fifth year of training. There is an equivalent test of competence in endodontics where students must either demonstrate clinical skill and associated behaviors in the endodontic management of a single canal anterior or premolar tooth, from access to master apical cone fit (SCOT II) or access, determination of the number of canals, corrected working length, and complete instrumentation of a posterior multi-rooted tooth. This examination takes place in the first semester of the fifth year.A clinical examination in periodontology (CAP) takes place in the first semester of the fifth year. Students must demonstrate periodontal screening, history taking, full periodontal assessment, diagnosis and management strategies. For the psychomotor skills portion of the competency examination, students must detect and remove calculus, plaque and stains from teeth via scaling and or root planning using hand instruments. A SCOT-III, where students must demonstrate psychomotor hand skills by preparing abutment teeth for a 3-unit fixed bridge and fabrication of a provisional bridge is completed in the first semester of the fifth year. Except for the SCOT-III, all assessments take place on live patients who are themselves under the care of the student. These assessments all take place during the clinical phase of training and students are not required or mandated to practice on typodonts before any of these assessments since students are expected to have completed the minimum clinical requirements before the assessment or working towards completing these requirements. The successful completion of pre-clinical courses, inclusive of exercises on typodonts, is used as the benchmark to progress to clinical training only and is not considered or counted as a pre-requisite to be eligible for the clinical test of competence.Rubrics using clinical criteria are used by assessors to facilitate objective scoring. Additionally, a minimum of two faculty assessors allows for the robust assessment of complex competencies. The final grade given for these competency assessments is a global grade, where several individual competencies were assessed during the management of the patient.All tests of competencies, except SCOT-III, described in the foregoing paragraphs are authentic assessments where students apply didactic and experiential knowledge and psychomotor skills to the real-life problem of patient management. Patients are first pre-approved and these assessments require students to manage clinical patients in a dental setting. Students are assessed on psychomotor skill performance, professional attitudes and behaviors and application of appropriate supporting knowledge in the management of a patient in a realistic setting without assistance. For example, the SCOT I test will include a composite assessment of the presentation of the patient inclusive of medical, social and dental history, the administration of local anaesthesia, the removal of carious tooth structure, final cavity design, selection and application of an appropriate restorative material and the finished and polished restoration.Retrospective data for 81 students were included in this analysis. Data were entered into SPSS Version 28  and a one-sample Kolmogorov-Smirnov test of normalcy was used for each of the variables. This was followed by a non-parametric Spearman’s Rho correlation analysis at a p-level of 0.05. Correlation was ascertained between grades for tests of competence and the corresponding clinical requirements. For example, clinical requirements completed in operative dentistry were compared with SCOT I scores. A value of zero was recorded in the dataset for students who did not complete any category of clinical requirements. These were not considered missing values and were not removed or substituted with a proxy value for the analysis.The mean numbers of clinical requirements and grades attained in tests of competence are presented in Tables Table Miller’s assessment pyramid describes the assessment of the performance of learners in unstandardized settings as the highest form of assessment . ClinicaWithin competency-based frameworks, assessment for learning should be the foundation of the assessment strategy over specified periods. This ensures that learners adopt a self-assessment approach to identify gaps in knowledge, skills, and attitudes and institute self-corrective measures for filling these deficiencies. Completing minimum clinical experiences provides opportunities for learning through in-action and on-action reflection, self-assessment and incorporation of faculty feedback into subsequent patient encounters. This ongoing and continuous process of complex learning, as students aim to achieve global competencies in the management of patients, may be the reason for the statistically significant positive correlation between the completion of clinical requirements and grades achieved in tests of competency.This explanation, however, does not completely clarify the attainment of global competence since a statistically significant weak correlation was found between the number of posterior endodontics procedures completed and performance in tests of endodontic competence, despite the relatively low mean numbers of procedures completed. Additionally, the mean clinical requirement for fixed prosthodontics was comparable to the absolute minimum clinical requirement of two completed units, however, there was a moderate correlation that was not statistically significant with the corresponding test of competency. Even with operative procedures where the mean number of procedures performed far exceeded the minimum clinical requirements, only a weak correlation was noted. These mixed results are comparable to work carried out by Chambers who concluded that performance in independent tests of clinical skills was unrelated to the number of procedures previously completed .In medical literature, the concept of competence and competency are often erroneously used interchangeably . In dentWhat is apparent from this analysis of retrospective data is that 22% of students had no experience in posterior endodontic procedures while 25% of students had no experience in fixed prosthodontics before tests of competence were taken. This dental school allows students to complete minimum clinical requirements after the final examination but before graduation. This potentially can put students at an educational disadvantage before such gateway assessments, particularly since positive relationships have been noted between clinical activity in fixed prosthodontic procedures and clinical dental student confidence . This fiThe null hypothesis was rejected since a positive correlation was found between the absolute clinical requirements completed and grades in tests of competence. However, only a weak to moderate degree of correlation was found between the completion of clinical requirements and performance in tests of competence for common clinical procedures that new dental graduates should be able to perform.


Plant growth-promoting rhizobacteria (PGPR) are group of bacteria inhabiting the rhizosphere and colonize the root environment. These organisms can be used for improving plant growth and for the sustainability of agricultural production under unfavorable environments. Rhizosphere microorganisms can produce extracellular chemical signals that help in establishing a complex signaling network between host and microbes. PGPR colonizes plant roots, inspires plant growth, and reduces disease or injury due to insects. Presently abundant research work has been done on PGPR and many of them are being commercialized for crops. PGPR can be used as bio-fertilizers for the improvement of plant health and yield under stressful environments. Bio-fertilization is considered as a major nitrogen source for different crop plants worldwide. Similarly, PGPR are accountable for increasing N-fixation in legumes, promote free-living N-fixing bacteria, and improve the availability and distribution of supplementary nutrients in the rhizosphere .Microorganisms are involved in the alteration of metabolomic pathways of the host plants thus assisting in systemic resistance of the plants. They help in the up-regulation of stress-responsive secondary metabolites, thus helping in the regulation of metabolic activities in cells. However, a better insight into their mechanism of action and their starring role in plant growth and development is essential for agricultural production and research. It has been investigated that Stemphylium lycopersici and Stemphylium solani significantly reduced the adverse effects of chromium stress in soybean by converting the toxic Cr-VI to a less toxic form known as Cr-III. The isolated fungal strains also boosted the growth of soybean under heavy metal stress by enhancing the production of phytohormones, plant secondary metabolites, antioxidant enzymes and free radical scavenging enzymes. Based on these results, both the fungal isolates can be used as a potential candidate for developing a biofertilizer for Cr contaminated soils .Microorganisms play a significant role in the bioremediation of heavy metals. The accumulation of heavy metals in the food crops not only reduces the growth and yield of crop plants but also has harmful impacts on human health. Recently it has been reported that the collective application of fungal strains Mashabela et al.). It has also been reported that the application of P. aeruginosa hinders the mechanisms of quorum-sensing in soft rot pathogen Lelliottia amnigena by generating specific metabolites accountable for the inhibition of quorum sensing. The ethyl acetate extract of the same bacterium was inhibitory to biofilm formation thus suppressed the pathogenicity related traits of soft rot initiating pathogen L. amnigena. This study is a useful step toward the development of a novel strategy to control the plant pathogen virulence in susceptible plants . Lin et al. reported that the application of phosphate solubilizing strain Bacillus megaterium upregulated the expression of genes responsible for drought, salt and heat stress in plants. The strain also effectively upregulated the amino acids and carbohydrate metabolic pathways in potato plants. Beside this the strain helps in absorption of nutrients, promoting root growth, physiological, and metabolic activities in potato plants. The use of PGPR in agriculture offers a promise for improving the growth of plants and their resistance to various stresses by altering plant metabolomes.Metabolomics is utilized as a principal tool to comprehend the responses of plants to various biotic and abiotic factors. Several biogenic volatile compounds are produced in different plant species. However, little information is available about the contribution of PGPR in altering the plant metabolome and making them more resistant to various stresses (Khan et al., NK wrote the editorial. NI, RC, and KA reviewed and edited the editorial. All authors contributed to the article and approved the submitted version.


Sequential socioeconomic shocks, including the COVID-19 pandemic, economic recession, or energy and refugee crises in the face of violent conflicts, have led to the failure of healthcare systems in Europe. Against this background, the aim of this study was to evaluate the resilience of regional gynecological and obstetric inpatient care using the example of a regional core medical provider in central Germany. Base data were retrieved from Marburg University Hospital and underwent standardized calculation and descriptive statistical assessment pursuant to the aG-DRG catalog. The data illustrate a decline in the average length of patient stays and average case complexity in combination with increasing patient turnover for the six-year observation period of 2017–2022. Core profitability of the departments of gynecology and obstetrics deteriorated in the year of 2022. The results suggest weakened resilience of gynecological and obstetrics inpatient care in the setting of a regional core medical provider in central Germany and indicate how it may have failed in core economic profitability. This is consistent with predictions about the lack of resilience of health systems and the critical economic situation of German hospitals in the face of ongoing socioeconomic shocks that collaterally endanger women’s health care. On 23 February 2023, the Organization for Economic Cooperation and Development (OECD) published its detailed health policy report covering the lack of health systems’ resilience during the COVID-19 pandemic and following socioeconomic consequences. Since the global spread of the disease, the scientific interest in targeted investment in and restructuring of health systems’ resilience and infrastructure, to build up robustness for the upcoming crises, has skyrocketed. The capacity to absorb the effects of socioeconomic shocks on healthcare has gained new significance in times of globalization [Hence, following the repeated socioeconomic shocks of the preceding years, worrying news hit the German hospital sector at the cusp of 2023. While still on the ropes and struggling with the COVID-19 pandemic aftermath, the national hospital questionnaire revealed rather dark conclusions about the current state of and performance predictions for German hospitals. Compared with the year of 2021, the proportion of hospitals with negative annual results was expected to rise from 43% to 59%, while positive outcomes dropped from 44% to an expected 20%. This means a reduction by half of the share of hospitals recording an annual surplus. Only 6% of German hospital managers rated their economic situation in 2022 to be rather good, while more than half of the care institutions expect their financial situation to deteriorate in 2023. Consequently, the German Hospital Association  fears a predicted wave of hospital insolvencies to roll in for the year of 2023. While recent data from the German Federal Statistical Office is still pending, experiences from the first pandemic year of 2020 fuel these critical predictions . OmissioPublic health has kept a bird’s eye view on healthcare resilience, neglecting differentiated assessments for singular medical fields. Although gynecological and obstetric care contains 25,834 hospital beds, accounting for 5.3% of German inpatient care capacity, scientific consideration of previous developments on the women’s health-care situation, its resilience and financial soundness, presents as scarce and insufficient . The seaIn this study, we conduct an epidemiological evaluation of gynecological and obstetric inpatient care for the catchment area of a regional core medical provider in central Germany, the Marburg University Hospital, to identify metrics for assessing associated care resilience from easily-obtainable administrative data. We investigate whether associations between spatial resilience and the performance dimension can be measured by calculating standardized health services indicators and whether these translate into the development of economic performance to identify potential setbacks to women’s health care during times of the aforementioned socioeconomic events.®  and retrieving treatment data for all inpatient cases of the departments of gynecology and obstetrics of Marburg University Hospital during the six-year observation period from 2017 to 2022. Consequently, a total of nTotal = 36,940 patient cases were selected for assessment. Furthermore, the annual income statements of each department were collected from the internal financial-accounting department and included for further analysis.Data extraction was performed by accessing the hospital performance controlling system QlikView®  for each year of observation according to the aG-DRG (German Diagnosis Related Groups) standards pursuant to §17b Initially, the primary and secondary diagnoses per patient case were identified based on ICD-10 classification . Thereupon, the standardized indicators of case-mix index (CMI), patient clinical complexity level (PCCL), and average length of stay (Av LoS) were calculated using ExcelCMI represents an indicator for determining average case severity and allows for conclusions with regard to the economic efficiency and resource consumption per patient. It is obtained by the division of the accumulated relative weight by the accumulated patient number per department or hospital within a specific time period. The relative weight is a defined point value determined by the aG-DRG catalog for each viable inpatient treatment and is used as a multiplier for the economic base rate  to determine the revenue per patient case  .CMI=CasThe PCCL value is calculated based on the severity of the case-specific secondary diagnoses  in accordance with the algorithm developed as part of the CCL Refinement Project . TherefoAvLoS was calculated in accordance with the aG-DRG catalog by cumulating the absolute days of inpatient treatment and then dividing by the corresponding number of patients for each specific observation period.Further analysis of the departments’ income statements was performed according to multi-level contribution-margin accounting, a well-tested and established methodology for analyzing profitability of organizational entities in cost accounting. The calculation was conducted for the separate operational units of the departments of gynecology and obstetrics according to the methodology proposed by Friedl et al. ,16. FurtTotal Revenue −Variable Costs = Contribution Margin I−Service-Related Fixed Costs (≙ Personnel)= Contribution Margin II−Division-Related Fixed Costs (Dep C)= Operating Income (Gross Profit)As the sum of variable costs and service-related fixed costs approximates to the sum of costs of material  and personnel (Personnel) in the case of a German healthcare provider, it was accumulated to the position of service costs (Serv C). Total costs  equate to the sum of Dep C and Serv C. Further internal clearings related to depreciation and amortization or the university hospital’s total operating expenses, i.e., general administrative costs, research and development or restructuring costs, and the interest expense or taxes were neglected for further assessment and calculation to limit the analysis to the specific department’s core profitability. In the following, the economic positions were calculated as absolute figures per department and to the denominator of the annual patient number (pp), i.e.:® according to the aforementioned annual comparisons.Descriptive statistical analysis was applied to calculate the relative change in % for prior-year  and first-to-last year comparison (17/22) as well as pre- to post-COVID-19 time periods (17–19/20–22). Equivalently, relative changes in % of the income statement positions were calculated with the use of ExcelObstetrics, NGynecology), AvLoS and CMI from To allow for comparison of dissimilar economic and epidemiological data of the departments over the entire period under consideration, the base data of patient number  gynecological and NObstetrics = 25,598  obstetric cases. In relative assessment, total number of obstetrics patients increases during the observation period , leaving 2022 as the only year with annual prior-year decline (21/22Obstetrics = −7.5%). Taking the Department of Gynecology into consideration, annual increase in patient number during the pre-COVID-19 time period  is followed by a decline after the occurrence of COVID-19 . The assessment of standardized health services indicators indicates an overall decline in CMI and AvLoS for both medical specialties during the entire time period under investigation and pre- to post-COVID-19 comparison .Gynecology = −10.5%). Gross profit depicts the sole relative annual decline for both departments in 2022 to 2021 comparison .Obstetrics, NGynecology, CMI, and AvLoS to Gross Profit for comparability reasons. The normalized illustration portrays a pre-pandemic increase of NObstetrics and NGynecology . CMI and Av LoS depict an overall decrease for both departments during the entire observation period . Furthermore, gross profit decreases from 2021 to 2022 in comparison with both sub-groups, leaving the last year of observation with the lowest gross profit for the department of gynecology (Gross ProfitGynecology22 = 0.92).Women’s healthcare is built on a close-knit interaction of political, environmental, and socio-economic factors . It requAgainst the background of previous neglect elaborated in research, the present study suggests weakened resilience of gynecological and obstetrics inpatient care in the setting of a regional core medical provider in central Germany, the Marburg University Hospital, by assessing standardized health services indicators according to the aG-DRG catalog for the observation period of 2017 to 2022. Furthermore, the assessment of the departments’ income statements based on multi-level contribution-margin accounting indicates failed core economic profitability following ongoing socioeconomic shocks. Beyond that, the combined visualization of the normalized development of AvLoS, CMI, patient number, and gross profit illustrates how the failed resilience of care may connect and may have caused core economic profitability failure. These main findings are discussed in detail in the following.CMI, AvLoS, or PCCL represent health-services indicators that are easily-attainable via standardized calculation based on data retrieved from any hospital’s information system. As such, they are widely used for controlling performance and management in DRG-based health systems, i.e., Austria, Poland, England, Ireland, France, Finland, Sweden, Spain, and many others. Nevertheless, with regard to gynecology and obstetrics, health-services research has neglected continuous monitoring and how related developments may have rendered the care situation vulnerable. The most recent health-services research literature covering the organizational state of gynecological and obstetric care in German public health leads back to 2015, when Augurzky et al. criticized the economic state of and care quality in the women’s health sector . These aGynecology2022 = 0.35 PCCLObstetrics2022 = 0.41). This finding contradicts the recommendations of Augurzky et al. from the year of 2015 and the most recent reform proposals by the German Federal Ministry of Health  from December 2022 [This anticipated concentration of care is reflected by an ongoing annual increase of patient numbers for the departments of gynecology and obstetrics in the case of Marburg University Hospital. Ongoing expansion of the inpatient catchment area, based on the gradual closure of peripheral care providers, has led to a fully centralized inpatient care situation, leaving the hospital as the central primary gynecological and obstetric core care provider in its region. A gradual decline in CMI shows that the upholding centralization does not push high-complexity cases to the inpatient provider but instead dilutes the average case complexity and economic efficiency. PCCL, as an additional indicator of the severity of the patient-related disease burden, presents as very low on average for gynecology and obstetrics  and obstetrics (GrossProfit21/22Obstetrics = −31.9%). In the light of ongoing socioeconomic destabilization, this finding may only mark the beginning of an ongoing deterioration. Keeping in mind that the assessment only includes the departments’ core profitability and neglects necessary organizational investments and costs including depreciation and amortization or the hospital’s total operating expenses, and the interest expense or taxes, this observation may only show the tip of the iceberg. Overall, these findings coincide with the predictions of the German hospital questionnaire and the negative forecast of the German Hospital Association [Multi-layer contribution-margin accounting is a well-established instrument of corporate management. As a method for determining the operating result, it is an important component of every commercial controlling system and is also becoming increasingly widespread in the healthcare sector. It allows for a differentiated assessment and comparison of departmental performance in an iterative and transparent calculation of expenses and revenues towards the economic core profitability ,16. Thusociation . This illustrated that the lack of inpatient care resilience in the setting of a medical core provider in central Germany may connect to the failure of its core economic profitability in 2022 in light of sequential socioeconomic shocks of the preceding years. Due to the high degree of inpatient care centralization, we suppose that the financial destabilization of a core provider would collaterally endanger regional women’s health care quality.The conducted evaluation provides considerable limitations. As such, the study design follows a single-center approach and is limited to an inpatient care setting, which sets boundaries to the transferability and generalizability of the results. Furthermore, the analysis is based on the data of an inpatient care provider in Germany and, therefore, restricts findings to health systems with DRG-based reimbursement. Based on continuous adjustment processes of the aG-DRG or ICD methodologies, biases according to miscoding cannot be completely ruled out. Moreover, further external effects in connection to fraudulent coding and misdiagnoses must be taken into account. The retrospective study design limits the evaluation to descriptive statistical assessment of regular administrative data and neglects a differentiated assessment of health utility.Despite the single-center approach, the inpatient catchment area of Marburg University Hospital has proven to provide an adequate base for conducting regional health services research in Germany via a multitude of previous studies of the Institute for Health Care Management of Philipps-University Marburg. This leads back to the high inpatient care concentration and the balanced socioeconomic and rather rural environment of Marburg-Biedenkopf county, which compares to German standards to a sufficient degree. Furthermore, the targeted evaluation of regional resilience allows for a single-center study design.Nevertheless, an expansion of the research design to an outpatient setting, also multi-center and multi-national analysis in subsequent studies, are desired to allow for transferability and generalizability of the findings to other health systems and urban settings. Furthermore, prospective data gathering and addition of further variables into a possible study design  would allow for statistical significance measurement of the developments and extend the analysis to the dimension of health utility assessment. Since the pandemic outbreak of COVID-19, European healthcare has been tested by sequential socioeconomic shocks including economic recession as well as related energy and refugee crises in view of the prevailing Russian-Ukrainian conflict. As a result, the failure of healthcare systems’ resilience in the face of these developments has taken on a new central role in health services research. In conjunction, the German Hospital Association fears that the economic state of its hospitals will deteriorate and collaterally endanger care quality. Being historically underrepresented, women’s health and gynecological and obstetric care have been neglected for differentiated assessment of the care resilience and consequences on economic efficiency of its care providers. By using easily-obtainable standardized health services indicators, this study investigated the weakened resilience of gynecological and obstetric inpatient care in the setting of a core medical provider in central Germany and suggests how ongoing pressure from socioeconomic shocks has led to its financial destabilization. The combination of a dilutive effect of decreasing average case complexity due to care centralization and increasing patient turnover has rendered economic efficiency critical. This pressure, following recurring socioeconomic shocks, has led to subsequent financial deterioration of the departments of gynecology and obstetrics of Marburg University Hospital in terms of gross profit in 2022. Although health services research stakeholders request a restructuring of gynecological and obstetric care for many years, i.e., to bundle low-complexity cases in decentralized care networks while high-complexity care should be reserved for inpatient maximum-care suppliers, our findings oppose these suggestions. We suggest this development would endanger care quality in women’s healthcare; therefore, we advocate for the expansion of scientific efforts to develop further and adapt innovative models of resilience to the peculiarities of gynecological and obstetric care. Financial soundness and interoperable out- and in-patient networks must be reinforced to build up regional and national resilience, to allow women’s health to absorb the effects of future socioeconomic shocks more efficiently and effectively.


As healthcare systems increasingly embrace population health management, the integration of health and social care to improve the health and well-being of individuals is crucial. Thus, we conducted a qualitative study in Singapore to understand health and social care professionals’ (HCPs and SCPs) perception of the roles they played in delivering community-based care.A descriptive phenomenological research design was adopted. HCPs and SCPs (n = 53) providing services in community settings were recruited purposefully and interviewed through eleven focus group discussions. Each session was recorded and transcribed. Thematic analysis was applied.Our results revealed eight themes in three main categories describing the roles played by HCPs and SCPs, including: (1) delivering needs-based care in community settings; (2) activating and empowering clients in health care, and (3) fostering community-based sustainable support networks. Six barriers encountered while performing these roles were also identified.Our results highlight that the roles of HCPs and SCPs go beyond the provision of direct medical and social care. They were involved in activating and empowering clients to take care of their health, and importantly, fostering community-based sustainable support networks to better empower individuals in coping with health challenges. The identified barriers shed light on areas for potential improvements for integrated community care. As the population ages, the prevalence of multi-morbidity, disabilities, and dysfunctions is expected to rise . The recIn Singapore, the drive to establish sustainable care services has led to multiple policy initiatives aimed at transitioning care from hospitals to the community and home settings . This trPublished studies have examined the organisational roles and functions of HCPs and SCPs in integrated health-social care settings 678. Howe67In addition, literature has pointed out that culture influences population health needs, care seeking patterns, and care delivery 10. As suHow do HCPs and SCPs perceive their roles in the provision of community-based health and social care to support individuals in poor health?What barriers did they encounter while fulfilling their roles?This qualitative study is part of a larger scale study aiming to develop and validate a health resilience measure in community-dwelling adults. The study employed a descriptive phenomenological approach  to exploParticipants were purposively recruited through three healthcare institutions located in the northern and central regions of Singapore. Managers who were responsible for the operations of community-based programmes assisted in sharing the study invitation letter with potential participants and referred HCPs and SCPs in any of the three healthcare institutions or their community partners in the central or northern regions if his/her work involved caring for the health and/or wellness of residents in the community.Of the 83 referrals received, 9 were excluded as they were not involved in direct community care, 20 declined due to work commitment, and 1 withdrew after consenting due to family commitment. A total of 53 HCPs and SCPs  who were involved in direct community care participated in the FGDs. Majority of the participants were aged between 21 – 40 years , females (73.6%), and Chinese (86.8%).The HCPs were from the Community Health Team  in the three healthcare institutions which comprised an inter-professional team of nurses, allied health professionals, pharmacists, health coaches, operation staff, and medical social workers. They worked with SCPs and other professionals from their community partners in respective communities.Data was collected via focus group discussions (FGDs). FGDs, which build on the group dynamics, allow for exploring diverse perspectives and enabling open and deeper discussions across various care providers working in health and social care organisations in the community setting, and allow researchers to reveal a range of viewpoints and insights that might not emerge through individual interviews .To facilitate meaningful discussions, a semi-structured interview guide was developed to understand HCPs and SCPs’ perceived roles in community care. It contains a list of open-ended questions (Appendix 1) to guide and encourage participants to share their personal experiences and opinions on the research topic, which was incorporated with probing questions to delve deeper into participants’ responses, enabling a more comprehensive understanding of their perspectives. The interview guide was piloted to ensure that it elicited relevant and valuable information during the FGDs.The FGDs were conducted virtually via a video conferencing platform (Zoom) between January and June 2021. Each FGD comprised a mix of four to six HCPs and SCPs from different organisations. This diverse composition allows for a wide range of perspectives relevant to the research topic were represented.Each FGD was facilitated by an experienced female doctoral-level mixed-method researcher (TWS). The sessions were co-facilitated by two other female researchers, GLX who holds a master’s degree in public health, and YWF who is a doctoral-level epidemiologist. All researchers possessed substantial expertise in health services research and extensive experience in the healthcare sector. Throughout the discussions, the facilitators remained attentive to any potential dominance of certain participants or the halo effect, ensuring that all voices were heard, and that no individual overshadowed the others.Each FGD lasted 90–120 minutes. To capture the valuable insights shared during these sessions, all FGDs were recorded using Zoom’s recording function with field notes taken. The audio recordings were transcribed into anonymised verbatim transcripts with a common format. The study team cross-checked the transcriptions against the original audio recordings to ensure the fidelity of the information without returning to participants for correction. SQR qualitative software NVivo version 12  was usedAs guided by the research questions, thematic analysis using an inductive approach, which primarily uses detailed readings of raw data to derive concepts or themes through researcher’s interpretations 1516, was15Close reading of raw data: Two researchers (GLX and YWF) independently read the first three interview transcripts several times to familiarize with content and gain an understanding of key points and ideas mentioned by the participants.Initial open coding: The two researchers openly coded the text line-by-line using specific or lower-level codes created from actual phrases or meanings in specific text segments and identified general or higher-level codes (themes) based on similarity and patterns observed in specific codes to address the research questions. Then they checked their sets of codes to establish the extent of overlap of the codes and themes.Development of preliminary coding system: To ensure rigor, a discussion involving the facilitator (TWS) was held to review and establish a more robust set of emergent codes and themes. Consensus on the codes and themes were derived through multiple discussions among the three researchers. A working codebook was crafted and operational descriptions for the themes were created.Continuing revision and refinement of the working codebook: The two researchers coded the remaining transcripts and searched for codes, including contradictory points of view and new insights. The codes and themes might be combined or linked under a superordinate category (summary category) when the meanings were similar. To address issues of trustworthiness and credibility, emergent themes were constantly compared and discussed. The refined codebook with examples of codes for each theme was presented in Appendix 2.By employing these steps, the research team ensured the transparency of the thematic analysis. All the researchers maintained a neutral standpoint on the topic and practiced reflexivity throughout the research process . We adopEthical approval for this study was obtained from the National Healthcare Group’s Domain Specific Review Board (Reference number: 2019/00753). The study was conducted in accordance with the Declaration of Helsinki. Written informed consent was obtained from each participant prior to the commencement of the study.Our analysis revealed 8 themes, which were further organised into three overarching summative categories that described the self-perceived roles of HCPs and SCPs in the provision of community-based health and social care to support individuals in poor health. The three categories were: (1) delivering needs-based community care (three themes); (2) empowering clients in managing their own health (two themes), and (3) building community-based sustainable support networks (three themes). Within each category, barriers to role fulfilment have also been identified.This category encompasses three distinct themes that illustrate the pivotal role played by HCPs and SCPs in providing direct and personalized care to address individuals’ needs in the community.Dedicated HCPs and SCPs played a pivotal role in delivering continued medical care, either during home visits or at respective Community Nursing Posts to ensure smooth care transition and good recovery progress, and to maintain their independence in the community. The types of medical care mainly included managing chronic conditions, reviewing laboratory test results, administering medications, improving independency in activities of daily living, providing and referring to secondary or tertiary care whenever needed  when talking to the clients so that the clients were more accepting of the message delivered (Quote 2).HCPs and SCPs were aware that having hope and making necessary psychological adjustments in a person’s social roles or perception of life are essential parts of the process to thrive for better health. As some of the clients faced difficulties in accepting changes in their health and life, HCPs and SCPs provided psycho-emotional support to promote better psychological adjustments Quote 3, . The typWhile describing their roles of providing direct medical care and psycho-emotional support, participants emphasized the importance of showing respect and empathy and being sensitive to clients’ unmet needs, however, they acknowledged that sometimes they failed to see the person as a whole as they tended to be task-focused instead of person-centred while fulfilling their own KPIs and guidelines , and services provided by the community partners such as the Singapore Association for Counselling and the Family Service Centres  and lack of a systematic streamlined integration  reflect the current situation of community care in Singapore and provide some insights for the review of the integration process and the sustainability of current integrated care model. Collaborative efforts across healthcare and social care sectors to improve the breadth and depth of the integration  are required to better address these issues. The newly launched PACE-It mobile app  – a secuThe study has several strengths. First, both HCPs and SCPs across different position levels from various organisations were recruited and shared freely during the discussion. Hence, the findings of the study should be able to represent the actual roles performed by community-based HCPs and SCPs. Second, the systematic processes of inquiry and data analysis enable the study team to capture a comprehensive overview of HCPs and SCPs roles which were inductively emerged from experiences and narratives. It is worth mentioning that our study might suffer from the potential biases inherent in FGDs, which mainly include 1) social desirability bias as participants may alter their responses to align with perceived social norms, 2) peer pressure as participants might be influenced by the prevailing opinions within the group, 3) moderator bias as the moderator’s tone, or personal beliefs might influence the direction of the discussion, and 4) selection bias as the HCPs and SCPs were informed of the study by the managers who were actively involved in population health management and community care transformation, and those who participated might have a higher interest in the research topic than those who did not participate. In addition, only HCPs and SCPs in one regional health system of Singapore were recruited, hence, the findings may not be generalizable to other regional health systems if there are differences in real practice and should be interpreted with caution. Further research should investigate whether the roles described are similar among community-based HCPs and SCPs in other regional health systems.Our results highlight that the roles of HCPs and SCPs go beyond community-based direct care provision. They were involved in activating and empowering clients in health care, and importantly, fostering community-based sustainable support networks to better support individuals in coping with health challenges.The additional files for this article can be found as follows:10.5334/ijic.7617.s1Appendix 1.FGD Interview guide.10.5334/ijic.7617.s2Appendix 2.The refined codebook with codes, themes and categories.


The human intraparietal sulcus (IPS) covers large portions of the posterior cortical surface and has been implicated in a variety of cognitive functions. It is, however, unclear how cognitive functions dissociate between the IPS's heterogeneous subdivisions, particularly in perspective to their connectivity profile.We applied a neuroinformatics driven system-level decoding on three cytoarchitectural distinct subdivisions  per hemisphere, with the aim to disentangle the cognitive profile of the IPS in conjunction with functionally connected cortical regions.attention, language, grasping, recognition memory, rotation, detection of motions/shapes and navigation–with varying degrees of dissociation across subdivisions and hemispheres. By probing the spatial overlap between systems-level co-activations of the IPS and seven canonical intrinsic resting state networks, we observed a trend toward more co-activation between hIP1 and the front parietal network, between hIP2 and hIP3 and the dorsal attention network, and between hIP3 and the visual and somatomotor network.The system-level decoding revealed nine functional systems based on meta-analytical associations of IPS subdivisions and their cortical coactivations: Two systems–working memory and numeric cognition–which are centered on all IPS subdivisions, and seven systems–Our results confirm previous findings on the IPS's role in cognition but also point to previously unknown differentiation along the IPS, which present viable starting points for future work. We also present the systems-level decoding as promising approach toward functional decoding of the human connectome. The human intraparietal sulcus separates the superior (SPL) from the inferior parietal lobule (IPL) within posterior parietal cortex  in combination with a cortical parcellation . Formally, the posterior probability is computed as P = p(P(activation|term)/P where the prior probability p is set beforehand to 0.5 . This rather conservative approach equates the possibly distinct baserate of terms within the database, which enables the handling of otherwise very different posterior probabilities, that are used for the interpretation of functional decoding results .Calculation of reverse inferences provides posterior probabilities of a term given activation of the region post-hoc using an in-house MATLAB  and by visualizing the IPS-centered cortical systems associated with each topic as surface maps, including a spatial comparison with the 7Networks described in Yeo et al. . A full working memory and a numeric cognition system with connections to all three hIP seeds in both hemispheres, an attention system with connections to all three hIP but with preference for the right hemisphere, and six more focal systems with stronger dissociations among the three seeds and hemispheres: language, grasping, recognition memory, rotation, detection of motions/shapes and navigation. In The systems-level decoding revealed nine cognitive systems grounded within IPS: a working memory and numeric cognition systems were similarly centered in all three IPS regions in both hemispheres and showed a high degree of topological overlap with each other. This was also apparent in their overlap with the 7Networks: In both systems, co-activations of each seed showed the largest overlap with the frontoparietal (FPN) and the dorsal attention network (DAN), and were absent for the limbic network. Overlap with the ventral attention network (VAN) followed a gradient across seed regions in both hemispheres, with increasing overlap from hIP1 to hIP3. Overlaps with the default mode network (DMN) were largest for bilateral hIP1, and overlap with the visual and somatomotor networks was most apparent for bilateral hIP3. The comparison with the 7Networks also revealed differences between the two systems, indicating that they are not isomorphic: The numeric cognition system showed relatively more overlap with the DAN relative to the FPN, the gradient of VAN contributions across seed regions was more pronounced in the working memory system, and right IPS showed more co-activations with the SMN in numeric cognition when compared to working memory. The numerical cognition system also had higher internal consistency by having very similar associations with the different terms across seed regions, while different working memory terms were more distributed across seed regions  and overlap with the SMN was only visible for the posterior seeds in the right hemisphere. While all seed regions co-activated with regions within the DAN and the VAN, DAN associations were more pronounced for right hemispheric seeds and VAN associations were more pronounced in the left. Within the left hemisphere, the overlap with DAN and VAN shifted across seed regions: posterior seeds showed more DAN overlap, anterior seeds more overlap with the VAN. The terms were heterogeneously distributed over the IPS seed regions, with right hIP3 as having the largest number of term associations. Interestingly, the terms describe mostly spatial and executive  processes and do not cover aspects of attentional alerting.The language system displayed a strong lateralization toward the left hemisphere. We only observed right hemispheric contributions from hIP1. The terms building the corpus of this system can be mainly assigned to second language learning and bilingualism , however, with additional terms describing visual and phonological related language processes  showed similar topological overlap with the 7Networks, which was most strong for DAN, VAN, and the visual networks. Co-activations with the SMN was largely restricted to the most posterior hIP3.The IPS-centered mental rotation system was the most focal system and only contained the term “rotation,” while all IPS seeds (except for left hIP1) contributed to the system, the most pronounced contribution was observed for right hIP2. The co-activations of this region were also more distributed across the 7Networks with most co-activations in the FPN, DAN, and VAN. The other four seed regions showed only co-activations with the DAN and the visual network.The navigation system was more lateralized toward the right hemisphere. Of note, the major seed regions on the right were hIP1 and hIP3, while the major seed region on left was hIP2. While the co-activations of all seed regions in the navigation system overlapped most dominantly with the FPN, there were also differences between the seeds with more posterior seeds showing stronger coactivations with DAN, VAN, SMN, and the visual network, and more anterior seeds co-activating more extensively with regions in the DMN.The recognition memory system was one of the smallest IPS-centered systems: The system was mainly centered in right hIP1 with minor links to the three seeds on the left. Co-activations of the seed region were most dominantly in the FPN and DMN, followed by the VAN.The motions/shapes system, was mainly centered in right hIP3 an left hIP2. For both seeds, co-activations overlapped with the DAN, FPN, and VAN. Right hIP3 showed also strong coactivations with the visual network, while the co-activations with left hIP2 were also pronounced within the DMN.The other small system, the The main goal of the present study was to disentangle the functional profiles of three cytoarchitecturally distinct bilateral IPS regions through meta-analytic decoding across the neuroimaging literature in two complementary ways: We conducted a standard Bayesian reverse inference decoding on the IPS regions individually, and a systems-level decoding that reveals joint seed-cortical co-activations as retrieved from the Neurosynth database. The systems-level decoding unraveled several IPS-centered functional cortical systems involved in a variety of cognitive functions. Our decoding framework revealed both similarities and dissimilarities between the different IPS regions and the behavioral relevance of their co-activation profiles.numeric cognition. The engagement of the IPS in these processes was consistently found and is well-described in the neuroimaging literature  of quantity representations, and the left IPS in symbolic  processing  is supposed to be engaged in visually controlled hand movements, whereas activation in the caudal bank (CIP) was associated with three-dimensional surface orientation and mental representation of objects . This fits previous work that implicated the left intraparietal lobule  in language learning  on right hIP3. This right hemispheric dominance was accompanied by substantial overlaps with the VAN, the FPN, the DAN, visual areas and the SMN. Spatial navigation depends on the integration of exogenous sensory  information and a controlled course of action if a visual cue is behaviorally relevant. Both actions are accomplished by the interactions of brain regions located in the VAN, the DAN and the FPN  consisted of regions of the FPN, the DAN, the DMN and VAN. Notably, the IPS has been consistently associated with familiarity-related processes of memory recollection  recollection memory seems to be restricted to a single IPS seed .The novel systems-level decoding approach proved useful in recovering structure-function associations of the IPS beyond the localized associations from the standard Bayesian reverse decoding framework. The cognitive profile of the IPS is heterogeneous but also quite uniform across different subregions. Not surprisingly for a putative cortical hub region, the IPS's functional repertoire becomes most visible in conjunction with its functional interactions with widespread cortical regions across several intrinsic networks. The present results provide a reference for the interpretation of cognitive neuroscience experiments and highlights several starting points for future investigations for the connectome-wide representation of cognitive and behavioral functions.The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.All analysis used secondary data and no new human participants were generated. Ethics approval was obtained by the authors of the original datasets from their respective ethics review boards.Material preparation and data collection was performed by OB and SM. OB implemented the computer code, supporting algorithms, and analyzed the data. OB drafted the manuscript and final revisions were done by SM. All authors contributed to the study conception, design, read, and approved the final manuscript.


Increasing agricultural productivity has long been touted as the main avenue to lifting the rural poor out of poverty and ensuring their sustainable development. The adoption of sustainable agricultural practices (SAPs) is vital for spurring agricultural productivity in a changing climate environment. This paper examines the factors (including long-term climate variability) influencing the adoption of multiple SAPs  and their impact on crop productivity.This study uses a nationally representative, geo-referenced plot-level data from a household survey in Nigeria. A multistage sampling technique was used to select households for the survey. The multivariate and ordered probit models were employed to estimate the adoption and intensity of adoption respectively, while the instrumental variables approach was used to examine the impact of the technologies on productivity.The results provide evidence of interdependences between the SAPs, and that the factors that determine the initial adoption decisions are not necessarily the same factors that influence the intensity of use of the technologies. Climate risks in terms of high variability in temperature and rainfall affect SAPs adoption and their intensity of use. Access to agricultural extension, years of education and off-farm activities of the plot manager, and household wealth influence the use of improved seeds and inorganic fertilizer. Organic fertilizers are used mainly by households with large livestock units and those that live in areas with low soil nutrients and greenness index. In general, the intensity of SAPs adoption is influenced by wage and off-farm activities, and access to agricultural extension services. On the productivity side, inorganic fertilizer is positively correlated with plot-level productivity.These results have implications for rural development policies in Nigeria aimed at nudging farmers to adopt multiple technologies on their plots, while enhancing an outward shift of their crop production functions. Providing technical and financial resources to extension agents is crucial so they could better reach rural smallholder households with the knowledge and benefits of these SAPs. In addition, smallholder households should diversify their livelihood portfolios to include non-farm income generating activities. Agricultural Research and Development should target factors that respond to climate variabilities (such as drought resistant and early maturing varieties). There is a need for improved infrastructures  that will allow farmers to access these innovations. Agriculture continues to be the main source of livelihood of the rural poor in Sub-Saharan Africa (SSA). Increasing agricultural productivity has long been touted as the main avenue to lifting the rural poor out of poverty and ensuring their sustainable development. Agricultural production can be increased by either expanding the area under cultivation, changing cropping systems, and or use of sustainable productivity enhancing practices . Over thAgriculture is the second largest share of the Nigerian economy, contributing an average of 24% to the country’s Gross Domestic Product (GDP) over the past decade . The groWhile the government has implemented number of policies aimed at boosting agricultural productivity and food security, rural smallholder households in Nigeria continue to face supply and demand side challenges: notably poor land tenure system, very low level of irrigation development, limited research on agricultural technologies, high cost of farm inputs, poor access to markets, and high postharvest losses and waste . These aThere are a number of theoretical and empirical studies on the adoption of SAPs , 37, 46.This paper contributes to the growing literature on agricultural technology adoption, climate change and productivity in the following respect. First, this study uses nationally representative, geo-referenced plot-level data to rigorously examine the adoption of SAPs  at the plot-level in rural Nigeria. Second, this study contributes to the literature by examining the determinants of adoption and intensity of adoption of multiple SAPs at the plot-level, employing estimation strategies that allow for interrelationships between the SAPs and farmers choosing a mix of practices , 24, 49.The rest of the paper is structured as follows. In “This paper uses data from the fourth wave of the Nigeria General Household Survey (GHS)—Panel, conducted by the National Bureau of Statistics (NBS), covering the 2018/2019 agricultural season . The GHSThe GHS-Panel 2018/2019 data contain 5025 households, of which 4976 households were successfully interviewed with complete information. Of the 4976 households, 3384 were located in rural areas, while the remaining 1592 were located in urban areas. Of the 3384 rural households, 2704 engaged in crop farming and provided complete plot-level input and output information for the 2018/2019 agricultural season. Given that one of the main objectives of this paper is examining productivity, including incorporating climate and other biophysical variables , the sample was restricted further to only plots that were measured using GPS device, with available coordinates. All plots cultivated and harvested by the household during the reference agriculture season and have GPS information were included in the analysis, irrespective of the crops planted on them. At the end of the cleaning process, 5616 plots from 2558 households were included in the analysis.The GPS coordinates from the survey allow for linking household- and plot-level data to geo-referenced soil and climate variables. The publicly available GHS-Panel 2018/2019 data contain some relevant soil and weather variables. However, due to the requirements of the present study, additional rainfall and temperature variables were generated. This was done by merging the household and plot-level GPS coordinates with the Africa Rainfall Climatology version 2 (ARC2) of the National Oceanic and Atmospheric Administration’s (NOAA) database.The GHS-Panel 2018/2019 has rich plot-level information on several SAPs. The SAPs considered in this study are improved seeds, inorganic fertilizer, organic fertilizer, and legume intercropping. Improved seeds include the use of modern, high yielding varieties recommended by the Federal Ministry of Agriculture and Rural Development (FMARD), adapted to different agro-ecological zones of the country. Households were asked if the seed they planted on a given plot during the agricultural season was improved, as well as the name and certification status of the seed, if improved. Thus, a plot is defined as having been planted with improved seed if the household responded yes to the question of if the seed planted is improved. The descriptive result shows that about 9% of plots were planted with improved seeds , and Urea. Following Refs.  and 49]49], adopIn order to examine the impact of the SAPs on productivity, the dependent variable is defined as the monetary value of crop(s) per harvested plot area. For a given harvested plot, the survey asks for the value of crop harvested (excluding expected harvest). This value was then divided by the total hectares of harvested plot area and used as the measure of productivity of that plot. Productivity is measured in terms of value (Naira) per hectare instead of quantities (kilograms per hectare) because of the difficulty of aggregating different kinds of crops that may grow on the same plot and may have different productivity levels and economic values , 38, 39.3Based on economic theory, the adoption and crop productivity literature , 30, 37,Rural smallholder households in Nigeria adopt a mixture of technologies on their plots, either simultaneously or sequentially. Applying multiple technologies on the same plot may result in complementarity or substitutability, where the adoption of one technology may increase the propensity to adopt another, and vice versa. With multiple SAPs, there is possible interdependence between the unobserved heterogeneity, and thus, this interdependence should be taken into account when modeling household adoption decisions involving multiple alternatives. Further, in the presence of multiple technologies, adoption becomes path dependent, where lessons learned from adopting the first technology might influence the adoption of subsequent ones.Intensity of adoption is equally important when examining the adoption of multiple technologies at the plot level. This paper defines intensity of adoption as the number of technologies applied per plot in the growing season. Following Teklewold et al. , intensiFollowing the extensive review of literature on adoption of SAPs , 49, 50,ith household ith household adopts the jth technology on plot ith household using technology Let Such that the binary outcome for each technology is given asThe multivariate probit (MVP) model is thus characterized by a set of binary dependent variables equal to 1 if the household adopts technology  Mundlak  approachGiven that the MVP technique described above is only able to identify the factors influencing the adoption of the SAPs, this paper goes a step further to estimate an ordered probit model to examine the extent to which households adopt the SAPs on their plots. Theoretically, the factors that affect the adoption of the practices may differ from the factors that determine the extent of application on plots. Generally, intensity of adoption has been measured using continuous variables  , 44, 52.Following D’Souza et al. , Wollni This equation is estimated using the Maximum Likelihood estimation procedure.The paper further examines the impact of SAPs on crop productivity using the production function approach. Crop productivity is measured as the value of total harvests per area harvested of plot (Naira/hectare) , 5, 23. ivreg2h program in Stata by Baum and Schaffer [ivreg2h procedure works by using the model’s data (exogenous variables) to generate additional instruments to instrument the potential endogenous variables. These model generated instruments are used alongside the externally supplied instruments to allow for achieving identification and also correct for possible weak instruments.This paper employed the instrumental variables (IV) procedure proposed by Lewbel   that may affect productivity. Following economic theory and empirical literature [Like in every IV technique, the choice of external instruments is critical for the terature , 9, longterature . The valTable In order to explore descriptively, the interdependence among SAPs adoption, the conditional and unconditional probabilities of adoption were estimated Table . UncondiThe maximum likelihood estimates of the MVP model of the factors affecting the adoption of SAPs at the plot-level in rural Nigeria are presented in Tables The correlation matrix in Table The MVP model results vary substantially across the SAPs equations, indicating the heterogeneous nature of the results, and therefore warrant discussing the results separately. The results presented in Table The analysis reveals the importance of long-term climate variabilities on households’ decision to adopt the SAPs. Households located in areas with high long-term variability in rainfall are less likely to use improved seeds, but more likely to adopt organic fertilizers. Further, in areas with high variability in daily temperatures, households are more likely to use organic and inorganic fertilizers to circumvent potential negative impact of temperatures during the growing season. Similarly, high variations in growing degree days (GDD) decrease the propensity of a plot receiving organic and inorganic fertilizers. In addition, high long-term variations in the number of days that the average maximum temperatures are above 34 °C during the planting season (March–June) deters farmers from using organic fertilizers and legume intercropping, while at the same time spurring the use of improved seeds. Finally, rainfall shortfall during the planting season tends to discourage the use of improved seeds and legume intercropping.The results demonstrate further the importance of household demographic characteristics on SAPs adoption in rural Nigeria. The number of years of education of the plot manager has a positive significant effect on inorganic fertilizer and improved seeds adoption but no significant effect on the use of the other technologies. Male-managed plots are more likely to receive organic fertilizers compared to female-managed plots. The availability of road infrastructure, proxied by distance from the household’s dwelling to main market, negatively affect the use of most of the technologies. Specifically, households residing farther from the main markets are less likely to use inorganic fertilizers on their plot, which is expected given the probable high transaction cost of obtaining the inputs.Households with access to extension services are more likely to adopt improved seeds and inorganic fertilizers, indicating the importance of agricultural extension services on SAPs adoption in rural Nigeria, corroborating the findings of Tambo and Abdoulaye . The resPlot size has a positive significant effect on organic and inorganic fertilizers adoption, as well as the propensity of a plot being intercropped with legumes. This result is consistent with the findings of Kassie et al.  for imprThe long-term greenness of the location of the household, proxied by the normalized difference vegetation index (NDVI), decreases the probability of farmers applying organic and inorganic fertilizers to their plots. Agronomically, the greenness of a vegetation denotes fertility, and therefore farmers may not be enthused about investing in soil enhancing technologies if the greenness index of the area is high. The nutrient availability constraints results show that households that face higher constraints in terms of nutrient availability are more likely to utilize improved seeds and legume intercropping.The use of SAPs is also explained by household wealth and agricultural capital indices. Households with high wealth index use technologies that require initial capital investment, such as improved seeds, organic, and inorganic fertilizers. This finding is consistent with Tekelwold et al.  and AsfaThe ordered probit model results (both pooled and random effects) of the intensity of SAPs adoption are presented in Table The results reveal the importance of climate variables on adoption intensity. Households located in areas with high long-term rainfall shortfall during the growing season are less likely to apply two technologies, but more likely to not use any technology. High variability in daily temperatures tend to foster adoption intensity. However, high variability in growing degree days and the number of days where the maximum temperature is above 34 degree Celsius during the growing season tend to decrease the intensity of use of the technologies on plot.The results also show that involvement in non-farm activities increase the intensity of adoption of the technologies. Specifically, farmers who work in a non-farm business are about 6.8% more likely to adopt at least one technology and 1.2% more likely to adopt more than two technologies on their plot.Road infrastructure, proxied by distance from household’s dwelling to main market, has a negative significant effect on the intensity of adoption. Households who are farther from the main market are about 0.01% less likely to adopt more than one technology and 0.1% more likely to not use any SAP. Similarly, distance from plot to homestead has negative significant effect on adoption intensity, corroborating Teklewold et al.  and OyetAnother important geographic variable that has negative significant effect on the intensity of adoption is greenness index. Households located in areas with high long-term greenness index are less likely to adopt at least one technology. Households located in the north-west part of the country are less likely to adopt at least one technology on their plots, while those located in the north central zone are more likely to do so. In fact, rural households from the north-east are about 27.9% more likely to adopt at least 2 technologies. Household wealth index and livestock size also positively influence the intensity of use of the technologies at the plot level.ivreg2h results of the impact of SAPs on crop productivity are presented. The OLS estimator provides the impact of the SAPs on crop productivity, without considering potential endogeneity problems of the SAPs in the productivity model. The OLS estimator assumes that the use of these technologies is exogenously determined within the production function. Endogeneity, however, occurs when there is a non-zero correlation between the error term of the production function and other covariates. For instance, there might be unobserved variables that affect crop productivity and also determines the adoption of the technologies. The endogeneity test result suggests that the SAPs are endogenous in the production function.ivreg2h technique is employed to correct for the shortcomings of the OLS.In Table ivreg2h is a Stata program contributed by Baum and Schaffer [The Schaffer . The proSchaffer  method tivreg2h creates standard form (centered) variables and used as instruments. These standard, model generated instruments can either by themselves serve to instrument the endogenous variables or can be combined with the external instruments (in this case the long-term climate variables presented earlier). Like other IV estimators, the validity of these instruments is verified in the ivreg2h by conducting three tests—underidentification, weakidentification, and overidentification, presented at the bottom of Table ivreg2h estimation procedure. While the test results confirm the validity of the chosen instruments, it is important to emphasize that no instrumental variable approach is perfect. Thus, while the results presented below are vital, they should be interpreted and applied with caution.This approach of Lewbel's allows for constructing instruments as simple functions of the model's data (exogenous variables). For each regressor, The results indicate that the adoption of improved seeds has no significant effect on plot-level productivity, though it has the expected sign. As expected, however, the use of inorganic fertilizers significantly increases crop productivity. The use of organic fertilizer, on the other hand, makes negative significant contribution to productivity. This can possibly be attributed to the fact that some organic fertilizers, especially crop residues and animal droppings, take longer to decompose and render their benefit within the short growing season, and the strong positive correlation between inorganic and organic fertilizer discussed earlier under the conditional probabilities. This finding is also consistent with that of Asfaw et al.  who founThis paper looks further at how crop productivity is explained by household and plot-level factors. As expected, the results show that high greenness (NDVI) during the growing season increases agricultural productivity. Delay in the start of the wettest dekad is negatively correlated with productivity. We also see that the amount of rainfall during the growing season positively influences productivity. Soil characteristics of the plot, such as topography, nutrient availability, and water retentions, are critical in explaining plot productivity. The results show that plots with high nutrient availability constraints are less productive. Erosion is generally more prevalent on steep plots, potentially washing away the topsoil and rendering them less productive. As expected, irrigation and access to agricultural extension services positively impacts productivity.Crop productivity from plots operated by older farmers tend to be significantly higher than those managed by younger farmers. Moreover, plots operated by households with high dependency ratios are more productive, compared to those otherwise. As expected, crop productivity tends to increase with household wealth. Plot-level productivity also varies inversely with the size of livestock (TLU) owned by the household; households with large livestock sizes tend to be less productive. Large TLU might require households reallocating their resources from crop to livestock production, potentially leading to low crop output.Sustainable agricultural practices have long been hailed as positive production function shifters, and empirical evidence indicates that the adoption of these practices depends on a number of household characteristics, plot-level technical factors, as well as weather variables. This study aimed to unravel the factors that influence the adoption and intensity thereof of multiple SAPs, and their impact on crop productivity, using nationally representative plot-level data from rural Nigeria. The multivariate and ordered probit models were used to identify the determinants of adoption and intensity of use, respectively. The impact of adoption on crop productivity was examined using the instrumental variables approach to control for endogeneity and achieve identification.The results indicate that the application of organic and inorganic fertilizer to plots are negatively and positively correlated with crop productivity, respectively. This study also finds the importance of soil fertility and climate-related variables on crop productivity. The results reveal complementarities and substitutabilities of SAPs use at the plot-level, implying that policies geared at promoting the adoption of the SAPs should take into account these interdependencies.Despite these interdependencies, the factors that influence the adoption and intensity of use of the SAPs are heterogeneous: household demographic characteristics, plot-level technical factors, and long-term climate variabilities. High long-term rainfall variability tends to discourage farmers from using organic fertilizers and improved seeds. Similarly, high variability in temperatures tends to nudge farmers to use organic, inorganic, and legume intercropping, and their combinations on their plots. These underscore the importance of favorable long-term climatic conditions to households’ adoption decisions of SAPs.Plots, whose managers had access to extension services, have spent more years in school, have off-farm income generating activities and live in households with high wealth index, are more likely to receive improved seeds and inorganic fertilizers. Similarly, the use of organic fertilizer is stimulated by gender of the plot manager, long-term greenness (negatively), distance to market, and wealth indices.(such as drought resistant and early maturing varieties). There is also a need for improved infrastructures  to allow farmers access these innovations.These results have implications for rural development policies in Nigeria aimed at nudging farmers to adopt multiple technologies, while enhancing an outward shift of their crop production functions. First, given the strong correlation between extension access and adoption of SAPs, it is important that agricultural extension service providers in rural Nigeria be well resourced technically and financially so they can reach smallholder households in rural areas with the knowledge and benefits of these practices. In addition, smallholder households should be encouraged to diversify their livelihood portfolios to include non-farm income generating activities. Further, given the strong relationship between long-term climate variabilities and SAPs adoption and productivity, it is important that agricultural Research and Development target factors that respond to climate variabilities Finally, the adoption of improved agricultural practices has potential to impact household welfare beyond plot-level productivity. Thus, future studies need to examine the welfare  implications of adopting multiple agricultural technologies in rural Nigeria.