Dementia is one of the most critical challenges of our time. According to the Dementia Statistics Hub, only about 66 % of all UK residents with dementia were diagnosed in 2017–2018. Yet, there are reservations about the early diagnosis of dementia-related diseases. As a result, the UK National Screening Committee does not recommend systematic population screening of dementia, although case-finding strategies are still applied for high-risk groups.This study added additional evidence of the effectiveness of the National Dementia Strategy and increased numbers of diagnosis of dementia on the younger cohorts of the older people, using the intrinsic estimator age-period-cohort (APC) models and the English Longitudinal Study of Ageing data.Age effects show that diagnosis increases in volume only among those aged 75 and above, suggesting that many of those aged below 75 might not be diagnosed in time. Period effects show that although there was an initial increase due to the new policy implementation, the trend stalled in later years, indicating that the increase might not have been even across the period when controlled for age and cohort. The study also shows that cohort effects indicate lower prevalence in younger cohorts controlled for age and period effects.Although more research in diverse contexts is warranted, this study cautions against the abandonment of timely diagnosis, increased screening and case-finding, and shows some effectiveness of prevention strategies on the national level. According to Dementia Statistics Hub, one in three people with dementia are left undiagnosed in the UK . Between The National Dementia Strategy (NDS) was launched in February 2009 to improve awareness about the illness, encourage an increase in diagnosis, prevention, and the quality of care for people diagnosed with dementia-related diseases. In 2012, NDS was superseded by Dementia Challenge, which was then updated to Dementia 2020 Challenge in 2015.Among other changes with the UK-wide dementia policy, more people with mild dementia were prescribed acetylcholinesterase inhibitors, whereas antipsychotic prescriptions continued to decrease . DoneganAlthough the present paper does not aim to call for the reversal of the current screening mandate in the UK, since the harmful effects of the early diagnosis need to be addressed and clear ethical and procedural measures outlined in the communication with the patients and caregivers , its objAs the age effects are expected to follow the national recommendations on screening and case-finding, this study is mostly interested in the analysis of period and cohort effects. The invariable period effects would suggest that there were no screening, case-finding, and diagnosis increase in the period, controlled for age and cohort, which we know is not factual in the case of the diagnosis of dementia in the analysed period . On the Data. The English Longitudinal Study of Ageing (ELSA) is used for the analysis [analysis  and was Study Design and Participants. ELSA survey collection started in 2002 and interviewed people aged 50 years and older living in a private household in England. The original sample was based on the respondents who participated in the Health Survey for England in 1998, 1999, and 2001. Attrition levels in ELSA are, in general, higher than in comparable studies in the US , which can be explained by prior wave health conditions, passing away, lower literacy levels among attrited, and cultural differences in attitudes toward participating in longitudinal studies[The dependent variable is measured by whether the diagnoses of dementia-related diseases, including Alzheimer’s disease, were reported at the surveyed wave. The outcome is a dummy variable, 1 for ‘yes’ and 0 for ‘no’.Table The analysis is based on the five-year intervals of the categories of age, period, and cohort, which are usually used in the analysis of APC effects –11. The This paper’s models employ the intrinsic estimator (IE) to disentangle APC effects in dementia-related diseases , 12. TheIn public health research, Bell’s HAPC  models, developed in A Bell , are useTable Age effects based on the IE model in Table Period effects, presented in Fig. The cohort effects in this study can potentially show the effectiveness of the dementia risk prevention policy if a decreasing trend in prevalence is detected in earlier cohorts, net of age and period effects see Fig. . The treThis study provides additional evidence of the effectiveness of the UK National Dementia Strategy and Dementia Challenge of 2012–2015, particularly of the timely diagnosis of dementia and risk prevention, based on the intrinsic estimator APC analysis. The study provides a novel way to use APC models to analyse the effectiveness of preventive and diagnostic measures using longitudinal data.The findings confirm that age effects follow the screening recommendations on the national level. The period effects reveal a substantial increase in diagnosis following the implementation of the National Dementia Strategy and consequent stall in the trend in the later years. The cohort effects show some improvement in younger cohorts, suggesting the effectiveness of preventive policy or generational changes in lifestyles.Nonetheless, the evidence presented in this study is not conclusive because of the limited data, and more research is warranted, particularly using a range of data from diverse contexts. The way to do this is to analyse the APC effects across different contexts, depending on their dementia-detection strategies and selected preventive measures, including in other nations of the UK , as well as European, North American, Asian, and other contexts. The analysis within different nations of the UK is important because of the differences in approaches to diagnoses and diagnostic support across the four nations, which closely intertwined with patients’ decision-making on usefulness of a diagnosis and ultimately on whether the diagnosis is sought out.One limitation of this study is that the prevalence of early detection of dementia-related diseases in the younger cohorts can also be related to other cohort-related changes: lifestyles and decreases in alcohol consumption and smoking, among other things. The policy push toward controlling and decreasing smoking among the population in the late 90 s-early 2000 s has had a tremendous effect on the perception of public smoking and second-hand smoking, which affected the numbers of smokers across many nations. Already preceding England’s smoking ban in the workplace in 2007, the public opinion toward smoking has shifted dramatically.Another limitation is the high rates of attrition in ELSA. In this study, this is particularly relating to the mortality rates in older cohorts. The use of IE models, which require a rectangular shape of the data, helps the analysis because the older cohorts are removed from the analysis. Still, the results of this study regarding the older cohorts (particularly of those born between 1925 and 1929) might be biased because healthier older people live longer years, whereas the mortality rate is higher among older people with dementia-related conditions. The interpretations of the present study’s results regarding older cohorts must take into consideration that real prevalence rates would be higher.Despite the limitations of this study, the data used are from the national survey, which makes the results of this study generalisable to older people living in England with some caution as in the limitations discussed above.Future research could focus on the effects of preventive measures and increased diagnosis over longer periods of time, particularly focusing on case-finding among high-risk populations and other dementia detection strategies.


This article examines the relation between counting, counts and accountability. It does so by comparing the responses of the British government to deaths associated with Covid-19 in 2020 to its responses to deaths associated with the 2003 invasion of Iraq. Similarities and dissimilarities between the cases regarding what counted as data, what data were taken to count, what data counted for, and how data were counted provide the basis for considering how the bounds of democratic accountability are constituted. Based on these two cases, the article sets out the metaphors of leaks and cascades as ways of characterising the data practices whereby counts, counting and accountability get configured. By situating deaths associated with Covid-19 against previous experience with deaths from war, the article also proposes how claims to truth and ignorance might figure in any future official inquiry into the handling of the pandemic. Data fracture. Historical, political and sociological studies of science have explored the contrasting but often co-existing characterisations of data: given and made .As a response to potential concerns about the how comparative cases are likened and differentiated, this article moves between drawing out similarities and differences. The next section begins by attending to similarities between responses to Covid-19 and the Iraq war. In particular, it identifies how officials argued for the inability to establish definitive death t McGoey  termed ‘In mapping out possibilities for accountability, a principal purpose of this argument is to support thinking anew. This will take place in two directions: the extensive counting efforts in the case of Covid-19 are used to suggest the highly delimited bounds of political accountability in relation to the past actions taken in relation to the Iraq war. Furthermore, the official discounting of counts in the Iraq war is used to forewarn how the British state could respond to accountability demands for deaths associated with Covid-19. Along these lines, at the time of the drafting of this article, there is much anticipation of a future public inquiry into the government’s handling of the pandemic. The final section proposes some likely fault lines for this kind of truth-seeking and ignorance-producing endeavour.AccountableRequired or expected to justify actions or decisions; responsible.‘ministers are accountable to Parliament’ Able to be explained or understood.3During the spring of 2020, British ministers and advisors repeatedly offered justifications for imposing and lifting Covid-19 lockdown restrictions. Traditional political forums to hold government to account for its decisions, such as Parliamentary debate and media interviews, were complemented with novel ones such as the daily press briefings at Number Ten Downing Street.Within these interactions, data—on confirmed cases, hospital admissions, critical care bed patients, and on deaths—functioned as one of the central bases for constituting mutual relations of accountability. Along these lines, counting the dead with a view to assessing government performance was an explicit ongoing topic from the start of the pandemic. For instance, when the Number 10 press briefings began in March 2020, one of the forms of data presented included a slide scaling deaths totals in different countries  Question Time in Parliament, the leader of the opposition Labour Party, Keith Starmer, began by asking:When the Prime Minister returned to work a week ago Monday, he said that many people were looking at the “apparent success” of the Government’s approach, but yesterday we learned that, tragically, at least 29,427 people in the UK have now lost their lives to this dreadful virus. That is now the highest number in Europe and the second highest in the world. That is not success, or apparent success, so can the Prime Minister tell us: how on earth did it come to this?  in which the government was asked to account for the rising and comparatively high number of deaths in the UK, in which officials responded through what could be characterised as a tactic of The category of ‘excess deaths’ gained popular salience in the UK during the pandemic. Long familiar to public health specialists, establishing the extent of excess deaths involves comparing the total number of deaths over a given time period to what would be expected in the absence of a major stress, such as an infectious disease. The promises of this measure are that it avoids the vagaries of how deaths are attributed to diseases and it captures indirect deaths .The import placed on Covid-19 excess deaths will serve as the entry topic for comparing the pandemic to armed conflict. Years previously, the advisability of measuring excess deaths as a gauge of harm figured prominently in British politics in relation to another major national undertaking: the 2003 invasion of Iraq and the post-invasion conflict that followed.As background, in March 2003 a coalition of military forces from the United States, the UK, Australia and Poland invaded Iraq. In the UK, the invasion was largely justified in terms of the  alleged Iraqi possession of so-called weapons of mass destruction. The initial decision by British Prime Minister Tony Blair to support the US-led war effort generated significant domestic political opposition prior to the invasion. While the Iraqi military forces were overrun within a matters of weeks and a Coalition Provisional Authority initially put in place to govern, conflict persisted. The military occupation of the country would become opposed by an armed insurgency. In the years after 2003, the ensuing guerrilla war resulted in considerable deaths to both Iraqis as well as the occupying military forces. The mounting deaths generated further opposition to the original invasion in the US, UK and elsewhere. The analysis of the British government response to attempt to establish Iraqi deaths presented in this article is largely drawn from previous research of the author based on documents obtained under the UK Freedom of Information (FoI) Act Rappert, , 2012b a5As part of the overall contests associated with the invasion, attention to civilian death counts in Iraq underwent a series of shifts within the British government. Between 2003 and 2004, internal government deliberations about the possibility of deriving figures on the number of civilians directly killed in the initial combat phase were initiated in response to growing Parliamentary and public concern post invasion . The reason for this disregarding was likely concerns raised in inter-ministry consultations. Documents obtained under the FoI Act indicated that those within the civil service repeatedly cited the improvements made to the quality of the underlying data in the 2006 study . Promise was held out by state officials that something like a reliable understanding of deaths was at least potentially attainable at some future date that might allow for evaluating state action. In the case of Iraq, though, this potential was ambiguously situated against the stated impossibility of collecting ‘reliable’ data.The previous section indicated some initial points of similarity and difference in the orientation to counts by contrasting how the counting of deaths varied between the two cases. The possibilities for accountability through counting will be examined by considering the assumptions and choices associated with the inter-related matters of (1) the attention to what was being counted; (2) the resources mobilised in counting; and (3) the identified purposes of counting.In this section, I want to unpack these headline similarities with regard to the status of Lancet figure of 655,000 deaths and other tallies, yet without clarifying what those other tallies (such as Iraq Body Count) measured. What they measured was only a sub-set of what was captured by the Lancet’s all-encompassing excess death figure.7While the aforementioned disparity between alternative Iraqi death counts was a frequent topic of note by British officials, much less commonplace was attention to differences in what was being counted. For instance, Lord Triesman’s October 2006 statement noted the contrast between the 2006 The contrasts to the case of Covid-19 in relation to counting are stark. For instance, the circulation of multiple death counts pertaining to potentially overlapping categories was taken as a problem by state agencies from the start of the pandemic—one that needed to be remediated least public trust and the ability to track the pandemic suffer see PHE, . The resCentral categories of deaths were also revised in response to identified statistical limitations. Notably, for example, in the UK the primary sources for death counts were (1) the Department of Health and Social Care (DHSC) daily figures pertaining to those who tested positive for Covid-19, and (2) the Office of National Statistics (ONS) weekly figures derived from death certificates in which Covid-19 was mentioned. In weekly bulletins and one-off reports, the ONS broke down registered deaths by age, sex, region and place of death  hospitals use of a dedicated patient notification system, (2) Health Protections Teams from Public Health England through an electronic reporting system, and (3) comparing confirmed positive Covid-19 case lists held centrally in the pre-existent Second Generation Surveillance System PHE,  with heaIn addition, transparency in the procedures for tallying death was sought in order to promote public confidence PHE,  rather tBut if re-enforcing existing ‘control’ mechanisms was a feature of mobilisation efforts, so too was the overhaul of previous epistemic conventions. For instance, the Office of National Statistics produced weekly figures derived from death certificates. Against mounting concerns that care home deaths related to Covid-19 were being missed, in April 2020 the ONS sought to gauge them in England ONS, . To do sIn the case of Iraq, Lord Triesman’s call in 2006 for ‘considerable study’ about the methods for deriving casualty figures did not lead to the government commissioning such research or adopting externally derived figures  Armed Forces Minister at the time of the invasion, Adam Ingram, argued in front of the Iraq Inquiry that establishing the number of Iraqi deaths would have not altered the military reality. This was so because the killing ‘was not being carried out by us on the civilians’ , or revising use of force training and oversight. Yet, such purposes were seldom explicitly stated, let alone agreed between stakeholders, and certainly rarer still were the comparative merits of specific methodologies related to agreed purposes.If a sense of purpose was lacking in this respect for officials, it was lacking in other respects in the wider political and media debate. Just as which deaths were included in death counts was rarely specified, so too was the purpose of figures. In the case of armed conflict, these purposes can vary from memorialising suffering of innocents (a key aim of the Iraq Body Count), establishing assistance and reconstruction requirements, assessing the effectiveness of policies  groups might face higher risks than those from White ethnic groups. In response to these concerns, and to wider ones about BAME health outcome disparities, the British government commissioned Public Health England to analyse surveillance data PHE, . When thnot serve. In the case of British lockdown policies in the first half of 2020, figures on deaths did not inform government formal cost-benefit calculations intended to justify the severity and duration of the restrictions placed on free movement. This situation differs from many other nation-state activities wherein the need to justify controversial policies has led to new methods to commodify and value bodies , the contrast could hardly be starker. Counting was not treated as a duty of the British state from the start (or thereafter).Building on the identification of these highly contrasting configurations of the volume, velocity, variety, and value of data, I now want to sum up the differences between the cases by elaborating the notions of cascades and leaks.cascades signals a situation wherein deriving and analysing data is regarded as crucial. More than just this though, cascade also signals the sequential modification of data and its analysis. In the case of Covid-19, a significant challenge faced by state agencies was how to manage the profusion of data and data types emerging over a relatively short period of time in order to present the most accurate and useful tallies possible. Counts of deaths at any one time could thereby inform subsequent actions. Overall, the identification of unknowns and uncertainties associated with how to count spurred further data generation efforts. However, the case of Covid-19 illustrates that establishing a dynamic pattern of counting need not led enable accountability. Indeed, at least to date, the very fluidity of counting efforts has been positioned by officials so as to undercut the need to account for death counts. As noted in Section Two, against the unfolding pandemic, claims were made that it was too early to evaluate deaths. As an inter-linked sequence of ongoing activities, the cascading together of data in relation to Covid-19 deaths served as grounds for forestalling calls to account for what had taken place.The metaphor of leaks signals an alternative set of practices and orientations. In the case of the invasion of Iraq, amassing data on deaths was not treated to as vital by officials; it was even regarded as a distraction. As such, no pattern of successive, iterative stages of data gathering and analysing was generated. As noted in Section Two, against emerging excess death counts, refutations were made against the possibility of counting deaths and the unreliability of any death counts. Instead of the identification of unknowns and uncertainties leading to the mobilisation of further resources and innovations as they had done in the case of Covid-19, for Iraq unknowns and uncertainties were treated by the British state over many years as standing against the possibility of establishing how many Iraqis died. In short, data on deaths led nowhere. The challenge of securing accountability from officials in these conditions stemmed from the limited amount of data available and the manner it was called into doubt—again and again.In contrast, the metaphor of More than just speaking to the manner officials operated vis-à-vis accountability for deaths, I want to use the metaphors of cascades and leaks to speak to the varied conditions faced by analysts—scholars, journalists and others—seeking to offer second-order analyses of statecraft.‘Leak’ provides an apt metaphor in the case of Iraq since, at least for many years following 2003, what was understood about internal government deliberations derived from small openings in access that were not planned. These included the unsanctioned release of documents to the media or official papers obtained through the FoI Act that come into force in 2005. Interpreting FoI documents brings a host of complications—a prominent one being partiality. While studies by the author prior to the Iraq Inquiry were able to draw on three sets of overlapping FoI requests during 2008–2010, in the end only some 48 emails, letters, and other documents (often moderately redacted) were obtained. Later, when the official Iraq Inquiry was given widespread access to official documentation and was able to call witnesses to testify, the limitations of the history that could be constructed previously became evident actions Rappert, ?In the case of Covid-19, with the emerging cascading of information, it is still possible to attribute underlying motives or interests to ministers and advisors . However, the extent of activity taking place across varied organisations within and outside of the state makes appeals to the motivations and wilful acts of individuals less salient, because the ability of officials to delimit or steer what is taking place is comparatively conditioned by others. Indeed, an important feature of the discussion of Covid-19 has been the manner it has involved public contests of a panoply of expertise that extends far beyond the central machinery of the state  public inquiry into the handling of Covid-19 in the UK. As in the case of the Iraq war, public inquiries have long figured as prominent occasions for investigating the rights and wrongs of British statecraft. They have also been topics of contest regarding whether their scope, terms and powers have held governments to scrutiny  in the face of inconvenient developments (Rappert, Rappert, .Standards and Expertise For deaths in Iraq, central characterisations of the data available—most notably its ‘reliability’—were marshalled in a manner that fostered ambiguity about what claims were being made and what evaluative standards were in operation. While considerable efforts have been undertaken to establish shared meaning of technical terms and categories related to the methods of determining Covid-19-related deaths, the standard for judging the validity of data remains open to contest. At the time of writing, for instance, the inability to establish the ‘true’, ‘exact’ or ‘absolutely firm’ death toll has served as a basis for some commentators to posit an irreducible ignorance regarding deaths (e.g., Lyons, Purpose An appeal to true deaths tolls suggests an all-purpose number is possible in the first place. Against the multiple totals forwarded for Iraq, the inability to establish one definitive measure was positioned as scuppering the wisdom of trying to derive tallies at all. The suggestion that counts could vary depending on the purposes for which they served was rarely voiced. In the case of Covid-19, figures on deaths have had a complex relation to purpose. Numbers have been used to inform public health responses, but also to memorialise victims. To instil public trust, repeated efforts have been made to standardise what deaths within public reporting figures. Despite such efforts, uncertainty about the possibility of causally attributing deaths to Covid-19 has also been acknowledged. Such complexity provides ample ground for multiple and conflicting claims about what data matter, and the ultimate possibility for ‘adequately’ understanding deaths. Thus, a matter for the future is how to ensure the scope for plurality in purposes does not become a basis for substantially undermining the possibility for justifying actions.Efforts to determine the number of deaths associated with Covid-19 have been central to the response measures of many governments, NGOs and inter-governmental agencies. In part, assembling such data has been regarded as vital in holding governments to account for their actions and inactions. And yet, promoting political accountability through data is not at all straightforward.By comparing two major cases of statecraft in which methodological concerns associated with deriving death tallies have featured prominently in public debates, this article has considered the fraught relation between data and accountability. It has done so through distinguishing the varied commitments and investments associated with counts and counting. What has been sought is a two way reflection. By contrasting the extensive efforts to count Covid-19 deaths against the scant efforts taken in the case of Iraqi dead, I have illustrated how efforts can be made to delimit democratic accountability. In addition, the strategies of officials to discount death counts in the Iraq war have served to warn how the British state might contest demands for accountability for Covid-19 related deaths. How such possibilities unfold in the years to come will be a measure of both democracy and data.


Synthetic polymer materials are widely used in contemporary public art creation. This review summarizes the application methods and current situation of synthetic polymer materials in public art, analyzes the reasons behind them and points out the deficiencies in this research field. Finally, the development trend of the interaction between synthetic polymer materials and public art is put forward. A world without plastics, or synthetic organic polymers, seems unimaginable today . As withIn the development of human history, the history and development of public art and materials have gone hand in hand . Art is From the interdisciplinary perspective, this paper describes the present situation of the application of synthetic polymer materials in contemporary public art, explores the application methods of synthetic polymers in contemporary public art, analyzes the deep-seated reasons for the wide application of synthetic polymer materials in public art and points out the shortcomings of current research in this field. Lastly, the cross-development trend between synthetic polymer materials and public art is put forward. Through the research methods of literature research, data collection and case analysis, this study discusses the facts, processes, mechanisms and future possibilities of the integrated development of synthetic polymer materials and public art, in order to provide new ideas and possibilities for the further innovation and coordinated development of public art and polymer materials.In order to effectively obtain research literature on the application of polymer materials in public art, as of January 2022, the authors first searched the Chinese literature database CNKI with the term “public art, materials” through “theme”. CNKI returned 151 related documents. Among them, there were 93 academic journals, 30 master’s theses, 1 doctoral thesis and 1 conference thesis. The earliest literature was published in 2002. The main topic data are as follows .After a systematic study, the discussion of “materials” in the Chinese literature mainly focuses on the color, texture and cultural connotation of public art materials ,12,13. TIn the SCOUPS literature database, the string “public art” and “material *” was searched, with irrelevant studies eliminated, and a total of 157 related studies were obtained. The main types of studies were as follows: 85 academic papers, 37 conference papers, 17 monographs and chapters, 11 reviews and 3 works. The earliest literature was published in 1994. The main subject data are shown in the following table .Through a systematic study, the discussion of public art materials in the English literature mainly focuses on the sociality of public art ,22, and The above literature provides a theoretical basis for the analysis of specific materials in this paper, and at the same time, the following conclusions can be drawn: First, as a relatively young art form, the research on public art started recently within the last twenty years. Secondly, the research on contemporary public art mainly focuses on the perspective of sociology and art, while the research on contemporary public art from the perspective of materials science is still relatively weak. Finally, although there are many studies on polymer materials and environmental art and product design, the research on synthetic polymer materials and public art has not yet been initiated.In order to illustrate the importance of synthetic polymer materials in contemporary public art, the performance requirements of public art materials are briefly introduced. The basic performance of materials directly affects the selection of materials in public art creation. Designers choose materials according to the presentation effect of works of art and different conditions such as the environmental temperature and climate. Please see the physical properties that have a great influence on public art in Materials have one of the most important roles that can complete artistic creation. Any art that cannot be presented through materials is just a castle in the air . The devTraditional public sculpture works often use a single material or make the shape as a whole in the sculpture design, so as to avoid a fracture of the connection point and other problems. To some extent, this limits the richness of modeling and materials of public sculpture works. With the continuous expansion of the volume of urban space, larger spaces need larger works, but the corrosion resistance of steel cannot meet the requirements of outdoor public sculpture works. Public art must have a positive response to the times, which is reflected in the application of materials in the composite era, on the one hand, and the expression of ideas in the era, on the other hand . Synthet(1) Synthetic polymer materials are used as adhesives to improve the richness of public art materials. Polymer adhesives have a long history of use in public buildings and art. As early as 2000 years ago, people in the Qin Dynasty of China began to use mortar made of glutinous rice paste and lime as the adhesive for the cornerstone of the Great Wall . The pol−1, which is the highest among all chemical bonds [(2) Synthetic polymer materials are used as external coatings to improve the weather resistance of materials for large-scale public works of art. Because public art is often set in an outdoor space, the weather resistance of materials is extremely high. Steel structures have high strength and good toughness, but their corrosion resistance is poor and they can easily rust, which seriously limits their application in public art. In 1982, the Asahi Glass Company of Japan developed fluoroolefin-vinyl ether copolymer (FEVE), which created a room-temperature curable fluororesin that can be dissolved in aromatic hydrocarbon, lipid and ketone solvents at room temperature. It overcame the disadvantage that the original fluorocarbon coating cannot be cured at room temperature, realized the ideal of coating fluorocarbon coatings on construction sites and greatly expanded the application field of fluorocarbon coatings . Fluorocal bonds . For exa(3) Synthetic polymer materials, as the main material, embody the characteristics of the times of public artwork. Take plastics as an example. Plastics are organic synthetic materials made of resin which have certain chemical corrosion resistance and impact resistance, and there are many types, such as polyethylene terephthalate (PET or PETE), high-density polyethylene (HDPE), polyvinyl chloride (PVC or vinyl), low-density polyethylene (LDPE), polypropylene (PP) and polystyrene (PS or Styrofoam). Plastics can be seen everywhere in modern life and are widely used in public art. They are a relatively energy-saving material, easy to process and low in cost. They can keep the shape of objects unchanged at normal temperature. In many cases, plastics are also used as a substitute for many natural materials, such as plexiglass plates and artificial marble. Plastic is a light and easy-to-form material too. The famous public artwork “Rubber Duck”  created (4) Synthetic polymer materials appear in public artwork in the form of ready-made products, which expresses the public art’s attention to current social problems. In order to arouse the audience’s attention, contemporary public art often directly uses articles in daily life as raw materials for works of art. Due to the close relationship with people’s daily life, synthetic polymer materials often appear in contemporary public artwork. For example, discarded plastic products are often used in public welfare design, advocating the concept of environmental protection. As a representative of public artwork using polymer ready-made product materials, “Whale”  is made Compared with traditional sculpture materials such as marble and brass, synthetic polymer materials are not suitable for making traditional conceptual public artwork. Long-term exposure to ultraviolet radiation will cause discoloration, structural strength reduction and poor resistance to changing temperatures; some materials begin to crumble after several years of exposure to weather conditions. Additionally, probably the most important aspect is the problems with recycling. What makes synthetic polymer materials so dominant in the creation of contemporary public art?As the basis for the presentation of public art, materials’ position in public art has been paid increasing attention by artists and the public . At the Contrasted with other art forms, the most important feature of public art lies in its publicity. It can be said that publicity is the core of public art values. Sociologically speaking, “public” in “public art” refers to a social field, specifically, a public field . The strContemporary public art plays a vital role in the change and exploration of materials in the process of dispelling the solemn and dignified form and core value of traditional urban sculptures. Since Duchamp sent urinals to an exhibition in 1917, the boundaries between high and low materials in artistic works have completely disappeared, breaking the sense of distance and alienation between traditional shelf art and the audience . Synthet(1) Compared with other artistic materials, polymer materials have obvious advantages in physical properties. First of all, synthetic polymer materials have high strength and good toughness, which cannot be compared with ceramics, glass, wood and other materials. This ensures that polymer materials have strong anti-wear ability in application, which is suitable for public works of art such as stations and shopping malls with large flows of personnel and more contact with the public. Secondly, polymer materials have strong corrosion resistance. In rainy and snowy weather or places with harsh climatic conditions, their chemical properties are stable, and problems do not easily occur. Compared with steel or other organic materials, synthetic polymer materials are more suitable for works in seaside and outdoor spaces. Thirdly, polymer materials are lighter than other traditional public art materials. The lighter mass makes it possible for synthetic polymer materials to form works with more difficult structural mechanics, thus presenting a more dramatic artistic image. Fourthly, synthetic polymer materials have the advantages of easy processing and modification . Polymer(2) Synthetic polymer materials can reduce the production cost and shorten the production cycle of public works of art. The increasingly common setting of public art and public facilities requires lower production costs and more efficient process methods. In the actual creation of public art, the materials and processing costs often occupy a large part of a public art project’s entrustment fees, especially for works which are placed in commercial spaces . Relativ(3) In public art, synthetic polymer materials have richer and freer forms of expression. Artistic creation cannot be separated from the support of materials, and the richness of artistic materials can provide more possibilities for artistic creation. The color of public spaces has a strong visual impact on people, and the color of polymer materials is extremely rich. For example, the melamine resin coating material has already proved its value in public art design because of its infinite design potential. Some polymer materials, such as plastics, can show almost any desired color after adding various fillers and colorants during processing.In addition to color, synthetic polymer materials can achieve a varied texture in public art. The texture of a material is the reflection of the human sensory system’s response to the material due to physiological stimulation or the information obtained from the surface characteristics of the material by the human perceptual system . The matSynthetic polymer materials can also break through the traditional modeling concept and create new esthetic feelings and forms. For example, high-strength thin-film materials in synthetic polymer materials have laid the foundation for the wide application of membrane structures. Because of their reasonable stress, beautiful shape and economic advantages, they are widely applied in vibrant modern public buildings. Because of their light weight, membrane buildings can cover space with a large span without internal support. The flexibility of materials allows people to design and use space more flexibly and creatively. For example, Saudi Arabia’s International Terminal uses a hyperbolic membrane roof supported by a mast to ensure a long-span tent structure with fiber tension under wind load in any direction, creating a unique soft curve in the internal space, which is concise and lively and conforms to the characteristics of the times. The Ulubo Church designed by designer Jay Cha determines the best pattern of light and shadow through a translucent polycarbonate vinegar plate as the sun moves around the building. Optical fibers are applied to create a short-term feeling for the space. Different layering technologies are adopted, and the opening and closing methods of panels can be changed to produce frame scenes. The level of indoor light is also adjusted with the position of the structure in the site, making the building a sculpture of light using light translucent panels .(4) The continuous development of synthetic polymer materials has continuously improved their disadvantages in the application of public art. Although synthetic polymer materials have many advantages, they also have some disadvantages such as their quick aging and difficult degradation, which restrict their application in public art to some extent. However, with the continuous progress of polymer material technology, these shortcomings are being effectively improved. If a plasticizer is added in the molding process of the material, the machinability of the material can be improved, and the glass transition temperature can be reduced to improve the cold resistance of the material. The addition of amine antioxidants, phenolic antioxidants, sulfur-containing organic compounds and phosphorus-containing compounds in the processing of synthetic polymer materials can quickly react with peroxide radicals, thus effectively slowing down the oxidation process of materials. In the manufacturing process of materials, if light stabilizers such as light shielding agents, ultraviolet absorbers, quenchers and free radical scavengers are added, the photoaging degradation of materials can be avoided . Through(5) Composite technology effectively enhances the properties of synthetic polymer materials. Composite polymer materials are multiphase solid materials formed by the composite bonding of polymer materials and other substances with different compositions, shapes and properties, and they also have interfaces . The greThe development of degradable polymer materials makes synthetic polymer materials more environmentally friendly. They are difficult to be degraded naturally, which is one of the reasons why they have been criticized in the application of public art. For example, polyethylene, polypropylene and polyvinyl chloride all take hundreds of years to degrade, and waste plastics are usually treated through landfill and incineration, resulting in increasingly serious environmental pollution problems . DegradaAlthough synthetic polymer materials play a vital role in the development of public art, there are still many shortcomings in the application of synthetic polymer materials in contemporary public art.First of all, the theoretical research on the application of synthetic polymer materials in contemporary public art is insufficient. This can be seen from combing through the previous research results. Synthetic polymer materials have become unavoidable materials in public art creation and have played an important role in promoting the development of public art. Under this background, the lack of corresponding theoretical research should not exist. Theoretical research can play a key summing-up, guiding and leading role in practical creation. The lag or even vacancy of theoretical research reflects the lack of rational understanding and consciousness of the application of polymer materials in public art in academic circles, and it is still in a spontaneous unconscious state. Academic circles lack the necessary discussion on the facts, processes, mechanisms and future possibilities of the combined development of these two fields, which is not conducive to the further innovation and integration of public art and polymer materials.Secondly, there is a lack of interdisciplinary exploration and cooperation, which is reflected in both theory and practice. In terms of theory, it has been mentioned earlier that the research from the multidisciplinary perspective is relatively scarce, and in-depth theoretical exploration jointly carried out by scholars of materials science and art science is even more difficult to find. In practice, due to the lack of support from materials disciplines and scholars, the application of synthetic polymer materials to public works of art is generally at a relatively low-end civil level. Most of the polymer materials used are products that can be purchased anywhere in the market. These products have a low technical content and are easy to operate. Although these common civil materials have balanced properties, they sometimes cannot meet the requirements of a specific performance aspect in public art. Due to the lack of professional materials science support, many excellent public artwork design schemes can only stay at the stage of design drawings. Moreover, due to the lack of knowledge of polymer materials, artists’ imagination and creativity are also limited. At the same time, due to the lack of artists’ “strange” material property requirements for polymer materials science, many opportunities for polymer material innovation have also been missed.Synthetic polymer materials have become some of the most important materials in contemporary public art creation. There is strong evidence that many influential contemporary public artworks use synthetic polymer materials. Synthetic polymer materials are mainly used in public art in the following four ways. First, they are used as a strong adhesive to bond different parts of the work. Second, they are used as the external anti-corrosion and color coatings of works, which not only greatly improve the tolerance of public artwork to the harsh environment but also provide rich colors. Third, they are used as the main material of the work, sometimes even the only material. Fourth, they have become the constituent materials of public works of art in the form of ready-made products. The reasons why synthetic polymer materials are so widely used in contemporary public art are mainly the following two points: First, synthetic polymer materials are the most common and hackneyed materials in people’s daily life. This conforms to the value concept of contemporary public art, which is to try to eliminate the distance between artwork and audiences and emphasize the affinity of people. Second, the excellent performance of synthetic polymer materials relative to traditional sculpture materials meets the practical needs of the development of contemporary public art. These excellent characteristics include: more stable physical properties, lower price, shorter production cycle, more novel and free expression forms and richer innovation possibilities. In addition, the rapid improvement in the performance of synthetic polymer materials in environmental friendliness, weather resistance and degradability has made up for the shortcomings of the materials to a certain extent, making them more popular in the field of public art. However, compared with the fruitful practical achievements, the theoretical research on the application of synthetic polymer materials in contemporary public art is still relatively weak. There is still much room for further cooperation between experts in polymer materials science and art. Although this study broadly describes and analyzes the application of synthetic polymer materials in contemporary public art creation from a macro perspective, there are still deficiencies in the discussion of the application possibility of different synthetic polymer materials in public art creation. It is hoped that this can be deeply discussed in the follow-up research.Science and art are inseparable, just like two sides of a coin . Contemp


The purpose of this study is to investigate the relationship between corporate social responsibility (CSR), corporate reputation (CR), and brand equity (BE). Building on the resource-based theory of the firm, this study proposes a theoretical framework. In this framework, CSR is theorized to strengthen CR and brand equity, directly and indirectly, through consumer trust. We used a questionnaire survey approach. In the questionnaire, 17 items were used with a 5-point Likert-Scale . Data were collected from the consumers of the banking sector in the vicinity of Lahore, Pakistan. To estimate the proposed relationships in the conceptual model, we use structural equation modeling (SEM) through Smart PLS 3.2. The outcomes of this study confirm that CSR significantly impacts CR and brand equity. It is also demonstrated that trust mediates positively and significantly in the relationship between CSR, CR, and BE. Results of the present study have several implications for the senior management, marketing expert, administrators, and policymakers. This study expresses how CSR boosts BE and CR. Moreover, this study also indicates that trust is an important factor that enhances BE and CR. Corporate social responsibility (CSR) is attracting a lot of interest and attention in the competitive world market . The impAccording to The lack of attention paid with respect to contributing to society and the well-being of the community in which they operate has been noted. Furthermore, PSBs generally serve the federal government as well as various provincial governments. As a result, the government becomes its main customer, and they amuse and attract a regular customer base in order to compete in a competitive market . As a reOne possible reason is that PSBs are not cognizant that investing in CSR can greatly help build their reputation and brand equity, further attracting customers and their loyalty, thereby increasing their overall profitability. The PSB management and board of directors seem unaware and ignorant about their critical role as CSR participants and good corporate citizens, which can substantially help build a reputation and BE for their organization. Unfortunately, no such study on CSR activities for PSBs in Pakistan has been found that endorses the concept and theory of CSR initiatives that can contribute toward building reputation and brand equity. The results of such a study can significantly help to attract the attention of management and the board of directors of PSB in deciding their future course of action to CSR activities. Based on the above literature insights about CRS, trust, BE, and CR, this study proposes the following questions:RQ1. Does CSR influence BE and CR?RQ2. How does trust intervene between BE, CR, and CSR?This study is organized as follows: section “Hypotheses Framing and Conceptual Framework” describes the hypotheses framing and conceptual model. Section “Research Methods” presents the research methods. Section “Results” is about the data analysis and results, whereas section “Discussions” highlights the discussion of this study. Finally, section “Conclusion” is about the conclusion, limitation, and future research directions.via resource-based view (RBV) of a company when these types of leads executions and exercises impact the advantages of the firms. The manageable upper hand can be collected from these immaterial resources on the off chance that they are uncommon, important, and supreme . The questionnaire is consists of five sections. The first section includes the demographic information of the respondents. The second section took insight of the customers about CSR activities. The third part of the questionnaire measured the respondent’s level of trust in the banking sector. The fourth part of the questionnaire explained the CR -related information, and the last and fifth sections encompassed acclaimed variables that measure BE dimensions. Before data collection, the authors also conducted a pilot study to check the reliability and validity of the questionnaire. The pilot study respondents suggested some modifications to the questionnaire. Therefore, the questionnaire was revised as per the recommended feedback from the pilot study respondents. So the revised questionnaire was distributed for data collection.The items of CSR are adopted from The items of CR were adopted by The items of BE are adopted from previous studies We use to trust the items developed by The data was collected using self-administered questionnaires from the consumers of banking sectors living in Lahore city, the capital of Punjab province of Pakistan. The banking sector consumers for this research refer to those people who are aged above 18 years and have an account in any bank during the survey. Data were collected between 2018 and 2019. This survey was conducted during the working hours of the banks. A non-probabilistic sampling technique with a combination of convenience sampling techniques was used for this research to measure demographic variables like respondent gender, qualification, age, and income. Above all, variables ensure that the sample signifies the sociodemographic features of the present population. At present, for this study, initially, a total of 550 survey instruments were circulated, and from these, 342 questionnaires were received and 23 castoffs due to incomplete information that leaves us with 319 responses. Also, 10 unusable ware responses were identified, leaving 309 responses for the final analysis of this research. The majority of respondents in this research were men, around 57.09%, and women 46.91% aged between 20 and 60 years. Most of the audience holds a bachelor’s degree 950 (16%) and belongs to middle-income families earning $200–690 monthly (43.89%). For more detailed analysis, all variables were inspected for data entry errors, missing values, and the fit between distributions using the software SmartPLS.The relationships drawn in the conceptual model were examined using the SEM method. The rationale for choosing SEM over the covariance-based SEM approach is that it is less vulnerable to sample size.The degree to which all of the multiple elements of the model are used to test its convergent validity , shown iThe degrees that display actuality or affirm convergent validity are referred to as average variance extracted (AVE) . The AVEDiscriminant validity demonstrates that objects and their constructs have distinct meanings . Its valCross loading is a technique for demonstrating that the loading value of the indicator is highest with one construct and lowest with another . Table 4The standardized root mean square residual (SRMR), which is based on converting both the sample covariance matrix and the predicted covariance matrix into correlation matrices, is a measure of the mean absolute value of the covariance residuals. The difference between the observed correlation and the model indicated correlation matrix is defined as the SRMR. As a result, it is possible to use the average size of the differences between observed and anticipated correlations as an absolute measure of (model) fit. A good fit is defined as a value <0.10 or 0.08 . The SRMR Square’s partial least square regression model shows us how much variation is explained by independent variables on the dependent variable and model strength. The goodness of fit of the model is shown in this analysis. It should have a value >0.3. The coefficient of determination (R square) values are >0.3, which is greater than the threshold value, indicating the goodness of the model in The aim of this study was to investigate how CSR, directly and indirectly, influences CR and BE, using trust as a mediating variable. Previously, such studies were conducted in developed countries, such as the United States, United Kingdom, and other western countries. However, a limited amount of findings are argued and their findings are presented on emerging countries like Pakistan. So, the limited studies on the emerging countries have still shown the scarcity of findings from the banking sector perspective. Authors believe that financial institutions ought to identify their significant roles in the socio-economic development of any country. To the best of the knowledge of the author, this research is among the earliest research paradigms to investigate the impact of CSR on CR and BE in the Pakistani organizational context, especially by considering trust as a mediating variable. So, the exploration of this study is the role of trust as a mediating instrument. CSR activities help in the cumulative status of a corporate organization amongst its customers, employees, and stakeholders.First, we focused on the direct relationship between CSR and CR and BE. The results show that CSR has a positive and significant impact on CR and BE, supporting our hypotheses H1 and H2. Prior studies have shown that CSR has a positive relationship with CR and BE . The finSecond, this study depicts the positive and direct effects of CRS on trust, which supports Hypothesis 3. The finding of this study supports the research conducted by Third, in this study, we test the mediated effect of trust between CSR, CR, and BE. It also translates significant results, which is a novel and original contribution in emerging countries like Pakistan, which supports H4 and H5. The mediated results support the findings of previous studies . ForcadeThe results of this study confirmed the linkages among CSR, CR, and BE in the banking sector of Pakistan. Moreover, the finding of this research indicates that in the direct relationship, CSR positively influences CR and brand equity. The outcome of this study also confirms that trust positively and significantly mediates between CSR, CR, and brand equity. Furthermore, the outcomes confirmed that CSR has a positive and significant relationship with CR and brand equity.This study highlight that the PSBs spend their resources on CSR activities to lead to significant advantages for partners and society. While participating in CSR exercises, PSBs will gain a progressively positive discernment and a reasonable frame of mind of their partners and stakeholders. Along with the fruitful insights, it is more important for banking and other industries to invest in the CSR interventions that can contribute to gain sustainable competitive advantage. Similarly, the investment in CSR is also fruitful for both stakeholders and the community. The exact outcomes of the examination show that CSR has an immediate positive and circuitous impact on CR and BE because findings here reveal that CSR indirectly influences CR as mediated by trust. Furthermore, discoveries uncover that the backhanded effects of CSR exercise on CR while mediated by trust. The multifaceted CSR demonstrated as a CR and BE are more viable explanations behind CSR exercises. Then again, buyer trust might be seen as a result of firms captivating CSR exercises. The solid connection between CSR activities and CR proves that an organization occupied with socially dependable exercises can anticipate different helpful results.This research was conducted in the banking sector of Pakistan. The findings indicate some practical implications for the banking sector of Pakistan that could increase the organizational CR and BE through CSR. First, the managers need to create an environment of CSR activities. Those planning to do while establishing and maintaining strong relationships with firms and consumers through these CSR activities are more likely to create positive outcomes such as BE and CR . Second,This research has some limitations that may affect the generalization of its findings. First, due to time constraints and scared resources, the nature of our study was cross-sectional instead of a longitudinal design. Therefore, we recommend future researchers conduct a longitudinal mode study using CSR predictors on industrial BE and CR for more generalized results. Second, the data is collected from the second biggest city of Pakistan, an expensive city in Pakistan, affecting the buyers buying power. Such research will conduct in four to five different cities of the country, which will have generalized the study results. Third, the data was collected from the banking sector, which might cause common method bias. As the job nature of the target population is different from each other, future studies should focus on individuals who have similar jobs. In the future, such kind of study will explore the relationship between CSR and CR using the well-being of the customer as a mediating variable.The original contributions presented in the study are included in the article/supplementary material, further inquiries can be directed to the corresponding authors.MS and MA conceived the idea of the study. SR worked on the research methodology and helped in drafting the manuscript. MM worked on the results and analysis, and interpretation of model results. TO supervised the project and intensively edited the language of the manuscript. YZ approved and read the final manuscript and participated in the critical appraisal of the manuscript. All authors contributed to the article and approved the submitted version.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


Background: In recent years, worldwide opioid use has seen a sharp increase, especially for the treatment of chronic non-cancer pain. Catalonia is no exception to this trend. However, no recent studies have addressed the socioeconomic and gender inequalities in opioid use in the different geographical areas of Catalonia.Methods: We performed an ecological study to analyse the associations between socioeconomic status, gender and the use of opioids in the 372 Health Areas of Catalonia. Robust Poisson models were performed to analyse the data provided from the Central Register of Insured Persons and dispensing data from the Electronic Prescription Database.Results: The results show that socioeconomic status has a major impact on opioid use, with the most deprived areas presenting the highest levels of use. There are major inequalities in the DDD/1,000 inhabitants per areas. Moreover, women have much higher utilization rates than men, especially in more deprived areas. The greatest difference is observed in the use of weak opioids in women: the DDD/1,000 inhabitants per day was 2.34 in the area with the lowest use, compared with 22.18 in the area with the highest use.Conclusions: Our findings suggest that stronger action is needed to promote best practices in prescribing for chronic pain and to reduce socioeconomic and gender variation between geographical areas. This study provides a model for routine monitoring of opioid prescription for targeted interventions aimed at lowering high-dose consumption in specifically identified areas. Pain is a growing public health priority. Demographic changes, rising comorbidity rates, the difficulty of making accurate diagnoses, and poor access to treatment are some of the challenges faced by healthcare systems in the management of chronic pain. Among all the treatment options, opioids have played an increasingly important role in the control of moderate to severe pain .The main indication of strong opioids is for acute pain of moderate to severe intensity, especially for oncological or postoperative pain . Due to Given the generalised increase in consumption, various indicators of misuse (including addiction rates or overdose-related deaths) have been described in different contexts, and have revealed similar trends . This trThough less pronounced than in the United States, a similar trend has been observed in Europe in the last few years . IncreasAn issue that has not been widely addressed so far is the presence of inequalities in opioid use. The analysis of the social determinants of opioid use has been paid far less attention than clinical characteristics and age as the main determinants of its increase, despite the reports of ethnic, socioeconomic, gender, and geographical variations .The aim of the present study is to analyse the geographical, socioeconomic, and gender determinants of the use of opioids for CNCP in Catalonia.Multi-group ecological study using the health area (HA) as unit of analysis. In 2019, the Administrative Health Division divided Catalonia into 372 HAs. The entire Catalan population as of 2019 was considered as the study population, comprising a total of 7,653,845 inhabitants.Two data sources were used. The first was the Central Registry of Insured Persons, in order to obtain the reference population for 2019. This is an automated file that includes all residents in Catalonia and their sociodemographic characteristics . The second was the Electronic Prescription Database, an administrative database providing data on outpatient dispensing, corresponding to the drugs dispensed by all pharmacy offices during the year 2019. It has been systematically validated by the healthcare system, which pays part of the prescription, and by the providers  which carry out the billing. From this database, we obtained all the doses dispensed in defined daily doses (DDD) for each of the opioids selected according to age, sex, HA and medical diagnosis associated with the prescription. Drugs were all coded according to Anatomical Therapeutic Chemical (ATC) system (level 7) and medical diagnoses according to the Clinical Classification Software (CCS) level .The study included all opioid drugs authorised for analgesic purposes and available at community pharmacies in Spain in 2019. We distinguished between strong and weak opioids following the classification recorded at the 1961 Convention of Narcotic Drugs . Drugs wThe DDD/1,000 inhabitants per day is the main unit measure of the study. The DDD is a global standardised measure of drug consumption that corresponds to the assumed average maintenance dose per day for a drug used in its main indication among adults. DDDs are established and updated by the WHO . The DDDSocioeconomic variables: The composite socioeconomic index  was used to measure the socioeconomic level of each HA, and specifically the level of deprivation. The ISC includes mainly employment , social , economic (income level), health  variables. It has shown a high correlation with healthcare use and morbidity in HA . Higher Sociodemographic variables: Sex, HA, and age of the opioid users, categorised into five groups: 0–14, 15–44, 45–64, 65–74, and 75 years or more.Clinical variable: A clinical binary variable was constructed to reflect whether the opioid was prescribed for a cancer diagnosis: all cancer diagnoses included in the multi-level category CCS 2 (neoplasm), vs all other patients who did not have a cancer diagnosis (CNCP).First, we performed a descriptive analysis of opioid users of Catalonia by age, socioeconomic status and sex.Second, we determined the rate of opioid use  by drug type, sex, socioeconomic status, age group, and diagnosis. The use rate was calculated by using the dispensing data to obtain the total DDD according to the sociodemographic, socioeconomic and clinical variables and the reference population as a denominator. We then performed a descriptive analysis of the DDD/1,000 inhabitants per day by drug type.Then, we conducted a direct standardization of DDD/1,000 inhabitants per day by age using the total population of Catalonia in 2019 as our reference population, for both sexes. To obtain a summary of all the information, the standardised values were displayed using maps of the HAs in Catalonia for both men and women.p-values.Finally, robust Poisson models were run to test the association between opioid use  and ISC quartiles by age and sex for both weak and strong opioid types. The models were adjusted for cancer diagnosis and age. Additional robust Poisson models were run, stratified by cancer diagnosis. From these models, we estimated the odds ratio (OR) with corresponding 95% confidence intervals (CI) and associated The statistical analysis was carried out using the STATA 16.1 IC  softwareThe total study population comprised 3,755,837 (49.07%) men and 3,898,009 (50.93%) women. Opioids were used by 218,354 males (36.44%) and 380,904 females (63.56%). .p < 0.001), while in men the difference was 60% . However, the socioeconomic gradients observed between areas were, in most cases, steeper for weak opioids than strong opioids, for all age ranges and for both sexes.Furthermore, a steeper gradient was observed in women than in men, for all ages. This gap was particularly noticeable in the 45–64 years age range, for both strong and weak opioids. For example, use of strong opioids was 106% higher in women in Q4 areas than in their peers in Q1 areas  was recorded in the Barcelona 5-C HA (an affluent district of the city), and the highest rate (22.18) was recorded in the Badalona 5 HA (a deprived area). In addition, the descriptive maps show that in metropolitan areas the inequalities were more evident, both in terms of socioeconomic status and in opioid use. This finding was especially notable in the metropolitan area of Barcelona, but it was also observed in the cities of Girona, Lleida, and Tarragona, three of the region’s major urban areas.These socioeconomic differences in opioid use could be explained by two factors. The first possible explanation concerns the differences between the individual socioeconomic characteristics of the inhabitants of the different HAs. Previous literature reports have highlighted the wide-ranging impact of socioeconomic conditions on the population’s health . In the Other important issues for debate are environmental or individual differences such as the access to supplementary treatments  and the access to pain treatment specialists in different HAs. These treatments may be less accessible to some people, either for economic reasons, lack of time, or because they cannot prioritize their own care. Differences between HAs may also be driven by the availability of multidisciplinary services in pain management. In this context, the results of the study suggest that opioid analgesics have become a fast and economical way for the Catalan health system to treat CNCP. In addition, opioid management differs according to the approaches of the medical teams and the guidelines in place in each HA, which may explain some of the differences in use patterns. Previous studies in the United Kingdom, which like Catalonia has a universal healthcare system, have identified similar risk factors in opioid prescribing, including the lack of time spent on dedicated patient care and socioeconomic deprivation . In contThis study found a more pronounced socioeconomic gradient in the prescription of weak than of strong opioids. This may be due to the fact that the prescription of strong opioids tends to be more protocolised and controlled, which may reduce the differences in consumption between socioeconomic groups. Likewise, in the prescription of opioids for a cancer diagnosis, socioeconomic status has a much lower impact than in the case of a diagnosis of non-oncological pain. There are two possible explanations for this. First, cancer is a particularly sensitive issue for the healthcare system and its treatment follows clearly established guidelines, with the result that the influence of socioeconomic factors is probably less important than in other situations. Second, the data on drug prescription used in this study corresponded to drugs dispensed at a community pharmacy office; it was not possible to obtain data on consumption in the hospital or long-term care setting. Despite the fact that socioeconomic status has a lesser impact on the prescription of opioids for oncological pain, our results indicated some notably high values in the most disadvantaged HAs, especially in the prescription of strong opioids. On this point, previous research has pointed out that an individual’s socioeconomic status affects their risk of developing cancer .From a gender perspective, the results show huge differences in the consumption of opioids between men and women. The issue of gender inequalities in health has been extensively studied; women have been found to present worse indicators of perceived health and higher prevalence of certain pathologies  and painIn interpreting the results, the greater proportion of women in the population should be borne in mind. This difference becomes wider at more advanced ages, as women in the over-75 age group outnumber men by 50%. However, data on individual opioid users showed that, in the same population, there were more female than male users in absolute and relative terms for both strong and weak opioids, thus maintaining the gender differences.The results of the study show that the socioeconomic gradient in opioid use is much more pronounced in women than in men. Gender should be established as a key social factor in opioid consumption for two reasons: the gender bias in the health system and the poorer health status of women, partly due to a higher manifestation of pain symptoms and partly due to their less favourable socioeconomic status. These dimensions are intersectional and explain, among other things, the large differences observed between men and women .This study has some limitations. First of all, as it is an ecological study, it is impossible to determine the effect that the various factors have on the use of opioid analgesics at the individual level. Also, within an HA with an assigned ISC, there might be individuals with very different characteristics. Second, the 1 year time period used in the study does not allow us to determine trends in opioid use. Third, cancer prevalence and the patients-per-physician ratio in each HA were not taken into account. Finally, the data corresponds to the drugs dispensed by the public health system in pharmacies. Therefore, we do not have data on private consumption , or data on hospitals or long-term care prescriptions.The data on opioid prescribing should also be interpreted with care. A high opioid use does not necessarily reflect inadequate pain control management; it may represent a satisfactory response of the health system to the requirements of the population. The aim of this study is to highlight the gap existing between use rates due to different socioeconomic and sociodemographic factors, and is certainly not to criticise legitimate medical uses.Despite the limitations, this study presents a number of strengths. We used administrative medical databases that include records of all public healthcare services and prescriptions dispensed for the whole Catalan population. These sources provided valuable information and are increasingly used as a robust tool in public health research.To conclude, our results shed light on the social differences existing between geographical areas in the management of opioid use in CNCP. Our findings calls for stronger action to promote best practices in prescribing for chronic pain and to reduce socioeconomic and gender variation between geographical areas. This study also provides a model for routine monitoring of opioid prescribing in order to promote interventions able to reduce high-dose consumption in identified HAs.


Using a risk-based approach, the SAGIR network (dedicated to wildlife disease surveillance) had to strengthen surveillance activities after ASF was confirmed in Belgium in September 2018, very near the French border. Three new active dead wild boars search protocols supplemented opportunistic surveillance in Level III risk areas: patrols by volunteer hunters, professional systematic combing, and dog detection. Those protocols were targeted in terms of location and time and complemented each other. The main objectives of the designed surveillance system were (i) to assure early detection in case of introduction of the disease and (ii) to support the free status of the zone. Compiling the surveillance effort was thus a necessity to assure authorities and producer representatives that the sometimes low number of carcasses detected was not a consequence of no surveillance activities. The human involvement in implementing those activities was significant: more than 1000 8-h days just for the time spent in the field on active search activities. We calculated a specific indicator to enable a comparison of the surveillance results from different zones, including non-infected Belgian zones with strengthened surveillance activities. This was a first step in the evaluation of the efficacy of our surveillance activities in a WB population. Field experiments and modelling dead WB detection probability are planned to supplement this evaluation. Belgium regained its ASF-free status in November 2020, and ASF was not detected in France in either the WB or domestic pig populations. Since 1986, a network dedicated to wildlife disease surveillance called SAGIR has been in place in France (mainland and overseas territories). SAGIR is a participatory network organising an event-based surveillance, which aims at detecting the principal causes of wildlife mortality (As African Swine Fever (ASF) spread in Eastern Europe between 2014 and 2018, the level of vigilance was progressively raised within the SAGIR network in France, but no specific area of the territory was assumed to be at higher risk of introduction. The detection of ASF in the wild boar (WB) population in Belgium around 10 km from the French border in September 2018  to assure early detection in case of introduction of ASF and (ii) to support the free status of the zone. To early detect the disease, SAGIR had to detect, sample, and test as many WB carcasses as possible (roadkill included). As the movement restrictions and the hunting ban reduce the chances for passive surveillance, surveillance reinforcement through active carcass search was proposed. Protocols that assured professional and voluntary observation in good biosecurity conditions were developed for three types of searches: (i) hunter patrols, (ii) systematic combing of forest in at-risk forests, and (iii) dog detection. From mid-February 2019, an active surveillance program was also conducted. Twenty percent of the hunted WBs were sampled and tested by RT-PCR (data not presented). We also developed a procedure for dating carcasses (with the support of forensic police) in case of confirmed infection.Documenting freedom from disease in a wild population is a methodological challenge. Although hunting bags may be used as a proxy for the WB population, it is impossible to know how many naturally dead WBs are present in a territory during a specific period and, as a consequence, how many of them the surveillance activities should detect. In a crisis context, “no carcass” may be understood as “no surveillance” by authorities or producer representatives. It quickly became necessary to collect and document the surveillance effort, in particular for active searches. Surveillance purely event-based was impossible to measure, as it is based on a high number of field actors performing activities not specifically dedicated to surveillance.In this article, we describe how ASF surveillance activities were conducted from September 2018 to the end of August 2020 in the wild boar population of the region at the border with Belgium. We analysed the surveillance effort for each of the surveillance modalities in order to learn lessons in terms of human resource management in a context of high risk of introduction in an area. We have also developed an indicator to compare surveillance efficacy between zones (in France and in Belgium). Finally, we discussed how those activities contributed to document freedom of disease in the WB population at the border with Belgium.Level III: infected area or area where infection is suspected  (ZO in Level II A: increased risk of introduction by long- or medium-distance transmission (the rest of the territory).In September 2018, the French metropolitan territory was divided into three areas using a risk-based surveillance approach :Level I2, divided into three fenced zones .No part of metropolitan France was kept in Level I, as this level is the base level in a context of low risk of introduction. Surveillance efforts were thus distributed differently in these three areas. Active search activities were only implemented in the Level III area, including 134 (from 15/09/2018 to 19/10/2018), then 50 municipalities at the border with Belgium . The objective was to have at least one hunter patrol per week in each hunting ground. Hunters had to organise a search (prospecting), targeting areas with known WB presence based on their experience of the past few years and their field observations. The route should include, if present:mud and water holes (known to be commonly used by WBs) and feeding grounds as areas known to be attractive to WBs;fences and valley where WBs may look for small rivers. Indeed, we know that infected WBs will look for water (because of the fever) and may be more easily stopped by physical barriers and be unable to escape. As a consequence, they may be found dead along fences –6.Hunter patrols were organised rapidly in September 2018. These were initially planned for a few weeks to help assess the epidemiological situation at the border with Belgium. This activity targeted municipalities at the border with the infected Belgian area .Systematic combing of forests, unlike hunter patrols, aimed to cover the entirety of a forest area using a method also implemented in Belgium: silent drive “hunt” by teams of around 10 persons. ONF  foresters were responsible for supervising the teams made up of military volunteers and ONCFS staff. We selected areas to be combed from forests in buffer zones of 5–7 km from the nearest Belgian ASF cases. Forests shared between France and Belgium were prioritised. This surveillance activity started in January 2019 and stopped in July 2019, when no new cases had been reported <7 km from the border. Between January and July 2019, they were planned every week or every 2 weeks based on a rapid risk assessment analysing the locations of the Belgian ASF cases, the forest continuity between the cases and the French border, and the presence of fences. Planning was also determined by the availability of human resources.Dog detection was planned for the same at-risk area as the systematic combing but in different locations: at the border of the forests, close to rivers, in pastures and in areas that are difficult for humans to access. In January 2019, three dog handlers contracted by ONCFS started to train their dogs to detect the scent of dead WB, and fieldwork started 3–4 weeks later. During the study period, five other dogs were trained and used in the field. The protocol included restrictions during very hot or very cold periods. A specific biosecurity procedure was developed for this activity, including washing and disinfecting the dogs' legs after each field session .For each of those surveillance activities, a specific form was designed, filled out, and compiled. Hunting organisations developed a shared database and were responsible for compiling and entering data for hunter patrols. They also collected forms from foresters and entered data for systematic combing. The ONCFS compiled the dog detection and systematic combing data.In addition to weekly summary reports of the number of carcasses detected in each area, we had to report the surveillance effort related to the active search activities performed in the Level III area. The spatial unit used to compile data was the hunting ground. Other authorised activities involving professionals in the field were also reported (forestry work or drive hunts during the hunting season). Although those activities were not specifically dedicated to surveillance, they were performed by people who had received information or training on ASF and knew that it was compulsory to report any dead WBs observed.To better understand the human resources needed for each activity, the surveillance effort was measured by calculating the total number of field sessions, their duration, and the total human involvement in hours (duration of each field session multiplied by the number of people involved). Surveillance effort for opportunistic surveillance was impossible to measure. We also calculated the average spatial coverage—as a line or a surface covered—for each active search activity.To evaluate surveillance efficacy, we developed an indicator enabling us to roughly compare the surveillance results between zones by dividing the number of carcasses detected by a proxy for the WB population. The proxy used is the forest surface area because it is assumed to be proportional to the WB population , 8. The The zones to be compared included the three zones of our Level III area in France  and three zones in Belgium at the border with France  . Due to ASF RT-PCR analyses were performed by local screening laboratories. Two commercial kits were used: ADIAVET ASFV Fast Time and ID Gene ASF Duplex. In case of positivity, the sample would have been sent to the French national reference laboratory (ANSES).Hunter patrols were initially planned for a few weeks to evaluate the epidemiological situation in the hunting grounds closest to the Belgian ASF cases. In the end, they were continued until the end of 2020 to support the free status of the zone as well as to guarantee early detection in case of introduction. In total, between September 2018 and August 2020, 2144 field sessions were organised with some fluctuation over the months .Systematic combing activities started just after an ASF case was confirmed in two WBs hunted outside the infected and fenced area in Belgium in January 2019  were organised. We also had to adapt our biosecurity protocol to properly clean and disinfect the dogs' legs with appropriate products only at the end of the day and not after each search session, as this procedure was a source of stress for some of the dogs.www.plateforme-esa.fr).Reporting was organised on a weekly basis by producing tables with all the carcasses detected and tested for ASF by zone and maps compiling all the search activities at each hunting ground level. Reports were posted on the National Animal Health Surveillance Platform (NAHSP) website  is given in n = 57), but each session lasted on average 03:50 . The dog detection teams worked on 66 days from February 2019 to August 2020, with search activities lasting on average 02:30 per day . A working day with the detection dogs was divided into small search sessions of 00:50 on average (median: 00:43) separated by resting and/or training time.The way the field teams were organised was also very different for the three activities. In more than 80% of cases, the hunter patrols were implemented by only one hunter , whereas systematic combing was performed by a team of 11 people on average . Dog detection teams were usually made up of the dog handler(s) and one person from the ONCFS . The duration (in hours) of the field sessions also differed: whereas hunter patrols lasted on average 02:12 per session  over a long period , the field sessions for systematic combing were more limited in number (Distance travelled by hunter patrols was 5.6 km on average per field session (median: 4.6 km). Systematic combing covered on average 388 ha per field session (median: 400 ha) with an average speed of 109 ha per hour (median: 104 ha). The distance travelled by dog handlers was 4.7 km on average per field day (median: 4.9 km). We calculated that the dogs covered 2.3 times more distance than the dog handlers.2 Level III area as defined in In total, 54 carcasses were reported in the Level III zone, 53 were collected and tested using RT-PCR testing, and 1 was not found by the field team (detected on the roadside by an observer) (see Opportunistic surveillance (SAGIR) detected 85% of the carcasses in the Level III area (46/54), with most reports made by hunters (37%), farmers or common citizens (22%), and ONCFS officers (15%). If you exclude roadkill , the opportunistic surveillance share decreases to 65% during the first year, increasing the share found due to active search activities.2 of forest in the French ZBC and ZBS zones but a lower number detected in ZBN. Compared to Belgian areas, the number of carcasses detected per kilometre square of forest in ZBC and ZBS is similar to the Belgian ZOR_SUD but lower than in ZOR_NO. The ZOR_ZI_SO zone had the highest number of carcasses per kilometre square of forest area, but this zone had a different status to the others as it was declared infected between January 2019 and May 2020.As presented in the results, we had to adapt the systematic combing protocol because it was arduous to implement and because it was very demanding in terms of human resources. We decided to target forest areas where dead WBs were most likely to be found using the model developed by . In a noproviding appropriate feedback to field actors is a key issue and is never perfect in a crisis context.a changing agenda makes it difficult to prepare well. For instance, in the changing and uncertain epidemiological context, we were not able to draw up a long-term plan for surveillance activities from the beginning: hunter patrols initially planned for a few weeks had to be maintained for 2 years.policy decisions related to the hunting ban or financial compensation for hunting societies negatively affected communication with hunters and sometimes the data reports.delay in paying the patrols similarly complicated communication. Administrative procedures for such payments need to be better anticipated in the future.it was also difficult for volunteers to understand the need to report their field sessions on a weekly basis when hunting was re-opened.as the expected results in most cases were “no carcass found”, those implementing the searches might have experienced a feeling of failure. Our communication probably has to promote the objective of the fieldwork better.The results also show that the number of hunter patrols was not steady over the months despite being planned on a weekly basis. Different hypotheses can be put forward. Firstly, although this activity was compensated, hunters were involved on a voluntary basis, so they had no obligation to do the patrols and had to cope with their professional and personal constraints. Secondly, we also perceived it was difficult to keep them motivated across the entire period. Proposed explanations based on feedback we received are that:https://www.kobotoolbox.org/). Because it came too late in the programme, this tool was not routinely used in the end.Compiling data from different sources and using different spatial scales was not straightforward. It was thus decided to develop a shared database and an Android application supporting spatial data. A prototype was developed and tested using the KoBoToolbox platform . Those activities are, however, tricky points in the organisation of the surveillance activities. To complete this picture, a qualitative assessment of the perception of field actors would be necessary: as some activities were very demanding, we perceived that field teams were exhausted after a 1-year period.2. Guberti et al. . We can hypothesise that the WB population was shared to some extent between the two countries . Thus, we used a proxy for this population (surface area of the forest) to calculate an indicator of the surveillance efficacy and we observed increased detection of carcasses in proximity to the ASF cases. Thus, proportionally to the forest surface area, more dead WBs were detected in France in ZBC and ZBS compared to ZBN, the farthest zone from the epizootic front. The difference is not only explained by more intense active search activities in ZBC and ZBS. Indeed, the opportunistic surveillance also detected fewer carcasses in ZBN proportionally to the forest surface area. We can hypothesise that the landscape may have influenced observation and thus reporting of carcasses in ZBN (more dense forest area with restricted public access). Nevertheless, field actors' lower awareness cannot be excluded.Similarly, more dead WBs were detected in the Belgian zones closest to the epizootic front. Proportionally to the forest surface area, more dead WBs were detected in the Belgian ZOR_NO zone compared to ZOR_SUD, not directly in continuity with the infected forest. Similarly, ZOR_ZI_SO, which was classified as an infected area from January 2019 to May 2020, had the highest number of carcasses detected despite only a few  confirmeFinally, we note that active search activities interestingly supplement the results of opportunistic surveillance. For instance, between January and April 2019, 50% of the carcasses (excluding roadkill) were detected by active surveillance. Although, in the end, hunter patrols did not detect many carcasses compared to the time they spent in the field, they were a guarantee that no abnormal mass mortality occurred.France remained free from disease, and Belgium regained its free status in November 2020 . DespiteSurveillance of an epizootic in wildlife is always challenging. In this experience, we had to increase the field presence to actively detect new carcasses in a changing epidemiological situation. Those efforts contributed to increasing the number of carcasses detected. They were also a guarantee that no abnormal mass mortality occurred in the WB population.The study of the surveillance effort and the comparison of the number of carcasses detected by surface area of forest is a first step in the evaluation of the surveillance activities undertaken during this crisis. In order to improve this evaluation, we are planning to organise a field experiment to compare, within an experimental plan, the efficacy of our different active search methods in controlled conditions. The criteria to be controlled relate to visibility and accessibility for the observers (the landscape is being modelled according to those criteria). We also plan to deepen our analysis on the carcass distribution and to better explore the probability of detection by comparing different surveillance efforts in the Level III area in France and the equivalent area in Belgium.The datasets presented in this article are not readily available because their are a share property of OFB, FNC and Ministry of Agriculture. Requests to access the datasets should be directed to the corresponding author.Ethical review and approval was not required for the animal study because All animals tested were animal found dead.SD, PC, EF, AD, and SR: active search protocol design. SD, CU, PC, and GP: data compiling. SD: data analysis. SD, GG, PC, EF, and TP: paper writing. SD, CU, TP, PC, GG, AD, ER, J-YC, GP, EF, and SR: critical revision of the manuscript. All authors contributed to the article and approved the submitted version.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.