Despite the expansion of literature on social accountability in low-and middle-income countries, little is known about how health providers experience daily social pressure and citizen feedback. This study used a narrative inquiry approach to explore the function of daily social accountability relations among maternal health care workers in rural Malawi. Through semi-structured interviews with 32 nurses and 19 clinicians, we collected 155 feedback cases allowing the identification of four main strategies social actors use to express their opinion and concerns about maternal health services. We found that women who used delivery care express their appreciation for successful deliveries directly to the health worker but complaints, such as on absenteeism and poor interpersonal behaviour, follow an indirect route via intermediaries such as the health workers’ spouse, co-workers or the health committee who forward some cases of misbehaviour to district authorities. The findings suggest that citizen feedback is important for the socialization, motivation and retention of maternal healthcare workers in under resourced rural settings. Practitioners and external development programmes should understand and recognize the value of already existing accountability mechanisms and foster social accountability approaches that allow communities as well as health workers to challenge the systemic obstacles to quality and respectful service delivery. Responsive, people-centred and respectful maternal health care is increasingly recognized as a critical component of efforts to improve maternal health outcomes and reduce maternal mortality –3. In loIn general terms, social accountability refers to citizens’ demands for greater accountability from political and governmental actors for their actions and decisions, as well as for service delivery failures . TranslaEvidence on the effect of such interventions is mixed because data on interventions in different contexts is fragmented . Social et al. (2013) showed that even though health service users are aware of their rights and expectations in healthcare, they lack effective channels through which they can voice their concerns and complaints and hold health professionals accountable [et al. (2013) in Malawi found that many rural facilities are monitored infrequently by District Health Management Teams, while another study reports that 28.7% of health workers in Malawi receive no supervision at all [Studies on the health system in Malawi sketch a grim picture of the accountability landscape in which citizens have a limited “repertoire” of social action  and in wountable . Health ountable . Beyond et al. 13 showedountable . In ordeountable ,23. On tountable ,25. A stn at all ,27. The n at all ,27.In this context, we assume that the provision of respectful services may rely, to a large extent, on local accountability arrangements between citizens and providers. Formal participatory mechanisms, such as Health Committees, may be part of these arrangements, but informal networks and relationships may be just as important . This paIn this paper, we use elements of the conceptual accountability framework by Bovens . We refeinformation of the forum about the responsibilities standards and outcomes of the conduct of the actor followed by the questioning, discussion and passing of a judgment of the actor’s conduct. Finally, the forum can impose consequences to the actor; rewards for a positive, and sanctions for a negative judgement [The accountability relationship between the actor and the forum consists of several steps including the udgement . In commpersuade through insistence on collective values rather than to coerce through “hard” sanctions, threats or financial incentives [Firstly, standards and norms of good maternal health care are likely constructed locally and assessment and judgement are likely to be based more on social norms, values and expectations than on predefined quality standards . Furthercentives ,14,33. Pcentives ,34 and scentives . This frThe study was conducted in the Northern region of Malawi in one of the six districts, Mzimba district, between April and June 2016. The Northern Region is the least populated region, home to only 13% of the total population . The disPrimary health care in Malawi is offered by a network of around 977 functional health facilities, including health posts, health centres (HCs) and hospitals. These comprise public-governmental facilities (50%) as well as private non-for-profit facilities of the Christian Health Association of Malawi (CHAM) (17%) and other providers (33%) . HCs, thThis study targeted rural HCs and hospitals in Mzimba district, both government and CHAM owned. The government also employs health staff in the CHAM HCs and the working conditions in both types of HCs are comparable. A total of 39 HCs in Mzimba district were eligible for the study as rural facilities providing maternal health care. Administratively, the district is divided in two subdistricts, Mzimba North and South, containing respectively 12 and 27 eligible HCs. Each subdistrict is further divided into clusters of HCs that are constructed by the District Health Management Team for their supervision visits on the basis of the geographical concentration of HCs. Subdistrict North contained one cluster covering all the 12 HCs that were selected for the study and subdistrict South contained six clusters of which three clusters were selected based on a random sampling strategy. The selected three clusters in the south hosted a total of 14 HCs. Hence, the total number of HCs included in the study was 26, of which six were CHAM and 20 government owned. Their distance to the district capital  ranged from 15 to 132 kilometres. Nine of the selected facilities had three or more skilled birth attendants, 13 had two skilled birth attendants, and four had just one. The number of deliveries conducted ranged from 36 to 723 in the year 2014 [From the 26 selected HCs, a purposive sampling of the study population was based on the following eligibility criteria: 1) government employed skilled birth attendants , identifet al. (2010), feedback is defined as a statement or a summary of performance of delivery care over a specified period of time or regarding one event (i.e. assisted delivery) [The main data collection method was individual, semi-structured interview with nurses and clinicians. The interviews were divided between two researchers who each conducted around 25 interviews within a period of five weeks. The main goal of the interview was to gather information on social accountability relations and processes. The technique chosen was narrative inquiry, a research method that collects personal experiences of past events . A scopielivery) . We deveThe interviews were conducted in English and lasted approximately 50–60 minutes. The three main questions were preceded by a mapping exercise of social actors in the immediate environment of the respondent. The actors enumerated were displayed in front of the respondent after which the three questions were posed. For each case presented, respondents were probed to explain when and how the situation occurred. The narrative inquiry approach, alternating engaging and sensitive questions, was expected to yield data that could show the breadth of HWs’ web of social accountability relations, including cases of criticism that might be difficult to share.The individual interviews were complemented by two group discussions (one in each district) with HWs who participated in the study (n = 12) and new participants (n = 3). The aim was to share and validate the preliminary findings of the interviews, to evaluate the research and to discuss practical implications.The interviews and group discussions were audio recorded, except for one interview where the respondent did not want to be recorded. The audio recordings were transcribed verbatim by the researchers and externally employed transcribers from Malawi. Sensitive data was removed from the transcripts.what (was the feedback about?), who (were the providers/messengers of feedback?) when and where (did it happen?), how (was the feedback transferred?) were coded, as well as the perception of the respondent on the case . Duplicate cases, where a respondent mentioned the same case twice in an interview, were removed as well as cases that were not clear in terms of the main codes: topic, social actor, or feedback method. The codes helped to get a first overview of frequencies of these main codes. In a next stage, a cross-case analysis was performed to identify patterns, every time taking a different code as entry point , to identify the theme that made most analytic sense. This was done in an iterative way through inter-researcher reflection, reference to notes and group discussion notes, and discussion among researchers. We used standard frequency analyses in SPSS (version 22.0) to describe HW characteristics.The interviews led to narratives of social accountability that we framed as “feedback cases”. Cases were extracted from the transcripts with the help of qualitative data analysis software, MaxQDA (version 12), and coded using framework analysis. This method allows contrasting and comparing data by themes across many cases, as well as retaining the connection to other aspects of individual accounts . For eacEthical approval for this study was granted by the National Health Science Research Committee of the Ministry of Health in Malawi (NHSRC#15/03/1398). Prior to the interviews and group discussions, the researchers introduced themselves and the research project, read the informed consent form out loud, and participants were asked to provide written or verbal consent. Consent to audiotape the interview and discussions was obtained through informed consent as well as prior to the start of the interview by asking the participants. All information given by participants during the research was considered to be strictly confidential and the findings of the research were based on anonymized data as described in the section above regarding data management (48). Moreover, transcribers for this research were selected based on the criteria that they did not have any links to the communities and HCs included in the study in order to ensure anonymity . The traIn total, 155 feedback cases were collected. Respondents were allowed to share more than one example of a feedback case. Respondents provided between 1–7 cases with an average of 2.9 examples per HW. There were no major differences in the averages of cases shared between the districts and professions. In the following, the cases are analysed according to: 1) type of actors providing feedback; 2) topics and types of feedback; and 3) reaction of HWs to these types of feedback.Within the recipient group, women who come for their delivery were mentioned most often, followed by guardians, relatives and husbands. Within the group of community leaders, HCAC members and chiefs were mentioned in an almost equal number of cases. The data show the heterogeneity of social actors having regular interactions with HWs on their performance, including spouses and friends in the private sphere and the HCAC as the more formal structure with the mandate to monitor health service delivery and manage complaints. Differences were noted between nurses and clinicians whereby nurses  shared more cases of feedback from relations nearby (spouses and patients) and clinicians from friends, parents and siblings, often living outside of the community. Chiefs and other community leaders were mentioned in equal numbers by nurses and clinicians. Throughout the paper, the actors will generally be mentioned by their cluster name.The different groups of actors provide feedback on different service delivery issues and in different ways. The different feedback methods, actors and topics are summarized in not treat certain women  express their gratitude for a successful normal delivery at the labour ward or before discharge. Other nurses, however, experience that almost all women show some form of appreciation, even if it is just a facial expression. Expressions of gratitude for positive birth outcomes after complicated deliveries and referrals are more frequent and explicit than after normal deliveries. In such cases, women and their relatives almost always come to thank the HW verbally, sometimes multiple times: after the delivery, during the postnatal check-up and on the street. Even in the case of a maternal death, a male nurse was thanked for trying everything possible to save a woman with anaemia by personally travelling to surrounding facilities to find blood.Although expressions of gratitude from recipients appear most frequently in the feedback accounts, a number of respondents indicated that not all women thank for the services received as Material and symbolic rewards for successful deliveries involve women and their relatives offering gifts or food items or asking the HW to name the baby. One nurse experienced being called “doctor” instead of “nurse” as a form of appreciation, and another felt appreciated when a newborn was being presented as her daughter. Such material or symbolic feedback was reported 17 times, most often in cases of successful complicated deliveries conducted at the HC  or the lack of attention from the HW. According to the HWs, disapproval of the HW’s services is sometimes expressed by non-verbal acts, including the absence of comments, and women and guardians leaving the HC without saying goodbye. Most critical feedback or complaints, however, are expressed verbally but indirectly through intermediaries.“know the community”  clinicians talk about the HCAC than nurses and females. This may be explained by the fact that the formal counterpart of the HCAC in the HC is the officer-in-charge. In the study sites, most in-charge positions are filled by  clinicians.A number of feedback cases (n = 17) revealed that users or communities also have a collective approach to communicate their satisfaction or disapproval of HWs or the HC. Rather than receiving feedback from particular persons, feedback then reaches HWs through conversations in public spaces.the nurse that doesn’t know how to work”. Around the HC, during opening hours as well, HWs report hearing patients grumbling among each other about the long waiting time or unfriendly HWs. While women do this in the maternity home or shelter with each other, husbands are more vocal in public about the quality of services as reported by multiple HWs  and recurrent misbehaviour  of a nurse or clinician to the District Health Office. Most of these processes involved written documentation.Health workers were asked to indicate how they felt about feedback incidences and how these affected their behaviour towards their work and their patients. Four HWs said that the evaluation and judgement by the community does not influence their work. According to a female nurse and an officer-in-charge, the health outcome itself, the delivery of a healthy baby or failure to do so, is already the main indicator of performance; social feedback does not influence that. On the other extreme, three HWs stated community feedback was their most important source of feedback  to collective (public buzz) to more formalized processes . They are part of a larger repertoire of voice mechanisms in which citizens try to obtain more or better services. The cases show the informal character of these processes; most of them are unorganised, spontaneous or unsolicited by either the HW or community structures such as the HCAC. The findings support our assumptions that informal social accountability relies on citizens exerting soft pressure on HWs through expressions of gratitude and approval, appeals to pride and responsibility, combined with tactics to indirectly communicate complaints. Shaming and embarrassment in public is used to some extent.Informal forms of social feedback, both positive and negative, seem to encourage most HWs to provide more effort and they remind them of the relational and communicative aspects of care. The findings show that informal feedback and accountability has its limitations in that it is inadequate to deal with “serious cases” of abuse, failed referrals and assumed neglect, leading to maternal or child death. Such incidents are complex, related to individual personal factors or based on accountability failures at multiple levels of the health system, beyond the sphere of control of communities and HWs. When informal feedback then evolves around suspicion and blame of individual HWs, it can have a negative effect on patient-provider interpersonal communication and interaction, and on public trust in HCs, even leading to conflict, including violence against HWs .While social accountability is often conceptualised as a formal process or an intervention, this study draws attention to existing accountability relations in the daily life of rural HWs. There are at least two reasons why it is important to pay attention to these relations. First, at the individual level, accountability in the form of feedback and informal sanctions trigger both incentives and disincentives for HWs to maintain or provide respectful care. Second, the presence and influence of an informal accountability web has implications for formal social accountability initiatives.how to live in the community”, how to adapt to a different culture, relate well with others and keep up despite difficult circumstances. In the group discussion, HWs argued that such moral guidance reminds them of their mission and ethical standards learned at medical school. We argue that advice and feedback demonstrating public recognition, mental and social support provide a hidden form of moral pressure on HWs to respect social and professional norms such as punctuality, respect and friendliness. In addition, they constitute important non-material sources for socialisation, motivation and retention, crucial for rural HWs as also suggested in a study on Human Resource Incentives in Malawi [Given that the findings generally focused on instances of positive feedback, we are best able to discuss the incentives provided by informal relations, particularly for rural HWs. The HWs in our study often operate on their own or in teams of two as many HCs do not have the required number of five skilled birth attendants. They try to cope with the limited resources they have at their disposal to provide a basic level of acceptable care. During the interviews, they expressed their frustration with the lack of resources and materials, and with the difficulties of being accepted by the community, especially when coming from another district. HWs regularly received advice from family members, spouses, friends and community leaders on “n Malawi . ClearlyWhile it is important to recognize that daily feedback and advice mechanisms matter for HWs in rural settings, we raise questions as to how they relate to formal social accountability initiatives. If much accountability takes place in the form of daily, informal and hidden interactions, one has to ask to what extent they are inclusive. Social accountability mechanisms that are based on individual interactions run the risk of involving only vocal citizens or those who have the best connections, potentially leading to HWs exclusive or selective responsiveness . One als“the incremental making and institutionalisation of informal rules, when reinforced with the more formalised procedural accountability, can build accountability relationships that work”  suggests,  2013: 44). From o 2013: 44. Each ac 2013: 44. A syste suggests 2013: 44. Such an 2013: 44 and how  2013: 44.Second, the emergence of constructive accountability relations, whether informal or formal, remains largely theoretical when HWs, communities and community structures are not given the authority and the resources to fulfil their mandate to provide and monitor maternal health services . Practic“is not a bureaucratic machine but a configuration of social processes” [de facto, also in contexts where de jure accountability structures are well developed and implemented [Finally, our study suggests some broader lessons for the field of accountability, governance and health systems beyond social accountability as a sub-field. In the introduction, we suggested that informal accountability relations form a substitute for weak formal social and bureaucratic accountability mechanisms. We suggest that informal social accountability exists regardless of the presence or strength of formal social, bureaucratic or judicial accountability mechanisms. As Therkildsen (2014) suggests, a health system ocesses” . In genelemented ,55.The collection of case stories of HWs helped to capture the lived experiences of participants. It generated a rich map of social feedback relations and it showed the variety of perspectives on, and reactions to, feedback relations. The results describe the informal accountability network of maternal health care workers in a typical rural district. Service provision conditions and community-provider relations may be similar in other rural Malawian districts and lessons may be transferable to other rural areas, even outside of Malawi. The findings may, however, not be transferable to health facilities and providers in urban districts. We hypothesise that HWs in urban areas are less remote from other accountability mechanisms, such as peer and supervisor feedback, and less dependent on their social environment to get inputs to steer their performance, motivation and retention. Further research should clarify this point.We accumulated data on a relatively large number of individual HWs’ relations, but the open character of the interviews did not allow for group comparison. Additional research, in particular quantitative approaches to social network analysis, could offer interesting insights into structures of communication and accountability in local health systems and differentiate between groups, based on, for example, profession, gender, age and work experience.One of the risks of narrative interviews is that informants try to present themselves in a favourable light . In addiInternal reliability was improved by the use of multiple researchers in the field and at the analysis stage. The coding schemes were jointly developed and tested by three researchers. Participants’ accounts were coded by two researchers who aimed to reach a consensus on the interpretation of each case.While social accountability is often conceptualised as a formal process or an intervention, this study shows that existing daily relations of feedback and informal sanctions play an important role in promoting or maintaining respectful care. This paper argues for revisiting the assumptions of social accountability. In the development and evaluation of social accountability interventions, it would be useful to analyse these spontaneous types of feedback in addition to the solicited ones through formal interventions. In addition, given the suggested importance of a web of social accountability relations for health worker performance, it is important to understand how health workers perceive themselves and their responsibilities vis-à-vis their social environment and to identify ways in which their interaction and relations with communities and other professionals can be enhanced.S1 Table(DOCX)Click here for additional data file.


The pH, redox potential, and sulfate and sulfide concentrations were measured twice a week over a maximum of 171 days. The microbial communities in the bioreactors were characterized by qPCR and high throughput amplicon sequencing. The pH in the bioreactors fluctuated between 5.0 and 7.7 with the highest amount of up to 50% sulfate removed measured around pH 6. Dissimilatory sulfate reducing bacteria (SRB) constituted only between 1% and 15% of the bacterial communities. Predicted bacterial metagenomes indicated a high prevalence of assimilatory sulfate reduction proceeding to formation of l-cystein and acetate, assimilatory and dissimilatory nitrate reduction, denitrification, and oxidation of ethanol to acetaldehyde with further conversion to ethanolamine, but not to acetate. Despite efforts to maintain optimal conditions for biological sulfate reduction in the bioreactors, only a small part of the microorganisms were SRB. The microbial communities were highly diverse, containing bacteria, archaea, and fungi, all of which affected the overall microbial processes in the bioreactors. While it is important to monitor specific physicochemical parameters in bioreactors, molecular assessment of the microbial communities may serve as a tool to identify biological factors affecting bioreactor functions and to optimize physicochemical attributes for ideal bioreactor performance.Sulfate-rich mine water must be treated before it is released into natural water bodies. We tested ethanol as substrate in bioreactors designed for biological sulfate removal from mine water containing up to 9 g L As mentioned above, acetate may be produced through the oxidation of ethanol via acetaldehyde, and if not further oxidized to acetyl CoA by the acetyl-CoA synthetase enzyme, acetate accumulates in the solution. We used the PICRUSt software [In our study, we detected accumulation of acetate in the effluent, leading to acidification of the bioreactors and a decrease in the sulfate removal process . Celis esoftware  in orderl-cysteine  caused acetate to accumulate. It is possible that the long HRT (173 h) allowed non-SRB microorganisms to accumulate and form biomass that competed with the SRB.Excess sulfate can also affect the reactor performance, as it may result in elevated redox potential and lowered pH and thus diminish the sulfate reduction activity . These c2. However, Ozuolmez et al. [Desulfovibrio vulgaris and Methanosaeta concilii can coexist in cultures, where H2 leaking from the aceticlastic methanogenesis of M. concilii is used for sulfate reduction by D. vibrio. In addition, the authors showed that even the acetotrophic SRB Desulfobacter latus and M. concilii coexisted in the cultures rather than competing for resources.The presence of aceticlastic methanogens in the bioreactors can be explained by the prevalent acetate produced in the bioreactors. Nevertheless, Dar et al.  and Krisz et al.  showed t+ [The fungi present in the bioreactors may also add to the production of acetate and overall acidity, because of fermentation. Fungi are able to utilize many different types of organic compounds as substrate, but ultimately, in the absence of oxygen, the Saccharomycetes and Eurotiomycetes can turn to fermentation, in which they produce acetate or other organic acids and H+ .2 via acetate. It could also be possible to employ genetically modified microbial species or consortia in order to design bioreactor consortia to perform specific processes for optimal results and better control of the bioreactor processes.Despite the easy accessibility of ethanol as electron donor for biological sulfate removal processes, the ethanol in our case was incompletely oxidized. In addition, the reactor conditions may have supported more biomass growth and development of a strong community of fermenters. It is possible that more efficient biological sulfate reduction and thus sulfate removal could be achieved with shorter HRT, which would allow for the SRB to reduce the influx sulfate without allowing for excess biomass growth, and to screen for microbial consortia that are able to oxidize acetaldehyde to acetyl-CoA and further to COBased on previous tests on our laboratory, we hypothesized that the microbial community in our sulfate removal bioreactors had high microbial diversity, but that the communities were dominated by sulfate reducers. In addition, we hypothesized that ethanol is a suitable electron donor for the biological sulfate reduction in the treatment of sulfate-rich water originating from a northern mine.2S as well as the accumulation of acetate, may have inhibited growth and activity of the SRB in the bioreactors. The elevated concentration of acetate may be due to the prevalence of fermentation, which may be allowed to develop because of long HRT, and is thus a symptom rather than cause of malfunction of the bioreactors. Analysis of the microbial community gave added insight into the microbial processes taking place in the bioreactors and may serve as an indicator tool for process failure and tool for optimization of the sulfate removal process. Our study also indicated that parameters normally used for monitoring a SBR process such as redox and pH, may not be sufficient for assuring a functioning process.In this study, we tested the suitability of using ethanol as an electron donor for sulfate reduction for the biological treatment of sulfate-rich mine water with low metal content. The performance of the bioreactors was monitored by measuring pH, RedOx potential, and sulfide and sulfate content throughout the experiment. The microbial communities in the used laboratory-scale bioreactors were characterized using a high throughput sequencing technique and bioinformatics. We found that acetate accumulated in the bioreactors and that the sulfate removal rate was generally low when using ethanol with the tested mine water. The microbial communities in the different bioreactors consisted mostly of non-SRB, with a dominance of nitrate and nitrite reducing sulfide oxidizing taxa. A high input sulfate level and a low pH, together with undissociated H


Schizophrenia has recently been related to reduced physical functioning , 2. The Atypical and typical antipsychotics seem to have different effects with regard to the inflammatory state. Individuals taking atypical antipsychotics such as quetiapine and olanzapine show higher levels of CRP compared with other antipsychotics . ClozapiBesides its potential function as a biomarker for schizophrenia, CRP is also synthesized by hepatocytes under the regulatory control of IL-6, released by macrophages and adipocytes . ElevateTherefore, inflammatory processes seem to play a crucial role in the pathophysiology of schizophrenia, while physical functioning is further associated with this illness. Thus, a dynamically interacting network of these three components emerges, and the study by Szortyka and colleagues investigated the association of schizophrenia, inflammatory markers, and physical functional capacity.N = 28) had been suffering from schizophrenia for more than 7 years. To test the physical functional capacity, the participants completed the 6-minute-walk test (6MWT) and blood pressure, heart rate (HR), respiratory rate, peripheral oxygen saturation, and dyspnea were measured at the beginning and at the end of the test, while HR and blood oxygen saturation (BOS) were also measured during the test. Blood samples were collected to examine CRP.For this purpose, a cross-sectional study was designed, including stable outpatients with a diagnosis of schizophrenia. Forty patients aged between 18 and 60 took part in this study, whereby 18% of the participants were female and the remaining 82% male. All patients already had a history of schizophrenia with at least four episodes, and all patients were receiving psychopharmacological treatment. Most of the patients  was lower in the patients compared with the average physical functioning of the general population. In addition, the HR and CRP levels were higher in the clinical sample compared with the general population. Only 3 of the total 40 patients reached the minimum predicted distance. The impaired 6MWD  and dyspnea were correlated to CRP and an association between impaired physical functioning and elevated levels of CRP in patients suffering from schizophrenia emerged.The present study was the first to identify a link between reduced functional capacity and an increased inflammatory marker in patients with schizophrenia. This finding needs to be highlighted since most existing studies have focused on physical exercise to improve functions of schizophrenic patients and not on the “baseline” physical functioning. Still, it remains unclear whether reduced physical functioning is a direct result of schizophrenia or whether it is due to a lack of motivation to exercise because of the different consequences of schizophrenia. Future studies need to assess this issue since it was shown that patients with schizophrenia spend less time doing physical activities, potentially leading to impaired physical functioning . FurtherThere were two subgroups in the study (schizophrenia less or more than 7 years) and as no further information was provided about the differences between these groups, they probably did not differ in the physical tests. Nevertheless, it would have been relevant to clarify that and to further elucidate if there were differences with regard to gender. Kahl and colleagues showed that reduced muscle mass and depression are associated with male gender and chronicity , so it mThe authors failed to provide more information on the association between CRP and physical functioning. However, the measurement of additional inflammatory and anti-inflammatory markers such as IL-6, NF-KB, TNF-alpha, or IL-10 in a longitudinal setting would be relevant to clarify the underlying pathophysiology linking schizophrenia, inflammation, and reduced physical functioning, thereby revealing causal relations. Furthermore, the inflammation regulating role of steroid hormones needs to be taken into account, when examining the effects of inflammatory markers in psychiatric conditions –26. The The authors furthermore refer to the state of the patients as “stable schizophrenia” , indicatMoreover, the study did not include a control group with healthy individuals, which would have significantly strengthened the identified differences. Importantly, a lack of information is present with regard to the specific medication the patients took. This information should be provided in future studies in order to differentiate between the types of antipsychotics and their effects on the disease, inflammatory state, and physical functioning to a better extent.In conclusion, the study of Szortyka and colleagues provides new and promising insights in the field of biomarker research for schizophrenia and the relation to physical functioning. Future studies should include a broad spectrum of relevant cytokines to present the complex picture of interacting cytokines in schizophrenia, clinical tests , and more specific information about the patients and their medication. The pathophysiology of schizophrenia includes a network of functions and markers varying in patients suffering from schizophrenia compared with the general population. To elucidate this complex interacting system, large studies are required to capture probable moderation or mediation processes. This would help to gain a better understanding of the underlying pathophysiology of schizophrenia and ultimately develop more efficient therapies.RE wrote the first draft of this manuscript and edited subsequent versions. AW revised the first draft and edited subsequent versions.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.


The birth of smart materials such as piezoelectric (PZT) transducers has aided in revolutionizing the field of structural health monitoring (SHM) based on non-destructive testing (NDT) methods. While a relatively new NDT method known as the electromechanical (EMI) technique has been investigated for more than two decades, there are still various problems that must be solved before it is applied to real structures. The technique, which has a significant potential to contribute to the creation of one of the most effective SHM systems, involves the use of a single PZT for exciting and sensing of the host structure. In this paper, studies applied for the past decade related to the EMI technique have been reviewed to understand its trend. In addition, new concepts and ideas proposed by various authors are also surveyed, and the paper concludes with a discussion of the potential directions for future works. The birth of smart materials such as piezoelectric (PZT) transducers has aided in revolutionizing the field of structural health monitoring (SHM) based on non-destructive testing (NDT) methods. One of the relatively new NDT methods, known as the electromechanical impedance (EMI) technique, has been a focus of international research for two decades; however, it has not been fully commercialized due to many existing limitations. In general, SHM is usually applied on-site, where the majority of inspection work is visual . For thiA well-designed SHM system can minimize the overall maintenance costs of a structure by detecting damage at an early age, allowing action to be taken early to prevent further damage. One possible approach is the EMI technique, as it uses a single PZT transducer that acts as both actuator and sensor . The advExcellent reviews of the EMI technique can be found in previous studies, including Park et al. , Yang et2, to excite the host structure above 20 kHz, at which point the response is acquired using the same PZT transducer. The PZT is typically attached to the surface of the host structure using an adhesive, and a low voltage of 1V is used to deliver excitation to the structure. The 1-D model introduced by Liang et al. [The theoretical development of the EMI technique was first introduced by Liang et al.  and has e alarms .(1)Y(ω)Various authors including Sun et al. , Zhou etBhalla et al.  proposedectively .(3)Y¯=GN is the number of PZT transducers with the dimension L, W and H. X, Y and Z, respectively. Lastly, the equations for Realizing the limitations (such as PZT shape and size) of the 1-D and 2-D models developed by various authors, Annamdas and Soh ,16 preseZ) can be approximated by dividing the input voltage (iV) by the current through the sensing resistor (I). The development of a low-cost EMI technique has continued to be investigated by various researchers. Xu and Giurgiutiu [Since the introduction of the EMI technique, it has generally been applied using an impedance analyzer such as the Agilent 4194 A. However, the high cost of such devices created a demand for lower-cost ways of applying the EMI technique, as an impedance analyzer can cost up to US$40,000. Peairs et al.  introducurgiutiu , Bhalla urgiutiu  and Paniurgiutiu .The EMI technique is a local damage detection method that is very effective for assessing the health of a nearby area. However, it is a method that can be difficult to manage when monitoring large structures, as it may involve hundreds to thousands of piezoelectric transducers. As the traditional wired systems with a large number of sensors can be very costly, this has highlighted the significance of wireless sensor nodes. The benefits of the wireless systems are well summarized by Spencer et al.  and LyncOne of the advantages of the EMI technique is that a single PZT transducer acts as both an actuator and sensor, simultaneously. In general, PZT ceramics have been used for majority of research related to the EMI technique where piezoelectric diaphragms (buzzers) have also proven to be effective for conducting the technique ,28,29. HReReN is the number of impedance signatures, with the symbols When the properties of a structure change , the impedance signature also changes, with greater variations subjected to larger damage. For this reason, once the impedance signatures are acquired, it is necessary to quantify the severity of damage. In general, there are 4 different statistical equations used for the quantitative assessment of the signatures . These aRMSD metric having been used the most. Tseng and Naidu [RMSD and MAPD were more suitable for locating and characterizing the growth of damage, whereas covariance and CC were more suitable for identifying the increase in damage size at a fixed location. Tawie and Lee [RMSD, MAPD and CC). The PZT transducer was attached to the 150 mm3 sized concrete specimen where impedance was measured on days 7, 14 and 28. From the study, the authors discovered that MAPD correlated better than both the RMSD and CC metrics. Xu and Jiang [RMSD, MAPD and CCD. A number of PZT transducers were surface-bonded to the upper flange of the steel girder and the concrete slab, where bolt loosening was identified by monitoring impedance signatures. Hu et al. [RMSD, CCD (CCD = 1 − CC) and a new damage index proposed by the authors, Ry/Rx. The results showed that the frequency range below 100 kHz performed better than ranges above this frequency range for damage identification, with the authors confirming that the proposed new damage index showed better results. Wandowski et al. [CB), a statistical metric other than the aforementioned four equations, to evaluate the performance of the EMI technique on composite structures subjected to damage. Here, the authors found that CB performed better than RMSD as CB values increased, with an increased level of damage at different temperatures.Thus far, most of the researchers who have been investigating the EMI technique have used one of these 4 statistical equations, with the nd Naidu  investig and Lee  used thend Jiang  investigu et al.  focused i et al.  used CheOther statistical metrics for analyzing the impedance signatures include average square deviation (ASD), united mechanical impedance (UMI), ellipse damage index (EDI) and others, and new metrics in the field of the EMI technique are being proposed by various researchers ,44,45. HThe real application of the EMI technique was adopted for the first time by Annamdas and Yang (2012) in Singapore, Telok Blangah district . The worAlthough that there are still many issues to be dealt with regarding the EMI technique, one can expect to see more applications of the EMI technique onto real structures in the future. Since the EMI technique can detect any changes in structural property, the range of its application is very wide. The research for this technique has reached beyond mechanical and civil engineering fields as various authors have attempted the EMI technique to be used for biological applications. Tabrizi et al.  investigRegarding mechanical and civil engineering field applications, the EMI technique has proven to be effective in various areas including crack and load damage of various structures, debonding of composite adhesive layer, corrosion of metallic structures, bolt loosening of bridge components, prestressed concrete (PSC) related force loss and concrete strength predictions. Detecting a crack or notch using the EMI technique of structures can be said to be one of the most investigated areas of the EMI technique. This includes detecting damage subjected to different structure types such as metal, composites and concrete structures ,57,58,59Although that the frequency domain analysis of the EMI technique has been researched in vast amounts, very little has been published related to time domain analysis methods where it uses the excitation circuit proposed by Baptista and Vieira . From vaIf no peaks can be found when sweeping the frequency ranges to search a region with multiple peaks, the EMI technique may fail to detect any structural damage. Without any resonance, the changes in the impedance signature can be quite small. To solve this problem, Na and Lee proposed a method of creating a resonance frequency range when applying the EMI technique , and various authors have already evaluated how an ANN can perform when incorporated into the EMI technique. When an ANN is applied to the EMI technique, a decent amount of training is usually required for the algorithm to successfully identify damage. Some common types of ANN techniques can be found in Giurgiutiu and Kropas-Hughes , in whicThe trend of combining the ANN algorithm with the EMI technique can be said to be increasing, as the statistical metrics such as RMSD, MAPD, covariance and CC are not sufficient to quantify, locate and identify what kind of damage the structure has received.Since the introduction of the EMI technique, countless studies have been carried out in this area, with many reporting promising results. However, most of the studies performed were under laboratory conditions or mainly theoretically based, which raises questions regarding their potential in real-life applications, particularly under harsh environments. Although structure damage changes the impedance signature, other factors such as variations in temperature and the durability of PZT transducers can also cause the signatures to change as well. Yang et al.  investigAlthough multiple techniques have been proposed to compensate the temperature effect of the EMI technique, it is extremely difficult to compensate this effect completely. Sometimes the variations in impedance signatures can be unpredictable, as some peaks may shift or increase/decrease in amplitude more than others .To gain a better understanding of an engineering system, modeling is an essential field of research, and a large number of studies are published in this area each year. Considering the EMI technique, PZT-structure interaction models have been intensively developed. However, there are limitations to these solutions when they are applied to real structures, as they can be only applied to simple structures such as beams, shells and plates with simple boundary conditions. As such, finite element method (FEM) became known as an alternative solution. With powerful FEM tools, the efficiency of FE modeling is increasing every day, particularly with the advancement of computer technology. A well summarized work on FE-based simulation of PZT-structure interaction can be found in the PhD dissertation by Lalande , in whicThus far, the majority of the FEM simulation studies related to the EMI technique have used either ANSYS or ABAQUS. Since the EMI technique is a non-modeled method that is heavily reliant on acquired impedance signatures, incorporating FEM may enable the achievement of the ultimate goal of locating, identifying and quantifying the size of damage.For the EMI technique to be applied to SHM system, the durability of the PZT transducer and the bonding layer must be high. While many PZT manufacturers claim that the PZT deterioration rate is less than 5% per decade, environmental factors must be taken into account. Environmental factors such as changes in temperature over a long period of time can lead to thermal fatigue, while rain or sea water exposure could result in acidic and alkaline attacks. In addition, the PZT transducer should endure both the mechanical and electrical cyclic loading. Although there are ways to protect the PZT transducers, such as embedding them into the structure or covering them up with silicon or epoxy, the PZTs cannot be replaced if they are damaged. In addition, changes in the properties of the cover (silicon or epoxy) can cause the impedance signatures to change, causing a fault alarm. For this reason, the influence of these factors needs to be eliminated through compensation algorithms, or perhaps by using a control or multiple PZT transducers.Regarding sensing range, the EMI technique is a local method that uses high frequency excitation. For this reason, the sensing range is limited to several meters, depending on the properties of the PZT and the host structure. As such, cost issues arise when dealing with large structures, as a vast number of PZT transducers need to be installed. This shows that using the EMI technique alone to develop SHM system is very difficult, and a global method  should be incorporated to create an efficient SHM system. A well-known combination of the EMI technique with the guided wave-based technique has been investigated in Giurgiutiu et al.  where itAs the Fourth Industrial Revolution approaches, various areas of technology have become key items of interest around the globe. Technologies such as artificial intelligence (AI) and drones can be said to be closely related to the EMI technique. Although the amount of ANN work in conjunction to the EMI technique is increasing every day, the combination of drones with the EMI technique  is in the very beginning stage of research. Although visual inspection-based drone monitoring technology is advancing, this technology has limitations when searching for internal damage or even small cracks, which can be difficult to identify using a camera. Some of the work on visual based SHM using drones can be found in Ellenberg et al. , Ham et The first work on combining the EMI technique with drone was performed by Na and Baek , using aBy 2050, it has been predicted that up to 70% of the world’s population will live in urban areas and with this fact, the importance of developing a smart-city is becoming more and more important. One of the vital aspects for achieving an efficient smart-city lies within the field of sensors. With a vast number of sensors installed around the city, management of the overall system may depend on factors such as the number of sensors. For this reason, the importance of multi-functional sensors will become more important as this may reduce the total number of sensors required for an effective smart city. As mentioned in a previous section, the impedance signatures during the EMI technique has been experimentally proven to vary with change in temperatures. This gives the possibility of the EMI technique not only to detect damage but also predict the temperature of the host structure, simultaneously. With this idea, it may be possible to reduce two sensors into a single sensor to reduce the overall number of sensors required for a structural health monitoring system.With sensing range limitations of the EMI technique, one may suggest that the real application of such technique can be very limited. However, a future technology such as the ‘Hyperloop’ system can demand such technique as the EMI technique is effective for detecting damage at a very early stage. The Hyperloop system is a new type of ground transportation technology which can theoretically travel up to 1200 km per hour, moving at a speed faster than an airplane. The concept of the technology can be seen in In this work, we have reviewed studies that have been conducted on the application of EMI technique, focusing on the latest research in the field. While the EMI technique has been researched for over two decades, there are still various problems to be solved in its application. These problems include the limited sensing range, the need to select a suitable frequency range, the need to compensate for environmental factors such as temperature variations, efficient statistical metrics etc., which need to be solved to achieve one of the ultimate goals of locating and identifying damage type. For this reason, one of the trends is that the studies using ANN has increased everyday where it has proven to give promising outcome for the EMI technique. As well, ANN has been investigated not only for measuring structural damage but for a variety of applications including selecting suitable frequency range, temperature compensation, predicting concrete strength, bolt loosening etc. The EMI technique has great potential, with numerous studies being conducted to solve various problems. However, since most of the studies have been conducted under lab conditions, future research should be more focused on real structures in order to identify critical problems using the EMI technique. Nevertheless, continuous research by experts and advancement in computer technologies will bring new solutions and ideas, with FEM simulations becoming more effective for bringing the EMI technique one step closer to commercialization.


Many discoveries in the life sciences have been made using material from living stock collections. These collections provide a uniform and stable supply of living organisms and related materials that enhance the reproducibility of research and minimize the need for repetitive calibration. While collections differ in many ways, they all require expertise in maintaining living organisms and good logistical systems for keeping track of stocks and fulfilling requests for specimens. Here, we review some of the contributions made by living stock collections to research across all branches of the tree of life, and outline the challenges they face.DOI:http://dx.doi.org/10.7554/eLife.24611.001 The goals of living stock collections are to preserve the genetic diversity of target organisms, to maintain research materials, and make these resources available to researchers around the world. Living stock collections are distinct from other bio-repositories, such as natural history museums  and biobThe collections are typically housed within stock centers, seed banks, vivariums and botanical gardens, which are usually based at a university or other research institution. Collections make their resources available in a number of ways: these include distributing resources to qualified researchers, providing access to materials at the collection for specific experiments, and the sharing of detailed historical information regarding each organism or strain.Living collections have been identified as the foundation of the emerging bioeconomy  and theyLiving collections are funded by a number of mechanisms. In the United States, for example, the Department of Agriculture Agricultural Research Service (USDA-ARS) supports several centers that conserve and distribute germplasm of agricultural importance. Similarly, the National Institutes of Health (NIH) maintains diverse collections of animal models of human disease such as rodents, swine, axoltls and primates. Finally, the National Science Foundation (NSF) has supported diverse living genetic and biodiversity collections for over 50 years through a competitive program now called Collections in Support of Biological Research (CSBR).The global research and development community values living collections as demonstrated by recent progress in the development of networks to create a global microbial research commons . These eOur focus here is on open living research collections in the USA that are funded by a combination of competitive grants and community user fees . Many ofIf the centers that harbor these collections cease to exist, or even if their operations must be reduced below a certain critical threshold, the negative consequences to the scientific community are unavoidable. For example, without stock centers there is an increased risk of researchers using inauthentic materials (such as contaminated or improperly identified stocks), research communities may become more exclusive, and it may cost more to generate key strains, clones, lines or varieties. Ultimately, this makes it harder for researchers to reproduce key results .Escherichia coli  was isolated and shared through the USDA NRRL collection . In some cases, such as certain fruit fly species in the genus Drosophila, the stock center is the only source of these stocks as they can no longer be collected in the wild.Historically, living collections have generally focused on organisms that serve research communities of significant sizes, often corresponding to model systems that have been broadly embraced by the community . These agreements typically limit both rights and liabilities and can assume a variety of levels of rigor, ranging from implied, to “click-through”, to formal. For example, the Addgene plasmid collection has been assembled with intellectual property management at the forefront, simplifying subsequent distribution of resources . Europeahttp://www.usccn.org/Pages/USCCN_Nagoya_2017.aspx). As exemplified by the engagement at this meeting, staff at living collections are at the forefront of ensuring that ethical practices are followed in obtaining and distributing living resources. Importantly, the participants heard from the USA National Focal Point for the Nagoya Protocol that the USA does not restrict access to germplasm, although certain landowners or managers, such as the US National Park System, may have their own requirements for accessing genetic resources.USA culture collections addressed the question of how to ensure compliance at an NSF-sponsored meeting in February. This meeting was open to collaborators from every domain of life, and included participants from natural history collections, as well as living research and biodiversity collections (https://absch.cbd.int/). The highly divergent perspectives on what constitutes “access” emphasize that researchers should consult the ABSCH prior to using genetic resources (or information) with an origin outside their own country.Additional presentations at the meeting emphasized that each party to the Nagoya Protocol is required to establish their own national legislation on Access and Benefit Sharing. Brazil and the EU have the most mature legislation, accessed via the Convention on Biological Diversity Access and Benefit Sharing Clearing-House .Thank you for submitting your article "Public living collections and their role in biological research: Impact, challenges, and expectations" for consideration by The reviewers have discussed the reviews with one another and the Reviewing Editor has drafted this decision to help you prepare a revised submission.Summary: The manuscript describes the important role of living stock collections in scientific research, underlining the major challenges that they face today.Although the manuscript deals with a very important issue in biological research, the reviewers feel that there are some aspects that could be discussed in more detail to make the manuscript more valuable to the research community and improve the arguments for continued support of public living stock collections.Essential revisions:1) The importance and the necessity of financial support is mentioned too often in several different paragraphs. This gives the impression that the manuscript was written to promote the collections in order to ask for money (public money). Please cut, or at least revise, most of the sentences related to financial support and rewrite the manuscript accordingly.2) The reviewers consider living collections to be indispensable as accessible references for taxonomic (hence identification) purposes. Please expand the discussion on this topic, including a reflection on the present situation about the coverage of the complete biodiversity.More information from reviewer #2: "Preserving and making reference material available also imposes a very strict quality control (QC) on the viability and the authenticity of living stock cultures/collections that are maintained/preserved. One must realize that this QC is crucial and that a correct application of the implemented QC system is key for the operational value of the whole system. Indeed, living stocks are subjected to genetic drifting during their preservation period. If the cultures are used for taxonomic references, the taxonomic markers are usually stable enough for identification above the strain/specimen level. However, when markers are used for identification at or even below the strain level (isolate/specimen level) the reference strains may have undergone genetic changes that make them no longer suited as references for identification, or in those cases where the living stocks are used in certified test in e.g. pharmaceutical context."3) Although the problem of integration of data is mentioned in the manuscript, it is not discussed deeply enough to underpin the lack of interest for the situation along with the lack of financial support.More information from reviewer #2: "Researchers often exchange material in collections (mostly for free). In many cases, neither the donating nor the receiving party have the skills or the attitude to control the authenticity of the material that is exchanged resulting in the use of non-equivalent material for their research. This means that the results of cumulative research must be treated with a degree of criticism. Live stocks are also exchanged between collections and in this cases an important number of discrepancies of various nature are reported. If researchers plan to integrate data from different collections several controls need to be introduced as has been demonstrated by the various papers of the strainInfo team . Make Histri: Reconstructing the exchange history of bacterial and archaeal type strains. Syst Appl Microbiol 34: 328-336. Verslyppe, B., De Smet, W., De Baets, B., De Vos, P., Dawyndt, P. (2014). StrainInfo introduces electronic passports for microorganisms. Syst. Appl. Microbiol. 37(1): 42-50 etc.)"4) Include more in-depth discussion of some of the ethical issues surround living collections:Often the research has been supported by public money and hence the data belong to the public domain. However, protective actions are seldom undertaken to prevent this data being used for private, commercialized applications. Although the international community tried to take care of this problem via treatments and conventions . Unfortunately, these conventions are not recognized by all governments on the globe and are more like a burden.Only about 10-15% of the biological material that has been the subject of research is available via public collections. It is clear that from a scientific viewpoint, this is unacceptable and should be of major concern. Essential revisions:1) The importance and the necessity of financial support is mentioned too often in several different paragraphs. This gives the impression that the manuscript was written to promote the collections in order to ask for money (public money). Please cut, or at least revise, most of the sentences related to financial support and rewrite the manuscript accordingly.We eliminated most of the instances in which the manuscript promoted the collections as if asking for public funds, and modified the text accordingly. However, funding remains one of the challenges, hence it deserves to be mentioned.2) The reviewers consider living collections to be indispensable as accessible references for taxonomic (hence identification) purposes. Please expand the discussion on this topic, including a reflection on the present situation about the coverage of the complete biodiversity.More information from reviewer #2: "Preserving and making reference material available also imposes a very strict quality control (QC) on the viability and the authenticity of living stock cultures/collections that are maintained/preserved. One must realize that this QC is crucial and that a correct application of the implemented QC system is key for the operational value of the whole system. Indeed, living stocks are subjected to genetic drifting during their preservation period. If the cultures are used for taxonomic references, the taxonomic markers are usually stable enough for identification above the strain/specimen level. However, when markers are used for identification at or even below the strain level (isolate/specimen level) the reference strains may have undergone genetic changes that make them no longer suited as references for identification, or in those cases where the living stocks are used in certified test in e.g. pharmaceutical context."To address the first part of the comment by the reviewer, we added a new short section entitled “Living Collections Capture an Important, Yet Minor Fraction of Extant Biodiversity”. To address the issue of quality control and collection integrity, we added a second short new section entitled “Challenges to Maintaining Collection Integrity”.3) Although the problem of integration of data is mentioned in the manuscript, it is not discussed deeply enough to underpin the lack of interest for the situation along with the lack of financial support.More information from reviewer #2: "Researchers often exchange material in collections (mostly for free). In many cases, neither the donating nor the receiving party have the skills or the attitude to control the authenticity of the material that is exchanged resulting in the use of non-equivalent material for their research. This means that the results of cumulative research must be treated with a degree of criticism. Live stocks are also exchanged between collections and in this cases an important number of discrepancies of various nature are reported. If researchers plan to integrate data from different collections several controls need to be introduced as has been demonstrated by the various papers of the strainInfo team . Make Histri: Reconstructing the exchange history of bacterial and archaeal type strains. Syst Appl Microbiol 34: 328-336. Verslyppe, B., De Smet, W., De Baets, B., De Vos, P., Dawyndt, P. (2014). StrainInfo introduces electronic passports for microorganisms. Syst. Appl. Microbiol. 37(1): 42-50 etc.)"The revised manuscript includes the following paragraph as part of the newly added “Challenges to Maintaining Collection Integrity” section: “Materials in collections are usually deposited by independent researchers and may be exchanged between stock centers, generating additional challenges in controlling the authenticity and equivalency of the stocks. […] To what extent a similar data integration and tracking system that follows each stock can be adopted by other communities is unclear, although a persistent uniform resource identifier would help deal with this issue.”4) Include more in-depth discussion of some of the ethical issues surround living collections:Often the research has been supported by public money and hence the data belong to the public domain. However, protective actions are seldom undertaken to prevent this data being used for private, commercialized applications. Although the international community tried to take care of this problem via treatments and conventions . Unfortunately, these conventions are not recognized by all governments on the globe and are more like a burden.Only about 10-15% of the biological material that has been the subject of research is available via public collections. It is clear that from a scientific viewpoint, this is unacceptable and should be of major concern.We don't think that this is necessarily an issue that can be discussed constructively in this perspective for the following reasons: 1) Depending on the funding source and the community that each center serves, there is a wide range of ethical issues associated with the stocks that the centers in which the authors are involved distribute. 2) The perspective does address the issue of MTAs, and MTAs do address the issue of how stocks should be used. 3) The discussion of how public domain research his being used for profit by industry is one that goes way beyond the issues that this centers are involved with.


The seminal origin of what is considered “green chemistry” today might be ascribed to the launch of the Responsible Careil (ACC)  and to til (ACC) . The conil (ACC) ) and theil (ACC) –5. Very The first goal of green chemistry is to provide a solid solution to the need for an ex novo design of the existing and necessary chemical processes by primarily considering safety, pollution prevention, waste minimization and energy optimization. To achieve such goals, the necessity of chemists from different areas is evident. Also important is how this novel approach to scientific research has led to a different and hopefully more effective paradigm in the collaboration between industry and academia.2 consumption.It is obvious that the chemical yield represents just one of the many features that a process must possess to be considered efficient. It is of extreme importance nowadays to consider not only the safety of a chemical procedure, but also the proper selection of solvents, starting materials, and technologies used to generate and control reactive intermediates. In addition, the need for minimizing toxic waste and the respective disposal cost highlights how crucial it is to consider the recovery and reuse of the materials needed for a synthetic process. It is also very important to promote the use of biomass-derived chemicals that feature an intrinsically lower COAdditionally, the pivotal role of catalysis is indisputable. Significant efforts are being directed towards the development of effective catalytic methodologies with safer and cheaper substrates where reactivity is achieved through catalysis that can replace the classically used, highly reactive species. While for immediate economical reasons the use of well-established methodologies based on homogeneous catalysis may be initially preferred, many efforts are directed toward the development of heterogeneous catalytic approaches, aiming at an easier recovery and better reuse of the catalyst.Beilstein Journal of Organic Chemistry, including “Strategies in asymmetric catalysis” by Tehshik P. Yoon [Another key aspect of green chemistry, closely related to the chemical efficiency and efficiency of a protocol, is the technology behind the process. In fact, energy and time optimization are important factors. Increasing interest is being directed towards the development of innovative mixing and heating technologies that, individually or in combination, may furnish an innovative solution for controlling the safety and the reactivity of a chemical process and may facilitate the recovery and reuse of the materials used, which contribute to minimizing the energy consumption and increasing the overall efficiency of a process. Flow chemistry, microwave or ultrasonic irradiation, and mechano-chemistry are just a few representative examples of research platforms being independently developed, but all offer innovative tools for realizing chemically and environmentally efficient processes. Representative examples of these directions have been the subject of other excellent Thematic Series in the  P. Yoon , “Organo P. Yoon , “C–H fu P. Yoon , “Bifunc P. Yoon , “Sustai P. Yoon , and “Or P. Yoon , provingThe breadth of chemical and technological innovations makes the definition of novel metrics for the evaluation of the quality of a new process in the field of green chemistry necessary. A key aspect of green chemistry is in fact the comparison of the different strategies available by considering as many experimental aspects as possible. Of course the most important feature to be evaluated is the correct measure of the waste generated, which is derived from both the synthetic strategy and the technology used. The fundamental role of green metrics is to evaluate the modern classification of chemical transformations in relation to the potential or actual pollution produced. In some cases, such as calculating the waste associated with the mass of the material used, this is easily evaluated. However, it may be more difficult to compare energy, time, labor costs, and other variables of a process. Certainly, innovation is the most important goal of green chemistry, but it is also the most difficult feature to measure and evaluate. Novel chemistry and innovative technologies are needed for the development of future, sustainable, chemical production. To reach this goal, both fundamental research, as well as the ability to translate the innovation into real world applications, should be combined.Beilstein Journal of Organic Chemistry, represent an ideal medium for disseminating scientific efforts in this context. This Thematic Series, “Green chemistry”, collects original research and review articles, where an obviously limited but highly exemplificative portion of the broad field of green chemistry is described.Organic chemistry, with its kaleidoscope of interests and applications, offers the arena where countless opportunities exist to effectively contribute to the development of green chemistry. Journals dedicated to the field of organic chemistry, such as the Luigi VaccaroPerugia, November 2016


Historically, older cats and dogs have been particularly at-risk for euthanasia in animal shelters due to their lower perceived appeal for adoption. This study found that the condition at intake had the greatest impact on the outcomes of older cats and dogs. Additionally, the application of specialized veterinary care, such as orthopedic surgery or chronic disease maintenance, is discussed as factors that inform higher rates of live outcomes for these senior companion animals. These findings demonstrate that if shelters integrate practices that address the specific needs of ageing companion animals, the live outcomes for this population can increase.With advances in veterinary medicine that can increase the lifespan of cats and dogs and the effectiveness of spay/neuter programs in reducing the juvenile population of pets, animal shelters are experiencing an increasing population of older companion animals in their care. The purpose of this study was to assess the factors that inform the outcomes of these older cats and dogs. The sample consisted of 124 cats and 122 dogs that were over the age of 84 months (seven years) who were taken into a shelter over a one-year period. To assess the impact of condition at intake on the outcome for the senior animals, a multinomial logistic regression was performed. These findings indicate that preventative programming that can address the reasons these older animals are surrendered, as well as advancements in specialized medical or behavioral programs for ageing companion animals, may support an increase in live outcomes for older cats and dogs in shelters. Further study is needed to evaluate how the quality of life of older animals is impacted by remaining in the care of shelters rather than being euthanized. There is a growing body of evidence documenting the positive impacts of pet-keeping in communities. Particularly, the literature has demonstrated that efforts directed toward increasing pet-keeping through the adoptions of companion animals in shelters and rescues can result in improvements in public health ,2,3,4. TAs spay/neuter of companion animals has become more widely practiced in the United States (U.S.), the population of companion animals in shelters has become less populated with juveniles and more populated with older cats and dogs ,14,15. SDespite the evidence that age impacts the current outcomes for older cats and dogs in shelters, the literature has yet to document the influence of other factors in addition to age that can impact the outcomes of this population. This study evaluated the influence of a variety of factors on the outcomes of “senior” cats and dogs at the private, non-profit animal rescue, Austin Pets Alive! (APA), in Austin, Texas. Beyond age, this study also looked at other considerations for shelter decision-making, including breed, size, condition on intake, treatment plan, and reason for surrender. Understanding these variables and the relationship that they have to length of stay and live outcomes can support animal shelters in critically evaluating their policies and programs for older cats and dogs.A retrospective cohort study was conducted on data obtained from APA’s ShelterLuv database. APA was selected due to its collection of innovative programs that are reported to result in a higher rate of live outcomes for animals who have been largely considered euthanasia candidates in traditional animal shelters . As a prData collected for each animal in the study sample included date of intake to APA, intake type , estimated age at intake (in months), weight at intake, identified primary breed, reason for surrender to AAC (if applicable), qualitative description of condition upon intake at APA, qualitative description of plan for treatment once in the care of APA, total number of days in the custody of APA, the number of days while in the custody of APA when the animal was in off-site foster care, the number of days while in the custody of APA when the animal was on-site at APA, outcome date (if applicable), and outcome type . The length of stay  for animals in the sample who had been returned to APA following an initial adoption were reported using the animals’ most recent time in APA’s care. The outcomes reported also reflect the animals’ status at the end of the study period on 24 November 2017. While not included within the APA data on the three length of stay variables , the average time each animal was in the care of AAC prior to being transferred to APA was between 1–5 days.Categories for reason for surrender to AAC included stray, people issues, animal illness, deceased caretaker, negligence, or abandoned. Stray was used if the animal was brought into AAC by an animal protection officer or by someone other than the animal’s caretaker. People issues encompassed reasons cited by the relinquishing family, such as: allergies, housing restrictions, and moving. Animal illness was used if the family of the senior cat or dog cited they could not afford to care for the animal anymore because the illness had become physically, economically, or emotionally difficult to sustain. Deceased caretaker was used if the animal was relinquished due to the death of one of the animal’s caretakers. Negligence was used if the animal was removed from a home by AAC due to a cruelty or neglect case. Abandoned was used if the animal had a microchip upon intake to AAC as a stray, but was never reclaimed by the individual listed on the microchip. Time in custody included the date the animal was accepted for transfer from AAC to the date the animal’s outcome at APA was recorded. For animals that are still in the care of APA, the final day of the study period, 24th November, was used as the last day for time in custody. Time in foster was the number of days of the animal’s total time in custody that was spent in off-site care with an APA registered foster family or in “pre-adopt” status in the home of a potential adopter. Time on-site was the number of days of the animal’s total time in custody that was spent on-site at APA in one of their kennels.When possible, the data was coded into nominal or ordinal variables for the purposes of analyses. Identified primary breed was based upon what was indicated either by the relinquishing individual at intake (if applicable) or by the AAC staff member who conducted the animal’s initial evaluation. Breeds were then grouped according to the National Dog Show categories of: herding, hound, non-sporting, sporting, terrier, toy, or working . The quap value greater than or equal to 0.05 considered statistically significant.A series of descriptive statistics were used to assess the sample of cats and dogs. A multinomial logistic regression was performed to determine the impact of the reason for surrender, condition at intake, and the treatment plan on the senior animals’ outcomes. A 95% confidence interval was used for all statistical analyses, with any result of a The sample of companion animals included in the study encompassed 124 cats and 122 dogs who were over the age of 84 months (7 years) and transferred from AAC to APA due to medical or behavior concerns. Most of the cats and dogs in the sample  were 9 years or older . A majorThe average time in custody for the cats included in the study  was less than the average time in custody for dogs  with length of stay that had a range of 1–348 days in custody for cats and 1–367 days in custody for dogs . The aveThroughout their length of stay, cats spent a greater amount of time on-site at APA  than dogs , with a range of 0–194 days spent on-site for cats and a range of 0–208 days spent on-site for dogs. Dogs spent a greater amount of time in foster homes  than cats , with a range of 0–367 days in foster for dogs and 0–345 days in foster for cats .To determine the impact of condition at intake on the outcomes for the senior animals, a multinomial logistic regression was performed. To control for potentially confounding variables, reason for surrender was included along with condition at intake for the model. The outcomes for cats and dogs, grouped by their treatment plan are presented in 2(8) = 60.04, p < 0.01) and for dogs (χ2(8) = 62.61, p < 0.01).Using the variables reason for surrender, condition at intake, and outcome of the senior animals, a significant model was achieved for cats  status  in veterinary medicine and the use of the marks developed from the Asilomar Accords in sheltering are similar systems for categorization that utilize information such as condition at intake to predict the outcome of the animal when in their care ,41. The Senior animals may be euthanized in shelters because older cats and dogs often have longer lengths of stay that increases their risk of infectious disease . Senior The larger percentage of total time in custody that is spent in off-site foster care for these senior animals is an important finding in that placement in a foster home is believed to enhance the quality of life for animals who experience extended lengths of stay when in shelter custody. While the length of stay remains an important metric for assessing the potential for decreasing quality of life and/or non-live outcomes for sheltered animals, critically examining the additional factors such as resources allocated to these animals during that length of stay may support the goal of increasing live outcomes for this population, while also preserving the animal’s quality of life. Beyond documenting the overall length of stay and outcome from APA’s practices, assessing the physical and socioemotional impacts of this approach was beyond the scope of this study. Further studies are needed to examine how increasing the time and financial resources invested into veterinary or behavioral assessment of a senior animal on intake impacts both the shelter staff members’ and the animals’ experience in the shelter prior to their outcome.While individual shelters may consider allocating their own resources to improved medical and behavioral assessment for all animals in their care, it is important to acknowledge that transfer partnerships and community partnering are emerging as effective approaches to increasing live outcomes for all at-risk animals in shelters, particularly when an individual organization’s resources are limited ,49,50. IBy determining the gaps in shelters’ programs for older cats and dogs, shelter management can address the factors that have driven this population to be one of the most at-risk for euthanasia. Furthermore, this research highlights the importance of preventative outreach, specialized medical and behavior programs, and a strong foster care system that are equipped to address the needs of older animals in their homes and in a shelter.