Exploring the influences of education,intelligence and income on mental disorders

Background Previous studies have shown that educational attainment(EA),intelligence and income are key factors associated with mental disorders.However,the direct effects of each factor on major mental disorders are unclear.Aims We aimed to evaluate the overall and independent causal effects of the three psychosocial factors on common mental disorders.Methods Using genome-wide association study summary datasets,we performed Mendelian randomisation(MR)and multivariable MR(MVMR)analyses to assess potential associations between the 3 factors(EA,N=766345;household income,N=392422;intelligence,N=146808)and 13 common mental disorders,with sample sizes ranging from 9907 to 807553.Inverse-variance weighting was employed as the main method in the MR analysis.Results Our MR analysis showed that(1)higher EA was a protective factor for eight mental disorders but contributed to anorexia nervosa,obsessive-compulsive disorder(OCD),bipolar disorder(BD)and autism spectrum disorder(ASD);(2)higher intelligence was a protective factor for five mental disorders but a risk factor for OCD and ASD;(3)higher household income protected against 10 mental disorders but confers risk for anorexia nervosa.Our MVMR analysis showed that(1)higher EA was a direct protective factor for attention-deficit/hyperactivity disorder(ADHD)and insomnia but a direct risk factor for schizophrenia,BD and ASD;(2)higher intelligence was a direct protective factor for schizophrenia but a direct risk factor for major depressive disorder(MDD)and ASD;(3)higher income was a direct protective factor for seven mental disorders,including schizophrenia,BD,MDD,ASD,post-traumatic stress disorder,ADHD and anxiety disorder.Conclusions Our study reveals that education,intelligence and income intertwine with each other.For each factor,its independent effects on mental disorders present a more complex picture than its overall effects.

Cost of Medical Treatment for Primary Open-Angle Glaucoma in Relation to Patients’ Income and Its Impact on the Prognosis of the Disease, in Bouaké University Hospital

Introduction: Medical treatment for POAG is continuous and lifelong treatment. The aim of this study was to evaluate the relationship between the cost of this treatment and patients’ income and the impact of this relationship on treatment compliance. Materials and Methods: Prospective cross-sectional study with a descriptive aim covering sociodemographic data, average incomes, and direct and indirect costs of treatment of 57 patients followed for POAG during the period from January 1, 2012, to December 31, 2016 (5 years). Results: The patients were aged 25 to 77 years (mean = 54.4 years) with a male predominance (sex ratio = 1.5). Retirees were the most represented (26.32%), followed by workers in the informal sector (14.04%) and housewives (12.28%). Patients who had an annual income less than or equal to 900,000 CFA francs (€1370.83) per year represented 56.14% and those who did not have health coverage represented 57.89%. The treatment was monotherapy (64.91%), dual therapy (31.58%) or triple therapy (3.05%) and the average ratio of “annual cost of treatment to annual income” was 0.56 with for maximum 2.23 and 0.02 as minimum. Patients who considered the cost of treatment unbearable for their income represented 78.95%. Conclusion: Prevention of blindness due to glaucoma requires early detection but also the establishment of health coverage mechanisms to improve compliance with medical treatment. In addition, consideration should be given to the development of glaucoma surgery in our country, the indication of which could be the first intention in certain patients, considering for those patients, the geographical and financial accessibility of medical treatment. .

Influence of Transportation Accessibility on Urban-rural Income Disparity and Its Spatial Heterogeneity

Transportation accessibility has been treated as an important means of reducing the urban-rural income disparity.However,only a few studies have examined the effects of different types of transportation accessibility on urban-rural income disparity and their spatial heterogeneity.Based on data from 285 prefecture-level(and above)Chinese cities in 2000,2005,2010,2015,and 2020,this study uses spatial econometric models to examine how highway accessibility and railway accessibility influence the urban-rural income disparity and to identify their spatial heterogeneity.The result reveals that highway accessibility and railway accessibility have‘coreperiphery’ring-like circle structures.The urban-rural income disparity exhibits strong spatial clustering effects.Both highway accessibility and railway accessibility are negatively associated with urban-rural income disparity,and the former having a greater effect size.Moreover,there is a substitution effect between highway accessibility and railway accessibility in the whole sample.Furthermore,these associations differ in geographic regions.In the central region,highway accessibility is more important in reducing the urban-rural income disparity,but its effect is weakened with the increase of railway accessibility.In the western region,railway accessibility has a larger effect on narrowing the urban-rural income disparity,and this effect is strengthened by the increase of highway accessibility.We conclude that improving transportation accessibility is conducive to reducing the urban-rural income disparity but its effect is spatial heterogenetic.Highways and railways should be developed in a coordinated manner to promote an integrated transport network system.

Digitalization’s Effects on Income Growth and Distribution-Evidence from the CHDES Database

Using the CHDES database,we created the CIDI to comprehensively quantify digital adoption at the individual level and examine digitalization’s impact on individual income.Empirical analysis results indicate that increasing the CIDI by one standard deviation(0.13)improves individual income by 5.93 percentage points,which remains true after a series of endogeneity and robustness tests.In the heterogeneity analysis,we discovered that when digital adoption grows,residents in the countryside and county seats can earn more money through internet business operations and other channels.This helps to decrease the urban-rural income divide,but it has also pushed those digitally skilled into high-paying sectors,widening the income gaps between sectors.In the mechanism analysis,we developed an income function that takes into account the individual level of digitalization to show that digitalization can boost income by increasing working hours or labor participation and adjusting the portfolio of individual material,human,and social capital.In this paper,we have expanded the system for measuring the individual levels of digitalization by offering basic data,research methodology,and policy suggestions for the digital economy’s inclusive development.

First experience in laparoscopic surgery in low and middle income countries: A systematic review

BACKGROUND Laparoscopic surgery has reduced morbidity and mortality rates,shorter post-operative recovery periods and lower complication rates than open surgery.It is routine practice in high-income countries and is becoming increasingly common in countries with limited resources.However,introducing laparoscopic surgery in low-and-middle-income countries(LMIC)can be expensive and requires resour-ces,equipment,and trainers.AIM To report the challenges and benefits of introducing laparoscopic surgery in LMIC as well as to identify solutions to these challenges for countries with limited finances and resources.METHODS MEDLINE,EMBASE and Cochrane databases were searched for studies reporting first experience in laparoscopic surgery in LMIC.Included studies were published between 1996 and 2022 with full text available in English.Exclusion criteria were studies considering only open surgery,ear,nose,and throat,endoscopy,arthro-scopy,hysteroscopy,cystoscopy,transplant,or bariatric surgery.RESULTS Ten studies out of 3409 screened papers,from eight LMIC were eligible for inclusion in the final analysis,totaling 2497 patients.Most reported challenges were related to costs of equipment and training programmes,equipment pro-blems such as faulty equipment,and access to surgical kits.Training-related challenges were reliance on foreign trainers and lack of locally trained surgeons and theatre staff.The benefits of introducing laparoscopic surgery were economic and clinical,including a reduction in hospital stay,complications,and morbidi-ty/mortality.The introduction of laparoscopic surgery also provided training opportunities for junior doctors.CONCLUSION Despite financial and technical challenges,many studies emphasise the overall benefit of introducing laparoscopic surgery in LMICs such as reduced hospital stay and the related lower cost for patients.While many of the clinical centres in LMICs have proposed practical solutions to the challenges reported,more support is critically required,in particular regarding training.

Effect of nutrition-related infodemics and social media on maternal experience: A nationwide survey in a low/middle income country

BACKGROUND Undernutrition is a crucial cause of morbidity and mortality among children in low-or middle-income countries(LMICs).A better understanding of maternal general healthy nutrition knowledge,as well as misbeliefs,is highly essential,especially in such settings.In the current era of infodemics,it is very strenuous for mothers to select not only the right source for maternal nutrition information but the correct information as well.AIM To assess maternal healthy nutritional knowledge and nutrition-related misbeliefs and misinformation in an LMIC,and to determine the sources of such information and their assessment methods.METHODS This cross-sectional analytical observational study enrolled 5148 randomly selected Egyptian mothers who had one or more children less than 15 years old.The data were collected through online questionnaire forms:One was for the general nutrition knowledge assessment,and the other was for the nutritional myth score.Sources of information and ways of evaluating internet sources using the Currency,Relevance,Authority,Accuracy,and Purpose test were additionally analyzed.RESULTS The mean general nutrition knowledge score was 29±9,with a percent score of 70.8%±12.1%(total score:41).The median myth score was 9(interquartile range:6,12;total score:18).The primary sources of nutrition knowledge for the enrolled mothers were social media platforms(55%).Half of the mothers managed information for currency and authority,except for considering the author's contact information.More than 60%regularly checked information for accuracy and purpose.The mothers with significant nutrition knowledge checked periodically for the author's contact information(P=0.012).The nutrition myth score was significantly lower among mothers who periodically checked the evidence of the information(P=0.016).Mothers dependent on their healthcare providers as the primary source of their general nutritional knowledge were less likely to hold myths by 13%(P=0.044).However,using social media increased the likelihood of having myths among mothers by approximately 1.2(P=0.001).CONCLUSION Social media platforms were found to be the primary source of maternal nutrition information in the current era of infodemics.However,healthcare providers were the only source for decreasing the incidence of maternal myths among the surveyed mothers.

Taxation Models and Improvement Proposals for Personal Income Tax in the Sharing Economy

As an innovative economic model,the sharing economy has seen rapid growth globally in recent years.It has not only brought a profound impact on traditional economies but also injected new vitality and momentum into the sustainable development of the social economy.However,for the sharing economy,the process of collecting personal income tax is facing several issues,such as the ambiguity of tax policies regarding personal income,challenges in identifying taxpayers,and difficulties in defining income.To achieve the fairness and efficiency of personal income tax collection in the sharing economy,this study proposes optimized regulatory mechanisms and conducts in-depth discussions on the adjustment of personal income tax policies,innovation in tax management technology,and improvement in the quality of personal income tax services.

Study on the Influence of the Coordinated Development of Resident Income and GDP on Local Economic Development:Take Shandong Province as an Example

With the rapid development of China’s economy,the coordinated development of resident income and GDP has become an important indicator to measure local economic development.How to realize the synergistic growth of the two in the new era is of great significance for promoting the sustainable development of the local economy.Based on the theory of the coordinated development of resident income and GDP,this paper will take Shandong Province as an example to analyze the interaction between resident income growth and GDP,find out the influencing factors that restrict the coordinated development of resident income and GDP,and explore the impact of the coordinated development of resident income and GDP on local economic development.Finally,relevant policies will be studied.How to effectively increase residents’income,promote the sustainable and healthy development of the local economy,and put forward relevant suggestions to promote the coordinated development of residents’income and GDP.

Study on the Impact of Collective Commercial Construction Land Entering the Market on Rural Residents’Income:Taking Deqing County,Zhejiang Province as an Example

The entry of collective construction land for business purposes is an important measure for deepening the reform of the rural land system,promoting the flow of urban and rural factors,and realizing rural revitalization.Since the production of the first batch of pilot projects in 2015,33 county-level cities have participated in the pilot policy by 2023.Deqing County,Zhejiang Province,as the first area to participate in the pilot project,aims to achieve more fruitful results.This paper first examines how promoting farmers’income through the market entry of agricultural land can be achieved,then uses the synthetic control method to quantitatively study the impact of collective operational construction land on farmers’income using panel data from 2011 to 2019,and finally proposes relevant suggestions from the perspective of system reform.

Epidemiological, Clinical Aspects and Outcome of Measles in a Low-Income Country in 2023

Introduction: Measles remains a worrying health problem in sub-Saharan African countries. There have been measles outbreaks in Cameroon with the most recent occurring between October 2022 and September 2023. The Centre region of Cameroon was the most affected in the country and being at the frontline of the fight against this illness, we conducted this study in order to determine the epidemiological and clinical characteristics as well as the outcome of children who contracted the measles and were hospitalized at the Yaoundé Gynaeco-Obstetric and Pediatric Hospital. Methodology: We conducted a cross-sectional descriptive and prospective study for one year from October 2022 to November 2023 corresponding to the duration of the outbreak. We included all children admitted in the pediatric unit for measles and its complications during this period. Results: In total, 60 children were enrolled. Their caregivers were mostly their mothers who had a mean age of 34.71 ± 9.55 years living in significant precarious conditions for the majority. The median age of children was 16 months (09 - 30 months). Twenty six percent of children (16) were less than 9 months. Girls were predominant (55%). Most children were not up to date with their routine EPI vaccination (80%) and most did not receive the measles and Rubella vaccine (76.67%). Clinical manifestations, included fever, conjunctivitis, and cough. Skin rash and catarrh (98.33% and 86.67% respectively) are the case definition signs of measles. The outcome was unfavorable for 4 children. One had a neurological disorder: coma and three presented with pneumonia and severe respiratory distress (6.67%). Conclusion: Measles is still being a reality and claiming lives in our context, emphasis should be made on immunization coverage and if possible, advocacies should be formulated to decrease the age of measles vaccine administration.

Key Factors to Consider When Introducing a New Vaccine in Low-Income Settings: Lessons from Malawi Expanded Program on Immunization

Introduction: As new vaccines become available, countries must assess the relevance to introduce them into their vaccination schedules. Malawi has recently introduced several new vaccines and plans to introduce more. This study was conducted to identify key factors that need to be considered when deciding to introduce a new vaccine and current challenges faced by low and middle income countries using Malawi as an example. Methodology: The study employed a desk review approach, examining published literature from various sources such as PubMed, Medline, and Google Scholar. Policy documents from organizations like the World Health Organization, GAVI the Alliance, and the Ministry of Health for Malawi were also included. A total of 99 articles and documents on new vaccine introduction, challenges of immunization, policy documents in immunization and health systems strengthening were included. The review focused on addressing five key areas critical to new vaccine introduction namely: the need for a vaccine, availability of the vaccine, safety and effectiveness of the vaccine, demand for the vaccine, and the prudent use of public or private funds. Results: Malawi considered the burden of cervical cancer and the significance of malaria in the country when introducing the HPV and malaria vaccines. The country opted for vaccines that can be handled by the cold chain capacity and available human resources. Despite that malaria vaccine and Typhoid Conjugate Vaccine trials were done in country, there are limited vaccine safety and efficacy trials conducted in Malawi, leading to a reliance on WHO-prequalified vaccines. Demand for newly introduced vaccines varied, with high demand for Oral Cholera Vaccine during a cholera outbreak, while demand for COVID-19 vaccines decreased over time. Although cost-effectiveness studies were limited in the country, 2 studies indicated that Typhoid Conjugate Vaccine and malaria vaccine would be cost effective. All these have been implemented despite having challenges like lack of accurate surveillance data, inadequate cold chain capacity, limited safety and efficacy vaccine clinical trials, political influence, and limited funding. Conclusion: Despite several challenges Malawi set a good example of the careful considerations required before introducing a new vaccine. The process involves data review, priority setting, precise planning, and consultation with stakeholders. Low-income countries should invest in vaccine safety, efficacy, and cost-effectiveness trials.

Characteristics of Infertile Clientele Attending a Public in Vitro Fertilization Clinic: Appraising Priorities in a Low-Income Country

Introduction: Infertilityaffects one in six couples, and it is an important public health issue largely due to thepervasive effects on the emotional and psychological wellbeing of affected couples. In many developing nations emphasis is placed on childbirth and inability to fulfill this role can be very distressing. There is an unmet need for assisted reproductive technology (ART) in many developing countries and where facilities exist, they are mostly privately owned, expensive and concentrated in urban areas. To bridge this gap, public fertility clinics have been established to provide subsidized care. Evaluating the characteristics and peculiarities of clientele presenting at these public facilities will aid planning and prioritization of care. Methodology: A descriptive retrospective study of 116 infertile patients presenting to the fertility clinic of the University College Hospital, Ibadan, Nigeria from inception on the 14th of February 2019 and 31st of December 2022.Data was analyzed using the Statical Package for Social Sciences (IBM, SPSS, New York) version 23. Descriptive statistics were used to summarize the results which were presented with the aid of bar charts and frequency tables. Result: The mean age of the patients was 40.70 ± 6.62 years. Post-menopausal patients accounted for about one-fifth of the study population while 80.2% (93 women) were older than 35 years. The mean duration of infertility was 9.39 ± 6.11years and nine patients (7.8%) had a duration greater than 2 decades. Secondary infertility occurred in 67.2% of the women. Twenty-nine women (25%) had undergone myomectomy prior to presentation. Hypertension (11.2%) was the most prevalent comorbidity. Nineteen patients (16.4%) had used contraceptives in the past with the male condom (36.8%)being the most preponderant. Sixty-seven patients had experienced pregnancy losses before 28 weeks of gestation while just 16 patients (13.8%) had undergone ART, and none was successful. Conclusion: Secondary infertility was the prevalent type of infertility and may not be unconnected with the low contraceptive usage and high risk of sexually transmitted infection. Late presentation coupled with a large proportion of post-menopausal clientele suggests delayed health-seeking behavior most probably due to the prohibitive cost of ART. The need to streamline services offered in public fertility clinics is paramount in low-income countries grappling with scarce resources. A pragmatic approach will involve the provision of low-cost ART, while enhancing gamete donation programs through the implementation of gamete sharing policies. This will invariably bridge the unmet need and skewed access to ART in developing countries.

A Prediction Model of Peasants’ Income in China Based on BP Neural Network

According to the related data affecting the peasants’ income in China in the years 1978-2008,a total of 13 indices are selected,such as agricultural population,output value of primary industry,and rural employees.Based on the standardized method and BP neural network method,the peasants’ income and the artificial neural network model are established and analyzed.Results show that the simulation value agrees well with the real value;the neural network model with improved BP algorithm has high prediction accuracy,rapid convergence rate and good generalization ability.Finally,suggestions are put forward to increase the peasants’ income,such as promoting the process of urbanization,developing small and medium-sized enterprises in rural areas,encouraging intensive operation,and strengthening the rural infrastructure and agricultural science and technology input.

Impact of Plastic Waste on the Human Health in Low-Income Countries: A Systematic Review

Background: Plastic pollution is the accumulation of waste composed of plastic and its derivatives all over the environment. Whether in the form of visible garbage or microparticles, as it slowly degrades, plastic pollution poses significant threats to terrestrial and aquatic habitats and the wildlife that call them home, whether through ingestion, entanglement or exposure to the chemicals contained in the material. Unfortunately, there is a lack of documentation on the impact of plastic waste on human health in low- and middle-income countries (LMICs). Methods: We searched five electronic databases (PubMed, Embase, Global Health, CINAHL and Web of Science) and gray literature, following the preferred reporting elements for systematic reviews and meta-analyses (PRISMA), for the impact of plastic waste on human health in developing countries. We included quantitative and qualitative studies written in English and French. We assessed the quality of the included articles using the Mixed Methods Appraisal tool (MMAT). Results: A total of 3779 articles were initially identified by searching electronic databases. After eliminating duplicates, 3167 articles were reviewed based on title and abstract, and 26 were selected for full-text review. Only three articles were retained. The three articles dealt with practices likely to lead to oral exposure to plastic chemicals in human health, as well as the level of awareness of participants concerning the possible impact of plastic on human health, namely, the use of plastic baby bottles, the use of microwaves to cook food and reheat precooked food, the use of plastic bottles to store water in the refrigerator, water purifier containers with plastic bodies and plastic lunch boxes, the reuse of plastic bags and the inadequacy of treatment facilities. Conclusion: Plastic waste poses different risks to human health at every stage of its life cycle. Hence, strategies must be adopted to raise public awareness of the dangers of plastic waste to their health. Trial registration: The review protocol is registered in the PROSPERO international prospective register of systematic reviews (ID = CRD42023409087).

Income Growth of Peasants Based on Grey Theory

Taking Jiangsu Province for example and using the relevant data in Jiangsu Statistical Yearbook and Statistical Communique of Jiangsu Province on National Economic and Social Development during 2002-2009,the thesis selects eight indexes including per capita net income of farmers,the fixed asset investment level in rural areas,average educational level,agricultural scientific and technological level,urbanization level,industrialization level,average consumption level per rural residents and per capita GDP and adopts the theory of grey correlation to analyze the factors influencing the peasants' net income.As shown in the result,the effect on the peasants' net income gives the following subsequence from great to little:average consumption level per capita of rural residents,urbanization level,average educational level,industrialization level,per capita GDP,number of scientific and technical personnel and fixed asset investment level in rural areas,that is,r06>r04>r02>r05>r07>r03>r01.Then combining with the practical conditions,the thesis makes a detailed analysis of each factor influencing the peasant's income growth and proposes corresponding measures in order to improve the peasants' income.

Study on the Industrial Structure and Peasants' Income in the Mountainous Areas in Zhejiang Province

With the constant increase of farmers' incomes, the declining ratio of low-income farmers and the development of rural economy in the mountainous areas of Zhejiang Province, the farmers gain much more transfer income from the secondary allocation and their lives were greatly improved. But due to the uneven economic development, the agricultural development level of different land forms differs greatly and there is still a large gap between the incomes of urban and rural residents. In this paper, through an in-depth analysis of the farmers' income, agricultural industrial structure and urban-rural income gap in different mountainous areas of Zhejiang Province, some advices were proposed to increase the farmers' incomes.

Rural transformation,income growth,and poverty reduction by region in China in the past four decades

China has experienced rapid rural transformation in the past four decades.Accompanying the rapid transformation is a significant rise in rural household income and a substantial fall in rural poverty.This paper examines the evolutions of and the relationships between rural transformation(high-value agriculture and rural non-farm employment)and its outcomes(per capita rural income and rural poverty incidence)using provincial-level data.The results show that 31 provinces/autonomous regions/municipalities have undergone significant rural transformation,but the level and speed of rural transformation differed considerably.Moreover,an increased level of rural transformation is often associated with higher per capita rural income and reduced rural poverty incidence.Notably,a category of provincial rural transformation based on high-value agriculture and rural non-farm employment is also analyzed.We further discuss the likely impacts of institutions,policies,and investments(IPIs)on rural transformation and conclude with policy implications.

Income Growth,Income Gaps,and Rural Poverty Reduction in China

This paper analyzes the evolving trends in China’s rural poverty from 1988 to 2018 and how income growth and income gaps contributed to poverty reduction using rural household data from the China Household Income Project(CHIP).We find that after China’s reform and opening up policy introduced in 1978,China’s rural poverty has been reduced substantially due primarily to income growth,although this poverty-reducing effect was partially offset by widening income gaps.During the progress of this poverty reduction,however,income distribution replaced income growth as the key driver.For the extremely poor in particular,their poverty status hinged upon income distribution.As revealed by our empirical analysis of income sources,wage income became the chief source of income for rural households,contributing a rising share to poverty reduction in the countryside.The contribution of net income from government transfer to poverty reduction has increased in recent years,and this contribution has been increased with the deepening level of poverty.Calculation of the pro-poor growth index suggests that the poor population primarily benefited from the trickle-down effect of economic growth,and the economic growth pattern has yet to lean towards pro-poor growth.

Between food fulfillment and income:Can urban agriculture contribute to both?

Food and Agriculture Organization(FAO)is appealing for a global implementation of urban agricultural strate-gies to increase food availability.Bandung,a city in Indonesia,is already participating in this initiative.This research aimed to assess the contribution of urban agriculture toward household food fulfillment and income.Furthermore,the impacts on urban,subsistence,semi-commercial,and commercial agriculture were considered.In-depth interviews to obtain qualitative data and observations were also utilized.A survey of 321 households,consisting of 107 for each urban agricultural type,used questionnaires to obtain quantitative data.These inputs were further analyzed to determine the contribution of household food fulfillment and income.The results showed that average urban agriculture has an insignificant and significant contribution of 9%and 41.5%to household food fulfillment and income.This was due to the vast complexities of metropolitan problems,including limited access to land,lack of participation,dependence on on-market products,and increasing commercialization which opposed urban agricultural policies。

Impacts of Agroecological Technologies Adoption on Agricultural Yield and Income for Millet and Cowpea Producers from Maradi and Zinder Regions in Niger

This article assesses the impacts of agroecological technologies adoption on the agricultural yields and incomes for millet and cowpea producers in Niger from both Maradi and Zinder regions. For this purpose, a set of descriptive statistics methods are applied to data collected from 1950 producers from 80 villages. Results indicate that the density of semi, HPK variety, compost and IT 90 variety are the most adopted agroecological technologies with respective adoption rates of 87%, 69%, 64.3% and 64%. Moreover, results show that millet producers that adopted agro-ecological technologies have on average multiplied by 2.00 and 2.96 times their production, in Zinder and Maradi regions respectively. Besides, findings reveal that cowpea producers that adopted agro-ecological technologies have on average multiplied by 2.00 and 3.21 times their production, in Zinder and Maradi regions respectively. Finally, results support that the improvement in millet and cowpea yields has led to increase in producers’ total income by 2 and 3 times respectively in Zinder and Maradi regions. Since agroecological technologies improve agricultural yields and income, we suggest policy makers to recommend their adoption and diffusion.