Responsible higher education institutions have an impact on society and economic, environmental, and social development. These effects define the axes of the socially responsible management of the universities. The concept of university social responsibility (USR) manages these relationships to produce a positive impact on society through higher education, research, and the transfer of knowledge and technology, as well as education for sustainability. For this study, worldwide research into this subject was studied for the period 1970–2019. A bibliometric analysis of 870 articles was made, obtaining results for the scientific productivity of the journals, authors, institutions, and countries contributing to this research. The main category is business, management, and accounting. The most productive journal is the Business and Society Review, while the California Management Review is the most cited. The authors with the most articles are Stavnezer, Luo, and Lanero. The most productive institution is Wuhan University. The United States is the country with the most publications and citations, and the same country, together with the United Kingdom, make the most international contributions. Evidence shows growing worldwide interest in the economic and environmental impacts of USR. Future research should focus on analysing the links between the responsible and sustainable consumption of universities and their short-term financial, economic, and sustainable impacts. In recent decades, the impact of global changes, both economic and political, social, environmental, and technological, has led to a shift in the role of higher education institutions (HEIs) in contemporary society ,2. In thCurrently, the survival of universities is related to the social and environmental implications of their actions. In this sense, the transfer of knowledge, associated with economic growth and social development, has a place in public and economic policy ,2,3.Thereby, the social responsibility of universities includes education, organization, cognition, equity, and socialization, to create more sustainable societies . AmongstSince the classical definition of the university as a community of learning and teaching, knowledge has become one of the main instruments for the development of societies ,7. For tTo the initial missions of universities, which were teaching and research, a third has been added related to community commitment. This “third mission” has drawn attention to university institutions on the part of international agencies and political leaders , promotiThe concept of university social responsibility (USR) is based on the statements of the stakeholder’s theory, in order to unify the commitment that it acquires to fulfil the expectations of the different groups in their economic, social, and environmental functions.In this context, the revised literature points to terminological inaccuracy concerning the main concept of research. USR is a concept that derives and connects with the terms Social responsibility, corporate social responsibility (CSR), sustainable development, corporate environmental responsibility (CER) and education for sustainability, and not with terms related to philanthropy ,11.Thereby, with some generality, USR is a commitment of the university institution to develop initiatives that promote its relationship with the different social groups of society. Similarly, it is considered university management policy to promote actions that improve this relationship between the university and society, to balance the impact at both academic and organizational level . TherefoAs regards putting USR into practice, it can be considered within the regulatory framework of quality management in relation to the commitment of universities to meet the demands of knowledge transfer and research results . In partA quality education is the basis for improving people′s lives, as well as for sustainable development. Great progress has been made in access to education at all levels and, similarly, in enrolment rates at universities, particularly for girls and women. Although basic literacy has increased markedly, greater efforts are needed to achieve the goals of universal education and achieve equality for women in the university and their insertion in technical careers.In this sense, the quality management of HE is linked to sustainability and the development of a peaceful and equal society. These aspects, in turn, influence the generation of a higher quality of life and a greater positive impact on the environment, on the welfare state and on the economy in general ,10.Likewise, in the last decades, universities have gone from being dependent on centrals governments, elitist, small, closed and with little scientific production, to reverse this situation and be autonomous, decentralized, internationalized and more active in research, in general lines. This evolution has also meant that the institution participates in the environment in which it is located and cares about the social, economic, and environmental aspects in a productive way, generating innovation and added value ,12,14.The review of the literature, on the other hand, has found different studies that discuss whether universities, as institutions committed to sustainable development, use the USR as an instrument to favourably manage their reputation in their financial statements  or, on tIn addition, there is the controversy of equating the CSR with the USR, since the former was formed as a concept of market requirements for business organization, while from a university perspective, it emerged in response to the social needs linking its development with knowledge transfer from HEIs ,21.This has justified the interest to develop this research. Hence, the motivation of this study is to document the evolution of the knowledge base of the economic and environmental impacts of USR, with the intention of contributing to educational institutions to the approach of sustainable consumption, in relation to minimizing the environmental impact and satisfying consumer needs, both for present and future generations.From the reviewed literature, the research questions have been identified, which refer to determining what is the structure of knowledge about the economic and environmental impacts of USR; which are the most productive authors, institutions and countries; and what are the thematic axes that this research topic develops and towards which they are evolving.One of the main limitations of this study is to discern whether, among other variables, the number of publications related to a particular community is due to the demands of given interest groups, or on the contrary, to the needs of society.Accordingly, the main objective of this study is to analyse research trends on the economic and environmental impacts of USR globally over the period 1970–2019, i.e., over the last fifty years. This period ranges from the first article published on this topic (1970) to the last full year (2019). The study is consequent in admitting that the extensive period analysed covers numerous global socials, economic and political changes, which have involved different approaches in the management of university campuses. Furthermore, the appearance of new concepts has modified the analysis in scientific research on this topic.To answers these research questions, a sample of 870 selected scientific journal articles from the Elsevier Scopus database was analysed. The bibliometric method was followed to synthesize the knowledge base on the implications of USR in a global context.Finally, it should be noted that the research lines currently being developed on the subject include, among other things, the relation between the effect of implementing social responsibility policies in public and private universities in different countries with different political and economic systems. In addition, different studies are being related that analyse the outcome of social responsibility of HEIs with policies of inclusion and diversity.The study of USR is based on the theoretical principles of interest groups analysis, which, together with the basic concepts, define the reference framework in this field of research. Hence, these explanatory principles define how a set of phenomena behaves, to systematise and generalize individual cases. Consequently, with the study carried out, In 1930, Ortega y Gasset, in his work “Mission of the University”, and E. Allen Gaw, in his publication “Social Education”, discussed of the roles that university institutions needed to play in order to participate in the process of modernising society, and proposed, in a debate still valid today, that higher education (HE) should be reformed for the benefit of society ,23,24.In 2003, at the World Conference on Higher Education, UNESCO stressed the importance of the well-being of nations and the quality and scope of HEIs. Since then, arguments and definitions have flowed that make it possible to distinguish the practices and policies of social responsibility related with universities from those that mainly relate to companies.In particular, among the purposes pursued by HEIs, are, in politics, the development of democracy and conflict resolution ; in the Universities today have a complex end goal, whereby they must respond to confusing questions of strategy. These strategies and alternatives should be aimed, amongst other things, at analysing the causes of the expansion of HE , to seekIn this sense, the triple helix model is a valid framework for describing interactions and relationships between universities, industries, and governments, with a view to capitalizing on knowledge ,33. TherThe literature review has made it possible to analyse documents that are what have allowed us to define the bases of this research. This subsection examined the theoretical principles used to conceptually argue the link between social responsibility, sustainable consumption, corporate sustainability, and HEIs ,51,52. TThe concept of USR must be established according to the axioms of stakeholder theory to unify its commitment to meeting the expectations of the different stakeholders in their health, economic, social, and environmental functions ,54.First, the theoretical approach of stakeholders, enunciated in 1984 by Freeman , is estaOn the other hand, recent decades have seen a growth in the influence of stakeholders on organizations, but to successfully implement and manage social responsibility, there is a need to know and identify their needs and expectations. The implementation of stakeholder theory in HEIs in order to create knowledge-based societies led to the need to promote university policies in social responsibility based on participatory methods, and thus contribute to the liaison between academic and research functions, and social needs and problems ,61.For all these reasons, in recent decades, universities have gone from being dependent on central governments, elitist, small, closed and with little scientific production, to reverse this situation and be autonomous, decentralized, internationalized and more active in research, in lines general. This evolution has also meant that the institution participates in the environment in which it is located and cares about the social, economic, and environmental aspects in a productive way, generating innovation and added value ,60.The revised literature provides definitions for the basics of this research topic. Some reflections are included on the terms and concepts used in the context of this research, which have helped model the term university social responsibility (USR) from the idea of corporate social responsibility (CSR). Hence, Likewise, although the official definitions of CSR refer mainly to companies, the general consensus is that the foundations of CSR affect all types of organizations, be they companies, public administrations, labour unions, or NGOs among others. Furthermore, it is a voluntary initiative of management and good governance, which, integrated from the decision-making of an organization, takes into account its stakeholders, and economic, social, and environmental variables. For these reasons, the USR is the answer that the university must train responsible citizens with their environment, creators of creative ideas and committed to help solve social, economic, and environmental issues.Since its initial definition, the concept of the CSR has not undergone major changes, although its role in company strategy has evolved, as has the effect that socially responsible actions had on sustainable development. The term emerged as a response of companies to growing social and corporative concerns with issues that included social, environmental and consumer interests.Since its inception, CSR has been extensively studied and researched ,63,64,65As regards social responsibility, institutions should treat laws and regulations as opportunities for improvement, insisting on ethical behaviour in their interactions with stakeholders . In thisFor its part, the concept of sustainability formally appeared for the first time in the Brundtland Report in 1987 , relatedFurthermore, just as companies and other organisations have recognised the demand for greater social and environmental sustainability, universities have responded with new pedagogical approaches. Hence, arose the concept of education for sustainable development (EDS), a term that refers to the various forms of learning and teaching associated with the sustainable development of societies . In thisIn relation to the basis of sustainable development and the Sustainable Development Goals (SDGs) by 2030, education allows for self-reliance, fosters economic growth by improving skills and improving people′s lives. Thus, the USR and stakeholders require better access and quality to the university, eliminating, among others, gender inequalities, food insecurity and armed conflicts .In addition, by bringing together these concepts that address social responsibility from different perspectives, it is noted that, from their origin, universities have been the basis of education and, to some extent, of social sustainability. In this context, universities are obliged to implement a series of ethical principles and values in the fields of management, teaching, and research, so that they declare their intentions, in this sense, in their vision and mission ,79,80.Hence, in the knowledge society, USR refers to managing the strategic model in the context of a socially responsible HEI. For this reason, the implementation of the USR entails self-criticism from the institution itself, responsibly assessing the impact of its actions on society ,82. ThatAs mentioned by A. Parsons  of the UThis social concept reviews the actions of universities in a knowledge society to determine the applicability of CSR in these educational institutions. At the same time, USR encompasses the operational variables that a university must manage if it is to be socially responsible in terms of support for inclusion, community education, and respect for and conservation of the environment or natural resources ,13.As regards the USR regulatory framework, the international standard ISO 9001, which deals with the quality of management systems and accreditation, certifies universities in terms of optimal processes of organization and planning of activities. ISO 26,000 establishes the management and focus of social responsibility in universities from a managerial perspective to achieve a sustainable society ,86.The Bologna Process (1999), the basis of the subsequent European Higher Education Area (EHEA), which is organized on the principles of quality, mobility, diversity and competitiveness, was initially directed towards increasing employment in the European Union and the transformation of the European higher education system into an instrument for attracting students and teachers on a global scale. Thereby, the incorporation of the social dimension of HEIs was not initially considered. Subsequently, the following statements have examined the influence that universities have on the development of European society ,87,88. ITherefore, in 2015, with the support of the European Union′s Lifelong Learning Programme, the Comparative Research Project on University Social Responsibility in Europe and the Development of a Community Reference Framework (EU-USR) were initiated. On the initiative of certain leading European Union universities regarded as leaders in social responsibility, the objective of this common European model was to optimise the USR of all universities. Initially, it was formed in response to the European Commission′s political priority on the need for a common social responsibility strategy for all European universities. Today, many European universities understand their social dimension, promoting policies and practices, albeit without a frame of reference .Likewise, both the Millennium Development Goals, in 2000, and the SDGs, in 2015, mainly in SDG 4, have promoted, in relation to the USR, an inclusive, equitable and quality education that promotes learning opportunities during all life for all. In this way, these resolutions establish the bases for the achievement of a quality education as a foundation to improve people′s lives and sustainable development.In this sense, the European Commission managed the INHERIT project  to stimulate effective policies, practices and innovations in relation to key environmental stressors and the underlying causes of inequity in health. Likewise, the objective of this Horizon 2020 research project, for the period 2016–2019, was to promote the change of sedentary lifestyles and those outside the circular economy, and thus formulate scenarios to create a more sustainable future. In other words, this project sought to design and implement intersectoral initiatives to achieve healthier social change .Scientometrics is the science that studies and measures scientific production. It is also known as the scientific and empirical study of science and its results. In practice, there is a significant overlap between scientometrics and other scientific fields: bibliometric, information system, information science and scientific policy . It is bBibliometric, on the other hand, applies mathematical and statistical methods to the literature of a scientific nature and the authors that produce it, with the aim of studying and analysing scientific activity. The instruments used to measure aspects of scientific activity are bibliometric indicators, which are measures that provide information on the results of scientific activity in any of its manifestations . It was The objective of this study is to provide an insight into the overall dynamics of research and the state of the issue regarding the economic-environmental impacts of the USR in a global context. To achieve the proposed objective, a quantitative analysis was carried out, using bibliometric, to identify, organize and analyse trends in the research topic. In recent decades, it has contributed to the review of scientific knowledge, and has been successfully used in various scientific fields ,94.According to the reviewed literature of the study topic, mainly the one detailed in The choice of the Scopus database is due to the fact that, when performing the initial search in the Web of Science (WoS) and Scopus databases, it showed a significant difference in the volume of articles in the analyzed period 1970–2019, since 559 articles were extracted from WoS, and 870 articles from Scopus.Additionally, Scopus has greater advantages over other databases, such as WoS or Google Scholar, among which are: (i) it is considered the largest repository of peer-reviewed literature; (ii) it minimizes the risk of losing documents during the search; (iii) it is easily accessible and offers some tools for data visualization and analysis, in addition to presenting the option of downloading content in different formats; and, (iv) it presents a variety of data.The process followed in the selection of the sample of documents conforms to the flowchart of Thereby, in phase 1 (identification), 249,478 records were identified from the Scopus database, considering all fields for each of the key search terms , all types of documents, and all years in the data range .In phase 2 (screening), the option of “article title, abstract and keywords” was chosen in the field of each term, so that 248,123 records were excluded, so 1355 records were identified.Subsequently, in phase 3 (eligibility), only the articles were selected as the type of document, to guarantee the quality derived from the peer review process. In this phase, 420 documents were excluded, so it had 935 records.As for the time horizon of analysis, this is between 1970 and 2019, both included, that is, from the publication of the first article on this topic (1970), to the last full year (2019). For this reason, in the last phase (included), 65 documents are excluded, so the final sample included 870 articles.In short, the search selected records of subfields of title, abstract and keywords, in the period that contains the last 50 years, from 1970 to 2019, in the same way that it has been successfully applied in other studies that have used the bibliometric methodology ,97,98. TTherefore, the final sample included a total of 870 articles, both open access and non-open access. The variables analysed were year of publication, thematic area, journal, author, author’s country of affiliation, institution to which the author is affiliated, and keywords that define the publication.In this study, the indicators of scientific production analysed were the distribution by years of published articles, the productivity of authors, countries, and institutions . As for In addition, collaborative structure indicators, which measure the links between authors and countries, were analysed through network mapping and processing tools due to their reliability and suitability in the bibliometric analysis.VOSviewer software  was applied for the analysis of collaboration structure and relationship indicators, by co-authorship and co-occurrence analysis, which provides data on interactions and the evaluation of subject-matters, to measure the activities of research networks. In other words, this tool allows analysis for the purpose of displaying relationship maps and network links between authors, institutions, countries, and keywords. Subsequently, this software tool allows you to recognize research trends based on the use of keywords in research articles. In this sense, network mapping refers to the process of seeing the connection and structure of the network in order to map the dynamics of science, in this case, of a certain research field, and which seeks to explore the structure underlying similarities and interrelationships between documents ,101.Likewise, the clustering algorithm of VOSviewer allows communities to be detected in a network that considers modularity, that is, a measure that assesses the quality of community structures. Thereby, modularity-based clustering of VOSviewer provides networks where nodes are densely connected internally within groups, but without external connection between different groups. In this way, it unifies the mapping and grouping approaches, in addition to dividing the research carried out into documents . The resThis section presents and discusses the results of scientific production concerning the economic-environmental impacts of USR in a global context, as well as the distribution of publications by subject area and journal, and the scientific production of authors, institutions, and countries. The results obtained from the analysis of the keywords associated with this field of research are also discussed.As with the number of articles, the total number of authors also increased during the period analysed. In the last decade (2010–2019), 85.70% of the total number of authors for the whole 50-year period published at least one article. While only 11 authors published in this field of research in the first decade (1970–1979) a total of 2001 authors were active in the period 2010–2019. The average number of authors in the third and fourth decades was 2.8 authors per article, while in the last period studied it was 2.7 authors per article.The number of countries involved in the publication of articles on this research subject increased from 2 in the first decade, 1970–1979, to 86 in the last period analysed, representing 95.56%. During the whole period analysed, 90 countries contributed to the publication of articles on the scope of USR.In addition, the number of citations grew exponentially, from the first period (2001–2003), increasing from 813 to 5737 in the last period analysed (2010–2019). It should be noted that the articles corresponding to the most recent decades will receive a greater number of citations in coming years, both because of their recent publication and impact, and for their distribution in open-access . This isFinally, the number of journals where USR articles were published increased from 2 in the first period, 1970–1979, to 397, in the last decade analysed, 2010–2019, which also accounts for 88.03% of the total number of journals examined in the 50-year period.Scientific production on the research topic, influenced by the link with the concepts of corporate social responsibility and the HEI at a global level, was developed in line with the technological advance that brought about the appearance of the Internet globally, leading to greater ease in the use of data and international academic and research cooperation ,91,98.In addition, articles published in the English language account for 92% of the total, as the main language of science. Here, English is followed by Chinese (4%) and Spanish (2%). The remaining languages do not add up to 1%.During the period analysed, 1970–2019, there are several categories in which works related to the economic and environmental impacts of USR can be found. In this way, according to the Scopus classification, there are a total of 26 thematic areas into which the 870 articles analysed are classified. It must be borne in mind here that the same article can be classified in more than one category, depending on the interest of the author and the publisher.The association of publications in this field of research, mainly the categories of Business, Management and Accounting, and Social Sciences, arises from the conceptual and practical link of the dialogue between the USR and the stakeholders, about the economic, social, and environmental factors ,51.Moreover, as can be seen in The important changes that have taken place in these five decades, both socially, economically, politically, culturally and environmentally, have obviously motivated scientific production to evolve, since the researcher and academic seek and need to find answers to these changes. Along these lines, the Millennium Development Goals, in 2000, and the SDGs, in 2015, mainly in SDG 4, stand out mainly in the promotion of quality education ,51,70.By country, among the 20 most important journals in the USR publication are those of European origin: United Kingdom (7), Netherlands (3), Lithuania (2), Switzerland (1), Poland (1), Czech Republic (1), Romania (1), and those of American origin (4).The journal that has published most articles on the economic and environmental impacts of USR globally is Business and Society Review, with 50 articles, which represents 5.75% of the total number of articles published from 1970 to 2019.The California Management Review is the journal that has occupied the first position in the ranking for more decades, two of the five periods analysed . It also stands out because it attracts great interest from the scientific community, as seen by the high number of citations that it received (2098), and for the average number of citations per article (87.42). It is also the journal that has the highest H index for published articles on USR, with 15, which is far from the journal’s overall H index for all subjects, which stands at 118. The journal Nucleic Acids Research has the highest impact factor SJR, 8.636 (Q1), followed by the Journal of Experimental Medicine, with 7.941 (Q1), and the California Management Review, with 2.658 (Q1).It is important to mention how the journal Sustainability, with 13 articles published on the subject since 2015, has become the journal that has ascended most in terms of ranking, standing seventh throughout the period analysed (1970–2019) and fourth for 2010–2019.The authors who have published the most articles on the subject are Stavnezer , Luo , and Lanero , with four articles each.The author with the highest number of USR citations is the Australian, Brammer, with a total of 387, which also places him as the author with the highest average number of citations per article, with 129, followed by the Americans, Stavnezer, with 302 citations and an average of 75.50 citations per article, and then Schrader, with 258 and 86, respectively. In addition, Stavnezer has the highest h-index, 4.Of the 10 most prolific authors in the publication of articles on this research subject, four are of Spanish origin, from the University of Granada , and three American .The lack of international co-authorship of Spanish institutions is interesting. By contrast, 50% and 83.3%, respectively, of the articles on the economic and environmental impacts of USR from the Chinese Academy of Sciences and York University are internationally co-authored, with the same number of articles as the Spanish, University of Cadiz (6). In addition, York University shows its international credentials with the highest average number of citations per article published with international collaboration (141.60). It is also of note that the Loyola University of Chicago, despite international collaboration in 20% of their articles, have no citations in these publications.In this sense, efforts being made by HEIs in recent years in relation to educational activity for sustainable development, are relevant, because, as UNESCO points out, education is one of the most effective tools to stimulate the changes necessary to achieve sustainable development ,105. ForThe above data refer to the ranking of the most productive countries in the publication of articles on USR for the whole the period analysed, underlining its research potential, with 171 articles in the last period alone (2010–2019). During this last decade, China has moved into second place, with 82 articles published, replacing the United Kingdom, which held this position in the previous two decades . These countries , together with Spain and Canada, are the main promoters of USR research globally, since, they have been responsible for publishing 54.94% of the world total.The remaining five countries  have published fewer articles. Of this group, Germany, with the fourth largest number of citations (987) in 27 published articles, presents the third best h-index (15) in articles on USR, and has held eighth position for the last two decades studied.In seven of the countries in Thereby, cluster 1, the largest, includes 7 countries: India, Indonesia, Iran, Lithuania, Malaysia, Pakistan, and United Arab Emirates. Group 2 consists of Croatia, Czech Republic, Poland, Russian Federation, Slovakia, and Ukraine. Cluster 3 is led by Japan, and includes France, Hungary, Romania, Sweden, and Turkey. Cluster 4 is headed by the United States and includes China, Hong Kong, Lebanon, and South Korea. The fifth cluster, led by the United Kingdom, includes Brazil, Italy, Portugal, and Spain. Cluster 6 consists of Belgium, Finland, Netherlands, and Saudi Arabia. Group 7 consists of Australia, South Africa, and Thailand. Cluster 8 consists of Denmark, Switzerland, and Taiwan. Cluster 9 consists of Austria and Germany. Cluster 10 is made up of Canada and Algeria. Finally, cluster 11 contains Norway and Singapore.The five most common keywords used during the period analysed (1970–2019) are sustainability (in 66 articles), priority journal (45), sustainable development (43), controlled study (36), and corporate strategy (28). As regards the first term, Sustainability, in the last period (2010–2019), co-occurrence is in 92.4% of the published articles on USR. Moreover, the literature review of the term Sustainability suggests that word is used as a synonym, or an equivalent term, of Sustainable Development ,110.Of the top 20 keywords, six have started to be associated with this field of research during the last period examined (2010–2019). These are stakeholders (position 9), students (12), financial performance (15), innovation (18), management (19), and perception (20).These lines group all terms related to the economic and environmental impacts of USR globally. Hence, the “sustainability” line includes aspects related to sustainable development in a global context of HEIs . The “goThe development and evolution of this field involves new concepts and study arguments at a global level, such as “corporate citizenship and higher education behavior”, “green university”, “green campus”, “sustainable university”, “green corridors”, “circular community”, “reducing private car use”, “networked governance”, “inclusive university”, “responsibility for health”, “work-life balance”, “physical space”, “healthy lifestyle”, “healthy campus”, “eco inclusion”, or “inclusive education management”.For all these reasons, obtaining a quality education is the basis for improving people′s lives, as well as contributing positively to sustainable development. In this sense, progress has been made in terms of access to education at all levels and in enrolment rates in universities, mainly for women and girls. On the other hand, basic literacy has increased substantially, although greater efforts are needed to achieve the goals of universal education and achieve equality for women in the University and their insertion in technical careers.Hence, the quality management of HEIs are aligned with sustainability and with the development of an egalitarian society, with the purpose of SDG 4 guaranteeing inclusive, equitable and quality education, and promoting lifelong learning opportunities ,82.In recent years, HEIs are undergoing changes at a global level, albeit in a heterogeneous way. It is key to admit that there is a disparity in performance, but also in the resources, capacities, and scope in which these institutions carry out their activity. The modernization of the universities has meant that their focus is turned from the academic and research perspective, and pay attention to the stakeholders, with special reference to the characteristics of their immediate geographical context that marks the environment of competition and the available potential markets. The organizational heterogeneity of the different HEIs has a direct impact on the implications in the decisions that are related to the economic, social, and environmental aspects.The evolution of research on this topic encourages the appearance of different projects at the international level, with the aim of considering a positive environmental impact, a sustainable and responsible consumption, to offer a more sustainable future in relation to the SDGs.In the context of both corporate sustainability, SDGs and responsible consumption, initiatives emerge, such as, the EuroHealthNet research platform promotes evidence-based approaches to health, equity and well-being, through collaboration between decision makers and researchers and their results. In this regard, it provides an evidence base for policies and practices that address health inequalities and environmental threats to health . LikewisThese initiatives promote sustainable consumption to improve sustainable performance, in addition to meeting the needs of consumers, and increasing the quality of life of citizens. It is about improving, through public or private initiatives, both the efficiency of resources, as well as increasing the use of renewable energy, reducing carbon emissions, and minimizing waste ,123,124.Future studies on this topic should focus on new research lines that will determine, among others, whether the ethical code of a given university reflects its commitment to sustainable development; or, also, to evaluate, as a sustainability challenge, the participation of HE in business ethics.Furthermore, on the other hand, the research must identify what actions are necessary for a more responsible future, related to the economy, demography, sustainability, health, well-being, social inequalities, equity, and the environment.Even, it should be analysed how the promotion of educational practices on social responsibility and focused on the development of the consciousness of millennial students, will have a positive effect on responsible consumption. Green marketing, from both educational institutions and their providers, must be extensively studied to highlight these fraudulent practices, which undermine the image of HEIs.It would also be necessary, on the other hand, to develop academic and scientific contributions that establish the dimensions that contribute to the strengthening of the USR from the social, economic, healthy, welfare and sustainable points of view.These new thematic axes should also create models that measure the satisfaction of interested parties with the practical aspects of the USR, institutionalize the link between USR and learning services; evaluate the impact of strategies that develop partnerships between HEIs and other institutions or organizations with respect to achieving the objective of sustainable development, and analyse the links between the responsible and sustainable consumption of universities and their short-term financial, economic, and sustainable impacts.In short, research at the global level, both from the initiative of the individual researcher and from joint projects, should develop studies that extol the sustainable consumption of HEIs in their USR actions, from the consumption of products and services that minimize the environmental impact, maximize the economic impact, and satisfy the needs of the societies to which they are linked, for both present and future generations.The objective of this study was to analyse the scientific production of the economic and environmental impacts of USR in the last 50 years through a bibliometric analysis of 870 articles obtained from the Scopus database. The findings made it possible to identify the main drivers, potential tendencies, and certain gaps in critical knowledge. It is concluded that the USR, as a mechanism that allows the dissemination of HEI values and so ensures their economic, environmental, and social sustainability, is committed to the demands of its various interest groups. Thereby, the thematic areas, journals, authors, institutions, and countries involved USR publications have been identified.The number of scientific papers published per year during the period 1970–2019 has increased, especially in the last decade, when 743 articles were published, representing 85.70% of total contributions to this research topic.The thematic area of business, management, and accounting is the most common, since it groups 27% of the articles, followed by Social Sciences with 25%, and Environmental Science with 14%. Furthermore, regulatory developments have influenced the development of articles related to the business, management, and accounting and social sciences subject areas.The most productive journal on the scope of USR worldwide has been the British journal, Business and Society Review, with 50 publications, representing 5.75% of the total number of articles published in the study period. Of the journals that contribute to this topic, 45% are positioned in the first quartile of the Scopus database. The American journal, California Management Review has the highest number of citations , the highest average number of citations per article (87.82) and the highest h-index for published articles in this subject area (15).The authors who have published the most on the subject are Stavnezer (USA), Luo (China), and Lanero (Spain), with four articles each. Brammer, an Australian from Macquarie University, is the author with the highest number of citations (387), and the best average citations per article (129). Stavnezer is also the author with the highest h-index for contributions on USR (4).The most productive institution in this research area is Wuhan University, China, with 10 articles. The Canadian York University has the highest number of citations (709), the best average citations per article (118.17), and it is the institution with the most international collaborations in its work on the USR (83.3%). Among the institutions that have contributed the most to the subject but with no international collaboration in their articles during the period studied are Cadiz University and Jaume I University (Spain) and Loyola University of Chicago (USA).The main countries that have contributed to this area of research, in terms of the number of articles and international collaboration, during the period 1970–2019, are, in order, the United States, the United Kingdom, China, Spain, and Canada. The United States presents the largest number of published articles (212) and citations (4550), in addition to the highest h-index, with 34.Future research lines on this topic will focus on (i) determining whether the ethical codes of a given university reflect its commitment to sustainable development, (ii) assessing the involvement of HE in business ethics like a challenge of sustainability, (iii) identifying what actions are needed for a healthier future, related to the economy, demography, sustainability, health, wellbeing, social inequalities, equity, and the environment, and (iv) promoting educational practices focused on the development of millennial students′ awareness of social responsibility and investment.Among the main future research lines to be pursued are, principally, those that must (i) determine whether the ethical code of a given university reflects its commitment to sustainable development; (ii) evaluate the participation of HE in business ethics; (iii) identify the actions necessary for a more responsible future, (iv) analyse how the promotion of educational practices on social responsibility and focused on the development of the consciousness of millennial students will have a positive effect on responsible consumption; (v) study green marketing, both from educational institutions and from their suppliers; or (vi) analyse the links between the responsible and sustainable consumption of universities and their short-term financial, economic, and sustainable impacts.This study supposes an analysis of the scientific production and the actors that stimulate the investigation of the socio-economic and environmental dimensions on University Social Responsibility during the period 1970–2019, as well as the identification of the lines of investigation and their evolution and transformation. Innovation in this research field has been identified based on the morphology of the groups of authors, institutions, countries, and keywords, and the intensity of the relationships that develop in them. The results obtained are a complement to the knowledge of the evolution of the socio-economic and environmental dimensions on USR and allow to establish the relationship between science and technology, and to inform the decision-making process.Likewise, this research is of interest since it makes known the importance of USR in training responsible citizens with their environment, generators of creative ideas and committed to help solve social and environmental problems. This study contributes to disseminating the need for universities to make available to students, not only knowledge but also the possibility of developing competencies and skills, which give them the opportunity to transform their participation in social action initiatives.With a triple-pronged approach, the USR allows the implementation of progress policies and actions that lead towards sustainability. In this way, the research we carry out fosters a greater knowledge of the tools for more sustainable progress in our society. In this sense, the investigation and dissemination of these terms allows the promotion of initiatives that promote the ethical conduct of the citizen towards herself/himself and with her/his environment, and goes far beyond compliance with legal obligations, but seeks to raise awareness and respond to forge responsible students with their environment and with humanity.Finally, it should be noted that research on the economic and environmental impacts of USR worldwide has followed an upward trend of exponential growth, especially in the last decade studied, namely 2010–2019.


War is a stressful factor for children and families. During war, there are two categories of children including those who are directly attacked and all of their amenities such as school, house, and social structure are influenced and destroyed. Another category includes children who are indirectly observing these disasters through social media and the first group, in addition to psychological aspects, suffers from nutritional and physical health problems. In this study, the researcher aims to find out if there is any solution to provide psychological safety and nutritional and physical health for children involved in war.In this study, articles published in English and Persian languages in scientific sites, journals and conferences of Medical Sciences of Iran and Red Crescent, SID, PubMed and Scopus, and humanities were searched by keywords such as psychological health safety, violence against children, vulnerability of children during war, nutritional and physical health of children, and solutions to provide supplies and health during war.The results show that during war, it is necessary to gather information from the study area exposed to danger. Costs estimation, maintenance and storage of food supplies, supplying kitchens, warehouses and mobile refrigerators, providing food and shelter, establishment of hospitals and schools, education to cope with crisis for families and people working with children, and separating the consumer groups to maintain nutritional health of children are necessary. But the most important element is psychological health of children and it is necessary to train people before the accident and send them to the area. These people should know that children are more sensitive and understand the situations.To solve psychological problems of children, parents and authorities should prepare a comprehensive plan to reduce psychological injuries. For children who may need tranquilizers for psychological disorders, the presence of psychologist and psychiatrist is necessary. For health and nutrition of children, correct planning and prediction and management can reduce losses caused by the crisis.Children, War, Psychological problems, Food supply, Health


Continuously evolving technologies make dentistry one of the most advanced sectors in the field of medicine. The digital improvements in recent years have brought many advantages to clinicians and patients, including reduced working times, lower costs and increased efficiency of performance. Some of the most important digital technologies introduced in the dental filed are cone beam computer tomography (CBCT) scan, Computer Aided Design/Computer Aided Manufacturing (CAD-CAM) systems, and intraoral scanners. All of these allow faster and more accurate rehabilitations, with the opportunity of pre-simulation of the final treatment. The evolution of computer science has brought significant advantages in the medical and dental fields, making the diagnosis and execution of even complex treatments, such as implantology and bone reconstruction, possible. The digital world is trying to supplant the traditional analog workflow, and over time, with the further advance of technologies, it should tend to be the treatment of choice of our patients. Digital Health, is an innovative approach to medicine. The broad scope of digital health includes the computerization of healthcare processes, digitization of medical documents, computerization of medical records, creation of electronic files, and electronic prescriptions ,2. ExampThe digitalization of medical records allows the clinician to share and update the patients’ informations in real time, and archive the documents more easily, with full respect for the general data protection and privacy requirements, also using cloud technologies. Instead, analog medical records are usually stored in "physical" environments such as archives or warehouses, which everyone can access. Digital documents contain sensitive data, hence it is of importance that the digitized medical records can be examined only by operators, based on an approved workflow, which was previously established. There may be many attempts to hack digital information (data breach), so it is necessary to protect them with certified procedures, starting from the software houses and ranging to the person authorized to treat them.An example of lifesaving technological solution is geolocation, which can be used to quickly locate an emergency situation that requires the intervention of rescuers. Some emergency interventions would not be possible without the availability of satellite tracking systems and the app map-based running on smartphones ,4. OtherThe digitization of the medical profession, in all sectors, advances inexorably and offers advantages that combine analog workflows with new technologies. Digital technologies can support clinicians to make accurate diagnostic-based decisions, as well as supporting patients to make better-informed consent about their own treatment. Moreover, new options for facilitating the prevention or early diagnosis of life-threatening diseases, and management of chronic conditions outside of traditional care settings, can be provided using an innovative digital health approach. In the dental field, there are several specialities that have undergone evident changes in all the steps of the protocols and materials, including but not limiting to orthodontics, implantology, prostheses, and all the dental laboratory procedures. This allows for accurate prosthetically/functional-driven planning, proper aesthetic/functional pre-evaluation of the proposed therapy, computer-assisted execution of the treatment, as well as continuous follow-up of the patients. The main revolution was the Computer-Aided Design/Computer-Aided Manufacturing (CAD-CAM) technology, initially proposed to increase the performance of the restorations, reduce the costs and the fabrication times, and improve patient satisfaction/aesthetics. The CAD-CAM technologies make both the project and the execution faster, consisting of a three-dimensional design (planning/project) of the virtual treatment through the use of a computer, that than results in computer-assisted production of the same by the use of milling or printing machines. This technology offers several advantages, such as the accuracy of a computer-based planning/project, the rapidity of digital impression, the quality of digital-made products and its reproducibility at any time. Another very important advantage is a three-dimensional pre-visualization (simulation) that allows the final object/execution to be shown on the screen, so that the clinician can evaluate it from every viewpoint, increasing diagnostic capabilities and the accuracy of the treatments. All of this also allows for rapid communication between clinicians, other collaborators, and patients ,7.Some of the last considerable innovations in digital medicine are the digital impressions, optically detected by intraoral scanners (IOS), the introduction of the Cone-Beam Computerized Tomography (CBCT) scan, and the combination of both, thanks to which diagnosis and planning are faster, predictable and safe. There are various types of IOS and CBCT on the market that depend on the acquisition technology, the possibility of processing the files and the type of file generated.Intraoral scanners use structured light scanning, which consists of projecting a grid onto the surface of the tooth, where a series of high-resolution cameras reads its distortion. The detected distortion is processed by a microprocessor which transforms this data into a dimensionally perfect object, visible directly in the acquisition software. The intraoral scanner is the perfect completion for all CAD-CAM productions; the main benefit is the possibility of immediately checking the level of accuracy of the impression with the patient still in the chair. Another great advantage is the possibility of analyzing the occlusal relationships between arches, so as to define whether the occlusal distance is suitable for the creation of CAD-CAM restorations with specific materials. Last but not least is the possibility to send impressions by email, avoiding a waste of time for delivery.1)Night guards;2)Dental aligners;3)Fixed dental prosthesis;4)Guide for dental surgery.Some of the major applications in the dental field are: Its increasing use is also linked to implantology, in which scan bodies are used instead of conventional transfers. Implants are then repositioned in this precise position due to CAD software that matches the specific geometric shape of the scan body, with its dedicate library, allowing the design of individual abutments, frameworks and crowns. It has been demonstrate that the system is precise and accurate, since it does not suffer from distortions due to the traditional impression of the transfers. Moreover, the greater precision in the digital impression techniques has allowed its use, in combination with Digital Imaging and COmmunications in Medicine (DICOM) data derived from CBCT, for even more accurate diagnosis and virtual implant planning, including the production of surgical guides ,9. For tIn orthodontics, the introduction of intraoral and facial scanners, 3D printing machines, and, before that, digital radiology, including a CBTC scan, have improved both the diagnosis and execution of the orthodontic treatment. Digital studio models offer a viable alternative to traditional plaster models. Their advantages in orthodontic diagnosis and treatment planning include the easier and quicker transfer of electronic data, immediate consultation, and reduced space for storage . DigitalAesthetics is another application that benefits from intraoral scanners and digital workflow, consisting of smile design and simulation, prototype mock-ups, and veneer manufacturing. This is possible by the acquisition of digital impressions, a series of photos of the face and the patient’s smile, and through a smile design software that allows to shape the entire appearance of the smile area. In this way, clinicians have the opportunity to discuss with the patient and to decide with him/her the aesthetics of the restoration before the treatment starts ,17,18. TEven complete or partial prostheses, on both natural teeth and implants, could be made through a fully digital workflow, that allows clinicians and dental technicians to fabricate the restoration in all of its aspects, potentially reducing production times, and therefore the overall waiting times for both clinicians and patients, and, not least, the costs ,20,21,22Every treatment starts with the acquisition of the dental impressions which can be quickly detected using an intraoral scanner . The digital models are processed with dedicated CAD software. Through this digital workflow, there is no need to physically deliver the impressions to the dental technicians, and this also allows the process to be safer from a biological point of view ,24,25. DEven if working in a fully digital work-flow, simple and complex treatments could be performed. As in the clinic, patient’s aesthetic and virtual jaw’s movements can be simulated before the treatment, allowing both clinicians and dental technicians to better evaluate the proposed treatment plan, and to evaluate in advance the overall cost and time required for the treatment ,33,34,35In conclusion, it is true that these technologies will need to be further improved, and strong scientific evidence presented, before replacing the analog procedures. There are different aspects that need to be evaluated, therefore, both by the clinicians and patients, and in this way they could decide how to face the necessary treatments and feel more relaxed.


JMA Journal, a new official English medical journal.The Japan Medical Association (JMA) and the Japanese Association of Medical Sciences (JAMS) have launched the Asian Medical Journal in 1958 (renamed JMAJ in 2001), the JMA has been publishing Japanese medical studies and its activities in English.Since the inception of the JMA Journal, a peer-reviewed publication, is issued with the cooperation of the JAMS as a new global platform for information dissemination, in place of the traditional JMAJ but continuing its traditions.With due consideration of the environment of global health and medical information provisions, the JMA Journal covers all aspects of medicine and medical care, and includes contributions from medical researchers and healthcare professionals in Japan and elsewhere, on a wide range of areas, including original work, health policy, global health, and other commentary.The JMA Journal will promote international medical science and contribute to the improvement of the quality of health care by being read and cited by many people.The publication of this type of comprehensive medical journal is the first challenge in Japan. We sincerely hope that the Yoshitake Yokokura, MD, PhDPresident, Japan Medical AssociationPresident, World Medical Association


Nutritional deficiencies  developing as a side effect of radiotherapy (RT) currently represents a significant but still inaccurately studied clinical problem in cancer patients. The incidence of malnutrition observed in head and neck cancer (HNC) patients in oncological radiology departments can reach 80%. The presence of malnutrition, sarcopenia, and cachexia is associated with an unfavorable prognosis of the disease, higher mortality, and deterioration of the quality of life. Therefore, it is necessary to identify patients with a high risk of both metabolic syndromes. However, the number of studies investigating potential predictive markers for the mentioned purposes is still significantly limited. This literature review summarizes the incidence of nutritional deficiencies in HNC patients prior to therapy and after the commencement of RT, and presents recent perspectives for the prediction of unfavorable nutritional changes developing as a result of applied RT. Head and neck cancer (HNC) consists of a group of malignant neoplasms, mainly squamous-cell carcinomas (approx. 90% of tumors), that are heterogeneous with regard to their anatomical location, etiology, and clinical presentation, occurring in the mouth, throat, larynx, salivary glands, paranasal sinuses, and ear ,2. HNC fHNC is characterized by an unfavorable prognosis and the percentage of 5-year survival in this group of patients, regardless of the stage of cancer progression, which also depends on the anatomical location of the tumor, its degree of differentiation, the treatment used, and the clinical-demographic characteristics of the patient, does not usually exceed 30–40% ,8. In adThe choice of the HNC treatment method depends on the anatomical location, clinical stage, and histological differentiation of the tumor, as well as the clinical and demographic features of the patient, including age, fitness, the presence of comorbidities, and the nutritional status. In addition to surgical treatment, radiotherapy (RT) constitutes essential and routine HNC treatment, and in advanced stages of the disease, it is often supplemented with chemotherapy (CRT). If radical RT is used as the sole method of treatment or in combination with chemotherapy, conventional radiation doses are used /day for 5 days a week in a treatment regimen lasting 5–7 weeks ). This allows the achievement of therapeutic effects comparable to surgical treatment and permits the organ affected by cancer to be saved. Currently, in order to reduce RT complications, save healthy tissue, and precisely adjust the radiation dose delivered to the tumor tissue, Intensity Modulated Radiation Therapy (IMRT) is used ,15,16,17Regardless of the applied RT scheme and the obtained treatment results, RT is associated with a high risk of developing early or late radiation reactions. These adverse effects can be more fatal in the case of CRT. Moreover, various degrees of toxicity are observed in all patients who have completed the full course of treatment. Serious physical symptoms and functional disorders and losses caused by the disease and its treatment using RT have negative clinical, psychological, and social effects ,19. The Currently, the definition of malnutrition, cachexia, and sarcopenia is the subject of lively discussions among researchers of various specialties. A multifactorial background leading to the development of the two metabolic disorders, including abnormalities in the functioning of biochemical, molecular, and immunological pathways, effectively prevents the achievement of the desired consensus ,22. AccoFollowing the initiation of the neoplastic process and its further progression, the key function of the body, which is nutrition, becomes impaired. In the physiological state, nutrition is precisely controlled by mechanisms regulating hunger, satiety, and molecular and biochemical pathways responsible for the supply of substances that provide energy to tissues and then their use for the needs of intracellular metabolism. The proper functioning of the above mechanisms allows the body to maintain a dynamic balance between the processes of energy-providing substance consumption and their use for cellular metabolism, as well as the storage of their surplus  ,31. The The result of the above-described metabolic disorders developing under the influence of the ongoing cancer process is disruption of the body’s caloric balance, the development of inflammation, a loss of cell mass, and a change in the body composition that can lead to the development of malnutrition or wasting of the body ,40.For decades, the presence of cancer cachexia was considered an obvious consequence of the ongoing neoplastic process in the body. Over the years, however, significant differences have been observed in the response to treatment and the survival of patients suffering from cancer cachexia compared to patients with a normal nutritional status, despite similar clinical-demographic characteristics. Unlike cachexia, sarcopenia was previously matched with an older age. Nevertheless, 22.5% of cancer patients present a risk for sarcopenia. Alarmingly, the prevalence of sarcopenia in HNC patients has been demonstrated to be high, although there is considerable between-study variation (16–71%). We now know that malnutrition, sarcopenia, and cachexia in cancer patients constitute an unfavorable clinical factor associated with deterioration in the quality of life and a worse response to the applied therapy, as well as a shorter survival time . MalnutrHNC patients are at a very high risk of developing malnutrition, and about 60,000–90,000 patients die from cancer cachexia every year. The high rate of malnutrition in this group of patients is affected by the anatomical location of the tumor, the degree of its infiltration of the structures responsible for providing food to the body, and the toxicity of the applied therapy ,44. ApprMalnutrition, cachexia, and sarcopenia developing as a side effect of cancer treatment is currently a significant but still inaccurately studied clinical problem in cancer patients. RT or CRT, which are characterized by a high aggressiveness in the destruction of tumor tissue, unfortunately also damage healthy tissues, which results in either the development of malnutrition or intensification of the already existing malnutrition, leading to cachexia ,62. The Assessment of the risk of cancer malnutrition, sarcopenia or cachexia at the stage of RT planning in HNC patients seems to be crucial for determining the patient’s further prognosis, the success of the applied therapy, and the risk of early and long-term effects of its toxicity . The curp < 0.001) or have a worse performance status (according to ECOG-WHO), and they were less likely to have a tumor located in the larynx, stage I or II disease, or p16-positive oropharyngeal cancer [Elevations in inflammatory cytokines and impairments in leptin/ghrelin functioning are associated with symptoms of cancer cachexia. Moreover, leptin level can decrease after the commencement of RT . In anotl cancer . Clinical cancer ,112. TheThere are limited data concerning the predictive value of nutritional support in RT-treated HNC patients, because most studies have focused on the treatment methods of post-RT nutritional deficits. However, according to nutritional management guidelines, nutritional intervention should be part of the management of RT-treated HNC patients. Nutritional intervention should be tailored to meet the needs of the patient and be realistic for the patient to achieve. Individualized nutritional intervention either during planning or for early stage RT may be beneficial in terms of decreasing the impact of its side effects, as follows: Decreasing unintended weight loss; improving dietary intake and quality of life; reducing acute toxicities and treatment interruptions; and positively affecting the survival. It is recommended that nutritional intervention takes place before RT is started and continued during and after treatment ,114. ForMalnutrition, cachexia, sarcopenia, and body composition changes are some of the major issues in RT-treated HNC patients. Unfortunately, there are a lack of established clinical guidelines allowing the successful management of HNC patients undergoing RT intervention. Data from oncology departments of European hospitals prove that only 30–60% of cancer patients at risk of malnutrition receive nutritional support in the form of oral supplementation, as well as parenteral or enteral nutrition . By sele


Since 2016, Brazil has been in the midst of its largest sylvatic yellow fever epidemic ever, found predominantly outside the Amazon region. Cases originating from Brazil have been reported in France, the Netherlands, Romania, Switzerland, Argentina, and Chile. The epidemic began in the Central-West region of Brazil in 2014, spreading into the Southern region, with significant non-human primate transmission continuing towards Paraguay and Argentina. This report is an integrative review of Pan American Health Organization cooperation during a sylvatic yellow fever epidemic.  The Pan American Health Organization has played a central role in handling the yellow fever emergency, collaborating with the Ministry of Health and various research groups in supporting interventions of different response areas. The Pan American Health Organization's technical cooperation included: training and workshops to exchange experiences, carrying out technical cooperation in patient management and epidemiological, entomological, laboratory, and epizootic surveillance, organizing the assistance network, and acquiring strategic inputs. The Pan American Health Organization’s technical cooperation supported the Ministry of Health’s decision to adopt a single-dose vaccine and use fractional doses to support the vaccination needs of more than 39,000,000 people. The coronavirus disease 2019 pandemic contributed to the failure of reaching the yellow fever vaccination goals and made it difficult to integrate the yellow fever vaccine into recommended areas. Given the ongoing coronavirus disease 2019 pandemic, it is necessary to strengthen measures for the surveillance, prevention, and control of yellow fever with multilateral cooperation between countries. Brazil is currently experiencing its greatest sylvatic yellow fever (YF) epidemic ever, reaching a record number of cases  between 2016 and 2018. The epidemic is centered predominantly outside the Amazon region , and has reached more than 4 times the number of all cases over the previous 20 years. As YF is typically a multimodal epidemic, we consider the period from 2016-2018, after the epidemic began in the Central-West region of Brazil in 2014 and spread into the Southern region, to be part of the two or more waves marking the peak of an epidemicThis particular epidemic was marked by the persistent transmission of the virus in non-human primates (NHP), even in periods of low seasonality, which has subsequently affected areas previously considered to be without risk, such as the states of Rio de Janeiro and Espírito Santo, and the eastern portions of Bahia and São Paulo. This increase in the territory affected by the virus, along with an associated increase in the recommendation of anti-yellow fever vaccination, has increased vaccine demand by 30,000,000 doses. Currently, vaccination is being expanded to include the whole country. YF transmission has been so intense that there have been reports of cases originating in Brazil documented in France, the Netherlands, Romania, Switzerland, Argentina, and ChileAedes albopictus mosquitoes captured in the state of Minas Gerais. It is widely known that these insects are capable of bridging the gap between sylvatic and urban transmission, increasing the risk of YF re-urbanization,In addition to the known epidemic described above, the Evandro Chagas Institute of the Health Surveillance Secretariat of the Brazilian Ministry of Health detected the YF virus in In regards to the overlap of this YF epidemic with the ongoing coronavirus disease 2019 (COVID-19) pandemic, the present report aimed to present the strategies adopted by the Pan American Health Organization (PAHO) in order to improve the understanding of various types of international technical cooperation in health care. The present report entails an integrative review of the cooperative actions carried out by PAHO in coping with the YF epidemic from 2016 to 2020.The Ministry of Health (MoH), in compliance with the International Health Regulations (IHR), notified PAHO of known YF cases in January 2017. PAHO then issued an epidemiologic alert for all American countries, in accordance with the IHR, which has been found to be an effective instrument with which to start response activities in the event of a disease outbreak.in situ and providing of supportive interventions in different response areas, PAHO facilitated the dialogue of several health institutions, and contributed to the knowledge regarding YF transmission, as described in the post-event evaluation and control actions of YF in the state of Minas GeraisIn Brazil, PAHO has played a central role in the technical handling of the current YF emergency, collaborating with the MoH and MoH-partnered research groups in regards to the national response and preparation of other countries within the Americas that may be affected by this YF epidemic. Through the direct participation of their specialized teams The response to the ongoing YF epidemic has brought together the expertise of scientists from different disciplinary fields, involving clinical, epidemiological, virological, laboratory, and public policy aspects, forming a multidisciplinary and multi-institutional team. It is worth mentioning that the established research capacity in Brazil was decisive in ensuring a fast and accurate response. The participation of the Evandro Chagas Institute and the Oswaldo Cruz Foundation (Fiocruz), which are federal institutes whose missions are to produce, disseminate, and share knowledge and technology that contributes to bettering the health and the quality of life of the Brazilian population, was very important to the YF response. In addition to generating knowledge, Fiocruz is also responsible for producing immunobiological and diagnostic tests.Aedes aegypti in 1942. Historically, technical cooperation in the fight against YF was began with the inception of PAHO, which has addressed the disease since its creation in 1902, as the International Sanitary Bureau of the American Republics. The program was institutionalized at the first International Sanitary Convention of the American Republics in 1902, during which the vector-borne transmission of YF, a historically neglected theme, was discussed. PAHO is proud to have achieved the elimination of urban YF with the eradication of Honoring its mission “to promote equity in health, to combat disease, and to improve the quality of, and lengthen the lives of the peoples of the Americas”, PAHO has spared no efforts to tackle this epidemic, which has been supported by the Global Outbreak Alert and Response Network (GOARN).PAHO's technical cooperation occurred in several ways: training and workshops to exchange experiences; carrying out technical cooperation in the areas of patient management and epidemiological, entomological, laboratory, and epizootic disease surveillance; and organization of an assistance network. Equally important was the dissemination of knowledge with support for the creation of distance education courses, the publication of handbooks, the hiring of personnel for laboratory and field epidemiology activities, and the acquisition of strategic items, including dry ice, syringes, software licenses, vaccines, and supplies for molecular and histopathological diagnosis.PAHO also organized, for the first time on the American continent, a meeting for the Eliminate Yellow Fever Epidemics (EYE) strategy, including the World Health Organization (WHO), United Nations International Children’s Emergency Fund (UNICEF), and Global Alliance for Vaccines and Immunization (GAVI), with more than 130 partners. PAHO’s technical cooperation supported the decision of the MoH to adopt a single-dose vaccine, which had been recommended by the organization since 2013, and the use of fractional doses to support the vaccination needs of more than 39,000,000 people. The 7,648,772 fractional doses used provided savings of more than 6,000,000 doses. ,Professionals hired by PAHO, who then transferred to Brazilian National Laboratories, had significant findings of the YF virus in monkeys of the Callitrichidae family. Managerial support for decisions to expand the recommended vaccination area, adjust the vaccination schedule (adoption of a single dose), and adopt a campaign for fractional doses are also among the cooperative activities carried out by PAHO in Brazil during the current YF epidemic,It is worth emphasizing PAHO's participation in the genomic surveillance of YF, a decisive measure to direct Brazil’s response and reaction to national and international concerns about transmission dynamics, including the type of transmission cycle (sylvatic or urban), virus travel speed and origin, and level of introduction of the virus , etc. In this regard, it is also necessary to mention PAHO's support of the studies that culminated in the publications “Genomic and epidemiological monitoring of yellow fever virus transmission potential” and “Yellow fever virus reemergence and spread in Southeast Brazil, 2016-2019”The present technical report is necessary due to the weakening role of the World Health Organization (WHO) in the coordination of efforts against COVID-19, and the non-compliance of various nations to the IHR. These factors, along with the reduction of funding to WHO by powerful nations, have diminished both the spirit of solidarity between nations and the multilateral approach needed to respond adequately to the pandemicThe ongoing YF epidemic in Brazil continues to show a significant rate of transmission in the Central-West and Southern regions of Brazil, continuing towards Paraguay and Argentina. The COVID-19 pandemic has contributed to the failure of Brazil to meet the YF vaccination coverage goals, and has made it difficult to implement the YF vaccine in recommended areas. During the ongoing COVID-19 pandemic, it is necessary to strengthen measures for the surveillance, prevention, and control of YF, and multilateral cooperation between countries.


Autophagy is an evolutionarily conserved process that occurs in yeast, plants, and animals. Despite many years of research, some aspects of autophagy are still not fully explained. This mostly concerns the final stages of autophagy, which have not received as much interest from the scientific community as the initial stages of this process. The final stages of autophagy that we take into consideration in this review include the formation and degradation of the autophagic bodies as well as the efflux of metabolites from the vacuole to the cytoplasm. The autophagic bodies are formed through the fusion of an autophagosome and vacuole during macroautophagy and by vacuolar membrane invagination or protrusion during microautophagy. Then they are rapidly degraded by vacuolar lytic enzymes, and products of the degradation are reused. In this paper, we summarize the available information on the trafficking of the autophagosome towards the vacuole, the fusion of the autophagosome with the vacuole, the formation and decomposition of autophagic bodies inside the vacuole, and the efflux of metabolites to the cytoplasm. Special attention is given to the formation and degradation of autophagic bodies and metabolite salvage in plant cells. Autophagy, which literally means “self-eating”, plays a crucial role in the degradation of useless or damaged cell components such as macromolecules, protein complexes, and organelles. Autophagy also plays a role in the degradation of foreign elements for cells, such as bacteria, viruses or sperm residues after egg cell fertilization. It is a conserved process that occurs in a similar way in fungal, animal and plant cells. This process was first observed in the 1960s, and for decades it was thought to involve non-selective degradation of cellular elements ,3. HowevSome stages of autophagy are currently subject to intensive study, and our knowledge is gradually increasing. Areas of strong research interest include the initiation of autophagy, formation and elongation of the phagophore, and identification of the receptors and scaffold proteins involved in selective kinds of autophagy. However, despite many years of research, some aspects of autophagy are still not fully understood. Our knowledge about some stages of autophagy is poor, even fragmentary, and in addition, these stages are currently not of interest to many scientists. These include the final stages of autophagy, in particular, the degradation of autophagic bodies and the recovery of metabolites constituting the final products of autophagy. We specifically focus on the formation and degradation of autophagic bodies and metabolite salvage in plant cells and we compare this knowledge to data related to yeast.Macroautophagy is by far the best-studied and described type of autophagy. The first visible symptom of macroautophagy is the appearance in the cytoplasm of a cup-shaped structure, called the phagophore . The phaComponents of the cytoskeleton play an important role in the cytoplasmic transport of autophagosomes . It is aMagnaporthe oryzae, Pichia pastoris, Saccharomyces cerevisiae, and Schizosaccharomyces pombe [During the fusion of the autophagosome with the vacuole in yeast, the outer membrane of the autophagosome is connected and incarnated to the tonoplast, while the inner membrane together with the content becomes the autophagic body inside the vacuole  24,25,55,56. In es pombe ,63,64,65es pombe , syntaxies pombe , syntaxies pombe ,69,70, aes pombe ,71,72,73Arabidopsis mutants with T-DNA VTI12 insertion, growing in rich-nutrient conditions, presented a normal phenotype, whereas under nutrient-poor conditions accelerated aging was observed, confirming that VTI12 is involved in autophagy in plants [Arabidopsis and Populus and it participates in, among other processes, the formation of the wood conductive elements when programmed cell death occurs [In plants, the fusion of autophagosome and vacuole and the mechanisms regulating this process are poorly understood. So far, only the involvement of protein VTI12 has been confirmed in the fusion of autophagosome and vacuole in plants , Table 1n plants ,75,76,77n plants  or intran plants , VTI12 ih occurs ,81. The h occurs ,82. Moreh occurs . NeverthPichia pastoris and degradation of anthocyanin aggregates in Arabidopsis thaliana [The amount of data in the literature that describes the process of microautophagy in fungi, animals and plants, including its course, regulation mechanisms, and importance for the cell, is much smaller than the information on macroautophagy. During microautophagy, an autophagosome is not formed, but the tonoplast creates an invagination into which the cargo moves. The invagination of the tonoplast increases and the cargo is engulfed into the vacuole forming an autophagic body  83,84,8,884,85. thaliana ,87. Howethaliana   and proteinase B (Prb1) , Table 3Arabidopsis thaliana is likely to act similarly to yeast Pep4 by activating cascades of other hydrolases that are responsible for the hydrolysis of various structures found inside vacuoles, including the autophagic body  embryo axes during seed germination [The regulation of the whole autophagy process is an extensive topic, which has been intensively studied for several decades. In short, autophagy under normal conditions occurs at a low intensity; however, this process is clearly enhanced as a result of various types of abiotic and biotic stresses ,130,131.mination . Enhancemination ,138,139.mination , caused mination .Research on autophagy is currently being carried out in many research centers around the world and is the focus of interest for many research teams. The research on autophagy has two faces. On one hand, the initial stages of autophagy, selective types of autophagy and its significance in the etiology, course, and prevention of diseases is being studied intensively, while on the other hand, there are still many aspects of autophagy that are not popular among the scientific community. The events occurring in the final stages of autophagy have been explored only marginally and require a lot of research to be fully understood. Knowledge regarding the formation and, in particular, degradation of the autophagic body is sparse. Also, the efflux of metabolites from the vacuole to the cytoplasm is poorly investigated and understood. These stages of autophagy have not been intensively studied, indeed, they have been analyzed somewhat incidentally and are often written about using generalities and conjecture. Nevertheless, these latter stages are very important stages, because they complete the entire process of autophagy. Although autophagy has been known since the 1960s, and in the last two or three decades our knowledge on autophagy has increased dramatically, there are still many unanswered questions. For example, is the autophagic body degraded by nonspecific vacuolar lytic enzymes, or is the autophagic body degraded by some specific autophagy-related enzymes? Or do both of these enzymes participate in the degradation of the autophagic body? Another poorly understood stage of autophagy in plants is the transport of metabolites from the vacuole to the cytoplasm after autophagic body degradation. Also, in this case, there are other unanswered questions such as whether the constitutive vacuolar membrane transporters are involved in the transport of metabolites to the cytoplasm or whether some autophagy-related transporters are necessary for the metabolite salvage at the end of autophagy. It is also unknown whether, and how the spectrum and level of vacuolar lytic enzymes and membrane transporters change during enhanced autophagy occurring under different stresses, for example, during carbon or nitrogen starvation. In summary, so far, we have only discovered the tip of the iceberg and there remains much to be explored on the way to a full understanding of the whole process of autophagy.


Sensors. The context of the special issue theme is first briefly described. This is then followed by an outline of each paper that provides information on the problem addressed; the proposed solution/approach; and, where relevant, the results of the evaluation of the proposed solution.This editorial gives an overview of the papers included in the Special Issue on “Security, Privacy, and Trustworthiness of Sensor Networks and Internet of Things” of  The rapid developments in hardware, software, and communication technologies have facilitated the spread of interconnected sensors, actuators and heterogeneous devices. An example is single board computers, which collect and exchange a large amount of data for offering a new class of advanced services characterized by being available anywhere, at any time and for anyone. This ecosystem is widely referred to as the Internet of Things (IoT). In the past years, the number of deployments both for Sensor Networks (SN) and the IoT grew significantly. This continuous and exponential growth is facilitated by investments and research activities originating from industry, academia and governments, while the penetration of these technologies is also driven by the high technology acceptance rates of both consumers and technologists across disciplines. Such networks collect, store, and exchange a large volume of heterogeneous data. Nevertheless, their rapid and widespread deployment, along with their participation in the provisioning of potentially critical services , raise numerous issues related to the security, privacy, and trustworthiness of the performed operations and provided services. Accordingly, research into the security and privacy of the IoT and sensor networks is attracting increasing attention from both industry and academia. In line with these efforts, the central theme of this Special Issue is to investigate novel methodologies, theories, technologies, techniques, and solutions for IoT/SN security, trust and privacy. In particular, this Special Issue aims at addressing these topics across multiple abstraction levels, ranging from architectural models, the provisioning of services, protocols and interfaces, as well as specific implementation approaches.Fifteen papers have been published in this special issue. Brief presentations of these are given in the next section.In the first paper of the special issue , entitleIn , entitleIn , entitleIn , entitleIn , entitleIn , entitlePaper , entitlePaper , entitlePaper , entitlePaper , entitlePaper , entitlePaper , entitlePaper , entitlePaper , entitleThe last paper in the special issue , entitle


Childhood malnutrition of every form, including undernutrition , micronutrient deficiencies, as well as overweight and obesity, consists a triple burden of disease, especially for low- and middle-income countries, and is one of the leading causes of poor health and a major impediment to personal development and achievement of full human potential worldwide . GloballMalnutrition is a global public health problem that is associated with high health care cost, and increased morbidity and mortality . ApproxiWhile there has been some progress concerning the reduction of undernourished population from over one billion people in the 1990s to 793 million in 2015 , around At the same time, both in high-income and low- and middle-income countries, rates of childhood overweight and obesity are rising . In the The risk of morbidity and mortality in adult life increases among persons who are overweight or obese as children or adolescents ,26,27,30This Special Issue comprises of both research and review articles, which focus on diverse components of malnutrition among healthy and non-healthy population groups spanning high income and low- and middle-income contexts. Each of the papers provides the readers with a chance to examine a different aspect of childhood malnutrition and highlights the urgent need for design and implementation of the necessary actions and policies for its prevention and control.Readers are encouraged to explore these articles and consider the role of malnutrition as a risk factor in their own context. Every country in the world and every population group is affected by one or more forms of malnutrition ,4,29. Co


Wiktor Stein is considered one of the founders of Polish neurology after World War II Fig. . He creaWiktor Stein was born on November 28, 1899 in Lviv. His father, Maurycy Stein, was a doctor and a representative of the Jewish intelligentsia in Rohatyn (70 km from Lviv—south-eastern Poland before World War II), where during the second half of the nineteenth century the Jewish community comprised approximately 48% of the city’s total population [After returning to Poland and the nostrification of his medical diploma, he was again promoted, at the Jagiellonian University in Krakow on February 4, 1926. The same year he started working at the Lviv State Hospital. In the period between January 1, 1927 and March 31, 1938, he worked at the Department of Nervous Diseases of the Lviv Hospital. In 1935 he completed an internship at the Neurological Clinic in Paris, headed by Georges Charles Guillain (1876–1961). Also in that year he became the head of the Lviv Polyclinic, where he worked until the outbreak of World War II.In the years 1928–1936 he was the secretary of the Neurological and Psychiatric Society in Lviv, in the works of which he took an active part. During the Second World War he was in exile in Romania, where, as an outstanding violinist, he was a concertmaster in the Craiova Philharmonic Orchestra. After repatriation in 1946, he worked in Wroclaw as an assistant in the psychiatric clinic of the local University and as the head of the Neurological Department of the Provincial Hospital of Nervous Diseases. Two years later, he moved to Lublin, where he was entrusted with the management of the UMCS Neurological Clinic. He was nominated an associate professor in 1950 and a full professor in 1957. He held the position of head of the clinic until his retirement in 1970. In 1965 he became an honorary member of the French Neurological Society. His scientific achievements include over 40 works devoted to clinical matters. Wiktor Stein died on April 11, 1979.Stein was conducting research on neurological diseases before World War II. Working at the neurological clinic in Lviv, together with Goldschlag, he published works on Swift’s disease (dermato-polyneuritis)  and aftePublications from the 1950s and 1960s concerned research on changes in the cerebrospinal fluid in the course of tuberculous meningitis. Both pulmonary and non-pulmonary tuberculosis were huge epidemiological and clinical problems in post-war Poland. In his works, Stein used modern immunological methods; he studied the presence of specific antituberculin antibodies in the cerebrospinal fluid and considered the diagnostic value of these observations . His ownNumerous original papers included those devoted to circulatory disorders in the spinal cord, carotid insufficiency, and rehabilitation of patients with sciatica. The Iron Curtain dividing Europe from the late 1940s made it difficult to exchange scientific ideas between East and West. However, archives of the Medical University of Lublin contain numerous traces of correspondence between Stein and scientists from the USA, France, Israel, Spain, Belgium, Netherlands and Germany asking him for his publications which were unavailable in full version in the West. Such requests were directed to Stein by, among others, Alfred J. Crowle of the Colorado Foundation for Research on Tuberculosis and Julio H. Garcia of the Medical College of Virginia. These archival documents are proof of a vivid exchange of scientific thought between Stein and many Western research centers.Wiktor Stein was first and foremost a clinical neurologist, an excellent diagnostician, precise in clinical thinking. He was admired by colleagues and valued by patients. He combined the best traditions of Lviv neurological school, with a deep understanding of the need for rapid progress in neurology. The expression of the last was his constant and firm support for the development of neurosurgery. The ability of perspective vision and the correctness of assessing new phenomena was the result of the Professor's comprehensive, natural, humanistic and artistic mind.


The English Longitudinal Study of Ageing (ELSA) is a unique and rich resource of information on the health, social, wellbeing and economic circumstances of the English population aged 50 and older. The current sample contains data from up to nine waves of data collection covering a period of seventeen years (2002-2019). The multidisciplinary and longitudinal nature of the data allows the examination of complex relationships and causal processes. The survey data are designed to investigate a broad set of topics to help understand the ageing process. These include predictors of well-being, health trajectories, disability and healthy life expectancy, the determinants of economic position in older age, the links between socioeconomic status, physical health and functioning, cognition and mental health, the nature and timing of retirement and post-retirement labor market activity, household and family structure, social networks and social supports; patterns, determinants and consequences of social, civic and cultural participation.


An author name was incorrectly spelled as Mohammad Mirhakkak. The correct spelling is Mohammad Hassan Mirhakkak.Thomas Wolf was not included as an author in the published article. The corrected Author Contributions Statement appears below.TD and KT contributed to the conception and design of the work, data acquisition, data analysis, interpretation of the data, and drafting and revising the manuscript critically for intellectual content. M-LY and K-YY contributed to the conception and design of the work, data analysis, interpretation of the data, and revising the manuscript critically for intellectual content. GP contributed to the design of the work, data analysis, interpretation of the data, and revising the manuscript critically for intellectual content. SS, MM, W-LW, AN, CY, AL, TW, and K-HC contributed to the data analysis and interpretation of data, and revising the manuscript critically for intellectual content. All authors contributed to the article and approved the submitted version.The authors apologize for this error and state that this does not change the scientific conclusions of the article in any way. The original article has been updated.