Lens and solution properties in patients with and without midday fogging

INTRODUCTION

Midday fogging is a complication of scleral lens (SL) wear that interrupts clear vision during the course of wear. SLs can be made with a variety of gas permeable materials, sizes and surface treatments, and various solutions are available for storing the lenses and for filling them before application on the eye. Many of these factors have been implicated as possible contributors to midday fogging. This study explored the lens and solution properties in habitual SL wearers with and without midday fogging.

METHODS

In this prospective study, 48 habitual SL wearers were evaluated and asked to report whether they experienced midday fogging and if they removed their lenses during the day. They completed the Ocular Surface Disease Index (OSDI), which is a validated tool for dry eye assessment. Lens parameters (material, coatings and diameter) and lens storage and filling solutions were documented. Backward elimination of regression terms evaluated the lens and solution properties in those with and without fogging. OSDI scores were compared using the Mann-Whitney analysis.

RESULTS

Collectively, the lens properties and solutions accounted for 27.7% of the variance related to midday fogging. None of the factors alone had a significant impact upon midday fogging. The median (interquartile range) OSDI score for those with fogging [37 (35)] was significantly different from those without fogging [10 (15)], with the scores corresponding to severe dry eye and normal eyes, respectively.

CONCLUSION

SL wearers with midday fogging exhibited similar symptoms to patients with severe dry eye. Lens and solution characteristics may play a small role in patients with midday fogging, although changing just a single factor is not likely to impact its presence.

Peristomal skin care: seeking the solution to maintain skin integrity?

Francesca Ramadan reviews the mechanisms, benefits and limitations of the most common peristomal skin complication treatments, empowering stoma care practitioners to provide more effective and personalised solutions for their patients.

The Use of Big Data in Personalized Healthcare to Reduce Inventory Waste and Optimize Patient Treatment

Precision medicine is emerging as an integral component in delivering care in the health system leading to better diagnosis and optimizing the treatment of patients. This growth is due to the new technologies in the data science field that have led to the ability to model complex diseases. Precision medicine is based on genomics and omics facilities that provide information about molecular proteins and biomarkers that could lead to discoveries for the treatment of patients suffering from various diseases. However, the main problems related to precision medicine are the ability to analyze, interpret, and integrate data. Hence, there is a lack of smooth transition from conventional to precision medicine. Therefore, this work reviews the limitations and discusses the benefits of overcoming them if big data tools are utilized and merged with precision medicine. The results from this review indicate that most of the literature focuses on the challenges rather than providing flexible solutions to adapt big data to precision medicine. As a result, this paper adds to the literature by proposing potential technical, educational, and infrastructural solutions in big data for a better transition to precision medicine.

The Burden of Suboptimal Insulin Dosing in People with Diabetes in Spain: Barriers and Solutions from the Physician Perspective

Background

This study aimed to determine physicians' perceptions of the extent of suboptimal insulin dosing and the barriers and solutions to optimal dosing in people with diabetes (PwD) treated with insulin.

Methods

A cross-sectional online survey was conducted in four countries with primary care physicians and endocrinologists treating PwD using insulin pens, which included 53 questions on physicians' characteristics and their perceptions of the behaviors of PwD in relation to insulin dosing routines, unmet needs and potential solutions. Analyses were descriptive.

Results

Of the 160 physicians (80 primary care physicians, 80 specialists) surveyed in Spain, 58.1% were male and 88.8% had been qualified to practice for more than five years. Most physicians (>65%) indicated that 0-30% of PwD missed or skipped, mistimed, or miscalculated an insulin dose in the last 30 days. Common reasons for these actions were that PwD forgot, were out of their normal routine, were too busy or distracted, or were unsure of how much insulin to take. To optimize insulin dosing, over 75% of physicians considered it very helpful for PwD to have real-time insulin dosing calculation guidance, mobile app reminders, a device automatically recording glucose measurements and/or insulin, having insulin and glucose data in one place, and having the time for more meaningful conversations about insulin dosing routines.

Conclusion

According to physicians' perspectives, suboptimal insulin dosing remains common among PwD. This survey highlights the need for integrated and automated insulin dosing support to manage the complexity of insulin treatment, improve communications between PwD and physicians, and ultimately improve outcomes for PwD.

User needs and design features of sanitation digital solutions in Kawempe division, Kampala Uganda: a user centered design approach

Despite improvements in access to water and sanitation services globally, a significant population in Sub Saharan Africa has limited access to improved sanitation facilities. Furthermore, there is lack of a centralized digital platform for data exchange among stakeholders for sanitation services planning and provision in Uganda. A user centered design (UCD) approach was used to develop and pilot a one stop sanitation digital solutions (SaniDigS) center in Kawempe division, Kampala, Uganda. This involved three phases (1) understanding the sanitation status of the community which involved interviewing 1,844 household heads, (2) specifying the user needs of the proposed digital solution through stakeholder meetings and (3) Co designing of the innovations with potential users through stakeholder workshops. The quantitative data was visualized through the SaniDigS platform dashboard. The stakeholder meeting transcripts and notes were thematically analyzed to identify the user needs. The community user needs included an innovation that ensures confidentiality, is low cost and user friendly without internet connection. The service provider needed a sanitation digital solution that can market their sanitation products while, policy makers and planners needed comprehensive, real time data collection and sharing for trend analysis and informed decision making. The codesigned features of the SaniDigS informed by the user needs included: The SaniDigS Champion Application, SaniDigS platform dashboard, SaniDigS mobile application and the call center. The community in Kawempe showed need for subsidized sanitation products and we recommend further research to evaluate the effects of SaniDigS on planning, coordination, and access to sanitation services.

[Difficulties and Countermeasures for Ortho Process Optimization in DR System]

Making an Ortho image is an important method to diagnose spinal and leg lesions in clinic. As the whole process requires multiple exposures in different positions, and it is very complicated and time consuming, it leads to low efficiency and it's hard to obtain ideal stitching result from image quality. The optimization of the workflow can not only reduce the workload of the operator, improve the work efficiency, but also improve the comfort of the patient in the process, finally to ensure the quality of the stitching image. This paper firstly introduces the background and workflow of making an Ortho image. Then, each optimization solutions are elaborated, including the encountered difficulties and the countermeasures. It provides a detailed reference about how to realize the Ortho function in DR system.

Effect of a Novel sputtering process on the chemical and biological properties of silver-gold alloys

Silver-gold nanocrystalline films were sputtered on HDPE substrates by a physical vapour deposition process using alloys with a nominal composition of 65% silver/35% gold or 35% silver/65% gold by weight, with comparison to a 100% silver target. Novel process conditions were introduced to include both water and oxygen as reactive gases. X-ray diffraction and chemical digests were used to assess the structure and chemical composition of the films. Log reductions and corrected zone of inhibition tests were used to measure the biological properties. Despite a range of physical and chemical properties, biological tests showed that the bactericidal properties of all silver-gold films were comparable with silver-only films in the short term and 65% silver films made with Novel sputtering conditions had comparable bacteriostatic abilities to silver-only over a 7-day period. The benefit of including gold may be seen in future studies of anti-inflammatory activity.

Exploring locally developed ELT materials in the context of curriculum-based value education in China: challenges and solutions

The development of locally developed English language teaching (ELT) materials is believed to be conducive to meeting the requirements of local language education policies and practices, and to enhance learners' agency. In China, in order to implement national educational policy of curriculum-based value education, many locally developed ELT materials have been recently developed. However, there is a paucity of empirical research concerning the actual effects of such materials in practice. This study presents an empirical study of a recently developed set of teaching materials in the context of curriculum-based value education by adopting an approach consisting of questionnaires and interviews to examine the attitudes and experiences of users of these materials. The findings revealed a range of challenges in the use of these materials, including issues related to language and content of the materials, the integration of ideological and value elements, and the development of multi-dimensional teaching materials. The article then proposes possible solutions from the perspectives of optimizing the writing community, carefully selecting teaching materials, innovating the integration of ideological and political elements, and improving the development of multi-dimensional teaching materials. A framework for the evaluation of locally developed ELT materials is also proposed, with the intention of offering a useful benchmark for enhancing the development of such materials.

Periodontal Guided Tissue Regeneration Membranes: Limitations and Possible Solutions for the Bottleneck Analysis

Guided tissue regeneration (GTR) is an important surgical method for periodontal regeneration. By placing barrier membrane on the root surface of the tooth to guide the adhesion and proliferation of periodontal ligament cells, periodontal tissue regeneration can be achieved. This review intends to analyze the current limitations of GTR membranes and to propose possible solutions for developing new ones. Limitations of current GTR membranes include nonabsorbable membranes and absorbable synthetic polymer membranes exhibit weak biocompatibility; when applying to a large defect wound, the natural collagen membrane with fast degradation rate have limited mechanical strength, and the barrier function may not be maintained well. Although the degradation time can be prolonged after cross-linking, it may cause foreign body reaction and affect tissue integration; The clinical operation of current barrier membranes is inconvenient. In addition, most of the barrier membranes lack bioactivity and will not actively promote periodontal tissue regeneration. Possible solutions include using electrospinning (ELS) techniques, nanofiber scaffolds, or developing functional gradient membranes to improve their biocompatibility; adding Mg, Zn, and/or other metal alloys, or using 3D printing technology to improve their mechanical strength; increasing the concentration of nanoparticles or using directional arrangement of membrane fibers to control the fiber diameter and porosity of the membrane, which can improve their barrier function; mixing natural and synthetic polymers as well as other biomaterials with different degradation rates in proportion to change the degradation rate and maintain barrier function; to improve the convenience of clinical operation, barrier membranes that meets personalized adhesion to the wound defect can be manufactured; developing local controlled release drug delivery systems to improve their bioactivity. Impact statement This review provides an up-to-date summary of commonly commercial periodontal guided tissue regeneration membranes, and analyze their limitations in clinical use. Using studies published recently to explore possible solutions from several perspectives and to raise possible strategies in the future. Several strategies have tested in vivo/in vitro, which will guide the way to propel clinical translation, meeting clinical needs.

Overcoming ethical and legal obstacles to data linkage in health research: stakeholder perspectives

Introduction

Data linkage for health research purposes enables the answering of countless new research questions, is said to be cost effective and less intrusive than other means of data collection. Nevertheless, health researchers are currently dealing with a complicated, fragmented, and inconsistent regulatory landscape with regard to the processing of data, and progress in health research is hindered.

Aim

We designed a qualitative study to assess what different stakeholders perceive as ethical and legal obstacles to data linkage for health research purposes, and how these obstacles could be overcome.

Methods

Two focus groups and eighteen semi-structured in-depth interviews were held to collect opinions and insights of various stakeholders. An inductive thematic analysis approach was used to identify overarching themes.

Results

This study showed that the ambiguity regarding the 'correct' interpretation of the law, the fragmentation of policies governing the processing of personal health data, and the demandingness of legal requirements are experienced as causes for the impediment of data linkage for research purposes by the participating stakeholders. To remove or reduce these obstacles authoritative interpretations of the laws and regulations governing data linkage should be issued. The participants furthermore encouraged the harmonisation of data linkage policies, as well as promoting trust and transparency and the enhancement of technical and organisational measures. Lastly, there is a demand for legislative and regulatory modifications amongst the participants.

Conclusions

To overcome the obstacles in data linkage for scientific research purposes, perhaps we should shift the focus from adapting the current laws and regulations governing data linkage, or even designing completely new laws, towards creating a more thorough understanding of the law and making better use of the flexibilities within the existing legislation. Important steps in achieving this shift could be clarification of the legal provisions governing data linkage by issuing authoritative interpretations, as well as the strengthening of ethical-legal oversight bodies.

Healthcare professionals' perceived challenges and solutions when providing rehabilitation to persons living with dementia-A scoping review

AIM

This review aimed to map studies related to healthcare professionals' perceptions and attitudes towards the rehabilitation for persons living with dementia and extract what they perceive are the barriers and solutions.

BACKGROUND

Rehabilitation can improve the quality of life and integration of persons living with dementia into society. However, there are several barriers to accessing rehabilitation services. Healthcare professionals are a source of information to understand the challenges and provide solutions to improve these services.

DESIGN

Arksey and O' Malley (International Journal of Social Research Methodology, 8, 2005 and 19) five-step framework for scoping reviews and the PRISMA-ScR checklist was used. The PAGER (Patterns, Advances, Gaps, Evidence for practice and Research recommendations) framework was used to identify research and practice recommendations.

METHOD

Seven databases including Medline Complete, Academic Search Ultimate, Ageline, CINAHL, PsycInfo, Pubmed and Google Scholar were searched. The healthcare professionals' perceived challenges and solutions were categorised using Braun & Clarke (Qualitative Research in Psychology, 3, 2006 and 77) thematic analysis.

RESULTS

Fifteen articles were selected for review. The challenges and solutions were organised according to their association with three stakeholders; the persons living with dementia/informal caregivers, healthcare professionals and the organisation providing the service. Nine of the studies focused on persons living with dementia following a fall or a hip fracture. Most of the studies focused on the perceptions of allied healthcare professionals, with nurses working in rehabilitation settings being underrepresented.

CONCLUSION

Healthcare professionals have to consider the complexity of rehabilitating persons living with dementia irrespective of the rehabilitation speciality. Moreover, more studies are needed that focus on the views of rehabilitation nurses.

RELEVANCE TO CLINICAL PRACTICE

This review provides further evidence of the healthcare professionals' misconceptions about the rehabilitation potential of persons living with dementia. There is a need to educate healthcare professionals about the societal, attitudinal and environmental barriers faced by persons living with dementia and their caregivers.

PATIENT CONTRIBUTION

No Patient or Public Contribution-scoping review.

A narrative review of exercise participation among adults with prediabetes or type 2 diabetes: barriers and solutions

Type 2 diabetes (T2D) has been rising in prevalence over the past few decades in the US and worldwide. T2D contributes to significant morbidity and premature mortality, primarily due to cardiovascular disease (CVD). Exercise is a major cornerstone of therapy for T2D as a result of its positive effects on glycemic control, blood pressure, weight loss and cardiovascular risk as well as other measures of health. However, studies show that a majority of people with T2D do not exercise regularly. The reasons given as to why exercise goals are not met are varied and include physiological, psychological, social, cultural and environmental barriers to exercise. One potential cause of inactivity in people with T2D is impaired cardiorespiratory fitness, even in the absence of clinically evident complications. The exercise impairment, although present in both sexes, is greater in women than men with T2D. Women with T2D also experience greater perceived exertion with exercise than their counterparts without diabetes. These physiological barriers are in addition to constructed societal barriers including cultural expectations of bearing the burden of childrearing for women and in some cultures, having limited access to exercise because of additional cultural expectations. People at risk for and with diabetes more commonly experience unfavorable social determinants of health (SDOH) than people without diabetes, represented by neighborhood deprivation. Neighborhood deprivation measures lack of resources in an area influencing socioeconomic status including many SDOH such as income, housing conditions, living environment, education and employment. Higher indices of neighborhood deprivation have been associated with increased risk of all-cause, cardiovascular and cancer related mortality. Unfavorable SDOH is also associated with obesity and lower levels of physical activity. Ideally regular physical activity should be incorporated into all communities as part of a productive and healthy lifestyle. One potential solution to improve access to physical activity is designing and building environments with increased walkability, greenspace and safe recreational areas. Other potential solutions include the use of continuous glucose monitors as real-time feedback tools aimed to increase motivation for physical activity, counseling aimed at improving self-efficacy towards exercise and even acquiring a dog to increase walking time. In this narrative review, we aim to examine some traditional and novel barriers to exercise, as well as present evidence on novel interventions or solutions to overcome barriers to increase exercise and physical activity in all people with prediabetes and T2D.

Challenges and Suggested Solutions for Functional Neurosurgery Practitioners and Patients in Saudi Arabia: Cross-Sectional Study

INTRODUCTION

 This cross-sectional study aimed to investigate the challenges encountered by functional neurosurgery practitioners in Saudi Arabia and identify potential solutions to address these challenges. Beyond identifying these challenges, the study explicitly aims to propose viable solutions that can alleviate the observed concerns.

METHODS

 A cross-sectional survey was conducted among full practicing functional neurosurgery practitioners practicing in Saudi Arabia between January 2022 and March 2023. A total of 412 functional neurosurgery practitioners from all regions participated in the study. Additionally, a survey was conducted among 1045 patients who underwent functional neurosurgery in Saudi Arabia during the study period. The questionnaire included questions on the challenges faced by functional neurosurgery practitioners and patients in Saudi Arabia, as well as potential solutions to address these challenges. Furthermore, a literature review was conducted to identify previous research on this topic.

RESULTS

The study found that practitioners faced significant challenges related to a lack of specialized training programs, inadequate funding, and limited access to advanced technology and equipment. Specifically, 37.9% of practitioners reported that limited access to advanced technology and equipment limited the types of procedures they could perform, while 28.6% reported that it increased the risk of complications. The shortage of qualified staff (34.7%) and lack of standardized protocols (39.6%) were also identified as barriers to successful practice. On the patient side, challenges included limited access to information and support (not specified), inadequate communication with practitioners, and financial burden.  Discussion: The findings of this study suggest that improving the quality of functional neurosurgery in Saudi Arabia requires addressing these challenges. Several potential solutions were proposed, including the establishment of specialized training programs, increased funding for research and equipment, and the development of standardized protocols and regulations to enhance the quality of care. Additionally, improving patient education, communication, and support can enhance patient outcomes and satisfaction. Promoting international collaborations and partnerships with experienced centers and neurosurgeons can further improve the practice of functional neurosurgery in Saudi Arabia.

CONCLUSION

The study identified significant challenges faced by functional neurosurgery practitioners and patients in Saudi Arabia and proposed several potential solutions to address these challenges. These findings can serve as a starting point for improving the practice of functional neurosurgery in Saudi Arabia, ultimately leading to improved patient outcomes and quality of life. Further research is needed to assess the effectiveness of these proposed solutions in addressing the challenges faced by functional neurosurgery practitioners and patients in Saudi Arabia.

Solutions discourse in disaster displacement: implications for policy and practice

Displacement in the context of disasters and climate change has gained considerable attention in international policy processes pertaining to migration and displacement over the past few years. However, analysis of currently dominant understandings of disaster displacement and its solutions at the global level, and how these translate into practice in relation to operational realities at the national level, remains scarce. This paper seeks to promote greater reflections on the discourse of displacement solutions in the context of disasters and climate change. It examines both the advancements and remaining gaps in approaches to disasters, displacement, and solutions and how these collectively shape the conceptualisation of solutions to disaster displacement. The inquiry sheds light on the dominant framings and their underlying assumptions and highlights the implications that they entail for understanding and responding to disaster displacement. It also underscores the importance of critical engagement with discursive practices at the international and national level.

Achieving Digital Health Equity by Personalizing the Patient Experience

Background

COVID saw a significant increase in the use of virtual care, supporting its utility and its benefits. It also revealed that unfortunately there are limitations and gaps we still need to address, including inequitable access to digitally enabled health care tools.

Methods

On November 8, 2022, the Mass General Brigham held the Third Annual Virtual Care Symposium: Demystifying Clinical Appropriateness in Virtual Care and What's Ahead for Pay Parity. One panel addressed digital health equity and key points are summarized here.

Results

Four experts discussed the key domains of digital equity and inclusion in the session titled "Achieving Digital Health Equity: Is it a One-Size-Fits-All Approach or Personalized Patient Experience?" These included lessons from strategies and tactics being used by hospitals and health systems to address digital equity issues; and opportunities to achieve digital health equity for specific populations (e.g., Medicaid).

Conclusions

Understanding the drivers of digital health disparities can help organizations and health care systems develop and test strategies to reduce them and improve access to quality health care through digitally enabled technologies and delivery channels.

Collecting touch DNA from glass surfaces using different sampling solutions and volumes: Immediate and storage effects on genetic STR analysis

Touch DNA has become increasingly important evidence in todays' forensic casework. However, due to its invisible nature and typically minute amounts of DNA, the collection of biological material from touched objects remains a particular challenge that underscores the importance of the best collection methods for maximum recovery efficiency. So far, swabs moistened with water are often utilized in forensic crime scene investigations for touch DNA sampling, even though an aqueous solution provokes osmosis, endangering the cell's integrity. The aim of the research presented here was to systematically determine whether DNA recovery from touched glass items can be significantly increased by varying swabbing solutions and volumes compared with water-moistened swabs and dry swabbing. A second objective was to investigate the possible effects of storage of swab solutions prior to genetic analysis on DNA yield and profile quality when stored for 3 and 12 months, as is often the case with crime scene samples. Overall, the results indicate that adapting volumes of the sampling solutions had no significant effect on DNA yield, while the detergent-based solutions performed better than water and dry removal, with the SDS reagent yielding statistically significant results. Further, stored samples showed an increase in degradation indices for all solutions tested, but no deterioration in DNA content and profile quality, allowing for unrestricted processing of touch DNA samples stored for at least 12 months. One further finding was a strong intraindividual change in DNA amounts observed over the 23 deposition days which may be related to the donor's menstrual cycle.

Effect of calcium hypochlorite and sodium thiosulfate on the bond strength to pulp chamber dentin: A laboratory investigation

This study aimed to compare the effect of sodium hypochlorite (NaOCl) and calcium hypochlorite [Ca(OCl)₂ ] on the bond strength to pulp chamber dentin when followed or not by the use of sodium thiosulfate (Na₂ S₂ O₃ ). The pulp chamber of fifty human molars were divided into five groups (n = 10) according to the immersion protocol: 2.5% NaOCl; 2.5% NaOCl + 5% Na₂ S₂ O₃ ; 2.5% Ca(OCl)₂ ; 2.5% Ca(OCl)₂ + 5% Na₂ S₂ O₃ ; and 0.9% sodium chloride (NaCl; control). Subsequently, the samples were restored with resin composite. Three sticks each were obtained and subjected to microtensile testing. SEM/EDS analyses of the pulp chamber roof (n = 8) were carried out for mineral quantification. Elemental analysis data were investigated via one-way ANOVA and Tukey's post hoc, and bond strength data by post hoc pairwise comparisons using the Kruskal-Wallis test. Use of 2.5% NaOCl was associated with the lowest value of bond strength, while 2.5% Ca(OCl)₂ had similar bond strength to that of the 0.9% NaCl control. Using 5% Na₂ S₂ O₃ was able to increase the bond strength after 2.5% NaOCl, but not after 2.5% Ca(OCl)₂ . The group treated only with 2.5% Ca(OCl)₂ had a higher Ca/P ratio on the dentin surface. Dentin treated with Ca(OCl)₂ was not affected by Na₂ S₂ O₃ and showed bond strength similar to the 0.9% NaCl.

Challenges in the Sustainability of Brachytherapy Service in Contemporary Radiotherapy

Brachytherapy has a long history of delivering a highly conformal radiation dose to the target volume with sparing of adjacent normal tissue and has an irreplaceable role in certain cancers, such as cervical and prostate cancers. There have been futile attempts to replace brachytherapy with other radiation techniques. Despite that there are multifaceted challenges in preserving this dying art, from establishment, to a trained workforce, to maintenance of the equipment and source replacement costs. Here we focus on the challenges to access brachytherapy, the availability and distribution of care across the globe and appropriate training leading to proper implementation of the procedure. Brachytherapy holds a significant place in the treatment armamentarium of most common cancers, such as cervical, prostate, head and neck and skin cancers. However, there is an uneven distribution of brachytherapy facilities, not only across the globe, but also at a national level, with a larger proportion of facilities concentrated in certain regions, more so in low and low-middle income countries. The regions with the highest incidence of cervical cancer have the least access to brachytherapy facilities. Attempts to bridge the gap are essential and should be focused on uniform distribution and access to care, improving training of the workforce through specialised training programmes, reducing the cost of care, planning to reduce the recurring cost, generating evidence and research guidelines, renewing interest in brachytherapy through rebranding, use of social media and building an attainable long-term roadmap.

Identifying the Needs of Older Adults Associated with Daily Activities: A Qualitative Study

INTRODUCTION

By 2050, older adults will constitute 16% of the world population; hence, there is an urgent demand and challenge to design solutions (products and services) that meet the needs of this age group. This study sought to analyse the needs that impact the well-being of Chilean older adults and present possible solutions through the design of products.

METHODOLOGY

A qualitative study was used, where focus groups were held with older adults, industrial designers, health professionals, and entrepreneurs on the needs and design of solutions for older adults.

RESULTS

A general map was obtained that linked the categories and subcategories related to the relevant needs and solutions, which were then classified in a framework.

CONCLUSIONS

The resulting proposal places the needs in different fields of expertise; and thus, enables positioning, broadening, and expanding upon the map to share knowledge, between the user and key experts, to co-create solutions.

Unveiling and addressing implementation barriers of vaccination communication strategy: Perspectives from government officials at national and provincial levels

Communication strategy is one of the support of primary health care (PHC) that can address demand-side barriers and socio-cultural factors to promote better services. Conversely, communication strategies have not been a distinct emphasis of vaccination research in the country until now. Therefore, this study aimed to find the elements that influence the provision of vaccination communication in Pakistan. Twenty-two semi-structured interviews with key stakeholders in vaccine communication were conducted using qualitative methodologies (Jan 2022-March 2022). The interviews revolved around factors affecting the implementation of communication. Interviews were transcribed and analyzed using thematic analysis. By using the SURE framework, numerous factors that affect vaccination communication were identified under three major themes such as organizational-level, constitutional, and community-level factors. Five subthemes marked the organizational-level factors such as constrained budget, infrastructure deficits, inconsistent comprehensive strategy, health workforce, and inadequate training. Two subthemes are derived regarding constitutional and community-level factors, respectively, such as governance and leadership, health communication interventions not a policymaker's priority, community perceptions and practices, and formal partnership lacking between national and local stakeholders. Additionally, employment of established communication committees, improved money allocation, engagement of traditional and religious institutions, and political backing were identified as solutions for improvement. Communication activities are an important part of immunization programs in order to increase vaccination coverage. To be able to execute communication interventions more successfully, national and provincial stakeholders must work together to identify the elements that affect vaccine provision. Additional rigorous implementation studies could aid in the development of clearer knowledge of the system-wide constraints obstructing the program's efficiency.

[The inopportune repatriation of ship crew members as a threat to mental health disorders]

In case of illness or injury of ship crew member during entire stay on board of the ship and until the end of repatriation, the shipowner is responsible for paying wages in full size and pays all expenses on medical care and arrival at final destination. Due to effect of external and internal factors, mental health of crew members became one of actual modern problems. The article considers main provisions of labor and collective agreement of crew member, determines responsibilities of shipowner for organizing repatriation and appropriate actions when its terms are increased, identifies problematic aspects of disorders of mental health of seaman on board the ship and substantiates possible solutions of modern problems.

Patient-Identified Solutions to Primary Care Access Barriers in Canada: The Viewpoints of Nepalese Immigrant Community Members

BACKGROUND

Accessing healthcare for immigrants in Canada is complicated by many difficulties. With the continued and upward trend of immigration to Canada, it is crucial to identify the solutions to the barriers from the perspectives of different immigrant communities as they encounter them including the relatively smaller and less studied population groups of immigrants. As such, Nepalese immigrants in Canada are a South Asian ethnic group who have their own distinct language, culture, and socio-economic backgrounds, however, their experience with accessing healthcare in Canada is scarce in the literature.

METHODS

We conducted 12 focus group discussions with first-generation Nepalese immigrants who had experiences with primary care use in Canada. Informed consent and demographic information were obtained before each focus group discussion. The verbatim transcription of the focus groups was analyzed using thematic analysis.

RESULTS

The participants expressed a range of potential solutions to overcome the barriers, which we presented using the socio-ecological framework into 4 different levels. This includes individual-, community-, service provider-, and government/policy-levels. Individual-level actions included improving self-awareness and knowledge of health in general and navigating the healthcare system and proactively improving the language skills and assimilating into the Canadian culture. Examples of community-level actions included community events to share health information with immigrants, health literacy programs, and driving/carpooling to clinics or hospitals. Actions at the service provider level were mainly focused on enhancing communications, cultural competency training for providers, and ensuring to hire primary care workforce representing various ethnocultural backgrounds. Overall, focus group participants believed that the provincial and federal government, as appropriate, should increase support for dental and vision care support and take actions to increase the healthcare capacity, particularly by employing internationally graduated health professionals.

CONCLUSIONS

Access to primary care is essential for the health of immigrant populations in Canada. Individuals, community organizations, health service providers, and governments need to work both individually and collaboratively to improve immigrants' primary care access.

BioMThermDB 1.0: Thermophysical Database of Proteins in Solutions

We present here a freely available web-based database, called BioMThermDB 1.0, of thermophysical and dynamic properties of various proteins and their aqueous solutions. It contains the hydrodynamic radius, electrophoretic mobility, zeta potential, self-diffusion coefficient, solution viscosity, and cloud-point temperature, as well as the conditions for those determinations and details of the experimental method. It can facilitate the meta-analysis and visualization of data, can enable comparisons, and may be useful for comparing theoretical model predictions with experiments.

Nasal irrigation with various solutions for adults with allergic rhinitis: A protocol for systematic review and meta-analysis of randomized controlled trials

BACKGROUND

Nasal douching or irrigation has been recommended for adjunctive therapy of sinonasal diseases including allergic rhinitis (AR) for many years. Previous study reported large-volume high-pressure device as an effective standard application, but the solutions was remains controversy. This study systematically review the clinical efficacy of nasal irrigation with various solutions for adults with AR from medical literature.

METHODS

This research systematically asses clinical trial about nasal irrigation with various solutions for adults with AR from medical literature. The sources were PubMed, ProQuest, Scopus, Cochrane Register of Controlled Trials databases, and gray literature from google scholar and RAMA repository limited to English and Bahasa Indonesia language articles, published from January 2017 to July 2022. Only randomized controlled trials involving the human subjects studies will be included. The inclusion criteria research must be related to nasal irrigation for AR, and should be full texted available. Literature management, screening, data extraction will use Rayyan.ai tools. The quality assessment of qualified paper and risk of bias will be assessing independent conducted by 2 reviewer with risk of bias 2. We will use Review Manager (RevMan) [Computer program] Version 5.4. The Cochrane Collaboration, 2020 tools to produce the systematic review and meta-analysis.

RESULTS

After completion of the study process, the data analysis and review will be reported. The results will be publicized through a peer-review journal publication.

CONCLUSION

The results of the systematic review will summarize the efficacy of various nasal irrigation for adults with AR, so it can be used as clinician recommendation.

Risk-benefit perceptions, preferences for solutions, and gaining trust: Listening to New Jersey's Atlantic Ocean port communities

We designed a survey to measure public preferences for management actions at ports that would reduce negative risk perceptions, increase competence-based trust, and overall provide port managers with opportunities to build communication channels with surrounding populations. A total of 511 people who lived in a 45-square mile area of New Jersey containing over 300,000 people and a dozen large and small ports responded to solutions that offered independent science support, provided ongoing public health surveillance, and economic assistance for local communities. Environmental health concerns about air, noise, fires, port security, and protection against climate-related impacts were major correlates of these preferences. Yet many residents recognized economic benefits associated with nearby ports and many either trusted port management or were neutral and felt not well informed. Those who had a personal or family connection to the port were stronger port supporters. The most important finding and challenge for port managers is building ongoing relationships with the majority of nearby residents who are not aware of port activities, which presents an opportunity for increasing trust through proactive outreach and listening to nearby community representatives.

Home dialysis in older adults: challenges and solutions

There is a rising demand for dialysis in the older population given the increased numbers of older adults living with chronic kidney disease (CKD) progressing to kidney failure. Home dialysis, i.e. peritoneal dialysis (PD) and home hemodialysis (HHD), has been available for decades, but more recently there has been a rapid increase in home dialysis utilization as patients and clinicians consider its practical and clinical advantages. For older adults, incident home dialysis utilization more than doubled and prevalent home dialysis growth nearly doubled over the past decade. Whilst its advantages and recent rise in popularity are evident, there are numerous barriers and challenges that are important to consider prior to initiating older adults on home dialysis. Some nephrology healthcare professionals do not view home dialysis as an option for older adults. Successful delivery of home dialysis for older adults may be made even more difficult by physical or cognitive limitations, concerns around dialysis adequacy, and treatment-related complications, as well as challenges relating to caregiver burnout and patient frailty that are unique to home dialysis and older adults. Ultimately, it would be important for clinicians, patients and their caregivers to define what constitutes a 'successful therapy' to ensure treatment goals are aligned towards each individual's priorities of care, considering the complex challenges that surround an older adult receiving home dialysis. In this review, we evaluate some of the key challenges surrounding the delivery of home dialysis to older adults and propose potential solutions based on updated evidence to overcome these challenges.

Male Farmers' Perspectives on Psychological Wellbeing Self-Management Strategies That Work for Them and How Barriers to Seeking Professional Mental Health Assistance Could Be Overcome

This research aimed to explore the self-management strategies that Australian male farmers use to improve or maintain their psychological wellbeing and their views on what would assist them to overcome barriers to seeking professional mental health assistance. Individual semi-structured telephone interviews were audio-recorded with consent. Qualitative data were analysed inductively using thematic analysis. Fifteen male farmers participated, who were an average of thirty-nine years of age (23-74 years) with twenty years of farming experience (5-57 years). Seven themes relating to self-management strategies were identified: (1) interacting with a supportive network; (2) involvement in groups and teams; (3) physical activity; (4) proactively educating themselves; (5) self-prioritising and deliberately maintaining work-life balance; (6) being grateful; and (7) focusing on the controllable aspects of farming. Five themes were identified that related to mitigating barriers to seeking mental health assistance: (1) actively welcoming mental health professionals into the community; (2) normalising help-seeking; (3) making seeking mental health assistance a priority; (4) offering services that are culturally appropriate and accessible for male farmers; and (5) tailoring mental health information delivery to farming populations. Australian male farmers already use strategies to maintain and improve their mental health that are culturally and contextually appropriate. These proactive strategies could form the basis of interventions aiming to further promote male farmers' wellbeing. Barriers to seeking professional mental health assistance may be overcome by implementing solutions directly suggested by male farmers. Given the elevated risk of suicide in this group, investment in trialing promotion of these strategies is warranted.

Seeding hope: restoring nature to restore ourselves. Nature restoration as an essential mental health intervention

This commentary offers stories of hope and regeneration in the face of the interconnected crises we face. Those of us in the health sector have the opportunity to undo the false separation that has arisen between the care we offer ourselves and the care we offer our natural spaces. Access to a healthy environment offers myriad health benefits and has been declared a human right. Beyond this, cultivating a sense of kinship with the natural world unlocks further mental health benefits and promotes a deep sense of meaning and vitality. Widespread restoration of nature, combined with the equitable reconnection of people to these restored environments, must become one of the most important aspects of public health in this century. This paper, written from a UK perspective, describes examples where people are already weaving these strands together and offers practical suggestions for healthcare professionals who want to know how this relates to their role and their everyday practice.

Identifying the Challenges of Simulating the Hospital Emergency Department in the Event of Emergencies and Providing Effective Solutions: A Qualitative Study

INTRODUCTION

Emergencies and disasters occur in any society, and it is the hospitals and their emergency department staff who must be prepared in such cases. Therefore, 1 of the effective methods of training medical care staff is the use of simulators. However, when introducing new simulation approaches, we face many challenges. The aim of this study was to identify challenges of the simulation of the hospital emergency department during disasters and provide effective solutions.

METHODS

This conventional content, thematic, analysis study was conducted in 2021. Participants were selected from Iranian experts using purposeful and snowball sampling methods. Data were collected using semi-structured interviews and were analyzed by the content analysis.

RESULTS

After analyzing the data, the challenges of simulating the hospital emergency department during disasters were identified in 2 main components and 6 perspectives, which included organizational components (inappropriate and aimless training methods, lack of interaction and cooperation, lack of funding, and inadequate physical space) and technological components (weak information management and lack of interdisciplinary cooperation). Solutions included management (resource support) and data sharing and exchange (infrastructures, cooperation and coordination).

CONCLUSION

The simulation technology can be used as a method for training and improving the quality of health care services in emergencies. Considering that most of these challenges can be solved and need the full support of managers and policy makers, by examining these issues, supporting staff of health care centers are advised to make a significant contribution to the advancement of education and problem reduction in the event of disasters.

"I Thought It Was Normal:" Perspectives of Black Nursing Students From High-Risk IPV Communities on Causes and Solutions to IPV in the Black Community

Black individuals are at high risk for intimate partner violence (IPV) but are less likely to utilize existing IPV services and supports. In an effort toward developing more culturally responsive IPV solutions for the Black community, researchers set out to understand how residents of high-risk IPV communities explained the high rates of IPV in their community, and what they thought possible solutions would entail. A purposive sample of 22 Black nursing students (20 female, 2 male) from a high-IPV risk predominately Black community in Western New York who were students enrolled in a Licensed Practitioner Nursing (LPN) program attended four focus groups that utilized a semi-structured interview format. Their verbatim responses were analyzed using qualitative inductive thematic analysis. Participants identified five major causes of IPV in Black communities: (a) weakened family structure, (b) IPV is normalized (c) community lacks IPV knowledge, (d) mistrust of formal resources, and (e) mental health. They also identified 10 solutions to IPV in Black communities: (a) counseling, (b) peer support groups, (c) use of technology, (d) resources to create self-sufficiency, (e) education, (f) culturally specific resources, (g) reduce stigma, (h) public service announcements, (i) substance abuse treatment, and (j) IPV screenings. Research and clinical implications of the research are discussed, including how these might inform the creation of culturally responsive interventions.

Public-private partnership in Iranian hospitals: Challenges and opportunities

BACKGROUND

Nowadays, various strategies are applied by governments to control costs and finance hospitals and the health sector. Public-private partnership (PPP) option is one of these strategies. Considering the growing importance of hospitals in different communities and their problems, this study aimed to identify PPP challenges, opportunities and solutions in hospitals. This study aimed to identify the challenges and opportunities of PPP in the country's hospitals and then offered an appropriate solution to overcome these challenges.

MATERIALS AND METHODS

This is a qualitative study and content analysis approach is undertaken. The participants were selected through purposive sampling and data were collected using a semi-structured interview with experts in the public and private health sector until the saturation point achieved. Data analysis was performed through the thematic analysis of expert's statements using MAXQDA. 10 software in this sector.

RESULTS

According to the study results, 3 main themes (challenges, opportunities, and solutions), 10 sub-themes, and 32 codes were identified in relation to the public and private partnership. 4 sub-themes on challenges of PPP, 3 sub-themes on partnership opportunities and 3 sub-themes on challenges solutions were identified.

CONCLUSION

The results of this study revealed that given the discussed challenges the most important challenge seems to be not evaluated outsourcings, incorrect usage of participatory models, and inadequate and inappropriate postoutsourcing supervision, however, it appears evaluated outsourcing backed with adequate supervision could solve many current hospitals' problems.

A framework for educating and empowering students by teaching about history and consequences of bias in STEM

Racism and bias are pervasive in society—and science, technology, engineering, and mathematics (STEM) fields are not immune to these issues. It is imperative that we educate ourselves and our students about the history and consequences of this bias in STEM, investigate the research showing bias toward marginalized groups, understand how to interpret misuses of science in perpetuating bias, and identify advances and solutions to overcome racism and bias throughout our professional and personal lives. Here, we present one model for teaching a universal course for participants of all professional stages to address these issues and initiate solutions. As very few institutions require students to enroll in courses on racism and bias in STEM or even offer such courses, our curriculum could be used as a blueprint for implementation across institutions. Ultimately, institutions and academic disciplines can incorporate this important material with more region and/or discipline specific studies of bias.

Food Supply Impacts and Solutions Associated with the COVID-19 Pandemic: A Regional Australian Case Study

This study aimed to explore how food supply chains were impacted by COVID-19 and identify how the region could be better prepared for future crises. An online survey was completed by 107 consumers. In-depth interviews were conducted with 27 food supply stakeholders working in food production, distribution, retail, hospitality, institutions (i.e., childcare), logistics/freight and local government. Pre-COVID-19, farmer-direct distribution options and hospitality businesses comprised a substantial proportion of local food producer businesses. During the COVID-19 pandemic, consumers favoured local food supply options, farmers collaborated, and produce usually destined for export was redirected into local markets. Critical food supply actions included keeping borders open to food freight, enhancing social capital through real-time business communication, and business flexibility. Solutions included business adaptation, for example, farmers selling produce boxes and hospitality businesses selling excess stock, COVID-safe delivery, and collaboration through digital networks. To better prepare the region for future crises, actions to support communities could include a community approach to agriculture, increasing food supply diversity, facilitating transport to aid food distribution and purchasing, and more effective messaging to discourage panic buying. Actions to support retailers could include increasing access to wholesalers through online platforms. Actions to support producers could include improving infrastructure, such as more regional distribution facilities.

Grassroots and Youth-Led Climate Solutions From The Gambia

Climate change and environmental degradation are among the greatest threats to human health. Youth campaigners have very effectively focused global attention on the crisis, however children from the Global South are often under-represented (sometimes deliberately) in the dialogue. In The Gambia, West Africa, the impacts of climate change are already being directly experienced by the population, and this will worsen in coming years. There is strong government and community commitment to adapt to these challenges, as evidenced by The Gambia currently being the only country on target to meet the Paris agreement according to the Nationally Determined Contributions, but again children's voices are often missing-while their views could yield valuable additional insights. Here, we describe a "Climate Change Solutions Festival" that targeted and engaged school children from 13 to 18 years, and is to our knowledge, the first peer-to-peer (and student-to-professional) learning festival on climate change solutions for students in The Gambia. The event gave a unique insight into perceived climate change problems and scalable, affordable and sometimes very creative solutions that could be implemented in the local area. Logistical and practical methods for running the festival are shared, as well as details on all solutions demonstrated in enough detail to be duplicated. We also performed a narrative review of the most popular stalls to explore the scientific basis of these solutions and discuss these in a global context. Overall, we find extremely strong, grass-roots and student engagement in the Gambia and clear evidence of learning about climate change and the impacts of environmental degradation more broadly. Nevertheless, we reflect that in order to enact these proposed local solutions further steps to evaluate acceptability of adoption, feasibility within the communities, cost-benefit analyses and ability to scale solutions are needed. This could be the focus of future experiential learning activities with students and partnering stakeholders.

Challenges faced by ethics committee members in India during COVID-19 pandemic: A mixed-methods exploration

Background & objectives

The COVID-19 pandemic had a distinct impact on scientific research and Ethics Committees (ECs). We conducted a mixed-methods investigation to understand the issues faced and solutions identified by ECs during this pandemic in India.

Methods

A quantitative online survey form (30 members) and qualitative in-depth interviews (10 members) from various ECs were conducted. Thematic content analysis for qualitative and proportion analysis for quantitative data was carried out.

Results

During the online survey, an average difficulty score, which was measured using the Visual Analogue Scale, was 5.3 (SD 2.1). Pressure for expedited approvals was felt by EC members with a drastic increase in the number of submission of research projects. The scarcity of information on investigational products (IPs) and requisite consent process posed major hurdles. Ongoing non-COVID studies and post-graduate dissertations were badly hit due to the shift in attention towards COVID-related research. Non-familiarity with virtual technology and lack of face-to-face interactions were highlighted as demerits. However, a few of the EC members welcomed newer methods, being time-saving, convenient and reducing travel hassles. Site monitoring and severe adverse event-related analyses were also negatively impacted upon. Solutions included the alternate methods of consenting (virtual, abbreviated), a detailed explanation of the protocol and IPs and benefits versus risk assessment.

Interpretation & conclusions

Despite various challenges posed by the COVID-19 pandemic, the ECs in India steered well through the hurdles. Moreover, adapting a hybrid mode, technical training and updating guidelines were perceived as urgent by EC members.

Social Isolation, Loneliness and Generalized Anxiety: Implications and Associations during the COVID-19 Quarantine

The COVID-19 pandemic has resulted in a predominantly global quarantine response that has been associated with social isolation, loneliness, and anxiety. The foregoing experiences have been amply documented to have profound impacts on health, morbidity, and mortality. This narrative review uses the extant neurobiological and theoretical literature to explore the association between social isolation, loneliness, and anxiety in the context of quarantine during the COVID-19 pandemic. Emerging evidence suggests that distinct health issues (e.g., a sedentary lifestyle, a diminished overall sense of well-being) are associated with social isolation and loneliness. The health implications of social isolation and loneliness during quarantine have a heterogenous and comorbid nature and, as a result, form a link to anxiety. The limbic system plays a role in fear and anxiety response; the bed nucleus of the stria terminalis, amygdala, HPA axis, hippocampus, prefrontal cortex, insula, and locus coeruleus have an impact in a prolonged anxious state. In the conclusion, possible solutions are considered and remarks are made on future areas of exploration.

Obstacles and Solutions Driving the Development of a National Teleradiology Network

Background: Teleradiology has the potential to link medical experts and specialties despite geographical separation. In a project report about hospital-based teleradiology, the significance of technical and human factors during the implementation and growth of a teleradiology network are explored. Evaluation: The article identifies major obstacles during the implementation and growth of the teleradiology network of the Berlin Trauma Hospital (BG Unfallkrankenhaus Berlin) between 2004 and 2020 in semi-structured interviews with senior staff members. Quantitative analysis of examination numbers, patient numbers, and profits relates the efforts of the staff members to the monetary benefits and success of the network. Identification of qualitative and quantitative factors for success: Soft and hard facilitators and solutions driving the development of the national teleradiology network are identified. Obstacles were often solved by technical innovations, but the time span between required personal efforts, endurance, and flexibility of local and external team members. The article describes innovations driven by teleradiology and hints at the impact of teleradiology on modern medical care by relating the expansion of the teleradiology network to patient transfers and profits. Conclusion: In addition to technical improvements, interpersonal collaborations were key to the success of the teleradiology network of the Berlin Trauma Hospital and remained a unique feature and selling point of this teleradiology network.

Thermoresponsive Molecular Brushes with a Rigid-Chain Aromatic Polyester Backbone and Poly-2-alkyl-2-oxazoline Side Chains

A new polycondensation aromatic rigid-chain polyester macroinitiator was synthesized and used to graft linear poly-2-ethyl-2-oxazoline as well as poly-2-isopropyl-2-oxazoline by cationic polymerization. The prepared copolymers and the macroinitiator were characterized by NMR, GPC, AFM, turbidimetry, static, and dynamic light scattering. The molar masses of the polyester main chain and the grafted copolymers with poly-2-ethyl-2-oxazoline and poly-2-isopropyl-2-oxazoline side chains were 26,500, 208,000, and 67,900, respectively. The molar masses of the side chains of poly-2-ethyl-2-oxazoline and poly-2-isopropyl-2-oxazoline and their grafting densities were 7400 and 3400 and 0.53 and 0.27, respectively. In chloroform, the copolymers conformation can be considered as a cylinder wormlike chain, the diameter of which depends on the side chain length. In water at low temperatures, the macromolecules of the poly-2-ethyl-2-oxazoline copolymer assume a wormlike conformation because their backbones are well shielded by side chains, whereas the copolymer with short side chains and low grafting density strongly aggregates, which was visualized by AFM. The phase separation temperatures of the copolymers were lower than those of linear analogs of the side chains and decreased with the concentration for both samples. The LCST were estimated to be around 45 °C for the poly-2-ethyl-2-oxazoline graft copolymer, and below 20 °C for the poly-2-isopropyl-2-oxazoline graft copolymer.

The challenges to a successful COVID-19 vaccination programme in Africa

The COVID-19 vaccination campaign is an ongoing worldwide effort to vaccinate large numbers of people against COVID-19 in order to ensure protection from the disease, control the rate of infection, reduce severe outcomes, and get back to normal life. Most African countries had a delay in the initiation of their COVID-19 vaccine national rollout compared to other regions in the world, and the goal of the immunization exercise in the continent is to vaccinate over 60% of the African population to attain herd immunity. Over the years, vaccination programmes are usually faced with challenges in Africa because of numerous factors. So far, some of the major challenges threatening the success of the COVID-19 vaccination rollout in most African countries includes the slow onset of the vaccination exercise, limited funds, concerns around vaccine safety and uncertainties, storage requirements and regulatory hurdles for vaccines, limited shelf life of COVID-19 vaccines, inability to access vulnerable communities in a timely fashion, problems around the use of different vaccines, and wars and conflicts. The solutions and other imperative recommendations to these challenges were provided so as to optimize the vaccination programme and to achieve an appreciable success in the COVID-19 vaccination programme on the continent. In conclusion, a holistic and timely planning, fast execution of plans, rigorous community involvement, and a robust multi-sectoral partnership will ensure a successful COVID-19 vaccination campaign in Africa.

Association of Plasma Uremic Solute Levels with Residual Kidney Function in Children on Peritoneal Dialysis

BACKGROUND AND OBJECTIVES

Residual native kidney function confers health benefits in patients on dialysis. It can facilitate control of extracellular volume and inorganic ion concentrations. Residual kidney function can also limit the accumulation of uremic solutes. This study assessed whether lower plasma concentrations of uremic solutes were associated with residual kidney function in pediatric patients on peritoneal dialysis.

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS

Samples were analyzed from 29 pediatric patients on peritoneal dialysis, including 13 without residual kidney function and ten with residual kidney function. Metabolomic analysis by untargeted mass spectrometry compared plasma solute levels in patients with and without residual kidney function. Dialytic and residual clearances of selected solutes were also measured by assays using chemical standards.

RESULTS

Metabolomic analysis showed that plasma levels of 256 uremic solutes in patients with residual kidney function averaged 64% (interquartile range, 51%-81%) of the values in patients without residual kidney function who had similar total Kt/V_urea. The plasma levels were significantly lower for 59 of the 256 solutes in the patients with residual kidney function and significantly higher for none. Assays using chemical standards showed that residual kidney function provides a higher portion of the total clearance for nonurea solutes than it does for urea.

CONCLUSIONS

Concentrations of many uremic solutes are lower in patients on peritoneal dialysis with residual kidney function than in those without residual kidney function receiving similar treatment as assessed by Kt/V_urea.

Psychosocial aspects of suicide in largest industry of farmers in Vidarbha Region of Maharashtra

India consists of 16% of the world's population, but sustains only 2.4% of land resources. The agriculture sector is the only livelihood to two-third of its population, which gives employment to 57% of the workforce and is a raw material source to a large number of industries. Farmer suicides account for approximately 10% of all suicides in India. The national suicide rate is 10.6/lac, whereas in Maharashtra it is 14.2/lac, in Andhra Pradesh 12.1/lac, in Telangana 27.7/lac, and in Chhattisgarh 27.7/lac. The National Crime Records Bureau data from 1995 to 2006 show that 200,000 farmers had committed suicide, with an average rate of 16,000/year. Every 7^th suicide in the country is a farmers' suicide. The first state where suicides were reported was Maharashtra with particularly in the Vidarbha region. In Maharashtra, farmers' suicide rate is 60% higher than the general suicide rate. Every 5^th farmers' suicide committed in the country had occurred in Maharashtra, Vidarbha being a particularly sensitive region but also in Punjab, Uttar Pradesh, Kerala, and Karnataka. In a country of 70 million farmers, 10 in every 100,000 farmers commit suicide. Many inquiry commissions were formed and recommendations were implemented, especially in Punjab. The problem of suicide is not only reported in India but also reported in different parts of the world like England and Wales. We adopted the psychological autopsy approach to offer some insight into the reason why these individuals resorted to such a drastic step.

The Influence of Iron Ions on Optical Brighteners and Their Application to Cotton Fabrics

The influence of iron ions at concentrations of 0.2, 0.5, and 1.0 g/L on optical brighteners of the groups stilbene and biphenyl in solution and on cotton fabric was investigated. Both groups of optical brighteners are intended for detergent formulations. The influence of iron ions was studied by absorption and fluorescence spectra in solution and by whiteness degree, identifying color differences using CIEL*a*b* coordinates and Ultraviolet Protection Factor (UPF) of cotton fabrics. The obtained results in solutions and cotton fabrics showed different behavior of optical brighteners stilbene and biphenyl in the presence of iron. Stilbene compounds with metal ions produced new species capable of absorbing in the UV-B region of the spectrum. A biphenyl compound in combination with iron had no effect on the absorption properties. Both optical brighteners were influenced by iron ions in the sense of fluorescence quenching. The influence of iron ions in single- and two-bath treatments of cotton fabrics after one cycle on whiteness degree and UPF was negligible.

The Contribution of NMR Spectroscopy in Understanding Perovskite Stabilization Phenomena

Although it has been exploited since the late 1900s to study hybrid perovskite materials, nuclear magnetic resonance (NMR) spectroscopy has only recently received extraordinary research attention in this field. This very powerful technique allows the study of the physico-chemical and structural properties of molecules by observing the quantum mechanical magnetic properties of an atomic nucleus, in solution as well as in solid state. Its versatility makes it a promising technique either for the atomic and molecular characterization of perovskite precursors in colloidal solution or for the study of the geometry and phase transitions of the obtained perovskite crystals, commonly used as a reference material compared with thin films prepared for applications in optoelectronic devices. This review will explore beyond the current focus on the stability of perovskites (3D in bulk and nanocrystals) investigated via NMR spectroscopy, in order to highlight the chemical flexibility of perovskites and the role of interactions for thermodynamic and moisture stabilization. The exceptional potential of the vast NMR tool set in perovskite structural characterization will be discussed, aimed at choosing the most stable material for optoelectronic applications. The concept of a double-sided characterization in solution and in solid state, in which the organic and inorganic structural components provide unique interactions with each other and with the external components (solvents, additives, etc.), for material solutions processed in thin films, denotes a significant contemporary target.

The use of qualitative methods in venous thromboembolism research

INTRODUCTION

Qualitative research has been increasingly used in health care research to allow in-depth insights and understanding of patients' lived experiences for poorly understood phenomena. The psychological stress mechanisms underlying fear, dyspnea, and pain after venous thromboembolism (VTE) remain poorly understood. However, novice VTE researchers may not be familiar with the process of undertaking qualitative research.

OBJECTIVE

The aim of this article is to describe the planning, methodology and execution of qualitative methods, using the example of patients' lived experiences during and after the diagnosis of VTE. We discuss challenges and solutions in implementing qualitative research methods in health care research.

METHODS

Patients were recruited from the emergency department and clinic using in-person and phone contact. We used both in-person and video format to interview 24 patients. Interviews were guided by a set of questions to be explored but conducted to elucidate unique thoughts and opinions from patients.

RESULTS

For recruitment, "cold-calling" was found to be largely unsuccessful. Many patients have preexisting diagnoses of anxiety and depression. Video interviews were found to be at least as effective as in-person interviews. Interviews revealed unique post-VTE experiences from all participants, with a wide range of impact on quality of life. Themes that were most common included perceptions of physician communication, fear of recurrence, and concerns of death.

CONCLUSION

A qualitative research approach can reveal individual experiences and psychosocial impact in patients diagnosed with VTE, which allow the researchers to better comprehend the complexity of this phenomenon and its impact in health care.

Assessing Consumer Preference for Overpackaging Solutions in E-Commerce

The emergence of e-commerce and express delivery services has significantly transformed business operations and consumer shopping experience. However, the resulting problem of packaging waste, particularly from overpackaging, poses serious challenges to environmental sustainability and human health. Existing research has proposed many solutions from various perspectives, but very few have considered the acceptability and consumer preference for these proposals. Using the value co-creation (VCC) theory, we established a research model to explore consumer preferences for e-commerce overpackaging solutions. A survey of 632 online consumers in Guangzhou and Shenzhen was conducted, and data were analyzed using the SmartPLS software. The results show that establishing a recycling system, government policy, and consumers’ environmental awareness have a significant positive impact on consumer preference, while combined packaging has a significant negative impact. We also found that government policy plays an intermediary role in establishing a recycling system and consumer preference. Based on these findings, we recommend that enterprises establish and improve their packaging recycling systems and that e-commerce platforms provide alternative options to combined packaging. Also, the government should play a guiding and coordinating role for enterprises and consumers, and environmental awareness among consumers should actively be promoted.

Security challenges and solutions using healthcare cloud computing

Cloud computing is among the most beneficial solutions to digital problems. Security is one of the focal issues in cloud computing technology, and this study aims at investigating security issues of cloud computing and their probable solutions. A systematic review was performed using Scopus, Pubmed, Science Direct, and Web of Science databases. Once the title and abstract were evaluated, the quality of studies was assessed in order to choose the most relevant according to exclusion and inclusion criteria. Then, the full texts of studies selected were read thoroughly to extract the necessary results. According to the review, data security, availability, and integrity, as well as information confidentiality and network security, were the major challenges in cloud security. Further, data encryption, authentication, and classification, besides application programming interfaces (API), were security solutions to cloud infrastructure. Data encryption could be applied to store and retrieve data from the cloud in order to provide secure communication. Besides, several central challenges, which make the cloud security engineering process problematic, have been considered in this study.

Challenges and Solutions to Viral Diseases of Finfish in Marine Aquaculture

Aquaculture is the fastest food-producing sector in the world, accounting for one-third of global food production. As is the case with all intensive farming systems, increase in infectious diseases has adversely impacted the growth of marine fish farming worldwide. Viral diseases cause high economic losses in marine aquaculture. We provide an overview of the major challenges limiting the control and prevention of viral diseases in marine fish farming, as well as highlight potential solutions. The major challenges include increase in the number of emerging viral diseases, wild reservoirs, migratory species, anthropogenic activities, limitations in diagnostic tools and expertise, transportation of virus contaminated ballast water, and international trade. The proposed solutions to these problems include developing biosecurity policies at global and national levels, implementation of biosecurity measures, vaccine development, use of antiviral drugs and probiotics to combat viral infections, selective breeding of disease-resistant fish, use of improved diagnostic tools, disease surveillance, as well as promoting the use of good husbandry and management practices. A multifaceted approach combining several control strategies would provide more effective long-lasting solutions to reduction in viral infections in marine aquaculture than using a single disease control approach like vaccination alone.