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Globally, the nursing profession constitutes the largest proportion of the health workforce; however, it is challenged by widespread workforce shortages relative to need. Strategies to promote recruitment of the nursing workforce are well-established, with a lesser focus on strategies to alleviate the burden on the existing workforce. This burden may be exacerbated by the impact of low-value health care, characterised as health care that provides little or no benefit for patients, or has the potential to cause harm. Low-value health care is a global problem, a major contributor to the waste of healthcare resources, and a key focus of health system reform. Evidence of variation in low-value health care has been identified across countries and system levels. Research on low-value health care has largely focused on the medical profession, with a paucity of research examining either low-value health care or the de-implementation of low-value health care from a nursing perspective. The objective of this paper is to provide a scholarly discussion of the literature around low-value health care and de-implementation, with the purpose of identifying implications for nursing research. With increasing pressures on the global nursing workforce, research identifying low-value health care and developing approaches to de-implement this care, is crucial. [ABSTRACT FROM AUTHOR]

The paper is dedicated to the security measures within the concept of MetaHospital. The idea of MetaHospital is an answer to the modern challenges of time where interaction through digital media is no longer a fantasy. In this paper authors describe the idea of MetaHospital and its modules as well as the ways of personal data protection. The data protection model is given and with a detailed description of each stage. Through the incorporation of rigorous data security protocols, MetaHospital guarantees the safeguarding of patient information, cultivating a trustworthy environment for medical care and research endeavours. Committed to progress and patient well-being, MetaHospital persistently refines its practices, leveraging technology and data-driven perspectives to enhance healthcare delivery and optimize patient outcomes. [ABSTRACT FROM AUTHOR]

Talking about sexuality in a health care total institution is not an easy task insofar as it contributes to the disclosing of the subjective and cultural postures of professionals, in contexts still marked by the absence or lack of professional training on this subject. Talking about sexuality can also endanger or challenge the institution. This paper presents a secondary analysis of what is presented as a form of "clinical ethnography". The materials used in this study were collected in 1996–1997, in the context of a crisis situation caused by the revelation of illicit sexual relations between a head special educator and a young woman labelled as mentally handicapped, in a care institution. In the course of a psychosociological intervention carried out in response to a request from the management of the institution, professionals from different categories were able to express themselves on these "events" and to address, more generally, issues related to sexuality in the institution. The sessions, moderated by the author of the study and a psychoanalytic research assistant, were recorded and transcribed for subsequent feedback to participants. The thematic content analysis of the transcripts of the sessions allowed for a better understanding of the psychosocial obstacles to communication about sexuality, the subjective difficulties related to speaking out, the phenomena of denial of sexuality, as well as the representations of sexuality in institutional situations. The documents discussed here invite reflection on the complexity of collecting information and stories about sexuality in institutional settings. They explore communication processes and, in particular, the difficulties of communicating about sexuality and sexual abuse in institutions in the health and social sector. This study suggests ways in which clinical support can be provided to teams affected by and confronted with traumatic events and the personal and professional difficulties that may arise from such situations. [ABSTRACT FROM AUTHOR]

Trauma-informed care practices are associated with a culture of safety following traumatic experiences, including medical trauma. An interactive, web-based training package ('Responsive CARE') was developed for voluntary uptake by paediatric burns health professionals to increase staff knowledge about trauma-informed practice. This paper reports on a mixed methods process evaluation conducted alongside a preliminary effectiveness study of 'Responsive CARE'. The process evaluation was conducted using The Consolidated Framework for Implementation Research (CFIR) and a logic model, to examine feasibility of both the intervention and implementation strategy. Health practitioners (including senior managers) delivering care to children and caregivers attending an outpatient burns service were eligible to enrol in 'Responsive CARE'. Qualitative interview data and quantitative metadata were used to evaluate the implementation outcomes (adoption, acceptability, fidelity, feasibility and preliminary effectiveness). Children and caregivers attending an outpatient service for change of burn wound dressing or burn scar management during the 3-month control or 3-month intervention period were eligible to enrol in the effectiveness study. The impact on child pain and distress, as well as cost, was investigated using a pretest-posttest design. Thirteen (from anticipated 50 enrolled) health professionals (all female) with mean 10 years (SD=11) of experience with paediatric burns hospital-based outpatient care completed an average of 65% (range 36% to 88%) of available content. Twenty-five semi-structured interviews were completed with health practitioners (21 female) and with 14 caregivers (11 female). Four themes were identified as influencing feasibility and acceptability of the intervention: 1) Keeping a trauma-informed lens; 2) Ways of incorporating trauma-informed care; 3) Working within system constraints; and 4) Being trauma-informed. Preliminary effectiveness data included 177 participants (median age 2 years, and median total body surface area burn 1%). Causal assumptions within the logic model were unable to be fully tested, secondary to lower-than-expected adoption and fidelity. We found no significant difference for pain, distress and per-patient hospital care costs between groups (pre- and post-intervention). Future implementation strategies should include organizational support to keep a trauma-informed lens and to incorporate trauma-informed principles within a medical model of care. Despite efforts to co-design a staff education intervention and implementation approach focused on stakeholder engagement, adaptations are indicated to both the intervention and implementation strategies to promote uptake highlighting the complexity of changing clinician behaviours. ● The Consolidated Framework for Implementation Research was a good fit for study purpose. ● Strategies targeting stakeholder engagement were insufficient for optimal uptake. ● Assessing readiness and capacity for change may be central to successful implementation. [ABSTRACT FROM AUTHOR]

Multiplatform messaging applications also referred to as cross-platform instant messaging play an important role in delivery of healthcare and education with its low cost, ease of use and accessibility. To evaluate the existing evidence regarding the use of multiplatform messaging applications in facilitating consultations and decision-making processes in the context of burns care, as well as to assess the impact of such applications on burns care and rehabilitation. A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines and PROSPERO protocol CRD42021265203. The CASP and JBI tools were used to evaluate the quality of the studies. Eight hundred fifty-three papers were retrieved from PubMed, CINAHL, Scopus, EMBASE and LILACS published up to July 2022 (updated August 2023) with no time restrictions applied. An analysis of the seven studies included in this review, inclusive of 16 Multiplatform messaging applications, revealed six themes. These encompassed the utilization of social media for directing and managing clinical practice, as a mode of communication, for evaluating the quality-of-care provision, for investigating available platforms and their technological features, measuring quality of life and for examining issues related to confidentiality. Multiplatform messaging applications offer a solution for individuals with burn injuries to stay in direct contact with burn specialist clinicians for their follow-up and subsequent rehabilitation phase of recovery. • Multiplatform messaging applications play an important role in burn care. • Such platforms avoid unnecessary admissions and are easily accessible and cost- effective. • Multiplatform messaging apps allow burn survivors and caregivers to maintain direct communication with clinicians. • Multiplatform messaging applications lack transparency regarding confidentiality and privacy. [ABSTRACT FROM AUTHOR]

In this paper, we present a review of several selected talks presented at the CTTACC conference (Cellular Therapies in Trauma and Critical Care) held in Scottsdale, AZ in May 2023. This conference review highlights the potential for cellular therapies to "reset" the dysregulated immune response and restore physiologic functions to normal. Improvements in medical care systems and technology have increasingly saved lives after major traumatic events. However, many of these patients have complicated post-traumatic sequelae, ranging from short-term multi-organ failure to chronic critical illness. Patients with chronic critical illness have been found to have dysregulated immune responses. These abnormal and harmful immune responses persist for years after the initial insult and can potentially be mitigated by treatment with cellular therapies. The sessions emphasized the need for more research and clinical trials with cellular therapies for the treatment of a multitude of chronic illnesses: post-trauma, radiation injury, COVID-19, burns, traumatic brain injury (TBI) and other chronic infections. [ABSTRACT FROM AUTHOR]

• Submitted paper is important due to the fact that transplantation is considered as a treatment of choice for end stage liver failure and the number of organ recipients constantly grows. Many of them are at childbearing age, like patients suffering from Wilson's disease, who pharmacologically untreated, usually develop liver failure in second and third decade of life. • We wanted to prove that women with Wilson's disease treated with organ transplantation have a chance for conception and delivery of healthy children. Therefore, monitoring of pregnancy and transplanted organ's functions must be intensified. Medical care during pregnancy requires cooperation between obstetricians and transplantologists. Wilson's disease is a rare autosomal recessive disorder. Due to a defect in membrane copper transporter, copper is not excreted in the bile and accumulates in the tissues. The only treatment for acute liver failure in Wilson's disease is a liver transplant. Assessment of the course of pregnancies and comparison of obstetric outcomes in female liver transplant recipients in the course of Wilson's disease. Retrospective analysis of data of women, who were pregnant and gave birth in the years: 2017 to 2023. Evaluation of their liver function used pharmacotherapy and obstetric outcomes. We recorded 11 pregnancies in liver transplantation recipients due to Wilson's disease. Ten single pregnancies and 1 twin (DCDA) were observed. In all pregnancies, graft functions and immunosuppressive drug concentrations were monitored. Three women suffered from epilepsy, one was diagnosed with psychiatric disorder. Two were diagnosed with cholestasis, and another 2 with gestational diabetes. Two of them were treated for pregnancy-induced hypertension and 2 developed preeclampsia. Deterioration of liver function parameters in pregnancy was observed in 2 cases. In total, 8 full-term babies were born and 4 late-preterm, including twins at 35 weeks of gestation. Seven pregnancies were delivered by caesarean section and 4 delivered vaginally. No complications in early postpartum period have been reported. Women with Wilson's disease treated with organ transplantation have a chance of successful pregnancies and deliveries. [ABSTRACT FROM AUTHOR]

Digital remote care has emerged as a transformative approach in the delivery of healthcare services. This paper presents an empirical case study that investigates the utilization of digital remote care for postoperative rehabilitation in a relatively large-scale implementation in China. To gather the empirical data, we employed a mixed-methods approach including observations, document analysis, semi-structured interviews, and a participatory workshop. The findings obtained from these diverse sources were documented and analyzed through journey mapping, which provides a holistic view of the process of delivering digital remote care services. Drawing from the journey map, we gain insights into the specific problems faced by health professionals and use this knowledge to identify areas for improvement. Simultaneously, we recognize opportunities to enhance the overall digital remote care experience and facilitate a successful large-scale implementation. [ABSTRACT FROM AUTHOR]

The European health care system is moving toward personalised, distributed, and home-based services. This is made possible via new and improved connected medical devices (CMDs), and will benefit health care providers in terms of reduced cost and improved service. Patients will see improved quality of life in terms of reduced travel time and reduced stress via treatment at home or where they want it. However, for these benefits to be fully realised, the cybersecurity of CMDs needs to be ensured. This paper presents a brief survey of challenges to building security into CMDs, and introduces NEMECYS, an EU-funded project which will help practitioners to (a) comply with Medical Device (MD) regulations; (b) be able to apply proportionate MD cybersecurity, and (c) build in cybersecurity by design for both MDs and the connected scenarios they operate in. [ABSTRACT FROM AUTHOR]

The SmartEUS project aims to design, develop, and test a highly innovative model for the provision of Emergency Urgency Services (EUS) based on the concept of clinical pathway (i.e., the entire emergency care chain). The project is innovative both from an organizational and technological point of view. It is based on an e-Health approach, capable of exploiting new digital technologies in a coordinated way to support the evolution of emergency health systems towards dynamic and safer processes. The paper presents the SmartEUS platform which can integrate the information from all the key players in medical emergency response (emergency operation center, emergency medical service, hospital emergency department) improving their coordination. The most relevant innovations of the proposed solution are data integration and interoperability, advanced communication and collaboration, knowledge-based resource allocation, telemedicine integration to support decision making in dispatching and resource assignment. In fact, a Decision Support System is integrated into SmartEUS cloud platform to suggest to the emergency operation center which emergency medical service and hospital emergency department. In fact, information on the patient status can include results from ambulance's on board telediagnosis equipment, alerting the hospital emergency department even before the arrive of the patient, thus guaranteeing the appropriateness of care according to patient needs (e.g., patient pre-triage index, potential pre-hospital diagnosis) and reducing emergency department overcrowding and resources saturation. [ABSTRACT FROM AUTHOR]

General anaesthesia is in common use for patients undergoing surgical procedures, with the option of both inhalational and intravenous anaesthetic techniques. Anaesthetic gases are often excluded from discussions on sustainable healthcare delivery, despite being a significant contributor to the overall environmental impact of healthcare services. A literature review was carried out on previously published papers on the impact anaesthetic gases have on our environment and at ways to reduce their impact in current anaesthetic practice. The aim was to write a narrative review detailing the areas of concern as well as the current clinical situation in the European setting. The two classes of inhaled anaesthetic agent most frequently used are nitrous oxide and volatile agents (most commonly sevoflurane, isoflurane and desflurane). Both are recognised greenhouse gases that contribute to climate change. Minor modifications in the use of anaesthetic gases can have a significant environmental impact. These modifications include avoiding nitrous oxide whenever possible, avoiding desflurane (and using sevoflurane instead), using low flow anaesthesia during maintenance, swapping volatile-based anaesthesia for a TIVA technique when clinically appropriate and considering the use of central neuraxial or regional anaesthesia in place of general anaesthesia when possible. • Anaesthetic gases include volatile agents and nitrous oxide, both known greenhouse gases • The most common volatile anaesthetic agents used in Ireland is sevoflurane • Sevoflurane is the least damaging gas to the environment • Minor modifications in the use of these gases can have an environmental impact [ABSTRACT FROM AUTHOR]

Timely diagnosis is crucial for the successful treatment of a serious medical condition like brain hemorrhage. Deep learning algorithms have shown great promise in applications for medical image analysis, like the identification of brain hemorrhages. The goal of this study is to assess how well various deep learning algorithms can detect brain hemorrhages. Using a suitable dataset, the study evaluates the computational efficiency, accuracy, sensitivity, and specificity of the selected algorithms. The results demonstrate the potential of deep learning models to assist physicians in identifying this potentially fatal condition and demonstrate how well they can identify brain hemorrhages. The study's findings improve automated brain hemorrhage detection technology, improving patient outcomes and the efficiency of healthcare delivery. EfficientNetB3 typically achieves higher accuracy due to its increased model complexity. Despite its increased complexity, EfficientNetB3 is still more parameter-efficient and computationally efficient than many alternative architectures. EfficientNetB3's strong performance and feature extraction capabilities make it a good choice for transfer learning tasks. Out of all the models implemented in this paper, the proposed model with EfficientNetB3 gave the best accuracy for training as well as validation i.e. 99.95% and 93.29% respectively followed by EfficientNetB2, ResNet, SEResNext and ResNext. [ABSTRACT FROM AUTHOR]

For over a decade, mobile applications are frequently used to make people's daily lives more accessible in all areas, such as commerce, tourism, education, medical care, and others. For implementing these applications, several frameworks exist that can accomplish this task, such as Google's Flutter, Microsoft's Xamarin, Facebook's React Native, Apple's Swift UI, Ionic, Django..etc. However, choosing the best framework to develop an application is not a simple enough decision for developers. This paper presents a detailed analysis of the four most widely used frameworks for implementing mobile applications: React Native, Swift UI, Flutter, and Xamarin. Furthermore, this study also aims to assist developers in choosing the most suitable framework by proposing an application that can recommend the best framework according to the needs entered by answering the questions, which are generally related to the relevant criteria resulting from the analysis of these frameworks. [ABSTRACT FROM AUTHOR]

This paper presents a global approach for implementing Digital Predictive Maintenance (DPM), based on the principles of the digital industry. The proposed approach is applicable at both academic and professional scales, across all sectors and all sizes of organisations. This approach consists of four main phases: the identification of the system or work environment, the identification of the specific targets that justify the adoption of digital maintenance, the choice of appropriate digital technologies for predictive maintenance and the implementation of maintenance X.0 at all levels (i.e., strategic, tactical and/or operational). To validate this approach, the healthcare sector was chosen as a field of application. The uninterrupted operation of facilities and equipment in this sector is paramount. The adoption of maintenance X.0, which has already demonstrated significant benefits in other sectors, would be of great value in the healthcare sector. By applying our approach to the Pneumatic Tube System (PTS) at the Ibn Sina University Hospital Center (actually) in Rabat, Morocco, we have succeeded in introducing a structured and streamlined implementation of DPM in the healthcare sector. [ABSTRACT FROM AUTHOR]

Due to the rise of the nurse practitioner (NP) role in long-term care settings, it is important to understand the underlying structures and processes that influence NP and physician care models. This scoping review aims to answer the question, "What are the structures, processes, and outcomes of care models involving NPs and physicians in long-term care (LTC) homes?" A secondary aim was to describe the structural enablers and barriers across care models. Seven databases were searched. Studies that described NPs and physicians working in LTC were identified and included in the review. We stratified the findings by care model and synthesized using the Donabedian model, which evaluates health care quality based on 3 dimensions: structure, process, and outcome. We then categorized macro, meso, and micro structural enablers and barriers. Sixty papers were included in the review. The main structural influencers within 5 care models included policies on scope of practice, clarity of role description, and workload. A limited number of papers referred to the process of enabling the development of a working relationship. Thirty-five (49%) studies described resident, staff, and health system outcomes. Although structural characteristics of NP and physician care models are described in-depth, there is less detail on the processes that occur within the NP and physician care models. We highlight structural barriers and enablers within the care models, allowing for recognition of the importance of organizational influence on the NP and physician relationship. Future work should focus on the processes of the relationships in the models by identifying the drivers and initiators of collaboration between NPs and physicians and how these relationships influence outcomes. [ABSTRACT FROM AUTHOR]

Artificial intelligence (AI) is emerging as a promising healthcare technology. Especially in critical, data-driven, and complex environments such as acute care, the use of AI can significantly improve treatment processes and support clinical staff. To date, AI applications in healthcare are scarce. Research remains fragmented across individual applications. To address this gap, we conduct a systematic literature review. In this review, we map the status quo of AI research in acute care and use service-dominant logic (SDL) from service science as a framework to integrate our analysis. Using a multilayered lens, we (1) identify intended beneficiaries of AI, (2) identify relevant activities supported by AI, and (3) determine those steps of the patient journey that have been in the spotlight for AI research. Our findings suggest that researchers have focused on hospital staff members as intended beneficiaries during the first three steps of the patient journey: admission, diagnosis, and treatment. The patient's perspective, however, remains underexplored. Moreover, 96 % of the research papers we reviewed focus on AI development and proof-of-concept studies, while only 4 % employ and test AI applications in the field. We identify three priorities for future AI research in acute care and provide suitable research methods. • First approach to combine systematic literature review with key determinants of SDL • SDL as an appropriate means to assess existent AI research in acute care • Four analysis determinants (micro level, meso level, activities, patient journey) • 96 % of the research papers focus on AI development and proof-of-concept. • 4 % of the research papers employ field study testing. [ABSTRACT FROM AUTHOR]

Over the last twenty years, patient opinions of the received healthcare services have emerged as a crucial quality indicator and a valuable instrument for evaluating the service quality of health organizations. However, many surveyors still utilized uncertain information for conducting this evaluation process. Whereas, in the past few years, the issues of inconsistency, indeterminacy, and uncertainty in data have been growing and have become a matter of concern in dealing with decision-making issues. This paper proposes an improved RAFSI method based on a single-valued trapezoidal neutrosophic number (SVTraNN) as a multi-attribute framework for dealing with a healthcare service quality evaluation. The proposed framework consists of two features: a feature for determining numerical criteria weights involving the procedures of the Ordinal Priority Approach (OPA) and a feature for selecting the best polyclinic through contributing our new SVTraNN Harmonic and arithmetic mean to yield criterion functions in the RAFSI method. This paper then compares the results obtained by the proposed method with other SVTraNN decision-making methods. A comparative analysis and rank reversal testing of the improved method demonstrated that the multi-attribute framework proffers the option of capability and stability in overcoming inconsistency, indeterminacy, and uncertainty information efficiently during the healthcare service quality evaluation. [ABSTRACT FROM AUTHOR]

This paper identifies and examines pathways in which online mental health forums assist in building personal resilience and address the mental ill-health of rural residents. We use a resilience theory to develop a Theoretical Resilience Framework and apply it to empirical qualitative data deriving from three of Australia's online mental health forums as well as interviews with forum users. Using thematic analysis and an abductive approach to generating new knowledge, we develop a logic model illustrating links between factors influencing personal resilience, factors acting upon resilience, and intermediate and long-term outcomes that online mental health forums have on their users. Our study demonstrates that online forums can provide ongoing and timely services to those in need, and they support the adaptive capacity of individuals to cope with stressors and a variety of challenges they face. Embedded in a rural setting, the paper adds understanding to the role of technology and online forums in addressing geographical isolation. Ultimately, our work helps to develop new sources of knowledge about rural resilience and supporting mental health service provision in rural places. • Online mental health forums contribute to enhanced personal resilience. • Online mental health forums address gaps in rural health and care service provision. • The forums offer ongoing, flexible and instant support, and respond to specific needs in real time. • Online anonymity might be a crucial factor in reaching out for help with mental health in rural locations. • Collective action of forum experts with lived experience counteracts factors that contribute to poor personal resilience. [ABSTRACT FROM AUTHOR]

In the complex landscape of healthcare supply chains, challenges extend well beyond internal operational concerns, necessitating innovative solutions that align with the evolving technological landscape. The metaverse has emerged as a compelling solution to address these challenges by offering the potential for significant enhancements in efficiency and traceability. This paper focuses on both the theoretical underpinnings and practical applications of integrating the metaverse into healthcare supply chain management. Employing the Cyber-Physical-Social System framework, the study comprehensively explores the pivotal roles played by emerging information technologies in constructing the metaverse and overseeing various stages of the healthcare supply chain. The practical application is exemplified through the introduction of the TraceLink example, illustrating the successful healthcare supply chain digitalization. Furthermore, the paper introduces a barrier framework based on the Technology-Organization-Environment framework, addressing obstacles such as obsolete management technologies, data security, organizational structure, and societal acceptance. The examination and comparison of individual barriers using the Bayesian best-worst method further provide a nuanced understanding of the challenges. This comprehensive exploration not only equips research scholars with profound insights for addressing these challenges but also lays the foundation for future endeavors. The envisioned improvements in healthcare service delivery hold substantial benefits for patients and the industry, making this research a pioneering exploration of the metaverse's potential applications within the realm of the healthcare supply chain. [ABSTRACT FROM AUTHOR]

Health inequalities are a perennial concern for policymakers and in service delivery to ensure fair and equitable access and outcomes. As health inequalities are socially influenced by employment, income, and education, this impacts healthcare services among socio-economically disadvantaged groups, making it a pertinent area for investigation in seeking to promote equitable access. Researchers widely acknowledge that health equity is a multi-faceted problem requiring approaches to understand the complexity and interconnections in hospital planning as a precursor to healthcare delivery. Operations research offers the potential to develop analytical models and frameworks to aid in complex decision-making that has both a strategic and operational function in problem-solving. This paper develops a simulation-based modelling framework (SimulEQUITY) to model the complexities in addressing health inequalities at a hospital level. The model encompasses an entire hospital operation (including inpatient, outpatient, and emergency department services) using the discrete-event simulation method to simulate the behaviour and performance of real-world systems, processes, or organisations. The paper makes a sustained contribution to knowledge by challenging the existing population-level planning approaches in healthcare that often overlook individual patient needs, especially within disadvantaged groups. By holistically modelling an entire hospital, socio-economic variations in patients' pathways are developed by incorporating individual patient attributes and variables. This innovative framework facilitates the exploration of diverse scenarios, from processes to resources and environmental factors, enabling key decision-makers to evaluate what intervention strategies to adopt as well as the likely scenarios for future patterns of healthcare inequality. The paper outlines the decision-support toolkit developed and the practical application of the SimulEQUITY model through to implementation within a hospital in the UK. This moves hospital management and strategic planning to a more dynamic position where a software-based approach, incorporating complexity, is implicit in the modelling rather than simplification and generalisation arising from the use of population-based models. [ABSTRACT FROM AUTHOR]

This paper analyses the process of generalisation of an innovative government-led public practice in the healthcare sector. The scaling and embedding involved in this generalisation process are assumed to be dependent on the multiple implementation processes (consecutive or simultaneous) that lead to a routine use of the innovation in different adopters. This paper, therefore, proposes the use of a configurational theory approach to conceptualise each implementation of the innovation during the generalisation process and shed light on the generalisation's scaling and embedding efforts. It suggests a set of recommendations and practices for generalisation managers, most notably: i) they should regard generalisations as organic processes where their main role is to create space for experimentation, learning and negotiation, and ii) they should adopt different modes of governance to identify adequate mechanisms and strategies and guide their actions. This configurational perspective allows them to monitor and manage the evolution of implementations, informs the valuable learning processes that take place in a generalisation and has been found to be a useful tool to support the crucial collaboration among the actors involved in a generalisation. • Configurational model for innovation implementations in generalisations • Model useful for managing scaling and embedding of government-led public practices • Configurational perspective informs valuable learning processes in generalisations. • Tool useful to support managerial actions to promote generalisation • Framing adequate to leverage the use of flexibility within socio-technical systems [ABSTRACT FROM AUTHOR]

Since 2007, the number of HIV diagnoses in Turkey has increased more than 600% and the AIDS-related deaths have more than doubled. Despite trans community being severely impacted by the growing epidemic, there exists a conspicuous absence of epidemiological data regarding the HIV burden of trans people. This paper examines the medical experiences of HIV-positive trans women who engage in sex work and the harmful violence they encounter at the hands of health providers. The paper emphasizes the urgent need for comprehensive interventions to address the intersecting issues of HIV risk, structural violence, and discrimination faced by HIV-positive trans sex workers, one of the most marginalized communities worldwide. To interpret better how transphobia and HIVphobia become deeply entangled in Turkish medical settings, the paper draws from the concepts of iatrogenesis , necropolitics, and immunity. By bringing together these conceptual tools with long-term ethnographic data and in-depth interviews, this paper demonstrates that trans women are treated by healthcare providers as though they are always-already infectious. The paper contends that aggressive immunitarian boundaries, erected between healthcare personnel and individuals deemed "contagious others," are central to doctors' denial of medical care and reluctance to touch, examine, or even admit trans patients, particularly when they are HIV-positive. • Social immunization lies at the core of doctors' refusal of care for trans patients. • Social immunization is central to the operation of necropolitics and iatrogenesis. • Doctors establish violent boundaries in an attempt to "protect" themselves. • Trans women are assumed to be inherently contagious by healthcare providers. • Trans communities are slowly debilitated through denial of healthcare services. [ABSTRACT FROM AUTHOR]

Previous studies of service reconfiguration in healthcare have explored the influence of power on processes and outcomes. However, in these accounts the moral agency of managers is often underemphasised. This paper draws on the theoretical tools provided by the sociology of morality to help deepen understanding of the interaction between power and moral agency in service reconfiguration in healthcare. It presents results from a qualitative study of a pan-organisational service reconfiguration in the NHS in England, involving nineteen in-depth interviews with those leading the change and the analysis of twelve programme documents. We combine concepts of the moral background and epistemic governance to interpret participants' conviction that the service change was 'the right thing to do'. The paper shows how epistemic work carried out by service change regulations shaped the moral background within which participants worked. This, in turn, channelled their moral agency – specifically their commitment to patient care – in a way that also reflected central priorities. The paper adds to sociological understandings of service reconfiguration through considering the interaction of structure, agency and power, while also developing the concept of the moral background to show how power relations can influence moral beliefs. • Managers can show strong faith in uncertain evidence for healthcare service change. • The moral background explains this in a way which considers power and moral agency. • Confidence in evidence depends on background assumption of future as predictable. • Confidence also depends on premise that finances are not open to moral evaluation. • Service change regulations carry out epistemic work on background assumptions. [ABSTRACT FROM AUTHOR]

Although the metaverse is still in the early stages of development and implementation, it has the potential to revolutionize the way how businesses can interact with customers through both the virtual and real world. In particular, service industries are already exploring the opportunity to utilize the metaverse to provide more immersive, interactive and engaging customer experiences. However, the holistic overview of the future applications, opportunities, and challenges of a metaverse in the context of service industries from academic and expert perspectives is limited. By employing a multi-perspective approach, this study looks into these unexplored aspects of the metaverse in the context of service industries through informed and multifaceted narratives by leading academics and experts from cross-disciplinary backgrounds from media and communication, education, hospitality, financial services, retail, tourism and healthcare. The main opportunities identified include the development of new experiences, the introduction of novel inter-world interactions, and new business-consumer relations within the metaverse. The key challenges covered include current technological boundaries, limitations of the experiences in the metaverse, health issues, and data privacy, security, and legal issues. The paper concludes with formulating future research agendas and presenting contributions to literature and implications for practice. • It explores future applications, opportunities, challenges, and research agenda of the metaverse in service industries. • Opportunities include new experiences development, novel inter-world interactions, and new business-consumer relations. • Key Challenges are technological boundaries, limited experiences, health, data privacy, security, and legal issues. • The paper concludes with formulating future research agendas and presenting contributions to literature and practice. [ABSTRACT FROM AUTHOR]

Patient nonadherence to healthcare providers' recommendations is a major obstacle to desired health outcomes. It results in health deterioration and hospitalization, which might have been avoided with a high level of patient adherence. This paper reviews the literature addressing the issue of adherence in healthcare operations. A total of 73 published articles from operations research and management science journals are included in the review as a result of the systematic search that covered studies from inception until October 26, 2022. This paper is the first comprehensive review of adherence-related research in the operations research field. We summarize how adherence is measured, the research contexts, interactions between adherence and the healthcare system, and how adherence is modeled mathematically. Furthermore, we review adherence-related research at clinical, hospital, and healthcare system levels of planning and control, in addition to medical decision-making. We identify the opportunities in adherence research under the following themes: Supporting proactive management of adherence for healthcare providers, designing a healthcare system that enables adherence, developing personalized treatments, and addressing the global health issues of antimicrobial resistance and vaccine hesitancy. • Review of patient adherence to therapy from an operations research perspective. • Covers 73 studies from inception until 2022 by a systematic search. • Discusses measurements, contexts, interactions with the healthcare system, models. • Examines every level of healthcare planning and control. • Presents four main research directions to advance the field. [ABSTRACT FROM AUTHOR]

Integrating Internet of Things (IoT) technologies in the healthcare industry represents a transformative shift with tangible benefits. This paper provides a detailed examination of IoT adoption in healthcare, focusing on specific sensor types and communication methods. It underscores successful real-world applications, including remote patient monitoring, individualized treatment strategies, and streamlined healthcare delivery. Furthermore, it delves into the intricate challenges to realizing the full potential of IoT in healthcare. This includes addressing data security concerns, ensuring seamless interoperability, and optimizing the use of IoT-generated data. The paper seeks to inspire practitioners and researchers by highlighting the practical implications of IoT in healthcare, emphasizing the ways IoT can enhance patient care, resource allocation, and overall healthcare efficiency. • More than 103 references from top journals are analyzed. • A systematic theoretical analysis of IoT applications in healthcare is provided. • General works on IoT applications in healthcare are well summarized. • Future challenges of IoT applications in healthcare are analyzed from several standpoints. [ABSTRACT FROM AUTHOR]

• Numerous barriers to service provision exist for young people with complex needs. • Strategies for service engagement are required at the practitioner and system level. • Practitioner-level strategies included relational and structural approaches. • System-level strategies included flexible and collaborative approaches. • Young people appear to benefit most from services adapted to their needs. Young people with complex needs often have a range of co-occurring challenges that require the support of multiple government agencies and services. Increasingly, government agencies are working with young people who present with co-occurring and comorbid complex needs requiring co-ordinated multi-agency responses. However, agencies and services are often faced with multiple obstacles and challenges to meeting the needs of these young people, placing them at increased risk of poor outcomes during their adolescence and into adulthood. The objective of this Rapid Evidence Assessment (REA) was to provide practice insights as they relate to service engagement for young people with complex needs to highlight ways in which service delivery can be enhanced. Published academic literature as well as relevant material from the grey literature on young people aged 10–25 was synthesized to identify: (a) the principal barriers to service provision, and (b) strategies that facilitate service engagement. A total of 18 papers met the eligibility criteria for review. Papers were assessed using the critical appraisal skills programme (CASP). Individual and system level barriers were identified, including the characteristics of young people and the nature and structure of services. Strategies were identified at the practitioner level (e.g., benefits of relational, structural and empowerment approaches), and the system level (e.g., flexible services, collaborative approaches and improved staffing and resources). The review highlighted the importance of creating a service environment that is structured around the needs of young people rather than one which requires vulnerable young people to adapt to services. [ABSTRACT FROM AUTHOR]

The human vestibular system is adversely affected by the aging process. Recent evidence indicates that vestibular information and cognitive functions are related, suggesting that age-related vestibular loss may contribute to cognitive impairment. In this study, we aimed to investigate the effects of repetitive, home-based galvanic vestibular stimulation (GVS) on cognitive functions in healthy older adults. Twenty-one participants (age = 64.66 ± 2.97 years, 12 females) were randomly allocated to either a home-based GVS or an active control group. The GVS intervention lasted 20 min per session, five times a week, for two weeks (10 sessions). Cognitive functions were assessed before and after the intervention using the Stroop Test, Trail Making Test A&B, and Dual-Task (digit recall and paper-pencil tracking test). Our findings revealed a significant group-by-time interaction effect for the tracking accuracy (F (1,18) = 7.713, p = 0.012, η p 2 = 0.30), with only the home-based GVS group showing significant improvement (t = −2.544, p = 0.029). The proposed home-based GVS protocol offers a promising non-pharmacological avenue for enhancing visuospatial ability in healthy older adults. Further research is needed to investigate the effects of different GVS protocols on various cognitive functions, particularly in older individuals with different health conditions. • Home-based GVS is feasible for older adults. • Repetitive GVS improves visuospatial ability in healthy older adults. • GVS is a promising non-pharmacological tool for improving cognition. [ABSTRACT FROM AUTHOR]

If Europe's health systems make a conscious decision to increase their utilization of technology and techniques that can enhance prevention and expedite early-stage diagnosis, they can effectively address the growing challenges of disease. By embracing these advancements, these health systems can significantly improve their response to emerging health issues.However, at present the effective integration and exploitation of these opportunities remains hesitant and suboptimal, and health and health services underperform accordingly, with patients suffering from the continuing variations in diagnosis and access to innovation. This paper presents a comprehensive study that examines the current state of various influential disciplines and factors in European countries. It specifically focuses on the adoption of Next Generation Screening technologies and the development stage of Public Health Genomics. The assessment of these areas is presented in the context of a rapidly changing policy environment, which provides an opportunity for a fundamental reconsideration of how and where new tools can be integrated into healthcare systems and routine practices. Top of Form [Display omitted] • NGS Adoption: European nations differ in NGS tech adoption, with disparities between leaders and laggards. • Policy Impact: Strong policies enhance NGS tech integration in healthcare. • Collaboration: Unified data standards, legal frameworks, and training are essential for Europe-wide NGS integration. • Benefits: NGS integration improves healthcare services, research, diagnostics, and treatments. • Conditions: Progress requires better workforce capacity, data sharing, collaboration, and policy leadership. [ABSTRACT FROM AUTHOR]

Electronic clinical decision support tools (eCDSTs) are interventions designed to facilitate clinical decision-making using targeted medical knowledge and patient information. While eCDSTs have been demonstrated to improve quality of care, there is a paucity of research relating to the acceptability of eCDSTs in primary care from the patients' perspective. This study aims to summarize current evidence relating to primary care patients' perceptions and experiences on the use of eCDSTs by their clinician to provide care. Four databases (Medline, Embase, CINAHL and Cochrane Library) were searched for qualitative and quantitative studies with outcomes relating to patients' perceptions of the use of clinician-facing or shared-eCDSTs. Data extraction and critical appraisal using the Johanna Briggs Institute Critical Appraisal checklists were carried out independently by reviewers. Qualitative and quantitative outcomes were synthesized independently. We used Richardson et al. 'Patient Evaluation of Artificial Intelligence (AI) in Healthcare' framework for qualitative analysis. 20 papers were included for synthesis. eCDSTs were generally well-regarded by patients. The key facilitators for use were promoting informed decision-making, prompting discussions, aiding clinical decision-making, and enabling information sharing. Key barriers for use were lack of holistic care, 'medicalized' language, and confidentiality concerns. Our study identified important aspects to consider in the development of future eCDSTs. Patients were generally positive regarding the use of eCDSTs; however, patient's perspectives should be included from the conception of new eCDSTs to ensure recommendations align with the needs of patients and clinicians. The study results contribute to ensuring the acceptability of eCDSTs for patients and their unique needs. Encouragement is given for future development to adopt and build upon these findings. Additional research focusing on patients' perceptions of using eCDSTs for specific health conditions is deemed necessary. • Patients reported that eCDSTs enhance communication and discussions with their GPs in consultations. • eCDSTs were viewed as a source of education and a useful tool that can enhance GP performance. • eCDSTs can facilitate inter-clinician information sharing. • -eCDST language should be clearer and understandable for lay individuals. • -eCDST recommendations were too 'medicalised' and should incorporate more personal factors. [ABSTRACT FROM AUTHOR]

A notable feature of the Italian healthcare system – where funding is centralized and regions manage services locally – is the mismatch between expenditure and funding dynamics, leading to a structural deficit and frequent bailouts on the part the regions. To explain the actions of central and regional governments, we propose a strategic game. The nature of the game varies depending on whether we are in an electoral period for the renewal of the regional government. During elections, regional incumbents use their information advantages, and it is rational for them to increase the deficit, whereas for the central government, it is rational to reduce transfers. That result is confirmed by the empirical analysis run on the 15 Italian Regions with ordinary statutes between 1982 and 2020. We have used Italy as a case study to demonstrate the relevance of our hypothesis, but we believe that the theoretical framework proposed in our paper can be applied to explain the significance of political cycles in determining the interaction between different levels of government in other federal contexts. • An expenditure-funding dynamics mismatch characterizes the Italian healthcare system • A strategic game describes the interaction between central government and regions • During elections, regions increase deficit, the central government reduce transfers • Empirical analysis of the 15 Italian Regions, between 1982–2020, confirms the results [ABSTRACT FROM AUTHOR]

The acceptance of new technologies by elderly individuals has been long debated in literature, showing barriers in their adoption. However, recent technology features such as gamification have been promising a great deal of impact on their intention to use new technology-based solutions. Particularly in the healthcare sector, gamification has been suggested to increase elderly individuals' intention to use digital therapeutics. However, in the attempt to incentivize the adoption of these new technological innovations, the importance of socialization has been advanced as a further reinforcement mechanism by improving the social interactions of elderly patients thanks to the connections with young or expert people. In this paper, we aim to investigate whether the use of gamification affects elderly patients' intention to use new digital therapeutics (DTx) trying to shed lights on the importance of socialization as a winning strategy to boost their adoption. Through an explorative research design, we conducted a study among a selected group of 168 elderly participants. Our findings reveal that these patients' perceived ease of use gamification-based digital therapeutics positively affects their intention to use, via the perceived usefulness of such new technological features. More importantly, we find that this effect increases in magnitude as elderly patients' socialization tendency seeking increases, revealing the importance of socialization-oriented strategies in stimulating elderly's positive reactions to technological tools. This results in a higher willingness to adopt new digital healthcare therapeutics. Implications for both theory and practices emerge from this research. • Digital therapeutics (DTx) may improve elderly active aging. • Gamification-based systems enrich DTx opportunity. • Patients' perceived ease of use gamification-based digital therapeutics positively affects their intention to use. • Patients' socialization tendency increases their higher willingness to adopt DTx. [ABSTRACT FROM AUTHOR]

• Changes in the risk of road traffic injury in Norway from 1970 to 2022 are described. • Possible explanations of the changes are discussed. • The reporting of injuries in official statistics has declined over time. • A real decline in risk is found after adjusting for incomplete reporting. This paper describes changes in the risk of road traffic injury in Norway during the period from 1970 to 2022. During this period, the risk of fatal and personal injury declined by more than 70 % for most groups of road users. There are five main potential explanations of a decline in the risk of injury: (1) a reduced probability of accidents that have the potential for causing injury; (2) an improved protection against injury given that an accident has occurred; (3) improved medical care increasing the survival rate, given an injury (this would reduce the number of fatalities, but not the number of injuries); (4) a tendency for the reporting of injuries in official accident statistics to decline over time; (5) uncertain or erroneous estimates of the exposure to the risk of injury. The decline in the risk of road traffic injuries in Norway after 1970 can probably be attributed to a combination of reduced reporting of injuries in official statistics, improved protection against injury in accidents, and (for fatal injuries) improved medical care. Insurance data, available from 1992, do not indicate a reduction in the risk of accidents leading to insurance claims. Incomplete and possibly erroneous data for mopeds and motorcycles make it impossible to identify sources of changes in injury risk over time for these modes of transport. [ABSTRACT FROM AUTHOR]

Non-state armed actors can shape provision of public goods by impeding provision, becoming providers themselves, or taking control of the means for provision. While the literature is prolific at analyzing the former two channels, the third one is underexplored. How does criminal governance affect public goods provisioning via state capture? And do these dynamics facilitate the survival of non-state armed groups? This paper seeks to answer these questions. I argue that institutional cooptation by non-state armed actors (NSAs) affects public goods provisioning negatively in contexts of institutional decentralization. In these circumstances, public resource transfers can strengthen rather than weaken NSAs. To test my argument, I analyze the Colombian case, where criminal insurgencies took control of and diverted public health funds toward their pockets. Using data on health care providers, as well as the presence of NSAs at the municipal level, I show via two-way fixed effects models that municipalities experiencing paramilitary cooptation see a decrease in public health care provision. Similarly, public resource transfers decrease paramilitary demobilizations. This has important implications for the evaluation of decentralization as a strategy for political stabilization, peacekeeping, and development in fragile contexts, as well as for understanding the impact of public spending in strengthening rather than weakening NSAs. • State capture by non-state armed actors (NSAs) hinders public goods provisioning. • Decentralization strengthens NSAs when criminal governance occurs via state capture. • NSA state capture in Colombia stalled health care expansion and NSA demobilization. [ABSTRACT FROM AUTHOR]

The United States offers two markedly different subsidy structures for private health insurance. When covered through employer-based plans, employees and their dependents benefit from the exclusion from taxable income of the premiums. Individuals without access to employer coverage may obtain subsidies for Marketplace coverage. This paper seeks to understand how the public subsidies embedded in the privately financed portion of the U.S. healthcare system impact the payments families are required to make under both ESI and Marketplace coverage, and the implications for finance equity. Using the Household Component of the Medical Expenditure Panel Survey (MEPS-HC) and Marketplace premium data, we assess horizontal and vertical equity by calculating public subsidies for and expected family spending under each coverage source and using Lorenz curves and Gini and concentration coefficients. Our study pooled the 2018 and 2019 MEPS-HC to achieve a sample size of 10,593 observations. Our simulations showed a marked horizontal inequity for lower-income families with access to employer coverage who cannot obtain Marketplace subsidies. Relative to both the financing of employer coverage and earlier Marketplace tax credits, the more generous Marketplace premium subsidies, first made available in 2021 under the American Rescue Plan Act, substantially increased the vertical equity of Marketplace financing. While Marketplace subsidies have clearly improved equity within the United States, we conclude with a comparison to other OECD countries highlighting the persistence of inequities in the U.S. stemming from its noteworthy reliance on employer-based private health insurance. • United States uses employer and individual private health insurance coverage. • No recent investigations of horizontal and vertical equity of U.S. private coverage. • Analysis of Gini coefficients and Lorenz curves suggests regressivity. • Public policies including insurance subsidies can reduce inequities. [ABSTRACT FROM AUTHOR]

Health insurance expansions can improve health outcomes by increasing access to healthcare. This is especially true among the poorer segments of the population, who may not be able to afford the cost of healthcare, or might lack the information about where to seek proper medical care. In this paper we examine whether increased access to health insurance has historically reduced height inequality by promoting body growth, particularly among poor individuals, and so enhanced their height, a widely used and well-established anthropometric health and well-being indicator. We draw on data from a large global panel of countries for which we could measure height inequality. Our evidence documents that indeed within-country differences in height inequality decreased following health insurance expansions towards near-universal coverage. • First study: health insurance reduces height and health inequality. • Large global sample over 200 years. • "Big picture" of health inequality in the long run. • Instrumental variable techniques suggest causal relationship. [ABSTRACT FROM AUTHOR]

• Aboriginal perceptions about the overrepresentation of Aboriginal infants in out-of-home care include adversities related to colonisation not addressed prenatally, unnecessary reports, and unnecessary removals. • System causes of unnecessary reports include bias in reporting, visibility bias, health worker lack of experience and high demand for community services. • System causes of unnecessary removals include bias in removal decisions, bias in risk assessment instruments, power imbalances in child protection decision-making and lack of culturally informed community-based residential services following birth. • System causes of unmet need prenatally include disparity between resources for Aboriginal services and need, fear and distrust of child protection, an inexperienced Aboriginal workforce and challenges identifying high risk Aboriginal families prenatally. • Core components of an effective response to tackle system causes of Aboriginal baby removals include mediation of child protection activities, supportive links between Aboriginal services, child protection and health workers, culturally grounded case practice, traditional cultural activities, and flexible support funds. The increasing rate of statutory Aboriginal infant removal in Australia, which has reached almost 10% of live births in the state of Victoria, is a crisis motivating radical change in child protection pathways. This paper describes the problem analysis and design phases of an Aboriginal-led systems change project intended to ensure Aboriginal infants are raised safe and strong in family, Community, and culture by creating a response capable of shifting underlying system factors. Dialogue and deliberation processes involving 27 practitioners working within Aboriginal health and social care programs in the Bayside Peninsula Area of metropolitan Melbourne, the traditional land of the Bunurong people, was the overarching method used to develop a shared understanding of the problem of Aboriginal infant removals and reach a consensus about what to do in the local system. The themes that emerged during problem analysis reflect a risk/bias theoretical perspective, and in the design phase, it was deemed necessary to reduce both child safety-related risk as well as bias in the child protection system that responds to risk. The ensuing Bringing Up Aboriginal Babies at Home program has a clear systems theory of change, and a service blueprint describing how it is going to be implemented. Bringing Up Aboriginal Babies at Home practice resonates with other programs that have evolved independently in Australia and in other western child protection jurisdictions to reduce infant removals, including building trust for engagement, inspiring hope, openness and transparency, activating extended networks of formal and informal supports, and close collaboration with antenatal and child protection services. Program evaluation will determine whether Bringing Up Aboriginal Babies at Home (BUABAH) can be implemented with fidelity, tackle identified system flaws, reduce the number of Aboriginal infants taken into statutory care and become sustainable. [ABSTRACT FROM AUTHOR]

To access contemporary healthcare, patients must find and navigate a complex socio-technical network of human and digital actors linked in multi-modal pathways. Asynchronous, digitally-mediated triage decisions have largely replaced synchronous conversations between humans. In this paper, we draw on a large qualitative dataset from a multi-site study of remote and digital technologies in general practice to understand widening inequities of access. We theorise our data by bringing together traditional candidacy theory (in particular, concepts of self-assessment, help-seeking, adjudication and negotiation) and socio-technical and technology structuration theories (in particular, concepts of user configuration, articulation, distanciation, disembedding, and recursivity), thus producing a novel theory of digital candidacy. We propose that both human and technological actors (in different ways) embody social structures which affect how they 'act' in social situations. Digital technologies contain inbuilt assumptions about users' capabilities, needs, rights, and skills. Patients' ability to self-assess as sick, access digital platforms, self-advocate, and navigate multiple stages in the pathway, including adapting to and compensating for limitations in the technology, vary widely and are markedly patterned by disadvantage. Not every patient can craft an accurate digital facsimile on which the subsequent adjudication decision will be made; those who create incomplete, flawed or unpersuasive digital facsimiles may be deprioritised or misdirected. Staff who know about such patients may use articulation measures to ensure a personalised and appropriate access package, but they cannot identify or fully mitigate all such cases. The decisions and actions of human and technological agents at the time of an attempt to access care can significantly influence, disrupt, and reconstitute candidacy both immediately and recursively over time, and also recursively shape the system itself. These findings underscore the need for services to be (co-)designed with attention to the exclusionary tendencies of digital technologies and technology-supported processes and pathways. • Digital access and triage involves a network of technological and human agents. • Digitalised systems exacerbate existing inequities, and create new ones. • Technologies are encoded with assumptions, limiting their use and accessibility. • These assumptions lock out some users, recursively affecting health service usage. • Individual practices' digital options must depend on local staff and patient needs. [ABSTRACT FROM AUTHOR]

The characteristic features of 21st-century corporate capitalism – monopoly and financialization – are increasingly being recognized by public health scholars as undermining the foundations of human health. While the "vectors" through which this is occurring are well known – poverty, inequality, climate change among others – locating the root cause of this process in the nature and institutions of contemporary capitalism is relatively new. Researchers have been somewhat slow to study the relationship between contemporary capitalism and human health. In this paper, we focus on one of the leading causes of death in the United States; cancer, and empirically estimate the relationship between various measures of financialization and monopoly in the US healthcare system and cancer mortality. The measures we focus on are for the hospital industry, the health insurance industry, and the pharmaceutical industry. Using a fixed effects model with different specifications and control variables, our analysis is at the state level for the years 2012–2019. These variables include data on population demographic controls, social and economic factors, and health behavior and clinical care. We compare Medicaid expansion states with non-Medicaid expansion states to investigate variations in state-level funded health insurance coverage. The results show a statistically significant positive correlation between the HHI index in the individual healthcare market and cancer mortality and the opioid dispensing rate and cancer mortality. • We analyze how corporate capitalism is related to cancer mortality. • Recently, corporate capitalism has become more common in the healthcare industry. • We find a correlation between hospital net revenue, profit, and cancer mortality. • There is a link between the HHI index in insurance markets and cancer mortality. [ABSTRACT FROM AUTHOR]

The cognitive load experienced by humans is an important factor affecting their performance. Cognitive overload or underload may result in suboptimal human performance and may compromise safety in emerging human-in-the-loop systems. In driving, cognitive overload, due to various secondary tasks, such as texting, results in driver distraction. On the other hand, cognitive underload may result in fatigue. In automated manufacturing systems, a distracted operator may be prone to muscle injuries. Similar outcomes are possible in many other fields of human performance such as aviation, healthcare, and learning environments. The challenge with such human-centred applications is that the cognitive load is not directly measurable. Only the change in cognitive load is measured indirectly through various physiological, behavioural, performance-based and subjective means. A method to objectively assess the performance of such diverse measures of cognitive load is lacking in the literature. In this paper, a performance metric for the comparison of different measures to determine the cognitive workload is proposed in terms of the signal-to-noise ratio. Using this performance metric, several measures of cognitive load, that fall under the four broad groups were compared on the same scale for their ability to measure changes in cognitive load. Using the proposed metrics, the cognitive load measures were compared based on data collected from 28 participants while they underwent n -back tasks of varying difficulty. The results show that the proposed performance evaluation method can be useful to individually assess different measures of cognitive load. [ABSTRACT FROM AUTHOR]

• Trauma-informed practice is being trialled in response to extra-familial risks and harms. • An institutional ethnography found sources of knowledge impact this innovation. • Professionals may say young people are 'known-to-services' but be distant from them. • Being proximal to young people and advocating for their needs helps to know them. • To be trauma-informed, professionals must relationally know those they support. Efforts to shift from criminal justice to welfare-based responses to exploitation and other forms of extra-familial risks and harms, have centred relational approaches. In particular, the role that relationships between professionals and young people can play in providing a sense of safety as well as a route to wider support services when young people come to harm beyond their families is under consideration. In parallel, trauma-informed practice is increasingly promoted as a tool for creating service conditions in which relational practice can thrive. In this paper we present data from an institutional ethnography of two social care organisations in the UK which are endeavouring to adopt trauma-informed responses to extra-familial risks and harms. We use observation, focus group, and case file data collected in two time periods, to illustrate a relationship we identified between the nature and source of knowledge that guided professional responses, the ability of professionals to form relationships with young people affected by extra-familial risks and harms, and the capacity for their organisations to be trauma-informed. In doing so we trouble an established discourse in many social care organisations, that young people subject to intervention are 'known-to-services' and call for more responses in which young people are 'known-by-professionals' who are supporting them. Far from being a matter of semantics, we discuss how these two ways of knowing about young people, and the situations they face, potentially facilitate or undermine key pillars of trauma-informed practice, and the relational approaches that make such practice possible. [ABSTRACT FROM AUTHOR]

Currently, there are limited options for patients with visual impairment or blindness to obtain accessible written medication information. The objectives of this study were to determine the availability of accessible medication guides provided by the manufacturer and identify common barriers reported by patients with visual impairment in obtaining accessible written medication information in health care settings. Prospective, cross-sectional study. Participants of the survey portion included individuals with visual impairment who were administered an online questionnaire. Availability of accessible medication guides as verified by 39 manufacturers and accessibility assessed using a checklist based on revised Section 508 guidelines and testing with a screen reader for accessibility. To identify barriers in obtaining written medication information, respondents were recruited by Qualtrics to fill out an anonymous, online 13-question survey from September to October 2022. All manufacturers did not provide an accessible medication guide or an alternative format. Common errors found by the screen reader were lack of a description for images (alternative text) and headings were not available to help with navigation. As for the survey, a total of 699 participants responded. The median age was 35 years and 49% of respondents were female. A paper copy was the most common format (38%) provided in the pharmacy and barriers identified included lack of Braille or electronic options and personnel not equipped to serve patients with visual impairment. With the lack of accessible written medication information as a barrier to health equity, pharmacists and manufacturers need to provide alternative formats such as audio, electronic formats, or Braille to patients with visual impairment. [ABSTRACT FROM AUTHOR]

Arctium lappa L. root is a well-known Chinese medicine with high medicinal and food values. Arctium lappa L. root polysaccharide (ALP), as the main component and bioactive substance, has a variety of biological activities, including anti-inflammatory, antioxidant, hypoglycemic, hypolipidemic, antithrombotic, immunomodulatory activity and improvement of intestinal flora. The biological activities of polysaccharides are closely related to their structures, and different extraction and purification methods will yield different polysaccharide structures. As a kind of natural polysaccharide, ALP has a broad application prospect in drug carrier. In this paper, we reviewed the research progress on the extraction, purification, structural characterization, biological activities, structure-activity relationship and drug carrier application of ALP, in order to provide basic reference for the development and application of medical and health care value. At the same time, the shortcomings of ALP research are discussed in depth, and the potential development prospect and future research direction are prospected. [ABSTRACT FROM AUTHOR]

Value-based payment aims to shift the focus from traditional volume-driven arrangements to a system that rewards providers for the quality and value of care delivered. Previous research has shown that it is difficult for providers to change their medical and organizational practices to adopt value-based payment, but the role of actors in these reforms has remained underexposed. This paper unravels the motives of non-clinical and clinical professionals to maintain institutionalized payment practices when faced with value-based payment. To illuminate these motives, a case study was conducted in a Dutch hospital alliance that aimed to implement value-based payment to incentivize the transition to novel interventions in a prostate cancer care pathway. Data collection consisted of observations and interviews with actors on multiple levels in the hospital (sales departments, medical specialist enterprises (MSEs) and physicians). On each actor level, motives for maintaining currently prevailing institutional practices were present. Regulative maintenance motives were more common for sales managers whereas cultural-cognitive and normative motives seemed to play an important role for physicians. An overarching motive was that desired transitions to novel interventions proved possible under the currently prevailing institutional logic, dismissing an urgent need for payment reform. Our analysis further revealed that actors engage in diverse institutional maintenance work, and that some actor groups' institutional work carries more weight than others because of the dependency relationships that exist between hospitals, MSEs and physicians. Physicians depend on MSEs and sales departments, who act as gatekeepers and buffers, to decide whether the value-based payment reform is either adopted or abandoned. • Physicians depend on other hospital actors for pursuing value-based payment reform. • Payment reform prompts actors to assess flaws of current payment practices. • Current payment practices persist due to perceived lack of payment reform necessity. • It is important to look beyond the insurer–provider nexus during payment reform. [ABSTRACT FROM AUTHOR]

Many Latinx and Indigenous Mexican populations in the United States Southwest live in unincorporated communities in the US-Mexico borderlands called colonias. These environmental justice communities often lack basic infrastructure, including healthcare services, prompting many to seek services across the border. However, due to geopolitical factors more vulnerable caregivers are limited to utilize healthcare services in the US. This paper reports the experiences and healthcare decision-making of caregivers living in colonias in the US-Mexico border region who care for children with respiratory health conditions. This study was carried out from September to December 2020. Focus groups and interviews were conducted with Latinx and Indigenous Mexican caregivers of children with asthma or respiratory distress. Qualitative interviews elicited caregivers' perspectives on the environmental factors affecting children's chronic health conditions and use of healthcare services. The analysis employed the concept of structure vulnerability to theorize geography as a structural determinant of health for caregivers faced with making healthcare decisions for their suffering from respiratory health conditions. A survey was administered to collect basic sociodemographic information. A total of 36 caregivers participated in the study. Structural factors including unincorporated community status and government inaction intersected with social determinants of health to prompt caregivers to cross the US-Mexico border to access healthcare services in Mexico for their children. Yet, more vulnerable caregivers (i.e., those without documentation status in the US) and their children, accessing healthcare services in the US was not an option limiting caregivers' ability to meet their children's healthcare needs. In such cases, geography acts as a structural determinant of health. This study shows the importance of geography in health. Rural unincorporated colonias located in the borderlands are precariously located and lack basic critical infrastructure including healthcare access. Within such places, historically and socially marginalized populations become invisible, are subject to the health effects of environmental hazards, and are limited depending on their positionality and thus vulnerability to healthcare services. • Municipal unincorporation contributes to health disparities among Latinx families in US-Mexico borderlands. • Latinx children in colonias are disproportionately exposed to environmental toxins. • Geography acts as a structural determinant of health for Latinx families in colonias. • A binational approach to health services should be prioritized for families in the borderlands. [ABSTRACT FROM AUTHOR]

This paper proposes a 4th-order class-AB low-pass filter (LPF) for wearable biological healthcare applications designed by cascading two 2nd-order LPFs. The proposed class-AB LPF uses quasi-floating gate (QFG), flipped source follower (FSF) and level-shifter (LS) techniques to boost its performance. The LPF is designed and validated in CMOS 180 nm technology which emulates the post-layout gain of −0.212 dB, bandwidth of 100 Hz, dynamic range (DR) of 50.26 dB, total harmonic distortion (THD) of −52.5 dB and figure of merit (FOM) of 1.71 × 10-15 J. The class-AB QFG FSF LPF consumes power and area of 0.224 nW and 0.0196 mm2, respectively. Furthermore, the statistically determined coefficient of variation for proposed LPF with 1000 iterations for gain is −0.035, THD is −0.172 and DR is 0.04, respectively. The class-AB QFG FSF LPF is compared with other LPFs which establishes its advantage in terms of low-power consumption and least figure of merit thus confirming its suitability for wearable healthcare applications. [ABSTRACT FROM AUTHOR]

Personal health records (PHR) offer significant benefit for patients, such as reducing medical cost and improving the quality of medical care. Majority of the current schemes lack provisions for tracking and revoking malicious doctors. The explicit access policies are prone to leaking patient private information. What is more, owning to the uneven distribution of medical supplies, shocking computational overhead during decryption is a burden that cannot be ignored for busy medical workers. This paper proposed a patient-centric medical service matching scheme that supports policy hiding, attribute matching, fine-grained access control, and user dynamic management. The scheme uses ciphertext policy-based attribute encryption (CP-ABE) to achieve fine-grained access control and supports policy hiding. It utilizes white-box tracking technology and binary tree structure to achieve malicious doctor tracking. Revocation information is ciphertext to achieve dynamic management of doctors. From the experimental results, it can be concluded that our protocol achieves both patient-centric security and performance advantages. • A secure patient-centric medical service matching scheme with policy hiding. • Achieve fine-grained access control and withdraw untrustworthy doctors. • Low computational and communication overhead. [ABSTRACT FROM AUTHOR]

Despite significant efforts to improve access to medications for opioid use disorder (MOUD), uptake remains low relative to the scope of the problem in the United States. A growing body of quantitative and qualitative research has documented consistent barriers to MOUD treatment access and retention, at the level of individuals, institutions, and society at large. Stigma - surrounding both people who use opioids (PWUO) and treatment using MOUD – is among the most-cited barriers by patients and providers alike, yet few studies have examined provider-based stigma specifically, or considered its interaction with other impediments to OUD care. This paper employs a qualitative approach to the analysis of provider-based stigma among professionals involved in the treatment or supervision of individuals with OUD. We conducted and analyzed interviews with 19 professionals as part of a larger mixed methods study on stigma among substance use treatment providers and court personnel in Pennsylvania. Beyond capturing providers' perceptions of PWUO and MOUD, the authors asked participants to describe barriers to recovery, and the effective delivery of care within this population. Interviewees enumerated multiple entrenched barriers that sometimes operated at different levels, such as criminal-legal involvement, which weakened PWUO's social networks and employment prospects, while undermining providers' attempts at continuity of care; moreover, participants cited the "War on Drugs" as an overarching impediment to effective substance use treatment, not least for its role in perpetuating stigma against PWUO. Interestingly, while an overwhelming majority of participants named stigma as a barrier to treatment at every level, most also articulated stigmatizing beliefs around PWUO. Namely, providers evoked one element of stigma – blameworthiness – in their contention that many PWUO are inadequately motivated to recover. In addition to adding further complexity to MOUD barriers research, this study troubles the notion that professional training and education on the disease model of addiction serve to eradicate stigma. • Uptake of medications for opioid use disorder remains low despite efforts to expand access. • Individual, institutional, and systemic barriers to MOUD interact to reduce usage. • Treatment providers identify stigma as a primary barrier to MOUD effectiveness at all levels. • Many treatment providers also express conceptions of people who use opioids as "blameworthy." [ABSTRACT FROM AUTHOR]

Running is a popular form of physical activity yet discontinuation is common. Interventions targeting physical activity adoption have shown modest effects, often with little translation into long-term participation, which may limit the health benefits available to the wider community. This paper details the development of a new online running intervention (Just Run) aimed at improving continuation of running activity in new runners through a motivational and psychological lens, including aspects of design, content, refinement, and usability testing. A six-step intervention mapping process was used to develop a theory-based online intervention using a mix of research designs. Key stakeholders including runners, coaches and relevant experts in physical activity and behavior change provided valuable insight, feedback and refinement of the education to be delivered. The final Just Run intervention included ten modules delivered online over twelve weeks to promote ongoing running participation through videos, testimonials, and activities. Key themes identified through the literature and stakeholder engagement process related to goal setting, self-efficacy, intrinsic motivation, social support and overcoming barriers to running participation. Usability testing confirmed the quality and suitability of the education to the target population. Just Run has been developed with a range of stakeholders to address an area of unmet need in the adoption and promotion of running. Just Run is a robust online intervention that has been designed and pre-tested with positive feedback and unique insights from key stakeholders. Further investigation is required to support its implementation to the wider community. • A six-step intervention mapping process informed the design of Just Run. • Key stakeholders contributed to the design of this motivational running intervention. • Goal setting and social support were key topics included in the designed material. • Positive usability testing confirmed the aptness of the education to runners. [ABSTRACT FROM AUTHOR]

Supplier selection is critical to the healthcare industry, especially in emergencies. Accurate and timely supply of healthcare resources can reduce economic cost and ensure the safety of people's lives. However, the healthcare supplier market is enormous and complex; making accurate evaluations of different suppliers and helping managers choose the most suitable one when considering many factors is becoming an important task. Many multicriteria decision-making (MCDM) methods have been applied to supplier selection in existing literature. However, the research on healthcare supplier selection still needs to be completed. In this paper, to deal with healthcare supplier selection problems when there is no sufficient time and information to decide with uncertainty, the stochastic multicriteria acceptability analysis (SMAA) method and multi-attributive border approximation area comparison (MABAC) method are first combined by taking both the advantages of SMAA and MABAC methods when the assessments are expressed by belief distributions (BDs). In the SMAA-MABAC method, the global ignorance in BDs and the uncertain criteria weights are considered by judging the feasible space to derive the final rank of healthcare suppliers with the most possible. The more straightforward calculation process of SMAA-MABAC makes it faster to make an accurate choice among various suppliers. Moreover, it is flexible to generate different recommended suggestions when diverse preference information is added in SMAA-MABAC. Finally, a case study of healthcare supplier selection is examined for managers based on distributed reviews, and targeted selection advice is given concerning different demands. Besides, the sensitive analysis is provided to better understand the influence of the criteria weights on the proposed model. The results of the comparative analysis also show the effectiveness and rationality of the proposed method. [ABSTRACT FROM AUTHOR]