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A lack of access to a sequence of introductory to top-level curricula in rural schools has widened the achievement disparity between rural and urban students and influenced the number of college degree holders in rural areas. Recently, surging diversity and differentiation in income levels across nonurbanized areas can serve as determinants of the development of academically rigorous course pipelines in rural schools. This study examines differentiation in spatial access to the curriculum ladder for rigorous mathematics in three southern U.S. states during the 2017–18 school year: Alabama, Arkansas, and Mississippi. Policy variations in these states yield different effects on the sequence of rigorous mathematics courses in rural high schools. Given that the mathematics course pipeline reinforces college access, access to academically challenging courses likely outweighs the rural disadvantages of college readiness in non-urban students and the persistence of inequality in public education. [ABSTRACT FROM AUTHOR]

Background: Research shows that undocumented migrants have difficulties in accessing healthcare. Act 2013:407 came into force in 2013 and entitled undocumented migrants to healthcare that cannot be deferred. To date, studies about undocumented migrants' access to care in Sweden and the impact of Act 2013:407 are sparse. Hence, the aim of this study was to describe professionals' experiences of access to healthcare for undocumented migrants in Sweden and the impact of Act 2013:407. Methods: A qualitative design with semi-structured interviews was employed. Nine interviews were carried out in 2015 with nurses at two NGO healthcare centres for undocumented migrants – and an additional seven interviews in 2022 with staff at an NGO healthcare centre for undocumented migrants and personnel at a regional health and medical care administration. Interpretive description was used for the analyses. Ethical considerations: Permission to carry out the study was obtained from managers at the participating NGOs and the regional health and medical care administration. Participants received verbal and written information about the study, and informed consent was obtained from all participants. Findings: Six categories emerged from the analysis: Changes since the Act was introduced, General problems with healthcare access, Care for undocumented migrants – politics and social economy, Lack of knowledge, 'Healthcare that cannot be deferred' and Being an undocumented migrant. Conclusion: Undocumented migrants' social needs are as great as their needs for healthcare. Healthcare staff are burdened with healthcare cost considerations which affect their judgement of care provision and prioritization. Healthcare staff attitudes towards undocumented migrants affect their access to healthcare. Undocumented migrants in need of healthcare are especially vulnerable due to their legal status, being ill and the fear of being reported and deported. To assure undocumented migrants' access to healthcare and maintain healthcare ethics, the only possible solution is to provide healthcare based on needs. [ABSTRACT FROM AUTHOR]

Objectives: In order to develop a better understanding of students' access to mental health services, we explored the experiences of health care professionals interacting with university students with mental health problems. Methods: We interviewed 23 professionals working across university advice and counselling services, NHS general practice, crisis, and psychological services in North and East London between June 2022 and January 2023. Our approach drew on reflexive thematic analysis and the principles of abductive analysis. The notion of candidacy – that is, how different needs are deemed deserving of health service attention – was particularly helpful to our understanding of the ongoing phenomenon of interest in the data. Results: Each student's access to mental health support was highly contingent on the student's dynamic social context and the pressures and organisation of the local health system. Professionals described how different students viewed different needs as deserving of health service attention. Which students reached the professional's service depended on the resources and relationships a student could draw upon, and the service's relative permeability. Once there, what action professionals took was strongly influenced by the professional's service expertise, resource constraints, the relationships the professional's service had with other organisations, the students' wishes, and whether students regarded treatment offers as acceptable. Conclusions: Candidacy offers a useful lens to view university students' access to mental health support. Access appears to be an increasingly intricate task for students, given the fragmented service landscape, surging demand for mental health care and challenges of emerging adulthood. Our findings suggest that policy goals to increase use of mental health services are unlikely to improve outcomes for students without policy makers and health systems giving holistic consideration of inter-service relationships and available resources. [ABSTRACT FROM AUTHOR]

This article examines the key drivers of farmers' adoption of technical advice and their preferred providers of agricultural extension services. Based on a primary survey conducted in western Uttar Pradesh, India, the data from 272 sample households were analysed using a binary logistic regression model. The findings suggest that farmers' decisions to adopt technical advice are influenced positively by farm size, household size, average hours spent on farms, training and awareness of the extension scheme. The positive relationship between farm size and technical advice adoption demonstrates the need for extension services to reconsider their strategies for reaching out to more marginal and small farmers, who account for over 85 per cent of agricultural households, by incorporating their priorities into their outreach programmes. Non-government extension sources are found to be important for access but not for the adoption of technical advice. However, in both commercial and public extension services, a lack of faith in extension services is the fundamental cause of the relatively low adoption rate. The low preference of information and communications technology-based extension services underlines that physical forms of extension services are far more important in developing countries like India. JEL Code: Q16 [ABSTRACT FROM AUTHOR]

Midlife, beginning at 40 years and extending to 65 years, a range that encompasses the late reproductive to late menopausal stages, is a unique time in women's lives, when hormonal and physical changes are often accompanied by psychological and social evolution. Access to sexual health and sexual well-being (SHSW) services, which include the prevention and management of sexually transmitted infections, contraception and the support of sexual function, pleasure and safety, is important for the health of midlife women, their relationships and community cohesion. The objective was to use the socio-ecological model to synthesise the barriers and enablers to SHSW services for midlife women in high-income countries. A systematic review of the enablers and barriers to women (including trans-gender and non-binary people) aged 40–65 years accessing SHSW services in high-income countries was undertaken. Four databases (PubMed, PsycINFO, Web of Science and Google Scholar) were searched for peer-reviewed publications. Findings were thematically extracted and reported in a narrative synthesis. Eighty-one studies were included; a minority specifically set out to study SHSW care for midlife women. The key barriers that emerged were the intersecting disadvantage of under-served groups, poor knowledge, about SHSW, and SHSW services, among women and their healthcare professionals (HCPs), and the over-arching effect of stigma, social connections and psychological factors on access to care. Enablers included intergenerational learning, interdisciplinary and one-stop women-only services, integration of SHSW into other services, peer support programmes, representation of minoritised midlife women working in SHSW, local and free facilities and financial incentives to access services for under-served groups. Efforts are needed to enhance education about SHSW and related services among midlife women and their healthcare providers. This increased education should be leveraged to improve research, public health messaging, interventions, policy development and access to comprehensive services, especially for midlife women from underserved groups. Plain language summary: Sexual health and sexual wellbeing services for midlife women in high income countries Midlife, beginning at 40 years and extending to 65 years, a range that encompasses the late reproductive to late menopausal stages, is a unique time in women's lives. Access to Sexual Health and Sexual Wellbeing (SHSW) services, which include the prevention and management of sexually transmitted infections, contraception and the support of sexual function, pleasure and safety, is important for the health of midlife women, their relationships and community cohesion. The objective of this systematic review was to use the socio-ecological model to synthesise the barriers and enablers to SHSW services for midlife women in high income countries. Eighty-one studies were included; a minority specifically set out to study SHSW care for midlife women. The key barriers that emerged were the intersecting disadvantage of under-served groups, poor knowledge, about SHSW, and SHSW services, among women and their HealthCare Professionals (HCPs), and the over-arching effect of stigma, social connections, and psychological factors on access to care. Enablers included intergenerational learning, interdisciplinary and one-stop women-only services, integration of SHSW into other services, peer support programmes, representation of minoritised midlife women working in SHSW, local and free facilities, and financial incentives for under-served groups to access services. The appetite for education about SHSW and SHSW services among midlife women and their HCPs should be capitalised upon, and utilised to improve research, public health messaging, interventions and access to holistic services, particularly for midlife women from under-served groups. [ABSTRACT FROM AUTHOR]

Little attention has been given to questions of blocked access in public administration research. We draw on past scholarship on access: qualitative research accounts in public administration that address access processes, problems, and possibilities; and our own experience with access challenges in a public school setting involving public sector employees. This allowed us to detail three methodological principles to facilitate the initiation of ethnographic research while access was constantly (re)negotiated: accounting for regulations, rules, and ruling artifacts; meaningful events; and routine and non-routine artifacts. We investigated public administration regulations, events, and artifacts, developing and employing an empirical method to collect data under conditions where access to primary field sites is blocked based on the boundary condition of our investigation. By describing the research findings and their applications, we demonstrate that conceptualizing access problems as multiple data layers can provide researchers with profound insights into relational dynamics, thereby enriching qualitative inquiry in public administration research. We conclude by arguing that this approach remains highly relevant even as field access is constantly negotiated. [ABSTRACT FROM AUTHOR]

In-depth understanding of dementia carer experience can assist clinicians by providing insight into dementia onset, symptoms and management, and help conceptualize and understand the pattern of dementia progress over time and what help is needed. We undertook a qualitative study to understand dementia carers experiences of providing care and reasons for admission to a residential aged care facility (RACF). Three themes were identified: (1) Challenges in the path to diagnosis and care, leading to delays accessing support; (2) Carer role impacted by living circumstances; and (3) Variation in decision support prior to admission to a RACF. Identifying dementia carer experiences, reinforces the need for more timely diagnosis, referral for support and interventions to promote better quality of life for a people living with dementia and their carer and to delay premature RACF placement. [ABSTRACT FROM AUTHOR]

This article explores the Lamasco Microgallery, a grassroots initiative borne from a community grant in Evansville, Indiana. Beyond showcasing art, the microgallery embodies a public philosophy of inclusivity and accessibility, challenging traditional museum models and fostering social connection through the visual arts. This article examines the microgallery's conception, philosophy, and the impact of its first exhibition and community reception. It argues that such unconventional spaces offer valuable platforms for community engagement, empowering residents to engage with diverse perspectives and cultivate a more inclusive community. [ABSTRACT FROM AUTHOR]

The internationalization brought about by online finding aids and the United States' expanding diverse population necessitates a renewed focus on representation and accessibility in archival research. The accessibility of archival resources depends on the language in which the content is offered to the public. Throughout the United States, the Spanish-speaking population continues to grow. Employees in the University of North Texas Special Collections department obtained grant funding to translate finding aids and digital exhibits into Spanish, with an emphasis on finding a translation solution that offered a balance between cost and quality (i.e., readability and accuracy). This article discusses possible options for translation, including translation vendors, Office 365, and DeepL; findings of the project, with specifics about the cost-effectiveness and quality of each option; and general advice to other institutions interested in undertaking translation projects, regardless of available resources. [ABSTRACT FROM AUTHOR]

The purpose of this descriptive study was to examine enrollment in string orchestra instruction across Texas. Three central research questions guided the investigation: (a) How well is orchestra represented in districts and schools across the state of Texas? (b) What are the characteristics (FRPL eligibility, locale, student race/ethnicity, size/UIL classification) of schools with orchestra programs in Texas? and (c) How do program enrollment and UIL participation vary among these characteristics? Using 2015–2016 enrollment data collected by the Texas Education Agency, we examined string enrollment within secondary traditional public schools in the state. Major findings were that more than two-thirds of schools offering strings were Title I eligible campuses and enrollment on urban, Title I eligible, and African American or Hispanic majority campuses had lower string enrollments than their suburban, non-Title I, and White majority counterparts. [ABSTRACT FROM AUTHOR]

This article proposes a modified reading of Thomas Elsaesser's theories of cinephilia, taking into account the new viewing practices established by the rise of online media streaming. Elsaesser characterised early film culture (labelled as 'take one') as rooted in celluloid and marked by a longing to view films that were not always easily available. By contrast, his characterisation of the later 'take two' era is one in which each new distribution technology (television, VHS, and so on) promises greater abundance and convenience, to the point where this new generation of cinephiles – in response to the widespread success of DVD – were perceived as having to deal with the 'anachronisms generated by total availability'. Amanda D. Lotz argues that streaming services appear to provide an extension of the 'take two' ideal, offering assurances of ' availability (on-demand libraries with many choices) and reliability (you don't have to watch it now or it's gone)'. I suggest, however, that the underlying impermanence of streaming has prompted fears related to both access and ownership, marking a break from the expectations surrounding the DVD (as well as its successors Blu-ray and 4K Ultra HD). The impact of content migration – fracturing access between a greater number of paid platforms – and particularly content delisting – the outright removal of access to a given text – can place certain works in a form of limbo. This article proposes the dawn of a new generation of cinephilia – a potential take three – marked by a newfound concern of ephemerality, albeit much more potential and localised than the widespread unavailability of the take one era. In essence, then, take three wrestles with the anachronisms of loss in a media landscape that, in many other ways, offers unprecedented levels of access to film and television content. [ABSTRACT FROM AUTHOR]

Home health care has a significant role in the care of Medicare beneficiaries. Certificate of Need (CON) laws for home health agencies limit their number in affected states. This study's objective was to evaluate the association of CON laws with the availability and service utilization of urban and rural home health agencies in CON states and non-CON states using the generalized estimating equations (GEE) method. The results from this study indicated that CON states have fewer home health agencies for their Medicare population than non-CON states, regardless of urbanicity or rurality. Home health agencies in CON states also have less service utilization in terms of care episodes and visits per patient. This study provides an understanding of the effects of CON laws on Medicare beneficiaries' home health access and experiences. [ABSTRACT FROM AUTHOR]

Almost three quarters of mental illnesses start by the age of 25, yet youth (18–25-year-olds) are often underrepresented in U.K. services. This is particularly true for those of ethnic minorities. In this study, we aimed to understand how young Pakistani women and their parents make decisions to seek help for severe mental health problems, and the barriers and facilitators to accessing professional help. Young Pakistani women with experience of severe mental health problems and their parents were recruited from a community sample. Semi-structured interviews were conducted with six young people and two parents. Data were analyzed using reflexive thematic analysis. Pakistani culture and its interplay with British culture strongly influenced the decisions and ability of young Pakistani women and their parents to help-seek, largely through the role of stigma. Low mental health literacy, stigma, and a lack of culturally informed services were identified as the most common barriers to accessing care. These barriers fed into the internalized stigma these young women experienced which, through fear of damaged reputation and personal prejudices, posed further barriers to seeking help. Participants highlighted recommendations for both individual-level (e.g., increased education and awareness) and service-level (e.g., greater choice over care) change to facilitate accessibility of professional help. Young Pakistani women face multiple culturally related challenges to accessing care for severe mental health problems at both the individual- and service-level. Novel suggestions to address these challenges, such as including youth peer support workers in services, may facilitate more inclusive and accessible services. [ABSTRACT FROM AUTHOR]

Consumer-directed Care (CDC) empowers older people to flexibly arrange services and enhances their well-being. Prior studies have suggested that limited attention and hassle costs are major demand-side barriers to using CDC. However, many other psychosocial factors were unexplored. In this study, we explore associations between CDC utilization and a wider range of psychosocial factors based on behavioral economics theories. A cross-sectional telephone survey of older persons (or family members that represent them) was conducted in Guangzhou, China in 2021. We adopted a two-stage sampling method based on administrative records and analyzed the data using multivariate logistic models. Procedural literacy, hassle costs, and social norms regarding CDC were associated with using CDC. The findings reveal nuances in the decision-making process, and people are not unboundedly rational in making care-related decisions. Policymakers could employ cost-effective tools to facilitate CDC utilization and optimize resources to address the most crucial service barriers. [ABSTRACT FROM AUTHOR]

Introduction: When the United States adopted Nemeth Code within Unified English Braille (UEB) Contexts and UEB Math/Science in 2016, students who were using braille had to learn a new code for science, technology, engineering, and mathematics (STEM). In late 2016, Bell and Silverman surveyed students about their initial experiences transitioning to a new braille code. However, to date there has not been additional research that includes students' perspectives regarding the long-term effect of the transition to a new braille code on their ability to learn. The purpose of this study was to learn about students' experiences in transitioning to a new braille code, whether students receive STEM braille materials in a timely manner, the technology students use in STEM, and what advice students have for teachers of students with visual impairments. Methods: In the spring of 2021, 11 middle and high school students who use braille for STEM classes participated in one of three focus groups. The data were analyzed using open-coding methods. Results: All participants had initially learned the Nemeth Braille Code for Mathematics and Science Notation and subsequently transitioned to one of the new braille codes. Students typically characterized learning a new braille code as easy. Most of the students had experienced delays in receiving braille materials, which sometimes negatively affected their ability to learn. Students reported using a variety of mainstream and assistive technologies. Discussion: Students should have consistent access to high-quality STEM materials in a timely manner in the braille code that they prefer. The students in this study articulated their preferences and were willing to advocate for themselves to overcome learning challenges in their STEM courses. Implications for Practitioners: Teachers of students with visual impairments can partner with general education STEM teachers and administrators to resolve persistent issues. Teachers can encourage students to voice their preferences and assist students in developing strategies before challenges arise. [ABSTRACT FROM AUTHOR]

Many genre scholars have focused on how individuals might build genre knowledge, generally understood as the enculturation processes, gradual stages, or ingredients that lead to one's facility with a genre in context. While genre knowledge describes whether people can engage genres, it does not describe the various factors that shape how people may engage genres. By consolidating scholarship across Rhetorical Genre Studies (RGS), this article characterizes genre access as the power, opportunity, permission, and/or right to engage genre. Furthermore, this article integrates Network Gatekeeping Theory to develop a micro-level analytical approach for explicitly describing genre access. The author demonstrates and develops genre access as a concept and analytical approach with an illustrative example from a larger ethnographic project. Specifically, this illustrative example explores genre access for the Staff Report, a common genre in local government that proposes recommendations from individual departments to their elected City Commissioners for voted approval. Overall, the purpose of this article is (1) to consolidate and extend RGS's exploration of the power, opportunity, permission, and/or right to engage genres; (2) to identify and name genre access as a fundamental aspect of how genres work; and (3) to provide a micro-level analytical language for researchers to tease out the various factors the shape genre access. [ABSTRACT FROM AUTHOR]

Psychotherapy of different types is recognized across the globe as an essential component of child and adolescent mental health services. At the same time, there are barriers and challenges in obtaining access to this modality that are as widespread as its acceptance. This article reviews barriers to accessing child and adolescent psychotherapy in high-income countries (HIC) as well as low/middle-income countries (LMIC). It also briefly reviews approaches to improve access using different interventions and modalities. We also report on our experience using one particular intervention, case management within pediatric collaborative care, as a promising approach for improving access in underserved populations. [ABSTRACT FROM AUTHOR]

Background: There are few studies focusing on pediatric teledermatology, and the impact of a large-scale pediatric teledermatology program on the accessibility and efficiency of dermatology care remains unclear. This study evaluated the impact of a state-wide implementation of a store-and-forward teledermatology program augmented by the incorporation of dermoscopy in pediatric patients visiting community health centers. Methods: It was a descriptive, retrospective cohort study of 876 pediatric dermatology referrals. Results: In the traditional referral system, only 60 patients (17.6%) were seen by dermatologists with average waiting times of 75 days due to limited access. In comparison, with an implementation of dermoscopy-aided teledermatology, all 536 teledermatology referrals received dermatological care within 24 h, of which only 64 (12%) patients requires face-to-face (F2F) consultation. Patients referred for F2F consultation via eConsults had a much lower no-show rate as compared to the traditional referral system (39% vs. 71%). Side by side comparison between general population and pediatric population has demonstrated shared features in efficiency and access improvement but revealed specific characteristics of pediatric teledermatology in terms of diagnosis and treatment. Conclusion: Coordinated store-and-forward teledermatology platform with incorporation of dermoscopy between large community care network and dermatology provider can greatly improve access to pediatric dermatology care especially in underserved population. The efficiency of teledermatology in access improvement for pediatric population is comparable with adult population in eConsults. There are also unique features and challenges in pediatric teledermatology that require further research. [ABSTRACT FROM AUTHOR]

Introduction: To reduce COVID-19 exposure risk, virtual visits became widely adopted as a common form of healthcare delivery for the general population. It is unknown how this affected the deaf population, a sociolinguistic minority group that continues to face communication and healthcare barriers. The survey's objective was to describe the deaf participants' experiences with telehealth visits. Methods: A 28-item online survey, available in American Sign Language and English, was developed and disseminated between November 2020 and January 2021. Ninety-nine deaf participants responded. Descriptive statistics were performed to assess the participant's virtual health care use, experiences, and communication approaches. Results: Seventy-five percent of respondents used telehealth at least once in the past 12 months (n = 74; age = 37.6 ± 14.5 years). Of those who used telehealth, nearly two-thirds experienced communication challenges (65.3%; n = 49). Half of the participants reported having to connect via a video relay service that employs interpreters who maintain general certification instead of a remote interpreter with specialized health care interpreting certifications for video visits with their health care providers (n = 37) and a third of participants reported needing to use their residual hearing to communicate with their providers (n = 25). Conclusion: Standard protocols for health care systems and providers are needed to minimize the burden of access on deaf patients and ensure virtual visits are equitable. It is recommended these visits be offered on Health Insurance Portability and Accountability Act-compliant platforms and include multi-way video to allow for the inclusion of remote medical interpreters and/or real-time captionists to ensure effective communication between the provider and the deaf patient occurs. [ABSTRACT FROM AUTHOR]

Wikipedia, despite its volunteer-driven nature, stands as a trustworthy repository of information, thanks to its transparent and verifiable processes. However, Large Language Models (LLMs) often use Wikipedia as a source without acknowledging it, creating a disconnect between users and Wikipedia's rich framework. This poses a triple threat to information literacy, Wikipedia's vitality, and the potential for dynamic, updated information. This article explores the interplay between representation, accessibility, and LLMs on Wikipedia, highlighting the importance of preserving Wikipedia as a space for access, representation, and ultimately advocacy in an increasingly LLM-dominated information landscape. This article contends that, despite being over two decades old, Wikipedia remains vital not only for knowledge accumulation but also as a sanctuary for the future of knowledge representation, championing representation and accessibility in the age of closed-system LLMs. [ABSTRACT FROM AUTHOR]

Objective: Benefits of integration of palliative care early in the trajectory of a patient's serious illness are well established in the literature. Yet, barriers to palliative care access in the US continue to exist. The purpose of this study is to synthesize existing qualitative data of patient, caregiver, and clinician perceptions of palliative care (PC) that influence PC access and use in the US. Methods: A formal qualitative meta-synthesis was completed. The meta-synthesis included 1) a systematic literature search of qualitative studies conducted from 2016 to 2021, 2) a critical appraisal of the included studies, and 3) a reciprocal translation of the study's findings through an interpretive thematic analysis. Results: Seven articles met inclusion criteria resulting in a sample size of patients (n=18), caregivers (n=15), and clinicians (n=118). Three themes emerged with associated subthemes: knowledge and opinions of PC (subthemes of patient and caregiver knowledge and awareness and clinician knowledge and beliefs); care coordination and collaboration (subthemes of communication and trust); and social and structural drivers (subthemes of socioeconomic demographics and time and resources). Conclusions: This qualitative meta-synthesis identifies barriers and facilitators to palliative care access and use. The study findings illuminate the commonalities and differences of the perceptions of the three key stakeholder groups. In addition, this qualitative meta-synthesis reveals the complexities within the US healthcare system, and the challenges patients and their caregivers face accessing PC. [ABSTRACT FROM AUTHOR]

Background and Objectives: Despite the rapid increase in the number of people living with dementia in Brazil, dementia care is limited. This study describes how people living with dementia and their carers access care, treatment, and support, and identifies what characteristics are likely to enable or prevent access. Research Design and Methods: We created 10 vignettes to illustrate fictitious but realistic scenarios involving people living with dementia in Brazil. The vignettes explore a combination of socioeconomic and demographic variables. They were completed using an in-depth desk review of the dementia care landscape in Brazil; a Strengths, Opportunities, Weaknesses, and Threats (SWOT) analysis of the desk review; and expert knowledge. The analysis focused on identifying common sources of service provision, barriers of access to care and support, and specific issues experienced by some population groups. Findings: Access to a dementia diagnosis, care, and support for people living with dementia in Brazil is limited. Demographic and socio-economic circumstances play a role in determining the type of services to which a person might have access. Poor knowledge about dementia, lack of capacity in the health system, and lack of formal long-term care support are among the identified barriers to accessing timely diagnosis, care, and support in the country. Discussion and Implications: Understanding the barriers and facilitators of access to diagnosis, treatment, and support for people with dementia and families with different demographic and socioeconomic characteristics is crucial for designing dementia policies that are context-specific and responsive to the care needs of different socioeconomic groups in Brazil. [ABSTRACT FROM AUTHOR]

Botswana has achieved a lot in education development since the country's independence in 1966. Public education funding and access increased significantly, literacy rates rose, more schools were constructed and student enrolment rates increased at both primary and secondary schools. However, this paper argues that Botswana's education system has been declining over the past 10 years, but that is concealed by the use of political spectacle. The data collected from secondary sources were used and subjected to content analysis. The findings show high public education expenditure and access in Botswana, but high failure rates; success narratives and pronouncements without commitment to educational effectiveness and efficiency; massive construction of public schools, but poor teaching–learning conditions; and trivialization of meaningful education reforms. This paper concludes by recommending the introduction of learner-friendly methods of assessment, improving teacher–government relations, the inclusion of stakeholders in education decision-making and the implementation of cost–benefit and cost-effectiveness measures in Botswana's education. [ABSTRACT FROM AUTHOR]

Successful conservation in Africa hinges on the perceptions of communities bordering protected areas. It is therefore vital for protected area stakeholders to know the perceptions of neighbouring communities in order to determine the factors that generate or undermine community support for conservation, so that appropriate management interventions can be implemented. Numerous studies consider benefits, but less relate to perceptions regarding both losses/costs and intangible benefits. This paper demonstrates a methodology with which to determine these factors, focusing on Kekana Gardens community, bordering Dinokeng Game Reserve, in Gauteng Province, South Africa. This qualitative study with 13 residents utilised focus group interviews and adapted nominal grouping technique. Six themes emerged, four of which comprise intangible benefits. This methodology can be applied to any community bordering a conservation area, assisting in crafting solutions that benefit both people and parks. [ABSTRACT FROM AUTHOR]

Barriers to healthcare experienced by Australian autistic adults have not been previously explored. We conducted a cross-sectional investigation of barriers to healthcare and associated factors from a subtle realism perspective. Perceived barriers to healthcare were obtained from the Barriers to Healthcare Checklist Short-Form (BHC). A total of 263 autistic and 70 non-autistic individuals completed the BHC. On average, autistic adults reported more barriers to healthcare (4.58) than non-autistic adults (0.76). Gender diversity, higher levels of generalised anxiety, greater global disability and less satisfaction with social support contributed to the experience of barriers to healthcare in autistic participants in regression modelling. Australian autistic adults face substantial barriers to healthcare. Understanding these barriers provides an opportunity to develop approaches to improve access; such as co-designing a healthcare access roadmap for autistic adults, with co-designed policies and practices which advocate for the needs of autistic adults. This study looked at how Australian autistic and non-autistic adults experience barriers to healthcare. We asked autistic and non-autistic adults to complete the Barriers to Healthcare Checklist Short-Form (BHC). We analysed data from 263 autistic adults and 70 non-autistic adults. We found that autistic adults experienced more barriers to healthcare than non-autistic adults. Gender diversity, feeling more anxious, having greater disability and feeling unsatisfied with social support contributed to barriers to healthcare in autistic participants. We recommend interventions such as developing and implementing a national action plan, similar to the National Roadmap for Improving the Health of People with Intellectual Disability (2021) to reduce barriers and address unmet healthcare needs of Australian autistic adults. We also recommend working with autistic adults to develop new policies and strategies, implementing environmental adaptations to health care facilities, and increasing Autism education opportunities for health professionals to address gaps in knowledge. [ABSTRACT FROM AUTHOR]

Do US lobbying patterns extend to other countries? To date no study has systematically compared US lobbying patterns with those of other countries using observational data. Taking advantage of similar lobbying disclosure rules in the US and Canada, we create a cross-country lobbying dataset. We focus on the United States-Mexico-Canada Agreement (USMCA) to control for timing, salience, and issue scope. This helps us attribute differences in firm mobilization and trade lobbying strategies across the two countries to differences in political institutions. Strikingly different USMCA lobbying patterns emerge. Within the same industry, trade associations, the executive branch, and in-house lobbyists play a larger role in Canada. Meanwhile, well-established determinants of US lobbying fail to explain patterns of mobilization and the use of external lobbyists in Canada. These findings provide insights into comparative lobbying studies and indicate that some stylized facts about lobbying are unique features of the US political system. [ABSTRACT FROM AUTHOR]

Telemedicine is seen as a useful tool in reducing gaps in health care but this technology-enabled care can also exacerbate health inequity if not implemented with a focus on inclusivity. Though many studies have reported improvements as well as exacerbation of disparities in access to care in their telehealth programs, there does not exist a common evaluation tool to assess these programs. To mitigate the impact of COVID-19 on health care workers and protect medically vulnerable children, in March 2020 we expanded our pre-established specialty and subspecialty direct-to-patient pediatric telemedicine program in a high volume urban pediatric health system. Our program aimed to prevent disparities in pediatric health care. In this study, using a "Pillars of Access" approach as a model to evaluate impact and access to care of our direct-to-patient telemedicine program, we analyzed the patients that were seen pre-COVID versus post-COVID. Our study demonstrated an increase in telemedicine visits for patients from diverse socioeconomic and racial backgrounds, and geographically underserved communities. We also observed an increase in telemedicine visits for mental health complaints and for certain categories of high-risk patients. This study was not designed to identify language and cultural barriers to telemedicine. Future identification of these specific barriers is needed. The tool to evaluate telehealth impact/access to care through a "Pillars of Access" approach presented here could serve as a model for implementation of telehealth programs. Our study highlights telemedicine programs as a mechanism to address healthcare inequity and overcome barriers to care. [ABSTRACT FROM AUTHOR]

Objective: The lack of anticancer drugs for curative and supportive purposes is the critical reason for the low survival rate in low-and-middle-income countries. This study aims to analyze whether the National Essential Medicines List (NEML) and Registered Essential Medicines List (REML) are in concordance with the World Health Organization (WHO) Essential Medicines List (EML) and whether the formularies prevalent in the country are parallel to each other and to the NEML. Method: An observational study design was used in which antineoplastic drugs from the 2021 NEML and REML were compared with 2021 WHO EML to evaluate their availability in Pakistan. Market access was determined. Moreover, the formularies of six different hospital types were compared with each other and with the NEML, and REML to estimate the availability within hospitals. Results: There were 66 anticancer drugs in 2021 WHO EML and all were found in Pakistan's 2021 NEML but only 48 drugs (73%) were found in the REML. Hydroxycarbamide and dasatinib were two registered drugs absent in all hospitals' formularies. The market access for anticancer medicines was 73% (48 of 66). Semigovernment hospital (86%) has the highest availability, followed by the government hospital (80%). All the hospitals have unregistered drugs including bortezomib, lenalidomide, and mesna. Conclusion: Pakistan's NEML adopts WHO EML abruptly but all medicines are not registered. The hospitals are trying their best to increase availability but optimum drug regulations to revise NEML based on the country's requirements and emphasizing registration of anticancer medicines are needed to improve the country's availability of antineoplastic agents. [ABSTRACT FROM AUTHOR]

Rural women in Bangladesh usually have lack of access, control and ownership over their land property because of existing patriarchal norms of the rural society. The prime objective of this study was to assess the impact of rural women's access to land on their income as well as household income. A multistage, geographically clustered, probability-based sampling approach was adopted for this study. Primary data were collected from the rural women living in two selected districts of Bangladesh. The Propensity Score Matching technique was used to assess the impact of land accessibility on household income and rural women's income. The Binary Logistic Regression technique was used to assess women's opinions. The study findings revealed that land had a positive impact on household income but rural women's income did not increase significantly despite having access to land. This study also showed that income, level of education, the existence of NGO operated programs in villages, and the number of visits to NGO offices by rural women were the key factors contributing to improving their overall well-being. Findings imply that the government should design an appropriate land ownership policy that guarantees titling as well as access for women to land. [ABSTRACT FROM AUTHOR]

This qualitative study explored the impact of COVID-19 on older rural-dwelling veterans and their caregivers enrolled in home-based primary care (HBPC) through the Birmingham VA Health Care System (BVAHCS). Phone interviews were conducted with 16 veterans and/or their caregivers and rapid qualitative analysis of interview notes was performed. Average age of veterans was 77 (range = 69–97) and 93.7% were white males. Despite a significant number of co-morbidities, 68.8% reported minimal adverse impacts of COVID-19 on overall physical and mental health. Like many healthcare teams, the inter-disciplinary VA HBPC team incorporated Telehealth during COVID-19. Telehealth utilization varied among the 16 participants, with 50% using telehealth independently, 37.5% needing assistance, and 12% lacking access. Our findings are consistent with prior research that identifies resilient characteristics as potentially protective in this high-risk older veteran population during the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

Public transport is a viable option that can help persons with visual disability to overcome mobility challenges. The main aim of the review is to identify existing provisions, barriers, and/or access to public transport services for persons with visual disability. A scoping review was conducted based on the framework proposed by Arskey and O'Malley. A total of 16 studies were systematically selected out of 273 published literatures which was obtained from electronic database searches. Four themes emerged from the selected studies. The major theme was challenges related to accessing public transport from the perspective of persons with visual disability (PVD) with presentation of information, drivers/workers attitude, bus design, technological barriers, and accessibility of public spaces being the subthemes. The other three themes were the challenges reported by the transport drivers, available facilities/adaptations and resolutions, and policies and recommendations. In conclusion, the current review suggests that access to public transportation for persons with visual disability is considerably inadequate. Poor presentation of information, inappropriate driver attitude, and inconsistent bus design seem to be the major barriers persons with visual disability encounter during public transport travel. [ABSTRACT FROM AUTHOR]

Assistive technology (AT) devices are designed to help people with visual impairments (PVIs) perform activities that would otherwise be difficult or impossible. Devices specifically designed to assist PVIs by attempting to restore sight or substitute it for another sense have a very low uptake rate. This study, conducted in England, aimed to investigate why this is the case by assessing accessibility to knowledge, awareness, and satisfaction with AT in general and with sensory restoration and substitution devices in particular. From a sample of 25 PVIs, ranging from 21 to 68 years old, results showed that participants knew where to find AT information; however, health care providers were not the main source of this information. Participants reported good awareness of different ATs, and of technologies they would not use, but reported poor awareness of specific sensory substitution and restoration devices. Only three participants reported using AT, each with different devices and varying levels of satisfaction. The results from this study suggest a possible breakdown in communication between health care providers and PVIs, and dissociation between reported AT awareness and reported access to AT information. Moreover, awareness of sensory restoration and substitution devices is poor, which may explain the limited use of such technology. [ABSTRACT FROM AUTHOR]

According to a proverb often referring to the misery that prevails in restricted if enlightened surroundings, "It is dark under the lamp." Urban areas have emerged as centers of excellence as far as economic development is concerned. People coming from diverse cultural, professional, and economic backgrounds live in cities. Gaps their economic conditions have led to various clusters of people much different from their rural counterparts. Comparing between urban and rural areas, studies often argued that urban education is exceptionally better. Adopting "descriptive analysis" of both secondary and primary data, this study notes that students living in urban slums suffer in terms of three parameters (access, attendance, and academic performance) of K-8 education. Government-run education neglects students living in the slums and this enabled NGOs to step in. Students living in tin-sheds receive education mainly through the government's initiatives, while those living in flats attend private, international, and elite-public schools. Students who live in tin-sheds cannot compete with those who live in flats, let alone the slums. The Covid-19 pandemic has further aggravated this crisis. Substantial policy intervention by the government may be the only viable way to ensure developing nations' K-8 urban education is safe from criticism. [ABSTRACT FROM AUTHOR]

This article examines methodological dilemmas surrounding entrée, emotion, and epistemology that can arise when conducting qualitative research in carceral settings. We address how our research team navigated consent and presentations of self for maintaining access; how they managed empathy and the emotional toll of conducting research in adversarial settings; and how conflicting narratives raised questions about data validity and knowledge construction. Analysis reveals how institutional power dynamics shape behind-the-scenes methodological decisions we make during fieldwork. Without open discussion, researchers risk perpetuating the opacity we seek to diffuse and replicating the power dynamics we aim to objectively document within total institutions. [ABSTRACT FROM AUTHOR]

To help achieve the initial goal of providing universal COVID-19 vaccine access to approximately 258 million adults in 62 US jurisdictions, the federal government launched the Federal Retail Pharmacy Program (FRPP) on February 11, 2021. We describe FRPP's collaboration among the federal government, US jurisdictions, federal entity partners, and 21 national chain and independent pharmacy networks to provide large-scale access to COVID-19 vaccines, particularly in communities disproportionately affected by COVID-19 (eg, people aged ≥65 years, people from racial and ethnic minority groups). FRPP initially provided 10 000 vaccination sites for people to access COVID-19 vaccines, which was increased to >35 000 vaccination sites by May 2021 and sustained through January 31, 2022. From February 11, 2021, through January 31, 2022, FRPP vaccination sites received 293 million doses and administered 219 million doses, representing 45% of all COVID-19 immunizations provided nationwide (38% of all first doses, 72% of all booster doses). This unprecedented public–private partnership allowed the federal government to rapidly adapt and scale up an equitable vaccination program to reach adults, later expanding access to vaccine-eligible children, during the COVID-19 pandemic. As the largest federal COVID-19 vaccination program, FRPP exemplifies how public–private partnerships can expand access to immunizations during a public health emergency. Pharmacies can help meet critical national public health goals by serving as convenient access points for sustained health services. Lessons learned from this effort—including the importance of strong coordination and communication, efficient reporting systems and data quality, and increasing access to and demand for vaccine, among others—may help improve future immunization programs and support health system resiliency, emphasizing community-level access and health equity during public health emergencies. [ABSTRACT FROM AUTHOR]

Introduction: This study investigated the accessibility and usability of online job applications by individuals with visual impairments who use screen readers. Method: Three blind, experienced screen reader users on the research team attempted to complete online job applications from 30 randomly selected Fortune 500 companies, with 90 application trials attempted. Each tester used a different screen reader and browser combination. Results: The testers experienced significant barriers to completing the online job applications: 50 of 90 (55.6%) attempts were successful, but 23 of the 30 (76.7%) websites had critical issues that prevented at least one tester from completing the application. Testers found 694 accessibility issues and gave an average ease-of-use rating of 3.60 (SD = 1.05) out of 5 for the job application websites. Twenty-six of the job application websites were created by eight job application software vendors, with significant variation in accessibility across different applications using the same vendor. Discussion: The accessibility and usability issues identified with the majority of online job applications evaluated present an unnecessary barrier to employment for screen reader users. While the 55.6% success rate found in this study is considerably higher compared to previous research, only 23.3% of the job application websites were accessible to all three screen readers. Implications: Job application software vendors and companies that create their own online job applications should take a Universal Design approach by following the Web Content Accessibility Guidelines (WCAG) and implementing recommended solutions to increase the accessibility of their applications. Software vendors are encouraged to only offer accessible options for creating online job applications, such that companies would not be able to create an inaccessible form. [ABSTRACT FROM AUTHOR]

The National Health Protection (NHP) of Indonesia is a pro-poor social health insurance as the government pays the monthly premium for the poor. A waste picker is classified as an urban poor group needing affordable or free access to health care. This study explores the extent to which the NHP protects the health of waste pickers and provides them with quality health care. For this mixed-method study, 342 waste pickers completed the survey, 40 engaged in interviews, and 15 participated in Natural Group Discussions. The study found that 20% of waste pickers were not enrolled in NHP due to issues such as incorrect validation of poverty, discrimination, illegal fees, nepotism, unaffordable premiums, and lack of interest in purchasing the health plan. Among those who were enrolled, waste pickers expressed satisfaction with the health care they received and the behavior of the staff. However, they did criticize certain aspects such as waiting times, service gaps between full-paying and subsidized patients, suspicion of the quality of medicines, complicated medical administration procedures, and inflexibility of the capitation system. The study concludes that despite the NHP, poor groups remain vulnerable to accessing free health care. [ABSTRACT FROM AUTHOR]

We conducted interviews with clinicians and staff involved in Veterans' decisions about where to receive their health care to assess experiences with community care coordination and identify areas for improvement. Insufficient time and knowledge were cited as barriers to assisting Veterans in making decisions about whether to use community care resources. Concerns regarding quality of community care and lack of patient understanding on the implications of accessing community care also arose. Clinicians need to be able to help Veterans make informed choices about where to receive their health care and may require decision support that integrates their informational needs with their values and preferences, clarity on the referral process, and improved ways to measure and describe quality of care to Veterans. VA has recognized issues with community care and established new initiatives but the rollout is complex and ongoing. [ABSTRACT FROM AUTHOR]

Acceleration is an effective approach for many high ability students, and it can be especially beneficial for Black students. Upstander teachers are those who recognize educational crises and the problem of overlooked and underdeveloped gifts and talents of Black students in regular and gifted education programs. They proactively identify Black students' intellectual and academic strengths and plan not only enrichment services, but accelerated pathways for Black students to be appropriately challenged. Too many Black students with gifts and talents succumb to boredom, underachievement, and atrophy when bystander teachers have low academic expectations of them and fail to recommend them for academically rigorous advanced and accelerated learning experiences. The purpose of this article is to present acceleration as a means of creating equitable opportunities in gifted education for gifted Black students using Frasier's Four A's framework: attitude, access, assessment, and accommodation. Specifically, the following questions are addressed: What are upstander attitudes toward acceleration and related policies? How can upstander teachers know if a Black student is a good candidate for acceleration and increase their access to acceleration? How can upstander teachers provide equitable assessments of Black students for acceleration? What can upstander teachers do to support acceleration programming that accommodates the needs of gifted Black students? Six tables provide an overview of acceleration types, a guide to promote equitable acceleration, and considerations for accelerating gifted Black students. [ABSTRACT FROM AUTHOR]

Pedagogic practices are central to how feminists from the West and the subcontinent have envisaged the liberatory transformation of society. Feminist methods of teaching-learning emphasise making educational material accessible, the creation of communities of learners historically excluded from education, the re- education for educators and making learners independent and equipped to continue the process of learning. In the Indian context, feminist pedagogy is key to challenging and replacing the default patriarchal and Brahminic setting of academia that perpetuates exclusion even when it grants admission. Writing pedagogy, following feminist methods, is building step-by-step access to teaching-learning that makes academic reading and writing doable. In that, it is de-brahmanising academic writing from appearing to be mystically transmitted only to those born into the socio-cultural capital to receive it. Drawing from reports by observers and participants, this article demonstrates how a conscious pedagogy of writing reworks access to academic reading, writing and thinking to directly address issues of intersectional marginalisations of gender. [ABSTRACT FROM AUTHOR]

The focus of this methodological paper is to discuss the challenges of conducting fieldwork, using reflections from our experiences of accessing a research site for ethnographic data collection. The research project aimed to explore nurses' social relations in their workplace and the inequities between and within these relations among nurses of diverse social positions. Due to the sensitive nature of this topic, access to the research site posed several challenges and was further complicated by the bureaucratic ethics process that governs clinical sites in Australia. Although this study was considered a low and negligible risk research, negotiating the ethics process was full of hitches and hindrances resulting in the refusal of access. This paper offers ethnographers a reflection on challenges in accessing clinical sites to conduct research and a discussion of strategies that may be useful to navigate and counter these challenges by managing social relations in the field. [ABSTRACT FROM AUTHOR]

This study explores the Health Code (Chinese: 健康码), a digital contact tracing application used in Mainland China during the COVID-19 pandemic, and examines the process and impact of its entry into users' lives and gradual infrastructuralisation within the field of internet infrastructure research. Results show that techno-nationalism was the basis for the inception, implementation, and development of the Health Code. Furthermore, the Health Code has gradually transformed from an early digital health credential into a type of 'access infrastructure' by linking physical, information, and communication infrastructure. As access infrastructure, the relationship between the Health Code and users was a tense one, with users actively engaging in 'micro-help' on social media platforms and performing 'soft-resistance' on psychological and operational levels. Concurrently, the Health Code was embedded into users' usage habits and social culture, becoming a shared memory and potential digital infrastructure for the future. [ABSTRACT FROM AUTHOR]

Keywords: telemedicine; telephone; internet; access; disparities EN telemedicine telephone internet access disparities 623 626 4 08/10/23 20230801 NES 230801 Introduction The use of telemedicine increased during the COVID-19 pandemic, facilitated by changes to billing structures that allowed reimbursement for telephone- and video-based care.[1] Systematic reviews have found that telemedicine for mental health and substance use disorders is effective and associated with high patient satisfaction.[2],[3] Despite favourable outcomes with both telephone- and video-based care, proposals have emerged to reduce or eliminate physician compensation for telephone-based care, which may decrease the number of physicians providing this service.[4],[5] To our knowledge, no studies have examined how de-listing telephone services would impact disparities in access to telemedicine in Canada. Discussion This study suggests that eliminating telephone-based care would both decrease access to telemedicine among Canadian households and exacerbate disparities in access to telemedicine. Conclusion This study suggests that eliminating telephone-based care would both decrease potential access to telemedicine among Canadian households and exacerbate disparities in access to telemedicine. [Extracted from the article]

England's "right to roam" continues to be a misnomer which is uneven in scope and inclusivity. While the Countryside and Rights of Way Act 2000 opened access to privately owned mountains, moors, heaths, and downs, the changes were not as bold as they at first seemed and access was still restricted. The 2000 Act was representative of the contemporary atmosphere in which concern for accessibility and inclusivity was strongly qualified, with a focus on non-disabled walkers at the expense of others. Though physical disabilities were now better catered for, much less was said about intellectual disabilities, race, ethnicity, place, income, and transport. Such issues have gathered increased awareness in recent years, but more remains to be done if access to the countryside is to be more equal. This article examines how "right to roam" and access legislation developed, and how engagement with disabled people was limited from the outset. [ABSTRACT FROM AUTHOR]

In this article, we present six autoethnographies of lives marked by crisis that reflect on the issues of access, very broadly defined, that the COVID 19 pandemic has raised or redefined for each of us. As the time of crisis has made access concerns more and more evident it also exposes how access is not an issue just for disabled people, but for all lives. Drawing on recent scholarship in disability studies that critically interrogates access through an intersectional lens, we take this unexpected unveiling as an occasion to further tease out the complexities, ambiguities, and messiness of access. [ABSTRACT FROM AUTHOR]

Objective: To analyze the feasibility and results of up-and-over access (UOA) for catheter-directed thrombolysis (CDT) in acute iliofemoral popliteal venous thrombosis (IFPVT). Methods: From June 2020 to June 2021, a total of 26 patients (26 lower limbs) undergoing CDT for IFPVT were included. According to the vascular access, the patients were divided into UOA group (n = 11, 10 left limbs and 1 right limb) and ipsilateral popliteal vein (ILPV) (n = 15, 15 left limbs) access group. The differences in preoperative characteristics and technical details between the two groups were compared. Results: Patients in UOA group were older than those in ILPV access group (67.64 ± 4.11 years VS. 52.73 ± 15.63 years, p =.003). The BMI of UOA group was significantly higher than that of ILPV access group (26.03 ± 1.62 kg/m2 VS 24.71 ± 1.46 kg/m2, p =.039). There were significantly more patients with simultaneous three comorbidities in UOA group than in ILPV access group (45.5% vs. 0, p =.043). Compared with ILPV access group, the duration of operation and fluoroscopy of UOA group were significantly longer (20.64 ± 3.41 min vs. 10.20 ± 1.42 min, p <.001; 18.18 ± 2.99 min vs. 6.13 ± 0.92 min, p <.001), but the technical success rate was significantly lower (54.5% vs. 100%, p =.007). In UOA group, the operation-related complications occurred, including catheter straying into lateral sacral vein (9.1%), retroperitoneal hematoma (9.1%), and thrombus shedding into filter (9.1%). Conclusion: The UOA may be attempted in patients who are unable to be prone, but this access is not an optimal pathway for CDT. [ABSTRACT FROM AUTHOR]

In this article, we contribute to an emerging body of literature concerning the often-overlooked topics of access and consent in research. We posit our understanding of access and consent as continuous ethical reflection and negotiation, conceptualised here as ethical performance, which is particularly valuable in research in institutional contexts defined by numerous power asymmetries. We draw empirically from research on street-level institutional encounters between social work practitioners and migrant-background service users in the Helsinki capital region. Access in this research was a multi-stage process including various stage-related negotiations, and the previous stages always influenced the stages that followed. Nevertheless, access and consent were always erratic and subject to revision. We describe how the need for ethical reflexivity arises in various concrete, often unpredictable, situations, and argue for the importance of paying explicit analytical attention to negotiations regarding access and consent. [ABSTRACT FROM AUTHOR]

Existing studies on the contemporary U.S. urban-rural divide have neglected its potential role in non-voting political participation. Theoretically, there are mixed expectations: for example, higher social capital in rural areas, alongside a generally older population, suggest rural areas should have greater political participation. Conversely, lower socioeconomic indicators and more physical distance barriers suggest the opposite. Using nationally stratified survey data from the 2018 CCES (N = 61,000) and 2020 CES (N = 60,000), we find that specific participation behaviors do not consistently vary across the urban-rural spectrum, controlling for demographic variables. The few consistently significant differences relate to the nature of location-based access. For instance, using 2020 and 2021 ACLED data, we find that an activity where non-rural residents participate more—protesting—occurs less often in rural areas, thus stymieing participation opportunities for rural and small-town residents. Alternatively, rural and small-town residents are consistently more likely to put up a sign, which may reflect a greater incidence of living in houses with yards compared to urban residents. Social media political participation behaviors do not yield urban-rural differences, further suggesting that once geographic access-related barriers are removed, participation rates are essentially similar across the urban-rural spectrum. [ABSTRACT FROM AUTHOR]