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Background: Although cervical cancer (CC) is highly preventable through appropriate screening methods like the Papanicolaou (Pap) test, which enables early detection of malignant and precancerous lesions, access to such screening has not been equitable across social groups. Sex workers and people with records of incarceration are among the most under-screened populations in Ontario. Little is known about the acceptability and feasibility of HPV self-sampling (HPV-SS) as an alternative cervical cancer screening method for these groups. This online, community-based mixed-methods pilot study aimed to address this knowledge gap. Methods: Eighty-four under- and never-screened sex workers and ex-prisoners aged 25–69 years and residing in the Greater Toronto Area, were recruited by community peer associates. Participants completed an online survey and viewed short videos about CC and screening with Pap and HPV-SS. Those who opted for HPV-SS conducted the test at one of two collaborating organizations. Results: The median age of participants was 36.5 years. Most had limited knowledge about CC and screening. Approximately 13% identified as non-binary, and 5% as two-spirit or trans men, with the majority having completed secondary education. Of the participants, 88% chose HPV-SS, and one-third tested positive for high-risk HPV types. The ability to self-sample without judgment from healthcare providers was noted as a key advantage. However, there was a need for training on proper HPV-SS techniques. Conclusions: To improve cervical cancer screening among sex workers, increasing awareness through participatory community co-creation of sexual health education is essential. Additionally, offering HPV-SS as a screening option is crucial, given its demonstrated acceptability and feasibility within this population, many of whom lack a primary care provider and face discriminatory attitudes in healthcare settings.

Agriculture is responsible for 99.4% of ammonia (NH3) emissions in the Republic of Ireland and the country has failed to comply with limits set down by the European Union National Emissions Ceiling Directive (NECD) for 9 of the last 11 reporting years. Hence, there exists an urgent need to reduce NH3 emissions to control air pollution and moderate other related environmental and health hazards. This study carries out farm-level marginal abatement cost curve analysis across different farm typologies in the Republic of Ireland. The study also addresses the interactions amongst the considered abatement options and explores the presence of farm system heterogeneity. This allows an assessment as to whether it is sub-optimal to adopt a mitigation measure across different farm systems. Findings indicate that the measures examined in this study are effective in abating NH3 emissions at varying levels across the different farm typologies. Ammonia mitigation measures such as liming, switching to protected urea and a crude protein reduction in livestock diets were primarily cost-saving while the increased clover measure moved between cost-saving and cost-positive depending on the farm system type. The presence of heterogeneity across the farm typologies was generally supported in this study, highlighting that optimal policy design should be tailored to reflect farms’ characteristics. Furthermore, a lower abatement potential was reported for the combined implementation of selected mitigation measures compared to the sum of individual measures due to interaction effects.

Abstract Background There is an increasing public, societal and policy imperative for effective integration of healthcare delivery systems. Central to integration in healthcare is a focus on people-centred health, access, patient empowerment, interprofessional teamwork and collaboration between all healthcare stakeholders – difficult to achieve in current silo-driven bureaucratic health organisations. Therefore, actor-network theory (ANT) offers a theoretical approach to understanding the complexities of healthcare delivery by unpacking the type of actor’s interplay between social elements and immaterial objects, their interactions, interdependencies and power dynamics. Aims The first of its type, this systematic review aims to identify, synthesise, and appraise extant literature on the use and application of ANT in healthcare contexts. Methods This systematic review was conducted in accordance with PRISMA guidelines and registered with PROSPERO. The authors generated a search strategy utilising 31 Boolean terms, conducting electronic searches of MEDLINE, CINAHL Complete, SCOPUS, PubMed, APA PsycINFO, Business Source Complete and Academic Search Complete. The studies obtained were evaluated for inclusion based on their alignment with the specified inclusion and exclusion criteria. Studies were independently evaluated by the authors, with all data synthesised using a thematic analysis. Results From an initial 2,533 studies, the systematic review included 103 studies which utilised ANT within a healthcare context. The analysis of the studies identified trends in the application of ANT across healthcare which we categorised into four themes: healthcare delivery systems, technology and data, integrated care, and innovation management. The findings demonstrated variability and fragmentation in the application of ANT, often diverging from its fundamental principles. Conclusions Decluttering the literature suggests three dimensions for understanding the relationships of actors, unidimensional ANT – based on single actors, bi-dimensional ANT, the relationship between two actors and multi-dimensional ANT, where human and non-human actors interact to impact healthcare outcomes. The limited number of studies on the use of ANT for integrated healthcare research highlights both its importance to the topic and the considerable research gap that must be addressed.

Abstract Background Hypertension, or high blood pressure, is a key modifiable risk factor for heart disease and stroke. International guidelines have highlighted ‘poor adherence to treatment’ and ‘physician inertia’ as major barriers to effective blood pressure management. The Maximising Adherence, Minimising Inertia (MIAMI) intervention, a theory-based complex intervention, supports General Practitioners (GPs) and people with hypertension in maximising medication use to manage blood pressure. This pilot cluster randomised control trial (RCT) aimed to collect and analyse feasibility data to refine the MIAMI intervention and assess the feasibility of a definitive RCT. Method A pilot cluster RCT with a MIAMI intervention arm and usual care control arm was conducted. Quantitative data collection consisting of clinical measures and a self-report questionnaire took place at baseline and twelve week follow up. Semi-structured interviews with GP and patient participants were conducted. Fidelity (as measured by a protocol checklist and through qualitative interviews) and health economics costings were assessed. Results Six GP practices (intervention arm n = 3, control arm n = 3) and 52 patients (intervention arm n = 25, control arm n = 27) took part. All six GP practices and 92% of patients were retained. Fidelity, as measured by a checklist and through qualitative interviews, was good but three deviations from protocol were identified. Outcomes and measures used were acceptable. The implementation cost of the MIAMI intervention was estimated at €490 per participant. The qualitative data demonstrated that the intervention was considered acceptable and feasible by both GP and patient participants, except for the urine test component, which GPs found difficult to incorporate into practice due to logistical challenges. Conclusions The MIAMI intervention was considered largely acceptable and feasible. Some changes to both intervention components and trial processes are required but with these in place a definitive RCT could be considered worthwhile. Trial registration ISRCTN registry, ISRCTN85009436, registered 17/1/23.

Despite increased advocacy and investments in mental health systems globally, there has been limited progress in reducing mental disorder prevalence. In this paper, we argue that meaningful advancements in population mental health necessitate addressing the fundamental sources of shared distress. Using a systems perspective, economic structures and policies are identified as the potential cause of causes of mental ill-health. Neoliberal ideologies, prioritizing economic optimization and continuous growth, contribute to the promotion of individualism, job insecurity, increasing demands on workers, parental stress, social disconnection and a broad range of manifestations well-recognized to erode mental health. We emphasize the need for mental health researchers and advocates to increasingly engage with the economic policy discourse to draw attention to mental health and well-being implications. We call for a shift towards a well-being economy to better align commercial interests with collective well-being and social prosperity. The involvement of individuals with lived mental ill-health experiences, practitioners and researchers is needed to mobilize communities for change and influence economic policies to safeguard well-being. Additionally, we call for the establishment of national mental wealth observatories to inform coordinated health, social and economic policies and realize the transition to a more sustainable well-being economy that offers promise for progress on population mental health outcomes. [phrase omitted] Malgre une meilleure sensibilisation et des investissements accrus dans A pesar del aumento de la promocion y las inversiones en sistemas de salud mental en todo el mundo, los avances en la reduccion de la prevalencia de los trastornos mentales han sido limitados. En este documento, sostenemos que para lograr avances significativos en la salud mental de la poblacion es necesario abordar las fuentes fundamentales de la angustia compartida. Mediante una perspectiva sistemica, las estructuras y politicas economicas se identifican como la posible causa de los problemas de salud mental. Las ideologias neoliberales, que priorizan la optimizacion economica y el crecimiento continuo, contribuyen al fomento del individualismo, la inseguridad laboral, el aumento de las exigencias a los trabajadores, el estres parental, la desconexion social y una gran variedad de manifestaciones bien reconocidas que perjudican la salud mental. Insistimos en la necesidad de que los investigadores y los defensores de la salud mental se impliquen cada vez mas en el discurso de la politica economica para atraer la atencion sobre las implicaciones para la salud mental y el bienestar. Pedimos un cambio hacia una economia del bienestar para alinear mejor los intereses comerciales con el bienestar colectivo y la prosperidad social. Para movilizar a las comunidades en favor del cambio e influir en las politicas economicas con el fin de salvaguardar el bienestar, es necesaria la participacion de personas que han padecido enfermedades mentales, profesionales e investigadores. Ademas, pedimos la creacion de observatorios nacionales de bienestar mental que sirvan de base a las politicas sanitarias, sociales y economicas coordinadas y permitan la transicion a una economia del bienestar mas sostenible, que ofrezca perspectivas de progreso en los resultados de salud mental de la poblacion. [phrase omitted] A pesar del aumento de la promocion y las inversiones en sistemas de salud mental en todo el mundo, los avances en la reduccion de la prevalencia de los trastornos mentales han sido limitados. En este documento, sostenemos que para lograr avances significativos en la salud mental de la poblacion es necesario abordar las fuentes fundamentales de la angustia compartida. Mediante una perspectiva sistemica, las estructuras y politicas economicas se identifican como la posible causa de los problemas de salud mental. Las ideologias neoliberales, que priorizan la optimizacion economica y el crecimiento continuo, contribuyen al fomento del individualismo, la inseguridad laboral, el aumento de las exigencias a los trabajadores, el estres parental, la desconexion social y una gran variedad de manifestaciones bien reconocidas que perjudican la salud mental. Insistimos en la necesidad de que los investigadores y los defensores de la salud mental se impliquen cada vez mas en el discurso de la politica economica para atraer la atencion sobre las implicaciones para la salud mental y el bienestar. Pedimos un cambio hacia una economia del bienestar para alinear mejor los intereses comerciales con el bienestar colectivo y la prosperidad social. Para movilizar a las comunidades en favor del cambio e influir en las politicas economicas con el fin de salvaguardar el bienestar, es necesaria la participacion de personas que han padecido enfermedades mentales, profesionales e investigadores. Ademas, pedimos la creacion de observatorios nacionales de bienestar mental que sirvan de base a las politicas sanitarias, sociales y economicas coordinadas y permitan la transicion a una economia del bienestar mas sostenible, que ofrezca perspectivas de progreso en los resultados de salud mental de la poblacion., Introduction Mental health systems are under-resourced, fragmented, inefficient and unable to meet the demands of the growing burden of mental and substance use disorders. Despite the intensive advocacy and action [...]

Abstract Firecrackers are a vital element of cultural festivities that happen worldwide. However, the hazardous by-products they emit have a significant impact on environmental pollution, leading to the greenhouse effect and climate change. Aluminium powder serves as the fuel in the traditional flash powder mixture, nitrate of potassium serves as an oxidizing agent, and sulphur acts as the igniter at exact concentrations. The presence of sulfur in the flash powder mixture is critical as it acts as an igniter, contributing to the formation of sulfur dioxide, which can cause environmental harm. We carried out an experiment employing Sargassum wightii brown seaweed powder as a replacement for sulphur at specific amounts to lessen the effects of sulphur in flash powder. We discovered that Sargassum wightii brown seaweed powder may replace up to 50% of the sulphur significance in the flash powder mixture without impairing the flash powder's traditional performance. Our experiments included impact and friction sensitivity, SEM, and FTIR analyses to evaluate the improved flash powder composition. The results revealed that the modified flash powder mixture SP5 and SP10 emits less emission by 12% and 21%, and produces similar noise performance of 108 and 107 dB(A) to the normal flash powder composition (SP), affirming that the SP10 flash powder is a viable alternative. Moreover, in our relentless pursuit to mitigate the detrimental effects on our environment, we have ingeniously introduced a novel product—the Chinese cracker made from vegetable waste paper. Not only does this innovative solution address concerns regarding land pollution, but it also presents a sustainable approach to consumer goods.

Abstract Healthcare requires practitioners to successfully negotiate boundaries between communities of practice (CoP) in a clinical landscape of practice (LoP), with development of interprofessional identity important in promoting successful interprofessional collaboration. Interprofessional education (IPE) centered around acute hospital inpatients offers a potential pathway to encourage boundary negotiation and interprofessional identity development. This study aimed to explore interprofessional student teams and their interactions with patients in an acute hospital setting, while investigating if such interactions encouraged interprofessional collaboration and the development of an interprofessional identity. Pivoting around acute hospital inpatients, four interprofessional workshops occurred involving senior medicine, nursing and physiotherapy students. We utilized a concurrent mixed methods design, with qualitative predominating. Qualitative reflexive thematic analysis of post-workshop semi-structured focus groups was supported by quantitative investigation using a validated pre-test post-test international socialisation and valuing scale. Using the landscapes of practice theory lens, we noted that the central role of acute hospital inpatients in the IPE workshops enabled healthcare students to develop knowledgeability of the clinical LoP, in line with the three modes of identification of LoP, namely Engagement, Imagination and Alignment. Following the IPE workshops, where acute inpatients played the pivotal role, students demonstrated a statistically significant increase in interprofessional collaborative practice in terms of the overall interprofessional socialisation and valuing scale and its subscales of value, ability, and comfort in working with each other. Our findings indicate that IPE centered around acute hospital inpatients is a beneficial and effective way to successfully implement IPE in the undergraduate curriculum.

Abstract Omaveloxolone is a nuclear factor (erythroid‐derived 2)‐like 2 activator approved in the United States and the European Union for the treatment of patients with Friedreich ataxia aged ≥16 years, with a recommended dosage of 150 mg orally once daily on an empty stomach. The effect of the US Food and Drug Administration (FDA) high‐fat breakfast on the pharmacokinetic profile of omaveloxolone observed in study 408‐C‐1703 (NCT03664453) deviated from the usual linear correlation between fed/fasted maximum plasma concentration (Cmax) and area under the concentration–time curve (AUC) ratios reported for various oral drugs across 323 food effect studies. Here, physiologically based biopharmaceutics modeling (PBBM) was implemented to predict and explain the effect of the FDA high‐fat breakfast on a 150‐mg dose of omaveloxolone. The model was developed and validated based on dissolution and pharmacokinetic data available across dose‐ranging, food effect, and drug–drug interaction clinical studies. PBBM predictions support clinical observations of the unique effect of a high‐fat meal on omaveloxolone pharmacokinetic profile, in which the Cmax increased by 350% with only a 15% increase in the AUC. Key parameters influencing omaveloxolone pharmacokinetics in the fasted state based on a parameter sensitivity analysis included bile salt solubilization, CYP3A4 activity, drug substance particle size distribution, and permeability. Mechanistically, in vivo omaveloxolone absorption was solubility and dissolution rate limited. However, in the fed state, higher bile salt solubilization led to more rapid dissolution with predominant absorption in the upper gastrointestinal tract, resulting in increased susceptibility to first‐pass gut extraction; this accounts for the lack of correlation between Cmax and AUC for omaveloxolone.

Abstract Background Research suggests an association between COVID-19 infection and certain financial hardships in the shorter term and among single-state and privately insured samples. Whether COVID-19 is associated with financial hardship in the longer-term or among socially vulnerable populations is unknown. Therefore, we examined whether COVID-19 was associated with a range of financial hardships 18 months after initial infection among a national cohort of Veterans enrolled in the Veterans Health Administration (VHA)—the largest national integrated health system in the US. We additionally explored the association between Veteran characteristics and financial hardship during the pandemic, irrespective of COVID-19. Methods We conducted a prospective, telephone-based survey. Out of 600 Veterans with COVID-19 from October 2020 through April 2021 who were invited to participate, 194 Veterans with COVID-19 and 194 matched comparators without a history of infection participated. Financial hardship outcomes included overall health-related financial strain, two behavioral financial hardships (e.g., taking less medication than prescribed due to cost), and seven material financial hardships (e.g., using up most or all savings). Weighted generalized estimating equations were used to estimate risk ratios (RR) and 95% confidence intervals (CI) of financial hardship by COVID-19 status, and to assess the relationship between infection and Veteran age, VHA copay status, and comorbidity score, irrespective of COVID-19 status. Results Among 388 respondents, 67% reported at least one type of financial hardship since March 2020, with 21% reporting behavioral hardships and 64% material hardships; 8% reported severe-to-extreme health-related financial strain. Compared with uninfected matched comparators, Veterans with a history of COVID-19 had greater risks of severe-to-extreme health-related financial strain (RR: 4.0, CI: 1.4–11.2), taking less medication due to cost (RR: 2.9, 95% CI: 1.0–8.6), and having a loved one take time off work to care for them (RR: 1.9, CI: 1.1–3.6). Irrespective of COVID-19 status, Veterans aged

The professional development (PD) of early childhood educators (ECEs) is key to childcare quality. The Professional Learning Community (PLC) model has been well-researched in K-12 settings and is found to have advantages over traditional models of PD; thus, it holds promise for educators in other settings such as early childhood education centers. Indeed, there is an increasing call for the implementation of this model in ECE settings. Some research has found that supporting ECEs' professional learning (PL) through PLC development is a promising approach; nonetheless, PLCs remain under-researched in early childhood contexts, and findings are less conclusive. The current study examined the potential of PLC development for supporting learning about Dialogic Reading (DR) -- a topic of interest to ECEs. In the current study, ECEs in one Canadian context participated in an online project in which they concurrently learned about the PLC model and DR. Our research, including ECEs' written reflections, and video data of the ECE-child storybook reading, yielded novel findings. These findings suggest that ECEs learned to employ the specific techniques of dialogic reading for engaging children and enriching the dialogic interactions during storybook reading, while also learning to enact processes associated with a PLC model. The ECEs attributed several features of the PLC model to deepening their DR learning. These findings and their implications for practice and future research are further considered.

This article describes how, the authors, as members of an action research writing group, responded to a comment about feeling vulnerable in risking bringing their work-in-progress to the group and in giving feedback to colleagues by adopting a cooperative inquiry approach to explore vulnerability and risk in the group. In cooperative inquiry group members act as both co-researcher and co-subject in the inquiry and action. The article describes the evolution of the group and how the topic of exploring risk and vulnerability emerged. The group's exploration is grounded in the theory and practice of cooperative inquiry that gives voice to the group members questioning and reflecting. The article concludes by offering three propositions to enhance the work of writing groups.

The current study investigated adolescents' (N = 213) decision finding processes and affective reactions to interactions on social media "via" 29 focus groups. As part of a larger study, adolescents participated in focus groups at two time-points across an academic year while participating in a school-based intervention promoting healthy romantic, interpersonal, and family relationships, job readiness, and financial literacy. Qualitative analyses indicated adolescents' experiences and decisions on social media platforms were informed by their "awareness of audiences", namely who they thought would view their posts and anticipated responses from "friends," "family members," "fans," "creeps," and "potential employers." Comprehensive school-based interventions may serve to effectively develop responsibility more broadly, as well as a specific awareness about online risks and behaviors.

Racial microaggressions, or subtle race-based insults are associated with negative consequences for receivers. Institutional racism in education directly influences the dissemination of these transgressions in schools, as school personnel may engage in microaggressive behavior toward each other and their students. Given recent calls to address racism, schools and districts may seek to implement trainings to improve school personnel's understanding of these transgressions and their consequences. As part of the current study, we explored factors that might contribute to school personnel's satisfaction with a microaggression training. Participants completed survey items to assess their colorblind racial attitudes, satisfaction with the workshop, and their perceptions surrounding the need for such trainings. We found that colorblind attitudes and perceptions of necessity predicted satisfaction. Implications and future directions for research are discussed. Impact Statement: Calls to address racial injustice in response to the murders of George Floyd and Breonna Taylor during the summer of 2021 have produced an increase in requests for antiracism workshops and trainings across several organizations and professions. In K-12 schools, these trainings may be beneficial in helping school personnel learn about and address racial microaggressions (race-based insults), which may hinder students' success. Although it is imperative that these conversations take place, it is equally important that we are able to understand how school personnel engage in these trainings to increase the likelihood that their behavior will change because of participation. The goal of this study was to understand factors that contribute to school personnel's satisfaction with a microaggression training.

An increasing body of work has found higher education to be a challenging and stressful environment. Meanwhile, research on workaholism, characterised by an uncontrollable urge to work excessively, has been gaining momentum. However, few studies have explored its impact within higher education. This study addressed this gap by conducting 27 semi-structured interviews with academics in the greater Dublin region, exploring the micro, meso, and macro-level factors influencing workaholism. Using a constructivist grounded theory approach, the study examined workaholism in higher education, unpacking Clark, Smith, and Haynes ([2020]. "The Multidimensional Workaholism Scale: Linking the Conceptualization and Measurement of Workaholism." "Journal of Applied Psychology" 105 (11): 1281-1307.) recent definition of workaholism as a multidimensional construct comprising motivation, cognition, emotion, and behaviour. Twelve participants displayed tendencies of excessive working and constant thoughts about work, driven by negative feelings when not working. These tendencies were rooted in motivations to gain control and build a personal brand. All elements of workaholism have micro, meso, and macro influences, understood through a transdisciplinary lens. As a result, this study calls for responsible, sustainable management within higher education to avoid the negative impacts of workaholism on academics, students, and institutions.

This systematic review aims to describe six types of physical activity interventions utilized with children and young adults ages 5-22 as a treatment for ASD. These interventions include swimming, cycling, neuromuscular training, yoga, sports, and exergaming. This examines the knowledge gaps regarding the details of these interventions via time (sessions, per week, overall length), the severity of ASD in participants (using a 4-point scale), and the outcomes specific to ASD (cognition, social skills, physical fitness, and behavior). A systematic search of peer-reviewed research articles was conducted across five databases focusing on physical activity as an intervention for children and young adults with ASD. From an initial screening of 387 records, 29 of the studies were included in the review. The analysis includes types of intervention, dependent measures, research design, and intervention duration. Types of intervention most studied (swimming, cycling, neuromuscular training, yoga, sports, and exergaming) were further analyzed. All studies found that physical activity as an intervention, improved aspects of physical fitness (endurance, strength, balance), cognition, social skills (language, eye contact, engaging with others), and/or behavior.

Category: Ankle; Trauma Introduction/Purpose: Ankle fractures are extremely common orthopaedic injuries that frequently require surgical fixation. In the post-operative setting these fractures are routinely monitored with radiographs. However, the utility of routine post-operative imaging in clinically asymptomatic patients is unclear. This study sought to examine how frequently post-operative radiographs result in management changing decisions for operatively treated ankle fractures. We further sought to identify whether the indication for the study would play a role in the clinical utility of the examination. Methods: This was a retrospective study conducted at a single level 1 trauma center. A detailed review of the hospital’s electronic health record was performed. All patients with operatively treated ankle fractures over a two-year period were identified. Patients required at least one post-operative xray for inclusion. Xrays were divided into surveillance xrays and clinically correlated xrays. Surveillance xrays were those obtained in otherwise asymptomatic patients ordered as part of standard clinic workflow. Clinically indicated xrays were defined as any xrays taken outside of the standard workflow or those in which there was a documented concern noted by the patient or provider. To quantify the cost associated with xrays, we performed a cost analysis. A multivariate logistic regression was then performed using patient demographic variables, fracture characteristics (open vs closed, comminution, syndesmotic injury), and whether the study was performed with a clinical concern or as part of standard asymptomatic follow-up screening. Results: A total of 193 patients with 438 xrays met inclusion criteria. Overall, five asymptomatic radiographs were determined to have changed management (1.3% of all asymptomatic xrays), while 18 clinically correlated xrays were determined to have resulted in a change in management or clinical decision making(38.3%). The difference between number of management changing studies between asymptomatic vs clinically driven xrays was significant (p < 0.001). The elimination of all asymptomatic xrays over the study period would have resulted in a savings of 21,825.62 USD per year. In the logistic regression, the only factor found to be significant in predicting a change in management was the presence of a documented clinical concern voiced by the patient (p < 0001). Conclusion: Screening radiographs in clinically asymptomatic patients with operatively managed ankle fractures have a low likelihood (Approx. 1%) of changing management. Such imaging represents costs to the healthcare system, increased time for patients during clinic visits, and radiation exposure. Such studies remain commonplace because of the concern for missed or delayed diagnosis. Future surveillance protocols must strike a careful balance between minimizing unnecessary studies, maximizing early complication detection, and being personalized towards individual patient level factors so as to optimize care and efficiency for both patient and health system.