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Due to the mirror symmetry breaking, chiral structures show fantastic electromagnetic (EM) properties involving negative refraction, giant optical activity, circular dichroism and asymmetric transmission. Aligned electric and magnetic dipoles excited in chiral structures contribute to the extraordinary properties. However, the chiral structures that exhibit n -fold rotational symmetry show a limited tunability of the chirality. In this paper, we propose a compact, light, and highly tunable anisotropic chiral structure to overcome this limitation and realize a linear-to-circular polarization conversion. The anisotropy is due to simultaneous excitations of two different pairs of aligned electric and magnetic dipoles. The 3-D omega-shaped structure, etched on two sides of one printed circuit board (PCB) with connecting metallic vias, achieves 60% of linear-to-circular conversion (transmission) efficiency at the operating frequency of 9.2 GHz. The desired 90° phase shift between the two orthogonal linear polarizations is not only from the chirality but also from the anisotropic chiral response slightly off the resonance. The work enables elegant and practical polarization control of EM waves.

Abstract Background Home-based care (HBC) services have gained global attention for their potential to reduce caregiver burden among informal caregivers of persons with dementia (PwDs), who experience high caregiving intensity. However, research on HBC and its effects on dementia caregiving in China remains limited. Methods Data were collected from primary caregivers of PwDs in Jiangsu Province, China. Caregiving intensity and HBC utilization were measured using self-developed instruments. Caregiver burden was assessed by The Burden Scale for Family Caregivers-short. Factor analysis was employed to decompose HBC services. Hierarchical multiple regression analysed the moderating effects of HBC on the relationship between caregiving intensity and burden. Results A community sample of 318 caregiver and PwDs dyads was included. Caregivers averagely aged 62.16 years, with 61% being female, 84% not employed, and 66.2% having low income. PwDs aged 77.45 years averagely, with 52.8% being female and an average behavioural problems score of 42.27. Caregivers averaged 15.19 on response measures. The number and time spent on ADL-based tasks were positively associated with caregiver burden (β = 0.26, p

BackgroundmHealth has increasingly been touted as having the potential to help Sub-Saharan Africa achieve their health-related sustainable development goals by reducing maternal mortality rates. Such interventions are implemented as one-way or two-way systems where maternal clients receive pregnancy related information via SMS. While such technologies often view the users (the maternal health client) as having agency to adopt, we know from pregnancy literature that the pregnancy experience in Africa and other developing countries is often more collective. In addition to the maternal health client, other members of the community have high stakes in the pregnancy, and this often affects maternal healthcare-seeking behavior.ObjectiveThe aim of this paper, therefore, is to understand the pathways through which these other members of the community affect mHealth use.MethodsThe study used a qualitative approach and a case study research design. We analyzed two mHealth cases from Kenya and Malawi. In the Kenyan case, maternal health clients had mobile phones to receive pregnancy-related messages, while in the Malawi case, maternal health clients did not have mobile phones. Data were collected through interviews and focus group discussions. The study used an inductive thematic analysis to analyze the data.ResultsThe findings show that maternal stakeholders form a community of purpose (CoP) that plays a crucial role in the implementation, uptake, and use of mHealth. The CoP influences maternal health clients through a diverse range of mechanisms ranging from sensitization, bridging the digital literacy gap and legitimization of the intervention. The nature of influence is largely dependent on the contextual socio-cultural nuances.ConclusionOur results provide useful insights to mHealth implementers to know how best to leverage the CoP for better mHealth uptake and usage. For example, engaging healthcare providers could champion adoption and use, while engaging other family-related stakeholders will ensure better usage and compliance, encourage behavior change, and reduce mHealth attrition.

Abstract Background Carers of patients with advanced organ failure (AOF) experience a tremendous caregiving burden. Social capital utilizes the internal strength of a community to support its members and may provide carers with comprehensive support. This study aimed to identify the different sources of social capital that can support carers of patients with AOF from the perspectives of stakeholders. Method A descriptive qualitative study was conducted in community settings from April 2021 to May 2022. Stakeholders from medical social work departments, self-help groups, and non-governmental organizations were recruited, while some community members were invited through online media platforms. Individual semi-structured interviews were conducted using an interview guide. Interview transcripts were analyzed using a qualitative description approach. In total, 98 stakeholders, including 25 carers, 25 patients, 24 professionals, and 24 community members, were recruited using purposive and snowball sampling. Results Six categories about social capital for carers emerged, namely, carer attributes, the community, social care services, healthcare services, information, and policies. While the attributes of carers and their relationships with care recipients had a significant influence on caregiving, support from different groups in the community, such as neighbors and employers, was valued. Good communication of information about caregiving and social services was emphasized as being helpful by carers and other stakeholders. While carers presented a need for various healthcare and social care services, several features of these services, including their person-centeredness and proactive reach, were deemed useful. At the societal level, policies and research on comprehensive supportive services are warranted. The different sources of social capital constitute a multi-layer support system in the community. Conclusion Carers can utilize personal attributes, interpersonal relationships, community resources, and societal contexts to enhance their caregiving. While this system can serve as a framework for building carer-friendly communities, interventions may be required to strengthen some aspects of social capital.

Abstract Background The COVID-19 pandemic has caused more than 462,417 deaths worldwide. A large number of patients with severe COVID-19 face death in hospital. Hospice care is truly a philosophy of care that delivers patient-centred care to the terminally ill and their families. Hospice care could provide many benefits for patients, families, and for hospice caregivers. The aim of this study is to investigate hospice care self-efficacy and identify its predictors among Chinese clinical medical staff in COVID-19 isolation wards of designated hospitals. Methods A cross-sectional design was used. The Hospice Care Self-Efficacy, Self-Competence in Death Work Scale, Positive Aspects of Caregiving, and Simplified Coping Style Questionnaires were administered between February and April 2020. A total of 281 eligible medical staff responded to the questionnaires, with a response rate of ≥78.9%. Results The mean score of hospice care self-efficacy was 47.04 (SD = 7.72). Self-efficacy was predicted by self-competence in death work (B = 0.433, P

Objectives: The coronavirus-19 (COVID-19) pandemic has claimed more than 5 million lives worldwide by November 2021. Implementation of lockdown measures, reallocation of medical resources, compounded by the reluctance to seek help, makes it exceptionally challenging for people with non-communicable diseases (NCD) to manage their diseases. This review evaluates the spill-over impact of the COVID-19 pandemic on people with NCDs including cardiovascular diseases, cancer, diabetes mellitus, chronic respiratory disease, chronic kidney disease, dementia, mental health disorders, and musculoskeletal disorders.Methods: Literature published in English was identified from PubMed and medRxiv from January 1, 2019 to November 30, 2020. A total of 119 articles were selected from 6,546 publications found.Results: The reduction of in-person care, screening procedures, delays in diagnosis, treatment, and social distancing policies have unanimously led to undesirable impacts on both physical and psychological health of NCD patients. This is projected to contribute to more excess deaths in the future.Conclusion: The spill-over impact of COVID-19 on patients with NCD is just beginning to unravel, extra efforts must be taken for planning the resumption of NCD healthcare services post-pandemic.

In this exploratory study, we examine political polarization regarding the online discussion of the COVID-19 pandemic. We use data from Reddit to explore the differences in the topics emphasized by different subreddits according to political ideology. We also examine whether there are systematic differences in the credibility of sources shared by the subscribers of subreddits that vary by ideology, and in the tendency to share information from sources implicated in spreading COVID-19 misinformation. Our results show polarization in topics of discussion: the Trump, White House, and economic relief topics are statistically more prominent in liberal subreddits, and China and deaths topics are more prominent in conservative subreddits. There are also significant differences between liberal and conservative subreddits in their preferences for news sources. Liberal subreddits share and discuss articles from more credible news sources than conservative subreddits, and conservative subreddits are more likely than liberal subreddits to share articles from sites flagged for publishing COVID-19 misinformation.

BackgroundThe growth of mobile technology in developing countries, coupled with pressing maternal health care challenges, has led to a widespread implementation of maternal mobile health (mHealth) innovations. However, reviews generating insights on how the characteristics of the interventions influence use are scarce. ObjectiveThis study aims to review maternal mHealth interventions in Kenya to explore the influence of intervention design and implementation characteristics on use by maternal health clients. We also provide a starting inventory for maternal mHealth interventions in the country. MethodsUsing a systematic approach, we retrieved a total of 1100 citations from both peer-reviewed and gray sources. Articles were screened on the basis of an inclusion and exclusion criterion, and the results synthesized by categorizing and characterizing the interventions presented in the articles. The first phase of the literature search was conducted between January and April 2019, and the second phase was conducted between April and June 2021. ResultsA total of 16 articles were retrieved, comprising 13 maternal mHealth interventions. The study highlighted various mHealth design and implementation characteristics that may influence the use of these interventions. ConclusionsIn addition to elaborating on insights that would be useful in the design and implementation of future interventions, this study contributes to a local inventory of maternal mHealth interventions that may be useful to researchers and implementers in mHealth. This study highlights the need for explanatory studies to elucidate maternal mHealth use, while complementing existing evidence on mHealth effectiveness.

Objective. This study aimed to examine the frequency and predictive factors of adverse oral and dental outcomes in patients with rheumatoid arthritis (RA) with the goal to address their unmet dental healthcare needs in the metropolitan city of Hong Kong. Methods. 238 RA patients followed up at local public hospitals were recruited in this cross-sectional study. A full dental examination was performed. Data were compared with the retrospective data collected from age-matched control groups in the community conducted in a territory-wide oral health survey in 2011. Predictive factors for severe periodontitis including various demographic and disease-specific factors were examined by multiple logistic regression analysis. Results. Loose teeth and gum bleeding were frequent dental complaints. Only 85.0% of RA patients had >20 natural teeth. Total edentulism was observed in 3.8% of patients, which was higher among adult (22–64 years) and elderly (>65 years old) RA patients than their respective age-matched community control groups. RA patients had a higher decayed, missing, and filled tooth score. Adult RA patients had a 5.3-fold increase in risk of severe periodontitis than their community counterparts. The plaque index was the main predisposing factor for severe periodontitis (odds ratio 17.5, p=0.001), which was worse among the 22–34 age group of patients. More RA patients required tooth extraction compared to dental filling for their community controls. Conclusion. Severe periodontitis is a major cause of unmet dental healthcare needs among RA patients in Hong Kong. It is recommended that dental care plans for RA patients be commenced early among newly diagnosed patients.

BackgroundMany maternal clients from poorly resourced communities die from preventable pregnancy-related complications. The situation is especially grave in sub-Saharan Africa. Mobile health (mHealth) interventions have the potential to improve maternal health outcomes. mHealth interventions are used to encourage behavioral change for health care–seeking by maternal clients. However, the appropriation of such interventions among maternal health clients is not always guaranteed. ObjectiveThis study aims to understand how maternal clients appropriate mHealth interventions and the factors that affect this appropriation. MethodsThis study used a hermeneutic literature review informed by the model of technology appropriation. We used data from three mHealth case studies in sub-Saharan Africa: Mobile Technology for Community Health, MomConnect, and Chipatala Cha Pa Foni. We used the search and acquisition hermeneutic circle to identify and retrieve peer-reviewed and gray literature from the Web of Science, Google Scholar, Google, and PubMed. We selected 17 papers for analysis. We organized the findings using three levels of the appropriation process: adoption, adaptation, and integration. ResultsThis study found that several factors affected how maternal clients appropriated mHealth interventions. The study noted that it is paramount that mHealth designers and implementers should consider the context of mHealth interventions when designing and implementing interventions. However, the usefulness of an mHealth intervention may enhance how maternal health clients appropriate it. Furthermore, a community of purpose around the maternal client may be vital to the success of the mHealth intervention. ConclusionsThe design and implementation of interventions have the potential to exacerbate inequalities within communities. To mitigate against inequalities during appropriation, it is recommended that communities of purpose be included in the design and implementation of maternal mHealth interventions.

This article provides findings from a study, in South Africa’s Western Cape Province, of microenterprises’ experiences and perceptions of use of information and communication technologies (ICTs) for general business activities and for acquiring online government business support information. Using the capability approach (CA) theoretical framework, the study analysed data from interviews with microenterprise owners and digital government experts. The study found that the microenterprises were adept in their use of ICTs in their businesses, but that they encountered problems in using online government business support information services. These problems were found to be the result of deficiencies in the online services’ content, structure, design, navigation, mobile-friendliness, language usage and bureaucratic requirements.

Abstract Introduction The importance of our study lies in the fact that we have demonstrated the occurrence of mechanical dysfunction within polypoid tissues, which promotes the development of polyps in the nasal cavity. Objective To change the paradigm of nasal polyposis (NP). In this new conception, the chronic nasal inflammatory process that occurs in response to allergies, to pollution, to changes in the epithelial barrier, or to other factors is merely the trigger of the development of the disease in individuals with a genetic predisposition to an abnormal tissue remodeling process, which leads to a derangement of the mechanical properties of the nasal mucosa and, consequently, allows it to grow unchecked. Data Synthesis We propose a fundamentally new approach to intervening in the pathological process of NP, addressing biomechanical properties, fluid dynamics, and the concept of surface tension. Conclusion The incorporation of biomechanical knowledge into our understanding of NP provides a new perspective to help elucidate the physiology and the pathology of nasal polyps, and new avenues for the treatment and cure of NP.

Background: Municipalities in South Africa are currently grappling with the introduction of Integrated Financial Management Information Systems (IFMIS) to improve financial management. Integrated Financial Management Information Systems have been found to be an important tool for economic growth and development by ensuring that municipalities have appropriate management of public resources with the goal of enhancing service delivery to the citizens. Integrated Financial Management Information Systems have been introduced in municipalities in South Africa; however, they have not widespread been used. Previous research mentions wide-range bottlenecks for the acceptance of new technology in government departments, among which are insufficient attention to change management process and acceptance by intended end-users. Objective: This research study focused on the post-implementation evaluation of IFMIS in municipalities, as well as challenges affecting the implementation of IFMIS. The aim was to establish areas of improvement in the implementation of IFMIS. Method: Three stages (unfreezing, change and refreezing) and eight steps for successful change management were used as theoretical background to investigate this study. The study employed a qualitative approach and case study research strategy underpinned by the interpretivist philosophical paradigm. The study was performed in five municipalities of the Western Cape province, Republic of South Africa. Interviews were conducted using 16 end-users who were assigned to use IFMIS for work purposes; and specifically, three end-users were interviewed in each of the five municipalities. Deductive thematic analysis was used to analyse the factors affecting change management in the implementation of IFMIS. Results: Findings show that the implementation of IFMIS in municipalities was a top-down approach that encompasses a linear process where systems were implemented by external vendors, and then introduced to end-users afterwards. The study revealed that end-users were not involved in the implementation, and also that there are challenges affecting system use because of non-involvement of end-users during system implementation. Conclusion: Implementation should be a user-oriented process, thus resulting in resistance to systems use. End-users should be part of the implementation process and their recommendations should be incorporated in the implementation process because people are more likely to accept the forthcoming change if they know what to expect.

Severe acute respiratory infections (SARI) remain one of the leading causes of mortality around the world in all age groups. There is large global variation in epidemiology, clinical management and outcomes, including mortality. We performed a short period observational data collection in critical care units distributed globally during regional peak SARI seasons from 1 January 2016 until 31 August 2017, using standardised data collection tools. Data were collected for 1 week on all admitted patients who met the inclusion criteria for SARI, with follow-up to hospital discharge. Proportions of patients across regions were compared for microbiology, management strategies and outcomes. Regions were divided geographically and economically according to World Bank definitions. Data were collected for 682 patients from 95 hospitals and 23 countries. The overall mortality was 9.5%. Of the patients, 21.7% were children, with case fatality proportions of 1% for those less than 5 years. The highest mortality was in those above 60 years, at 18.6%. Case fatality varied by region: East Asia and Pacific 10.2% (21 of 206), Sub-Saharan Africa 4.3% (8 of 188), South Asia 0% (0 of 35), North America 13.6% (25 of 184), and Europe and Central Asia 14.3% (9 of 63). Mortality in low-income and low-middle-income countries combined was 4% as compared with 14% in high-income countries. Organ dysfunction scores calculated on presentation in 560 patients where full data were available revealed Sequential Organ Failure Assessment (SOFA) scores on presentation were significantly associated with mortality and hospital length of stay. Patients in East Asia and Pacific (48%) and North America (24%) had the highest SOFA scores of >12. Multivariable analysis demonstrated that initial SOFA score and age were independent predictors of hospital survival. There was variability across regions and income groupings for the critical care management and outcomes of SARI. Intensive care unit-specific factors, geography and management features were less reliable than baseline severity for predicting ultimate outcome. These findings may help in planning future outbreak severity assessments, but more globally representative data are required.

This study employed finite element analysis to simulate ultrasonic metal bump direct bonding. The stress distribution on bonding interfaces in metal bump arrays made of Al, Cu, and Ni/Pd/Au was simulated by adjusting geometrical parameters of the bumps, including the shape, size, and height; the bonding was performed with ultrasonic vibration with a frequency of 35 kHz under a force of 200 N, temperature of 200 °C, and duration of 5 s. The simulation results revealed that the maximum stress of square bumps was greater than that of round bumps. The maximum stress of little square bumps was at least 15% greater than those of little round bumps and big round bumps. An experimental demonstration was performed in which bumps were created on Si chips through Al sputtering and lithography processes. Subtractive lithography etching was the only effective process for the bonding of bumps, and Ar plasma treatment magnified the joint strength. The actual joint shear strength was positively proportional to the simulated maximum stress. Specifically, the shear strength reached 44.6 MPa in the case of ultrasonic bonding for the little Al square bumps.

This paper investigates factors that motivate educators to use Information Communication Technologies (ICTs) in schools in disadvantaged areas. The study employed Herzberg' Motivation-Hygiene theory to guide the process of understanding the factors that motivate or demotivate educators when using the technology for teaching and learning. Qualitative research approach was used to gather and analyse information from educators from randomly sampled schools located in disadvantaged areas in the Western Cape. The study has shown that educators' motivation to use technology for curriculum delivery could be impacted by satisfaction derived from using the ICTs, individual expectations, responsibility and a sense of achievement experienced when using the technologies.

This article contributes a theoretical perspective on aspirations and technology in ICT4D research. The paper examines the aspirations for professional development of undergraduate pre-service teachers in South Africa, and the extent to which these are marked by or influence the formation of technology attitudes. It is found that the relations between professional aspirations and attitudes towards technology are fairly complex, and of mutual determination: technology is seen as a capacity enabler, instrumental in helping pre-service teachers fulfil their professional aspirations, which in turn motivate them to understand and integrate technology in their future teaching. The implications of this argument for wider ICT4D scholarship are discussed.