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Assisted reproductive technologies (ARTs) have become a widely utilized medical technology for treating infertility worldwide. However, societies and countries have applied these technologies in accordance with their cultural practices and belief systems. This paper presents an overview of ART providers in Bangladesh and analyzes their online content in addressing potential infertile couples. Examining the topic within the context of socio-economic and public health challenges in Bangladesh, particularly overpopulation, poverty, and lack of education, the research conducted a web content analysis of ART providers in Bangladesh from July 1 to September 1, 2023. Twenty active ART providers were identified using Google searches and an exploratory key. The analysis considered locations, landing page information, ethical standards, quality certification, foreign affiliations, and success rates. The findings revealed a concentration of centers in urban areas, raising concerns about equitable access. The absence of regulation and guidelines, coupled with the lack of ART clinic registration, highlighted potential risks to patient well-being. Landing page statements utilized highly emotive language and ambiguous terms, raising ethical concerns. The absence of explicit mention of quality standards, including ISO 9001:2000 certification, indicated potential gaps in transparency. Foreign affiliations were employed for credibility, raising concerns of misleading advertising. Limited and ambiguous reporting of success rates posed challenges for informed decision-making. Evident exploitative and commercialized practices raised concerns about potentially commodifying reproductive services. The study emphasizes the need for regulatory frameworks, transparency in reporting, adherence to ethical advertising, and increased cultural sensitivity to enhance the ethical standards of ART providers in Bangladesh. [ABSTRACT FROM AUTHOR]

Purpose: This study investigates the impact of patient characteristics and demographics on hospital charges for tonsillectomy as a treatment for pediatric obstructive sleep apnea (OSA). The aim is to identify potential disparities in hospital charges and contribute to efforts for equitable access to care. Methods: Data from the 2016 Healthcare Cost and Utilization Project (HCUP) Kid Inpatient Database (KID) was analyzed. The sample included 3,304 pediatric patients undergoing tonsillectomy ± adenoidectomy for OSA. Variables such as age, race, length of stay, hospital region, residential location, payer information, and median household income were collected. The primary outcome variable was hospital charge. Statistical analyses, including t-tests, ANOVA, and multiple linear regression, were conducted. Results: Among 3,304 pediatric patients undergoing tonsillectomy for OSA. The average total charges for tonsillectomy were $26,400, with a mean length of stay of 1.70 days. Significant differences in charges were observed based on patient race, hospital region, and payer information. No significant differences were found based on gender, discharge quarter, residential location, or median household income. Multiple linear regression showed race, hospital region, and residential location were significant predictors of total hospital charges. Conclusion: This study highlights the influence of patient demographics and regional factors on hospital charges for pediatric tonsillectomy in OSA cases. These findings underscore the importance of addressing potential disparities in healthcare access and resource allocation to ensure equitable care for children with OSA. Efforts should be made to promote fair and affordable treatment for all pediatric OSA patients, regardless of their demographic backgrounds. [ABSTRACT FROM AUTHOR]

In the 21st century, mega-constellations and interconnected satellite constellations deployed at various orbital altitudes, such as LEO, MEO, and GEO, with low Earth orbits (LEOs) being the most commonly used, have emerged as a trend, aiming to enhance the productivity and reduce the costs in space service delivery. The UNOOSA has noted the uncertainty in the exact number of satellites but conducted simulations based on a substantial sample, projecting a significant increase from the 2075 satellites recorded in orbit in 2018. This surge in the launch of mega-constellations poses profound challenges to existing international space laws, originally formulated with limited consideration for private space actors, who are increasingly engaging in space activities, particularly with the cost-effective utilization of mega-constellations. This study critically analyzes the compatibility of mega-constellations with the current international space laws by examining the applicability of mega-constellations concerning equitable access and the non-appropriation principle, addressing their potential occupation of substantial orbital spaces during activities, and analyzing whether the acquisition of orbital slot licenses violates these two principles. Following an in-depth analysis, this study proposes recommendations to amend the existing laws, aiming to resolve ambiguities and address emerging challenges. Recognizing the time-consuming process of amending international space laws, this study suggests practical recommendations for supplementary rules of the road, prompting reflection on the potential obsolescence of the current international space laws in the face of evolving space activities. [ABSTRACT FROM AUTHOR]

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Abstract Background Access to primary healthcare services is a core lever for reducing health inequalities. Population groups living with certain individual social characteristics are disproportionately more likely to experience barriers accessing care. This study identified profiles of access and continuity experiences of patients registered with a family physician working in team-based primary healthcare clinics and explored the associations of these profiles with individual and organizational characteristics. Methods A cross-sectional e-survey was conducted between September 2022 and April 2023. All registered adult patients with an email address at 104 team-based primary healthcare clinics in Quebec were invited to participate. Latent class analysis was used to identify patient profiles based on nine components of access to care and continuity experiences. Multinomial logistic regression models were fit to analyze each profile’s association with ten characteristics related to individual sociodemographics, perceived heath status, chronic conditions and two related to clinic area and size. Results Based on 87,155 patients who reported on their experience, four profiles were identified. “Easy access and continuity” (42% of respondents) was characterized by ease in almost all access and continuity components. Three profiles were characterized by diverging access and/or continuity difficulties. “Challenging booking” (32%) was characterized by patients having to try several times to obtain an appointment at their clinic. “Challenging continuity” (9%) was characterized by patients having to repeat information that should have been in their file. “Access and continuity barriers” (16%) was characterized by difficulties with all access and continuity components. Female gender and poor perceived health significantly increased the risk of belonging to the three profiles associated with difficulties by 1.5. Being a recently arrived immigrant (p = 0.036), having less than a high school education (p = 0.002) and being registered at a large clinic (p

The Victorian Precision Oncology Summit, convened in 2023, was a joint initiative between the Victorian Comprehensive Cancer Centre Alliance (VCCC Alliance) and the Monash Partners Comprehensive Cancer Consortium (MPCCC) and was proposed to guide a coordinated state-wide conversation about how the oncology sector can overcome some of the current obstacles in achieving equity of access to clinical cancer genomics for Victorian patients. Themes that emerged from discussion groups at the Summit include standardisation, centralisation, funding, education and communication and insights across those themes are outlined in this manuscript. The event served as a large consultation piece for the development of a broader precision oncology roadmap, which explores equitable access to molecular testing for Victorian patients, currently in development by the VCCC Alliance and MPCCC in collaboration with other key Victorian and national stakeholders. While this symposium was a Victorian initiative, it is felt that the insights garnered from this consultation piece will be of interest to consumer groups, clinicians, researchers, educators, policy makers and other key stakeholders in other states of Australia as well as in other countries implementing comprehensive genomic profiling within complex health systems.

The Victorian Precision Oncology Summit, convened in 2023, was a joint initiative between the Victorian Comprehensive Cancer Centre Alliance (VCCC Alliance) and the Monash Partners Comprehensive Cancer Consortium (MPCCC) and was proposed to guide a coordinated state-wide conversation about how the oncology sector can overcome some of the current obstacles in achieving equity of access to clinical cancer genomics for Victorian patients. Themes that emerged from discussion groups at the Summit include standardisation, centralisation, funding, education and communication and insights across those themes are outlined in this manuscript. The event served as a large consultation piece for the development of a broader precision oncology roadmap, which explores equitable access to molecular testing for Victorian patients, currently in development by the VCCC Alliance and MPCCC in collaboration with other key Victorian and national stakeholders. While this symposium was a Victorian initiative, it is felt that the insights garnered from this consultation piece will be of interest to consumer groups, clinicians, researchers, educators, policy makers and other key stakeholders in other states of Australia as well as in other countries implementing comprehensive genomic profiling within complex health systems. [ABSTRACT FROM AUTHOR]

Outdoor environmental education aims to immerse students in environmental spaces and create opportunities for classroom learning to be applied in the field. However, students from Black, Indigenous, and People of Color (BIPOC) and low-income communities often have less access to these educational opportunities. This study examined the environmental education programs of nine community organizations in the San Francisco (SF) Bay Area. Through twenty-one interviews with program educators, we assessed two areas: (1) place-based learning being used as a connective tool for students and the community, and (2) ways in which access barriers to programming were addressed. Findings showed that community spaces, like gardens, brought students and the community together to reinforce the mission of place-based learning. Additionally, the findings contribute to the field of outdoor environmental education and place-based education by addressing how local organizations strategized to support equitable access through tactics like financial support and multilingual programming and materials. [ABSTRACT FROM AUTHOR]

Microscopy core facilities are increasingly utilised research resources, but they are generally only available to users within the host institution. Such localised access misses an opportunity to facilitate research across a broader user base. Here, we present the model of an open‐access microscopy facility, using the Advanced Imaging Center (AIC) at Howard Hughes Medical Institute Janelia Research Campus as an example. The AIC has pioneered a model whereby advanced microscopy technologies and expertise are made accessible to researchers on a global scale. We detail our experiences in addressing the considerable challenges associated with this model for those who may be interested in launching an open‐access imaging facility. Importantly, we focus on how this model can empower researchers, particularly those from resource‐constrained settings. [ABSTRACT FROM AUTHOR]

This article explores how the African Vaccine Manufacturing Accelerator can support the sustainable production of vaccines in Africa. It highlights the value of the accelerator in relation to the Regional Vaccine Manufacturing Collaborative. The author proposes that this novel financing instrument should be well-designed and implemented in line with the targets of the Partnerships for African Vaccine Manufacturing. It should not be a decoupling tool to appease the institutional environment of the global vaccine market, but a sustainable demonstration of the goodwill and commitment of political and technical leaders to ensure equitable access to routine and epidemic-related vaccines in Africa. [ABSTRACT FROM AUTHOR]

In September 2023, prominent voices in Open Science and FAIR Data gathered in São Paulo, Brazil to celebrate the 25th anniversary of the Scientific Electronic Library Online (SciELO). Presentations and workshops were held that reviewed progress in the previous decades and scoped priorities for the time to come. The celebration was organised around the ideas of Open Science with Impact, Diversity, Equity, Inclusion and Accessibility (IDEIA). Here, I give a brief report on discussions around Accessibility. [ABSTRACT FROM AUTHOR]

Adolescents and young adults (AYAs) with cancer, representing those between 15 and 39 years of age, face distinctive challenges balancing their life stage with the physical, emotional, and social impacts of a cancer diagnosis. These challenges include fertility concerns, disruptions to educational and occupational pursuits, issues related to body image and sexual health, and the need for age-appropriate psychosocial support within their communities. The Princess Margaret Cancer Centre (PM), a quaternary care center, established a specialized AYA program in 2014, offering holistic and developmentally tailored psychosocial support and currently, efforts are underway to expand this to other regions in the province to address the need for equitable access. The establishment process involves securing funding, conducting an environmental scan, identifying service gaps, developing clinical pathways, and implementing AYA supportive care. An accessible AYA program should also consider social determinants of health, social location, intersectionality, and an interdisciplinary health approach in understanding health inequities in AYA oncology care. This paper describes the processes implemented and challenges faced in creating a community-based AYA program beyond major resource-rich cities and efforts to address intersectionality. [ABSTRACT FROM AUTHOR]

In April 2020, the World Health Organization launched a COVID-19 Vaccines Global Access (COVAX) Facility, a groundbreaking public health policy, to work "for global equitable access to COVID-19 vaccines". Although innovative, it fails to bridge the 'immunization gap' between high-income and low-income countries. The main reasons for this include: (1) failure to provide adequate incentives for self-financing countries to participate; (2) failure to design the vaccine allocation mechanism to reflect to national political considerations along with the perspective of medical ethics; (3) lack independent financing and power to enforce the policies globally. Constraints have limited the effectiveness of COVAX to date but transforming it into an information center to provide information on vaccine supply and demand, disseminate vaccine knowledge, and publish requests for help can accelerate progress. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic demonstrated that the current purely market-driven approaches to drug discovery and development alone are insufficient to drive equitable access to new therapies either in preparation for, or in response to, pandemics. A new global framework driven by equity is under negotiation at the World Health Organization to support pandemic preparedness and response. Some believe that the global intellectual property (IP) system itself is part of the problem and propose a purely Open Science approach. In this article, we discuss how existing IP frameworks and contractual agreements may be used to create rights and obligations to generate a more effective global response in future, drawing on experience gained in the COVID Moonshot program, a purely Open Science collaboration, and the ASAP AViDD drug discovery consortium, which uses a hybrid, phased model of Open Science, patent filing and contractual agreements. We conclude that ‘straight to generic’ drug discovery is appropriate in some domains, and that targeted patent protection, coupled with open licensing, can offer a route to generating affordable and equitable access for therapy areas where market forces have failed. The Extended Data contains a copy of our model IP policy, which can be used as a template by other discovery efforts seeking to ensure their drug candidates can be developed for globally equitable and affordable access.

Nonadherence to physicians’ recommendations can have a detrimental impact on patient health, to say nothing of the financial cost to the already unsustainable Canadian healthcare system. This comparative study aimed at gaining a deeper understanding of the factors influencing adherence to prescribed medications and lifestyle change recommendations among First Nations patients and patients of European ancestry. In-depth, face-to-face interviews were conducted with 40 participants in Northern British Columbia, Canada. Interviews were transcribed and qualitatively analyzed. Results show that medical adherence derives from an interaction between personal factors and situational or external factors. A comparative analysis revealed that a disproportionate number of First Nations patients faced situational barriers that impeded with medical adherence. These factors include geographical isolation, lack of access to a regular doctor, negative healthcare experiences, and financial constraints. Analyzed through a postcolonial interpretive lens, the research findings highlight the need to reduce systemic barriers within the healthcare system and the wider social context, especially among First Nations patients living in remote communities.

Adolescents and young adults (AYAs) with cancer, representing those between 15 and 39 years of age, face distinctive challenges balancing their life stage with the physical, emotional, and social impacts of a cancer diagnosis. These challenges include fertility concerns, disruptions to educational and occupational pursuits, issues related to body image and sexual health, and the need for age-appropriate psychosocial support within their communities. The Princess Margaret Cancer Centre (PM), a quaternary care center, established a specialized AYA program in 2014, offering holistic and developmentally tailored psychosocial support and currently, efforts are underway to expand this to other regions in the province to address the need for equitable access. The establishment process involves securing funding, conducting an environmental scan, identifying service gaps, developing clinical pathways, and implementing AYA supportive care. An accessible AYA program should also consider social determinants of health, social location, intersectionality, and an interdisciplinary health approach in understanding health inequities in AYA oncology care. This paper describes the processes implemented and challenges faced in creating a community-based AYA program beyond major resource-rich cities and efforts to address intersectionality.

In the 21st century, mega-constellations and interconnected satellite constellations deployed at various orbital altitudes, such as LEO, MEO, and GEO, with low Earth orbits (LEOs) being the most commonly used, have emerged as a trend, aiming to enhance the productivity and reduce the costs in space service delivery. The UNOOSA has noted the uncertainty in the exact number of satellites but conducted simulations based on a substantial sample, projecting a significant increase from the 2075 satellites recorded in orbit in 2018. This surge in the launch of mega-constellations poses profound challenges to existing international space laws, originally formulated with limited consideration for private space actors, who are increasingly engaging in space activities, particularly with the cost-effective utilization of mega-constellations. This study critically analyzes the compatibility of mega-constellations with the current international space laws by examining the applicability of mega-constellations concerning equitable access and the non-appropriation principle, addressing their potential occupation of substantial orbital spaces during activities, and analyzing whether the acquisition of orbital slot licenses violates these two principles. Following an in-depth analysis, this study proposes recommendations to amend the existing laws, aiming to resolve ambiguities and address emerging challenges. Recognizing the time-consuming process of amending international space laws, this study suggests practical recommendations for supplementary rules of the road, prompting reflection on the potential obsolescence of the current international space laws in the face of evolving space activities.

90% of the UK diabetic population are classified as T2DM. This study aims to compare outcomes after SPK transplant between recipients with T1DM or T2DM. Data on all UK SPK transplants from 2003-2019 were obtained from the NHSBT Registry (n = 2,236). Current SPK transplant selection criteria for T2DM requires insulin treatment and recipient BMI < 30 kg/m². After exclusions (re-transplants/ambiguous type of diabetes) we had a cohort of n = 2,154. Graft (GS) and patient (PS) survival analyses were conducted using Kaplan-Meier plots and Cox-regression models. Complications were compared using chisquared analyses. 95.6% of SPK transplants were performed in recipients with T1DM (n = 2,060). Univariate analysis showed comparable outcomes for pancreas GS at 1 year (p = 0.120), 3 years (p = 0.237), and 10 years (p = 0.196) and kidney GS at 1 year (p = 0.438), 3 years (p = 0.548), and 10 years (p = 0.947). PS was comparable at 1 year (p = 0.886) and 3 years (p = 0.237) and at 10 years (p = 0.161). Multi-variate analysis showed comparable outcomes in pancreas GS (p = 0.564, HR 1.221, 95% CI 0.619, 2.406) and PS(p = 0.556, HR 1.280, 95% CI 0.563, 2.911). Comparable rates of common complications were demonstrated. This is the largest series outside of the US evaluating outcomes after SPK transplants and shows similar outcomes between T1DM and T2DM recipients. It is hoped dissemination of this data will lead to increased referral rates and assessment of T2DM patients who could benefit from SPK transplantation. [ABSTRACT FROM AUTHOR]

The utilisation of telehealth among culturally and linguistically diverse communities in Australia remains unexplored. We aimed to describe telehealth (telephone and videoconference) utilisation within a major health service and identify sociodemographic factors that may contribute to limited telehealth access. Methods. A cross-sectional study was performed using service activity data from four metropolitan hospitals in Queensland, Australia. Outpatient department data (January to December 2021) were examined. These data included patients (N = 153 427) of all ages who had an outpatient appointment within 10 speciality services (i.e. Hepatology, Gastroenterology, Immunology and Psychology) that were the most frequent videoconference users. This study measured telehealth utilisation across the four tertiary hospitals and its association with sociodemographic factors. Descriptive statistics and regression analysis were used. Multivariate regression models were adjusted by sex, socioeconomic level and language use. Results. Overall, 39% of appointments were delivered through telehealth, with 65% of all reported telehealth services involving a telephone consultation. People who required interpreter services were 66% less likely to use telehealth services (OR adjusted 0.33, 95% CI 0.31–0.36, P < 0.05) than English-speaking people. Among those using telehealth, people requiring interpreter services were 13% less likely to use videoconference than phone (OR adjusted 0.87, 95% CI 0.77–0.98, P < 0.005). Conclusion. There is a gap in Australian telehealth service use for people with culturally diverse backgrounds and limited English proficiency. This study highlights a critical need to determine how people from culturally diverse backgrounds would like to engage with digital care options such as telehealth and the necessary support to enable this. [ABSTRACT FROM AUTHOR]

90% of the UK diabetic population are classified as T2DM. This study aims to compare outcomes after SPK transplant between recipients with T1DM or T2DM. Data on all UK SPK transplants from 2003–2019 were obtained from the NHSBT Registry (n = 2,236). Current SPK transplant selection criteria for T2DM requires insulin treatment and recipient BMI < 30 kg/m2. After exclusions (re-transplants/ambiguous type of diabetes) we had a cohort of n = 2,154. Graft (GS) and patient (PS) survival analyses were conducted using Kaplan-Meier plots and Cox-regression models. Complications were compared using chi-squared analyses. 95.6% of SPK transplants were performed in recipients with T1DM (n = 2,060). Univariate analysis showed comparable outcomes for pancreas GS at 1 year (p = 0.120), 3 years (p = 0.237), and 10 years (p = 0.196) and kidney GS at 1 year (p = 0.438), 3 years (p = 0.548), and 10 years (p = 0.947). PS was comparable at 1 year (p = 0.886) and 3 years (p = 0.237) and at 10 years (p = 0.161). Multi-variate analysis showed comparable outcomes in pancreas GS (p = 0.564, HR 1.221, 95% CI 0.619, 2.406) and PS(p = 0.556, HR 1.280, 95% CI 0.563, 2.911). Comparable rates of common complications were demonstrated. This is the largest series outside of the US evaluating outcomes after SPK transplants and shows similar outcomes between T1DM and T2DM recipients. It is hoped dissemination of this data will lead to increased referral rates and assessment of T2DM patients who could benefit from SPK transplantation.

AbstractIn relation to fee-free education policy, previous research was dominated by the implementation and evaluation of these policies, and no research has examined the effect of free education policies on equitable access and improving the quality of learning in Indonesia. The study aimed to examine the effect of free education policies on equitable access to education services and the quality of learning in Indonesia. The method used is quantitative with Structural Equation Modeling (SEM) data analysis. The results showed that: 1) the implementation of the free education policy had a direct and significant effect of 68.5% on equal access to education services, 2) the implementation of the free education policy had a direct and significant effect of 29.6% on improving the quality of learning, 3) the implementation of the free education policy also indirectly has an effect of 49.8% on improving the quality of learning, 4) the implementation of equitable access to educational services has a direct and significant effect of 72.7% on improving the quality of learning. This research contributes to providing an overview of the effectiveness of free education policies through school operational assistance funds to implementers and policy recipients and assists the government in formulating policies that will be able to help accelerate the achievement of national education goals.

The role of intellectual property in biomedical innovation is often construed by the source of its funding viz. public or private. While privately funded innovations are assumed to rely on intellectual property for monopolistic expansions and profit gains, publicly funded research is expected to serve the broader social good without proprietary constraints. In the light of the accumulating evidence over the last few decades, it is now understood that this causal narrative, appears simplistic. To gain a deeper understanding of innovation, whether profit-driven or socially oriented, it is crucial to examine the broader context of basic and translational research. This article investigates the management of intellectual property within two significant biomedical research funding organizations: the publicly funded United States National Institutes of Health (NIH) and the public-private-philanthropic partnership, the Coalition for Epidemic Preparedness Innovations (CEPI). The findings reveal that despite different claims about intellectual property strategies, these institutions exhibit similar practices influenced by the spectre of larger privatisation processes intrinsic to global market forces. This analysis suggests that a singular logic of one-size-fits-all approach to intellectual property is inadequate in promoting biomedical innovation for the greater public good. [ABSTRACT FROM AUTHOR]

Abstract: The rising costs of course materials have higher education stakeholders looking for alternatives to the traditional course materials acquisition model. Two models of interest are open educational resources and inclusive access. Open educational resources have been widely studied. However, inclusive access has had a sudden rise in adoption across the country. This quick rise has left gaps in the literature as to the efficacy of such programs. A review of the literature on the efficacy of inclusive access course materials models returned only four published studies. The purpose of this study was to examine the use of an inclusive access course materials model on student outcomes at a Technical College. The Technical College provided student outcome data for 7110 students across six courses. The analysis documented significant differences between the before and after inclusive access samples for five of the nine categories examined. Results of this study fall in line with previous studies that have examined the impact of inclusive access course materials models on student outcomes.

Background and Aims: To sustainably address challenges in implementing precision medicine (PM), coordinated efforts of different stakeholders are required. Understanding their expectations represents a first key step toward aligning on future actions and strategies. Here, we aimed to explore the expectations of different stakeholders from themselves and each other regarding PM. Methods: This collaborative qualitative study was initiated by the global multistakeholder consortium From Testing to Targeted Treatments (FT3). Structured interviews were conducted with participants from five stakeholder groups: patients/patient advocates, healthcare providers (HCPs), researchers, policymakers/regulators/payers and industry representatives. A broad reach across geography, roles, experiences, and disease areas was sought. Results were analyzed by grounded theory methodology. Results: All stakeholders stated that optimal implementation of PM can only be achieved through collaboration; industry representatives were the biggest promoters of collaboration. Stakeholders agreed that PM should be implemented focusing on the patient's best interest; HCPs were seen as important gatekeepers for PM by interacting directly with patients, and policymakers/payers were perceived as the most important drivers of access to PM. Areas of misalignment included the role of industry in clinical trial design and in access to PM (perceived as important by patients, HCPs and policymakers but not by industry representatives), and the stakeholders responsible for elaborating guidelines on PM use (patients indicated policymakers, while researchers indicated themselves). Priorities for optimal PM implementation and suggested actions included the need for enhancing high‐level policy focus, improving genomic literacy, optimizing the health technology assessment for PM, advocating for equitable access, promoting collaboration between industry and other stakeholder groups and development of reliable research standards. Conclusion: Stakeholder expectations revealed in this study suggested that no stakeholder group can drive change on its own; a global, multistakeholder collaborative approach that brings together current programs and best practices to support universal access to PM is needed. [ABSTRACT FROM AUTHOR]

Continuing medical education (CME) and continuing education (CE) provide frameworks for assimilating and disseminating new advancements and are mainstays of clinicians' professional development and accreditation. However, traditional CME/CE approaches may be challenged in providing opportunities for integrated and interprofessional learning and helping clinicians effectively translate innovations into individual practice. This Commentary describes the reflective learning approach, including its integration into CME/CE and how it can support interprofessional education. Also identified are barriers to reflective and interprofessional learning implementation and CME/CE access. The Commentary provides insights based on point-of-care reflection data and outlines considerations in trialing the use of an artificial intelligence (AI)-driven digital platform for reflective learning. Further, the Commentary describes how the AI-driven digital platform may help overcome barriers to reflective learning and interprofessional education and support equitable CME/CE program access. [ABSTRACT FROM AUTHOR]

Background: The 2019 VA Maintaining Systems and Strengthening Integrated Outside Networks Act, or MISSION Act, aimed to improve rural veteran access to care by expanding coverage for services in the community. Increased access to clinicians outside the US Department of Veterans Affairs (VA) could benefit rural veterans, who often face obstacles obtaining VA care. This solution, however, relies on clinics willing to navigate VA administrative processes. Objective: To investigate the experiences rural, non-VA clinicians and staff have while providing care to rural veterans and inform challenges and opportunities for high-quality, equitable care access and delivery. Design: Phenomenological qualitative study. Participants: Non-VA-affiliated primary care clinicians and staff in the Pacific Northwest. Approach: Semi-structured interviews with a purposive sample of eligible clinicians and staff between May and August 2020; data analyzed using thematic analysis. Key Results: We interviewed 13 clinicians and staff and identified four themes and multiple challenges related to providing care for rural veterans: (1) Confusion, variability and delays for VA administrative processes, (2) clarifying responsibility for dual-user veteran care, (3) accessing and sharing medical records outside the VA, and (4) negotiating communication pathways between systems and clinicians. Informants reported using workarounds to combat challenges, including using trial and error to gain expertise in VA system navigation, relying on veterans to act as intermediaries to coordinate their care, and depending on individual VA employees to support provider-to-provider communication and share system knowledge. Informants expressed concerns that dual-user veterans were more likely to have duplication or gaps in services. Conclusions: Findings highlight the need to reduce the bureaucratic burden of interacting with the VA. Further work is needed to tailor structures to address challenges rural community providers experience and to identify strategies to reduce care fragmentation across VA and non-VA providers and encourage long-term commitment to care for veterans. [ABSTRACT FROM AUTHOR]

Jessica J Bowley,1 Kirstie Faulkner,2 Jennifer Finch,3 Belinda Gavaghan,3 Michele Foster1 1The Hopkins Centre: Research for Rehabilitation and Resilience, Griffith University, Brisbane, Queensland, Australia; 2Central Queensland Hospital and Health Service, Rockhampton, Queensland, Australia; 3Allied Health Professions’ Office of Queensland, Clinical Excellence Queensland, Brisbane, Queensland, AustraliaCorrespondence: Jessica J Bowley, The Hopkins Centre, Griffith University, 170 Kessels Road, Brisbane, Queensland, Australia, Tel +61 3735 8136, Email jessica.bowley@alumni.griffithuni.edu.auIntroduction: The challenges associated with equitable healthcare access are often more pronounced for individuals living in rural and remote locations, compared to those in metropolitan locations. This study examined the health care transitions of rural- and remote-living patients with on-going sub-acute needs, following acute hospital discharge. This was done with the aim of exploring these patients’ experiences of client-centeredness and continuity of care, and identifying common challenges faced by rural and remote sub-acute patients accessing and transitioning to and through sub-acute care in a non-metropolitan context.Materials and Methods: Semi-structured interviews were conducted with 37 sub-acute patients. A qualitative descriptive approach was used to analyze the interview data and explore key emergent themes in relation to client-centeredness, continuity of care, and sub-acute transition challenges.Results: Interview participants’ average length of stay in sub-acute care was 31.6 days (range = 8– 86 days), with most transitioning from larger regional and metropolitan hospitals to on-going rural or remote sub-acute care (n = 19; 53%). Client-centeredness was primarily characterized by the quality of interpersonal experiences with staff, patient and familial involvement in care planning, and the degree to which patients felt their wishes were respected and advocated for. Continuity of care was characterized by access to and participation in rehabilitation services, and access to family and social supports. Challenges associated with sub-acute transitions were explored.Discussion: The findings suggest important implications for health care providers, including the need to implement earlier and more frequent opportunities for patient involvement throughout the sub-acute journey. The results offer a unique perspective on the way that continuity of care is experienced and conceptualized by rural and remote patients, suggesting a revision of what is required to achieve equitable care continuity for rural and remote residents receiving care far from home.Conclusion: It is pertinent for health care providers to consider the unique complexities associated with accessing on-going health care as a rural or remote Australian resident, and to develop mechanisms that support equitable access and continuity and facilitate continuity of care closer to home.Keywords: care transitions, equitable access, health care access, non-metropolitan, patient discharge, rehabilitation

Background: Equitable access to gender-affirming hormone treatment (GAHT) for trans and gender-diverse people has been identified as a key factor in addressing rates of poor health outcomes in the trans and gender-diverse community. In Australia, GAHT is largely delivered via a medical model, and within acute care facilities. Medicalisation and pathologisation of gender-affirming care acts as a significant barrier to access for many trans and gender-diverse individuals. Methods: This project incorporated a case study approach using multiple methods to investigate a recent community sponsored, co-designed program providing GAHT that included a peer navigator (PN) model of care in a primary healthcare (community health) setting. Results: Service activity in Year 1 and Year 2 demonstrated acceptability of the model, with over 1000 appointments delivered. This was supported by client feedback survey data collected at their initial (n = 110) and then 6-months post visit (n = 78) with the PN, and 31 interviews with clients, staff and stakeholders. Conclusion: Findings highlight the integral nature of the PN to the sustainability of the program, with some key insights into potential barriers. Basing service design on an Informed Consent model recognises the agency of the individual and their right to equitable access to health care of their choosing. Equitable access to gender-affirming hormone treatment (GAHT) for trans and gender-diverse people is universally poor, with most services located in highly medicalised, culturally unsafe environments. Normalising GAHT by locating services within culturally safe mainstream primary healthcare services increases engagement for the trans and gender-diverse community. This project identifies the impact of a trans and gender-diverse co-designed and led GAHT service on client engagement and satisfaction. [ABSTRACT FROM AUTHOR]

Ubiquitous computing has brought new challenges for the design of scenarios for people–technology interactions. Despite considerable research on formal accessibility standards, related work has hardly investigated them in ubiquitous computing contexts. In this work, we investigate means of analyzing accessibility aspects in ubiquitous environments based on two standard instruments: the Universal Design (UD) Principles and Guidelines and the W3C-WCAG (Web Content Accessibility Guidelines of the World Wide Web Consortium). Both instruments were applied to the context of socioenactive ubiquitous environments, providing insights into their applicability and shortcomings. As a result of this analysis we constructed UbiAccess, an instrument to evaluate access in ubiquitous scenarios, which combines and extends characteristics of both UD and W3C-WCAG, filling in some of the gaps we identified. The application of UbiAccess to a case study shows the advantages of its use in informing the evaluation of access in ubiquitous scenarios. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has profoundly affected the pharmaceutical industry, reshaping priorities, accelerating innovation, and highlighting vulnerabilities in global healthcare systems. This article provides a comprehensive analysis of the impact of COVID-19 on the pharmaceutical sector, examining key lessons learned and offering insights into the future outlook. It explores the rapid development of vaccines and therapeutics, shifts in regulatory frameworks, supply chain disruptions, and changes in healthcare delivery models. Additionally, the article discusses the broader implications of the pandemic on drug discovery, clinical trials, digital health technologies, and collaboration within the industry. By synthesizing lessons from the pandemic response, this article aims to inform strategic planning and decision-making in the pharmaceutical industry as it navigates the post-pandemic landscape. [ABSTRACT FROM AUTHOR]

Abstract Background and Aims To sustainably address challenges in implementing precision medicine (PM), coordinated efforts of different stakeholders are required. Understanding their expectations represents a first key step toward aligning on future actions and strategies. Here, we aimed to explore the expectations of different stakeholders from themselves and each other regarding PM. Methods This collaborative qualitative study was initiated by the global multistakeholder consortium From Testing to Targeted Treatments (FT3). Structured interviews were conducted with participants from five stakeholder groups: patients/patient advocates, healthcare providers (HCPs), researchers, policymakers/regulators/payers and industry representatives. A broad reach across geography, roles, experiences, and disease areas was sought. Results were analyzed by grounded theory methodology. Results All stakeholders stated that optimal implementation of PM can only be achieved through collaboration; industry representatives were the biggest promoters of collaboration. Stakeholders agreed that PM should be implemented focusing on the patient's best interest; HCPs were seen as important gatekeepers for PM by interacting directly with patients, and policymakers/payers were perceived as the most important drivers of access to PM. Areas of misalignment included the role of industry in clinical trial design and in access to PM (perceived as important by patients, HCPs and policymakers but not by industry representatives), and the stakeholders responsible for elaborating guidelines on PM use (patients indicated policymakers, while researchers indicated themselves). Priorities for optimal PM implementation and suggested actions included the need for enhancing high‐level policy focus, improving genomic literacy, optimizing the health technology assessment for PM, advocating for equitable access, promoting collaboration between industry and other stakeholder groups and development of reliable research standards. Conclusion Stakeholder expectations revealed in this study suggested that no stakeholder group can drive change on its own; a global, multistakeholder collaborative approach that brings together current programs and best practices to support universal access to PM is needed.

This study examines the relationship between households' access to critical facilities day-to-day and during weather-related extreme events. Despite a robust understanding of both day-to-day access and access during disasters, the interplay between the two remains unclear. To bridge this knowledge gap, we propose a novel empirical approach, using a Texas statewide household survey (N = 810). The survey evaluates day-to-day and past events access, exploring the experiences of respondents during multiple recent disasters, rather than focusing on a specific hazard. Using correlation analysis, we examined various access-related factors such as day-to-day trip duration, alternative trip duration, and loss of access during past events. Additionally, we evaluated the association between access-related factors and sociodemographic characteristics such as income, ethnicity, and urban status. The results indicate: (1) daily trip duration to critical facilities is associated with disrupted access during storm events, and (2) disparities persist during both day-to-day times and during extreme events. These results bring new insights to the existing body of knowledge on day-to-day access and access during disasters. The findings provide scientifically grounded evidence to city managers and planners, emphasizing the need for equitable distribution of facilities to enhance access to essential facilities both in daily life and during extreme weather-related events.

Background: The value of Early Childhood Care and Education (ECCE) is recognised as beneficial to the child and society. Research evidence on pre-primary ECCE access and quality in Sub-Saharan Africa is scarce. Aim: The aim of this article is to examine Botswana’s pre-primary school programme in enhancing accessibility and quality of ECCE provision. Setting: The study was conducted in 12 of the 24 primary schools implementing the pre-primary programme in a Gaborone sub-region. Methods: Adaptations of the Levesque Access Framework and Woodhead Quality Framework were applied to this qualitative research study. Using semi-structured interviews, 11 pre-primary teachers, 5 school heads or Heads of Department, and 3 Principal Education Officers (PEO) were interviewed, and the data collected was analysed thematically. Results: The findings suggest that the main barriers to the effective pre-primary programme rollout are supply-side and systemic. These barriers represent the public institutional environment (e.g. funding, inter-governmental co-ordination), policy design (e.g. the physical infrastructure delivery model, administrative barriers, enrolment policy), and programme implementation (enrolment practices, teaching personnel, learning materials, and assessment of learners). Conclusion: Although over 600 public schools have implemented the pre-primary programme, meeting the objectives of universal access, equitability, inclusivity, and quality remains a challenge in Botswana, as in many other African countries. Contribution: The findings offer research frameworks and evidence for understanding pre-primary ECCE accessibility and quality. Further, the research has policy, programmatic, and practice-based implications for pre-primary educators and policymakers.

This study examines the trends in mathematics learning for Grade 4 pupils in Ethiopia based on a longitudinal survey of 33 schools from 2012-13 to 2018-19. The study employs unique data collected both at the start and end of the General Education Quality Improvement Program – Phase II (GEQIP-II) reform targeting the same schools in six regions. The data included repeated measures of pupil learning outcomes plus child socio-economic background, teacher, and school characteristics. Despite the implementation of the GEQIP-II reform, we found that pupils’ mathematics learning levels declined between 2012-13 and 2018-19. Progress in mathematics within the 2018-19 academic year improved slightly compared to 2012-13, but there is difference in magnitude of learning progress for the two periods between pupils across rural-urban locations, regional states, and family economic backgrounds. There is an overall improvement in school and teacher ‘quality’ between 2012 and 2019, while there is some evidence of changes in student composition between the two periods. Consistent with the GEQIP-II reform in terms of supporting access and retention, pupils in 2018-19 were more likely to have attended pre-school, less often absent from school, and less likely to have dropped out, compared to pupils in the same grade level in 2012-13. In 2018-19, pupils’ caregivers are less likely to be literate, they have fewer assets at home, and they travel a relatively longer distance to school. Differences in mathematics learning levels and learning progress between disadvantaged pupils (i.e., pupils from rural areas, emerging regions, poorest socio-economic background) and their relatively advantaged counterparts are discussed in relation to the GEQIP-II educational reform.

Increasing anthropogenic pressure on the sea and alteration of coastscapes challenge the functioning of marine ecosystems and long-term reliance on blue economies, especially for developing southern economies. The structural hardening of shores can result in ecological disruptions, with cascading effects on the wellbeing and livelihoods of marginalised groups who depend on marine resources. Mitigation, adaptation and rehabilitation options for coastal developments should include innovative, socially responsible solutions to be used to modify shorelines and ensure long-term functionality of metropolitan coastal ecosystems. Nature-based innovations are being developed to improve surrogacy for natural marine ecosystems. The co-creation of nature-based structures, entailing partnerships between scientists and a local rural community is currently being considered in South Africa and we present this regional case study as a transdisciplinary framework for research in nature-based, ecological engineering of coastal systems. Novel transdisciplinary approaches include ecomusicological interventions, where traditional cultural expressions (TCEs) create opportunities for transgressive pedagogy. This step aims to ensure that the knowledge gathered through nature-based scientific research remains a part of community developed Indigenous knowledge systems. The merging of innovative, eco-creative approaches and TCEs has the potential to sustainably and ethically improve the functioning and diversity of coastal urban habitats. This review tackles the potential of transdisciplinary settings to transform urban coastlines using "low-tech" engineering and Indigenous eco-creative innovations to pedagogy, to benefit the people and biological communities as well as reduce social and gender inequalities. [ABSTRACT FROM AUTHOR]

The coronavirus disease 2019 (COVID-19) that can cause extreme acute respiratory syndrome has posed a catastrophic threat to public health. The vaccines had indeed restored optimism and, after more than two years of battling the pandemic, there is renewed hope for the transition to endemicity. At the start of vaccination efforts, when supply shortages of vaccines were inevitable, every nation determined the high-risk population groups to be given priority for the COVID-19 vaccines. In this paper, the characteristics of the initial COVID-19 vaccine recipients in Malaysia are described. In line with the policies of many other countries, Malaysia firstly inoculated frontline healthcare workers, and subsequently the list of front liners grew to include defense and security personnel and those involved in the provision of essential services. People with disabilities or those with special needs and several underlying medical conditions that increased their risk of developing severe COVID-related illnesses were included in the priority categories. These included patients with severe lung disease, chronic heart disease, chronic kidney disease, chronic liver disease, neurological disease, diabetes mellitus and obesity in adults, splenic dysfunction, and severe mental illness. With little information and under circumstances of great uncertainty, the Health Ministry of a middle-income country had developed a vaccination priority-list based on the disease's epidemiology and clinical data, vaccine type, operational considerations, and risk evaluation. Early evidence was presented and suggested that the full vaccination with any of the three predominant vaccines (AZD1222, BNT162b2, and CoronaVac) in the country had been highly effective in preventing COVID-19 infections, COVID-19-related ICU admissions, and death. As many SARS-CoV-2 variants of concern (VoC), such as the Omicron BA.2/4/5, are emerging, future vaccination strategies may necessitate the need to change the immunogen of the vaccine, as well as considerations for when to give high-risk groups booster injections. These considerations are valuable for future planning by policymakers and healthcare providers to make vaccination policy and decisions, especially for the inclusion of the COVID-19 vaccines into national immunization programs. [ABSTRACT FROM AUTHOR]