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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

• We identified five types of older trauma care models: centralised trauma management, consultation services, co-management, patient care protocols, and alert and triage systems. • The selection of a particular care model is driven by the local patient population profile, healthcare resources, and by treatment objective targeted. • Whilst one care model may not be appropriate for all settings, clinicians may select components of each model to optimise care. The number of older people hospitalised with major trauma is rapidly increasing. New models of care have emerged, such as co-management, and trauma centres dedicated to delivering geriatric trauma care. The aim of this scoping review was to explore in-hospital models of care for older adults who experience physical trauma. The search was conducted in accordance with the PRISMA- SC (preferred reporting items for systematic reviews and meta-analyses extension for scoping reviews) reporting guidelines. The National Heart Lung, and Blood Institute (NIH) study quality assessment tool was used to evaluate risk of bias in before and after non-randomised experimental studies. Of 2127 records returned from the database search, 43 papers were included. We identified five types of care models investigated in the reviewed studies: centralised trauma management, consultation services, co-management, patient care protocols, and alert and triage systems. The majority of patients were admitted under a specialised trauma service, intervention teams were for the most part multidisciplinary, and follow-up of patients post-discharge was seldom reported. Consultation services more often had advanced care and discharge planning as treatment objectives. In contrast, patient care protocol and alert systems commonly had management of anticoagulation as a treatment objective. Overall, the impact of the five models of care on patient outcomes was mixed. Given the variability in patient characteristics and capabilities of health services, models of care need to be matched to the local profile of older trauma patients. However, some standards should be incorporated into a care model, including identifying goals of care, medication review and follow up post-discharge. [ABSTRACT FROM AUTHOR]

Medical waste management (MWM) is a challenging issue for medical facility managers owing to its potential to prevent environmental and health risks. Many treatment technologies (TTs) have been used for MWM, and selecting appropriate TTs is a complex multi-criteria decision-making (MCDM) problem. In this paper, we propose a novel integrated MCDM method based on the best-worst method (BWM) and the VlseKriterijuska Optimizacija I Komoromisno Resenje (VIKOR) method under the Fermatean fuzzy environment to evaluate, rank, and select treatment technologies for medical waste management. First, novel distance measure and entropy measure for Fermatean fuzzy sets are developed, and their properties are examined. Second, different treatment technologies are evaluated by experts using Fermatean fuzzy sets. Third, the experts' weights are determined using a novel method based on the entropy measure, and the criteria weights are calculated by a novel hybrid criteria weight calculation method. Finally, the ranking of different treatment technologies is determined by the proposed method. To validate the proposed method, a real case study in Jinan, China is presented, where the proposed method is applied to determine the optimal health care waste (HCW) treatment technologies from five TTs with eight criteria. The results are compared to other MCDM methods, which shows the effectiveness and reliability of the proposed method. Moreover, sensitivity analysis is also carried out to show the robustness of the proposed method. From the results, it can be found that the proposed method could provide reliable and robust results for obtaining the optimal health care waste treatment technology. • Proposes a novel decision-making method under Fermatean fuzzy set called FF-BWM-VIKOR. • The FF-BWM-VIKOR method is proposed to select health care waste treatment technology. • Novel distance measure and entropy measure for Fermatean fuzzy sets are developed. • A hybrid criteria weight calculation method is proposed to determine weights of criteria. • A real case of health care waste treatment technology selection is presented. [ABSTRACT FROM AUTHOR]

In this paper we direct attention to unavoidable conflicts between disparate value systems co-existing within organizations. Drawing on John Law's concept of ordering and Boltanski and Thévenot's orders of worth , we understand incompatibilities inherent in implementation and governance as competing orders. In extracting and articulating competing orders from our abductive analysis of semi-structured interviews with primary care managers (n = 32) in a Swedish county council, we hope to enable actors to utilise and address them as they engage in implementation work. The potential of such an approach is exemplified by analysing a regional case of health promotion implementation pursued in 2019, in a Swedish county council. Early approaches to implementation and governance have entailed linear models emphasizing program fidelity. Critics have broadened this view by calling for optimization of multiple values and more room for professional judgment. We seek to add to this development by attending to how healthcare practices often entail different and at times conflicting configurations of patients, professionals and priorities. The county council in our case study attempted to steer primary care providers towards health promotion work. To capture the realities of the organization that primary care managers described, we propose that three competing orders can be discerned in primary care: the order of immediate care, focusing on professional judgments of the most pressing needs of patients; the order of accessible care, in which patients themselves define what needs should be cared for; and the order of future health emphasizing prevention of health in the future population. Each order enacts a specific prioritization between patients and a vision of what is or should be primary in primary care. Organizing implementation, we suggest, requires a balancing of orders of worth. • Disparate orders of worth co-exist in health care organizations. • Orders impact the ordering work i.e., what is being done, when, why and for whom. • Careful investigation of competing orders of worth is crucial in health care. • Implementation efforts should consider conflicting orders of worth. [ABSTRACT FROM AUTHOR]

An endemic challenge facing healthcare systems around the world is how to spread innovation more widely and sustainably. A common response to this challenge involves conducting pilot implementation studies to generate evidence of the innovation's benefits. However, despite the key role that such studies play in the local adoption of innovation, their contribution to the wider spread and sustainability of innovation is relatively under-researched and under-theorized. In this paper we examine this contribution through an empirical examination of the experiences of an innovation intermediary organization in the English NHS (National Health Service). We find that their work in mobilizing pilot-based evidence involves three main strands; configuring to context; transitioning evidence; and managing the transition. Through this analysis we contribute to theory by showing how the agency afforded by intermediary roles can support the effective transitioning of pilot-based evidence across different phases in the innovation journey, and across different occupational groups, and can thus help to create a positive feedback loop from localized early implementers of an innovation to later more widespread adoption and sustainability. Based on these findings, we develop insights on the reasons for the unnecessary repetition of pilots – so-called 'pilotitis'- and offer policy recommendations on how to enhance the role of pilots in the wider spread and sustainability of innovation. • Innovation intermediaries mobilize evidence from pilot studies to spread innovation. • Pilot-based evidence can link early adoption to wider spread and sustainability. • Mobilizing involves co-creating multiple forms of evidence with different groups. • Intermediary roles allow transitioning of pilot-based evidence into wider adoption. • Pilotitis involves a failure to transition evidence along the innovation journey. [ABSTRACT FROM AUTHOR]

• Mentoring literature contains diverse, but as yet unclassified, mentoring relationship types. • Mentoring for young people young people transitioning out of care must address specific contextual needs and barriers. • More attention is needed in mentoring literature on the policy context and the nature of the gender and power in mentoring relationships. In Australia, out-of-home care (OoHC) is provided to safeguard children and young people unable to live with their families. Typically, this care stops at 18 years of age, leaving many young people without the relational support to find employment and stable accommodation. Mentoring is increasingly proposed as a way to support young people exiting care, though the types of mentoring and contextual factors vary considerably. This rapid review aims to identify key features of mentoring programs that support young people in OoHC. This paper utilised a rapid review methodology to survey the academic literature on mentoring programs with young people in OoHC. The authors conducted literature searches in October 2022 using a search string designed to provide targeted exposure to the literature. Articles were limited by year and location, with the specific search string and limitations applied to the Scopus database, and Proquest and Informit platforms. Utilising literature, we identified five overlapping models for mentor–mentee relationships into a provisional typology of five categories based on varying levels of formality and familiarity in the relationships: 'formal', 'natural', 'near-age', 'peer', and 'therapeutic'. In doing so, we identified seven important features of mentor–mentee relationships: shared experiences, relationship duration, boundaries and other relationships, identity and self-worth, educational contexts, power and participation, and role modelling. We identified four issues relating to mentoring in OoHC that are informed by the needs and barriers experienced by young people: training and support for mentors, unique challenges faced by young people in OoHC, transition out of care, and the matching process. Lastly, we established what might impact mentoring programs buy critically reflecting on the policy context and notions of empowerment. This rapid review of mentoring programs for care-experienced young people seeking employment offers valuable insights to inform future programs. The findings highlight diverse and unclassified mentoring relationship types, the absence of anticipated gender-specific findings, a lack of examination of the policy context, and a need for more robust conceptualisations of empowerment. [ABSTRACT FROM AUTHOR]

This paper uses the gradual implementation of a primary healthcare (PHC) intervention in Costa Rica to examine the long-term effect of PHC on mortality. Nine years after opening a primary care center, known as a Health Area, there was an associated 13% reduction in age-adjusted mortality rate in the assigned patient population. The effect was highest among adults over 65 years of age and for those with noncommunicable diseases, such as cardiovascular-related causes of death. We also show that as Health Areas opened, more individuals sought care at primary care clinics, while fewer sought care at emergency rooms; these changes may have partially mediated the effect of the intervention on mortality. [ABSTRACT FROM AUTHOR]

Low-noise and low-power operation are important parameters of amplifier intended for wearable healthcare applications. However, along with these parameters the amplifier must be able to deliver high Common Mode Rejection Ratio (CMRR) for mitigating the effect of 50/60 Hz interference. This paper reports capacitively coupled-capacitive feedback amplifier based on Self Cascode Current Mirror-II (SCCM-II) Operational Transconductance Amplifier (OTA). The obtained results for proposed SCCM-II OTA based amplifier shows gain of 39.79 dB, input referred noise of 2.64 μ V r m s , bandwidth of 0.794-343.4 Hz, area consumption of 0.154 μ m 2 , power consumption of 2.54 μ W with ± 0.9 V supply. The noise efficiency factor and CMRR values for proposed amplifier are 3.87 and 122.1 dB, respectively. In-depth theoretical interpretations and mathematical modeling of amplifier are validated in 0. 18 μ m standard CMOS process using BSIM3V3 MOS device models. The Gaussian distribution plots of proposed amplifier for 200 Monte-Carlo iterations infer mean values for gain and CMRR are 39.79 dB and 112.96 dB which are very close to their nominal values. The proposed amplifier has been compared with conventional approach as well as with literature and improvement in results is observed in terms of input referred noise, power and CMMR. These advantages of the proposed amplifier make it suitable for non-invasive wearable healthcare applications. [ABSTRACT FROM AUTHOR]

A rising emphasis on patient involvement in clinical research and healthcare improvement has led to the steady incorporation of patients and caregivers into this work. However, interactional factors shaping recruitment processes are not well understood. In this paper, we present a qualitative analysis of interviews with twenty-six patients, family members, engagement staff and healthcare providers who are engaged in healthcare improvement work in the United States. We focus on how stakeholders account for recruitment decisions to participate in healthcare improvement work. We find that expressions of and judgments about patients' and caregivers' cultural health capital shape providers' decisions to extend invitations to participate in healthcare improvement work. These findings extend current conceptualizations of cultural health capital beyond the clinical encounter to reveal factors shaping patient recruitment into healthcare improvement work. In theorizing how cultural health capital shapes action in this new setting, we found that healthcare providers, engagement staff, and patients/caregivers attended to different aspects of cultural health capital when accounting for why they extended or received a recruitment pitch. We further found that participating in healthcare improvement work led to a boost in cultural health capital for patients and caregivers, which they could use to develop transmissible forms of cultural health capital for less centrally involved patients and caregivers. Finally, we describe how participants in healthcare improvement collaboratives account for a lack of diversity among partners. These findings help us hypothesize the consequences of recruitment processes that rely on displays and judgments of cultural health capital and identify possibilities for change. Using the case of healthcare improvement work in Collaborative Learning Health Systems, our findings advance past work on cultural health capital in medical sociology by theorizing the role of cultural health capital in recruitment processes. • Providers recruit patients for healthcare improvement work with subjective criteria. • Providers often recruit high-resourced, privileged patients that they "vibe" with. • Partners build cultural health capital from doing healthcare improvement work. • Recruiting for cultural health capital may exclude patients from diverse backgrounds. • The role of recruitment should be considered to improve partner representation. [ABSTRACT FROM AUTHOR]

The efficient distribution and timely vaccine delivery to the masses during any pandemic situation require reliable and efficient vaccine cold chain management (VCCM). Therefore, the present study is an effort to explore the factors of VCCM to develop a sustainable and resilient healthcare delivery system in any health outbreak. The factors of VCCM are scrutinized using Fuzzy-Delphi method and then prioritized adopting Fuzzy-Analytical Hierarchy Process (F-AHP) approach while considering the stakeholders' inputs. Finally, factors are categorized into clusters by implementing a machine learning tool ' k -means clustering' algorithm. The results of the study are further validated by conducting extended robustness tests. The findings of the study highlight the factors, namely, cold chain infrastructure, vaccine storage guidelines and availability of skilled professionals as the most important for VCCM. The ′ k -means clustering' algorithm analysis classifies all the 16 factors into three clusters: continuous process improvement (including eight factors), stakeholders' coordination (five factors) and maximum resource utility (three factors). The study can be significantly useful to VCCM decision-makers to implement the prioritized factors by ensuring the advanced cold chain infrastructure and issuing special storage and distribution guidelines to fight against health outbreaks like COVID-19. This is one of the few papers to discuss the factors of VCCM for developing a sustainable and resilient healthcare delivery system in the context of pandemics and stakeholders can address the factors in different clusters at a time. [Display omitted] • Vaccine cold chain management (VCCM) to develop a resilient healthcare delivery system during health outbreaks. • Prioritization of factors of VCCM using Fuzzy-Analytic Hierarchy Process approach. • Categorization of factors of VCCM by implementing a machine learning tool of K − m e a n s clustering algorithm. • Storage and distribution guidelines to fight against the COVID-19 outbreak. [ABSTRACT FROM AUTHOR]

The smart healthcare system plays a vital role in modern healthcare, facilitating the exchange of Electronic Patient Records (EPR), and improving medical care. Nevertheless, safeguarding the inherent security and confidentiality of EPR data persists as a formidable challenge. This issue demanding rigorous attention and innovative solutions. Digital watermarking safeguards the genuineness and integrity of digital images, and is widely employed. In medical imaging, it is vital to guarantee the confidentiality and security of patient data. In this paper, we propose an Encryption-Then-Embedding-Based data hiding scheme for medical images that combines cryptography and watermarking techniques. The proposed technique first encrypts the patient information using Advanced Encryption Standard-Galois/Counter Mode (AES-GCM) before embedding. The intensity-based image segmentation method is then used to select the Region of Non-interest (RONI) for embedding the encrypted patient information and the watermark using a Fused Transform-Based Method (FTBM). The experiments conducted in this study utilize a large dataset of medical data, The Cancer Genome Atlas Lung Adenocarcinoma Collection (TCGA-LUAD). The findings of this study demonstrate the efficacy of the proposed technique in safeguarding patient data while simultaneously preserving the quality of medical images. In comparison to existing techniques, the proposed approach demonstrates superior performance in terms of security, authenticity, and integrity. [ABSTRACT FROM AUTHOR]