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Performance issues could be appearing from anywhere in a computer system, finding the root cause of those issues is a troublesome issue due to the complexity of the modern systems and applications. Microsoft builds multiple mechanisms to make their engineers understand what is happening inside All Windows versions including Windows 10 Home and the behavior of any application working on it whether Microsoft services or even third-party applications, one of those mechanisms is the Event Tracing for Windows (ETW) which is the core of logging and tracing in Windows operating system to trace the internal events of the system and its applications. This study goes deep into internal process activities to investigate root cause analysis on Windows 10 Home 20H2, core i5 processor with 4 cores and 8GB of RAM. After simulating workload to get a performance issue, that makes the system and application get unresponsive, then using Windows Performance Toolkit WPT to trace and analyze the event log for root cause investigation. Our results demonstrate analysis works using WPT for decision making such as the reasons of underutilization on CPU and disk, labeling the highlighted patterns, the unbalanced use of system calls in memory, and deciding that the usage preview is the best way to get an idea about applications behavior inside Windows systems resources. Overall improving resources utilization usage and identifying the cause of slowing memory allocation, inefficient disk usage, and throughput. [ABSTRACT FROM AUTHOR]

Human papillomavirus (HPV) is currently linked to almost 35,000 new cases of cancer in women and men each year in the United States. Gardasil‐9 (Merck & Company), the only HPV vaccine now available in the United States, is nearly 100% effective at preventing precancers caused by oncogenic HPV types. In the United States, however, only about one half of adolescents are up to date with HPV vaccination. It is well known that health care clinicians' recommendations play a significant role in parents' decisions regarding HPV vaccination. A growing body of literature examines specific communication strategies for promoting uptake of the HPV vaccine. A comprehensive review of the evidence for each of these strategies is needed. The authors searched the PubMed, EMBASE, Cochrane Central Register of Controlled Trials, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, and Web of Science Complete databases for original articles with a defined clinician communication strategy and an outcome of HPV vaccine uptake or intention to vaccinate (PROSPERO registry no. CRD42020107602). In total, 46 studies were included. The authors identified two main strategies with strong evidence supporting their positive impact on vaccine uptake: strong recommendation and presumptive recommendation. Determinations about a causal relationship were limited by the small numbers of randomized controlled trials. There is also opportunity for more research to determine the effects of motivational interviewing and cancer‐prevention messaging. [ABSTRACT FROM AUTHOR]

Copyright of College of Law Journal for Legal & Political Sciences / Magallat Kulliyyat Al-Qanun Li-L-ulum Al-Qanuniyyat Wa-Al-Siyasiyyat is the property of Republic of Iraq Ministry of Higher Education & Scientific Research (MOHESR) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

HIV and substance use interact synergistically to exacerbate disease progression and contribute to poorer engagement in treatment. There is a lack of qualitative research exploring the complexity of systems that impact HIV patients' linkage to and retention in both substance use and HIV care. Data from qualitative individual interviews with 16 HIV and 13 substance use providers were analyzed using applied thematic analysis. Four themes emerged as barriers to linkage to care providers limited knowledge with appropriate referrals; limited access to treatment options within the community; difficult admission criteria to substance use facilities; and communication challenges across providers including power differential. Emergent themes as barriers to treatment retention were: unstable life of people who use drugs; providers' negative attitude and stigma towards patients; and transportation challenges. Interventions are needed to increase provider cross-training in HIV and substance use disorders, reduce barriers to accessing treatment, and improve communication across providers are needed. [ABSTRACT FROM AUTHOR]

Every nation's economic and social development is fueled by its people's skills and knowledge. In the modern era, ICT resources like PPT, Tutorial Videos, Animation, e-materials, and web resources are very helpful in the education sector for enhancing comprehension. to find out if the instructors of vocational skills in educational institutions possess ICT skills. to decide what methods and ICT systems will be applied in the institutions to teach vocational skills. to gain a deeper comprehension of the challenges faced by providers of vocational skills as well as the modifications and enhancements required for the current system. Multistage random sampling was used to select the sample. This study examined every skill-training facility and centre within the Taluks of Dindigul. 250 teachers who teach vocational skills were selected for the study. The data were analysed using the social science statistics package (SPSS).The statistics package for social science (SPSS) was used to analyse the data. Frequency, percentage, graphs, and other data analysis techniques were used. According to 50.8 percent of respondents, there are not enough ICT-based reference materials available for soft skill training. The majority of respondents (88 percent) also indicated a desire to receive training in ICT-based occupational skill instruction at the same time. All providers of occupational skills should therefore undergo thorough ICT-based teaching and learning training. Institutions must establish an environment that is appropriate for ICT-based education. [ABSTRACT FROM AUTHOR]

Introduction COVID-19 has drastically transformed healthcare delivery and forced many to utilize telehealth. This study aimed to comprehensively evaluate the telehealth service "Sehha" used during COVID-19 in Saudi Arabia and assess the provider experience and satisfaction with Sehha. Methods: A questionnaire was distributed by the Ministry of Health (MoH) to 362 physicians using Sehha. The questionnaire items were adapted from previous studies and then tested for content validity and reliability (α = 0.88). Results: The findings showed that most of the physicians improved their experience in telehealth because of COVID-19. The majority of the physicians (67.6 percent) reported being satisfied with Sehha. However, the most commonly perceived challenge by the physicians was difficulty in providing accurate medical assessments. Conclusion: COVID-19 has remarkably uncovered numerous benefits of telehealth. Therefore, telehealth should remain a permanent model of healthcare delivery with consideration of further telehealth development initiatives. [ABSTRACT FROM AUTHOR]

The Merit-Based Incentive Payment System began scoring physicians in 2017, with implementation of payment adjustments started in 2019. The program continues to evolve, with adjustments to measures, score weighting and consideration of patient complexity. However, there remain concerns about unintended consequences of this latest value-based payment program. This review summarizes the roll-out of the program in the first performance year (2017) and changes that will have an impact on payment adjustments in the 2022 performance year. Further, it explains the need for policy informed by clinical experience to protect access for vulnerable patients. [ABSTRACT FROM AUTHOR]

OBJECTIVES: Care coordination between schools and medical providers promotes child health, particularly for children with physical, emotional, and behavioral challenges. The purpose of this study was to assess caregivers' reports of provider- school communication for their children. Further, the study assessed if communication rates varied by child demographic or health conditions. METHODS: This study was a cross-sectional analysis of the 2016-2017 National Survey of Children's Health focused on school-aged children (age 6-17 years; n = 18,160). Weighted frequencies overall and stratified by provider-school communication status are reported. Multivariable logistic regression examined associations of provider-school communication. RESULTS: Only 23.5% of the total sample reported provider-school communication. The highest caregiver-reported communication prevalence was for children with diabetes (68.0%). Behavioral/mental health conditions, chronic physical health conditions or having increased medical complexity and needs were significantly associated with increased communication compared to those without these conditions. Odds Ratio (OR) and 95% Confidence Intervals (CI) for children with a behavioral/mental health condition were OR: 1.28; CI: 1.02 to 1.61, for children with a chronic physical health condition were OR: 1.37; CI: 1.15 to 1.63 and for children with special health care needs or with medical complexity were OR: 2.15; CI: 1.75 to 2.64 and OR: 1.77; CI: 1.09 to 2.87, respectively. Significant communication differences existed for every health condition (P < 0.05) except for children who had a blood disorder (P = 0.365). CONCLUSIONS: Caregiver perception of provider-school communication is low and differences in reported rates existed between health conditions and complexity status. Further work is needed to support provider-school-family communication for children with physical, mental, behavioral, and complex health conditions. [ABSTRACT FROM AUTHOR]

Black sexual minority men (BSMM) experience the worst HIV treatment outcomes in the United States. Drug use increases HIV transmission risks and reduces health care engagement. Perceived health care provider stigma and medical mistrust minimizes treatment efforts. This study identified nursing and health care preferences among drug-using BSMM. In-depth qualitative interviews were conducted among 30 BSMM who reported drug use in Baltimore City, MD, from December 2018 to March 2019. Analysis identified themes as client preferences for nursing practices and gaps in clinical services. Participants' ages ranged from 23 to 63 years (M = 41.1). Most (91%) reported living with HIV. The following themes were identified as nursing and health care preferences: (a) being genuine, (b) knowing drug treatment and social services, (c) understanding drug use effects, (d) providing mental health services, and (e) clarifying treatment recommendations. Nurses and health care facilities can improve cultural competency for drug-using BSMM. Future research should identify the impact of these preferences on HIV care outcomes among BSMM. [ABSTRACT FROM AUTHOR]

While the emergence of peer-to-peer (P2P) platforms has revolutionized the way people exchange goods, these platforms face the need to provide appealing products offered by independent providers. However, those providers have to deal with anonymous buyers, potentially hindering their perception of control over the exchange and their subsequent willingness to use the platform. Our research addresses this issue of providers' control. Because prior research uses either environment-centric or individual-centric measures of control, no accurate measure of perceived control exists. This research aims to contribute by providing a scale that—in line with control theories—differentiates among the perceptions of control that derive from individual (i.e., skills-related) and those that emerge from the environment (i.e., security-related, autonomy-related). The results of four empirical studies performed in the second-hand market provide strong empirical support for the validity of our control scale and its ability to explain the provider's experience on the P2P platform. [ABSTRACT FROM AUTHOR]

Abstract Background Transgender (trans) women face constrained access to gender-affirming HIV prevention and care. This is fueled in part by the convergence of limited trans knowledge and competency with anti-trans and HIV-related stigmas among social and healthcare providers. To advance gender-affirming HIV service delivery we implemented and evaluated ‘Transgender Education for Affirmative and Competent HIV and Healthcare (TEACHH)’. This theoretically-informed community-developed intervention aimed to increase providers’ gender-affirming HIV prevention and care knowledge and competency and reduce negative attitudes and biases among providers towards trans women living with and/or affected by HIV. Methods Healthcare and social service providers and providers in-training (e.g., physicians, nurses, social workers) working with trans women living with and/or affected by HIV (n = 78) participated in a non-randomized multi-site pilot study evaluating TEACHH with a pre-post-test design. Pre- and post-intervention surveys assessed participant characteristics, intervention feasibility (e.g., workshop completion rate) and acceptability (e.g., willingness to attend another training). Paired sample t-tests were conducted to assess pre-post intervention differences in perceived competency, attitudes/biases, and knowledge to provide gender-affirming HIV care to trans women living with HIV and trans persons. Results The intervention was feasible (100% workshop completion) and acceptable (91.9% indicated interest in future gender-affirming HIV care trainings). Post-intervention scores indicated significant improvement in: 1) knowledge, attitudes/biases and perceived competency in gender-affirming HIV care (score mean difference (MD) 8.49 (95% CI of MD: 6.12–10.86, p

• Health care system employee vaccination is important to avoid COVID-19 outbreaks. • Most health care system employees want the vaccine but some are unsure or refuse. • More employees identifying with Black or multiple race are vaccine hesitant. • Employees who are vaccine believers need little to no intervention for vaccination. • Addressing specific concerns of cautious acceptors or fence sitters may spur vaccination. Achieving high COVID-19 vaccination rates among employees is necessary to prevent outbreaks in health care settings. The goal of the study was to produce actionable and timely evidence about factors underlying the intention and decisions to obtain the COVID-19 vaccine by employees. The study was conducted from December 2020 – May 2021 with employees from a VA health care system in Southeastern US. The study used a convergent mixed methods design comprising two main activities: a cross-sectional survey conducted prior to COVID-19 vaccine distribution, and semi-structured interviews conducted 4–6 months after vaccine distribution. Data were collected about participant characteristics, vaccination intention prior to distribution, vaccination decision post-distribution, determinants of vaccination intention and decision, activating factors, sources of information and intervention needs. Data from the survey and interviews were analyzed separately and integrated narratively in the discussion. Prior to vaccine distribution, 77% of employees wanted to be vaccinated. Post vaccine distribution, we identified 5 distinct decision-making groups: 1) vaccine believers who actively sought vaccination and included those sometimes described as "immunization advocates", 2) go along to get along (GATGA) individuals who got vaccinated but did not actively seek it, 3) cautious acceptors who got the COVID-19 vaccine after some delay, 4) fence sitters who remained uncertain about getting vaccinated, and 5) vaccine refusers who actively rejected the COVID-19 vaccine. Participants identifying with Black or multiple races were more likely to express hesitancy in their vaccination intention. The findings of our study highlight distinct decision-making profiles associated with COVID-19 vaccination among employees of a VA health care system, and provide tailored recommendations to reduce vaccine hesitancy in this population. [ABSTRACT FROM AUTHOR]

This article addresses the development of a model for the material supply planning and management in the construction industry, using System Dynamics, supported by AHP supplier selection methods, evaluation and monitoring with ABC classification, all mediated by Vensim data analysis software. The supply management in the construction industry is studied and analyzed based on a collaborative model between suppliers and builders, under the CPFR model and the integration of the Last Planner System, which contributes to optimize the use of resources that allow completing all social interest housing (VIS) construction projects. The model simulates the impact and performance produced in the collaborative system, compliance with planning and profitability in VIS projects, appropriate selection, and supplier evaluation and monitoring. Finally, this model allows those who make strategic decisions in VIS projects to identify the most critical variables, assess their contribution, and make the right decisions to eliminate waste due to waiting time. [ABSTRACT FROM AUTHOR]

Background: Medications for opioid use disorder (MOUD) significantly decrease mortality but courts rarely refer participants with opioid use disorder to MOUD providers. Previous qualitative work suggests routine court referrals to MOUD providers are more likely if court team members perceive providers as "trustworthy." Court team members may also be less likely to refer participants to MOUD if they consider MOUD unaffordable, particularly in Florida, which has not expanded Medicaid. Our aims were to explore court team members' 1) perceptions of availability of local trustworthy MOUD providers, 2) characteristics associated with perceptions of availability of local trustworthy MOUD providers, including beliefs about MOUD efficacy, and 3) perceptions of MOUD affordability. Methods: An online survey was distributed to all criminal problem-solving court and dependency court team members in Florida in 2019 and 2020. Likert scale questions assessed respondent agreement with statements about the availability of any MOUD providers, the availability of trustworthy MOUD providers, and the affordability of MOUD for court participants. An open-ended question explored MOUD barriers. Spearman's rho, Friedman, Kruskal Wallis, and Mann-Whitney U tests were used for analyzing quantitative data and iterative categorization for qualitative data. Results: One hundred fifty-one respondents completed quantitative questions (26% response rate), and 42 completed the qualitative question. Respondents were more likely to agree that local MOUD providers are more available than trustworthy MOUD providers. Perceptions of trustworthy provider availability differed significantly by MOUD type and were associated with MOUD efficacy beliefs. Qualitative results suggest that MOUD providers offering counseling and individualized treatment are more trustworthy. Conclusions: Court team MOUD beliefs may influence their perceptions of providers, or negative experiences with providers may influence court team MOUD beliefs. Improving court team perceptions of local MOUD providers may be critical for facilitating court participant treatment access. [ABSTRACT FROM AUTHOR]

Objective: Hard-to-heal wounds are a common problem, worsened by ageing, and the increased prevalence of diabetes and morbid obesity. The provider–patient relationship has undergone a transformation, from a paternalistic to a mutual participation model, in which 'the physician tries to enter the patient's world to see the illness through the patient's eyes'. The indepth assessment of the impact of psychosocial, physical issues and provider–patient dynamics is crucial to wound healing and patient wellbeing. It can customise future treatment including physical therapy, psychological and social interventions to improve outcomes. Method: A new health-related quality of life instrument (HRQOL) proposal based on a survey consisting of 20 questions was completed by patients as a pilot project. The psychosocial, physical and provider–patient dynamics were evaluated. A total wound impact score (WIs) was tabulated, ranging from 20–80 points. A wound assessment and plan (PBW–AP) was created. Results: In our sample of 25 patients, 75% experienced a moderate WIs (50–69) and 5% experienced a severe WIs (31–49). Feeling angry about having a wound was reported by 40% of patients. A majority of patients (60%) thought about their wounds >1 hour per day. Importantly, 24% answered that their primary care physicians never mentioned their wounds. Conclusion: It is important for all physicians taking care of patients with hard-to-heal wounds to see 'the patient behind the wound'. The PBW–AP algorithm is an individualised, multidisciplinary assessment and intervention based on a WIs. It is designed not only to identify but also to tackle psychosocial, physical, and provider–patient issues, to improve overall quality of life, patient satisfaction and clinical outcomes. Based on the results, the PBW–AP algorithm was designed to be used at initial and subsequent visits as a roadmap for problem identification and intervention. [ABSTRACT FROM AUTHOR]

Background The HIV Medicine Association of the Infectious Disease Society of America publishes Primary Care Guidance for Persons with Human Immunodeficiency Virus. We assessed receipt of recommended baseline tests among newly diagnosed patients initiating HIV care. Methods The Medical Monitoring Project is a Centers for Disease Control and Prevention survey designed to produce nationally representative estimates of behavioral and clinical characteristics of adults with diagnosed HIV in the United States. We analyzed data for 725 participants in the 2015–2019 data collection cycles who received an HIV diagnosis within the past 2 years and had ≥1 HIV provider visit. We estimated the prevalence of having recommended tests after the first HIV provider visit and between 3 months before and 3/6 months after the first HIV provider visit and estimated prevalence differences of having 4 combinations of tests by sociodemographic and clinical characteristics. Results Within 6 months of care initiation, HIV monitoring tests were performed for 91.3% (95% CI, 88.7%–93.8%) of patients; coinfection blood tests, 27.5% (95% CI, 22.5%–32.4%); site-based STI tests, 59.7% (95% CI, 55.4%–63.9%); and blood chemistry and hematology tests, 50.8% (95% CI, 45.8%–55.8%). Patients who were younger, gay, or bisexual were more likely to receive site-based STI tests, and patients receiving care at Ryan White HIV/AIDS Program (RWHAP)–funded facilities were more likely than patients at non-RWHAP-funded facilities to receive all test combinations. Conclusions Receipt of recommended baseline tests among patients initiating HIV care was suboptimal but was more likely among patients at RWHAP-funded facilities. Embedding clinical decision support in HIV provider workflow could increase recommended baseline testing. [ABSTRACT FROM AUTHOR]

Background: Published literature on health care administration, management, and leadership and its impacts on health systems' programs to address health care inequities is limited, as is information about how organizations integrate health equity in their cultures, missions, and strategic plans. Purpose: The aims of this study were to identify the key components necessary for health systems to implement systematic organizational change to promote health equity and to describe approaches organizations have implemented. Methodology/Approach: We conducted an environmental scan to identify central principles for implementing lasting change in health systems and experts working to advance health equity through organizational change. We interviewed 19 experts in health equity and hospital executives in 2020. Using iterative thematic analysis, we identified common themes. Results: Consistent with the literature on organizational change, interviewees described a variety of systematic approaches to change, all of which involve the following core components: (a) committed and engaged leadership; (b) integrated organizational structure; (c) commitment to quality improvement and patient safety; (d) ongoing training and education; (e) effective data collection and analytics; and (f) stakeholder communication, engagement, and collaboration. Conclusion and Practice Implications: There is no "one-size-fits-all" approach to advancing health equity. Decisions about which components require the most attention vary depending on an organization's internal and external environment. Understanding those environments and identifying which levers will be most effective are essential. As provider organizations strive to develop more strategic and systematic approaches to addressing disparities, long-term vision and commitment are necessary to achieve sustainable organizational change. [ABSTRACT FROM AUTHOR]

Abstract Background There is a need for information and healthcare support for the fertility desires and contraceptive needs of people living with HIV (PLHIV) in order to provide safer conception support for sero-discordant couples wanting to safely conceive. A model to integrate sexual and reproductive health and HIV services was developed and implemented in a district hospital and six clinics in the eThekwini District, South Africa. Methods To evaluate the model’s success, a cross-sectional survey was conducted before and after implementation of the model. As part of this evaluation, fertility desires of PLHIV (both male and female), and providers’ perspectives thereof were explored. Changes in desires and attitudes after integration of services were investigated. Results Forty-six healthcare providers and 269 clients (48 male, 221 female) were surveyed at baseline, and 44 providers and 300 clients (70 male, 230 female) at endline. Various factors including relationship status, parity and antiretroviral treatment (ART) access influenced PLHIVs’ desires for children. Concerns for their own and their child’s health negatively impacted on PLHIV’s fertility desires. These concerns declined after integration of services. Similarly, providers’ concerns about PLHIV having children decreased after the implementation of the model. Conclusions Integrated services are important to facilitate provision of information on contraceptive options as well as safer conception information for PLHIV who want to have children.

Maria Sember, Chad Donley, Matthew Eggleston Department of Emergency Medicine, Mercy Health Youngstown Hospital, Youngstown, OH, USACorrespondence: Chad DonleyDepartment of Emergency Medicine, Mercy Health Youngstown Hospital, 1044 Belmont Avenue, Youngstown, OH, 44504, USATel +1 330-480-3667Fax +1-330-729-7961Email cwdonley@gmail.comIntroduction: Emergency department (ED) overcrowding is a nationally recognized problem and multiple strategies have been proposed and implemented with varying levels of success. It has caused patients to present to the ED but leave without being seen (LWBS). These patients suffer delayed diagnosis, delayed treatment, and ultimately increased morbidity and mortality. In efforts to decrease the number of patients who leave without being seen, one proposed solution is to place a provider in triage to evaluate these patients at the initial point of contact.Methods: A retrospective chart review was conducted on patient’s presenting to the Emergency Department from October through January for the years 2013 through 2017. A list of all patient dispositions for each study month was analyzed and compared for the 4 consecutive years with the implementation of an Advanced Practice Provider (APP) in triage.Results: A total of 2162 patients dispositioned as LWBS during the entire study period of October 2013 through January 2017 were enrolled in the analysis. After implementation of a provider in triage, there was a 39% overall decrease (95% CI 0.005) in patients who left the ED before completion of treatment. There was a 69% reduction (95% CI 0.005) in patients who left before seeing the provider in triage. After seeing the provider, we saw an 83% reduction (95% CI< 0.001) in LWBS. Overall, our initial LWBS rate was found to be 5%, and after implementation of a provider in triage that rate decreased to 1%.Discussion: The addition of a provider in triage decreased our LWBS rate from 5% to 1%. The addition of a provider in triage also helped identify sick patients in the waiting room and helped facilitate more rapid assessment of ED patients on arrival.Keywords: LWBS, triage, provider, ED overcrowding, walkouts, LWOTs, PIT

This paper presents an Open Government Data (OGD) publisher framework, with work roles, field of work, and environmental descriptions. Previous knowledge about publishers' work is fragmented, with gaps and variations, indicating a high level of complexity with variations in approaches and processes. A two-stage research approach, based on Design Science Research, was used to synthesize the publisher framework. First, a tentative framework was synthesized from previous research, empirical material, and public documents. Second, it was reviewed by informed OGD experts, as well as researchers attending a work conference, and evaluated in two international contexts. As a result, the publisher framework includes environments, social units, and fields of work. The publisher framework is ready to be evaluated in other international contexts, where as, practitioners can use it to inform their work.

Objective Chronic kidney disease is a worldwide public health issue, with increasing prevalence resulting in high morbidity and mortality. As a result, recognizing and treating it early can lead to improved outcomes. We hypothesized that some providers might be more comfortable making this diagnosis than others. Methods Retrospective study of 380 patients with chronic kidney disease seen between 2012 and 2016 in an outpatient setting. Results Three hundred and sixteen patients were treated by physicians and sixty-four by advanced practice providers. Chronic kidney disease was identified by the primary care providers in 318 patients (83.6%). Patients recognized with chronic kidney disease were older, 76 ± 8.8 vs 72 ± 7.45 years, p = 0.001; had lower GFR, 37 [29, 46] vs 57 [37, 76] ml/min/1.73 m2, p

Asthma prevalence is high and adherence to asthma guidelines is still less than adequate. The main objective of this study was to determine if there were significant differences in outcome measures if asthma care was provided per guidelines either by physicians (pediatric pulmonologists) or specialty trained advance practice nurses (APNs) This was a three-year, prospective cohort study of children referred by their primary care providers to a tertiary care center for better asthma control. Patients were provided asthma care per NAEPP guidelines including asthma education. Results were compared over time and between patients followed by physicians or APNs. Alpha level of significance was ≤0.05. The sample included 471 children, ages 2–17 years (mean = 6.4 ± 2.4 years). Physicians and APN's provided asthma care. Of the 471 children enrolled in the study, 176 (37%) were followed for the full three-year study period. At the initial visit, physician group reported more short courses of oral steroids and more unscheduled visits to PCP for acute asthma care in the past 6 months compared to those followed by APNs (<0.05 for all). Among the total cohort and both subgroups, there were significant improvements in mean Asthma Control Test (ACT), acute care need and mean days/month with asthma symptoms over a three-year period (p < 0.05). There was significantly more improvement in use of oral steroids and urgent care visits in physician group (p < 0.05). When asthma guidelines are followed, improvements in asthma control are achieved in children in both the MD and APN groups [ABSTRACT FROM AUTHOR]

High patient wait times, physician idle times, physician overtimes, and patient congestion are common problems encountered in clinics that add to health care costs. This paper investigates the effect of different appointment systems on the operational performance of a university clinic. The process at a student health center was modeled using the Rockwell Arena® simulation software. Individual Block rule, Bailey rule, 3-Bailey rule, and the Two-at-a-time rule were compared using the simulation model to test their effect on performance parameters. The performance parameters were the provider measures and patient measures. The individual block rule was the most patient-friendly with the shortest patient measures. The 3-Bailey rule was the most provider-friendly rule, which resulted in the least provider times. A Kepner-Tregoe analysis shows that the Bailey rule was the most suitable as it had a good trade-off between the patient and provider times compared to the others. [ABSTRACT FROM AUTHOR]

With the advent of the autonomous driving era, automobiles are being discussed as an extension of the media. The growth of the in-vehicle infotainment(IVI) system can provide various benefits and values to the driver and passengers. Although the development and research of related technologies is being carried out, there has been no research that specifically identified users' valuation on the main attributes of IVI systems. This study uses conjoint analysis to investigate key attributes and users' preferences. The results indicate that the most important attribute for IVI system is provider, followed by system operation type, main service and content type. For each attribute, consumers prefer a detachable infotainment system provided by a telecommunication company, and prefer to use information-oriented services and content that they have previously consumed. This paper provides practical implications, especially in terms of convergence, that operators can refer to in IVI development. [ABSTRACT FROM AUTHOR]

Copyright of Journal Law & Political Sciences (Arabic Version) is the property of Journal of Law & Political Sciences and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Services reach almost all aspects of human life, ranging from government services to private services such as trade, transportation services and communication services using mobile phones. The purpose of this study was to analyze the factors that affect customer satisfaction and customer loyalty. The data collection method used was a questionnaire, which was analyzed using SPSS-Amos. The results showed that service productivity affected consumer loyalty either directly or indirectly. Responsiveness only had a direct effect on customer loyalty. Accountability had an indirect effect on customer loyalty through customer satisfaction. Also, service attitude had a positive and significant effect on customer loyalty either directly or through service quality. The novelty of this study lies in the dimensions used in measuring the variables in service providers. [ABSTRACT FROM AUTHOR]

Introduction: Teleneurology has become widely adopted during severe acute respiratory syndrome coronavirus 2 pandemic. However, provider impressions about the teleneurology experience are not well described. Methods: A novel questionnaire was developed to collect provider impressions about video teleneurology encounters. All providers in the University of Pennsylvania Health System (UPHS) Neurology Department (N = 162) were asked to complete a questionnaire after each video teleneurology patient encounter between April and August 2020. Individual patient and encounter-level data were extracted from the electronic medical record. Results: One thousand six hundred three surveys were completed by 55 providers (response rate of 10.12%). The history obtained and the ability to connect with the patient were considered the same or better than an in-person visit in almost all encounters. The quality of the physician–patient relationship was good or excellent in 93%, while the overall experience was the same as an in-person visit in 73% of visits and better in 12%. Sixty-eight percent of respondents reported that none of the elements of the neurological examination if performed in person would have changed the assessment and plan. Assessment of the visit as the same or better increased from 83% in April to 89% in July and 95% in August. Headache (91%), multiple sclerosis and neuroimmunology (96%), and movement disorder (89%) providers had the highest proportion of ratings of same or better overall experience and neuromuscular providers the lowest (60%). Conclusions: Provider impressions about the teleneurology history, examination, and provider–patient relationship are favorable in the majority of responses. Important differences emerge between provider specialty and visit characteristics groups. [ABSTRACT FROM AUTHOR]

Objective: To understand how Title X providers currently engage with fertility awareness-based methods (FABMs) for pregnancy prevention in Title X clinics across the United States. Materials and Methods: We developed a survey to assess knowledge of fertility for purposes of pregnancy prevention, attitudes toward FABMs use for pregnancy prevention, and practices when patients request FABMs for pregnancy prevention. Results: In total, 329 participants who met all inclusion criteria completed the survey. Respondents were generally highly knowledgeable on fertility, felt neutrally toward FABMs or thought they were a nonviable option for most women, and were likely to respond to patient requests for FABMs for pregnancy prevention by providing information. Qualitative responses included several barriers to provision of FABMs for pregnancy prevention and few successes to provision. Conclusions: Fertility knowledge and discussion of specific methods increased with the number of methods included in the clinic's written materials or with the number of different FABMs someone at that clinic had been trained on. Significant clinician or administrative barriers may exist to offering FABMs to patients. Incorporating up-to-date information on a range of FABMs?rather than treating them as one method?into contraceptive counseling represents an opportunity to increase the contraceptive offering for clients who want them, leading to increased patient satisfaction and successful family planning outcomes.

Background: Intensive care unit (ICU) residents are exposed to high stress levels due to the intense nature of their work, which can impact their mental health and job performance. Heart rate measured through wearable devices has the potential to provide insights into residents' self-reported stress and aid in developing targeted interventions., Objective: This exploratory study aims to analyze continuous heart rate data and self-reported stress levels and stressors in ICU residents to examine correlations between physiological responses, stress levels, and daily stressors reported., Methods: A secondary data analysis was conducted on heart rate measurements and stress assessments collected from 57 ICU residents over a 3-week period using Fitbit Charge 3 devices. These devices captured continuous physiological data alongside daily surveys that assessed stress levels and identified stressors. The study used Spearman rank correlation, point-biserial correlation analysis, 2-tailed paired t tests, and mixed-effect models to analyze the relationship between heart rate features and stress indicators., Results: The findings reveal complex interactions between stress levels and heart rate patterns. The correlation analysis between stress levels and median heart rate values across different percentile ranges showed that lower percentile heart rates (bottom 5%, 10%, 25%, and 50%) had modest correlations with stress, whereas higher percentiles (top 50%, 25%, 10%, and 5%) did not correlate significantly (all P>.05). The 2-tailed paired t test indicated significant differences in stress levels reported in midday versus end-of-day surveys (P<.001), although these changes in stress levels were not consistently reflected in heart rate patterns. Additionally, we explored and found that stressors related to "other health" issues had the highest positive correlation with stress level changes from midday to end-of-day surveys. However, the weak effect of these stressors on peak heart rate suggests that their impact on physiological measures like heart rate is not yet clear. According to our mixed-effects model, stress levels significantly influenced heart rate variations when hierarchical data were taken into account (P=.03), meaning that as the stress level increased, there was a significant increase in mean heart rate., Conclusions: This study highlights the complexity of using heart rate as an indicator of stress, particularly in high-stress environments like the ICU. Our findings suggest that while heart rate is found to correlate with self-reported stress in the mixed-effect model, its impact is modest, and it should be combined with other physiological and psychological measures to obtain a more accurate and comprehensive assessment of residents' stress levels., (©Ruijing Wang, Olya Rezaeian, Onur Asan, Linghan Zhang, Ting Liao. Originally published in JMIR Formative Research (https://formative.jmir.org), 27.11.2024.)

Background: To expand veterans' access to health care, the Veterans Affairs (VA) Office of Connected Care explored a novel software feature called "Vitals" on its VA Video Connect telehealth platform. Vitals uses contactless, video-based, remote photoplethysmography (rPPG) through the infrared camera on veterans' smartphones (and other devices) to automatically scan their faces to provide real-time vital statistics on screen to both the provider and patient., Objective: This study aimed to assess VA clinical provider and veteran patient attitudes regarding the usability of Vitals., Methods: We conducted a mixed methods evaluation of Vitals among VA providers and patients, collecting data in July and August 2023 at the VA Boston Healthcare System and VA San Diego Healthcare System. We conducted analyses in October 2023. In-person usability testing sessions consisted of a think-aloud procedure while using the software, a semistructured interview, and a 26-item web-based survey., Results: Usability test sessions with 20 VA providers and 13 patients demonstrated that both groups found Vitals "useful" and "easy to use," and they rated its usability highly (86 and 82 points, respectively, on a 100-point scale). Regarding acceptability or willingness/intent to use, providers and patients generally expressed confidence and trust in Vitals readings, with high ratings of 90 and 85 points, respectively. Providers and patients rated Vitals highly for its feasibility and appropriateness for context (90 and 90 points, respectively). Finally, providers noted that Vitals' flexibility makes it appropriate and advantageous for implementation in a wide range of clinical contexts, particularly in specialty care. Providers believed that most clinical teams would readily integrate Vitals into their routine workflow because it saves time; delivers accurate, consistently collected vitals; and may reduce reporting errors. Providers and veterans suggested training and support materials that could improve Vitals adoption and implementation., Conclusions: While remote collection of vital readings has been described in the literature, this is one of the first accounts of testing a contactless vital signs measurement tool among providers and patients. If ongoing initiatives demonstrate accuracy in its readings, Vitals could enhance telemedicine by providing accurate and automatic reporting and recording of vitals; sending patients' vital readings (pending provider approval) directly to their electronic medical record; saving provider and patient time; and potentially reducing necessity of some home-based biometric devices. Understanding usability issues before US Food and Drug Administration approval of Vitals and its implementation could contribute to a seamless introduction of Vitals to VA providers and patients., (©Lynn Garvin, Eric Richardson, Leonie Heyworth, D Keith McInnes. Originally published in JMIR Formative Research (https://formative.jmir.org), 23.10.2024.)

Background. Shared decision making (SDM) for patients enrolling in differentiated antiretroviral therapy (DART) is crucial. Empirical evidence is lacking regarding factors promoting or hindering SDM implementation in DART provision in Ethiopia. Hence, this study aimed to explore the barriers and facilitators to implementing SDM for patients enrolled in DART in Northwest Ethiopia. Methods. A qualitative descriptive study using semi-structured interviews among 17 patients and 15 providers at health facilities providing DART service was conducted. The MAXQDA version 20 software was used for inductive coding. Interviews were analyzed using thematic analysis. Results. Ten themes emerged at 4 levels related to SDM in the provision of DART: patient, provider, organizational, and health system. At the patient level, 1) trust in providers (facilitator) and 2) patient's level of education (barrier) emerged as themes. At the provider level, 3) lack of familiarity with DART models (barrier) and 4) patient-provider relationship (barrier and facilitator) were emerged themes. At the organizational level, 5) workload (barrier) and 6) resources (barrier and facilitator) emerged as themes. At the health system level, 7) availability of DART models (facilitator), 8) not involving providers while initiating DART models (barrier), 9) other providers' involvement (facilitator), and 10) presence of other implementing partners (barrier) emerged as themes. Conclusions. Numerous barriers and facilitators influence the implementation of SDM in the provision of DART. Based on these findings, the following steps are recommended. Providing access to patient decision aids shall be in place to assist patients in making decisions about their preferred DART models. Health care workers shall be trained, and patients shall be given education to enhance the SDM process. Policy makers and program managers shall consider the resource context (training and size of human resources and convenience of rooms) for the delivery of ART service to have an appropriate implementation of SDM in clinical practice., Highlights: Shared decision making in DART is influenced by various barriers and facilitators present at the patient, provider, organizational, and health system levels.Patients need education, and health care staff need regular training to improve SDM in DART service provision.Patient access to decision support tools that aid in the selection of the preferred DART model in health facilities is critical.Policy makers and program managers shall consider the availability of adequate and trained human resources as well as provide adequate space and private rooms for SDM in the implementation of DART., Competing Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Financial support for this study was provided by the University of Gondar. The fund was given to the corresponding author for data collection purpose. The funding agreement ensured the authors’ independence in designing the study, interpreting the data, writing, and publishing the report., (© The Author(s) 2024.)

The article explores providers' experiences in tele-mental care, focusing on the concept of "distance" in care encounters. Providers described how telecare both magnified and bridged distance in patient interactions. While some found it challenging to connect with patients remotely, others appreciated the removal of physical barriers and increased focus on patient needs. The study highlights the complexities of tele-mental care and the importance of understanding how technology impacts communication and connection in healthcare settings. [Extracted from the article]

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This paper presents an Open Government Data (OGD) publisher framework, with work roles, field of work, and environmental descriptions. Previous knowledge about publishers' work is fragmented, with gaps and variations, indicating a high level of complexity with variations in approaches and processes. A two-stage research approach, based on Design Science Research, was used to synthesize the publisher framework. First, a tentative framework was synthesized from previous research, empirical material, and public documents. Second, it was reviewed by informed OGD experts, as well as researchers attending a work conference, and evaluated in two international contexts. As a result, the publisher framework includes environments, social units, and fields of work. The publisher framework is ready to be evaluated in other international contexts, where as, practitioners can use it to inform their work. [ABSTRACT FROM AUTHOR]

Background: Code status (CS) orders lack a universal definition. We aimed to improve provider understanding of order options.Measures: Provider's knowledge of CS terminology, ease of understanding CS orders and ease of starting CS discussions.Intervention: A multifaceted intervention including 1) altered CS order language in the electronic medical record (EMR) from "Full Interventions," "Limited Interventions," and "Comfort Measures Only" to "Full advanced cardiovascular life support (ACLS)," "Partial ACLS," and "No ACLS" 2) clinical tools for CS identification 3) provider education.Outcomes: Correct provider response rate for "Partial ACLS" and "No ACLS" terms increased from 43.5 to 60% and 20 to 71% (odds ratio 1.95; 95% confidence interval 0.99-3.83; P = 0.03, OR 9.8; CI 4.48-21.49; P < 0.001). The proportion of providers who felt understanding CS orders and starting conversations about CS was "very easy" (a score of 1-3 on a scale of 1 to 10) improved from 26.1 to 45.7% (P = 0.01) and 49.3 to 65.7% (P = 0.03).Conclusions/lessons Learned: Provider understanding of CS options can be improved with a combined QI intervention. [ABSTRACT FROM AUTHOR]

Chronic kidney disease is a worldwide public health issue, with increasing prevalence resulting in high morbidity and mortality. As a result, recognizing and treating it early can lead to improved outcomes. We hypothesized that some providers might be more comfortable making this diagnosis than others. Retrospective study of 380 patients with chronic kidney disease seen between 2012 and 2016 in an outpatient setting. Three hundred and sixteen patients were treated by physicians and sixty-four by advanced practice providers. Chronic kidney disease was identified by the primary care providers in 318 patients (83.6%). Patients recognized with chronic kidney disease were older, 76 ± 8.8 vs 72 ± 7.45 years, p = 0.001; had lower GFR, 37 [29, 46] vs 57 [37, 76] ml/min/1.73 m2, p < 0.0001 and were more likely to be seen by a physician compared to an advanced practice provider: 272/316 (86%) vs 46/64 (71.8%), p = 0.008. In multivariate analyses, care by a physician, OR = 2.27 (1.13–4.58), p = 0.02 was associated with increased recognition of chronic kidney disease. On the other hand, higher GFR was associated with decreased diagnosis of chronic kidney disease, OR = 0.95 (0.93–0.96), p < 0.0001. The odds of chronic kidney disease recognition were higher amongst physicians in comparison to non-physician providers. [ABSTRACT FROM AUTHOR]

Background: Transgender (trans) women face constrained access to gender-affirming HIV prevention and care. This is fueled in part by the convergence of limited trans knowledge and competency with anti-trans and HIV-related stigmas among social and healthcare providers. To advance gender-affirming HIV service delivery we implemented and evaluated 'Transgender Education for Affirmative and Competent HIV and Healthcare (TEACHH)'. This theoretically-informed community-developed intervention aimed to increase providers' gender-affirming HIV prevention and care knowledge and competency and reduce negative attitudes and biases among providers towards trans women living with and/or affected by HIV. Methods: Healthcare and social service providers and providers in-training (e.g., physicians, nurses, social workers) working with trans women living with and/or affected by HIV (n = 78) participated in a non-randomized multi-site pilot study evaluating TEACHH with a pre-post-test design. Pre- and post-intervention surveys assessed participant characteristics, intervention feasibility (e.g., workshop completion rate) and acceptability (e.g., willingness to attend another training). Paired sample t-tests were conducted to assess pre-post intervention differences in perceived competency, attitudes/biases, and knowledge to provide gender-affirming HIV care to trans women living with HIV and trans persons. Results: The intervention was feasible (100% workshop completion) and acceptable (91.9% indicated interest in future gender-affirming HIV care trainings). Post-intervention scores indicated significant improvement in: 1) knowledge, attitudes/biases and perceived competency in gender-affirming HIV care (score mean difference (MD) 8.49 (95% CI of MD: 6.12–10.86, p < 0.001, possible score range: 16–96), and 2) knowledge, attitudes/biases and perceived competency in gender-affirming healthcare (MD = 3.21; 95% CI of MD: 1.90–4.90, p < 0.001, possible score range: 9–63). Greater change in outcome measures from pre- to post-intervention was experienced by those with fewer trans and transfeminine clients served in the past year, in indirect service roles, and having received less prior training. Conclusions: This brief healthcare and social service provider intervention showed promise in improving gender-affirming provider knowledge, perceived competency, and attitudes/biases, particularly among those with less trans and HIV experience. Scale-up of TEACHH may increase access to gender-affirming health services and HIV prevention and care, increase healthcare access, and reduce HIV disparities among trans women. Trial registration: ClinicalTrials.gov (NCT04096053). [ABSTRACT FROM AUTHOR]

Providers must be knowledgeable on policy, systems and products to provide a person centred service and prescribe the most appropriate assistive product for each user. This study aimed to determine to what extent teaching and learning on assistive products are included in undergraduate curricula of the Health science faculties at three universities in the Western Cape Province of South Africa. Data were gathered through a cross sectional survey. Fifteen programmes were approached of whom eight participated. Information on teaching on assistive products was sourced from purposively identified key informants, through e-mail questionnaires. Descriptive analysis was done. A total of 104 assistive products were included in the eight programmes. Manual wheelchairs were the only product for which teaching was underscored by policy guidelines. Handheld mobility devices and wheelchairs were covered by five programmes. Teaching on assistive products for self-care, participation in domestic life, indoor and outdoor activities, employment and leisure was limited. Thirty seven products listed on the GATE List of 50 were taught by at least one of the programmes. Teaching and examination were theoretical in nature and occurred in professional silos. Clinical exposure was often incidental. For many products none of the four service delivery steps were covered. Assistive products were included in all the participating undergraduate programmes. The range of included products and the level of training were insufficient to prepare graduates to effectively address user's needs. Newly appointed graduates will require early in-service training to ensure appropriate assistive product service delivery. Undergraduate teaching on assistive products is provided in professional silos. Not all products on the GATE APL of 50 are included in under graduate teaching. Teaching does not always ensure a proficiency level that will support graduates to provide an independent AT service. [ABSTRACT FROM AUTHOR]

In the United States, Black and Latinx youth remain disproportionately affected by HIV. Oral antiretroviral pre-exposure prophylaxis (PrEP) is a proven effective HIV prevention strategy. PrEP is approved for use in people younger than the age of 18 years, but little is known about provider comfort and preparedness with prescribing it to adolescents. In this study, physicians provide their perspectives on the facilitators and barriers to PrEP access among adolescents. Focus groups (n = 23) were conducted with pediatric and family practitioners practicing in an urban community hospital setting to assess PrEP awareness and receptivity to use among adolescents. Most providers were unfamiliar with clinical guidelines for PrEP use, especially in determining adolescent candidates for PrEP use, including appropriate dosing regimen and follow-up procedures. Overall, providers had low intent on prescribing PrEP, citing concerns about consent, medication adherence, and appropriateness of primary care providers in prescribing and managing adolescent PrEP use. Strategies that will address provider education and comfort in prescribing PrEP to adolescents are required to increase PrEP access and uptake among communities disproportionally affected by HIV. [ABSTRACT FROM AUTHOR]

Background: Radiology does not routinely solicit feedback on radiology reports. The aim of the study is to report the feasibility and initial results of a multi-institutional quality improvement project implementing patient and provider feedback for radiology reports.Methods: A HIPAA-compliant, institutional review board-waived quality improvement effort at two institutions obtaining patient and provider feedback for radiology reports was implemented from January 2018 to May 2020.Intervention: A two-question survey (quantitative review and open text box feedback) was embedded into the electronic health records for patients and providers. Text-based feedback was evaluated, and patterns of feedback were categorized: thoroughness of reports, error in reports, timeliness of reports, access to reports, desire for patient summary, and desire for key images. We performed the χ2 test for categorical variables. P < .05 was considered significant.Results: Of 367 responses, patients provided 219 of 367 (60%), and providers provided 148 of 367 (40%) of the feedback. A higher proportion of patients reported satisfaction with reports (76% versus 65%, P = .023) and provided more feedback compared with providers (71% versus 50%, P < .0001). Both patients and providers commented on the thoroughness of reports (12% of patients versus 9% of providers) and errors in reports (8% of patients and 9% of providers). Patients disproportionately commented on timeliness of reports (11%) and access to the reports (6%) compared with providers (3% each). In addition, 7% of patients expressed a desire for patient summaries.Conclusion: Report-specific patient and provider feedback demonstrate the feasibility of embedding surveys into electronic medical records. Up to 9% of the feedback addressed an error in reports. [ABSTRACT FROM AUTHOR]

Healthcare cultural competence is defined as a process of delivering care by meeting the social, cultural, and linguistic needs of diverse populations, and should be optimized at all organizational levels to reduce racial disparities and poor patient outcomes. The American College of Obstetrics and Gynecology (ACOG) recognizes the importance of cultural competence and states that research should be conducted to identify and combat barriers that impede equitable care. In this prospective, pre- and post-intervention study design, we used the Healthcare Provider Cultural Competence Instrument (HPCCI) to measure five dimensions of cultural competence within the Department of Gynecology and Obstetrics in a large academic medical center. The intervention was a single Grand Rounds educational presentation on cultural diversity. Baseline survey response rate was 64%. Post-intervention survey response rate was 30%. Post-intervention survey results showed that cultural competence increased by statistically significant amounts across all five dimensions. Our results show an effective and feasible method to assess baseline cultural competency in a large interprofessional clinical department. Our results also indicate that a single intervention may have some positive impact on levels of cultural competence for a diverse interprofessional health care team. [ABSTRACT FROM AUTHOR]