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BACKGROUND: The COVID-19 pandemic underscored the challenge of swiftly disseminating research findings to a global audience. Language barriers further exacerbated disparities in access to timely scientific information, particularly for non-English speaking communities. The majority of COVID-19 research was published in English, limiting accessibility for Spanish-speaking populations. OBJECTIVE: This paper aims to assess the reach and effectiveness of AccesoCovid.com, a platform designed to disseminate up-to-date COVID-19 research in both English and Spanish, addressing the language gap in scientific communication. METHODS: AccesoCovid.com was developed through a partnership between the University of California, San Francisco (UCSF) and Universidad Nacional Autónoma de México (UNAM). The websites performance and user engagement were evaluated using Google Analytics over a span of 2 years. Key metrics included user language preference, geographical distribution, and site traffic. The website summarized and translated 1032 articles on various COVID-19 topics, such as Pharmaceutical Interventions and Vaccines. RESULTS: From February 2021 to February 2023, the platform attracted 57,000 users. Of the 43,000 unique new visitors, 84.2% (n=36,219) hailed from Spanish-speaking regions. The majority accessed the site organically through search engines, with 88.4% (n=38,000) of users arriving this way, while 5000 (11.6%) users accessed the site directly. Most users (n=30,894, 72.1%) preferred the Spanish version of the site. The websites most accessed category was Pharmaceutical Interventions and Vaccines, followed by Clinical Presentation and Management and Mental Health. Regarding language distribution, 72.1% (n=30,894) of users primarily used Spanish; 21.4% (n=9215) used English; and 6.7% (n=2891) spoke other languages, including Portuguese, Chinese, and German. Geographically, the website attracted visitors from 179 countries, with the highest visitor counts from Mexico (n=12,342, 28.7%), Spain (n=6405, 14.9%), the United States (n=4416, 10.3%), and Peru (n=3821, 8.9%). CONCLUSIONS: AccesoCovid.com successfully bridged a critical language gap in the dissemination of COVID-19 research. Its success underscores the pressing need for multilingual scientific resources. The platform demonstrated significant user engagement and reach, particularly in Spanish-speaking countries. This highlights the potential for similar platforms to ensure equitable access to scientific knowledge across diverse linguistic communities. Future efforts should focus on expanding to other languages and conducting formal evaluations to enhance user satisfaction and impact.

A constraint satisfaction problem (CSP), \(\textsf {Max-CSP}(\mathcal {F})\) , is specified by a finite set of constraints \(\mathcal {F}\subseteq \lbrace [q]^k \rightarrow \lbrace 0,1\rbrace \rbrace\) for positive integers q and k. An instance of the problem on n variables is given by m applications of constraints from \(\mathcal {F}\) to subsequences of the n variables, and the goal is to find an assignment to the variables that satisfies the maximum number of constraints. In the (γ ,β)-approximation version of the problem for parameters 0 ≤ β ≤ γ ≤ 1, the goal is to distinguish instances where at least γ fraction of the constraints can be satisfied from instances where at most β fraction of the constraints can be satisfied. In this work, we consider the approximability of this problem in the context of sketching algorithms and give a dichotomy result. Specifically, for every family \(\mathcal {F}\) and every β < γ, we show that either a linear sketching algorithm solves the problem in polylogarithmic space or the problem is not solvable by any sketching algorithm in \(o(\sqrt {n})\) space. In particular, we give non-trivial approximation algorithms using polylogarithmic space for infinitely many constraint satisfaction problems. We also extend previously known lower bounds for general streaming algorithms to a wide variety of problems, and in particular the case of q=k=2, where we get a dichotomy, and the case when the satisfying assignments of the constraints of \(\mathcal {F}\) support a distribution on \([q]^k\) with uniform marginals. Prior to this work, other than sporadic examples, the only systematic classes of CSPs that were analyzed considered the setting of Boolean variables q = 2, binary constraints k =2, and singleton families \(|\mathcal {F}|=1\) and only considered the setting where constraints are placed on literals rather than variables. Our positive results show wide applicability of bias-based algorithms used previously by [47] and [41], which we extend to include richer norm estimation algorithms, by giving a systematic way to discover biases. Our negative results combine the Fourier analytic methods of [56], which we extend to a wider class of CSPs, with a rich collection of reductions among communication complexity problems that lie at the heart of the negative results. In particular, previous works used Fourier analysis over the Boolean cube to initiate their results and the results seemed particularly tailored to functions on Boolean literals (i.e., with negations). Our techniques surprisingly allow us to get to general q-ary CSPs without negations by appealing to the same Fourier analytic starting point over Boolean hypercubes. [ABSTRACT FROM AUTHOR]

Deaf, deafblind, and hard of hearing (DDBHH) individuals experience barriers to accessing cancer screening, including ineffective patient-physician communication when discussing screening recommendations. For other underserved communities, culturally and linguistically aligned community health navigators (CHNs) have been shown to improve cancer screening and care. A needs assessment study was conducted to identify barriers and gather recommendations for CHN training resources. A community-based participatory needs assessment was conducted from May 2022 to June 2022 using three focus groups. Eight were cancer survivors, six advocates/navigators, and three clinicians. All questions were semi-structured and covered screening barriers, observations or personal experiences, perceived usefulness of having a CHN to promote cancer screening adherence, and training resources that may be useful to American Sign Language (ASL)-proficient CHNs, who are also culturally and linguistically aligned. Out of 20 focus group participants, seven self-identified as persons of color. Data highlighted systemic, attitudinal, communication, and personal-level barriers as recurrent themes. The most frequently cited barrier was access to training that supports the role and competencies of CHNs, followed by cultural considerations, access to cancer guidelines in ASL, dialect diversity in sign language, and the health system itself. Unaddressed barriers can contribute to health disparities, such as lower preventive cancer screening rates amongst DDBHH individuals. The next step is to translate recommendations into actionable tasks for DDBHH CHN training programs. As a result, CHNs will be well-equipped to help DDBHH individuals navigate and overcome their unique barriers to cancer screening and healthcare access.

Language barriers are major obstacles that Asian American immigrants face when accessing health care in the USA. This study was conducted to explore the impact of language barriers and facilitators on the health care of Asian Americans. Qualitative, in-depth interviews and quantitative surveys were conducted with 69 Asian Americans (Chinese, Filipino, Japanese, Malaysian, Indonesian, Vietnamese, and mixed Asian backgrounds) living with HIV (AALWH) in three urban areas (New York, San Francisco, and Los Angeles) in 2013 and from 2017 to 2020. The quantitative data indicate that language ability is negatively associated with stigma. Major themes emerged related to communication, including the impact of language barriers on HIV care and the positive impact of language facilitators-family members/friends, case managers, or interpreters-who can communicate with healthcare providers in the AALWH's native language. Language barriers negatively impact access to HIV-related services and thus result in decreased adherence to antiretroviral therapy, increased unmet healthcare needs, and increased HIV-related stigma. Language facilitators enhanced the connection between AALWH and the healthcare system by facilitating their engagement with health care providers. Language barriers experienced by AALWH not only impact their healthcare decisions and treatment choices but also increase levels of external stigma which may influence the process of acculturation to the host country. Language facilitators and barriers to health services for AALWH represent a target for future interventions in this population.

BACKGROUND: Persons who speak languages other than English are underrepresented in clinical trials, likely in part because of inadequate multilevel resources. We conducted a survey of institutions affiliated with the Childrens Oncology Group (COG) to characterize current research recruitment practices and resources regarding translation and interpretation services. METHODS: In October 2022, a 20-item survey was distributed electronically to institutions affiliated with COG to assess consent practices and resources for recruiting participants who speak languages other than English to COG trials. Descriptive statistics were used to summarize responses; responses were compared by institution size and type as well as respondent role. RESULTS: The survey was sent to 230 institutions, and the response rate was 60% (n = 139). In total, 60% (n = 83) of those respondents had access to short-form consent forms. Full consent form translation was required at 50% of institutions, and 12% of institutional review boards restricted use of centrally translated consent forms. Forty-six percent (n = 64) of institutions reported insufficient funding to support translation costs; 19% (n = 26) had access to no-cost translation services. Forty-four percent (n = 61) were required to use in-person interpreters for consent discussions; the most frequently cited barrier (56%) to obtaining consent was lack of available in-person interpreters. Forty-seven percent (n = 65) reported that recruiting persons who speak languages other than English to clinical trials was somewhat or very difficult. CONCLUSIONS: Institutions affiliated with COG face resource-specific challenges that impede recruitment of participants who speak languages other than English for clinical trials. These findings indicate an urgent need to identify strategies aimed at reducing recruitment barriers to ensure equitable access to clinical trials.

OBJECTIVES: This study aims to evaluate the Language Access Systems Improvement (LASI) initiatives impact on professional interpreter utilisation in primary care and to explore patient and clinician perspectives on professional interpreter use. DESIGN: Multi methods: Quantitative natural experiment pre-LASI and post-LASI, qualitative semistructured interviews with clinicians and focus groups with patients post-LASI. SETTING: Large, academic primary care practice. PARTICIPANTS: Cantonese, Mandarin, Spanish, English-speaking adult patients and their clinicians. INTERVENTION: LASI initiative: Implementation of a clinician language proficiency test and simultaneous provision of on-demand access to professional interpreters via video medical interpretation. MAIN OUTCOME MEASURES: Quantitative: Proportion of language discordant primary care visits which were professionally interpreted. Qualitative: Salient themes related to professional interpreter use and non-use. RESULTS: The researchers categorised language concordance for 1475 visits with 152 unique clinicians; 698 were not fully language concordant (202 pre-LASI and 496 post-LASI). Professional interpreter utilisation increased (pre-LASI 57% vs post-LASI 66%; p=0.01); the visits with the lowest percentage of profssional interpreter use post-LASI were those in which clinicians and patients had partial language concordance. In inverse probability weighted analysis, restricting to 499 visits with strict estimated propensity score overlap (100% common support), post-LASI visits had higher odds of using a professional interpreter compared with pre-LASI visits (OR 2.39; 95% CI 1.04 to 5.48). Qualitative results demonstrate video interpretation was convenient and well liked by both clinicians and patients. Some partially bilingual clinicians reported frustration with patient refusal of interpreter services; others reported using the video interpreters as a backup during visits. Views of the care-partner role differed for clinicians and patients. Clinicians reported sometimes having family interpret out of convenience or habit, whereas patients reported wanting family members present for support and advocacy, not interpretation. CONCLUSIONS: LASI increased utilisation of professional interpreters; however, this was least prominent for partially language concordant visits. Health systems wishing to implement LASI or similar interventions will need to support clinicians and patients with partial bilingual skills in their efforts to use professional interpreters. TRIAL REGISTRATION NUMBER: HSRP20153367.

INTRODUCTION/OBJECTIVES: More time spent with interpreters may support clinician-patient communication for patients with limited English proficiency (LEP), especially when interpreter support before and after clinical encounters is considered. We assessed whether more time spent with interpreters is associated with better patient-reported experiences of clinician-patient communication and interpreter support among patients with LEP. METHODS: Patients with LEP (n = 338) were surveyed about their experiences with both the clinician and interpreter. Duration of interpreter support during the encounter (in min) and auxiliary time spent before and after encounters supporting patients (in min) were documented by interpreters. Multivariable linear regression models were estimated to assess the association of the time duration of interpreter support and patient experiences of (1) clinician-patient communication, and (2) interpreter support, controlling for patient and encounter characteristics. RESULTS: The average encounter duration was 47.7 min (standard deviation, SD = 25.1), the average auxiliary time was 43.8 min (SD = 16.4), and the average total interpreter time was 91.1 min (SD = 28.6). LEP patients reported better experiences of interpreter support with a mean score of 97.4 out of 100 (SD = 6.99) compared to clinician-patient communication, with a mean score of 93.7 out of 100 (SD = 14.1). In adjusted analyses, total patient time spent with an interpreter was associated with better patient experiences of clinician-patient communication (β = 7.23, P

BACKGROUND: Disparities in diabetes care quality may have increased for patients with limited English language proficiency (LEP) compared to non-LEP patients during the COVID-19 pandemic. Changes in diabetes care quality for adult LEP and non-LEP patients of community health centers (CHCs) were examined from 2019 to 2020. METHODS: Adults with Type 2 diabetes (n = 15 965) of 88 CHC sites in California and with 1+ visit/year in 2019 and 2020 from OCHIN electronic health record data were included. Multivariable regression models estimated the association of LEP status and changes in diabetes care quality from 2019 to 2020, controlling for patient sociodemographic and clinical characteristics. Interaction terms (LEP × 2020) were used to estimate differential over time changes in (1) blood pressure screening, (2) blood pressure control (

When the COVID-19 pandemic mandated the swift shift to fully online learning, it triggered not only large-scale resistance but also upskilling and experimentation in order to meet the urgent demands of the crisis. This paper chronologically and thematically examines literature from 2000 to the present regarding barriers to communication in culturally diverse online delivered classes. Two empirical surveys yielded data which generically correlate with literature findings. However, some of the results fall outside this trend, specifically, the inverse anticipated level of comfort among faculty and students in fully online settings and the dominance of personality over cultural differences hindering communication. We found that pre-pandemic communication barriers have changed in the in-pandemic fully online setting and that some barriers, particular to digital settings, have emerged which were not observed in in-person learning, specifically, the degree to which a camera-on policy for online classes negatively impacted student attendance and participation. [ABSTRACT FROM AUTHOR]

This study aimed to unveil the teachers' challenges in the implementation of Homeroom Guidance Program. It also looked into the similarities and differences among the participants in terms of challenges, copings and insights. This qualitative multiple case study explored the challenges, coping strategies and insights of six class advisers randomly selected for the study. Results revealed that based on the experiences of the participants, language barrier, limited parental involvement and lack of support and motivation from the administration were the challenges encountered in the implementation. But despite these challenges, some teachers managed to cope by becoming resourceful to reach out for support and collaboration with stakeholders and to persevere for the program. As for the insights gained by the participants, most of them emphasized the acceptance for positive change and for continuous improvement and embracing the holistic impact of the homeroom guidance program. This study may serve as a guide to researchers and educational leaders to have a deeper understanding about the challenging journey of teachers in shaping the course of future studies, fostering a continuous and informed discourse and proper monitoring on the evolving landscape of homeroom guidance in education for its effective implementation. [ABSTRACT FROM AUTHOR]

Purpose Method Results Conclusion This study examined how the language of eyewitnesses (native vs. non‐native) and their perceived credibility influence the interrogation questions posed to them.In a previous study (Raver et al., Frontiers in Psychology, 2023, 14, 1240822), participants, assuming the role of interrogators, watched either a native or non‐native speaking eyewitness testify and were then asked to formulate interrogation questions to gather more information, as well as rate the witness’s credibility. In the present study, a new set of participants (N = 207) evaluated a subset of these interrogation questions in terms of (1) how leading they were, (2) whether the interrogator cast doubt on something the witness had said and (3) how open‐ended they were. The moderating role of witnesses’ perceived credibility on question framing was also examined.Results showed no main effect of language (native vs. non‐native) on any question type. For native speakers, lower (vs. higher) credibility led to more expressions of doubt. For non‐native speakers, credibility levels (high vs. low) had no effect on question framing.These findings highlight complex patterns in interrogation questioning that vary by witness language and perceived credibility, revealing a critical area for further exploration to mitigate potential cross‐linguistic biases. We discuss the study’s limitations and advocate for future research in diverse legal contexts to ensure fairness and uphold the integrity of witness testimonies across languages. [ABSTRACT FROM AUTHOR]

Aim: Research is key to the development of any nation, with health research being of high value to society. Research provides data that is useful for the generation and provision of knowledge needed for policy making, planning and strategic management to develop nations. Despite the African population accounting for nearly 14% of the world's population, little published research originates from African scholars. Purpose: The purpose of this article is to highlight the reasons for the lack of robust research by scientists from African low-and-middle-income countries and to emphasize the inequity experienced by African scientists in global health research. Possible solutions to the dearth in African global health research are equally explored. Findings: Insufficient research has led to poor growth, development and advancements in health in Africa. A significant gap in African-led and published research, lack of mentorship, inequitable access to research funding and grant eligibility, and increased dependency on foreign organizations have contributed to the lack of sustainability and failure of African research. Conclusion: Research is crucial for national development, especially in health. However, African researchers are underrepresented in global publications. To optimize research, local needs and African researchers must be prioritized, and research systems in African institutions must be strengthened. Additionally, the international community must respect, be transparent, and support research development in Africa. These efforts are essential for fostering a robust research environment, addressing global health challenges, and promoting sustainable development across Africa and LMICs. [ABSTRACT FROM AUTHOR]

ABSTRACT Aim Design Methods Results Conclusion Implication for the Profession and Patient Care Impact Reporting Method Patient or Public Contribution To explore what healthcare staff and staff in pharmacies experiences, as challenges, and possibilities in handling and use medications by foreign‐born persons or their relatives, and how necessary information is exchanged between different units in the healthcare chain to prevent medication errors.A qualitative explorative single‐unit case study in a primary healthcare centre, with connected home care and pharmacies in an immigrant‐dense area.Individual semi‐structured interviews with 17 respondents, including pharmacists, physicians and registered nurses, were conducted between May and December 2022, in Sweden. Inductive qualitative content analysis was applied.Six categories were identified: limited knowledge about medications, lack of knowledge about the Swedish system for medication prescriptions and pharmacy regulations, insufficient time to develop trusting relations, communication to support medication management, tools for facilitating safe use of medications and problems in exchange of information in the healthcare chain.Good communication is both a challenge and a prerequisite for safe medication management by well‐informed patients. To ensure patient safety, it is crucial to establish ways to communicate with patients about their medications, regardless of their language skills. Improving communication within the healthcare chain is essential to prevent medication errors.Understanding the complexity of medication management and preventing medication errors requires staff to communicate effectively with patients at all steps in the healthcare chain to identify their informational and educational needs.This study provides a comprehensive understanding of the importance of communication within the healthcare chain, including prescribing physicians, nurses, pharmacists and patients, to prevent medication errors.COREQ checklist.This study focused on staff at a healthcare centre and two pharmacies. [ABSTRACT FROM AUTHOR]

Background: Language and cultural discordance refer to when a physician and patient do not share the same language or culture. This can create barriers to providing high-quality care at the end-of-life (EoL). This study explores the intersections of language, culture, geography, and care model in EoL care from the perspectives of palliative care physicians. Methods: In this exploratory-descriptive qualitative study, semi-structured interviews (1-h) were conducted virtually between July and November 2023. We interviewed 16 family physicians with experience providing linguistic and/or culturally discordant palliative/EoL care in various urban, suburban, and rural regions of Ontario, who practiced at community and hospital outpatient clinics, home-based care, or long-term care homes. We used reflexive thematic analysis to identify themes across the interviews guided by the intersectionality theoretical framework. Results: We identified three themes 1) Visible barriers to care access due to the inability to communicate accurate information and insufficient time spent during appointments with patients; 2) Invisible barriers to care access, shaped by the Eurocentric approach to palliative care and physicians' lack of awareness on cultural discordance; 3) Workplace supports that currently exist and interventions that physicians would like to see. Community physicians following fee-for-service models were less likely to have access to professional interpreter services. Physicians in long-term care emphasized resource limitations to providing culturally-appropriate care environments. Conclusion: Cultural discordance required awareness of personal biases, while language discordance hindered basic communication. These findings will be useful in informing clinical practice guidelines and mobilizing policy-level change to improve palliative/EoL care for patients from linguistic and cultural minority groups. [ABSTRACT FROM AUTHOR]

Societal Impact Statement Summary As with any complex environmental challenge, information about the “invasive species problem” must be communicated effectively to generate widespread public trust, understanding, and engagement in solutions. However, there is growing recognition that conventional messaging strategies can be ineffective or even detrimental at activating the broader public. Flawed communication practices can have harmful societal impacts by perpetuating misinformation, propagating feelings of panic and fatalism, and disaffecting audience members within historically marginalized communities. In this article, we draw attention to existing communication barriers in invasion biology and attempt to address the flawed messaging strategies which perpetuate negative societal outcomes.Effective communication about introduced, invasive species is necessary for the public to engage in productive dialogue and participate in solutions. Best practices in communication are more essential than ever before, as the harmful environmental and societal impacts of invasive species are exacerbated by globalization and anthropogenic disturbance. In this article, we review how public misunderstanding and mistrust present persistent barriers to invasion biology communication. We then describe three flawed messaging strategies that underlie these barriers. These strategies include fear appeals, simplified invasion metaphors, and militaristic and xenophobic language. Though intended to inspire a public sense of urgency and action, these strategies more often stoke sentiments of confusion and mistrust when employed in practice. Efforts to develop new best practices in communication are already underway. However, there is a great need for efficacy testing and wider adoption among science and education professionals alike. We draw from the interdisciplinary literature to recommend specific forms of value appeals, metaphors, and language that are a promising foundation for improvement. [ABSTRACT FROM AUTHOR]

Aim Background Introduction Methods Findings Discussion Conclusion and implications for nursing practice To explore the social integration strategies adopted by internationally educated nurses during acculturation and to elucidate their role in facilitating successful adaptation to their host countries.With their remarkable resilience, internationally educated nurses navigate numerous challenges in their acculturation process in the host country.While the importance of effective social integration strategies in the acculturation and subsequent retention of internationally educated nurses is well known, the specific strategies adopted by these nurses have not been extensively explored. This study aims to fill this gap with its unique and significant focus on these strategies.Eight electronic databases were searched for English articles from inception to October 2023 to ensure a comprehensive review. The quality of the included studies was appraised using the Critical Appraisal Skills Program checklist. A meta‐synthesis was performed using Sandelowski and Barroso's two‐step approach, and a thematic analysis was performed according to Braun and Clarke's framework.This review included experiences of 258 internationally educated nurses across 16 primary studies and has yielded the overarching theme of ‘fostering a sense of belonging’. The overarching theme is supported by three themes: (1) cultivating social capital, (2) employing effective communications, and (3) engaging with the community.Internationally educated nurses' social integration is a complex process that leverages support networks, establishing connections and overcoming communication barriers. However, the most crucial element is the active involvement of the host community, which plays a significant role in internationally educated nurses’ acculturation journey.This review has highlighted the importance of social integration in internationally educated nurses’ acculturation journey. Interventions such as having a supportive social network, providing a customised communication programme, organising engagement activities and granting overseas home leave are practical strategies that can enhance this journey. [ABSTRACT FROM AUTHOR]

Background and Purpose: Despite the lack of proven efficacy, opioids historically have been used for the treatment of noncancer back pain. A variety of other effective therapeutic options for pain management are becoming more available over time. In 2016, Oregon implemented a unique and novel policy to improve evidence-based back pain care and promote safer and more effective opioid prescribing through the state's Medicaid program, the Oregon Health Plan. This article examines the ways providers adapted to providing care for patients with back pain in the context of COVID-19 and to better understand the challenges faced by and adaptations made by providers. Methods: We conducted focus groups with clinicians and physical pain treatment modality practitioners (PPTMPs). In total, 129 providers participated in one of six focus groups, including 74 clinicians (54%) and 55 PPTMPs (42%). Reflexive thematic analysis was used to construct themes or units of meaning across data. Results: Focus groups revealed concerns about PPE shortages, telemedicine challenges, communication barriers, and profession-specific responses to COVID-19, which hindered patient care and referrals. Focus groups also highlighted some advantages related to increased insight into patients' lives, which enhanced treatment. Care during COVID-19 has resulted in continued patient interest in telehealth and telemedicine. Conclusion: Optimizing use of these technologies for health conditions, such as back pain, adds to treatment options for patients and gives providers a more holistic understanding of patients' lives, the challenges they may face, and how that impacts their treatment. [ABSTRACT FROM AUTHOR]

Objective: The current study explored differences in mental health problems, services utilization, and support of graduate students by gender, race/ethnicity, and year in school. Participants: Participants consisted of 734 graduate students from a large, Midwestern university. Methods: Graduate students answered a series of questionnaires in fall 2021 assessing their mental health, services utilization, and perception of services. Results: Women (vs men) and participants in their second year and beyond (vs first year) reported greater mental health problems, negative impact of the pandemic, and more services utilization. White (vs non-White) participants reported greater negative impact of the pandemic, greater services utilization, and less financial strain. Finances, lack of knowledge about resources, and inadequate communication from the university about services were reported as treatment barriers. Conclusion: Graduate students struggle with mental health, and universities may need to improve communication with and tailor their services to graduate students specifically to better support them. [ABSTRACT FROM AUTHOR]

BACKGROUND: Spanish-speaking trauma and burn patients have unique needs in their postdischarge care navigation. The confluence of limited English proficiency, injury recovery, mental health, socioeconomic disadvantages, and acute stressors after hospital admission converge to enhance patients' vulnerability, but their specific needs and means of meeting these needs have not been well described. STUDY DESIGN: This prospective, cross-sectional survey study describes the results of a multi-institutional initiative devised to help Spanish-speaking trauma and burn patients in their care navigation after hospitalization. The pathway consisted of informational resources, intake and follow-up surveys, and multiple points of contact with a community health worker who aids in accessing community resources and navigating the healthcare system. RESULTS: From January 2022 to November 2023, there were 114 patients identified as eligible for the Non-English-Speaking Trauma Survivors pathway. Of these, 80 (70.2%) were reachable and consented to participate, and 68 were approached in person during their initial hospitalization. After initial screening, 60 (75.0%) eligible patients had a mental health, social services, or other need identified via our survey instrument. During the initial consultation with the community health worker, 48 of 60 patients with any identified need were connected to a resource (80%). Food support was the most prevalent need (46, 57.5%). More patients were connected to mental health resources (16) than reported need in this domain (7). CONCLUSIONS: The Non-English-Speaking Trauma Survivors pathway identified the specific needs of Spanishspeaking trauma and burn patients in their recovery, notably food, transportation, and utilities. The pathway also addressed disparities in postdischarge care by connecting patients with community resources, with particular improvement in access to mental healthcare. [ABSTRACT FROM AUTHOR]

There have been significant advances in the medical and surgical options available for contraception and management of menses for individuals, including those with intellectual developmental disorder. This new statement frames the ethical, legal, and medical issues of permanent contraception in children, adolescents, and young adults with intellectual developmental disorder, emphasizing the importance of utilizing long-acting reversible and minimally invasive treatments, whenever possible. The historical use and abuse of permanent contraception is briefly reviewed, providing the foundation for ongoing ethical and legal considerations, including issues of informed consent. The authors then discuss medical decision-making and patient preferences that should be considered and make recommendations to providers who are contemplating permanent contraception therapies in this population. [ABSTRACT FROM AUTHOR]

The aim of this qualitative evidence synthesis (QES) is to critically appraise the contemporary literature to gain a comprehensive understanding of the barriers and enablers of workplace integration needs of internationally educated nurses (IENs). An electronic search was conducted across multiple databases, and eligibility criteria were applied to identify papers published between January 2013 and July 2023. Out of the 830 studies initially retrieved, six met the inclusion criteria. Study quality was assessed using the Critical Appraisal Skills Programme (CASP) tool. Thematic analysis of the included studies revealed various barriers and enablers for workplace integration experienced by IENs. Barriers were: (a) IEN-related factors (cultural differences, language barriers, and disparities in the scope of nursing practice), (b) organizational factors (poor leadership), and (c) contextual factors (racism and discrimination). Enablers emerged were: (a) IEN-related factors (commitment to learn and adapt) and (b) organizational factors (structured multifaceted program, supportive workplace environment, and mentorship). Dynamic interaction exists among these factors, therefore interventions should address multiple barriers simultaneously. The QES has illuminated essential factors which impact the integration of IENs, and emphasizes the necessity of a comprehensive approach that considers the diverse challenges and opportunities that arise. [ABSTRACT FROM AUTHOR]

Gynecological cancers constitute an important global health problem with increasing incidence and prevalence. The aim of this study was to explain gynecologic cancer knowledge, attitudes, and cultural beliefs of Afghan refugee women living in Türkiye. This research was carried out as a descriptive phenomenological design for qualitative research. The study was conducted at the Refugee Support Center Association in Eskişehir, Türkiye, and data were collected between January and April 2023, guided by a semi-structured interview guide. Nineteen Afghan refugee women were interviewed. A purposive sampling method was used to recruit participants. Content analysis method was used for data analysis. Four overarching themes that described Afghan women's gynecologic cancer knowledge, attitudes, and cultural beliefs were identified: (a) limited awareness and knowledge of gynecological cancer among women, (b) women's attitudes toward gynecological cancers, (c) women's cultural beliefs regarding gynecological cancer, and (d) healthcare system factors. In line with the main themes, subthemes were created for each main theme. Afghan refugee women, who were in the double risk group as both women and refugees, had insufficient knowledge of gynecological cancers, and their cultural beliefs and attitudes played an essential role in their access to gynecological cancer-related preventive healthcare services. It is recommended that training be planned to increase the awareness and knowledge of Afghan women on gynecological cancers, considering their cultural characteristics. [ABSTRACT FROM AUTHOR]

The article examines the relationship between language and health equity, emphasizing language as a key factor in determining access to health services and information. Topics discussed include the ethical implications of language barriers, the importance of integrating language considerations into public health frameworks, and strategies for enhancing communication to improve health outcomes for marginalized populations.

The article explores the integration of intersectionality in understanding the health disparities faced by Limited English Proficiency (LEP) populations in relation to their legal status. Topics discussed include the impact of immigration status on access to healthcare, the role of language barriers in exacerbating health inequities, and the necessity of adopting an intersectional framework to inform policy and practice.

The article focuses on the importance of terminology in clinical and public health communication, advocating for the use of "non-English language preference" (NELP) over "limited English proficiency" (LEP) to better represent linguistic minority populations. Topics discussed include the multifaceted nature of language proficiency, the implications of using preference-based terminology, and the evolving nature of language in public health advocacy.

25.6 Million people in the United States have Limited English Proficiency (LEP), defined as insufficient ability to read, write, or understand English. We will (1) Delineate the merits of approaching language as a social determinant of health, (2) highlight pertinent public health values and guidelines which are most relevant to the plight of populations with LEP and (3) Use the COVID-19 pandemic as an example of how a breakdown in public health ethics values created harm for populations and patients with LEP. We define a framework to tease out public health responsibilities given some populations' limited proficiency in a society's predominant language. The American Public Health Association (APHA) public health ethics core values serve as a framework to interrogate current practices. We use the COVID-19 case to illustrate gaps between health policy and healthcare disparities experienced by populations with LEP. [ABSTRACT FROM AUTHOR]

Background: Language barriers have been identified as a key access barrier to healthcare services for immigrants. The aim of this study was twofold: to investigate immigrants' and healthcare professionals' experiences with barriers and facilitators of interpreter services, and to examine the influence of barriers to interpreter services on the quality of care from immigrant and healthcare professional perspectives. Methods: We searched PubMed, Embase, The Cochrane Library, Scopus, SocINDEX and PsycINFO, resulting in 1425 studies. A total of 21 original quantitative, qualitative and mixed methods studies published between 1996 and 2021 were assessed as eligible for inclusion. Results: Identified barriers included: lack of immediately available interpreter services, cost, lack of knowledge about availability, and attitude towards interpreter services. Facilitators included: a high number of interpreters in the requested language, awareness among healthcare professionals and patients of the patient's rights to interpreters, and a positive attitude towards use of interpreter services. Regarding quality of care, language barriers created safety risks for the patients, made patients feel unsafe, or delayed patient contact with the healthcare system. Conclusions: Immigrant patients and healthcare professionals experience barriers in using interpreter services due to restrictive policies regarding user fees and limitations to entitlement to interpreters, a limited number of qualified interpreters and lack of knowledge. Medical encounters with unaddressed language barriers can put patients at risk and reduce quality of care for immigrants, which calls for strengthening formal and informal access to interpreters. [ABSTRACT FROM AUTHOR]

Aim: To describe how clinicians provide culturally responsive care to culturally diverse people with kidney failure in haemodialysis centres. Background: Culturally diverse individuals receiving in‐centre maintenance haemodialysis have unique cultural needs. Unmet cultural needs can impair and profoundly affect their experiences. Given culturally responsive care has the potential to enhance the experiences of culturally diverse people, it is vital to understand how clinicians provide culturally responsive care. Method: A scoping review was undertaken using Arksey and OMalleys framework. Five databases: Medline and CINAHL Complete (EBSCO), PsycINFO, Embase (OVID) and ProQuest Theses and Dissertation databases were searched for research literature published in English between 1990 and 2023. Narrative synthesis was used to synthesise the data. Results: From the 17,271 records screened, 17 papers reporting 14 studies met the inclusion criteria. Narrative synthesis revealed two themes: (i) communication enablers and barriers including linguistic differences, professional and lay interpreter use; and (ii) the importance of culture, which encompassed acknowledging cultural priorities, accommodating cultural food preferences and access to cultural training. Conclusion: While competing priorities associated with haemodialysis may be a challenge for clinicians, recognising the significance of cultural care needs and accommodating them in care is important. Demonstrating respect towards cultural diversity and providing person‐centred care by facilitating the unique cultural needs of people with kidney failure in haemodialysis is imperative. Relevance to Clinical Practice: Culturally responsive care is complex and multidimensional. Individuals' cultural care needs should be acknowledged, respected, and accommodated in care. Patient or Public contribution: No patient or public contribution. The study protocol was registered in the Open Science Framework. https://osf.io/uv8g3. [ABSTRACT FROM AUTHOR]

Aim: To identify and examine the explanatory variables associated with clinical competence among registered nurses (RNs) and practical nurses (PNs) working in long‐term care facilities (LTCF) for older adults. Design and Methods: This was a cross‐sectional study. The competence test, 'the Ms. Olsen test', was used for data collection. A convenience sample of 337 nursing staff working in LTCFs for older adults was selected between December 2020 and January 2021. A quantitative, non‐experimental approach with multiple linear regression analysis examined the explanatory variables associated with clinical competence and the outcome variables. Results: The main findings of the linear regression analysis show that the nursing staff's increasing age, use of Swedish as a working language and use of the Finnish nursing practice standards had statistically significant relationships with clinical competence among the participating nursing staff. Conclusion: This is the first knowledge test that has been developed to test nursing staff's clinical competence in elderly care. In this study in Finland, the highest clinical competence was among the nursing staff who were Swedish‐speaking RNs working in institutional care homes caring for patients according to national practice standards. Implications: These results may be useful to nursing staff and managers working in elderly care to understand the explanatory variables associated with clinical competence in elderly care in Finland and in bilingual settings. The study highlights the importance of using national nursing standards in elderly nursing care. Knowing the explanatory variables associated with clinical competence can provide guidance for the further education of nursing staff in these settings. Impact: Caring according to national practice standards and caring for severely ill patients are associated with clinical competence. Reporting Method: The authors adhered to the EQUATOR network guidelines Appendix S1 STROBE to report observational cross‐sectional studies. Patient or Public Contribution: Registered and PNs completed a questionnaire for the data collection. [ABSTRACT FROM AUTHOR]

Objective: Care partners play an important role in diabetes management of people with diabetes. Although deaf and hard of hearing (DHH) adults experience diabetes at a higher rate than their hearing counterparts, there is a lack of information regarding the experience of care partners assisting those in the DHH community. There is a need to identify intentional support for this population. The purpose of this study was to explore how care partners of DHH people with diabetes provide helpful and unhelpful support, the care partner experience of providing support, and care partners' perceived diabetes self-management education, support needs, and recommendations. Research Design and Methods: We engaged a community advisory board of care partners to DHH people with diabetes to explore how care partners provide support, their individual experiences in providing support, and their suggestions for diabetes self-management education. We used thematic analysis to analyze individual and collective responses. Results: Three emergent themes were identified suggesting that care partners give support in a variety of ways, are often overwhelmed in meeting the demanding and ongoing needs of DHH people with diabetes, and have a multitude of suggestions for implementing a future diabetes care partner education program. We also identified some DHH population-specific challenges to diabetes care, including communication barriers with health care providers, inability to use hearing cues if a person with diabetes experiences a fall, and limited access to diabetes care education in sign language. Conclusion: These findings highlight a need to provide more support for care partners of DHH people with diabetes and to address the needs of DHH populations to ensure more equitable diabetes care. Further research is needed to adequately inform successful interventions for DHH people with diabetes and their care partners. [ABSTRACT FROM AUTHOR]

Lack of feedback about reports made to Adult Protective Services (APS) is an important barrier to elder mistreatment reporting. To better understand barriers and facilitators to APS-reporter communication, we conducted an environmental scan of state policies and practices. We gathered publicly available information from 52 states and territories on APS administrative structure, reporting, intake, investigation, and feedback processes; performed a secondary analysis of focus groups with Emergency Medical Services providers and APS staff; and interviewed 44 APS leaders in 24 states/territories. Results revealed variation in information-sharing with reporters. Qualitative analyses revealed three overarching themes related to whether, when, and how information is shared. Results were used to develop a model illustrating factors influencing APS decisions on sharing information. This model incorporates the type of reporter (professional or nonprofessional), their relationship with the APS client (brief or ongoing), and the potential risks and benefits of sharing information with the reporter. [ABSTRACT FROM AUTHOR]

The aim of this study is to investigate and analyse interpersonal communication as a prominent issue in modern educational practice. The authors employed various general scientific research methods including analysis and synthesis, the comparative method, as well as the inductive and deductive approaches. Additionally, a theoretical analysis of relevant research by other scholars was carried out in the final stage of the study. Throughout the research, the authors identified different types of communication and barriers to effective communication. Furthermore, three aspects of a teacher's speech culture were identified. This study explores the educational perspectives within the field of educational science and the emerging scientific concept of educational acmeology in global educational research. The focus on educational acmeology addresses the objective of enhancing teachers' psychological and educational skills, professional competence and the interplay between education and psychology. The findings contribute to the development of professional and scientific relationships among teachers as a result of successful acmeological practices. The practical significance of this research lies in its potential application to examine interpersonal communication as an acmeological problem in contemporary educational settings. [ABSTRACT FROM AUTHOR]

Agile meetings are an essential part of modern software development, but they often face challenges such as lack of focus, communication problems, technological difficulties, and the like. Previous research has often addressed individual issues of agile meetings but has not provided sufficiently integrated or practical models to comprehensively address these challenges. This research fills this gap, developing a theoretical model that not only identifies key issues but systematically links them to provide a deeper understanding of their impact on meeting effectiveness.In this paper, we present a theoretical model that depicts intra-team problems in agile meetings developed through a systematic literature review (SLR). After initial development, the model was validated and improved through the qualitative analysis of semi-structured interviews with IT experts. This research aimed to confirm the coverage and relevance of the content of the preliminary model, as well as to identify the need for modification. The results of the interviews suggest that the presented model is adequate but that there is a need for potential improvement. IT experts agreed with the items in the model, and some of them suggested improvements. The model is promising because it illustrates the key issues that influence the effectiveness of agile meetings in a promising way. IT experts agreed on the items in the model, and some of them suggested improving the model. [ABSTRACT FROM AUTHOR]

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Background/Objectives: Most of the research in assisted reproduction has focused on the stressful situation experienced by women or couples looking for a desired pregnancy; however, the stress experienced by assisted reproduction professional teams is seldom studied. The present study aims to evaluate burnout and its relationship with workplace stressors among assisted reproduction professionals. Methods: A cross-sectional design was used to conduct an online self-assessment national survey, sent to all members of the Spanish Association for Fertility. The questionnaire contained sociodemographic and occupational questions about stressors in the workplace and the Maslach Burnout Inventory (MBI-HSS) to assess the three subscales of burnout: emotional exhaustion, depersonalization and personal accomplishment. Results: The percentages showing high emotional exhaustion and depersonalization in the whole sample were 41.8% and 43.2%, respectively. Additionally, low personal accomplishment was displayed in 42.6% of the respondents. Embryologists stand out for presenting the highest percentages of burnout (emotional exhaustion = 72.1%; depersonalization = 48.1%; low personal accomplishment = 48.1%), whilst psychologists showed the lowest percentages in high emotional exhaustion (32.3%) and depersonalization (24%), and gynecologists in low personal accomplishment (28.5%). Working under pressure was the stressor most experienced by the sample (76.6%) and the one that better predicted the three subscales of burnout. Conclusions: This study highlights the close relationship between high levels of burnout and workplace stressors and shows the need to reduce workplace stressors to improve the well-being of professionals working in assisted reproduction, and, consequently, that of the patients they look after. [ABSTRACT FROM AUTHOR]

Background: Nursing education across the globe is rapidly evolving in terms of curricular expectations and professional preparation. While there is a plethora of curricular resources and graduate programs in the United States, in some countries, these resources are limited. Methods: The Fulbright Specialist program, the application process, and challenges as well as the benefits of the role are described. The deliverables by the Fulbright Specialist, e.g. demonstrating classroom pedagogical methods, providing access to an online doctoral program, and explaining publication strategies, are noted. Results: Immediate and 2-month follow-up information regarding the Specialist's deliverables are described. The benefits to the Specialist are also detailed. Conclusion: Nursing educators in the U.S. and leaders of nursing schools outside of the U.S. are invited to share pedagogical practices and provide faculty development through the Fulbright Specialist program. The benefits of a collaboration are mutually beneficial. [J Nurs Educ. 2024;63(11):781–784.] [ABSTRACT FROM AUTHOR]

The prevalence of dementia is increasing globally, with an estimated 139 million people expected to be living with dementia by 2050. Across numerous countries, substandard care for people with dementia is evident, with quality improvement needed. Recently, a focus on patient-reported experience measures (PREMs) has been utilised in healthcare services as a method of evaluating the care experiences provided and determining areas of improvement. The literature is scarce regarding the feasibility and acceptability of implementing PREMs with people with moderate to advanced dementia. This scoping review aimed to identify PREMs that have been used with vulnerable populations including people with cognitive impairment, mental health concerns, and children, outline dimensions included, and determine adaptions made to the PREMs to improve acceptability of the instruments for vulnerable populations. A database search of Medline was conducted to identify 36 studies including 32 PREMs. The PREMs identified covered a range of dimensions, most frequently care effectiveness, care environment, and patient involvement. The most common adaption to the PREMs was simplification of wording and sentence structure. Several measures conflated patient outcomes and patient satisfaction with patient experience, limiting utility for improving patient experience specifically. While several PREMs have been used with people with dementia, challenges in their implementation and their applicability to specific settings limit their use more broadly. Evidently, there is a need for development of a PREM for people with moderate to advanced dementia that is applicable across healthcare settings and is appropriately adapted for varying cognitive and communicative barriers. [ABSTRACT FROM AUTHOR]

Background: SafeBoosC-III is a pragmatic, multinational clinical trial evaluating cerebral oximetry-guided treatment for extremely preterm infants. In total, 1601 infants were randomised across 70 sites in Asia, Europe, and USA. To enhance data quality and patient care, a web-based training program was implemented for staff. We now report on the processes. Methods: All training modules consisted of initial learning material followed by a case-based quiz, with elaborate responses to correct as well as to wrong answers. Modules covered trial introduction, cerebral oximetry monitoring, treatment guidelines, cerebral ultrasound, and Good Clinical Practice. The introduction module was accessible in eight languages on an online platform, while language versions varied for other modules, due to different needs. Certification was earned upon module completion, relevant to the staff category. The training was not mandatory, but for motivational purposes, principal investigators continuously received local certification rate reports. Results: A total of 926 out of 2347 staff (39%) obtained certification. Amongst 295 staff who completed the evaluation, 83% rated the program as overall good and 94% found it relevant to clinical practice. Sites exhibited varying certification rates, with 10 at 0%, 43 between 0.1 and 79.9%, and 17 exceeding 80%. There was no correlation between the rate of certification in individual sites and how often the clinical management was changed due to cerebral hypoxia nor a correlation to site-specific estimates of the intervention effect. Conclusion: Despite language barriers and a low budget, our web-based training and certification program proved feasible. Only a minority of sites reached 80% certification of staff and an impact on the trial could not be detected. Trial registration: The SafeBoosC-III trial is registered at ClinicalTrials.gov NCT03770741. The first participant was randomised in June 2019 and recruitment was completed in December 2021. [ABSTRACT FROM AUTHOR]

Background: This study investigated the perceived barriers and potential facilitators for culturally sensitive care among general practitioners in Flanders. Understanding these dynamics is crucial for improving healthcare quality and equity. Methodology: Twenty-one in-depth interviews were conducted with Flemish GPs. Braun and Clarke's reflexive thematic analysis was employed to develop and interpret themes that elucidate shared underlying meanings and capture the nuanced challenges and strategies related to cultural sensitivity in healthcare. Results: Two core themes were generated: GPs' uncertainty and opposition. These themes manifest in emotional responses such as frustration, miscomprehension, and feelings of helplessness, influencing relational outcomes marked by patient disconnect and reduced motivation for cultural sensitivity. The barriers identified are exacerbated by resource scarcity and limited intercultural contact. Conversely, facilitators include structural elements like interpreters and individual strategies such as engagement, aimed at enhancing GPs' confidence in culturally diverse encounters. A meta-theme of perceived lack of control underscores the challenges, particularly regarding language barriers and resource constraints, highlighting the critical role of GPs' empowerment through enhanced intercultural communication skills. Conclusion: Addressing GPs' uncertainties and oppositions can mitigate related issues, thereby promoting comprehensive culturally sensitive care. Essential strategies include continuous education and policy reforms to dismantle structural barriers. Moreover, incentivizing culturally sensitive care through quality care financial incentives could bolster GP motivation. These insights are pivotal for stakeholders—practitioners, policymakers, and educators—committed to advancing culturally sensitive healthcare practices and, ultimately, for fostering more equitable care provision. [ABSTRACT FROM AUTHOR]

Movies often use allusions to add depth, create connections, and enrich the storytelling. However, translators may face challenges when subtitling movie allusions, as they must render both meaning and culture accurately despite existing language and cultural barriers. These challenges could be further complicated by the use of available AI tools attempting to subtitle movie allusions, while probably unaware of existing cultural complexities. This research investigates these challenges using qualitative and descriptive quantitative approaches by analyzing the movie Birdman or (The Unexpected Virtue of Ignorance), comprising13.014 words, to identify the types of allusions used and compare the human- vs. AI (ChatGPT)-generated Arabic subtitles in terms of the subtitling strategies, their frequency, and quality. The results revealed that the movie used 52 Noun Phrase (NP) allusions, where the writer intertextually employed a proper name to convey meaning, and 8 Key-Phrase (KP) allusions, where the writer used phrases that convey implicit meaning easily perceived by members of the source culture (by referring to religious, literary, or entertainment texts). For NP allusions, both the human translator and AI opted for retentive strategies; however, the human translator's preference to add guidance/parentheses to mark NP allusions was distinct. Additionally, it was observed that AI used neologism to render technology-related allusions, which could be a suggested strategy for NP subtitling into Arabic. For KP allusions, while the human translator seemed to be cognizant of the idea that KP allusions typically require a change in wording, AI fell short. Specifically, the human translator employed reduction in 5 out of 8 KPs, opting for minimum change/literal translation only three times. Conversely, AI utilized literal translation in all 8 examples, despite its awareness of the allusion and its intricate meaning/reference. As for the FAR assessment, for NP allusions, it revealed minor semantic errors in AI's subtitles that did not affect the plot. Regarding KP allusions, AI's subtitles were penalized in 5 out of its 8 Arabic renditions, in contrast to the human translator. Most of the errors were serious semantic errors that likely disrupted the flow of reading the subtitles due to conveying irrelevant meanings in the movie's/scene's context. Despite its functionality, this study suggests adding an extra parameter to the FAR model: consistency, as it plays a role in enhancing audience involvement and understanding. Its absence, as observed in some AI instances, can be misleading. [ABSTRACT FROM AUTHOR]

Military widow/ers can experience spousal death suddenly and in traumatic circumstances. Evidence shows that this experience often has a long-term effect on surviving family members, highlighting the unique experiences of loneliness and social isolation in the armed forces community. This study aimed to explore military widow/ers' lived experiences of social isolation and loneliness and unmet needs relating to social participation. This paper presents the qualitative findings of a sequential study in which Phase One utilized an online survey (N = 165) and Phase Two employed semi-structured interviews (N = 26). Almost all participants across both Phases discussed feeling lonely, socially isolated, or both. Findings highlight the complexity in transition from military spouse to military widow/er through the loss of a military community and geographical location. This was further compounded by language barriers and perceived hierarchy (through service life or circumstances of death) which created obstacles to help seeking. However, individuals who did join military widow/ers' associations valued peer support through shared connection and understanding. Peer support was particularly valued as, for many, existing relationships with friends or family members were often negatively impacted following bereavement. These changed relationships led to feelings of both vulnerability and loss. Consideration needs to be given to how access to appropriate support is gained and what provision needs to be in place. This study recommends the use of more inclusive language for the military bereaved to promote inclusive practices and broaden the availability of support, including that which would increase social participation, across the sector. [ABSTRACT FROM AUTHOR]

In federated learning, secret sharing is a key technology to maintain the privacy of participants' local models. Moreover, with the rapid development of quantum computers, existing federated learning privacy protection schemes based on secret sharing will no longer be able to guarantee the data security of participants in the post-quantum era. In addition, existing privacy protection methods have the problem of high communication and computational overhead. Although the multi-stage secret sharing scheme proposed by Pilaram et al. is one of the effective solutions to the above problems, existing studies have proven the privacy leakage risk of this scheme. This paper firstly designs a new lattice-based multi-stage secret sharing scheme Improved-Pilaram to solve the security problem, which allows participants to use public vectors to reconstruct different secret values without changing the secret sharing. Based on Improved-Pilaram, this article proposes a post-quantum secure federated learning scheme PQSF. PQSF uses double masking technology to encrypt model parameters and achieves mask reconstruction through secret sharing. Since Improved-Pilaram is multi-stage, participants do not need to update their local secret shares frequently during training. Analysis and experimental results show that the PQSF proposed in this paper reduces the communication complexity between participants and reduces the computational overhead by about 20% compared with existing solutions. [ABSTRACT FROM AUTHOR]

IntroductionMethodsResultsConclusionVisible minorities, a growing segment of Canada's population, have voiced concerns about experiencing racism while receiving care in the emergency department (ED). Understanding the ED care experiences of visible minorities is crucial to improving care and reducing health disparities.From June to August 2021, we collected data from participants in Kingston, Ontario using a sensemaking approach. Individuals who had accessed emergency care or accompanied someone else to the ED in the prior 24 months were eligible to participate. After sharing a brief narrative about their care experience, participants interpreted the experience by plotting their perspectives on a variety of pre-determined questions. Here, we conducted a thematic analysis of narratives involving patients who identified as visible minorities and complemented it with quantitative analysis of the participants’ interpretative responses. This mixed-methods approach highlighted the distinct experiences of visible minority participants in relation to a comparison group.Of the 1973 unique participants, 117 identified as a visible minority and 949 participants did not identify with an equity-deserving group (comparison group). Visible minority participants were more likely to report that too little attention was paid to their identity and more likely to express a desire for a balance between receiving the best medical care and being treated with kindness and respect. Visible minorities’ ED experiences were also more likely to be impacted by how emergency staff behaved. Qualitative analysis revealed negative experiences of feeling uninformed and disempowered, facing judgement and discrimination, and experiencing language barriers. Positive experiences of receiving compassionate care from staff also emerged.Visible minority perceptions of ED care were often negative and mainly focused on staff treatment. Cultural competency and language translation services are key areas for improvement to make ED care more accessible and equitable. [ABSTRACT FROM AUTHOR]

Finite-time consensus problem of hybrid-order heterogeneous multi-agent systems under a signed digraph topology is investigated in this paper. For heterogeneous multi-agent systems composed of first-order and second-order agents, a novel pinning event-triggered control protocol is devised to facilitate the attainment of the desired consensus state within a finite time. This control method overcomes communication barriers between first-order and second-order multi-agent systems, achieving effective control performance while reducing controller update frequency and communication costs. Based on graph theory and the Lyapunov stability method, several novel matrices are defined to address the finite-time consensus problem in hybrid-order multi-agent systems, and these matrices also facilitate the theoretical derivation process. Furthermore, it is demonstrated that the control protocol designed for hybrid-order systems is devoid of Zeno behavior. Finally, a detailed numerical example is supplied to illustrate the validity of the theoretical analysis. [ABSTRACT FROM AUTHOR]

Background: Immigrant populations, especially women, continue facing challenges in accessing quality healthcare, particularly sexual and reproductive health services (SRH). Poor cultural competent health systems contribute to communication challenges between immigrant women and healthcare providers perpetuating health disparities. This exploratory study describes these communication barriers from the perspective of Moroccan and Pakistani immigrant women and healthcare providers within the Catalan health system and its implications to ensure an equitable provision of SRH services. Methods: An exploratory-descriptive qualitative study was conducted in various municipalities of Barcelona with high concentration of immigrants. Eight focus groups (N = 51) and semi-structured interviews (N = 22) with Moroccan and Pakistani immigrant women were combined with key informant interviews (N = 13) with healthcare professionals. Thematic analysis and data triangulation were performed primarily using an inductive approach. Results: Language barriers and cultural differences in health needs, expectations, care-seeking behaviours and understanding of quality healthcare provision hindered the ability of immigrant women and providers to interact effectively. Limited availability of intercultural mediators and inadequate cultural competence training opportunities for health staff were also identified. Findings suggest a lack of minority representation in the Catalan health workforce and leadership roles. Conclusion: This study reinforces the evidence of persistent inequities in accessing healthcare among immigrant populations by focusing on the cultural competence barriers of the Catalan health system in the provision and access to SRH services. The regularization of adequately trained intercultural mediators, quality training in cultural competence for health staff and a commitment to increase workforce diversity would contribute to improve intercultural communication between immigrant patients and providers. An urgent call to action in this direction is needed to ensure an equitable access to SRH services among immigrant women. [ABSTRACT FROM AUTHOR]

Background: Numerous higher education institutions worldwide have adopted English‐language‐medium computer science courses and integrated online problem‐solving competitions to bridge gaps in theory and practice (Alhamami Education and Information Technologies, 2021; 26: 6549–6562). Objectives: This study aimed to investigate the factors influencing the use of online competitions in machine learning courses and their impact on student learning. We also analyse disparities in learning outcomes and instructional language effects (Chinese vs. English). Methods: Among 123 participants at northern Taiwan university, 74 chose Chinese instruction (CMI), and 49 opted for English instruction (EMI). The course spanned 18 weeks: team formation in week one, data analysis, machine learning, and deep learning from week 2 to 8, draft proposals and oral presentations by week 9, instructor guidance in weeks 9–17, followed by off‐campus competitions. In week 18, students presented projects for evaluation by judges. Results: The results showed improved scores in competition proposal writing and oral presentations, especially for CMI students, who excelled in these areas and in terms of creativity. CMI students emphasized domain knowledge, implementation completeness, and technical depth in proposals. The EMI students focused on implementation completeness and artificial intelligence model accuracy, along with creativity. Conclusion: CMI students achieved superior outcomes in machine learning courses, particularly in terms of competition proposals, oral presentations, and increased creativity. Instructional language choice significantly influenced learning trajectories, leading to distinct knowledge development focuses for CMI and EMI. Lay Description: What is already known about this topic: Historically, artificial intelligence (AI) education focused on theory and skills, but now there are AI competitions that encourage real‐world problem‐solving (AIdea. Competitions. 2023. https://aidea-web.tw/about?lang=zh).Competition‐based learning bridges the gap between academia and industry, fostering creativity and talent discovery (Abou‐Warda and Roberts. International Journal of Educational Management. 2016; 30(5): 698).Computer science education globally uses English as the primary language (Alhamami. Education and Information Technologies, 2021; 26: 6549–6562).Non‐English speaking nations are adopting English as the medium of instruction, impacting teaching effectiveness (Alhamami. Education and Information Technologies, 2021; 26: 6549–6562). What this paper adds: This study combines online problem‐solving competitions with machine learning courses, using both Chinese and English instruction.Individual tutoring tailored to each team's competition topic provided real‐world problem‐solving experience and fostered school‐enterprise interactions.A rubric was created for evaluating domain knowledge, proposal writing, presentation skills, AI model accuracy, and competition outcomes by external experts, instructors, TAs, and peers. Implications for practice and/or policy: Combining competition‐based learning with machine learning courses can boost students' domain knowledge, competition skills, and outcomes.This study confirms that using Chinese instruction in machine learning benefits non‐native English‐speaking students more than English instruction.Our teaching approach for information technology courses can be applied to develop students' relevant skills in this field. [ABSTRACT FROM AUTHOR]

In this study, the complaints of five last-mile delivery businesses with the highest business volume (Trendyol Express, Hepsijet, Kargoist, Sendeo and Kargomsende) established with a focus on e-commerce were discussed. The complaints of the businesses in question were accessed through sikayetvar.com, Turkey's largest complaint page, and a qualitative study was conducted using the content analysis method. The aim of the study is to examine the complaints of these last-step delivery companies, which were established with a focus on e-commerce logistics, and to present the analysis. For this purpose, the analysis of complaints was carried out through the MAXQDA program, 60 from each company and 300 complaints in total. As a result of the research, complaints were categorized as personnel-related, communication-related, delivery processes, product-related and business processes-related. As a result of the research, when all complaints were examined, it was determined that the most common problems in business processes were lack of information and incorrect/inconsistent information, while the most common complaints about product-related problems were loss of products in cargo companies and delivery of damaged products. It is seen that the basis of the problems related to the delivery processes lies in the courier problems and there are many complaints about delays in deliveries. In our theme of problems related to communication problems, the most common complaint was the difficulty in resolving the problem when it occurred. The examination of personnel-related issues reveals that unfavourable attitudes, behaviours, and apathy among staff have been the consequences. [ABSTRACT FROM AUTHOR]

The increasing cultural and ethnic diversity within global migrant populations necessitates the provision of culturally competent care by healthcare personnel. This narrative literature review critically analyzes existing literature on the delivery of culturally competent care to migrants, highlighting key theoretical frameworks, empirical findings, and practical strategies to enhance cultural competence in healthcare settings. The review identifies significant health disparities faced by migrants, including barriers to accessing healthcare, communication challenges, and systemic issues within healthcare institutions. It emphasizes the importance of comprehensive training programs, supportive organizational policies, community engagement, and the innovative use of technology and telemedicine. Furthermore, it addresses the future directions and research gaps, calling for longitudinal studies, the development of robust metrics, and targeted strategies to overcome the digital divide and ensure data privacy. By addressing these areas, healthcare providers, educators, and policymakers can improve healthcare delivery, reduce health disparities, and ensure equitable access to care for migrant populations. [ABSTRACT FROM AUTHOR]

Introduction: Divided narratives pose long‐standing difficulties in physician and patient communication. In decision‐making on cancer treatment, divided narratives between physicians and patients hinder mutual understanding and agreement over the illness and its treatment. For effective decision‐making on treatments, it is necessary to investigate the similarities and differences in these divided narratives. Methods: This study adopted a qualitative research design of narrative inquiry to examine the data, which included interviews with 32 cancer patients and 16 paired physicians in two hospitals in China. Data analysis was conducted using grounded theory to generate findings. Results: Both physicians and patients were concerned about goals and obstacles to their decision‐making on cancer treatment. Four common aspects of goal setting were identified from the divided narratives: decision pools, treatment goals, identity practice and preferred identity. Four common obstacles were identified: pains and trust, communication gap, financial issues and complex family. However, the meanings attached to these eight aspects differed between physicians and patients. Conclusion: Cancer treatment decision‐making is an encounter of the scientific world and lifeworld. A divided narrative approach can identify the similarities and differences in the decision‐making on cancer treatment between physicians and patients. Physicians generally adopt a rational decision‐making approach, whereas patients generally adopt a relational decision‐making approach. Despite the common concerns in their goals and obstacles, physicians and patients differed in their contextualized interpretations, which demonstrates the physicians' and the patients' pursuit of preferred identities in decision‐making. The results of this study provide a new perspective to treatment decision‐making, emphasizing the importance of narrative integration in reaching mutual agreement. Patient and Public Contribution: The findings were shared with 15 cancer patients and caregivers for feedback and advice in June 2024. This study was also presented at the international conferences of COMET (International and Interdisciplinary Conference on Communication, Medicine, and Ethics) and ICCH (International Conference on Communication in Healthcare) 2023 for continuous feedback and comments. [ABSTRACT FROM AUTHOR]