Cost Barriers Research Articles

Structure, Properties, and Recent Developments in Polysaccharide- and Aliphatic Polyester-Based Packaging—A Review

Food packaging plays an imperative role in the food processing sector by safeguarding foods from their point of harvesting until the moment of consumption. In recent years, biopolymers have attracted the attention of the scientific community as an alternative to conventional packaging materials. Among the available biopolymer sources, a lot of the focus has been on polysaccharides due to their superior barrier properties against gases, oils, and odors and their processing versatility. Moreover, there is also a growing interest in aliphatic polyester as a potential replacement for petrochemical-based synthetic plastics. Both polysaccharides and aliphatic polyesters have gained popularity in sustainable food packaging due to their unique characteristics, including their low cost, availability, biodegradability, gas and moisture barrier properties, film-forming capabilities, excellent heat resistance, and ability to be processed into films, trays, and coatings. This review highlights the structural features, properties, and recent advancements of several vital polysaccharides, namely, starch, chitosan, cellulose, alginate, pectin, carrageenan, and aliphatic polyesters, including polylactic acid (PLA) and polyhydroxybutyrate (PHB) for developing packaging materials, and their applications in the food industry. Conventional packaging and future perspectives of biopolymer-based food packaging are also comprehensively covered in this review.

Pathway toward Scalable Energy-Efficient Li-Mediated Ammonia Synthesis.

Lithium-mediated ammonia synthesis (LiMAS) is an emerging electrochemical method for NH3 production, featuring a meticulous three-step process involving Li+ electrodeposition, Li nitridation, and Li3N protolysis. The essence lies in the electrodeposition of Li+, a critical phase demanding current oscillations to fortify the solid-electrolyte interface (SEI) and ensure voltage stability. This distinctive operational cadence orchestrates Li nitridation and Li3N protolysis, profoundly influencing the NH3 selectivity. Increasing N2 pressure enhances the NH3 faradaic efficiency (FE) up to 20 bar, beyond which proton availability controls selectivity between Li nitridation and Li3N protolysis. The proton donor, typically alcohols, is a key factor, with 1-butanol observed to yield the highest NH3 FE. Counterion in the Li salt is also observed to be significant, with larger anions (e.g., exemplified by BF4-) improving SEI stability, directly impacting LiMAS efficacy. Notably, we report a peak NH3 FE of ∼70% and an NH3 current density of ∼-100 mA/cm2 via a delicate balance of process conditions, encompassing N2 pressure, proton donor, Li salt, and their respective concentrations. In contrast to the recent literature, we find that the theoretical maximum energy efficiency of LiMAS hinges significantly on the proton source, with LiMAS utilizing H2O calculated to have a maximum achievable energy efficiency of 27.8%. Despite inherent challenges, a technoeconomic analysis suggests high-pressure LiMAS to be more feasible than both ambient LiMAS and a modified green Haber-Bosch process. Our analysis finds that, at a 100 mA/cm2 NH3 current density and a 6 V cell voltage, LiMAS delivers green NH3 at an all-inclusive cost of $456 per ton, significantly lower than conventional cost barriers. Our economic analysis underscores high-pressure LiMAS as a potentially transformative technology that may revolutionize large-scale NH3 production, paving the way for a sustainable future.

Insurance Coverage for Gender-Affirming Voice and Communication Services: An In-Depth Analysis in a Midwestern U.S. State

Purpose: The aim of this study was to explore the gap between the need for gender-affirming voice and communication services (GAVCS) and insurance coverage within one state. Method: An electronic, cross-sectional survey of transgender/gender-diverse (TGD) adults assessed the incidence of insurance and cost barriers to GAVCS. Then, policies from 22 major insurers were reviewed using a web-based search and telephone inquiries. Finally, a tool was developed for clinicians to share available coverage for GAVCS by insurer. Results: Over half (53%) of 115 respondents reported vocal incongruence, but only 19.1% had pursued GAVCS. Of those who had not, 57% reported cost and/or insurance coverage were barriers (most of whom were commercially insured). Less than half of major Ohio insurance plans mentioned GAVCS coverage, and of those who did, less than half would consider covering it on a case-by-case basis. Creation of a tool that explained coverage across insurance companies was helpful, but challenging and labor-intensive. Conclusions: TGD individuals often experience a mismatch between their gender identity and societal perceptions of their voice, which can worsen dysphoria and compromise safety. GAVCS align voice with gender identity but are inconsistently covered by health insurance and can be costly, particularly for individuals who face socioeconomic marginalization. Inconsistent transparency in communicating coverage criteria further exacerbates access to GAVCS. Poor insurance coverage of GAVCS is an important barrier to accessing this evidence-based care, and more transparency and consistency in coverage is critical.

Marketing Strategy and Preference Analysis of Electric Cars in a Developing Country: A Perspective from the Philippines

The wide-scale integration of electric vehicles (EVs) in developed countries represents a significant technological innovation and a step toward reducing carbon emissions from transportation. Conversely, in developing nations like the Philippines, the adoption and availability of EVs have not been as rapid or widespread compared to other countries. In identifying this gap, this study delved into the preferences and factors influencing Filipino consumers’ willingness to purchase EVs. The study gathered 311 valid responses utilizing conjoint analysis with an orthogonal approach to assess the attributes influencing customers’ purchase decisions. Conjoint analysis tools such as IBM SPSS v25 statistics were utilized to infer consumer preference. The results determined that cost is the primary concern for consumers by a considerable margin; followed by battery type and charging method; along with the type of EV, driving range, and charging speed; and most minor concern is regenerative brakes. Therefore, there is an apparent sensitivity to price and technology. This study is the first to apply conjoint analysis to the Philippine market, delivering in-depth consumer preference insights that can help manufacturers and policymakers customize their approach to making EVs more attractive and more viable in less developed markets. The results suggest that a targeted effort to overcome cost barriers and improve technological literacy among prospective buyers should be productive for speeding up EV adoption in the Philippines. The results could be extended in future research to a broader assessment of socioeconomic and environmental benefits, laying out a broader plan for promoting sustainable solutions in transportation.

Examining the Uncertainties Surrounding Exosome Therapy in Androgenetic Alopecia: A Call for Evidence-Based Practice.

Hair loss, a pervasive and often distressing condition, affects a substantial number of individuals globally. Although conventional treatments such as hair transplantation, topicals, oral medications, and injectables exist, they have limitations, including the necessity for repeated treatments, potential adverse effects, and cost barriers. Exosome therapy, an innovative and burgeoning option within regenerative medicine, offers a novel approach to hair loss treatment. Exosomes are small vesicles that are produced from the membranes of late-endosomes and secreted by cells, playing a crucial role in intercellular communication. Research on humans is limited,1-4 and animal studies have shown that exosomes derived from various cell types can stimulate hair growth, resulting in increased research and development of exosome therapy for hair loss.5 Establishing a uniform reporting method for exosome therapy is vital as research in this area continues to expand. A standardized approach to research reporting and results is essential for comprehending the underlying mechanisms, safety, and efficacy of exosome therapy. This article provides an in-depth analysis of the current state of exosome therapy for hair loss, including potential advantages, and limitations, as well as directions for future research. J Drugs Dermatol. 2024;23(3)    doi:10.36849/JDD.7603.

Lives Saved Through Increasing Adherence to Follow-Up After Abnormal Cervical Cancer Screening Results.

To model the potential number of cancers prevented and life-years saved over a range of adherence rates to cervical cancer screening, surveillance follow-up, and follow-up colposcopy that may result from removing financial barriers to these essential clinical services. A previously validated decision-analytic Markov microsimulation model was used to evaluate the increase in adherence to screening, surveillance, and colposcopy after an abnormal cervical cancer screening result. For each incremental increase in adherence, we modeled the number of cervical cancer cases avoided, the stages at which the cancers were detected, the number of cervical cancer deaths avoided, and the number of life-years gained. Compared with current adherence rates, the model estimated that an optimized scenario of perfect screening, surveillance, and colposcopy adherence per 100,000 women currently eligible for screening in the United States was 128 (95% CI, 66-199) fewer cervical cancers detected (23%), 62 (95% CI, 7-120) fewer cervical cancer deaths (20%), and 2,135 (95% CI, 1,363-3,057) more life-years saved. Sensitivity analysis revealed that any increase in adherence led to clinically meaningful health benefits. The consequences of not attending routine screening or follow-up after an abnormal cervical cancer screening result are associated with preventable cervical cancer morbidity and premature mortality. Given the potential for the removal of consumer cost sharing to increase the use of necessary follow-up after abnormal screening results and to ultimately reduce cervical cancer morbidity and mortality, public and private payers should remove cost barriers to these essential services.

Entrepreneurial barriers in achieving sustainable business and cultivation of innovation: a resource-based view theory perspective

PurposeThe study aims to highlight the barriers faced by the entrepreneurs toward achieving sustainability in business and innovation cultivation by offering solutions for academicians, practitioners and policymakers. The study uses the resource-based view (RBV) theory to discuss how an organization’s resources and capabilities influence the competitive ambience and barriers faced by entrepreneurs.Design/methodology/approachThe present research uses grey-causal modelling (GSC) to analyse the barriers against successful entrepreneurship.FindingsThe research focuses on the usefulness of dynamic capabilities, managing and cooperating resources in the entrepreneurship setting. The paper highlights the importance of resource gathering and nurturing as a method to combat scarcity. This research further identifies that financial limitations, regulatory obstacles, challenges to sourcing qualified labour, poor infrastructure and technology, limited mentorship opportunities, lack of scalability, low initial cost barriers in product development and risk-averse attitudes are the major factors hindering entrepreneurs from obtaining sustainable business and innovation.Originality/valueThe contribution of this research to the literature is that it assesses RBV theory within the realm of entrepreneurship, providing a different perspective on resources and capabilities as well as the challenges faced by entrepreneurs. The systematic approach to the analysis and prioritization of various barriers is innovative, and it adds knowledge in this area.

A novel temporal mixed-integer market penetration model for cost-effective uptake of electric boilers in the UK chemical industry

The UK chemical industry is the largest consumer of natural gas for process heating and power generation, with an annual consumption of 26.3 TWh. Reduction in natural gas consumption and associated carbon emissions can be achieved through electrification of heat. However, the adoption of electric boilers is lethargic due to economic barriers. Hence, market-based policy interventions are required. This study aims to accelerate the adoption of electric boilers in the UK's chemical industry, aligning with the UK's ambitious 2035 industrial decarbonisation goals while considering economic impacts, by designing market-based policy interventions and comparing two adoption patterns. A novel multi-period Mixed-Integer Market Penetration Optimisation Model is developed and applied to inform decisions about transitioning from natural gas to electric boilers. The model is applied to a case study of all the heating systems (490 boilers) in the UK chemical industry from 1 MW to 60 MW boilers. Results show that effectively implementing a gas tax, electricity subsidy, annual grant and carbon tax can generate sufficient demand-pull to reduce the cost of electric boilers from 30 to 85 % depending on the boiler size. A carbon tax starting at £280 per tCO2e and reducing to £170 per tCO2e coupled with electricity subsidies is essential for this transition. The policies are designed such that a win-win is achieved between government and industry; specifically, revenue from the carbon tax and gas tax is used to support the grant and electricity subsidy thereby achieving cost neutrality for government. At 100 % uptake of electric boilers in 2033, the total carbon emissions reduce by 89 %, which is above the 2035 UK industry goal of 60 % reduction. The research establishes a robust policy timeline that can drive industrial electrification in the UK's chemical sector. It highlights the need for a multi-faceted approach, incorporating various policy instruments to overcome the barriers of high initial capital costs.

Prostate Cancer Screening Uptake in Transgender Women

There is no consensus in prostate-specific antigen (PSA) screening guidelines regarding transgender women despite their known prostate cancer risk. To identify factors associated with recent (within the last 2 years) PSA screening in transgender women compared with cisgender men. This case-control study used data from the 2018 and 2020 Behavioral Risk Factor Surveillance System (BRFSS) surveys to characterize rates of PSA screening for prostate cancer within the past 2 years and multivariable logistic regressions to characterize factors associated with recent screening among transgender women. The BRFSS program of the Centers for Disease Control and Prevention annually surveys over 400 000 US adults on behavioral risk factors, chronic illnesses, and use of preventive services. Respondents to the BRFSS who were cisgender men or transgender women 40 years or older and who had complete PSA testing responses and no prostate cancer history were included; 313 transgender women and 138 937 cisgender men met inclusion criteria. Matching was performed by age, race and ethnicity, educational level, employment, annual income, survey year, and cost barriers to care. Data were collected on November 2, 2022, and analyzed from November 2, 2022, to December 3, 2023. Rates of and factors associated with recent PSA screening in transgender women. Among the 1275 participants included in the matched cohort (255 transgender women and 1020 cisgender men; 570 [44.7%] aged 55-69 years), recent PSA screening rates among transgender women and cisgender men aged 55 to 69 were 22.2% (n = 26) and 36.3% (n = 165), respectively; among those 70 years and older, these rates were 41.8% (n = 26) and 40.2% (n = 98), respectively. In the matched cohort, transgender women had lower univariable odds of recent screening than cisgender men (odds ratio [OR], 0.65 [95% CI, 0.46-0.92]; P = .02). In a hierarchical regression analysis adding time since the last primary care visit, effect size and significance were unchanged (OR, 0.61 [95% CI, 0.42-0.87]; P = .007). After adding whether a clinician recommended a PSA test, there was no statistically significant difference in odds of screening between transgender women and cisgender men (OR, 0.83 [95% CI, 0.45-1.27]; P = .21). The results were further attenuated when clinician-led discussions of PSA screening advantages and disadvantages were added (OR, 0.87 [95% CI, 0.47-1.31]; P = .32). In a multivariable logistic regression among transgender women, having a recommendation for PSA testing was the factor with the strongest association with recent screening (OR, 12.40 [95% CI, 4.47-37.80]; P < .001). In this case-control study of one of the largest cohorts of transgender women studied regarding PSA screening, the findings suggest that access to care or sociodemographic factors were not principal drivers of the screening differences between transgender women and cisgender men; rather, these data underscore the clinician's role in influencing PSA screening among transgender women.

Battery leasing business for hydrogen fuel cell vehicles: Motorists' costs, adoption, and manufacturers’ profits

The high cost of the battery hinders the adoption of hydrogen fuel cell vehicles (HFCVs). Thus, we propose a battery leasing model to overcome this cost barrier, in which motorists own the vehicle without a battery, and the lifetime of the battery is shared by the subsequent motorists who lease the battery. We proposed a game model between a manufacturer and motorists and compared the battery leasing model with the traditional buyout model, calibrated with U.S. data. We found that, first, the battery leasing model promotes HFCV adoption; specifically, leasing battery significantly reduces motorists' costs and increases their utility, especially when battery cost is high. Compared to Mirai's lease option, our model motorists' costs could be reduced by 20%–42% currently, and 15%–27% in the future. Second, the battery leasing model operates better when hydrogen price and battery cost decrease, increasing adoption and manufacturer's profits. Finally, the battery leasing model is more profitable for manufacturers than the buyout model. In addition, low interest rates and high down payments will further extend the advantage of the battery lease model. This study deepens the understanding of the HFCV business model in decarbonizing the transport sector and the sharing economy in vehicle sharing.

Analysis of barriers related to the costs incident about the cargo transportation by cabotage

Cabotage in Brazil, despite offering cost reductions for the transportation of large cargo quantities, has been underutilized. The country boasts an extensive coastline and a demographic distribution favorable to the use of coastal shipping as a means of cargo transportation. The research aimed to identify the main barriers related to costs affecting coastal shipping in Brazil. The methodology relied on bibliographic and documentary research, encompassing books, journals, official documents, reports, as well as government websites. Five barriers were identified: Barriers related to fleet depreciation and renewal costs; Operational cost barriers; Capacity-related costs of vessels; Initial kilometer cost barriers; and Intermodality cost barriers. The conducted study could contribute to enhancing decision-making regarding cargo transportation in the country, while also encouraging investment decisions and promoting coastal shipping.

Cost Barriers as Factors Associated with Poor Asthma Control in the United States – Findings from Child Asthma Call Back Survey

Cost Barriers as Factors Associated with Poor Asthma Control in the United States – Findings from Child Asthma Call Back Survey

Underutilization of androgen deprivation therapy (ADT) intensification for the treatment of men with metastatic hormone-sensitive prostate cancer (mHSPC): A systematic review of real-world database studies.

66 Background: In the last decade, intensification of ADT with chemotherapy or androgen receptor pathway inhibitors (ARPi) has shown clinical benefits for men with mHSPC compared to ADT alone and has been recommended for mHSPC in clinical guidelines. The transition of these guidelines into real-world practice was investigated by several studies; however, these data have not been systematically summarized across the globe. Thus, we conducted a systematic literature review of real-world database (RWD) studies to summarize treatment patterns in mHSPC. Methods: An electronic search was performed in PubMed and Embase (covering citations until July 2023) and for relevant conferences of the past 2 years to identify RWD studies examining treatment patterns in men with mHSPC. Treatment patterns were summarized by overall study population across major geographies and factors associated with ADT intensification were described. Results: Of 2,325 retrieved citations, 29 studies met the inclusion criteria, with a total of 344,473 men with mHSPC covering study periods from 2014 to 2021. Most were cohort studies (n=26), utilizing electronic medical records (EMR)/chart reviews (n=18), and with RWDs from the United States (US) (n=21), followed by Europe (n=8), and Asia (n=6). Most studies included men with a median age of ≥70 years (n=23) and &gt;80% of men had an Eastern Cooperative Oncology Group performance status (ECOG PS) of 0/1 (n=5 of 8). In the US, most studies showed that ADT monotherapy was predominantly utilized (&gt;50%), followed by ADT/ARPi (20-40%), and ADT/chemotherapy (10-20%). Abiraterone was the most frequently used ARPi followed by enzalutamide. In Europe, most studies also reported ADT monotherapy (&gt;45%), followed by ADT/ARPi (11-25%), or ADT/chemotherapy (12-34%). In Asia, ADT monotherapy (&gt;62%) was the most common treatment in most studies, with low use of ADT/ARPIs (&lt;20%), and ADT/chemotherapy (&lt;15%). A few studies with recent EMR data (covering the 2020-21 data period) from cancer centers/registries showed high use of ADT/ARPi (&gt;40%) in both the US and Europe. Reported quantitative factors (n=13) associated with intensification beyond ADT were high disease burden (spread of metastases, high volume), young age, ECOG PS 0/1, low comorbidities, and treating physician specialty-oncologist; qualitative factors (n=2) were patient preference, unsatisfactory response to ADT treatment, ability to tolerate adverse events, and lack of cost barriers. Conclusions: This comprehensive review shows ADT monotherapy remained highly utilized across major geographies until 2021 despite new evidence and updated guideline recommendations. However, the utilization of intensified treatment with ARPi combinations is slowly increasing after the recent approvals in mHSPC.

Impact of Financial Costs on Patients' Fertility Preservation Decisions: An Examination of Qualitative Data from Female Young Adults with Cancer and Oncology Providers.

Purpose: To examine the impact of financial costs on fertility preservation decisions among female young adults (YAs) with cancer. Methods: Female YAs (N = 18; aged 21-36) with a history of cancer and oncology providers (N = 12) were recruited from an National Cancer Institute-designated comprehensive cancer center in a state without insurance coverage for fertility preservation. YAs and providers completed individual interviews and a brief online assessment. Qualitative description using thematic analysis was used to identify, analyze, and report common themes. Descriptive statistics was used to characterize the sample. Results: Female YAs and oncology providers highlighted the critical role that high out-of-pocket costs play in YAs' fertility preservation decisions along with the value that enhanced insurance coverage for fertility preservation would have for increasing female YAs' access to and utilization of fertility preservation. Although providers were concerned about preservation costs for their patients, they reported that their concerns did not impact whether they referred interested female YAs to reproductive specialists. Oncology providers expressed concern about inequities in utilization of fertility preservation for female and racially/ethnically minoritized YAs that were exacerbated by the high out-of-pocket fertility preservation costs. Conclusion: Cost is a significant barrier to fertility preservation for female YA cancer patients. Female YAs of reproductive age may benefit from decision support tools to assist with balancing the cost of fertility preservation with their values and family building goals. Policy-relevant interventions may mitigate cost barriers and improve access to care.

Whole-Body Vibration in Oncology Rehabilitation: Perceived Benefits, Barriers, and Clinician Willingness

Background: Patients with active and prior cancer diagnoses suffer a sequela of physical effects that negatively impact quality of life. Improvements in commonly impacted physiological systems have been achieved with the use of whole-body vibration (WBV). Current usage, appropriate diagnoses, and clinician perceptions of WBV remain unknown despite an increasing body of literature. The purpose of this study was to examine current practices and understand perceived indications, benefits, and barriers for the use of WBV in patients with cancer, particularly of clinicians working with pediatric populations. Methods: A Web-based survey was distributed via e-mail and social media posts to clinicians across the United States serving patients with cancer diagnoses. Results: Of a total of 72 responses, less than 3% of clinicians are currently using WBV in clinical practice. Diagnoses perceived as most appropriate for the use of WBV included leukemia/lymphoma (63.6%), central nervous system cancers (49.4%), and neuroblastoma (46.8%). Bone cancers were reported as the most inappropriate diagnoses (49.4%). Perceived benefits of WBV include improvements in blood flow, muscular strength, and bone mineral density. Lack of training (82%) and access to equipment (75%) were the most commonly reported barriers to use. Conclusion: WBV is perceived to be useful, safe, and beneficial for targeting effects of antineoplastic treatment for patients with cancer diagnoses, though current use is limited because of barriers of cost, access, and clinician knowledge.

Health system assessment for access to care after injury in low- or middle-income countries: A mixed methods study from Northern Malawi.

Injuries represent a vast and relatively neglected burden of disease affecting low- and middle-income countries (LMICs). While many health systems underperform in treating injured patients, most assessments have not considered the whole system. We integrated findings from 9 methods using a 3 delays approach (delays in seeking, reaching, or receiving care) to prioritise important trauma care health system barriers in Karonga, Northern Malawi, and exemplify a holistic health system assessment approach applicable in comparable settings. To provide multiple perspectives on each conceptual delay and include data from community-based and facility-based sources, we used 9 methods to examine the injury care health system. The methods were (1) household survey; (2) verbal autopsy analysis; (3) community focus group discussions (FGDs); (4) community photovoice; (5) facility care-pathway process mapping and elucidation of barriers following injury; (6) facility healthcare worker survey; (7) facility assessment survey; (8) clinical vignettes for care process quality assessment of facility-based healthcare workers; and (9) geographic information system (GIS) analysis. Empirical data collection took place in Karonga, Northern Malawi, between July 2019 and February 2020. We used a convergent parallel study design concurrently conducting all data collection before subsequently integrating results for interpretation. For each delay, a matrix was created to juxtapose method-specific data relevant to each barrier identified as driving delays to injury care. Using a consensus approach, we graded the evidence from each method as to whether an identified barrier was important within the health system. We identified 26 barriers to access timely quality injury care evidenced by at least 3 of the 9 study methods. There were 10 barriers at delay 1, 6 at delay 2, and 10 at delay 3. We found that the barriers "cost," "transport," and "physical resources" had the most methods providing strong evidence they were important health system barriers within delays 1 (seeking care), 2 (reaching care), and 3 (receiving care), respectively. Facility process mapping provided evidence for the greatest number of barriers-25 of 26 within the integrated analysis. There were some barriers with notable divergent findings between the community- and facility-based methods, as well as among different community- and facility-based methods, which are discussed. The main limitation of our study is that the framework for grading evidence strength for important health system barriers across the 9 studies was done by author-derived consensus; other researchers might have created a different framework. By integrating 9 different methods, including qualitative, quantitative, community-, patient-, and healthcare worker-derived data sources, we gained a rich insight into the functioning of this health system's ability to provide injury care. This approach allowed more holistic appraisal of this health system's issues by establishing convergence of evidence across the diverse methods used that the barriers of cost, transport, and physical resources were the most important health system barriers driving delays to seeking, reaching, and receiving injury care, respectively. This offers direction and confidence, over and above that derived from single methodology studies, for prioritising barriers to address through health service development and policy.

Trends in Health Care Coverage and Out-Of-Pocket Cost Barriers: A Gender Comparison.

Objective: The presence of disparities in access to health care and insurance coverage can have a tremendous impact on health care outcomes. Programs like the Affordable Care Act were implemented to improve health care access and to address the existing inequities. The objective of this study was to identify any disparities that exist between males and females regarding health care coverage and out-of-pocket cost to health care. Methods: This analysis was a cross-sectional study using the Behavioral Risk Factor Surveillance System survey data collected between 2013 and 2018. The primary predictor was sex assigned at birth (with the binary option of male vs. female). The primary outcome was adequate health coverage. Survey participants who indicated that they had health insurance with no out-of-pocket cost barriers to receiving medical care were considered to have adequate health coverage, while participants who did not meet these criteria were considered to have inadequate health coverage. Covariates measured were age, race/ethnicity, educational level, employment status, and annual household income. SAS survey procedures and weighting methods were used to measure the association between the sex and adequate health coverage, after controlling for covariates. Results: The data spanning 6 years included 2,249,749 adults, of whom 1,898,097 (84.4%) had adequate health coverage. Females made up 55.8% (N = 1,256,243) of the total sample. About 32.6% (N = 733,216) survey participants were aged ≥65 years. Most respondents, 77.6%, were White (Non-Hispanic). Across the 6-year period, females were more likely to have health insurance but with out-of-pocket costs that served as a barrier to their medical care (adjusted odds ratios with 95% CI from 2013 to 2018 were 1.36 [1.29-1.43], 1.38 [1.32-1.46], 1.31 [1.24-1.38], 1.33 [1.26-1.40], and 1.32 [1.25-1.40], respectively). Conclusions: Females were more likely than males to indicate an out-of-pocket cost barrier to medical care despite having health insurance.

Exploring enablers and inhibitors of AI‐enabled drones for manufacturing process audits: A mixed‐method approach

AbstractThe objective of this study is to explore the enablers and inhibitors of AI‐enabled drone adoption for manufacturing process audit using a mixed‐method design. A qualitative study was performed to explore the enablers and inhibitors. Further, based on the findings of the qualitative studies, a framework was proposed, and proposed hypotheses were examined using a survey‐based study. The results indicated that function, environmental, and epistemic values are major enablers, whereas vulnerability and sunk cost barriers are major inhibitors to adoption intention. The initial trust and inertia were crucial mediators, and organizations' technological innovativeness played a crucial moderating role. This study enriches the literature on technological adoption for sustainability and helps audit service providers design strategies to enhance AI‐enabled drone adoption for process audits.

Micro-mechanism investigation of hydrogen evolution reaction on anti-perovskite Ni3InN considering doping and strain effects

Anti-perovskites are considered as promising high-efficiency catalysts for hydrogen evolution reaction (HER) due to their low cost, adjustable composition, and small water dissociation kinetic barriers. Accounting strain effects, transition metal doping effects and solvent effects, we calculate HER micro-mechanism on anti-perovskite Ni3InN and conclude that HER on Ni3InN can be divided into two steps, rapid proton adsorption at the Bridge site and favorable H2 desorption at the Hollow site. We obtained 2 doping elements (Pt and Ir) from 20 transition metal elements that can enhance HER catalytic performance of Ni3InN. It is worth noting that applying a certain strain is beneficial for the catalytic performance of some doped Ni3InN (e.g. +2 %, +1% for Pt), while harmful for others (e.g. Ir). Our work provides a new perspective for the application of anti-perovskites in HER, which is meaningful for the development of HER catalysts.

‘I knew which one I wanted’: Interviews with Illinois patients to explore abortion method decision‐making after insurance expansion

AbstractIntroductionTo understand patient preferences around early abortion methods and care‐seeking during the coronavirus disease 2019 pandemic in a state that expanded insurance coverage for abortion care.MethodsWe conducted phone interviews between July 2021 and February 2022 with 50 Illinois residents (aged 18–45) who had recently sought abortion at 18 clinics throughout Illinois at or before 11 weeks of pregnancy. We used a semistructured interview guide to explore preferences, motivations and decision‐making around the abortion method. We coded transcripts and used code summaries to conduct a thematic content analysis.ResultsHalf of the participants chose medication abortion, and half chose procedural abortion. Some participants relied upon their past abortion experiences to choose a method. Participants' reasons for choosing medication abortion included home setting with support persons, the noninvasive nature, desiring a more ‘natural’ experience or negative perceptions of procedural abortions. Participants choosing procedural abortions valued increased certainty of completion, the option of sedation and the defined timeline of a clinic visit with fewer physical side effects. Some participants without insurance coverage were motivated to select a method based on cost. Around half of the participants expressed interest in considering a telehealth abortion.ConclusionsPatients cited complex and personal preferences influencing their method selection; when cost barriers were reduced, preferences centred physical or emotional experiences, setting, effectiveness and timing. As abortion access is increasingly restricted, many patients may still highly value a choice between medication and procedural abortion when possible.