Scopus Elsevier Research Articles

Meta-analysis of metal nanoparticles degrading pesticides: what parameters are relevant?

The rise in the global population demands an increasing food supply and methods to boost agricultural production. Pesticides are necessary for agricultural production models, avoiding losses of close to 40%. Nevertheless, the extensive use of pesticides can cause their accumulation in the environment, causing problems for human health, biota, and ecosystems. Thus, new technologies have emerged to remove these wastes efficiently. In recent years, metal and metal oxide nanoparticles (MNPs) have been reported as promising catalysts to degrade pesticides; however, a systematic understanding of their effect on pesticide degradation is still required. Therefore, this study focused on a meta-analysis of articles available in Elsevier's Scopus and Thomas Reuters Web of Science, found by searching for "nanoparticle pesticide" and "pesticide contamination." After passing different filters, the meta-analysis was performed with 408 observations from 94 reviews, which comprise insecticides, herbicides, and fungicides, including organophosphates, organochlorines, carbamates, triazines, and neonicotinoids. Herein, 14 different MNPs (Ag, Ni, Pd, Co3O4, BiOBr, Au, ZnO, Fe, TiO2, Cu, WO3, ZnS, SnO2, and Fe0), improved pesticide degradation, with the highest degradation rates achieved by Ag (85%) and Ni (82.5%). Additionally, the impact of the MNP functionalization, size, and concentration on pesticide degradation was quantified and compared. In general, the degradation rate increased when the MNPs were functionalized (~ 70%) compared to naked (~ 49%). Also, the particle size significantly affected the degradation of pesticides. To our knowledge, this study is the first meta-analysis performed about the impact of MNPs on pesticide degradation, providing an essential scientific basis for future studies.

ChatGPT for Computational Social Systems: From Conversational Applications to Human-Oriented Operating Systems

Welcome to the second issue of the IEEE TRANSACTIONS ON COMPUTATIONAL SOCIAL SYSTEMS (TCSS) of 2023. According to the latest update of CiteScoreTracker from Elsevier Scopus released on February 5, 2023, the CitesSore of TCSS has reached a historical high of 9.6. Many thanks to all for your great effort and support.

Посттравматический гемартроз с точки зрения теории воспаления

Introduction Post-traumatic hemarthrosis is identified as intra-articular hemorrhage accompanied by five classic signs of inflammation: hyperemia, hyperthermia, edema, pain and changes in the joint function. The objective of the study was to establish whether inflammation should be underestimated in post-traumatic hemarthrosis based on the analysis of the world scientific literature of recent years. Material and methods Internet search platform Web of Science (Clarivate Analytics, USA): databases Web of Science Core Collection (subscription access), Publons (open access), Medline (open access) were used to review scientific articles. Papers from the Scopus Elsevier database (Netherlands) were explored. The search depth was 15 years. Topics that did not receive coverage in the literature of this period were studied until the 1960s in some cases. More than 200 sources were identified on the subject. The literature published in the current year was analyzed covering 15.0 % of the materials, brought out in the last 5 years including the current year covering 56.3 %, in the last 10 years including the current year covering 73.8 %, in the last 15 years including the current year covering 81.3 %. Results and discussion The severity of injury and the accompanying inflammatory factors would characterize a rapid resolution or a more severe course of post-traumatic hemarthrosis during treatment. The combination of several variants of inflammation can lead to the development of complications including osteoarthritis in cases that show mechanisms of chronic systemic inflammation of low intensity being manifested at the time of injury; ankylosis of the joint resulting from chronic systemic inflammation of low intensity involving degenerative processes. Synovitis, as a complication of post-traumatic hemarthrosis, should be differentiated with signs of low-grade inflammation, chronic course of classical inflammation and presystemic inflammation (purulent arthritis) in view of the inflammation theory. Conclusion The analysis of modern literature has shown the complexity and versatility of aspects of inflammation in posttraumatic hemarthrosis. The lack of emphasis on the assessment of the inflammatory response in rehabilitation of patients with post‑traumatic hemarthrosis can result in complications causing preconditions for the development of osteoarthritis, ankylosis, synovitis.

TRENDS IN TOURISM RESEARCH IN MALAYSIA: A BIBLIOMETRIC ANALYSIS

This article presents a bibliometric review analyzing 43 years of research published between 1979 and 2022 from the Elsevier Scopus database. Through bibliographical analysis of 1,956 Scopus-indexed documents, the review found that this is very recent literature with over 89% of the relevant documents published since 2010. The contributions of institutional tourism publications by affiliation showed that Universiti Teknologi Malaysia (UiTM) had the highest number of publications. Meanwhile the Tourism Management, Current Issues in Hospitality and Tourism Research and Innovations and Planning Malaysia published the most significant number of publications related to tourism research. To the best of the researchers’ knowledge, this is the first bibliometric study to analyze tourism research in Malaysia.

Theoretical framework of sustainable value creation by companies. What do we know so far?

AbstractIn conditions of limited natural resources, growing social awareness, and ESG risk, sustainability and the pressure to be sustainable are gaining importance. Legislative requirements, good practices and recommendations as well as the stakeholders themselves expect from market participants, especially from the enterprise sector, that they will incorporate sustainability in their activities. Enterprises undertake adaptation activities towards sustainability by creating sustainable value based on their business models. The article aims to systematize the state of knowledge on how companies create sustainable value. Research results in this area are dispersed, and more studies discussing this topic comprehensively are needed. The article fills the gap in research by reviewing the existing studies on creating sustainable value. The analysis of publications was based on the academic databases of Elsevier Scopus and Web‐of‐Science. 101 publications were reviewed, and 31 categorization variables related to the area of research and issues addressed in scientific publications were created. Using a multidimensional correspondence analysis, three homogeneous clusters of publications were obtained: group I refers to articles concerning enterprises of various sizes (micro, small, SME, and start‐up); group II includes publications on Asia and Australia, which appeared in 2020 or later; group III concerns articles related to the research of large production companies in developed European countries. The result shows that companies build sustainable value in various ways, influenced by company's location and size. Among the dominant patterns of incorporating sustainable value, the following are indicated: building a sustainable supply chain, innovations, building relationships with stakeholders and consumers, sharing economy.

Artificial intelligence empowered conversational agents: A systematic literature review and research agenda

Consumer research on conversational agents (CAs) has been growing. To illustrate and map out research in this field, we conducted a systematic literature review (SLR) of published work indexed in the Clarivate Web of Science and Elsevier Scopus databases. Four dominant topical areas were identified through bibliographic coupling. They are 1) consumers’ trust in CAs; 2) Natural Language Processing (NLP) in developing and designing CAs; 3) communication with CAs; 4) impact of CAs on value creation and the value of CAs for business. We leverage these findings to provide an updated synopsis of extant scientific work. Moreover, we draw a framework whereby we identify the: 1) drivers of and motivators for adoption and engagement with CAs; and 2) the outcomes of CA adoption for both users and organizations. Finally, we leverage the framework to develop an agenda for future research.

Who are the most highly cited forensic scientists in the United States?

The most highly cited forensic practitioners in the United States were identified using a publicly available citation database that used six different citation metrics to calculate each person's composite citation score. The publication and citation data were gleaned from Elsevier's SCOPUS database, which contained information about ~7 million scientist each of whom had at least five entries in the database. Each individual was categorized into 22 scientific fields and 176 subfields, one of which was legal and forensic medicine (LFM). The database contained citation records for 13,388 individuals having LFM as their primary research discipline and 282 of these (2%) were classified as being highly cited. Another 99 individuals in the database had LFM as their secondary discipline, making a total of 381 highly cited forensic practitioners from 35 different countries. The career-long publication records of each individual were compared using their composite citation scores. Of the 381 highly cited scientists, 93 (24%) had an address somewhere in the United States. The various branches of forensics they specialized in were anthropology, criminalistics, DNA/genetics, odontology, pathology, statistics/epidemiology, and toxicology. The two most highly cited scientists, according to their composite citation score, were both specialists in DNA/genetics. Bibliometric methods are widely used for evaluating research performance in academia and a similar approach might be useful in jurisprudence, such as when an expert witness is instructed to testify in court and explain the meaning of scientific evidence.

Bibliometric Analysis of Poor Oral Health as a Risk Factor for Oral Cancer.

Poor oral health is a risk factor for oral cancer, and bibliometrics can tell us important things about publication trends and research. Oral cancer risk factors include smoking, betel nut chewing, alcohol consumption, trauma from sharp teeth, chronic infections, and other factors related to oral health. There is a need to understand the role of poor oral health as a risk factor. Thus, this study aimed to conduct a bibliometric analysis of the literature on poor oral health as a risk factor for oral cancer. A bibliometric analysis was conducted for poor oral health as a risk factor for oral cancer using RStudio 2021.09.0+351 "Ghost Orchid" Release (2021-09-20) for Windows, package "bibliometrix." The literary data for this study were derived from Elsevier's Scopus database, and the data were exported in BibTex format. The results considered the time frame of 1983 to 2022, with journals, books, newspaper articles, and others as sources, accounting for a total of 543 documents. The search yielded a total of 2,882 authors, with a total of 3,306 appearances. The results show that the research on poor oral health and oral cancer is mainly led by the United States (106), India (49), and China (46). The top author is Warnakulasuriya S, followed by Worthington HV. The research shows the countries that are currently working on the topics and helps set up future collaborations to improve the evidence produced and help the scientific community by finding research gaps and experts in this area of research.

Burnout and associated psychological issues among teachers: A Scoping Review

IntroductionWorldwide, stress and burnout continue to be a problem among teachers, leading to anxiety and depression. Burnout may adversely affect teachers’ health and is a risk factor for poor physical and mental well-being. Determining the prevalence and correlates of stress, burnout, anxiety, and depression among teachers is essential for addressing this public health concern.ObjectivesTo determine the extent of the current literature on the prevalence and correlates of stress, burnout, anxiety, and depression among teachersMethodsThis scoping review was performed using the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews). Relevant search terms were used to determine the prevalence and correlates of teachers’ stress, burnout, anxiety, and depression. Articles were identified using MEDLINE (Medical Literature Analysis and Retrieval System Online), EMBASE (Excerpta Medica Data Base), APA PsycINFO, CINAHL Plus (Cumulative Index of Nursing and Allied Health Literature), Scopus Elsevier and ERIC (Education Resources Information Center). The articles were extracted, reviewed, collated, and thematically analyzed, and the results were summarized and reported.ResultsWhen only clinically meaningful (moderate to severe) psychological conditions among teachers were considered, the prevalence of burnout ranged from 25.12% to 74%, stress ranged from 8.3% to 87.1%, anxiety ranged from 38% to 41.2% and depression ranged from 4% to 77%. The correlates of stress, burnout, anxiety, and depression identified in this review include socio-demographic factors such as sex, age, marital status, and school (organizational) and work-related factors including the years of teaching, class size, job satisfaction, and the subject taught.ConclusionsTeaching is challenging and yet one of the most rewarding professions, but several factors correlate with stress, burnout, anxiety, and depression among teachers. Highlighting these factors is the first step in recognizing the magnitude of the issues encountered by those in the teaching profession. Implementation of a school-based awareness and intervention program is crucial to resolve the early signs of teacher stress and burnout to avoid future deterioration.Disclosure of InterestNone Declared

Central neurocytomas: research trends, most cited papers, and scientometrics analysis to date

Central neurocytoma is the most common primary intraventricular tumor in adults being classified by the World Health Organization (WHO) as a benign grade II tumor with a good prognosis. Given the recent advances with regard to this tumor, a bibliometric analysis was due to study the future direction of research for neurocytomas. A comprehensive Elsevier's Scopus database search was performed to capture all published and indexed studies to date relevant to neurocytoma. A discrete set of validated bibliometric parameters were extracted and analyzed on R v4.1.3. A total of 1002 documents were included in our analysis covering a period between 1910 and 2021 (111 years). Around 98.5% of the documents were multi-author publications with a collaboration index (CI) of 4.21. Acta Neuropathologica, The American Journal of Surgical Pathology, and Cancer were the journals to include the highest number of top ten cited articles (2 out of 10 most cited articles, 20%). Switzerland (4 out of 10, 40%) accounted for the country to have the highest number of top 10 most cited articles with the USA (5588 out of 16,395 citations, 34.1%) having the greatest number of citations. Lastly, our analysis reported an annual growth rate of 6.9% for the number of papers produced by year. This is the first bibliometric analysis to study the top 10 most cited articles with regard to neurocytomas. A shift from histopathologic and clinical symptoms towards the treatment and management of the tumor was observed in our analysis.

FERTILIZANTE ALTERNATIVO A PARTIR DE CINZAS DE BIOMASSAS: UMA BREVE ANÁLISE BIBLIOMÉTRICA VIA SCOPUS

The present work aimed to identify and analyze the international scientific research regarding the application of biomass ash in agriculture. To this end, the Elsevier Scopus database and its tools were used as a bibliometric resource, where articles and reviews containing in their title, abstract, or keywords the terms ash, biomass, fertilizer, amendment, and soil, published between 1985 and 2021, were selected. A total of 108 articles were identified, of which 29 were published between 1985 and 2014 and 79 between 2015 and 2021. The increase in the number of publications on this subject in the last seven years is possibly related to the goals set by the Paris Agreement in 2015, which aims to reduce greenhouse gas emissions by replacing fossil fuels with renewable energy sources. Among them, biomass stands out, which has directly contributed to the increasing production of ash and, consequently, has stimulated scientific research on ways to reuse this residue and its effects. Besides agronomic efficiency, the bibliometric analysis revealed that scientific research has focused on the evaluation of environmental impacts caused by the ash application and the search for technological routes for the optimization of its use. The United States, India, and Spain have the largest number of publications on the subject; however, the University of Copenhagen, Denmark, the University of Aveiro, Portugal, and the University of Life Sciences in Poznań, Poland, are the institutions with the largest number of published articles on the subject. Regarding the journals with the largest number of scientific publications, the Science of the Total Environment, Environmental Science and Pollution Research, and Journal of Elementology stand out, which reflects the relations of the subject studied with the areas of environmental, agricultural, and biological science. Keywords: Mineral residue; recycling; agriculture; scientific research.

Virtual Reality Solutions Employing Artificial Intelligence Methods: A Systematic Literature Review

Although there are methods of artificial intelligence (AI) applied to virtual reality (VR) solutions, there are few studies in the literature. Thus, to fill this gap, we performed a systematic literature review of these methods. In this review, we apply a methodology proposed in the literature that locates existing studies, selects and evaluates contributions, analyses, and synthesizes data. We used Google Scholar and databases such as Elsevier's Scopus, ACM Digital Library, and IEEE Xplore Digital Library. A set of inclusion and exclusion criteria were used to select documents. The results showed that when AI methods are used in VR applications, the main advantages are high efficiency and precision of algorithms. Moreover, we observe that machine learning is the most applied AI scientific technique in VR applications. In conclusion, this paper showed that the combination of AI and VR contributes to new trends, opportunities, and applications for human-machine interactive devices, education, agriculture, transport, 3D image reconstruction, and health. We also concluded that the usage of AI in VR provides potential benefits in other fields of the real world such as teleconferencing, emotion interaction, tourist services, and image data extraction.

The scientometric analysis of body language research

Aim: The authors’ research investigated human metacommunications from the perspective of how these signals could be interpreted and used as risk indicators during customs controls. Modern customs technology uses risk indicators to create risk profiles, separate risk groups, and assign risk levels. One element of the research is identifying other researchers’ published results in scientific studies of human metacommunication and the lessons we could learn from these previous studies.Methodology: The authors chose to start their study by conducting a scientometric analysis using a database of publications with global coverage and high academic prestige. They decided on the Elsevier Scopus repository from several possible database options and used the keyword search method. They analysed the published data set between 1971 and 2021 using Elsevier’s SciVal analysis tool. The statistical analysis, a measure of scientific performance, focuses on the metadata of publications and provides the opportunity to identify in-depth correlations between these papers.Findings: A statistical analysis of the core population of n = 2278 publications and the exploration of metadata of reduced records between 1997 and 2021 allowed us to understand deeper correlations between records of n = 2101. The study on a sufficiently large number of individuals demonstrated the multiand interdisciplinary nature of the topic and the growing scientific interest in its research.Value: The study has identified core elements of the theme, its links and the scientific discipline fields identified by the publications investigated. The analysis includes an overview of the authors, institutions and countries that have published the most, the new scientific value provided by the publications, and the leading scientific journals for scientific discourse. On this basis, the authors suggest further research directions, particularly for researchers in law enforcement sciences.

The effect of polyphenols in post stroke adults: A systematic review of randomised controlled trials

After a stroke, survivors are often left with significant disabilities and are at a greater risk of recurrent strokes. It is vital stroke survivors receive effective treatments to assist with rehabilitation and reduce risk factors for secondary stroke. Observational and preclinical studies have highlighted the promising role of polyphenols in these regards. A systematic review of original research which assessed the role of polyphenols on health outcomes in post stroke adults was conducted. PROQUEST, SCOPUS (Elsevier), MEDLINE (EBSCO), Embase and Cochrane Library databases were searched up to the 29th of October 2021. A total of 9 studies met the full inclusion criteria and were included in this review. Several classes of polyphenols were assessed including hydroxybenzoic acids, stilbenes and flavonoids. Numerous health outcomes were assessed including vascular function, stroke disability, blood pressure, blood glucose and c-reactive protein. The majority of the studies included in this review (n=8) note improvements in the polyphenol groups for at least one outcome measure. However, small sample sizes, short trial length and reporting bias prevent firm conclusions from being drawn. This review provides promising preliminary evidence that polyphenols may be beneficial for post stroke adults, however, more research is required. To ensure reliable methodology and replication of results, future studies should include outcome statistics and effect sizes. Trials with a longer duration and large sample size should also be considered.

Assessing academic productivity of U.S. otolaryngology departments using the h(5) index.

We aim to examine the h(5) index of U.S. otolaryngology programs to help assess current academic productivity. A total of 116 otolaryngology departments with residency programs were included. Our primary outcome was the h(5) index, calculated cumulatively for faculty MDs, DOs, and PhDs within the department. Audiologists and clinical adjunct faculty were excluded. This was calculated over a 5-year period (2015-2019) using Elsevier's database SCOPUS. Faculty affiliation within SCOPUS was confirmed by cross-referencing department websites. The h(5) indices were calculated and then correlated with other publication metrics, including total publications by department and publications in major otolaryngology journals. The h(5) index was highly correlated positively with other metrics of academic productivity, including total publications and publications in top 10 otolaryngology journals. Greater variability in data was noted as the h(5) index increased. Similar trends were observed when the h(5) was compared to the number of residents accepted per year. Rankings of departments by Doximity and US News and World Report were positively correlated with h(5) though they remained weaker when compared to other correlations. h(5) indices are a valuable tool to objectively assess academic productivity for otolaryngology residency departments. They are a better indicator of academic productivity than national rankings.

Barriers and Gaps in Effective Health Communication at Both Public Health and Healthcare Delivery Levels During Epidemics and Pandemics; Systematic Review.

To assess gaps and barriers to effective health communication during epidemics, pandemics, and mass health emergencies. A systematic literature review was conducted in PubMed (National Library of Medicine, Maryland, USA), SCOPUS (Elsevier, Amsterdam, Netherlands), Cochrane (Cochrane, London, UK), and grey literature between 2000 to 2020. 16043 of 16535 identified citations were eliminated through title/ abstracts screening, 437 through full-text review and 55 articles were assessed qualitatively. Key barriers to effective health communication included misinformation, distrust, limited collaboration, and messaging inconsistency. Lack of information/ research was not the primary challenge. Major gaps were in mass and social media strategies, characteristics of messages, sociocultural contexts, digital communication, rapid response, providers' attitude and perception, and information source characteristics. Health messaging should be adaptable to information outlets and tailored for the most vulnerable. Denigration of individuals with inaccurate beliefs increases misinformation and baseline knowledge differences and fears should be addressed without polarization. Involving frontline providers in health communication strategies is crucial. Primary reason for misinformation is the failure of health sector to convincingly convey accurate information. With input from all stakeholders, especially trusted members of communities and providers, health communication should include reinvestment in methods, multidimensional and multidisciplinary approaches, consistent frameworks, improved social media usage, clear, simple, and targeted messaging, and addressing systematic disinformation and misinformation with intention.

How do Body Practices Affect the Psychological Aspects of Survivors Women Undergoing Treatment for Breast Cancer? Systematic Literature Review

Introduction: Body practices can bring physical, psychological benefits and social rehabilitation and may be an alternative treatment for breast cancer. Objective: To analyze the evidence of the results of body practices over the psychological aspects of survivors women undergoing treatment for breast cancer. Method: Systematic blind and independent review from September to December 2021 following the PRISMA guidelines, carried out in the databases: Embase Elsevier; PubMed Central; ScienceDirect; Scopus Elsevier and Web of Science – Core Collection. Results: Of 1,372 studies identified, 22 were included in this systematic review. Among the practices that stood out are meditation and Yoga, with anxiety being the most investigated variable by the studies. It is clear that body practices are options for non-pharmacological clinical treatments utilized in clinical practice by different health professionals in women who have survived breast cancer. Conclusion: Body practices proved to be beneficial in the treatment and psychological health of women who survived breast cancer. This evidence may help to implement body practices as a therapeutic resource to be used in the clinical practice of health professionals. However, more randomized clinical trials that follow study protocols more rigorously are suggested, so that the effectiveness of this approach can be evaluated in different clinical outcomes.

R2 advances in robotic-assisted spine surgery: comparative analysis of options, future directions, and bibliometric analysis of the literature

Spine surgery has undergone rapid advancements over the past several decades with the emergence of robotic and minimally invasive surgery (MIS). While conventional MIS spine surgery has had relative success, its complication profile has warranted continued efforts to improve clinical outcomes. We discuss the functional, clinical, and financial aspects of four robotic options for spinal pathologies, namely ROSA, Mazor X, Da Vinci, and ExcelsiusGPS, and conduct a bibliometric analysis to better understand current trends and applications of these robots as the field of robotic spine surgery continues to grow. An extensive search of English-language published literature on robotic-assisted spinal surgery was performed in Elsevier's Scopus database. A bibliometric analysis was then performed on the top 100 most cited papers. The search yielded articles regarding robotic-assisted spine surgery application, limitations, and functional outcomes secondary to spine pathology. Accuracy analyses of 1733 screw placements were reviewed. The top 100 papers were published between 1992 and 2020, with a significant increase from 2015 onwards. The top publishing institution was John Hopkins University (n = 8). The top contributing author was Dr. Isador H. Lieberman (n = 6). The USA (n = 34) had the most articles on robotic spinal surgery, followed by Germany (n = 12). This review examines robotic applications in spine surgery, including four available options: ROSA, Mazor X, Da Vinci, and ExcelsiusGPS. Publication output over time, surgical outcomes, screw accuracy, and cost-effectiveness of these technologies have been investigated here. Certain robots have functional, clinical, and financial differences worth noting. Given the dearth of existing literature reporting postoperative complications and long-term comparative outcomes, there is a clear need for further studies on this matter.

The 100 Most Cited Articles in Endoscopic Endonasal Skull Base Surgery: A Bibliometric Analysis

The accelerated growth of endoscopic endonasal skull base surgery has led to an abundance of highly cited works that have helped shape the field into its current state. Highlighting these works can serve as a guide for trainees and facilitate evidence-based clinical decision making and operative techniques. Elsevier's Scopus database was used to generate a list of the 100 most cited articles on endoscopic endonasal skull base surgery in September 2022. Results were categorized based on pathology, approach, study design, and study objective. A citation per year analysis was conducted to highlight later publications that may not have had the time to accumulate as many citations as older publications. The average number of citations for the 100 most cited articles was 210 per article (range 104-1285). Publication dates ranged from 1997 to 2019, with the highest number of articles among the 100 most cited being published in 2008 (15 articles). The journal with the greatest number of publications was Neurosurgery (30 articles). Of the 100 most cited articles, 77 were published between 2000 and 2010. Moreover, 40 of the 100 articles reported surgical outcomes and related complications, and the most common pathology was pituitary adenoma (25 articles). This article provides a list of highly influential articles in the field of endoscopic endonasal skull base surgery, highlighting its rapid evolution over the last 3decades and demonstrating its leap from small descriptive series confined to certain pathologies to larger cohorts exploring possible boundaries and other pathologies.

Barriers to Palliative Care Access in Patients With Intellectual Disability: A Scoping Review.

We conducted a literature review on publications since 2014 from three databases (MEDLINE, Biomed Central, and Elsevier Scopus), along with hand searches in scientific journals. The review included peer-reviewed studies written in English and Spanish language with quantitative and qualitative study designs. The participants were patients with intellectual disability and health professionals who had worked with them or had experience in palliative care. 22 studies met the selection criteria. The barriers identified were under referral to palliative care, reduced access, communication, and limited knowledge and experience by health professionals. Patients with intellectual disability do not get referred to PC frequently. Health professionals and caregivers do not recognize when it is necessary to make a referral, and they need to improve their communication abilities. Also, health care workers need more training in PC, pain management, anticipation of death, and use of opioids. More research and education on the palliative care needs and care for patients with intellectual disabilities is needed.