Flexible Scheduling Research Articles

Women at the top: a qualitative study of women in leadership positions in emergency medicine in Canada.

For the last two decades, more than half of Canadian medical students have been women, with an increasing number of medical trainees choosing emergency medicine as their careers. Despite a proportional increase of women in full-time faculty positions in emergency medicine, women are still underrepresented in leadership. The purpose of this study is to explore the experiences of women leaders in emergency medicine to identify common themes that may have contributed to their acquisition of leadership roles. Participants included women emergency medicine physicians in Canada who currently or previously held a leadership position. Data were collected through semi-structured interviews. Inductive thematic analysis was performed on the interview transcripts. Transcribed data were coded and categorized into recurrent themes. A narrative summary of the most impactful themes was presented. Twenty participants were interviewed. Most participants perceived career opportunities were due to chance, related to personal skill set, or required additional training. Participants highlighted the importance of mentorship and sponsorship. Gender expectations and traditional gender roles were perceived as having a negative impact on career leadership success. Participants acknowledged the need for women in leadership to empower younger generations of women to become leaders. For future emergency medicine leaders, participants suggested applying for leadership positions early, networking, and seeking mentorship. Potential supportive changes to leadership structures included explicit parental leave policies, flexible scheduling, and job sharing to encourage women leaders. To date, there has been no Canadian specific study exploring the factors contributing to the success of women leaders in emergency medicine. This study examines career advancement of women leaders in emergency medicine and provides useful insight to those aspiring to grow their careers, as well as to mentors and sponsors of women in emergency medicine.

Unsettled Times: The Contestation and Reproduction of Flexible Scheduling in Pandemic-Era Restaurant Work

Unsettled Times: The Contestation and Reproduction of Flexible Scheduling in Pandemic-Era Restaurant Work

Factors influencing multiple non-utilized healthcare appointments from patients' and healthcare providers' perspectives: a qualitative systematic review of the global literature.

The term "non-utilised appointments" emerged in 2019 but lacks a clear definition. We focus on multiple non-utilised appointments due to recent advances in understanding 'missingness' in UK healthcare. Studies on missed appointments show conflicting results regarding interventions like text messaging due to oversight of occasional versus repeated missed appointments. Understanding patient and healthcare-related factors in multiple non-utilised appointments is crucial for improving interventions and patient engagement. To identify factors influencing multiple non-utilised appointments from patients' and healthcare providers' perspectives. A systematic review of qualitative research identifying factors that influence multiple non-utilised appointments across diverse global health care settings. The review employed a qualitative systematic approach, encompassing diverse papers from multiple databases, irrespective of patient or healthcare provider age, location, or setting. Data analysis followed Thomas and Harden's thematic synthesis method. Themes are presented in alignment with both the health service and patient perspective aspects of the Levesque access model. Ten thousand and eighty-six records were retrieved. Five studies met the inclusion criteria and were analysed. Six key themes influenced appointment utilisation. Healthcare system determinants highlighted provider-patient relationship and professionalism, and healthcare organisation factors role in appointments utilisation. Patient experience and decision-making explored personal factors. Additionally, communication, support, and engagement delved into challenges with communication and language, family and social support, and socio-familial barriers to appointment utilisation. Health and well-being factors encompassed medical conditions, mental and emotional factors, and psychosocial determinants affecting appointment utilisation. Moreover, financial constraints and socioeconomic factors were identified as significant contributors. Lastly, healthcare access and barriers addressed transportation challenges, accessibility issues, and geographical barriers impacting healthcare access. The analysis reveals complex factors influencing multiple non-utilised appointments. Strong provider-patient relationships improve care accessibility. Flexible scheduling and patient-centred approaches are pivotal, alongside addressing workplace discrimination. Tailored healthcare services and overcoming geographical barriers are essential. Ensuring safety, accessibility, and communication, while supporting vulnerable groups and mental health needs, are necessary. Equitable access to services and alternative transportation solutions are essential for comprehensive healthcare delivery. PROSPERO CRD42023429465.

Coordination of medium-voltage distribution networks and microgrids based on an aggregate flexibility region approach

The large-scale integration of distributed energy resources (DERs) presents operational challenges for medium-voltage distribution networks (MVDNs) and microgrids (MGs) because the conventional centralized scheduling framework lacks of an effective information exchange mechanism for coordinating the scheduling between MVDNs and MGs while supporting privacy concerns. The present work addresses these issues by leveraging a convex hull-based aggregate flexibility region (AFR) associated with the scheduling capability of massive DERs to coordinate the scheduling between an MVDN and MGs efficiently with very limited information exchange. Specifically, the AFR associated with the DERs in an MG is constructed based on the convex hull fitting method, and coordinated scheduling is facilitated by introducing safety operation constraints for the MVDN based on the AFRs of the MGs. Moreover, the coordination model is transformed into a readily solvable quadratically constrained quadratic programming problem by applying second-order cone transformations. The results of numerical computations applied to an IEEE 33-bus test system demonstrate that the obtained AFRs effectively characterize the flexible scheduling capability of DERs, and the proposed coordinated scheduling mechanism between the MVDN and MGs reduces the network losses and voltage deviations of the MVDN, while preserving information privacy.

Suitability and Usefulness of a Flexible Dosing Timing of Oral Semaglutide to Maximize Benefit in Clinical Practice: An Expert Panel.

From clinical trials and observational data, oral semaglutide has proven to be the most effective second-line oral therapy for the management of patients with type 2 diabetes. This review aims to describe the perspective of an Italian expert panel that addressed the potential challenges arising during the use of oral semaglutide in the free-living conditions of routine clinical care. A group of Italian experts discussed and generated insights into the use of oral semaglutide in clinical practice. Key topics included the effectiveness of oral semaglutide in clinical practice, the positioning of the agent to optimize the treatment benefits, the possibility to adopt flexibility in the administration schedule, critical issues encountered, the role of patient communication and information in the importance of dose escalation and management of adverse events. Available data on efficacy and effectiveness of oral semaglutide from randomized clinical trials and real-world studies were reported, along with factors that determine tolerability and persistence on treatment. The debate over a fixed versus a flexible dosing schedule was critically addressed, providing anecdotical clues from a small case series and a real-world database. Additionally, a set of recommendations for clinicians to consider when prescribing oral semaglutide and during the process of patient monitoring were provided.

Beam-Hopping-Based Resource Allocation in Integrated Satellite-Terrestrial Networks.

The integrated satellite-terrestrial network (ISTN) provides a promising solution to achieve high-data-rate and ubiquitous connectivity in next-generation communication networks. Considering the scarce spectrum resources and unevenly distributed traffic demands, we investigate the resource allocation algorithms for ISTNs, where the beam-hopping (BH)-based satellite system and terrestrial systems share the same frequency band. Taking advantage of the scheduling flexibility of BH technology, the dynamical protection zones are constructed to avoid co-channel interference and improve the spectrum efficiency. Since both spectrum efficiency and user fairness are the key optimization indexes in practical systems, two resource allocation problems are formulated to maximize the weighted sum of capacity (MWSC) and maximize the minimum capacity-to-demand ratio (MMCDR) of ISTNs, respectively. By reformulating the problems as mixed-integer linear programming problems, optimal solutions are obtained. To reduce the computational complexity, two greedy suboptimal algorithms are proposed for the MWSC and MMCDR, respectively. The simulation results show that the proposed algorithms achieve higher spectrum efficiency and guarantee fairness between the satellite and terrestrial systems. It is also shown that both the greedy algorithms perform similarly to the optimal algorithms while having much lower complexity.

Remote work transition amidst COVID-19: Impacts on presenteeism, absenteeism, and worker well-being-A scoping review.

The COVID-19 pandemic has accelerated the transition to remote work, leading to increased attention on presenteeism and absenteeism among remote workers. Understanding the implications of these phenomena on worker health and productivity is crucial for optimizing remote work arrangements and developing policies to improve employee well-being. This scoping review aims to examine the occurrence of presenteeism and absenteeism among remote workers during the COVID-19 pandemic and the interrelated physical and mental health issues during these periods. PsycINFO, Medline, Embase, CINAHL, Eric, Business Source Premier, SCOPUS, and sociological abstracts were searched resulting in 1792 articles. Articles were included if the population of interest was 18+ (i.e., working age), engaged in full or part-time work, and the employees shifted from in-person to remote work due to the COVID-19 pandemic. All study designs, geographical areas, and papers written post-onset of the COVID-19 pandemic were included; however, systematic reviews were excluded. Data was charted into Microsoft Excel by 2 independent reviewers. The literature search identified 10 studies (i.e., seven cross-sectional studies, two qualitative studies, and one observational study). Five major overarching themes were identified specifically (1) telework and mental health (2) telework and physical health (3) worker benefits (4) gender dynamics and (5) difficulty navigating the teleworking environment. While remote work offers flexibility in terms of saved commute time and flexible work schedules, it also exacerbates challenges related to presenteeism, absenteeism, and work-life balance. These challenges include experiencing psychological distress, depression, anxiety, stress, sleep deprivation, musculoskeletal pain, difficulties concentrating at work for both women and working parents, struggles disconnecting after hours, and the inability to delineate between the work and home environment. The findings suggest that remote work during the COVID-19 pandemic has both positive and negative implications for worker well-being and productivity. However, future research needs to incorporate the potential effects of telework frequency (full time vs. part time) on employee productivity and its role on presenteeism and absenteeism, to gain a more comprehensive understanding on remote work difficulties. Addressing these challenges requires proactive interventions and support mechanisms to promote worker health and productivity in remote settings.

The Relationship between Smart Working and Workplace Social Capital: An Italian Case Study on Work Sustainability

The post-pandemic era is characterized by the diffusion of smart working. A review of the scientific literature reveals studies that deepen the understanding of how smart working is linked to people’s well-being. Meanwhile, the literature refers to social capital within organizations as working social capital (WSC) and highlights its different dimensions, which have repercussions on both individual and organizational levels. The present study aims to investigate the relationship between these two constructs. The chosen methodology is a case study of an Italian company (“the Company”). The case study methodology does not aim to generalize results, but rather to provide a detailed and in-depth analysis of a specific context and process. The tool used is a semi-structured interview with all 13 members of the Company. The interviews were examined via thematic analysis. Data analysis was conducted using the software NVivo and both a top-down process from theoretical references and a bottom-up process following the IPA technique. Several themes emerged. The main benefits include flexible work schedules and locations, increased autonomy and comfort, work–life balance, well-being, higher productivity, and efficiency. On the other hand, the main difficulties include social isolation, lack of human contact, increased stress, overwork, the absence of fruitful informal relationships, and the uneasy inclusion of juniors. The impact of these changes on the workplace social capital of the Company is related, in both positive and negative ways, to the bonds between colleagues and clients, employees’ sense of belonging to the Company, new employee engagement, and the need for casual informal relations. From the interviews also emerged how smart working is closely linked to environmental sustainability (reduced pollution) and governance (reduced costs of commuting and workspaces). Introducing the relationship between smart working and WSC broadens the perspective to include social sustainability (physical and mental health, well-being and quality of life) as well. The challenge awaiting companies around the world is to establish a balance between smart working and protecting the dimensions of social capital.

Prediction of COVID-19 patients’ participation in financing informal care using machine learning methods: willingness to pay and willingness to accept approaches

BackgroundInformal care plays an essential role in managing the COVID-19 pandemic. Expanding health insurance packages that reimburse caregivers' services through cost-sharing policies could increase financial resources. Predicting payers' willingness to contribute financially accurately is essential for implementing such a policy. This study aimed to identify the key variables related to WTP/WTA of COVID-19 patients for informal care in Sanandaj city, Iran.MethodsThis cross-sectional study involved 425 COVID-19 patients in Sanandaj city, Iran, and 23 potential risk factors. We compared the performance of three classifiers based on total accuracy, specificity, sensitivity, negative likelihood ratio, and positive likelihood ratio.ResultsFindings showed that the average total accuracy of all models was over 70%. Random trees had the most incredible total accuracy for both patient WTA and patient WTP(0.95 and 0.92). Also, the most significant specificity (0.93 and 0.94), sensitivity (0.91 and 0.87), and the lowest negative likelihood ratio (0.193 and 0.19) belonged to this model. According to the random tree model, the most critical factor in patient WTA were patient difficulty in personal activities, dependency on the caregiver, number of caregivers, patient employment, and education, caregiver employment and patient hospitalization history. Also, for WTP were history of COVID-19 death of patient's relatives, and patient employment status.ConclusionImplementing of a more flexible work schedule, encouraging employer to support employee to provide informal care, implementing educational programs to increase patients' efficacy, and providing accurate information could lead to increased patients' willingness to contribute and finally promote health outcomes in the population.

PECULIARITIES OF TEACHING ENGLISH TO ADULTS

Teaching English to adults presents a unique and captivating challenge distinct from instructing children or teenagers. Adults bring diverse backgrounds, motivations, and learning styles to language acquisition, making it essential for educators to adapt their approaches. Motivation is a key factor in adult learning, with adults often choosing to learn English for specific reasons such as career advancement or travel. While many adults urgently need English for international communication, they may face challenges due to prior unsuccessful learning experiences. The concept of "andragogy" emphasizes the practical orientation of adult learning, independent work, and the student's leading role in achieving specific goals. Notable psychologists like Carl Rogers stress the importance of relevance, preserving identity, involving the whole person, and encouraging self-criticism in successful adult learning. Ukrainian psychologists and scientists, including O. Tarnopolsky, M. Kushnirov, O. Palii, and T. Besarab, have explored the peculiarities of teaching English to adults. They highlight variations in language proficiency, goals, and learning styles among adult learners, advocating for individualization of training to cater to diverse needs. The time constraints of adults necessitate flexible schedules and the option for online learning. Practical language usage in real situations is crucial for effective learning.

Determinants of Work-Life Balance Among Police Officers: a Systematic Review Study

Objective: This study aims to identify the main factors affecting work-life balance among police officers. Method: This systematic literature review uses Bibliometrix software to identify relevant articles in the Web of Science and Scopus databases. After applying the inclusion and exclusion criteria, 19 articles were selected and analyzed. Results and Discussion: The main factors identified include competitive organizational culture, lack of family-friendly policies, shift rotations, unpredictable schedules, occupational stress, and the absence of supportive measures for work-life balance. These factors significantly impact the physical and psychological well-being of police officers, contributing to issues such as PTSD, chronic fatigue, and job dissatisfaction. Research Implications: Implementing family-friendly policies, ensuring flexible and predictable work schedules, and providing adequate organizational support can significantly improve work-life balance among police officers, leading to greater job satisfaction and the effectiveness of police forces. Originality/Value: This study contributes to the literature by systematically identifying and analyzing the main factors affecting work-life balance among police officers, providing insights into policies and practices to improve their well-being.

Designing a collaborative maintenance planning mechanism between airline and maintenance company using a bilevel model – Considering flexible maintenance schedule and service charges

Periodic aircraft Maintenance Repair and Overhaul (MRO) activities are compulsory. To capture the features of MRO operations between airline and maintenance company under MRO outsourcing mode, we consider a collaborative aircraft maintenance planning problem, in which the airline outsources its self-operated maintenance checks to an independent maintenance company. Under such context, MRO planning conflicts between two collaborates exists especially during maintenance peak period, as airline aims to maximize flight operations revenues by receiving timely MRO service. On the other hand, maintenance company strives to accomplish heterogenous demands without causing tardiness and involving excessive MRO resources cost. Therefore, finding an effective mechanism to eliminate the conflicts between maintenance demands (from airline company) and maintenance service supply capability (from maintenance company) is indispensable for collaboration. A bi-level optimization model is formulated to describe the conflicting objectives and maintenance planning features of two independent stakeholders. To facilitates a synchronization of demand and supply and reconcile MRO conflicts, flexible maintenance schedules and service charges decisions from two independent collaborators is involved in the model, enabling a maintenance planning negotiation for finding mutual beneficial maintenance plan. An iterative algorithm deploying bounding updating strategy is developed, which generates a series of convergent-oriented bounding constraints along the iterative negotiation and guides the adjustment of maintenance demand and supply towards equilibrium. Based on the computational results in solving various maintenance planning scenarios, the impacts of different features (e.g. resource availability, resource demands level, and penalty cost of service tardiness) on airline and service company’s planning performance are analysed, revealing that maintenance service company’s own interest can be assured and maintained though it is a follower in the collaboration framework Afterwards, the managerial insights for facilitating the maintenance collaboration are further discussed.

P-672 Is there a sweet spot for follicular size and/or estradiol level for the initiation of micronized progesterone to optimize natural proliferative phase (NPP) cryo-cycle outcome?

Abstract Study question Is there an optimal follicular size and/or estradiol level for the initiation of micronized progesterone to optimize outcomes in NPP cycles potentially restricting scheduling flexibility? Summary answer All follicular sizes >12 mm and estradiol levels >120 pg./mL do not significantly correlate with ongoing pregnancy rates (OPR) or pregnancy loss (PL). What is known already Planning of a frozen embryo transfer (FET) is feasible within either a natural (NC) or artificial cycle (AC). While AC-FETs offer flexibility in planning, concerns have raised due to studies indicating a higher risk for obstetric complications. Conversely, NC-FETs show a protective effect against these complications but are usually less flexible in planning and ask for more monitoring. Recently, the natural proliferative phase (NPP) protocol was described, in which luteal phase support is initiated as soon as the endometrium reaches 7mm. NPP-FETs were associated with ongoing pregnancy rates comparable to AC- and NC-FETs. Study design, size, duration A retrospective single-centre study including a total of 300 consecutive single frozen embryo transfers (FET), performed at a tertiary fertility centre between March 2023 and December 2023. All cycles were single blastocyst transfer cycles retained from IVF/ICSI cycles with autologous oocytes. Participants/materials, setting, methods A total of 227 patients underwent one or more frozen embryo transfer cycles. Administration of MVP 800mg BID was initiated after fulfilling the following criteria: follicular size > 12mm, estradiol level ≥120ng/mL and endometrium thickness ≥7mm. Blastocyst transfers were scheduled on the fifth day of MVP administration. Serum progesterone (P4) levels were determined on the day of transfer. Associations between treatment outcome, patient and cycle characteristics were explored using generalized estimating equations analyses. Main results and the role of chance The follicular size and estradiol level on the day of MVP initiation was not significantly associated with pregnancy rate (PR), ongoing pregnancy rate (OPR) or pregnancy loss (PL) (p = 0.386 and p = 0.260; p = 0.830 and p = 0.467; p = 0.978 and p = 0.313 respectively). Mean number of visits needed prior to the initiation of the MVP for scheduling the embryo transfer was 2.4 (SD 1.3). PR, but not OPR, was significantly associated with both the duration of the follicular phase as well as the number of visits (p = 0.008 and p = 0.006 respectively). For 91.3 % (274/300) of patients, embryo transfer could be scheduled on a weekday. 49% (146/300) of patients had a positive hCG test after the fresh blastocyst transfer in the NPP cycle. Ongoing pregnancy rate was 35 % (104/300), whereas pregnancy loss (early clinical miscarriage and biochemical pregnancy) was 23% (33/146). The OPR was significantly related to the age of the patient (p = 0.029). Both the PR as the OPR were significantly related the blastocyst quality (p = 0.008 and 0.009 respectively). The incidence of pregnancy loss was only significantly associated with blastocyst quality (p = 0.027). Mean serum P4 level at day of transfer was 19.4 ng/ml (SD 6.1) with a P4 level above 10ng/ml in 97% of cycles. Limitations, reasons for caution The retrospective character is a limitation of this study as well as the absence of live birth rate as a clinical outcome variable. Wider implications of the findings Flexibility about the required follicular sizes and estradiol levels open the perspective for exploring more flexible planning criteria such as lower thresholds for endometrial thickness. Further studies are needed to investigate whether ovulation occurs with formation of functional corpora lutea to effectively protect against hypertensive disorders. Trial registration number ONZ-2024-0015

¿Más de lo mismo? Condiciones laborales de las trabajadoras del hogar en las plataformas digitales en México

While digital platforms that connect domestic workers with employers have proliferated over the past two decades, academic research on this phenomenon remains limited. These platforms have the potential to improve working conditions in the sector, however, they often seem to perpetuate the job insecurity that has historically characterized domestic work. This article explores whether the working conditions of domestic workers on digital platforms differ significantly from traditional ones. Based on 24 interviews with workers in Mexico, it examines four key aspects of their conditions: (i) hours and schedule flexibility; (ii) workload; (iii) income and benefits; and (iv) discrimination, violence, and harassment. The findings reveal incremental improvements in the conditions of digital workers but no significant break from the historical precariousness. The article is intended to enrich the emerging literature on platforms dedicated to domestic work, especially in the context of the global south and Latin America, where they have received little attention so far. It focuses on the in-person employment relationship between workers and their employers, which has been little explored in previous research. The study contributes to a more comprehensive understanding of labor dynamics in this emerging work modality and highlights the need for labor regulations that include domestic workers connected through digital platforms.

Opinion of medical students and instructors on the challenges of in-person learning postcoronavirus disease 2019 pandemic.

Several universities switched back to face-to-face teaching in 2022 after 2 years of online classes during the coronavirus disease 2019 (COVID-19) crisis. There is no data from these students/teachers on the challenges in postpandemic face-to-face teaching and learning. The current study's aim was to identify the challenges of face-to-face teaching and learning postpandemic from the perspective of students and instructors. Undergraduate medical students (n = 210) registered in Imam Abdulrahman Bin Faisal University and instructors (n = 72) filled out online questionnaires from November 2022 to March 2023 on teaching-learning challenges in the postpandemic period. The questionnaires asked students about their interest in education, scores, degree of shyness, how clear the voices of the instructors wearing face masks were, fear of COVID-19, preferred mode of teaching, and advantages/disadvantages of face-to-face teaching. Descriptive statistics included frequencies and percentages for qualitative variables; Chi-square test was applied to assess association between categorical variables. Students reported a decrease in their educational interest postpandemic (47.1%), diffidence in interaction (42.4%), blurred teachers' voices because of the face masks (63.3%), and lack of teachers' empathy (47.6%). There was a significant association between preclinical year students and a decrease in educational interest (P = 0.002), diffidence in class interactions (P = 0.001), and fear of contracting COVID-19 infection while interacting with teachers (P = 0.04). Instructors complained of a decrease in students' interest in education (65.3%), especially the instructors of the clinical years (16.7% vs. 2.1%; P = 0.022). About 10% students reported taking leave from university on purpose due to fear of contracting COVID-19 infection; students and instructors both supported lecture recordings (98.6% and 63.9%, respectively). The students' and instructors' preferred platform for learning was "hybrid" (80.5% and 63.9%, respectively). Challenges faced by the students include decreased interest in learning, drop in scores, muffled voices because of the face masks, increased shyness, waste of time in commutes, lack of flexibility in schedules, increased workload, and fear of catching COVID-19 infection. There is strong support for hybrid/blended learning and recording lectures.

Generational Immigration Status Modifies the Association Between Psychosocial Distress and Substance Use Among Alternative High School Students

PurposeAlternative high schools (AHS) are designed to provide individualized education, more flexible scheduling, and smaller class sizes for students referred out of traditional high school. AHS students report higher levels of substance use (SU) and face disproportionately higher levels of trauma and toxic stress than their traditional high school peers. We sought to examine whether generational immigration (GenIm) status modifies the association of mental health and SU among AHS students using a longitudinal study of 1,060 Southern California AHS students. MethodsSubscales from the 21-item Depression Anxiety Stress Scale were administered. Effect modification was examined by GenIm status defined as first generation (born outside of the United States), second generation (born in the United States with a parent born outside the United States), or third generation (born in the United States with US-born parent(s)). Main outcomes included the number of times different substances were used in the past year over a 3-year period. ResultsMultilevel, negative binomial, covariate-adjusted latent growth curve models generated incidence rate ratios (IRRs) and 95% confidence intervals (CIs) of the time-varying association between depression, anxiety, or stress and the use of cigarettes, e-cigarettes, cigars, alcohol, or marijuana. Multiple-group models examined effect modification by GenIm status. DiscussionThe link between mental health and SU was stronger among first- and second-generation students than third-generation students. For example, a one-unit increase in stress relative to the average stress of students from the same school was associated with an increase in the rate of e-cigarette use among first-generation (IRR = 2.03, 95% CI = 1.07–3.85), second-generation (IRR = 2.25, 95% CI = 1.86–2.72), and third-generation (IRR = 1.68, 95% CI = 1.31–2.16) students. Effective strategies tailored to subgroups of AHS students are needed to counter disparities between traditional and alternative school systems that may contribute to long-term trajectories of SU.

Patient and Provider Perceptions of Barriers and Facilitators to Pre-exposure Prophylaxis Access and Adherence in Black and Latinx Young Men Who Have Sex with Men.

In the United States, the use of pre-exposure prophylaxis (PrEP) has led to a substantial decrease in HIV prevalence and incidence. However, some populations, including young men who have sex with men (YMSM) of color, continue to be disproportionately impacted, highlighting the need for tailored interventions addressing barriers to adequate PrEP access. In collaboration with partner clinics, we recruited 19 PrEP clients and 19 PrEP providers (n = 35) to participate in hour-long in-depth interviews. Although client interviews explored personal experiences with stigma, barriers, and motivators to PrEP and information preferences, provider interviews explored providers' perceived stigma in their clinic, perceived barriers and motivators to meeting clients' PrEP needs, and rapport building with clients. Most participants were affiliated with one of the southern partner clinics. Clients and providers noted similar determinants to PrEP access, uptake, and adherence. Both recognized the impact of personal barriers such as routine adjustments and perception of need, as well as institutional barriers such as transportation and financial difficulties. Clients emphasized the role of the client-provider relationship as part of contributing to willingness to disclose information such as HIV status and sexual practices. Providers noted the importance of sexual health and LGBTQ+ topics in their training. Despite limited geographical scope and the sensitive nature of HIV-related topics, this study has several implications. PrEP clinics may benefit from hiring providers who share identities and experiences with YMSM clients of color and operating with a flexible schedule. Medical provider training should include comprehensive sexual health and LGBTQ+ competencies to reduce bias in care.

Autonomy ranks as highest importance to dermatology physician assistants in Pennsylvania with highest compensations

Introduction: By exploring the relationship between compensation and job values, this research letter aims to contribute to the existing literature on health care professional compensation and job satisfaction, particularly within the context of dermatology physician assistants (PAs). Objectives: The authors aim to answer the question, “Does annual salary compensation correlate with any reported job values among dermatology PAs in Pennsylvania?” Method: This research letter presents a postsurvey analysis of a salary survey conducted among the members of the Pennsylvania Dermatology Physician Assistants (PDPA). The data used in this analysis were obtained from the previously published salary survey conducted by the PDPA. The survey asked participants to rank the factors most important in selecting a dermatology position. Results: Dermatology PAs in Pennsylvania who earned the highest income in a given year reported job autonomy as a top value [rs (79)=−0.2208, P=0.048]. Discussion: Schedule flexibility may allow PAs to be more productive in seeing more patients and, therefore, result in higher compensations. PAs with freedom, independence, and discretion may feel respected and valued. This could result in positive effects on productivity and, as a downstream result, higher compensation.

Security assessment and preventive control of combined electricity and heat systems with distributed electric thermal storage

Achieving carbon peak and neutrality targets can be accelerated by reducing wind power curtailment (WPC). However, WPC is constrained due to the electric thermal coupling characteristics of combined heat and power. To tackle this challenge, we propose an optimal scheduling framework for combined electricity and heat systems (CEHS) with distributed electric thermal storage (DETS) and perform security assessment and preventive control. Firstly, a general model is proposed to schedule DETS for different types of customers. The customer flexibility regulation variable (CFRV) for each customer is developed to fill this knowledge gap, and the excess thermal storage stored in DETS is used for auxiliary thermal network regulation (ATNR). Secondly, a two-stage security assessment and preventive control method for CEHS with DETS is proposed to correct overloaded branch flow. Thirdly, an evaluation index is developed to evaluate the severity of overloaded branches. The results show that the method of considering CFRV can reduce WPC and operation costs compared to the traditional method. Adopting ATNR enhances the flexibility and economics of grid scheduling compared to non-ATNR. Moreover, assessments of overloaded branches in various cases show that the preventive control method mitigates overload risks.

The risk of premature cardiac contractions (PAC/PVC) related to caffeine consumption among healthcare workers: A comprehensive review.

Premature atrial contractions (PACs) and premature ventricular contractions (PVCs) are ectopic heart rhythm disorders with implications for cardiovascular health. This study explores the relationship between caffeine consumption and the risk of PACs and PVCs, with a focus on healthcare workers, such as doctors, nurses, pharmacists, and midwives, who often rely on caffeine to combat fatigue, especially during night shifts. A thorough review was conducted through PubMed, Scopus, Google Scholar, and Web of Science, utilizing a combination of MeSH terms and keywords. Studies examining the link between caffeine consumption and PACs and PVCs, particularly in healthcare workers, were included. We found that caffeine shows various effects based on dosage and can impact arrhythmia risk. Individuals working long shifts, including healthcare professionals, are prone to increased caffeine intake, leading to higher cardiovascular risk. To mitigate these risks, tailored guidelines for caffeine consumption, flexible shift scheduling, and mental health support services are recommended. Promoting caffeine alternatives within healthcare institutions can be beneficial. Although caffeine may have potential benefits, its drawbacks, particularly concerning cardiovascular health, may surpass its advantages, especially when consumed in high doses. A multidisciplinary approach is crucial for healthcare workers' well-being and quality of patient care. Further research is required to refine and support these recommendations.