General Access Research Articles

General Practitioner Availability and Accessibility in Serbia Before and During the Pandemic

Abstract Background During the COVID-19 pandemic in Serbia, state-owned primary health centres’ general practitioners (GPs) served as the first point of care for adults (the population aged 19 years and older) and gatekeepers of the health system. The study highlights changes in the overall availability, accessibility, and workload of GPs during the pandemic. Methods We used routine health facility data at the national level to describe the changes in GPs over the past three years, before the pandemic (2017-2019) and during the pandemic (2020-2022). Specifically, we looked at the total number of GPs, the percentage of specialists, the average number of citizens per GP, the services used per capita, the average number of visits per GP, and the leading causes of morbidity. Results The study found a decrease in the total number of GPs in both periods (before: -10%, during: -9%) and in the number of specialists (before: -2%, during: -3%). During the pandemic, the average number of citizens per GP varied. In 2022, the average number of visits per GP decreased noticeably to 3557 GPs, of which 37% were specialists. In the same year, each GP received 6661 annual visits and served 1509 citizens on average. However, these figures exhibit considerable regional and geographical differences. Circulatory and respiratory diseases were the most common reasons for visiting a GP (about 14% and 13% of all visits, respectively). Up to 10% of all visits resulted in either a diagnosis of external factors that influence health status or in ill-defined symptoms, clinical and laboratory findings. Conclusions This study’s findings underscore the critical reductions in availability, accessibility, and workload of general practitioners in the Serbian public sector and emphasize the importance of strengthening the primary healthcare system to better respond to future challenges. Key messages • Public health officials should prioritize the development of effective strategies and policies that focus on improving the quality and accessibility of primary health care services in Serbia. • A greater investment in general practice is necessary to ensure it can effectively meet the population’s needs during health emergencies.

Implementing a prenatal health screening intervention for future fathers in Montreuil, France: most users are immigrants facing hardship

BackgroundPrenatal care provides pregnant women with repeated opportunities for prevention, screening and diagnosis that have no current extension to future fathers. It also contributes to women’s general better access to health. The goal of PARTAGE study was to evaluate the level and determinants of adherence to a prenatal prevention consultation dedicated to men.MethodsBetween January 2021 and April 2022, we conducted a monocentric interventional study in Montreuil hospital. We assessed the acceptance of a prenatal prevention consultation newly offered to every future father, through their pregnant partner’s prior consent to provide their contact details.ResultsThree thousand thirty-eight women provided contact information used to reach the fathers; effective contact was established with 2,516 men, of whom 1,333 (53%) came for prenatal prevention consultation. Immigrant men were more likely to come than French-born men (56% versus 49%, p < 0·001), and the more they faced social hardship, the more likely they were to accept the offer. In multivariate analysis, men born in Subsaharan Africa and Asia were twice as likely to attend the consultation as those born in Europe or North America.ConclusionAcceptance of this new offer was high. Moreover, this consultation was perceived by vulnerable immigrant men as an opportunity to integrate a healthcare system they would have otherwise remained deprived of.Trial registrationRegistry: ClinicalTrials.gov, US National Library of Medicine https://classic.clinicaltrials.gov/ct2/show/NCT05085717Clinical Trial number: NCT05085717.Date of registration: 20/10/2021.

Key-Value Cache Quantization in Large Language Models: A Safety Benchmark

The misuse of large language models (LLMs) is an ongoing concern with the expansion of general public access to LLMs. One reason for expanded access is the development of key-value (KV) cache quantization, a technique that significantly reduces both the large computing resource requirements and memory bottlenecks that are characteristic of LLMs. As more developers and vendors begin to prioritize efficiency in LLM training, protective measures against the misuse of language models become more of an afterthought. To address the expected increase of LLM misuse accompanying KV cache quantization, this paper covers a proof-of-concept benchmark to evaluate the proficiency of LLMs in response safety when tested against a sample of unsafe questions consisting of 13 different question categories. Response safety is a model’s ability to both clearly deny providing a response to a given question and avoid providing any additional information that attempts to provide an accurate answer. By testing the sample against the Meta Llama-2-7B pretrained chat model, we determine response safety fine-tuning considerations that address performance bias among the 13 question categories. We hope this study brings attention to not only the sacrifices of accuracy but also response safety of KV cache quantization in large language models. (Code and data are available at https://github.com/TimochiL/llm_benchmark.) Disclaimer: This paper contains examples of harmful language. Reader discretion is recommended.

ChatGPT M.D.: Is there any room for generative AI in neurology?

ChatGPT, a general artificial intelligence, has been recognized as a powerful tool in scientific writing and programming but its use as a medical tool is largely overlooked. The general accessibility, rapid response time and comprehensive training database might enable ChatGPT to serve as a diagnostic augmentation tool in certain clinical settings. The diagnostic process in neurology is often challenging and complex. In certain time-sensitive scenarios, rapid evaluation and diagnostic decisions are needed, while in other cases clinicians are faced with rare disorders and atypical disease manifestations. Due to these factors, the diagnostic accuracy in neurology is often suboptimal. Here we evaluated whether ChatGPT can be utilized as a valuable and innovative diagnostic augmentation tool in various neurological settings. We used synthetic data generated by neurological experts to represent descriptive anamneses of patients with known neurology-related diseases, then the probability for an appropriate diagnosis made by ChatGPT was measured. To give clarity to the accuracy of the AI-determined diagnosis, all cases have been cross-validated by other experts and general medical doctors as well. We found that ChatGPT-determined diagnostic accuracy (ranging from 68.5% ± 3.28% to 83.83% ± 2.73%) can reach the accuracy of other experts (81.66% ± 2.02%), furthermore, it surpasses the probability of an appropriate diagnosis if the examiner is a general medical doctor (57.15% ± 2.64%). Our results showcase the efficacy of general artificial intelligence like ChatGPT as a diagnostic augmentation tool in medicine. In the future, AI-based supporting tools might be useful amendments in medical practice and help to improve the diagnostic process in neurology.

Rapid and General Access to α‐Halogenated Carbonyl Compounds Using Amidine Halide Salts as Halogen Sources under Mild Conditions

Rapid and efficient construction of α‐haloketones with diazo compounds and amidine·HX (X = Cl, Br, I) salts as halogen sources has been recognized as a simple and practical strategy. The reaction exhibits a broad scope and scalability, thereby enabling synthesis of a broad spectrum of functionally orchestrated α‐haloketones under mild and metal‐free conditions in a short time. Control experiments established the involvement of triffate 11 in the mechanism

Urban and rural disparities in general hospital accessibility within a Chinese metropolis

Accessibility is one of the crucial criteria for measuring the ease of access to public services in a region. Given China’s historical rural–urban dualism and rapid urbanization process, there exist significant disparities in public services within metropolises. This study selects Nanjing as a representative metropolis and employs the Gaussian two-step floating catchment area method and an improved potential model to calculate the accessibility of comprehensive hospitals. Spatial autocorrelation and urban–rural disparities are analyzed, confirming spatial variations in healthcare service equity. The results show that: ①The spatial variability of accessibility to comprehensive hospitals is significant. The Gaussian two-step floating catchment method overestimates overall accessibility, and for Nanjing, the improved potential model with β = 1.5 proves more suitable. ②Accessibility exhibits pronounced clustering characteristics. Healthcare conditions for residents in the northern part of Liuhe District, eastern part of Qixia District, western part of Pukou District, peripheral areas of Jiangning District, eastern part of Gaochun District, and residents in Lishui District need improvement. ③Comprehensive healthcare services are relatively lacking in nearly 60% of rural areas. Our research findings provide valuable insights for improving spatial justice in public infrastructure in metropolises of developing countries.

Optimalisasi Potensi Lokal oleh Bumdes Berkarya dalam Pengembangan Desa Wisata Wonorejo, Kabupaten Karanganyar

This research aims to identify, analyze, and describe the development of the tourist village through the utilization of local potential by BUMDes Berkarya in Wonorejo Tourist Village, Jatiyoso District, Karanganyar Regency. This study uses descriptive research methods with a qualitative approach, employing data collection techniques such as observation, interviews, and documentation. The theory used in this research involves tourism destination elements consisting of five focuses: tourist attractions, attractions, tourist facilities and general facilities, accessibility, and brand images. The results of this research indicate that the development of the tourist village through the utilization of local potential by BUMDes Berkarya in Wonorejo Tourist Village is quite good and aligns with existing theories. However, there are still some shortcomings that need to be improved and further developed, such as incorporating local culture as an attraction, adding facilities, and improving accessibility to facilitate easier access. These improvements aim to achieve the goal of tourism development, which is to attract tourist visits and enhance community welfare.

Tourist Preferences for Hotels and Accommodation in Samosir Regency Based on Online Review

Purpose: This study aims to uncover tourist preferences for various accommodation types, including hotels in Samosir Regency. These preferences include attractiveness, facilities, and hospitality. Research methods: This study uses a qualitative approach through secondary research with data collection from online reviews. The sample consists of 50 accommodations in Samosir Regency based on Google Reviews with ratings &gt; 3.0 and more than 30 reviewers. Data was collected by searching on google.com/travel with a total search result or population of 118 items, and a sample of 50 was obtained using the purposive method with the provisions of the Google Review Summary where the Rating Review was &gt; 3.0; and the Number of Reviews &gt;30 reviewers. Data were analyzed based on the Component Review using a Likert scale for 3 elements of the tourism industry, namely (1) Attraction that consists of atmosphere, location, and property; (2) Facilities consisting of Amenities, Bathrooms, and Bedroom; and (3) Hospitality which consists of Service, Cleanliness, and Food. Result and discussion: The analysis result revealed that the element of attraction shows a very satisfying preference from tourists. In second place is a satisfying preference for hospitality elements. Meanwhile, the facilities element shows the lowest preference or is unsatisfactory. This description of preferences shows that among the elements of tourism, improving the quality of hotel/accommodation facilities can be the biggest priority in efforts to develop tourism in Samosir Regency in providing high satisfaction and return visits. Implication: As a tourist destination, Samosir Regency, which relies on the Lake Toba area, has experienced an increase in tourist visits from year to year, both foreign and local tourists. This is facilitated by the general public's access to information and locations using information technology and the Internet.

School bikeability – what is it, and why is it important? An overview of key indicators and measurement

ABSTRACT Despite the theoretical recognition of children’s specific needs regarding road safety, there remains a lack of literature focusing on children’s bikeability or bikeability to school. This is rather concerning as many developed countries have witnessed a decline in active travel to school over the past few decades, despite the existence of well-recognized positive benefits of cycling for children. Recognising the significance of school travel, this study addresses this gap. Through an overview of existing literature, it discusses the importance of school bikeability and sheds light on its specific differences from general accessibility and bikeability, and identifies a set of indicators for measuring it. These indicators, categorised into four domains – Cycling Infrastructure, Connectivity and urbanisation, Safety, and Surrounding environment, can be further utilised to assess school bikeability in any given area. The results of such an assessment can be effectively used to guide investments and policies aimed at establishing safe and secure cycling routes to and from schools.

SP8.1 - Emergency Robotic General Surgery in the UK: Operations, Staff, and Missed Opportunities

Abstract Aims The primary aim was to determine the volume of emergency robotic general surgery performed in the UK. Secondary aims were to determine compatible operations with opportunities for training and the availability of robotic-trained staff. Methods Freedom of Information (FOI) requests were sent to 122 UK Acute Trusts, asking for data on general surgery procedures (open, laparoscopic, robotic) from January 2019 to January 2023. Data on common emergency procedures, in-patient length of stay, robotic complications, and availability of robotically trained staff was requested. Results Of the 122 Acute Trusts, 22 did not respond (82% response rate), 32 had no general surgery robotic access, 16 could not comply due to cost (under section 12 of FOI Act), and 52 provided data. Fifteen Trusts performed emergency robotic surgeries: cholecystectomy (262 cases), hernia repair (140), and appendectomy (3). 86% of these Trusts utilized the DaVinci system, while the CMR Versius system was employed by the remaining 14%. There was a median of 12.5 (range 2-40) robotic-trained staff in-hours, versus a median of 0 (range 0-4) out-of-hours. Conclusions Emergency robotic general surgery in the UK is limited by financial constraints, staff availability, and selective procedural use. Compatible emergency operations that have been performed were cholecystectomies, hernias, and appendectomies. To expand its role, there's a need for training, infrastructure investment, and further research into the cost-effectiveness and outcomes of robotic surgery in emergency cases.

Accessibility derivative: Measuring the accessibility contribution of public transit routes

Accessibility is one of the most essential objectives of public transit systems as the transit service’s useability and service quality. The accessibility of transit systems as a whole is well understood; however, it is still unclear how each route contributes to the system-wide accessibility. Meanwhile, with a higher risk of disruptions and more uncertainties from climate change and other disruptions, there is an urgent need to systematically study the impacts of service change with the contribution of each route to general accessibility. To address this gap, we introduce the accessibility derivative, a model-agnostic measure of the contribution of each route in a transit system. We define the derivative of a route as the systemwide change in accessibility after removing the route from the system. We demonstrate how to calculate the derivative numerically from widely available public transit schedule and automated passenger count data. The measure reflects the inherent structure of a transit system and reveals the impacts of potential route-level service changes. The results provide firsthand evidence on public transit assessment and planning, including performance assessment, schedule redesign, and planning transfers.

Initial Experience With Ultra-High-Definition 3D Exoscope in Thyroid and Parathyroid Surgery.

Operation with a 3D exoscope has recently been introduced in clinical practice. The exoscope consists of two cameras placed in front of the operative field. Images are shown on a large 3D screen with high resolution. The system can be used to enhance precise dissection and provides new possibilities for improved ergonomics, fluorescence, and other optical-guided modalities. Initial experience with the ultra-high-definition (4K) 3D exoscope in thyroid and parathyroid operations. The exoscope (OrbEyeTM) was mounted on a holding system (Olympus). We used the exoscope in parathyroidectomy (N = 6) and thyroidectomy (N = 6). Immediate advantages and disadvantages were discussed and recorded. The learning curve for use of the exoscope may be shorter for surgeons with training in endoscopic or robotic procedures. There may be improved ergonomics compared with normal open-neck operations. Further, the optical guided operations can be used with fluorescence and have potential for different on-lay techniques in the future. The 4K 3D image quality is state-of-art and is highly appreciated during fine surgical dissection and eliminates the need for loupes. In several ways, using the ORBEYE™ in thyroid and parathyroid surgery provides the surgical team with a new and enhanced experience. This includes improved possibility for teaching, surgical ergonomics, and a 4K 3D camera with a powerful magnification system. However, it is not clear if utilization of these features would improve surgical outcomes. Furthermore, the ORBEYE™ lacks incorporation of parathyroid autofluorescence, and the current costs for the system do not facilitate general access to exoscope assisted operations.

Anthropic pressure drives resource selection of an adaptable generalist in human‐dominated landscapes

AbstractFew landscapes on earth remain free of human‐modification, which may influence resource selection in wildlife. To investigate the effects of anthropic pressure on wild boar (Sus scrofa) and explore management implications, we studied how diel resource selection of the species' main life stages changed with spatial variations of human access (e.g., for recreation), temporal changes in hunting pressure, and habitat type. Using 206,461 hourly GPS‐locations of 15 males, 11 females with dependent young, and 17 other females from south‐western Germany, we found anthropic pressure influenced resource selection more than ecological factors. All boars were more likely to select for low human‐access areas than high human‐access areas, regardless of habitat. Hunting pressure was most avoided by females with dependent piglets, followed by males and other females. Since both hunting activity and general human access affected resource selection, they should be considered simultaneously in wildlife management and conservation. We suggest the further establishment of wildlife reserves that are inaccessible to people where boar may remain more localized, thereby reducing the risk of disease transmission, and boar hunting to focus on open lands and refuge boundaries to reduce crop damage. This may also benefit overall human‐wildlife coexistence, animal welfare, and biodiversity conservation in anthropized environments.

Synthesis of Heterocycles by HNTf2-Catalyzed C–H Functionalization of Vinyldiazo Compounds with 3-Phenyl-3-hydroxyisoindolinone

AbstractA Brønsted acid catalyzed C–H functionalization of vinyldiazoacetates with 3-hydroxyisoindolinone is developed. This methodology provides a general access to E-substituted isoindolinone vinyldiazo compounds in good yields and excellent diastereoselectivities with broad substrate generality under mild conditions, and with 4-substituted 2-diazo-3-butenoates produces fused bicyclic pyrrolidines. The reaction generally involves addition of the N-acyl ketiminium electrophile, formed from the 3-hydroxyisoindolinone, to the vinylogous position of the vinyldiazo compound resulting in vinyldiazonium ion intermediates that undergo deprotonation to new vinyldiazo compounds or ring closure to fused bicyclic pyrrolidines.

Access to medicines, the Unified Health System, and intersectional injustices.

To estimate the prevalence of general and public access to prescription drugs in the Brazilian population aged 15 or older in 2019, and to identify inequities in access, according to intersections of gender, color/race, socioeconomic level, and territory. We analyzed data from the 2019 National Health Survey with respondents aged 15 years or older who had been prescribed a medication in a healthcare service in the two weeks prior to the interview (n = 19,819). The outcome variable was access to medicines, subdivided into general access (public, private and mixed), public access (via the Unified Health System - SUS) for those treated by the SUS, and public access (via the SUS) for those not treated by the SUS. The study's independent variables were used to represent axes of marginalization: gender, color/race, socioeconomic level, and territory. The prevalence of general and public access in the different groups analyzed was calculated and the association of the outcomes with the aforementioned axes was estimated with odds ratios (OR) using logistic regression models. There was a high prevalence of general access (84.9%), when all sources of access were considered, favoring more privileged segments of the population, such as men, white, and those of high socioeconomic status. When only the medicines prescribed in the SUS were considered, there was a low prevalence (30.4% access) that otherwise benefited marginalized population segments, such as women, black, and people from low socioeconomic backgrounds. Access to medicines through the SUS proves to be an instrument for combating intersectional inequities, lending credence to the idea that the SUS is an efficient public policy for promoting social justice.

A qualitative, multi-centre approach to the current state of digitalisation and automation of surveillance in infection prevention and control in German hospitals

BackgroundHealthcare associated infections (HAI) pose a major threat to healthcare systems resulting in an increased burden of disease. Surveillance plays a key role in rapidly identifying these infections and preventing further transmissions. Alas, in German hospitals, the majority of surveillance efforts have been heavily relying on labour intensive processes like manual chart review. In order to be able to identify further starting points for future digital tools and interventions to aid the surveillance of HAI we aimed to gain an understanding of the current state of digitalisation in the context of the general surveillance organisation in German clinics across all care-levels. The end user perspective of infection prevention and control (IPC) professionals was chosen to identify digital interventions that have the biggest impact on the daily surveillance work routines of IPC professionals. Perceived impediments in the advancement of surveillance digitalisation should be explored.MethodsFollowing the development of an interview guideline, eight IPC professionals from seven German hospitals of different care levels were questioned in semi- structured interviews between December 2022 and January 2023. These included questions about general surveillance organisation, access to digital data sources, software to aid the surveillance process as well as current issues in the surveillance process and implementation of software systems. Subsequently, after full transcription, the interview sections were categorized in code categories (first deductive then inductive coding) and analysed qualitatively.ResultsResults were characterised by high heterogeneity in terms of general surveillance organisation and access to digital data sources. Software configuration of hospital and laboratory information systems (HIS/LIS) as well as patient data management systems (PDMS) varied not only between hospitals of different care levels but also between hospitals of the same care level. Outside research projects, neither fully automatic software nor solutions utilising artificial intelligence have currently been implemented in clinical routine in any of the hospitals.ConclusionsAccess to digital data sources and software is increasingly available to aid surveillance of HAI. Nevertheless, surveillance processes in hospitals analysed in this study still heavily rely on manual processes. In the analysed hospitals, there is an implementation and funding gap of (semi-) automatic surveillance solutions in clinical practice, especially in healthcare facilities of lower care levels.

Copper‐Catalyzed Dearomative 1,2‐Hydroamination

AbstractCatalytic olefin hydroamination reactions are some of the most atom‐economical transformations that bridge readily available starting materials–olefins and high‐value‐added amines. Despite significant advances in this field over the last two decades, the formal hydroamination of nonactivated aromatic compounds remains an unsolved challenge. Herein, we report the extension of olefin hydroamination to aromatic π‐systems by using arenophile‐mediated dearomatization and Cu‐catalysis to perform 1,2‐hydroamination on nonactivated arenes. This strategy was applied to a variety of substituted arenes and heteroarenes to provide general access to structurally complex amines. We conducted DFT calculations to inform mechanistic understanding and rationalize unexpected selectivity trends. Furthermore, we developed a practical, scalable desymmetrization to deliver enantioenriched dearomatized products and enable downstream synthetic applications. We ultimately used this dearomative strategy to efficiently synthesize a collection of densely functionalized small molecules.

Copper-Catalyzed Dearomative 1,2-Hydroamination.

Catalytic olefin hydroamination reactions are some of the most atom-economical transformations that bridge readily available starting materials-olefins and high-value-added amines. Despite significant advances in this field over the last two decades, the formal hydroamination of nonactivated aromatic compounds remains an unsolved challenge. Herein, we report the extension of olefin hydroamination to aromatic π-systems by using arenophile-mediated dearomatization and Cu-catalysis to perform 1,2-hydroamination on nonactivated arenes. This strategy was applied to a variety of substituted arenes and heteroarenes to provide general access to structurally complex amines. We conducted DFT calculations to inform mechanistic understanding and rationalize unexpected selectivity trends. Furthermore, we developed a practical, scalable desymmetrization to deliver enantioenriched dearomatized products and enable downstream synthetic applications. We ultimately used this dearomative strategy to efficiently synthesize a collection of densely functionalized small molecules.

How to Conduct a Freedom-to-Operate Analysis for a Drug Repurposing Project

This document provides the general methodology and specific resource access points for performing a Freedom-to-Operate (FtO) analysis tailored to the needs of a drug repurposing project. It has been deliberately written to be performed with minimal technical resources: Only web access is required, and no use is made of artificial intelligence tools. It can be performed by the inventors, up to the point where potentially critical findings (if any) are discussed with a patent attorney. When done properly, this method actually improves the relevance of the analysis, since no patent specialist can be expected to be fully familiar with all the scientific aspects of a repurposing project. While patent searches are the dominant motive, there is also discussion of how to recruit suitable suppliers, an issue that is particularly important when the compound is reformulated (as will be the case in most cases).

A general strategy for the synthesis of taxane diterpenes.

The carbon skeleton of any organic molecule serves as the foundation for its three-dimensional structure, playing a pivotal role in determining its physical and biological properties1. As such, taxane diterpenes are one of the most well-known natural product families, primarily owing to the success of their most prominent compound, paclitaxel, an effective anticancer therapeutic for more than 25 years2-6. In contrast to classical taxanes, the bioactivity of cyclotaxanes (also referred to as complex taxanes) remains significantly underexplored. The carbon skeletons of these two groups of taxanes differ significantly, and so would typically their own distinct synthetic approaches. Here we report a versatile synthetic strategy based on the interconversion of complex molecular frameworks, providing general access to the wider taxane diterpene family. A range of classical and cyclotaxane frameworks was prepared including, among others, the total syntheses of taxinine K (2), canataxapropellane (5) and dipropellane C from a single advanced intermediate. The synthetic approach deliberately eschews biomimicry, emphasizing instead the power of stereoelectronic control in orchestrating the interconversion of polycyclic frameworks.