Geographical Settings Research Articles

Learning Plan Use in Undergraduate Medical Education: A Scoping Review.

How to best support self-regulated learning (SRL) skills development and track trainees' progress along their competency-based medical education learning trajectory is unclear. Learning plans (LPs) may be the answer; however, information on their use in undergraduate medical education (UME) is limited. This study summarizes the literature regarding LP use in UME, explores the student's role in LP development and implementation, and identifies additional research areas. MEDLINE, Embase, PsycInfo, Education Source, and Web of Science databases were searched for articles published from database inception to March 6, 2024, and relevant reference lists were manually searched. The review included studies of undergraduate medical students, studies of LP use, and studies of the UME stage in any geographic setting. Data were analyzed using quantitative and qualitative content analyses. The database search found 7,871 titles and abstracts with an additional 25 found from the manual search for a total of 7,896 articles, of which 39 met inclusion criteria. Many LPs lacked a guiding framework. LPs were associated with self-reported improved SRL skill development, learning structure, and learning outcomes. Barriers to their use for students and faculty were time to create and implement LPs, lack of training on LP development and implementation, and lack of engagement. Facilitators included SRL skill development, LP cocreation, and guidance by a trained mentor. Identified research gaps include objective outcome measures, longitudinal impact beyond UME, standardized framework for LP development and quality assessment, and training on SRL skills and LPs. This review demonstrates variability of LP use in UME. LPs appear to have potential to support medical student education and facilitate translation of SRL skills into residency training. Successful use requires training and an experienced mentor. However, more research is required to determine whether benefits of LPs outweigh the resources required for their use.

Adaptation of complex interventions for people with long-term conditions: a scoping review.

Adaptation seeks to transfer and implement healthcare interventions developed and evaluated in one context to another. The aim of this scoping review was to understand current approaches to the adaptation of complex interventions for people with long-term conditions (LTCs) and to identify issues for studies performed in low- and middle-income countries (LMICs). Bibliographic databases were searched from 2000 to October 2022. This review involved five stages: (i) definition of the research question(s); (ii) identifying relevant studies; (iii) study selection; (iv) data charting; and (v) data synthesis. Extraction included an assessment of the: rationale for adaptation; stages and levels of adaptation; use of theoretical frameworks, and quality of reporting using a checklist based on the 2021 ADAPT guidance. Twenty-five studies were included from across 21 LTCs and a range of complex interventions. The majority (16 studies) focused on macro (national or international) level interventions. The rationale for adaptation included intervention transfer across geographical settings [high-income country (HIC) to LMIC: six studies, one HIC to another: eight studies, one LMIC to another: two studies], or transfer across socio-economic/racial groups (five studies), or transfer between different health settings within a single country (one study). Overall, studies were judged to be of moderate reporting quality (median score 23, maximum 46), and typically focused on early stages of adaptation (identification and development) with limited outcome evaluation or implementation assessment of the adapted version of the intervention. Improved reporting of the adaptation for complex interventions targeted at LTCs is needed. Development of future adaptation methods guidance needs to consider the needs and priorities of the LMIC context.

Environmental drivers behind the exceptional increase in cyanobacterial blooms in Okavango Delta, Botswana

The Okavango Delta region in Botswana experienced exceptionally intense landscape-wide cyanobacterial harmful algal blooms (CyanoHABs) in 2020. In this study, the drivers behind CyanoHABs were determined from thirteen independent environmental variables, including vegetation indices, climate and meteorological parameters, and landscape variables. Annual Land Use Land Cover (LULC) maps were created from 2017 to 2020, with ∼89% accuracy to compute landscape variables such as LULC change. Generalized Additive Models (GAM) and Structural Equation Models (SEM) were used to determine the most important drivers behind the CyanoHABs. Normalized Difference Chlorophyll Index (NDCI) and Green Line Height (GLH) algorithms served as proxies for chlorophyll-a (green algae) and phycocyanin (cyanobacteria) concentrations. GAM models showed that seven out of the thirteen variables explained 89.9% of the variance for GLH. The models showcased that climate variables, including monthly precipitation (8.8%) and Palmer Severity Drought Index- PDSI (3.2%), along with landscape variables such as changes in Wetlands area (7.5%), and Normalized Difference Vegetation Index (NDVI) (5.4%) were the determining drivers behind the increased cyanobacterial activity within the Delta. Both PDSI and NDVI showed negative correlations with GLH, indicating that increased drought conditions could have led to large increases in toxic CyanoHAB activity within the region. This study provides new information about environmental drivers which can help monitor and predict regions at risk of future severe CyanoHABs outbreaks in the Okavango Delta, Botswana, and other similar data-scarce and ecologically sensitive areas in Africa.Plain Language Summary: The waters of the Okavango Delta in Northern Botswana experienced an exceptional increase in toxic cyanobacterial activity in recent years. Cyanobacterial blooms have been shown to affect local communities and wildlife in the past. To determine the drivers behind this increased bloom activity, we analyzed the effects of thirteen independent environmental variables using two different statistical models. Within this research, we focused on vegetation indices, meteorological, and landscape variables, as previous studies have shown their effect on cyanobacterial activity in other parts of the world. While driver determination for cyanobacteria has been done before, the environmental conditions most important for cyanobacterial growth can be specific to the geographic setting of a study site. The statistical analysis indicated that the increases in cyanobacterial bloom activity within the region were mainly driven by persistent drier conditions. To our knowledge, this is the first study to determine the driving factors behind cyanobacterial activity in this region of the world. Our findings will help to predict and monitor areas at risk of future severe cyanobacterial blooms in the Okavango Delta and other similar African ecosystems.

Geographic conditions impact the relationship between plant phenology and phylogeny

Plant phenology is influenced by a combined effect of phylogeny and climate, although it is yet unclear how these two variables work together to change phenology. We synthesized 107 previously published studies to examine whether phenological changes were impacted by both phylogeny and climate changes in various geographical settings globally. Phenological observation data from 52,463 plant species at 71 sites worldwide revealed that 90 % of phenological records showed phylogenetic conservation. i.e., closely related species exhibited similar phenology. To explore the significant and non-significant phylogenetic conservation between plant phenophases, our dataset comprises 5,47,000 observation records from the four main phenophases (leaf bud, leaf, flower, and fruit). Three-dimensional geographical distribution (altitude, latitude, and longitude) data analysis revealed that plant phenology may exhibit phylogenetic signals at finer special scales (optimal environmental conditions) that vanish in high altitude and latitude regions. Additionally, climatic sensitivity analysis suggested that phylogenetic signals were associated with plant phenophases and were stronger in the regions of ideal temperature (7–18 °C) and photoperiod (10–14 h) and weaker in harsh climatic conditions. These results show that phylogenetic conservation in plant phenological traits is frequently influenced by the interaction of harsh climatic conditions and geographical ranges. This meta-analysis enhances our knowledge of predicting species responses over geographic gradients under varied climatic conditions.

Impact of Institutional Practices and Surgical Complexity on Sarcoma Surgery Costs: Driving Efficiency in Value-Based Healthcare.

Sarcomas present a unique challenge within healthcare systems due to their rarity and complex treatment requirements. This study explores the economic impact of sarcoma surgeries across three Swiss tertiary healthcare institutions, utilizing a consistent surgical approach by a single surgeon to eliminate variability in surgical expertise as a confounding factor. By analyzing data from 356 surgeries recorded in a real-world-time data warehouse, this study assesses surgical and hospital costs relative to institutional characteristics and surgical complexity. Our findings reveal significant cost variations driven more by institutional resource management and pricing strategies than by surgical techniques. Surgical and total hospitalization costs were analyzed in relation to tumor dignity and complexity scores, showing that higher complexity and malignancy significantly increase costs. Interestingly, it was found that surgical costs accounted for only one-third of the total hospitalization costs, highlighting the substantial impact of non-surgical factors on the overall cost of care. The study underscores the need for standardized cost assessment practices and highlights the potential of predictive models in enhancing resource allocation and surgical planning. By advocating for value-based healthcare models and standardized treatment guidelines, this research contributes to more equitable and sustainable healthcare delivery for sarcoma patients. These insights affirm the necessity of including a full spectrum of care costs in value-based models to truly optimize healthcare delivery. These insights prompt a reevaluation of current policies and encourage further research across diverse geographical settings to refine cost management strategies in sarcoma treatment.

Exploring the mediating influence of acceptance of change: A study on gerontechnology acceptance, mental well-being, and urban–rural disparities among older adults

BackgroundThe global aging population necessitates leveraging technology for older adults' independence and mental well-being. Gerontechnology, tailored for older users, thrives when accessible and accepted, with the pivotal role of acceptance of change shaping its adoption. AimsThis study investigates the mediating role of acceptance of change in the relationship between gerontechnology acceptance and mental well-being among older adults and explores disparities in urban and rural settings Design & MethodsA cross-sectional, correlational design adhering to STROBE guidelines collected data through an interview survey from 802 older adults. Instruments included the Older Adult Structured Survey, Short Version of Senior Technology Acceptance, Acceptance of Change Scale, and the World Health Organization Well-Being Index. ResultsThe results underscore a significant correlation between technology adoption, adaptability, and mental well-being among 60-year-olds and older. Notably, an individual's openness to change significantly influences the technology-mental well-being relationship, emphasizing its impact on overall health. Urban areas exhibit a stronger positive correlation between technology acceptance and mental well-being, whereas rural regions demonstrate a more pronounced negative correlation. ConclusionThis research contributes valuable knowledge for addressing the unique challenges older adults face in diverse geographic settings, paving the way for targeted and effective initiatives. ImplicationsNurses should prioritize understanding the nexus between gerontechnology acceptance, change adaptability, and mental wellness, integrating technology education and culturally sensitive interventions to enhance care strategies for older adults in diverse geographic settings. This study lays the groundwork for developing person-centered geriatric nursing care plans, underscoring the importance of harnessing technology for improved mental well-being.

“Life…Gets Turned Upside-Down…” Opportunities to Improve Palliative Care for High-Grade Glioma

ContextEarly palliative care referral is recommended broadly in oncology. Yet, few patients with high-grade gliomas (HGG) – highly aggressive brain tumors – receive specialty palliative care consultation. ObjectivesTo delineate unique needs of HGG patients relative to other oncology patients according to perceptions of a diverse sample of US palliative medicine physicians and neuro-oncologists in each of the eight domains of palliative care; and to describe contrasts between physician specialties on indications for and timing of specialty palliative care referrals in HGG. MethodsBetween September 2021 and May 2023, we conducted semi-structured, 40-minute interviews with ten palliative medicine physicians and ten neuro-oncologists. Participants were recruited via purposive sampling for diversity in geographic setting, years in practice, and practice structure. Interviews were audio-recorded, professionally transcribed, and coded by two investigators. Data were analyzed thematically using a qualitative, phenomenological approach. ResultsThe palliative care needs of HGG relative to other cancers across palliative care domains are distinguished by poor prognosis, physical and cognitive deficits, and neuropsychiatric symptoms. Themes on indications for palliative care referral differed between neuro-oncologists and palliative physicians. Neuro-oncologists favored selective referral for clinical indications such as high non-neurologic symptom burden requiring time-intensive management. Palliative physicians favored early referral of most HGG patients, to allow for maximal benefit across HGG trajectory. ConclusionPatients with HGG have unique palliative care needs that affect palliative care delivery across care domains. Bidirectional education, enhanced collaboration, and consensus guidelines may help overcome barriers to specialty palliative care referral.

Psychosocial factors in knee osteoarthritis: Scoping review of evidence and future opportunities

ObjectiveIdentify, describe and produce an evidence map of studies investigating psychosocial factors association with, or effect on, clinical outcomes for people with knee osteoarthritis. MethodsScoping review of interventional and observational studies was performed. Medline (Ovid), Embase (Ovid), CINAHL, PsycInfo and Web of Science were searched on the 15th May 2023. Screening, data extraction and analysis was performed by two independent researchers. Extracted information included characteristics of studies plus which psychosocial factors were used to investigate association with, or effect on, clinical outcome(s). Descriptive statistics summarized the study design, temporal trend, geographic distribution, frequency of each psychosocial factor and whether associations/effects were observed. Results23,065 records were screened, with 108 studies selected. Eighty-two percent of studies (n=89/108) were cross-sectional in design. Number of studies increased over time and spanned 28 countries. Most research originated from the Americas region (55%, 59/108). Twenty-four psychosocial factors (11 psychological, 13 social) were identified. Depression (47%, n=48/102) and education (28%, n=29/102) were the most frequently reported psychological and social factors, respectively. Psychological factors were often reported to have an association with/effect on pain (81%, n=71/88) and physical function (75%, n=56/74). Social factors were less frequently reported to have an association with or effect on pain (57%, n=46/81) and physical function (50%, n=18/36). ConclusionPsychosocial factors are often associated with clinical outcomes for people with knee osteoarthritis. High-quality longitudinal studies examining a wide range of psychosocial factors across diverse cultural and geographical settings are key to continue informing the development of biopsychosocial models of care.

North and South in Medieval Iberia: A historical and environmental estimate through isotopic analyses.

The Middle Ages in the Iberian Peninsula is a period of special interest for studying the relationship of climate change with historical and socioeconomic processes. Between the 8th and 15th centuries AD, the Peninsula was characterized not only by complex political, cultural, and social transitions but also by major variations in the climate. The objective of this study was to examine differences in diet and mobility between distinct populations of the Peninsula and explore the possible relationship of diet, mobility, and culture with environmental variables and geographical settings. For this purpose, we obtained stable isotopic ratios of carbon and oxygen (δ13C and δ18O) from the enamel apatite of first upper incisors from 145 individuals at eight archeological sites that represent both Christian and Islamic communities and both rural and urban social settings. Results revealed a dietary difference between Christian and Islamic populations, observing a greater contribution of C4 plants, possibly sorghum, in the diet of the latter, especially in a rural setting. The disparity in oxygen isotopic ratios between populations from the North and South of the Peninsula is consistent with modern climatic differences between these regions. In this line, intraregional variability in oxygen isotopic ratios may hint at diachronic occupation phases under varying climatic conditions. The few isotopic outliers in our sample suggest overall low mobility levels.

Treatment outcomes in maxillofacial rehabilitation: a scoping review protocol.

The objective of this scoping review is to assess the treatment outcomes following maxillofacial rehabilitation and to identify the tools used to evaluate those outcomes. Maxillofacial defects caused due to tumor, trauma, or any pathology affects the patient physically, mentally, and psychologically. Various methodologies and strategies are used for jaw reconstruction and oral rehabilitation to help the patient regain the functions and quality of life that were lost due to the defect. The evaluation of these treatment outcomes is imperative to assess the success of rehabilitation. The review will include patients with any maxillofacial defect caused by a developmental anomaly, trauma, or tumor. The patients must have undergone any type of reconstruction and/or rehabilitation and can be from any age group. All treatment outcomes of maxillofacial rehabilitation will be considered. Information from primary and secondary sources and from diverse geographical settings will be included. This review will follow the JBI methodology for scoping reviews. Databases to be searched will include PubMed (Ovid), Scopus, PsycINFO (EBSCOhost), CINAHL (EBSCOhost), Web of Science, Cochrane CENTRAL, ProQuest Dissertations and Theses, and Google Scholar (first 10 pages of the search). Two independent reviewers will screen the titles and abstracts and extract data from selected studies. Data will be presented in tabular format, accompanied by a narrative summary. Open Science Framework https://osf.io/dp8wc.

Opportunity begets opportunity to drive macroevolutionary dynamics of a diverse lizard radiation.

Evolution proceeds unevenly across the tree of life, with some lineages accumulating diversity more rapidly than others. Explaining this disparity is challenging as similar evolutionary triggers often do not result in analogous shifts across the tree, and similar shifts may reflect different evolutionary triggers. We used a combination of approaches to directly consider such context-dependency and untangle the complex network of processes that shape macroevolutionary dynamics, focusing on Pleurodonta, a diverse radiation of lizards. Our approach shows that some lineage-wide signatures are lost when conditioned on sublineages: while viviparity appears to accelerate diversification, its effect size is overestimated by its association with the Andean mountains. Conversely, some signals that erode at broader phylogenetic scales emerge at shallower ones. Mountains, in general, do not affect speciation rates; rather, the occurrence in the Andean mountains specifically promotes diversification. Likewise, the evolution of larger sizes catalyzes diversification rates, but only within certain ecological and geographical settings. We caution that conventional methods of fitting models to entire trees may mistakenly assign diversification heterogeneity to specific factors despite evidence against their plausibility. Our study takes a significant stride toward disentangling confounding factors and identifying plausible sources of ecological opportunities in the diversification of large evolutionary radiations.

Oral Irrigation Devices: A Scoping Review.

Self-performed oral hygiene is essential for preventing dental caries, periodontal, and peri-implant diseases. Oral irrigators are adjunctive oral home care aids that may benefit oral health. However, the effects of oral irrigation on oral health, its role in oral home care, and its mechanism of action are not fully understood. A comprehensive search of the literature revealed no existing broad scoping reviews on oral irrigators. Therefore, this study aimed to provide a comprehensive systematic review of the literature on oral irrigation devices and identify evidence gaps. The Joanna Briggs Institute and Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews guidelines were utilized to prepare the review. Four databases and eight gray literature sources were searched for English publications across any geographical location or setting. Two hundred and seventy-five sources were included, predominantly from scientific journals and academic settings. Most studies originated from North America. Research primarily involved adults, with limited studies in children and adolescents. Oral irrigation was safe and well-accepted when used appropriately. It reduced periodontal inflammation, potentially by modulating the oral microbiota, but further research needs to clarify its mechanism of action. Promising results were reported in populations with dental implants and special needs. Patient acceptance appeared high, but standardized patient-reported outcome measures were rarely used. Anti-inflammatory benefits occurred consistently across populations and irrigant solutions. Plaque reduction findings were mixed, potentially reflecting differences in study designs and devices. Oral irrigators reduce periodontal inflammation, but their impact on plaque removal remains unclear. Well-designed, sufficiently powered trials of appropriate duration need to assess the clinical, microbiological, and inflammatory responses of the periodontium to oral irrigation, particularly those with periodontitis, dental implants, and special needs. Patient-reported outcome measures, costs, caries prevention, and environmental impact of oral irrigation need to be compared to other oral hygiene aids.

Determining anthropogenic pressure on the Southern Black Sea blue flag beaches

Coasts are settlement areas that attract human for many years. Türkiye, geographically located on Mediterranean Basin and Asian Continent passage with unique climate regime, has a great coastal zone. The mid-latitude geographic setting makes possible to experience coastal recreation and tourism activities for almost all year along. Among all activities sun, sea and sand tourism can be placed on the first stage. Recent changes in local climate of the Black Sea such as rising mean atmospheric temperatures and increasing number of sunny days have triggered touristic beach activities in the region. In the literature, there are different techniques for grading and classifying coastal beaches. In this study, as an integral part of coastal landscape formation Land Use/Land Cover (LULC) structure is linked to landscape value and regarded as cover changes that determines landscape pattern of the area under investigation. The research rationale of this study is based on an assumption of Southern Black Sea coastal blue flag beaches are under severe anthropogenic pressure. For this purpose, 15 blue flag beaches which are located on the Black Sea coast of Türkiye were selected based on their morphological dimensions. To determine landscape changes and potential human induced effects on selected beaches for the last 35–40 years period, georeferenced, atmospherically corrected Landsat 5 TM and Landsat 8 OLI-TIRS satellite images were used. Furthermore, carrying capacities for all researched beaches were calculated and documented in order to find the actual human usage frequencies during the high season. According to results of the study, it is clearly observed that all beach areas are under anthropogenic pressure. The most important evidence of this situation is the proportional increases in the IS (Impervious Surface) cover class in the classified images between 1984 and 1985 and 2021 in all 15 beaches. Moreover, these increases have reached up to 5–6 times for some beaches. As inferred, from the field surveys, beach carrying capacities were also exceeded for the most of the beaches under investigation. This means the blue flag beaches of Southern Black Sea are not only affected by construction and urbanization but also under intense pressure of overuse during the high seasons. It is revealed that these areas should be carefully managed with state-of-the-art techniques that prioritize adaptive planning that takes into account all stakeholders participation. Moreover, the activities, authorization and attitudes of municipalities regarding the coastal zones must be limited and inspected by a higher organization.

Drivers of genomic differentiation landscapes in populations of disparate ecological and geographical settings within mainland Apis cerana.

Elucidating the evolutionary processes that drive population divergence can enhance our understanding of the early stages of speciation and inform conservation management decisions. The honeybee Apis cerana displays extensive population divergence, providing an informative natural system for exploring these processes. The mainland lineage A. cerana includes several peripheral subspecies with disparate ecological and geographical settings radiated from a central ancestor. Under this evolutionary framework, we can explore the patterns of genome differentiation and the evolutionary models that explain them. We can also elucidate the contribution of non-genomic spatiotemporal mechanisms (extrinsic features) and genomic mechanisms (intrinsic features) that influence these genomic differentiation landscapes. Based on 293 whole genomes, a small part of the genome is highly differentiated between central-peripheral subspecies pairs, while low and partial parallelism partly reflects idiosyncratic responses to environmental differences. Combined elements of recurrent selection and speciation-with-gene-flow models generate the heterogeneous genome landscapes. These elements weight differently between central-island and other central-peripheral subspecies pairs, influenced by glacial cycles superimposed on different geomorphologies. Although local recombination rates exert a significant influence on patterns of genomic differentiation, it is unlikely that low-recombination rates regions were generated by structural variation. In conclusion, complex factors including geographical isolation, divergent ecological selection and non-uniform genome features have acted concertedly in the evolution of reproductive barriers that could reduce gene flow in part of the genome and facilitate the persistence of distinct populations within mainland lineage of A. cerana.

Dolutegravir plus boosted darunavir versus recommended standard-of-care antiretroviral regimens in people with HIV-1 for whom recommended first-line non-nucleoside reverse transcriptase inhibitor therapy has failed (D2EFT): an open-label, randomised, phase 3b/4 trial

Randomised comparative data on efficacy and safety of second-line antiretroviral therapy (ART) after failure of non-nucleoside reverse transcriptase inhibitors (NNRTIs) across diverse geographical settings are scarce. The aim of this study was to evaluate optimal second-line ART for people with HIV. D2EFT is a completed international, randomised, open-label, phase 3b/4 trial evaluating three second-line ART strategies in adults (aged ≥18 years) with HIV-1 for whom first-line NNRTI therapy has failed. The study was done at 28 sites across 14 countries in Asia, Africa, and Latin America. It was originally designed to compare recommended standard of care (ritonavir-boosted darunavir [800 mg darunavir plus 100 mg ritonavir once daily] plus two nucleoside reverse transcriptase inhibitors [NRTIs; dosed once or twice daily]) with a novel nucleoside sparing regimen of dolutegravir (50 mg once daily) with ritonavir-boosted darunavir. The study was adapted during the first year to add a third arm of dolutegravir (50 mg once daily) with fixed tenofovir disoproxil fumarate (300 mg once daily) plus either lamivudine (300 mg once daily) or emtricitabine (200 mg once daily). Participants were randomly assigned with a computer-generated, blocked randomisation scheme (block size of two) stratified by site, previous tenofovir disoproxil fumarate use, and HIV viral load. The trial was designed to evaluate non-inferiority of either interventional arm against standard of care for the primary outcome of virological suppression, as determined by HIV RNA load of less than 50 copies per mL at 48 weeks. The prespecified non-inferiority margin was 12%. Comparisons were made with a modified intention-to-treat population, including all participants randomly assigned but excluding administrative withdrawals. This study is registered with ClinicalTrials.gov, NCT03017872. 1190 individuals were screened; 828 participants were enrolled between Nov 1, 2017, and Dec 31, 2021. Two participants were unable to receive their assigned regimen for administrative reasons; and 826 participants were included in analyses. Median age was 39 years (IQR 33-46), and 450 (54%) participants were female. Baseline median CD4 count was 206 cells per μL (23-354) and median HIV RNA was 15 400 copies per mL (3600-65 986). The proportion of participants with HIV RNA of less than 50 copies per mL at 48 weeks was 194 (75%) of 257 in the ritonavir-boosted darunavir plus two NRTIs group, 222 (84%) of 264 in the ritonavir-boosted darunavir plus dolutegravir group, and 227 (78%) of 291 in the dolutegravir with tenofovir disoproxil fumarate plus either lamivudine or emtricitabine group. Compared with ritonavir-boosted darunavir plus two NRTIs, the difference in virological suppression was 8·6% (95% CI 1·7 to 15·5; p=0·016) for dolutegravir plus ritonavir-boosted darunavir and 6·7% (-1·2 to 14·4; p=0·093) for dolutegravir with tenofovir disoproxil fumarate plus either lamivudine or emtricitabine. Six deaths occurred, none of which were related to treatment. 19 pregnancies (11 livebirths) occurred with no congenital defects. In individuals experiencing failure of an NNRTI-based first-line ART, a switch to either dolutegravir plus ritonavir-boosted darunavir or dolutegravir with tenofovir disoproxil fumarate plus either lamivudine or emtricitabine, without universal access to genotyping, was non-inferior in achieving viral suppression compared with ritonavir-boosted darunavir plus two NRTIs. These global data support the most recent WHO treatment guidelines. UNITAID; National Institute of Allergy and Infectious Diseases, USA; National Health and Medical Research Council, Australia; ViiV Healthcare; and Janssen.

A qualitative exploration of health care workers’ approaches to relational harm reduction in HIV primary care settings

BackgroundStructural harm reduction is an approach to care for people who use drugs (PWUD) that incorporates services and resources (e.g., naloxone, sterile syringes). As conceptualized in our previous research, harm reduction is also “relational,” encompassing a patient-provider relationship that is non-judgmental and respectful of patients’ autonomy. Little is known about health care workers’ (HCW) knowledge or attitudes towards harm reduction beyond structural strategies, whose availability and legality vary across geographical settings. To operationalize how relational harm reduction is both characterized and employed in HIV care settings, where nearly half of patients have a diagnosed substance use disorder, we qualitatively explored HCWs’ knowledge of and use of harm reduction via individual in-depth interviews.MethodsOur study sample included three HIV clinics, one in Birmingham, Alabama (AL) and two in Pittsburgh, Pennsylvania (PA). We conducted individual interviews with n = 23 health care workers via Zoom, using a semi-structured interview guide to probe for questions around health care workers’ attitudes towards and experiences with providing care to PWH who use drugs and their knowledge of and attitudes towards relational and structural harm reduction. Data was analyzed in Dedoose using thematic analysis.ResultsQualitative analyses revealed two primary themes, Continuum of Relational Harm Reduction in Practice and Limited Harm Reduction Training. Nearly all HCWs (n = 19, 83%) described a patient interaction or expressed a sentiment that corresponded with the principles of relational harm reduction. Yet, over half of participants (n = 14, 61%) used language to describe PWH who use drugs that was stigmatizing or described an interaction that was antithetical to the principles of relational harm reduction. Five HCWs, all from Birmingham, were unaware of the term ‘harm reduction.’ Few HCWs had any harm reduction training, with most learning about harm reduction from webinars/conferences or on the job.ConclusionOur findings suggest that relational harm reduction in HIV care settings is practiced along a continuum, and that a range of behaviors exist even within individual HCWs (e.g., used stigmatizing terms such as “addict” but also described patient interactions that reflected patients’ autonomy). Given that harm reduction is typically described as a structural approach, a broader definition of harm reduction that is not dependent on policy-dependent resources is needed.

The Comparison of Different Instructional Styles in China and the United States on Early Education

Instructional styles play a critical role in shaping student outcomes. They determine the extent to which students participate in class. They also shape the resource allocation efforts assumed by instructors. While there are multiple studies which examine the implementation of different instructional styles, more research is needed to establish the variabilities in different instructional styles across different regions. Accordingly, this study examines the impact of instructional styles on early education, with a specific focus on China and the United States. In its comparative approach, it highlights the contrast between student-centered, constructivist teaching in the United States and the teacher-centered, Behaviorist approach in China. The comparison is intended to shed more light on the culture influences shaping teaching across different geographical settings. It provides a model of comparison for similar analyses in the future. The paper also discusses how societal and parental expectations shape instructional preferences and explores the effects of these styles on academic achievement, creativity, and critical thinking.

Examining the Relationship Between Technical Competencies, Personal Skills, and Employment Opportunities. Case of Albania

This paper critically examines the effects of technical competencies and personal abilities on employment. Emphasizing the crucial role of hard and soft skills in future development. Focusing on Albania, the study aims to investigate the influence of hard and soft skills on employment within both urban and rural contexts. Additionally, the paper seeks to unravel the disparities in employment policies between these areas, shedding light on the unique challenges and opportunities present in Albania's evolving employment. The literature review serves as the foundation for our research, providing essential insights into the influence of soft and hard skills within both urban and rural contexts, particularly in developing countries. Understanding the dynamics of these skills in employment is paramount for comprehending the nuances of workforce development and policy formulation in diverse geographic settings. The questionnaire, developed based on the insights gleaned from the literature review, was administered to managers and individuals involved in the recruitment process. Data collection involved a random sampling method, resulting in 182 respondents from rural areas and 179 respondents from urban areas. Statistical analysis was conducted using SPSS, version 23, with regression analysis employed to empirically assess the formulated hypotheses. In conclusion, the study underscores the fundamental role of education in facilitating employment opportunities, particularly in rural areas where diplomas hold prominence. However, the ability to retain employment and thrive in the labor market is contingent upon possessing essential soft skills. Thus, while education serves as a gateway to employment, cultivating soft skills is paramount for long-term success in both urban and rural employment areas. The findings of this paper hold significant value for individuals directly engaged in the recruitment process, including employers and employees alike. Employers stand to benefit from insights into the importance of prioritizing soft skills alongside hard skills when evaluating potential candidates, particularly in urban settings where these skills hold greater sway. Similarly, employees can leverage the understanding that possessing and refining soft skills is critical not only for securing employment but also for maintaining long-term market relevance. Overall, this study provides valuable guidance for enhancing recruitment practices and fostering career development in diverse employment contexts. This paper stands out for its focus on employment practices within both urban and rural areas, a perspective that offers a nuanced understanding of workforce dynamics. Furthermore, the inclusion of Albania as a case study adds a unique dimension, providing insights into employment practices within the context of a developing country. By exploring the employment landscape in Albania, the study offers valuable perspectives that may not be captured in studies conducted in more developed nations. This original contribution enhances our understanding of the intersection between urban-rural employment dynamics.

Green thinking: impact of smart technologies on supply chain management

Purpose The purpose of this research is to determine how supply chain management (SCM) might be less affected by COVID-19 by using innovative technologies such as the Internet of Things (IoT), eco-friendly corporate practices and other digital advancements. It strongly emphasizes the use of technology to improve supply networks’ and Omani firms’ performance. Design/methodology/approach Using a mixed-methods research strategy, this study integrates both qualitative and quantitative approaches. It involves a survey and interviews with supply chain and IT managers from various industries in Oman to gather data and evaluate the impact of technology on SCM. Findings This study finds that IoT capabilities, smart technologies (STs) and green practices significantly mitigate COVID-19 impacts on SCM. The performance of the supply chain and the business are both improved by these technologies’ positive effects on integrating various supply chain elements, such as suppliers, internal processes and customer relations. Research limitations/implications The main constraint of this study is its concentration on businesses in Oman, potentially restricting the applicability of its findings to broader contexts. Future studies could investigate similar frameworks across various geographic and industry settings. Practical implications The findings suggest that incorporating STs into SCM is crucial for enhancing operational efficiency and resilience against disruptions such as COVID-19. This offers valuable insights for managers and policymakers in adopting technology-driven strategies for SCM. Social implications This study highlights the significant role of technology in sustaining supply chains during pandemics, thereby supporting economic stability and societal well-being. It underscores the importance of technological advancements in maintaining supply chain continuity in challenging times. Originality/value By empirically examining the effect of emerging technologies on enhancing SCM in the context of the COVID-19 pandemic, specifically in the Oman market, this research makes a unique contribution to the body of knowledge.

Considering Contextual Influences on Fatherhood Program Participants’ Experiences

The current study assessed multiple changes over 1 year for fatherhood program participants and explored variations in challenges at program start, retention, and improvements in outcomes based on geographic setting, race, and sequencing of services. In a sample of 630 racially diverse fathers, we found enhanced economic vulnerability of urban fathers and Black/other minority fathers, and greater individual and work-related challenges for White fathers at program start. Results from growth modeling indicated fathers reported sustained growth over 1 year in nearly all measures assessed including relationship skills and functioning, hope for ensuring a positive future, father involvement and parent-child relationship quality, child academic adjustment, and commitments and ability to meet financial obligations. Evidence of enhanced benefit of programs in multiple areas over time for rural and White participants, compared with Black/other minority and urban fathers is presented. Results also indicate receiving case management first enhances fathers’ attendance and retention in program classes.