High Utilization Research Articles

Barriers and facilitators for universal gestational diabetes Mellitus screening in a low resource setting: a cross-sectional study in Sri Lanka

Gestational Diabetes Mellitus (GDM) is associated with adverse maternal and perinatal outcomes and increased risk of developing diabetes in later life. Sri Lanka adopted universal GDM screening at two time points in pregnancy (before 12 weeks and between 24 and 28 weeks) in 2014 and its utilization has not been assessed. This study assessed the utilization of GDM screening services and associated factors among antenatal mothers in Southern Sri Lanka. A cross-sectional study was carried out in a consecutive sample of 420 postpartum mothers who delivered at three major hospitals in Sri Lanka. Data were collected on socio-demographics, pregnancy, availability and utilization of screening services and logistics using an interviewer-administered questionnaire and a data record sheet. Data was analysed using SPSS software. Chi-square test and binary logistic regression was used to assess the association between variables. The coverage of first and second screening tests were 91.4% and 94.5% and timeliness were 72.4% and 59.5%, respectively. The median period of amenorrhoea at the first and second screening were 10.0 (inter-quartile range: 2.5) weeks and 28.0 (inter-quartile range: 1.5) weeks. A higher utilization was associated with higher income (OR = 3.4, 95% CI: 1.1–10.5) and planned pregnancy (OR = 4.9, 95% CI: 2.2–10.7) for the first screening test. Primiparity (OR = 0.3, 95% CI: 0.1–0.9) and proximity of the nearest laboratory (OR = 3.5, 95% CI: 1.0–12.0) were positively associated with the second screening test. The timeliness of both screening tests was associated with planned pregnancy (OR = 2.1, 95% CI: 1.1-4.0 and OR = 2.3, 95% CI: 1.1–4.5) and being non-employed during the pregnancy (OR = 2.5, 95% CI: 1.4–4.3 and OR = 2.3, 95% CI: 1.3–4.1). A high utilization of GDM screening was observed. Timeliness should be ensured through improved availability and accessibility of screening facilities.

Pure room temperature phosphorescence emission in nondoped OLEDs: adjustable oxidation states and excited-state modulation.

Purely organic room temperature phosphorescence (RTP) materials are a new kind of triplet emitter, which can harvest both singlet and triplet excitons in theory, thus showing great application potential for organic light-emitting diodes (OLEDs). However, nondoped OLEDs based on RTP emitters have been rarely explored owing to challenges in realizing efficient phosphorescence in single-component systems. Herein, three donor-acceptor-type luminogens were designed and synthesized in which phenothiazine, with different oxidation degrees, acted as the electron donor and acetophenone as the acceptor. The adjustable oxidation states of phenothiazine enabled the modulation of excited states, facilitating the transition from dual RTP and thermally activated delayed fluorescence emissions to pure RTP. A nondoped OLED device was then fabricated based on the pure RTP emitter, achieving a high exciton utilization efficiency of 86%, clearly demonstrating the enhancement of electroluminescence performance through RTP properties.

Predictors of Outpatient and Inpatient Service Utilization Among Publicly-Insured Youth With Eating Disorders.

Although eating disorders (EDs) affect youth from all socioeconomic backgrounds, little is known about the treatment experiences of under-resourced youth with EDs. To address this gap, we examined patterns of outpatient and inpatient service utilization among publicly-insured youth with EDs in California and potential disparities for youth with additional marginalized identities. Participants were identified from the full sample of California Medicaid/Medi-Cal beneficiaries aged 7-18 with ≥ 1 service episode between January 1, 2014 and December 31, 2016. Claims data were extracted for youth with a full year of claims after the first known ED diagnosis (N = 3311) to analyze outpatient mental health, outpatient medical/physical, inpatient mental health, and inpatient medical/physical service use across ED diagnosis and demographic characteristics (sex, age, race/ethnicity, and preferred language). Outpatient individual and family therapy service utilization was low across ED diagnoses (4-7 individual therapy sessions and ≈5 family therapy sessions annually). Conversely, hospitalization rates were high, particularly among youth with anorexia nervosa (27.8%) and bulimia nervosa (30.0%). Youth with other specified feeding or ED had high medical service utilization, with more days of outpatient medical care and greater odds of medical hospitalization than youth with all other diagnoses. Latinx youth, Black youth, and boys tended to receive fewer services after accounting for diagnosis, with disparities particularly pronounced for Latinx youth. Publicly-insured youth with EDs in California experience high hospitalization rates but receive limited outpatient therapy. Additional research is needed to identify possible unmet needs and factors contributing to treatment disparities among these youth.

Changes in exposure to environmental contaminants in the aftermath of Hurricane Maria among pregnant women in northern Puerto Rico

Experiencing a hurricane during pregnancy is associated with increased risk of adverse birth outcomes and poor mental health. Pregnant people from marginalized communities are more susceptible to adverse effects, as they have fewer resources to overcome hardships at a time when shelter and nutrition are essential. When Hurricane Maria (HM) devastated Puerto Rico in September 2017, the archipelago was already burdened with high poverty, health disparities, environmental contamination, and fragile utility infrastructure. We aimed to compare biomarkers of environmental exposures among pregnant participants in the PROTECT cohort before and after HM and to identify hurricane-related sources of exposure. Metals, PAHs, phthalate metabolites, and phenols were measured in urine samples collected from participants at three prenatal visits (2011–2019). Samples were categorized as before, <3 months, 3–6 months, and >6 months after HM. Using linear mixed effects models, we found that in the 6 months after HM, participants had higher Co, Ni, and DEHPTP concentrations, indicating increased exposure, and lower concentrations of PAHs, several metals, and phthalates, suggesting decreased exposure, compared to pre-HM levels. Biomarkers were not associated with potential exposure sources assessed through questionnaire or previously measured tap water contaminants. This study provides insight into how extreme weather events may alter environmental exposures among pregnant people in Puerto Rico. As climate change has increased the frequency and magnitude of such events, additional research is needed to clarify the implications for maternal and child health and to identify sources of related environmental exposures within this vulnerable population.

Prognostic evaluation of segmental ureterectomy combined with chemotherapy in high-grade non-metastatic ureteral cancer: a study based on the SEER database

This study evaluates the survival outcomes of segmental ureterectomy (SU) combined with chemotherapy in patients with high-grade non-metastatic ureteral cancer (UC) using data from the SEER database. A total of 1757 patients with Grade III-IV non-metastatic UC were analyzed. Overall survival (OS) was assessed through Kaplan–Meier analysis, and independent prognostic factors were identified via Cox regression. A Nomogram model was developed and evaluated using the concordance index, area under the time-dependent ROC curve, calibration curves, and decision curve analysis. The 1-, 3-, and 5-year OS rates were 82.8%, 55.6%, and 42.8%, respectively. Age, treatment protocol, T stage, and N stage were significant prognostic factors. Both SU + chemotherapy and radical nephroureterectomy (RNU) + chemotherapy demonstrated comparable survival outcomes, outperforming surgery alone, particularly in patients aged 70 and older. The Nomogram demonstrated high predictive accuracy and clinical utility. These findings suggest that SU + chemotherapy offers survival benefits similar to RNU + chemotherapy, making it a viable option, especially for elderly patients or those with impaired renal function.

Using Technology to Support Measurement-Based Care: Design and Implementation of the Measurement-Assisted Care Program.

The authors aimed to increase measurement-based care in an outpatient academic psychiatry service. The Measurement-Assisted Care program (MAC) was implemented as a clinical quality-improvement effort that included 4,665 unique patients and 176 clinicians over 12 months. The Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder scale (GAD-7), PTSD Checklist for DSM-5, and Brief Inventory of Thriving were automatically included in the patient electronic check-in process for new visits; the PHQ-9 and GAD-7 were included for return visits. Patient responses were automatically routed to clinicians' electronic health record inboxes and documentation templates. MAC was rolled out in two phases, and clinicians were surveyed about their use of MAC data 3-6 months after the start of the program. After implementation of MAC, PHQ-9 completion rates increased from 5% to 66% of visits for phase 1 and from 5% to 60% for phase 2. Post-MAC completion rates were higher for telehealth (70%) than for in-person (40%) visits. More than 90% of clinicians reported that MAC was useful with at least one of their three most recent patients, and 51% reported that it was useful with all three of their three most recent patients. Clinician adoption was high, with 78% reporting that they use MAC data to guide care. MAC increased the completion rate of patient-reported outcome measures, especially for telehealth visits. Clinicians reported that they frequently use and discuss MAC data with patients, implying that technology-supported workflows can help systems with high telehealth utilization capture and use patient-reported outcomes.

18 Past and current care practices for neonates with complex medical needs: A scoping review to support clinical program evaluation

Abstract Background Neonates with complex medical needs (NCMN) are a rapidly growing patient population internationally. Although NCMN are a relatively small proportion of all Neonatal Intensive Care Unit (NICU) admissions, they are high healthcare utilizers. Since 2018, a dedicated Neonatal Complex Care Team (NCCT) has cared for NCMN at a large quaternary care center. The NCCT cares for NCMN in a dedicated, single-family room, patient area within the NICU. This model of care has yet to be evaluated for its potential impact on healthcare outcomes. Objectives The objective of the scoping review is to determine the breadth of available literature on the care practices for the management of NCMN and to collate the available evidence to define outcome measures to be used in a formal program evaluation. Design/Methods The review followed the PRISMA extension for scoping reviews and utilized resources from the Joanna Briggs Institute. The two databases that were utilized include Medline via OVID and CINAHL. The dates for included publications are January 1st 1993, until July 15th 2023. Only studies published in English and primary research were included. Two independent reviewers performed the initial title and abstract screening, and the full text review. The data extraction was completed by one independent reviewer. Results 102 articles were included in the title and abstract screen, and 12 were considered for full text review. Four articles were included. Interventions discussed in the included articles ranged from discharge conferences with patient’s caregivers, to the implementation of an entirely new model of care. Multidisciplinary health care teams appear to be integral to the in-hospital care and smooth discharge of NCMN. We identified that caregiver involvement and satisfaction are important to the discharge process as they are primarily responsible for their infant’s care after discharge, and so it is important that the specifics of care are communicated and taught effectively. The outcomes of interest identified as most useful for clinical program evaluation were length of stay and readmission rate. Additionally there was limited data reported on long-term health outcomes of this patient population. Conclusion This scoping review identified few articles that reported new models of care, a lack of consistent outcomes used in evaluating existing care models and overall a gap in research in this rapidly growing patient population. There is more work to be done to improve care of NCMN and our findings will be used in designing future studies that evaluate care models.

Investigation of Arc Stability in Wire Arc Additive Manufacturing of 2319 Aluminum Alloy.

Wire Arc Additive Manufacturing (WAAM) technology, known for its low equipment and material costs, high material utilization, and high production efficiency, has found extensive applications in the fabrication of key components for the aerospace and aviation industries. The stability of the arc is crucial for the WAAM process as it directly affects the forming of the parts. In this study, the monitoring data of electrical signals and arc morphology during the WAAM process of 2319 aluminum alloy were investigated using a high-speed camera system and current/voltage acquisition system. By analyzing the current and voltage signals, as well as the arc imaging results, the influence of arc stability on the forming of the cladding layer was studied. The experimental results indicated that when both current and voltage exhibit regular periodic fluctuations, this manifests as a stable short-circuit droplet transition form, while sudden changes in these signals represent abnormal droplet transition forms. The adaptability of the process directly influenced the arc shape, thereby affecting the forming of the cladding layer. Under the process parameters of welding speed of 240 cm/min and wire feeding speed of 6.5 m/min, it was observed that the current signal exhibited a tight state and the variance of the arc width was minimized. This indicated that at a higher wire feeding speed, the droplet transfer frequency was increased. Under these process parameters, the arc output was more stable, resulting in a uniform metal coating.

Understanding the Factors Influencing Adoption of mHealth in Rural Patients: A Case of Embu, Kenya

Background and Purpose: Kenya and other low-income countries face healthcare challenges such as affordability, access, and health worker shortages. Digital technologies have disrupted traditional service delivery in industries such as banking and retail. Significant changes have not yet affected healthcare. Technological advancements in healthcare may help to leapfrog barriers such as the cost of physical infrastructure. The study examined the influence of technical, social, and individual factors in adopting mHealth products in Embu, Kenya. Methods: A cross-sectional quantitative study using a structured close-ended questionnaire was conducted in Embu, Kenya, between August and December 2019. Correlation and regression analysis were used to determine the effect of the influential factors on adopting mHealth products. Results: 207 (75%) randomly selected respondents over 18 years completed the survey, with the largest group (39.4%) aged between 35-44 years and 43% holding a post-secondary school diploma. Correlation analysis showed that social factors positively and significantly correlate to mHealth products' adoption (r (207) = .793, P &lt; .05), reflecting a generally favourable view towards using mobile phones for seeking healthcare. Similarly, technical factors showed a significant correlation with mHealth adoption (r (207) = .931, P &lt; .05), supported by widespread smartphone ownership and access to high-speed internet. Individual factors, including perceptions of the time-saving benefits of seeking healthcare services using a mobile phone, also demonstrated a positive correlation with the adoption of mHealth (r (207) = .708, P &lt; .05). Conclusions: Our study underscores the significant relationship of social, technical, and individual factors in adopting mHealth products. Digital health implementers should leverage increasing access to technical factors such as the Internet, smartphones, good mobile network coverage, and high utilization of social media to facilitate the positive adoption of mHealth. Our research provided insights from Embu; however, expansive studies encompassing rural and urban demographics are required to enhance generalizability

Progress and challenges in structural, in situ and operando characterization of single-atom catalysts by X-ray based synchrotron radiation techniques.

Single-atom catalysts (SACs) represent the ultimate size limit of nanoscale catalysts, combining the advantages of homogeneous and heterogeneous catalysts. SACs have isolated single-atom active sites that exhibit high atomic utilization efficiency, unique catalytic activity, and selectivity. Over the past few decades, synchrotron radiation techniques have played a crucial role in studying single-atom catalysis by identifying catalyst structures and enabling the understanding of reaction mechanisms. The profound comprehension of spectroscopic techniques and characteristics pertaining to SACs is important for exploring their catalytic activity origins and devising high-performance and stable SACs for industrial applications. In this review, we provide a comprehensive overview of the recent advances in X-ray based synchrotron radiation techniques for structural characterization and in situ/operando observation of SACs under reaction conditions. We emphasize the correlation between spectral fine features and structural characteristics of SACs, along with their analytical limitations. The development of IMST with spatial and temporal resolution is also discussed along with their significance in revealing the structural characteristics and reaction mechanisms of SACs. Additionally, this review explores the study of active center states using spectral fine characteristics combined with theoretical simulations, as well as spectroscopic analysis strategies utilizing machine learning methods to address challenges posed by atomic distribution inhomogeneity in SACs while envisaging potential applications integrating artificial intelligence seamlessly with experiments for real-time monitoring of single-atom catalytic processes.

Intelligent Monitoring and Visualization System for High Building Nighttime Utilization Based on Image Processing.

The rise of complex high-rise buildings has made building management increasingly challenging, especially the nighttime supervision of university laboratories. Idle occupation increases the risk of accidents and undermines campus sustainability. Effective occupancy detection is essential for optimizing campus building safety and energy efficiency. Environmental sensors for occupancy detection offer limited coverage and are costly, making them unsuitable for campuses. Surveillance cameras, as part of campus infrastructure, provide wide coverage. On this basis, we designed a detection algorithm that uses light brightness to assess nighttime building use. Experimental results showed that the algorithm achieves an average accuracy of 98.67%, enabling large-scale nighttime occupancy detection without the need for installing additional sensors, significantly improving the efficiency of campus building management. In addition, to address the limitations of indoor space representation in geographic information system (GIS) management models, this paper developed a comprehensive 3D GIS model based on a "building-floor-room" hierarchical structure, utilizing oblique photogrammetry and laser scanning technology. This study combined the detection results with real-world 3D data for visualization, providing a new perspective for the 3D spatiotemporal refinement of complex high-rise buildings, and providing a reference framework for the detection and analysis of other types of building environments.

One-Pot Fabrication of Copper-Doped WO3·H2O Opto-Functional Layered Device using Submerged Photosynthesis of Crystallites.

This study introduces a one-pot, submerged photosynthesis of crystallites (SPsC) method for fabricating monohydrate tungstic acid (WO3·H2O) nanoplates directly integrated onto a stainless steel mesh, offering a simplified production and enhanced device stability for optical functional applications. The fabricated devices demonstrate exceptional broadband light absorption across the ultraviolet (UV), visible (Vis), and near-infrared (NIR) ranges. Notably, 1% Cu doping significantly boosts the NIR absorption, yielding a high solar utilization efficiency of 81.40%. In solar water evaporation experiments, the devices exhibit a maximum temperature increase of 13 °C under 1-Sun (100 mW/cm2) illumination, achieving an energy conversion efficiency of 32.5%. Moreover, electrochemical characterization reveals light-induced conductivity changes and enhanced current density, suggesting potential applications in rectifying devices. This versatile and environmentally conscious SPsC fabrication method holds promise for the sustainable development of diverse nanodevices.

Understanding the utilization potential of lepidolite slag in cementitious materials: Composition characteristics, hydration properties, and high value-added cementitious system design

Lepidolite slag (LES) is a kind of solid waste produced by extracting lithium from lepidolite, but researches focused on it are still limited. This paper works on understanding the utilization potential of LES in cementitious materials from its composition characteristics, hydration properties, and high value-added cementitious system design. Results show that the reactivity of LES is notably low in both water and alkaline solution. As a supplementary cementitious material (SCM), LES exhibits several drawbacks, including prolonging setting time, reducing compressive strength, and deteriorating pore structure. With addition of 30 % LES, the compressive strength at 28 d decreased by 63.3 %. Considering the high gypsum content within LES, an all-solid waste cementitious system was designed using high-volume LES combined with blast furnace slag (BS) and a small amount of lime. System with 40 % LES presents similar compressive strength with system composed entirely of BS at both 7 d and 28 d. The mechanism is that the excellent compound activation effect of gypsum in LES and lime on BS promoted the transformation of hydrotalcite to ettringite in the system. Even when LES content reached 70 %, compressive strength at 28 d surpassed 15 MPa. This study proposes a novel high value-added utilization way for LES in cementitious materials.

Utilization of Rehabilitation Services and Rehabilitation-Related Patient Satisfaction Following Total Knee Arthroplasty-Results of the Prospective FInGK Study.

(1) Background: This study aims to examine rehabilitation service utilization among total knee arthroplasty (TKA) subjects and the influencing factors associated with rehabilitation-related satisfaction. (2) Methods: The FInGK study was a single-center prospective cohort study. Patients (≥18 years) undergoing primary or revision TKA in a German university hospital were consecutively recruited between December 2019-May 2021. The subjects filled in a questionnaire one day before surgery (t0) and at two (t1) and 12 (t2) months postoperatively. Multivariable logistic regression was conducted to determine the variables associated with the subjects' rehabilitation-related satisfaction. (3) Results: A total of 236 out of 241 (97.9%) subjects participated in t1 (59.3% female; mean age: 68.2 years). Overall, 94.7% underwent post-TKA rehabilitation measures, with inpatient rehabilitation being the predominant choice (85.4%). In total, 77.6% of those with rehabilitation were satisfied or very satisfied with their rehabilitation in general. Multivariable logistic regression showed that female sex (OR 3.42; CI 1.73-6.75) and satisfaction with the surgery in general after two months (OR 4.50; CI 1.96-10.33) were associated with the subjects' rehabilitation-related satisfaction. (4) Conclusions: We found a high utilization of rehabilitation services following TKA and a high rehabilitation-related satisfaction. In international comparison, the utilization of inpatient rehabilitation services was very high. Future research should investigate the effective components for rehabilitation-related satisfaction in both in- and outpatient TKA rehabilitation.

Trajectory Analysis of Healthcare Use Before and After Gastrointestinal Cancer Surgery.

Frailty correlates with worse post-operative outcomes and higher surgical costs, but the long-term impact on healthcare utilization remains ill-defined. We sought to evaluate patterns of healthcare utilization pre- and post-surgery among patients with gastrointestinal cancer and characterize the association with frailty. Data on patients who underwent surgical resection for liver, biliary, pancreatic, colon and rectal cancer were obtained from the 2005-2020 SEER-Medicare database. Frailty was assessed using the claims-based frailty index. Group-based trajectory modelling identified clusters of patients with discrete patterns of healthcare utilization. Multivariable regression was performed to predict cluster membership based on preoperative factors, including frailty. Among 66,684 beneficiaries, four distinct utilization trajectories based on data from 12 months before and after surgery were identified. Following a surge in utilization during the month of surgery, most patients reverted to pre-surgery baseline utilization (low: n=6588, 9.9%; moderate: n=17,627, 26.4%; high: n=29,850, 44.8%). However, a notable trajectory involving 12,619 (18.9%) patients was identified, wherein surgery precipitated a transition from a "low" pre-surgery utilization state to a "high" utilization state post-surgery. Frail patients were more likely to be among those individuals who transitioned to high utilizers (low: 4.2% vs. vs. transition: 12.6% vs. high: 7.5%; p<0.001). On multivariable analysis incorporating preoperative variables, frailty was associated with high group trajectory membership (ref: least and moderate; highest: OR 4.90, 95%CI 4.49-5.35; p<0.001). Patients with gastrointestinal cancer demonstrated distinct clusters of healthcare utilization after surgical resection. Preoperative predictive models may help differentiate different health care utilization trajectories to help tailor care for patients in the postoperative period.

In Situ Molecular Reconfiguration of Pyrene Redox-Active Molecules for High-Performance Aqueous Organic Flow Batteries.

Aqueous organic flow batteries (AOFBs) hold great potential for large-scale energy storage, however, scalable, green, and economical synthetic methods for stable organic redox-active molecules (ORAMs) are still required for their practical applications. Herein, pyrene-based ORAMs are obtained via an in situ organic electrolysis strategy in a flow cell. It is revealed that the water attacking pyrenes restructured molecules to produce a variety of isomers and dimers during the electrolysis, which can be modulated by regulating the local electron cloud density and steric hindrance of pyrene precursors. As a result, the molecularly reconfigured pyrene-based catholytes, even without any further purification, achieved a high electrolyte utilization of ≈96% and volumetric capacity above 50AhL-1. Inspiringly, remarkable cell stability with almost no capacity decay for ≈70 days is achieved, benefiting from the robust aromatic structure of the pyrene cores. The insights into the in situ electrosynthesis of pyrene-based ORAMs provided in the work will provide guidance for designing ultra-stable ORAMs for AOFB applications.

Retraction Note: High utility itemset mining: a Boolean operators-based modified grey wolf optimization algorithm

Retraction Note: High utility itemset mining: a Boolean operators-based modified grey wolf optimization algorithm

Narrative Review: Telemedicine Quality after the COVID-19 Public Health Emergency: Time to Reevaluate?

OBJECTIVE: This narrative review explores concerns and potential solutions for improving the quality of synchronous telemedicine visits for high utilizers like primary care, particularly after the COVID-19 pandemic. METHODS: A literature review identified studies published within the past 10 years focusing on telemedicine quality, primary care, and related aspects like liability, virtual exams, and patient safety. RESULTS: Despite the surge in popularity of telemedicine visits, concerns regarding their quality linger. These concerns encompass various aspects of the patient experience, administrative processes, and potential safety risks. Limitations in physical exam capabilities and the lack of readily available vital signs during telemedicine visits raise concerns about the accuracy of diagnoses. This is particularly true for situations requiring a more comprehensive physical assessment. Incomplete documentation due to abbreviated patient histories, missing physical exam findings, and the reliance on generic templates pose liability risks. This lack of thorough information makes it challenging to accurately capture the patient's condition and raises concerns about the quality of care provided. Patients themselves have expressed concerns about accuracy of a virtual visit, thus raising questions about the effectiveness of telemedicine in building rapport and ensuring clear communication. From an administrative standpoint, fears of misdiagnosis due to the limitations of virtual exams, inconsistencies in insurance coverage for telemedicine services, and unclear reimbursement standards for thorough visits continue to pose challenges. These uncertainties create ambiguity and make it difficult for healthcare providers to fully embrace telemedicine as a viable option. Finally, although mirroring in-person visit protocols for patient safety is considered crucial, many organizations currently lack standardized measures to ensure safety throughout the entire telemedicine journey. This includes potential risks during scheduling, appointment execution, and post-visit follow-up, highlighting the need for more robust safety protocols specifically designed for the telemedicine setting. Addressing these concerns is essential for ensuring the quality and sustainability of telemedicine integration. CONCLUSION: While telemedicine offers significant benefits, improving quality is essential for its sustainable integration into primary care. Standardizing protocols, educating clinicians and patients, implementing comprehensive physical exam procedures, and ensuring patient safety throughout the visit are key areas for improvement. Continuous monitoring and data analysis are crucial for identifying and addressing weaknesses and ensuring quality telemedicine care.

Delaying cyclization of polyacrylonitrile by boric acid for sulfurized poly(acrylonitrile) cathode materials

Sulfurized poly(acrylonitrile) (SPAN) has become one of the most promising cathode materials in rechargeable Lithium-Sulfur (Li-S) batteries due to their inhibited polysulfide dissolution, high sulfur utilization and excellent electrochemical performance via unique solid–solid conversion mechanism. However, the sulfur content of SPAN (<50 %) is still one of the significant reasons that restrict the electrochemical performance and practical applicability. In this paper, a small amount of boric acid (HBO) was introduced into the precursor of SPAN cathode materials easily before heat-treating, to increase the sulfur content and improve the electrochemical performance. Meanwhile, the results of first principles calculation suggested that the increase of sulfur content of SPAN was derived from the delayed cyclization of polyacrylonitrile (PAN) by HBO. We also discovered when the additive amount of HBO was 1.5 % of PAN mass, the SPAN cathode material possessed high sulfur content up to 54.24 wt%, and delivered prominent reversible electrochemical performances of 714 mAh/g at 0.2C and 734 mAh/g at 0.1C with high Coulombic efficiency. In summary, we proposed a simple and easy method to improve sulfur content and introduced a new strategy for the design of high-sulfur content and high-performance SPAN cathode materials.

Telehealth to increase healthcare access; perspectives of people who use drugs.

People who use drugs (PWUD) often face restricted healthcare access despite their heightened healthcare needs. Factors such as stigma, mistrust of the healthcare system, competing priorities, and geographical barriers pose significant healthcare access challenges. Telehealth offers an innovative solution to expand healthcare access for better inclusion of underserved populations in healthcare. We aimed to explore PWUDs' perceptions of telehealth as a healthcare delivery modality. We utilized purposive sampling to recruit participants (N = 57) for nine focus group discussions (FGDs) in Athens, Greece. Eligibility criteria required participants to be at least 18years, with current or prior injection drug use, and current internet access. The FGDs followed a semi-structured interview guide, were audio recorded, transcribed verbatim, translated into English, and de-identified. We applied thematic analysis to analyze FGD transcripts. Participants' mean (standard deviation) age was 47.9 (8.9) years, 89.5% (51/57) were male, 91.2% (52/57) were of Greek origin, and 61.4% (35/57) had attended at least 10years of school. Three main themes emerged from the FGDs: (1) high internet utilization for healthcare-related purposes among PWUD, (2) highlighting telehealth benefits despite access obstacles and PWUDs' concerns about diagnostic accuracy, and (3) approaches to overcome access obstacles and build digital trust. Participants extensively used the internet for healthcare-related processes, such as accessing healthcare information and scheduling provider appointments. Despite being telehealth-inexperienced, most participants expressed a strong willingness to embrace telehealth due to its perceived convenience, time-saving nature, and trusted digital environment. Some participants recognized that the inability to conduct physical examinations through telehealth reduces its diagnostic accuracy, while others expressed concerns about digital literacy and technological infrastructure accessibility. Most participants expressed a preference for video-based telehealth encounters over audio-only encounters. To build trust in telehealth and promote patient-centeredness, participants recommended an initial in-person visit, virtual eye contact during telehealth encounters, patient education, and partnerships with PWUD-supportive community organizations equipped with appropriate infrastructure. PWUD frequently use the internet for health-related purposes and suggested several approaches to enhance virtual trust. Their insights and suggestions are practical guidance for policymakers seeking to enhance healthcare access for underserved populations through telehealth. NCT05794984.