Important Barriers Research Articles

Barriers and facilitators for implementation of AI algorithms for ECG analysis and triage in patients with chest pain

Abstract Introduction Numerous artificial intelligence (AI) algorithms have been developed to assist in clinical decision-making, with a focus on areas like electrocardiogram (ECG) analysis due to the signal complexity and the varying levels of expertise among healthcare professionals. However, ensuring acceptance of these algorithms by end-users is paramount for successful implementation. Purpose This study aimed to identify barriers and facilitators related to implementation of an AI algorithm for ECG analysis and triage in patients with chest pain. Methods A three-round modified electronic Delphi study was conducted among Dutch potential end-users of an ECG-AI algorithm, including physicians, nurses and ambulance professionals. During the first round, participants brainstormed on barriers and facilitators, which were subsequently mapped to the Consolidated Framework for Implementation Research (CFIR). In the following two rounds, participants reviewed the identified barriers and facilitators for relevance and ranked them according to their importance. Results Twenty-five out of the initial forty respondents completed all three rounds, resulting in a dropout rate of 38%. Four barriers and twelve facilitators were identified. The most important facilitator was "Faster recognition of subtle ECG abnormalities", while "Poor model performance" emerged as the most important barrier. The most frequently mentioned corresponding CFIR domains were the innovation and inner setting domains. Conclusion The identification of barriers and facilitators provides valuable insights into the acceptance and utilisation of ECG-AI algorithms by end-users. By considering the CFIR domains, including innovation and inner setting, this study offers a comprehensive understanding of the contextual factors that influence the successful implementation of AI algorithms in healthcare settings. Addressing these barriers and facilitators will be crucial to facilitating future implementation processes.Barriers and facilitators

Cost-effectiveness of semaglutide for secondary prevention of cardiovascular disease in the United States

Abstract Background In the SELECT trial, semaglutide produced a 20% reduction in the composite of cardiovascular death, non-fatal myocardial infarction (MI), and non-fatal stroke in individuals with overweight or obesity who did not have diabetes but had established pre-existing cardiovascular disease (CVD). Cost is an important barrier to widespread uptake of semaglutide, particularly in the US, and the cost-effectiveness for the secondary prevention of CVD is uncertain. Purpose To evaluate the cost-effectiveness of semaglutide vs. no obesity treatment for the secondary prevention of CVD from a US healthcare sector perspective. Methods The CVD Policy Model is an established, validated simulation model of fatal and non-fatal CVD outcomes and costs in the US population. Using data from the National Health and Nutrition Examination Survey, we created a nationally representative cohort of SELECT-eligible individuals (age ≥45, BMI ≥27kg/m2, no diabetes, pre-existing CVD). Healthcare costs associated with acute and chronic CVD were estimated from national survey and claims data and inflated to 2023 US dollars. The simulated control arm received usual care; the intervention arm received weekly semaglutide 2.4mg injections (assuming 8% discontinuation, which occurs year one). We reproduced the effectiveness of semaglutide based on results of the SELECT trial primary cardiovascular composite endpoint (non-fatal MI, non-fatal strokes and CVD death). The base case assumed 7% of patients receiving semaglutide developed injection-site reactions. Monthly cost of semaglutide was assumed to be $717 (US price net of rebates and discounts), but this was varied in sensitivity analyses. The analysis adopted a health system perspective over lifetime horizon. Results Approximately 4.7 million US adults would meet SELECT trial eligibility criteria. Over a lifetime horizon, semaglutide is projected to avert 538,000 major adverse cardiovascular events (241,000 nonfatal MIs; 80,000 nonfatal stokes, and 217,000 cardiovascular deaths) at an incremental cost of $613 billion. The incremental cost effectiveness ratio for semaglutide was $443,000 per quality-adjusted life year (QALY) gained. In order to meet cost-effectiveness thresholds of $50,000/QALY, $100,000/QALY, $150,000/QALY, drug costs would have to decline 90%, 79%, and 69% respectively. In sensitivity analyses, lowering drug cost to the current UK price (~ $220 per patient per month) would improve the incremental cost-effectiveness of semaglutide to <$150,000 per QALY gained, a potential upper threshold for cost-effectiveness in the US. Conclusion Widespread uptake of semaglutide in the SELECT-eligible U.S. population would prevent a large number of cardiovascular events, but its use would be low economic value at current US prices. Lowering prices in line with those in Europe (e.g., monthly price from $717 to $223) would make the therapy cost-effective at a threshold of $150,000 per QALY gained.

Assessing the use of activity trackers in clinical practice: a survey of cardiac rehabilitation clinicians from Australia, Brazil, and Canada

Abstract Background The use of wearable activity trackers has been found to significantly improve health profile and cardiorespiratory fitness, as well as to reinforce positive health behaviours in patients participating in cardiac rehabilitation (CR) programs. However, clinicians’ perceptions of activity trackers and their use in clinical practice have not been widely explored. Purpose To describe perceptions, attitudes, and behaviours of CR clinicians towards the use and usefulness of activity trackers in CR programs, and identify barriers and enablers associated with their personal and clinical use. Methods Descriptive cross-sectional survey. Data were collected using Research Electronic Data Capture (REDCap) from April to December 2023. Clinicians working in CR programs were recruited in each country via social media, email and digital flyers, group chats and author networks. A purpose-built 44-item digital survey comprising four sections was constructed: (1) socio-demographic details, (2) personal and professional use of activity trackers, (3) perspectives on the use of activity trackers for CR, and (4) perceptions of factors affecting the use of activity trackers in CR. Results In total, 199 clinicians from Australia (n=44), Brazil (n=102) and Canada (n=53) responded to the survey. Most were women (74%), physiotherapists (37%), working at a metropolitan hospital (55%), with a median age of 35 years (range 22-71). The majority found activity trackers helpful for patients with goal setting and monitoring exercise (89%) and promoting patient engagement and autonomy beyond structured, supervised CR (75%). Activity trackers were also perceived to be useful in engaging patients in their own health (94%), improving patient-provider communication (73%), boosting patient adherence with directed exercise (87%), and improving patient’s understanding of their own health conditions (79%). Furthermore, activity trackers were perceived to enable a more personalised care (69%), increase accessibility to CR (45%) and be time- and cost-effective for CR programs (49%). Sixty percent were motivated to use activity trackers and 69% recommended the use of trackers to their patients. On the other hand, the use of activity trackers was reported to be related to dependence (44%) and excessive obsession of one’s own health (55%); 50% reported a lack of relevant policies on activity trackers for clinical use in their respective institutions and limited funding for purchasing activity trackers by health services (78%). Only 30% reported that there was support from leadership and/or peers for the use of activity trackers. Conclusion In general, clinicians held positive attitudes towards the use of activity trackers in CR. However, a lack of relevant policies, funding and support from leadership are important barriers to the adoption and use of activity trackers in CR programs. Development of guidelines for the use of activity trackers in clinical practice is warranted.

Perspectives of care providers on obstacles to healthcare access for people with disabilities in Ethiopia: a qualitative investigation

BackgroundDespite having similar healthcare needs to non-disabled individuals, people with disabilities in Ethiopia face significant challenges accessing healthcare services due to existing barriers. This study aimed to explore these barriers from the perspectives of care providers in primary healthcare facilities.MethodsQualitative research was conducted with care providers in Dire Dawa to identify barriers to healthcare access for people with disabilities. Thematic analysis was used to categorize data into themes.ResultsEight healthcare providers from four service departments participated in eight in-depth interviews and two focus groups. Six themes emerged: physical barriers, financial difficulties, non-accommodating diagnostic facilities, care providers’ attitudes and capacity, communication barriers, and lack of access to health information. Non-confidential and non-dignified care was also identified as a barrier.ConclusionThe study highlights important barriers that prevent people with disabilities from accessing primary healthcare services. Addressing these barriers is crucial for achieving disability-inclusive healthcare services. This research can serve as a starting point for further work in this area to promote equitable healthcare for people with disabilities.

Curcumin Administration Routes in Breast Cancer Treatment

Breast cancer is a public health concern worldwide, characterized by increasing incidence and mortality rates, requiring novel and effective therapeutic strategies. Curcumin is a bioactive compound extracted from turmeric with several pharmacological activities. Curcumin is a multifaceted anticancer agent through mechanisms including the modulation of signaling pathways, inhibition of cell proliferation, induction of apoptosis, and production of reactive oxygen species. However, the poor water solubility and bioavailability of curcumin create important barriers in its clinical application. This review elaborates on the therapeutic potential of curcumin in breast cancer treatment, focusing on the efficacy of different administration routes and synergistic effects with other therapeutic agents. The intravenous administration of curcumin-loaded nanoparticles significantly improves bioavailability and therapeutic outcomes compared to oral routes. Innovative formulations, such as nano-emulsifying drug delivery systems, have shown promise in enhancing oral bioavailability. While intravenous delivery ensures higher bioavailability and direct action on tumor cells, it is more invasive and expensive than oral administration. Advancing research on curcumin in breast cancer treatment is essential for improving therapeutic outcomes and enhancing the quality of life of patients.

Use of opioids and opioid alternatives during general anesthesia: a pan-Canadian survey among anesthesiologists.

While there is limited patient-centred evidence (i.e., evidence that is important for patients and end-users) to inform the use of pharmacologic opioid minimization strategies (i.e., the use of opioid alternatives) for adult surgical patients requiring general anesthesia, such strategies are increasingly being adopted into practice. Our objectives were to describe anesthesiologists' beliefs regarding intraoperative opioid minimizing strategies use and utility, and to explore important clinical decision-making factors. We conducted a pan-Canadian web-based survey of anesthesiologists that was distributed using a modified Dillman technique. Our multidisciplinary team, including a patientpartners panel, participated in the process of domains and items generation, items reduction, formatting, and composition. Our sampling frames were members of the Canadian Anesthesiologists' Society and members of the Association des Anesthésiologistes du Québec. We used the newsletters of each organization to distribute our survey, which was available in English and French and housed on the LimeSurvey (LimeSurvey GmbH, Hamburg, Germany) platform. From our eligible sampling frame, 18% completed the survey (356 respondents out of 2,008 eligible participants). Most of the respondents believed that using opioid minimization strategies during general anesthesia could improve postoperative clinical outcomes, including pain control (84% agree or strongly agree, n = 344/409). Reported use of pharmacologic opioid minimization strategies was variable; however, most respondents believed that nonsteroidal anti-inflammatory drugs, acetaminophen, N-methyl-D-aspartate receptor antagonists (ketamine), α2-adrenoceptor agonists (dexmedetomidine), corticosteroids, and intravenous lidocaine improve prostoperative clinical outcomes. The primary factors guiding decision-making regarding the use of opioid minimization strategies were postoperative acute pain intensity, the impact of acute pain on functioning, patient well-being (i.e., quality of recovery) and patient satisfaction with care. A lack of evidence was the most important barrier limiting the use of opioid minimization strategies. In our survey of Canadian anesthesiologists, several opioid minimization strategies were believed to be effective complements to general anesthesia, although there was substantial variation in their reported use. Future randomized controlled trials and systematic reviews evaluating the effectiveness of opioid minimization strategies should prioritize patient-centred outcome measures assessment such as the quality of recovery or the impact ofacute pain on functioning.

An Approach for Combining Clinical Judgment with Machine Learning to Inform Medical Decision Making: Analysis of Nonemergency Surgery Strategies for Acute Appendicitis in Patients with Multiple Long-Term Conditions.

Machine learning (ML) methods can identify complex patterns of treatment effect heterogeneity. However, before ML can help to personalize decision making, transparent approaches must be developed that draw on clinical judgment. We develop an approach that combines clinical judgment with ML to generate appropriate comparative effectiveness evidence for informing decision making. We motivate this approach in evaluating the effectiveness of nonemergency surgery (NES) strategies, such as antibiotic therapy, for people with acute appendicitis who have multiple long-term conditions (MLTCs) compared with emergency surgery (ES). Our 4-stage approach 1) draws on clinical judgment about which patient characteristics and morbidities modify the relative effectiveness of NES; 2) selects additional covariates from a high-dimensional covariate space (P > 500) by applying an ML approach, least absolute shrinkage and selection operator (LASSO), to large-scale administrative data (N = 24,312); 3) generates estimates of comparative effectiveness for relevant subgroups; and 4) presents evidence in a suitable form for decision making. This approach provides useful evidence for clinically relevant subgroups. We found that overall NES strategies led to increases in the mean number of days alive and out-of-hospital compared with ES, but estimates differed across subgroups, ranging from 21.2 (95% confidence interval: 1.8 to 40.5) for patients with chronic heart failure and chronic kidney disease to -10.4 (-29.8 to 9.1) for patients with cancer and hypertension. Our interactive tool for visualizing ML output allows for findings to be customized according to the specific needs of the clinical decision maker. This principled approach of combining clinical judgment with an ML approach can improve trust, relevance, and usefulness of the evidence generated for clinical decision making. Machine learning (ML) methods have many potential applications in medical decision making, but the lack of model interpretability and usability constitutes an important barrier for the wider adoption of ML evidence in practice.We develop a 4-stage approach for integrating clinical judgment into the way an ML approach is used to estimate and report comparative effectiveness.We illustrate the approach in undertaking an evaluation of nonemergency surgery (NES) strategies for acute appendicitis in patients with multiple long-term conditions and find that NES strategies lead to better outcomes compared with emergency surgery and that the effects differ across subgroups.We develop an interactive tool for visualizing the results of this study that allows findings to be customized according to the user's preferences.

What Psychological Factors Affect Return to Sports After Shoulder Stabilization Surgery? A Scoping Review

Objective: Despite excellent functional outcomes after shoulder stabilization surgery, a substantial number of patients fail to return to sports (RTS) at the preinjury level. The psychological factors affecting RTS postsurgery have been underexplored. This scoping review aimed to identify and analyze potential psychological factors influencing the decision to RTS after shoulder stabilization surgery. Data Sources: We reviewed the EBSCOhost/SPORTDiscus, PubMed/Medline, Scopus, EMBASE, and Cochrane Library databases for studies on patients with anterior glenohumeral instability who underwent stabilization surgery. We included studies that reported on RTS and considered the psychological factors influencing the decision to return. Main Results: Our analysis comprised 21 articles involving 2073 patients. Psychological factors influencing RTS after surgery were categorized within the framework of transactional stress and coping model. Primary appraisal factors, such as fear of reinjury, kinesiophobia, and anxiety, emerged as significant influencers. In addition, we explored factors related to social support, self-determination, motivation, competing interests, and advanced age. Assessment tools were used to evaluate the psychological readiness for RTS. Conclusions: This scoping review identified fear of reinjury and kinesiophobia as important psychological barriers to returning to sports after shoulder stabilization surgery. The limited use of psychological assessment tools and lack of comparative studies have restricted robust conclusions. Level of Evidence: Level IV, Scoping review.

The Role and Impact of Rooftop Photovoltaics in the Norwegian Energy System under Different Energy Transition Pathways

This study focuses on investigating the impact and cost‐competitiveness of solar power in a highly hydropower‐driven northern energy system. The goal is to assess the role of rooftop photovoltaics (PV) in the Norwegian energy system toward 2050 under different energy transition pathways. Energy system analysis is conducted using the IFE‐TIMES‐Norway model, with an integrated detailed representation of rooftop PV based on the tilt and azimuth of existing rooftops in Norway. A thorough sensitivity analysis is conducted to illustrate how investment in rooftop PV varies under different system and parameter conditions and to disclose important barriers for PV in similar energy systems. The results show that when PV investments are facilitated, solar power can potentially stand for 56% of all new investments, resulting in a share of 10% of the total electricity generation. With less competition from onshore wind power and favorable investment parameters, especially lowering the demand for the rate of return, the investments in PV will be four times higher and reach their full potential in commercial and apartment buildings by 2050. Additionally, the results highlight that the cost parameter functions as a barrier to other solutions that facilitate increased PV investments, such as flexibility and energy storage.

The Low-Income and Middle-Income Countries' Perspective on Global Neurosurgery Collaborations.

Access to neurosurgical care is limited in low-income and middle-income countries (LMICs) and in marginalized communities in high-income countries (HICs). International partnerships represent one possible means of addressing this issue. Insights from surgeons in HICs have been explored, but data from LMICs' counterparts are scarce. We aimed to study the perspectives of neurosurgeons and trainees from LMICs regarding global neurosurgery (GN) collaborations and interests, motivators, and challenges in participating. An online survey was conducted targeting neurosurgeons and trainees from LMICs. The survey explored demographics, previous experiences, ongoing activities, interests, and barriers related to GN activities. Data were collected between July 2022 and December 2022 and analyzed. Responses involved 436 individuals. The most represented region (25%) was sub-Saharan Africa, and most respondents were male (87.8%) aged 35-49 years. Interest in GN was high, with 91% after its developments. Most respondents (96.1%) expressed interest in training, professional, or research experience in HICs, but only 18.1% could cover the expenses. A majority (73.2%) strongly agreed to return to their home country for work after HIC training. Ongoing HIC-LMIC partnerships were reported by 27.8% of respondents. Clinical exposure emerged as the most relevant motivating factor (87%), while financial concerns, lack of opportunities, and lack of program support were identified as important barriers. Funding and dedicated time were highlighted as the most crucial facilitators. Understanding the perspectives of neurosurgeons and trainees from LMICs is essential to expanding HICs-LMICs collaborations and improving access to neurosurgical care worldwide. Financial support and targeted interventions are needed to address barriers and promote equitable partnerships in GN.

Gradual behaviour change towards meat reduction revisited: Applying the decisional balance scale in a Dutch study

Meat moderation is needed to mitigate climate change and to address issues related to animal welfare and public health. Yet little is known on the process that consumers go through towards meat-reduced diets. Strässner and Hartmann (2023) recently developed the decisional balance scale (DB scale) for meat reduction, in order to get a better understanding of the trade-offs that consumers encounter in this dietary shift. The current study sets out to replicate their German study in the Dutch context. A survey has been conducted among a representative sample of Dutch adults (N = 1982). Overall, the present study corroborated Strässner and Hartmann's findings. Similar to the German situation, Legitimation is the most important barrier, and the Downsides of factory farming is the most important motivator for meat reduction in the Netherlands. The present study extends the German study by comparing the DB scale with other established scales in research on meat reduction. Although several motivational elements related to the legitimacy of eating meat, health impact and production of meat appear in different instruments, the DB scale sets itself apart in adding practical elements (feasibility). Finally, the insights in the decision balance of population subgroups at different stages of behaviour change (no intention, intention, performing) showed that the further in the meat reduction process, the more the pros outweigh the cons. With this, the current study provides valuable insights in bolstering consumers in meat moderation. Our findings support the idea of a gradual shift and reveal that there is potential for acceleration in behaviour change towards meat reduction to be found in adjusting the self-evidence of high-intensity livestock farming systems and the meat-centric food consumption culture.

Intracellular Iron Deficiency and Abnormal Metabolism, Not Ferroptosis, Contributes to Homocysteine-Induced Vascular Endothelial Cell Death.

Background/Objectives: Homocysteine (Hcy) and iron are factors co-related with the progression of cardiovascular diseases. The vascular endothelium is an important barrier for physiological homeostasis, and its impairment initiates cardiovascular injury. However, the mechanism underlying Hcy-caused vascular endothelial cell injury and the participation of iron are not fully elucidated. This study aims to investigate the Hcy-induced vascular endothelial injury and iron metabolism dysfunction as well as the underlying molecular mechanism. Methods: Human umbilical vein endothelial cells (HUVECs) were employed as the experimental model to examine the Hcy-induced endothelial injury and its underlying mechanism via various biochemical assays. Results: Hcy suppressed the cell viability and proliferation and caused cell death in a concentration-dependent manner. Hcy induced cell cycle arrest, apoptosis, and autophagy as well as impairment of intracellular energy metabolism. Hcy disrupted the intracellular antioxidant system and mitochondrial function by increasing intracellular ROS, MDA and mitochondrial content, and decreasing the SOD activity and mitochondrial membrane potential. Hcy significantly reduced the GSH-Px activity along with the accumulation of intracellular GSH in a concentration-dependent manner. Ferroptosis inhibitors, Ferrostatin-1 (Fer-1), and Deferoxamine (DFO) significantly decreased the Hcy-caused cytotoxicity accompanied by a reduction in dysregulated mitochondria content, but only DFO ameliorated the elevation of intracellular ROS, and neither Fer-1 nor DFO affected the Hcy-caused reduction in intracellular ATP. In addition, Hcy decreased the intracellular concentration of iron, and supplementing Hcy with various concentrations of Fe3+ increased the cell viability and decreased the LDH release in a concentration-dependent manner. Hcy dramatically decreased the mRNA expression level of transferrin receptor while increasing the mRNA expression levels of transferrin, ferritin light chain, ferritin heavy chain, ferroportin, and SLC7A11. Moreover, Hcy suppressed the protein expression of phospho-Akt, phospho-mTOR, Beclin-1, LC3A/B, Nrf2, HO-1, phospho-MEK1/2, phospho-ERK1/2, and Caspase-3 in concentration- and time-dependent manners. Conclusions: Hcy-induced vascular endothelial injury is likely to be associated with apoptosis and autophagy, but not ferroptosis. The key underlying mechanisms are involved in the disruption of the intracellular antioxidant system and iron metabolism via regulation of PI3K/Akt/mTOR, MAPKs, Nrf2/HO-1, and iron metabolism.

Economic, social, and administrative barriers to achieving the sustainable development goal of good health and well-being

Good health and well-being are embedded in the 3rd Goal amongst the UN Sustainable Development Goals. The primary objective of this research was to identify the most critical economic, social, and administrative barriers to implementing the Expanded Program on Immunization (EPI) in the Punjab Province of Pakistan. A sequential exploratory design and case study technique were used, employing both qualitative and quantitative methods. In the first stage, in-depth interviews with 50 key officials were conducted to identify the most critical barriers to the EPI program. A quantitative analysis was then performed based on the results obtained from qualitative analysis, and rank orders of barriers were received from the same health department experts. The results indicate that twenty-eight barriers can cause implementation problems for this program. Still, the ten barriers that gained the maximum hits are the most important barriers, which include Shortage of vaccinators, mismanagement of vaccines’ cold chain, biometric android application, ice-lined refrigerators, communication gap, inadequate legislation of EPI program, capacity building issues with EPI staff, Misconceptions about EPI program, lack of awareness of the parents and community, refusal cases and inadequate cooperation of lady health workers (LHWs). Coordinated efforts of the government and the public are highly recommended to address these barriers.

Spatiotemporal Eolution and Prediction of Ecosystem Service Value in Taihang Mountains Based on MCCA Land Use Scenario Simulation

Ecosystem service value （ESV） is an important indicator related to regional ecological well-being, and understanding its evolution can provide references for regional ecological civilization construction and sustainable development. The Taihang Mountains, an important ecological security barrier in North China, were taken as an example. Based on land use data from 2000 to 2020, this study revealed the changes in land use and ecosystem service value in the Taihang Mountains and conducted multi-scenario simulations of ESV in 2035. Additionally, the land use transfer matrix, improved equivalent factor method, and mixed-cell cellular automata model were used. The results showed that： ① From 2000 to 2020, the main land use types in the Taihang Mountains were cropland, forest land, and grassland. The area of cropland and grassland significantly decreased, whereas the area of forest land and construction land remained stable. The scale of land use transfer was 2.06×104 km2, with a high intensity of transfer from cropland and grassland to other areas, mainly guided by ecological construction. ② The ecosystem service functions in the Taihang Mountains were mainly dominated by regulation services, and the overall ESV showed a stable upward trend, increasing by 1.51×1010 RMB from 2000 to 2020. The spatial distribution of ESV was uneven, and the polarization phenomenon was evident, with high-value areas concentrated in the high-altitude areas in the northern and central-southern parts and low-value areas mostly located in the flat foothills and central plateaus on both sides. They were greatly influenced by human activities. ③ By 2035, compared with that in 2020, the ESV in the Taihang Mountains was projected to increase by 5.37 billion RMB in the natural growth scenario, 4.34 billion RMB in the urban development scenario, and 7.64 billion RMB in the ecological tourism scenario, mainly due to the conversion from cropland and grassland to forest land. The natural growth scenario showed a high intensity of spatial transformation of ESV, the urban development scenario experienced severe ESV loss in cropland, and the ecological tourism scenario showed a significant increase in ESV, which was an effective path for promoting green development in the Taihang Mountains. The research results can provide scientific references for the healthy management and sustainable development of the ecosystem in the Taihang Mountains.

Ecosystem services driving factors and ecological conservation pattern construction, Qinghai-Tibet Plateau

Given that the Qinghai-Tibet Plateau (QTP) is an important ecological security barrier in western China, changes in its ecosystem services (ESs) have received attention. Using multivariate datas and model simulations, we evaluated the ESs of the QTP, revealed their driving factors, and constructed ecological conservation pattern based on ecosystem services index (ESI) and ecosystem sensitivity (ES). The results showed that: (1) The overall ESs of the QTP from 2000 to 2020 were positive, with a spatial distribution characteristic of decreasing from southeast to northwest. Forest and grassland were the key land use types promoting ESs. (2) Natural factors had a stronger influence on ESs than socioeconomic factors, with precipitation, FVC (Fractional Vegetation Cover) and NPP (Net Primary Productivity) had the strongest explanatory power for ESs. (3) The proportion of the collaborative development area (CDA), consolidation and enhancement area (CEA) and priority protection area (PPA) to the total area of the QTP was 19%, 56% and 25% respectively. The CDA should follow the concept of natural restoration and green development. The CEA should optimize the management system and do a good job of environmental management in combination with artificial restoration. The PPA should strictly prevent disturbances caused by human activities and protect the originality of natural landscapes such as glaciers, snow and permafrost.

Rebalancing immune homeostasis in combating disease: the impact of medicine food homology plants and gut microbiome

BackgroundGut microbiota plays an important role in multiple human physiological processes and an imbalance in it, including the species, abundance, and metabolites can lead to diseases. These enteric microorganisms modulate immune homeostasis by presenting a myriad of antigenic determinants and microbial metabolites. Medicinal and food homologous (MFH) plants, edible herbal materials for both medicine and food, are important parts of Traditional Chinese Medicine (TCM). MFH plants have drawn much attention due to their strong biological activity and low toxicity. However, the interplay of MFH and gut microbiota in rebalancing the immune homeostasis in combating diseases needs systematic illumination. PurposeThe review discusses the interaction between MFH and gut microbiota, including the effect of MFH on the major group of gut microbiota and the metabolic effect of gut microbiota on MFH. Moreover, how gut microbiota influences the immune system in terms of innate and adaptive immunity is addressed. Finally, the immunoregulatory mechanisms of MFH in regulation of host pathophysiology via gut microbiota are summarized. MethodsLiterature was searched, analyzed, and collected using databases, including PubMed, Web of Science, and Google Scholar using relevant keywords. The obtained articles were screened and summarized by the research content of MFH and gut microbiota in immune regulation. ResultsThe review demonstrates the interaction between MFH and gut microbiota in disease prevention and treatment. Not only do the intestinal microorganisms and intestinal mucosa constitute an important immune barrier of the human body, but also lymphoid tissue and diffused immune cells within the mucosa participate in the response of innate immunity and adaptive immunity. MFH modulates immune regulation by affecting intestinal flora, helps maintain the balance of the immune system and interfere with the occurrence and development of a broad category of diseases. ConclusionBeing absorbed from the gastrointestinal tract, MFH can have profound effects on gut microbiota. In turn, the gut microbiota also actively participate in the bioconversion of complex constituents from MFH, which could further influence their physiological and pharmacological properties. The review deepens the understanding of the relationship among MFH, gut microbiota, immune system, and human diseases and further promotes the progression of additional relevant research.

Ecosystem services in the Yangtze River Basin and their trade-offs/synergies relationships in response to climate change

Abstract The Yangtze River Basin is an important ecological security barrier with significant economic status, but it is greatly affected by climate change. Therefore, we investigated the spatio-temporal evolution characteristics of annual ecosystem service (net primary production (NPP), water conservation and soil retention), their interrelationships and responses to climate change in the Yangtze River Basin from 2001 to 2020. The annual NPP, soil retention and water conservation were 511 gC m−2, 632 t and 272 mm, respectively and they all increased over 2001–2020 though this varied in both time and space. The capacities of soil retention and water conservation did not increase, and even gradually decreased for first 10 years (2001–2010), most likely due to the subsequent effects of the catastrophic flood of Yangtze River occurred in 1998. There are tradeoffs between NPP and soil retention/water conservation in the west Sichaun Province, which is different from the rest of the Yangtze River Basin where synergistic relationships dominate. Precipitation is the dominate climatic influencing factor on the ecosystem service trends found in the Yangtze River Basin. The concept of ecosystem services is being incorporated into decision-making and management, this study is critical to guide regional effective resource utilization, ecosystem management decisions and feasible policies.

Ionic microsphere therapy for skin trauma

The skin is an important barrier for the body. Normal wound healing can be severely impeded by inadequate angiogenesis, excessive inflammation, and increased susceptibility to infection. Therefore, effective wound therapy should focus on accelerating the healing process and providing antimicrobial properties that are essential for wound recovery. Alginate (ALG) is a biocompatible polysaccharide substance capable of forming hydrogel dressings by cross-linking with metal ions, especially with Zn2+, Fe3+, Cu2+, and Ca2+ metal ions. The hydrogel formed by them can gradually release Zn2+, Fe3+, Cu2+, and Ca2+ during the process of wound repair, which has an important role in promoting angiogenesis and collagen deposition. Here, we prepared hydrogel microspheres (MS) based on cross-linking of different ions such as Zn-MS, Fe-MS, Cu-MS, and Ca-MS and investigated the effect of these ions on wound healing. In vitro and in vivo experiments showed that MS formed by Zn2+ enhanced antimicrobial activity, MS formed by Fe3+ and Cu2+ increased the formation of collagen fibers, and MS formed by Zn2+ and Ca2+ promoted the development of capillaries. So, the hydrogel MS formed by cross-linking ALG with these four ions are of great significance and research value in the field of skin wound application.

Shuttle Time for Seniors: The Impact of 8-Week Structured Badminton Training on Markers of Healthy Aging and Evaluation of Lived Experiences-A Quasi-Experimental Study.

Engagement in sport offers the potential for improved physical and psychological well-being and has been shown to be beneficial for promoting healthy aging. Opportunities for older adults to (re)engage with sport are limited by a paucity of age-appropriate introductory sports intervention programs. As such, the study evaluated the efficacy of a newly designed 8-week badminton training program (Shuttle Time for Seniors) on markers of healthy aging and the lived experiences of participation. Forty-three older adults assigned to a control (N = 20) or intervention group (N = 23) completed pre-post assessment of physical and cognitive function, self-efficacy for exercise, and well-being. Focus groups were conducted for program evaluation and to understand barriers and enablers to sustained participation. Those in the intervention group increased upper body strength, aerobic fitness, coincidence anticipation time, and self-efficacy for exercise. Objectively improved physical and cognitive functions were corroborated by perceived benefits indicated in thematic analysis. Shuttle Time for Seniors was perceived as appropriate for the population, where the age-appropriate opportunity to participate with likeminded people of similar ability was a primary motivator to engagement. Despite willingness to continue playing, lack of badminton infrastructure was a primary barrier to continued engagement. Shuttle Time for Seniors offered an important opportunity for older adults to (re)engage with badminton, where the physical and psychosocial benefits of group-based badminton improved facets important to healthy aging. Significance/Implications: Age-appropriate introductory intervention programs provide opportunity for older adults to (re)engage with sport. However, important barriers to long-term engagement need to be addressed from a whole systems perspective.

Family Management of Hypertension in Brazil: A Cross-Sectional Study.

In Brazil, research indicates that primary family members are the main source of support for individuals with chronic conditions such as hypertension (HTN). The burden of caregiving not only hinders effective HTN management but can also cause stress and anxiety, potentially leading to HTN in caregivers. Despite this, few studies have explored the impact of caregiving on these family members. Aims of the study were to: (1) Describe the prevalence of blood pressure (BP) control in family members of individuals with HTN; (2) identify family member perspectives on facilitators and barriers to HTN management; and (3) identify influences that help or interfere with family member functioning (levels of stress, quality of life [QOL], and caregiver burden). This descriptive, cross-sectional study included 213 family members randomly selected from 3 Family Health Strategy units. Family members were largely female (n = 143; 67.1%); the mean age was 60.1 years (SD ± 17.02) and 42.6% (n = 96) had less than a high school education. The three most important facilitators and barriers were related to medication, medical visits, healthy eating, physical activity, and stress. The mean systolic BP was 132.7 (SD ± 21.9) mmHg and a diastolic BP of 85.9 (SD ± 18.1) mmHg with 120 (56.3%) of family members classified as having normal BP. In regard to family member contributions to the self-care of the individual with HTN, family members displayed low levels of self-care maintenance (n = 148; 69.4%) and management (n = 47; 71.2%) support, while a slight majority (n = 114; 53.5%) had adequate levels of self-care confidence in supporting the individual with HTN. Family members (n = 189; 88.8%) showed moderate-to-high levels of perceived stress, but good physical (n = 189; 88.7%) and mental QOL (n = 196; 92%) and low levels of caregiver burden (n = 113; 53.1%). A variety of contextual sociocultural influences were associated with the outcomes under study. Family-based interventions are urgently needed to address the inadequate management of HTN.