Chief medical officers' perceptions of athlete cardiac screening.

Pathing the way from regulatory approval to market access for gene therapy products (GTPs): An integrative review in the US, EU5, Japan and China.

The transition to battery-electric trucks (BETs) is an essential step toward decarbonizing heavy-duty road transport. While early adopters have driven initial market uptake, achieving large-scale adoption requires understanding the barriers faced by the early majority (i.e., transport companies that have yet to transition). This study examines these barriers and identifies policy support needs to facilitate accelerated BET adoption. Drawing on four datasets from Germany and Sweden, including surveys, interviews, and workshops with more than 200 transport companies, this research compares the experiences of early adopters with the perceived barriers of the early majority. Findings reveal that the early majority perceives the issues encountered by early adopters during operation, such as charging infrastructure limitations, range constraints, and economic uncertainties, as continuous risks that reinforce their hesitancy toward adoption. Additionally, we uncover new barriers not extensively discussed in existing innovation diffusion literature: regulatory uncertainty and contested technological pathways. This study, therefore, contributes to innovation diffusion research by linking the decision-making of the early majority to early adopters’ experiences and by providing actionable policy recommendations to achieve transport sector decarbonization goals. • Key BET adoption barriers can be found across countries • Early majority can still face early adopter challenges in policy-led transitions • Regulatory uncertainty and contested technological pathways are unique barriers • Policies need to focus on stability and reliability in addition to prices

The study explored healthcare workers' experiences using the AfyaPro Connected Care app and identified key enablers and barriers to its adoption for diabetes and hypertension care in Ghana. The study applied the Technology Acceptance Model (TAM) to examine how perceptions of usefulness and ease of use of the app influence adoption and to address the gap in evidence on mHealth uptake by frontline providers in low- and middle-income country (LMIC) health systems. A qualitative study was conducted with 20 healthcare workers from two healthcare facilities. Semi-structured interviews, guided by the TAM, explored perceptions of the app's usefulness, ease of use, and behavioral intention. The framework was appropriate for examining individual and contextual drivers of technology adoption in resource-constrained healthcare settings. Interviews were transcribed verbatim and analysed thematically. Participants reported positive experiences with the app, noting reduced administrative burden, workflow integration, stronger patient-provider interaction and improved continuity of follow-up. The app enhanced access to specialist care, supported self-monitoring of blood pressure and glucose, and boosted confidence through its intuitive design and structured training. However, challenges persisted, including unstable power and internet connectivity, increased data entry workload, limited patient access and digital literacy, and restricted roles for junior staff. Participants recommended clearer roles, regular supervision, refresher training, and decision-support tools to improve sustainability and equitable adoption. This study adopts a user-centered and context-sensitive approach based on provider experiences. It shows how mHealth tools can be fitted into Ghana's healthcare system, where challenges like limited infrastructure and digital literacy affect use. Innovation is seen as adapting tools and systems through digital literacy training, decision-support in provider workflows, and blended care models, helping to build a fairer and more sustainable health system. Healthcare workers found the mHealth app feasible and acceptable. The findings highlight the potential of digital tools to improve chronic disease care in resource-limited settings. The study demonstrates how contextual factors in LMIC settings reshape key TAM constructs, with clear implications for mHealth policy, scale-up strategies, and refinement of technology adoption theory.

Simulating the interactions between per- and polyfluoroalkyl substances and kidney transporters for understanding their half-life and renal bioaccumulation.

The COVID-19 pandemic highlighted pediatric health care disparities and disrupted routine care, including social needs assessments. The American Academy of Pediatrics recommends universal screening for Social Determinants of Health (SDOH), yet implementation remains inconsistent in primary care settings. This quality improvement (QI) project aimed to implement a standardized, sustainable SDOH screening and referral process in pediatric primary care, hypothesizing that structured interventions would improve screening rates. This QI initiative was conducted from January to September 2023 across six practices within a large pediatric health system. Eligible patients (ages 0-19) included those attending their first well visit of the calendar year. The SMART aim targeted a 50% increase in SDOH screening compliance, from 28% at baseline to 42% over 9 months. Using the Consolidated Framework for Implementation Research and two Plan-Do-Study-Act cycles, the team addressed key implementation barriers and refined interventions. The primary measure was screening completion rate; the balancing measure was the number of refusals to screen. SDOH screening rates increased from 28% to 55%, with eligible patient volumes ranging from 2400 to 5500. All six practices demonstrated statistically significant improvements (P < 0.001). Positive screens ranged from 3.3% to 8% of patients screened. Screening refusals increased significantly (P < 0.001). Standardized SDOH screening, implemented through structured QI methods and stakeholder engagement, significantly improved screening rates in pediatric primary care. Future studies should assess referral effectiveness, clinical outcomes, cost-effectiveness, and strategies to mitigate patient discomfort and systemic barriers.

Robust gut microbiota as a key protective barrier for Ruditapes philippinarum survival following an extreme-rainfall disturbance.

Prevalence of Veteran-reported treatment barriers from the breast and gynecologic oncology system of excellence.

Construction is a fundamental sector in most economies, and its high consumption of physical resources presents major opportunities for applying circular economy principles to minimise waste and improve sustainability. Procurement functions at the intersection of construction supply chains, managing design, purchasing, and material sourcing activities. Effective information sharing both within and between organisations is essential for embedding circular economy principles into procurement processes. This paper adopts a systematic literature review approach to identify and synthesise research on information sharing in circular procurement. Descriptive analysis outlines the research trends, theoretical and methodological orientations, and geographical distribution of studies, while synthesis categorises barriers and enablers of information sharing across micro, meso, and macro-organisational levels. Additionally, circular economy-related information and knowledge management activities, such as creation, dissemination, and application, are mapped against stages of the strategic procurement process and the Royal Institute of British Architects Plan of Work, strengthening the study’s relevance to construction practice. By integrating fragmented yet expanding bodies of literature, the paper provides a comprehensive understanding of how circular economy information and knowledge management intersect with procurement in construction. It offers a construction-specific framework that embeds circularity throughout the procurement lifecycle, with support from the Resource-Based View and Institutional theory and also identifies key organisational enablers and barriers. The review also highlights limited empirical and theoretical integration in current research and recommends future studies that apply behavioural and organisational theories to explore knowledge-sharing dynamics, examine policy impacts, and assess the role of technology and skills development in advancing circular procurement.

Low-field magnetic resonance imaging (LF-MRI) has emerged as a transformative technology, offering portable and cost-effective solutions for medical imaging in resource-limited settings. However, LF-MRI systems face inherent challenges, including low signal-to-noise ratio (SNR) and reduced spatial resolution, which can compromise diagnostic accuracy. To systematically address these fundamental limitations, which involve complex, nonlinear image transformations, deep learning (DL) presents a powerful solution due to its proven capability in learning such mappings from data. This review explores the pivotal role of DL techniques in overcoming these limitations, focusing on two critical applications: denoising and super-resolution. Recent advancements in DL architectures-such as U-Net, generative adversarial networks (GANs), and diffusion models (DMs)-have demonstrated remarkable success in enhancing LF-MRI image quality. For denoising, supervised models like U-Net and denoising auto-encoders (DAEs) effectively suppress noise while preserving anatomical details, while unsupervised approaches (e.g., Cycle-GANs) leverage unpaired datasets to bridge the gap between low-field (LF) and high-field (HF) MRI. In super-resolution, DL models like 3D U-Net and residual channel attention networks (RCANs) reconstruct high-resolution images from LF inputs, enabling finer detail visualization for clinical diagnostics. Key findings highlight the superiority of DL over conventional iterative methods in adaptability, robustness, and real-time performance. However, challenges persist, including data dependency, computational costs, and limited interpretability. Innovations such as diffusion-driven neural representations and dual-acquisition 3D super-resolution further push the boundaries of LF-MRI quality. This review underscores DL's potential to democratize MRI access, particularly in low-resource regions, while outlining future directions: improving generalization, reducing training data requirements, and integrating postprocessing pipelines. By directly tackling the key barriers of image quality, DL-enhanced LF-MRI is poised to make a significant impact in clinical scenarios where accessibility and speed are paramount, such as point-of-care diagnostics and emergency clinic, thereby helping bridge global healthcare disparities.

Nursing Home Nursing Staff Perspective About Using Subepidermal Moisture Technology for Pressure Injury Prevention.

When the whole exceeds the sum of its parts: Squeezing greater cumulative benefit from cross-technology partnerships in bacterial infection.

Brewing potential of Wickerhamomyces anomalus: Growth, fermentation, and aroma characteristics

Non-coding RNAs as biomarkers and therapeutic targets in pancreatic cancer: Clinical implications and translational perspectives.

Unmanned aerial vehicles for communication recovery in post-disaster scenarios: A PRISMA-based systematic review

Fever after brain injury is a known contributor to poor outcomes; however, temperature-modulating devices (TMDs), such as surface and intravascular systems, face significant limitations, including delayed deployment, invasiveness, patient discomfort, skin integrity issues, frequent induction of shivering, and the need for sedation, all of which hinder timely neuroprotective therapy and confound neurological assessments. This first in-human study evaluated the safety and tolerability of an intranasal TMD, which delivers thermoelectrically temperature-regulated air via a nasal cannula to affect the core temperature. Five healthy, awake adult volunteers (median age 34 years old, 57.1% men) underwent intranasal cooling with 5°C cooled air delivered at flow rates between 15 and 58 liters per minute. The primary endpoints were safety and tolerability. The reduction in core body temperature was recorded using an esophageal temperature probe. No pharmacological agents or sedatives were administered to the patient. All participants exhibited a consistent downward trend in core body temperature, with an average reduction of 0.7°C at 30 minutes and 1.2°C at 60 minutes. Notably, no shivering or adverse events related to the intranasal TMD were reported. Cooling was well-tolerated, with esophageal probe placement being the only limiting factor for full protocol completion in some subjects. Participants remained fully conscious and communicative throughout the therapy. This intranasal TMD achieved clinically relevant core cooling without triggering shivering or requiring sedation, thereby addressing the key barriers associated with traditional TMDs. These promising early results support further investigation of this intranasal TMD in patients with acute neurological injury. Future studies should explore its performance in critical care and prehospital environments, where time-sensitive neuroprotection is most impactful.

Radiotherapy is essential for local tumor control, and increasing evidence highlights its ability to trigger systemic immune responses. However, the integration of this systemic activation into clinical treatment regimens remains limited. The immunosuppressive environment in the tumor microenvironment (TME) is a key barrier to translating the systemic immune effects of radiotherapy into clinical practice. Recently, epigenetic regulation has emerged as a key mechanism in modulating gene expression, closely linked to tumor initiation, progression, and immune evasion. Epigenetic inhibitors can influence immune cells and checkpoint molecules by altering DNA methylation and histone modifications, thus reshaping the TME. This review examines how radiotherapy induces epigenetic reprogramming to modulate immune responses and discusses how aberrant epigenetic alterations in tumor cells may impact radiotherapy-driven inflammatory responses. Additionally, this study provides an overview of clinical studies combining epigenetic inhibitors with radiotherapy and immunotherapy and suggests the potential role of epigenetic biomarkers in patient stratification for clinical applications.

Religion and culture strongly influence daily life in many populations. Children rely on the beliefs and habits of parents, caregivers, and teachers to manage their oral health. This study explored the oral health knowledge, perceptions, hygiene habits and care-seeking behaviours of parents and teachers of children attending Islamic boarding schools in Pakistan. A qualitative study was conducted in Lahore, Pakistan, during May-June 2024, including Focus Groups (FGs) with teachers (N = 3) and semi-structured interviews with parents (N = 17). Purposive sampling was used to recruit participants. Interview guide was based on research questions and previous literature. Interviews were audio-recorded, translated, and transcribed in English for thematic analysis. From the thematic analysis, two overarching themes emerged: (A) religion, culture, and oral health, and (B) attitudes, behaviours, and oral health. These themes were further divided into two and three major subthemes, encompassing six and eight minor subthemes, respectively. The major subthemes from theme (A) were: 1) oral health as part of Islamic religious teachings, and 2) the use of alternatives to toothbrushes. For theme (B), the major subthemes included: 1) brushing habits and dental problems among parents and children, 2) oral health-seeking behaviour and its barriers, and 3) the positive role of schools. This qualitative study offered deeper insights from teachers and parents for improving children's oral health. To effectively educate children, culturally and religiously sensitive health campaigns involving parents and religious teachers at schools are essential, as these adults serve as role models for establishing lifelong habits, including good oral hygiene practices. • Religio-cultural influences and personal rationale impact oral health. • Parents and teachers believed that home remedies are better in tackling dental problems than going to a dentist. • Key barriers to seeking dental treatment included high cost, fear of pain and lack of trust in dentists. • Schools should encourage regular brushing, organize dental camps, lectures and provide dental products to children.

Pyroptosis-inducing nanomedicines: A dual-mode therapeutic framework for apoptosis-resistant lung cancer.

Unlocking circular economy potential in pig farming: Waste, impacts and pathways from Southeast Vietnam