Major Barrier Research Articles

Factors associated with the use of oral health care services among seniors in Canada.

This study explores the link between dental insurance, income, and oral health care access among seniors (aged 65 and over) in Canada. It contributes to the understanding of oral health care among seniors before the implementation of the Canadian Dental Care Plan. This study uses data from the 2019/2020 Canadian Health Survey on Seniors (n=41,635) to report descriptive statistics and logistic regression model results and examine factors associated with seniors living in the community and access to oral health care services. At the time of the survey (2019/2020), 72.5% of seniors in Canada reported having had a dental visit in the past 12 months, with 83.0% of insured and 65.3% of uninsured seniors reporting visits. Seniors reporting excellent or very good oral health had a higher prevalence of visits (79.2%) compared with those with good, fair, or poor oral health (62.3%). Among seniors who had not visited a dental professional in three years, 56.3% deemed it unnecessary, and 30.8% identified cost as the major barrier. After sociodemographic characteristics were controlled for, insured seniors were more likely to have had a dental visit in the past 12 months (adjusted odds ratio [OR]: 2.27; 95% confidence interval [CI]: 2.03 to 2.54) and were less likely to avoid dental visits because of cost (OR: 0.18; 95% CI: 0.12 to 0.28) compared with their uninsured counterparts. This study underscores the role of dental insurance in seniors' oral health care access. While insurance is associated with seniors' access to oral health care services, the study also emphasizes the need to consider social determinants of oral health such as income, gender, age, level of education, and place of residence when assessing oral health care access for seniors.

A Case-Based Curriculum on Buprenorphine for Treatment of Opioid Use Disorder Among Internal Medicine Residents

Background: As the mandatory X-waiver requirements for prescribing buprenorphine have recently been lifted, general practitioners are being relied on to fill the treatment gap in prescribing medications for opioid use disorder (MOUD). However, insufficient clinician education remains a major barrier to prescribing MOUD in both inpatient and outpatient settings. Objective: To evaluate the impact of a new MOUD curriculum on internal medicine (IM) residents’ attitudes, comfort, and knowledge of buprenorphine in the inpatient and outpatient settings. Methods: All second-year IM residents (n = 46) participated in a 90-minute curricular session between July and October 2022 during scheduled mandatory didactic blocks. The curriculum was structured as a small group, case-based session focused on how to initiate sublingual buprenorphine (traditional and low-dose initiation). Residents completed identical and anonymous pre- and post-session surveys. A Wilcoxon signed rank test was used to analyze the data. Results: Thirty-nine (84.4%) second-year IM residents participated in the evaluation. Residents reported increased importance of independently initiating buprenorphine for hospitalized patients with opioid withdrawal ( P < .001). Residents were significantly more likely to endorse confidence in discussing MOUD with patients ( P < .001), initiating buprenorphine in inpatient and outpatient settings ( P < .001), and identifying patients who would benefit from low-dose buprenorphine initiation ( P = .002). There was a significant increase in the correct number of knowledge-based questions after the session (before = 1.55/4 vs after = 3.33/4; P value < .001). Conclusions: A 90-minute buprenorphine training improved residents’ attitudes toward, perceptions of competency, and knowledge of buprenorphine delivery to patients with OUD in the inpatient and outpatient setting.

Near‐surface plastic deformation in polycrystalline SrTiO3 via room‐temperature cyclic Brinell indentation

AbstractDislocations are being used to tune versatile mechanical and functional properties in oxides with most current studies focusing on single crystals. For potentially wider applications, polycrystalline ceramics are of concern, provided that dislocations can be successfully introduced. However, in addition to preexisting pores and flaws, a major barrier for bulk plastic deformation of polycrystalline ceramics lies in the grain boundaries (GBs), which can lead to dislocation pile‐up and cracking at the GBs due to the lack of sufficient independent slip systems in ceramics at room temperature. Here, we use the cyclic Brinell indentation method to circumvent the bulk deformation and focus on near‐surface regions to investigate the plastic deformation of polycrystalline SrTiO3 at room temperature. Dislocation etch‐pit analysis suggests that plastic deformation can be initiated within the grains, at the GBs, and from the GB triple junction pores. The deformability of the individual grains is found to be dependent on the number of cycles, as also independently evidenced on single‐crystal SrTiO3 with representative surface orientations (001), (011), and (111). We also identify a grain‐size‐dependent plastic deformation.

Clinical relevance of circulating tumor DNA in ovarian cancer: current issues and future opportunities.

Ovarian cancer (OC) is the most lethal gynecologic malignancy worldwide. Due to the lack of effective screening and early detection strategies, many patients with OC are diagnosed with advanced disease, where treatment is rarely curative. Moreover, OC is characterized by high intratumor heterogeneity, which represents a major barrier to the development of effective treatments. Conventional tumor biopsy and blood-based biomarkers, such as cancer antigen 125 (CA125), have different limitations. Liquid biopsy has recently emerged as an attractive and promising area of investigation in oncology, due to its minimally invasive, safe, comprehensive, and real-time dynamic nature. Preliminary evidence suggests a potential role of liquid biopsy to refine OC management, by improving screening, early diagnosis, assessment of response to treatment, detection, and profiling of drug resistance. The current knowledge and the potential clinical value of liquid biopsy in OC is discussed in this review to provide an overview of the clinical settings in which its use might support and improve diagnosis and treatment.

Endocannabinoid Receptor 2 Function is Associated with Tumor-Associated Macrophage Accumulation and Increases in T Cell Number to Initiate a Potent Antitumor Response in a Syngeneic Murine Model of Glioblastoma.

Introduction: Glioblastoma patients have a highly immunosuppressive tumor microenvironment and systemic immunosuppression that comprise a major barrier to immune checkpoint therapy. Based on the production of endocannabinoids by glioblastomas, we explored involvement of endocannabinoid receptor 2 (CB2R), encoded by the CNR2 gene, which is predominantly expressed by immune cells, in glioblastoma-related immunosuppression. Materials & Methods: Bioinformatics of human glioblastoma databases was used to correlate enzymes involved in the synthesis and degradation of endocannabinoids, as well as CB2Rs, with patient overall survival. Intrastriatal administration of luciferase-expressing, murine GL261 glioblastoma cells was used to establish in in vivo glioblastoma model for characterization of tumor growth and intratumoral immune cell infiltration, as well as provide immune cells for in vitro co-culture experiments. Involvement of CB2Rs was determined by treatment with CB2R agonist (GW405833) or CB2R antagonist (AM630). ELISA, FACS, and immunocytochemistry were used to determine perforin, granzyme B, and surface marker levels. Results: Bioinformatics of human glioblastoma databases showed high expression of CB2R and elevated endocannabinoid production correlated with poorer prognosis, and involved immune-associated pathways. AM630treatment of GL261 glioblastoma-bearing mice induced a potent antitumor response, with survival plateauing at 50% on Day 40, when all control mice (median survival 28 days) and mice treated with GW405833 (median survival 21 days) had died. Luciferase tumor imaging revealed accelerated tumor growth by GW405833 treatment, but stable or regressing tumors in AM630-treated mice. Notably, in spleens, AM630 treatment caused an 83% decrease in monocytes/macrophages, and 1.8- and 1.6-fold increases in CD8+ and CD4+ cells, respectively. Within tumors, there was a corresponding decrease in tumor-associated macrophages (TAMs) and increase in CD8+ T cells. In vitro, lymphocytes from AM630-treated mice showed greater cytotoxic function (increased percentage of perforin- and granzyme B-positive CD8+ T cells). Discussion: These results suggest that inhibition of CB2R enhances both immunosuppressive TAM infiltration and systemic T-cell suppression through CB2R activation, and that inhibition of CB2Rs can potently counter both the immunosuppressive tumor microenvironment, as well as systemic immunosuppression in glioblastoma.

MODL-11. LOW-GRADE GLIOMA 3D PATIENT-DERIVED ORGANOID PLATFORM AS TRANSFORMATIVE TOOL FOR TUMOR BIOLOGY AND TRANSLATIONAL RESEARCH

Abstract Unlike many high-grade tumors, low-grade glioma (LGG) has faced challenges in advancing scientific and clinical breakthroughs, affected by the limited capacity to develop representative preclinical tumor models. Major barriers to establishing traditional LGG cell culture systems have been cellular senescence and the need to introduce additional genetic modifications to obtain cultured growth. Such LGG models, while extremely valuable, require extensive periods for development and result in clonally selected lines which may not present the complexity of LGG tumor biology. To mitigate such challenges in LGG model development and address the need for three-dimensional tissue cultures, we have successfully generated organoids from fresh tissue specimens obtained from surgical resection. We have demonstrated success of this method on various pediatric brain tumor histologies and have expanded these approaches successfully to LGG. Through such efforts, we have developed 14 LGG tumors’ organoid models as well as other low-grade tumor’s models such as craniopharyngioma, schwannoma, meningioma, optic glioma, and oligodendroglioma. The tissue was processed immediately post-extraction and cultured in media solution on rotating platform. Organoid growth was observed within 1-3 weeks of initiation and tested for growth for up to 3 months. Phenotypic analysis revealed organoid cell composition representing clinical histology. The immune component was preserved in organoids for up to 40 days. MAPK pathway activity, a hallmark marker for KIAA-BRAF fusion positive pilocytic astrocytoma was preserved for up to 4 weeks. Our successful deployment of three-dimensional patient-tissue derived organoids provides for an efficient, simple workflow for the generation of unique and transformative preclinical models for the LGG field. Supported by the Children’s Brain Tumor network’s open science model, 3D organoids will provide investigations with broader resources for LGG tumor biology preclinical testing and support translational studies on behalf of the development of novel clinical trials.

Hambatan Komunikasi dan Penyelesaian Konflik Dalam Negosiasi Bisnis

Modern business, whether in trade of goods or services, is experiencing rapid growth that contributes to the global economy. However, globalization and technological advancements have brought challenges in communication and conflict resolution, especially in cross-cultural negotiations. This research aims to investigate communication barriers and conflict resolution strategies in the context of multicultural business negotiations, focusing on factors influencing intercultural communication and effective approaches to conflict resolution. A literature review approach is employed in this study. Data is collected from various related literature, including books, scientific journals, and articles discussing communication barriers and conflict resolution in business from 2015 to 2024. The data is critically analyzed to identify the relationship between communication barriers and conflict resolution in business negotiations. The research results indicate that language differences, communication styles, social norms, business ethics, and perceptions of time are major barriers in intercultural communication that can disrupt business negotiations. These barriers often lead to misunderstandings and conflicts that can damage business relationships. Additionally, interest-based approaches and Pancasila-based deliberation are identified as effective conflict resolution strategies, emphasizing the values of democracy, kinship, and mutual cooperation.

Development of the Vietnamese Rape Myths Acceptance Scales: A Web-Based Survey of Young Adults.

Rape myths-false but widely held beliefs that serve to deny and justify sexual aggression-present a major barrier to reporting and prevention of sexual violence in Vietnam and globally. Based on a parent study aimed at reducing sexual violence at two universities in Hanoi, we developed and assessed a contextualized measure of rape myths among young people in Vietnam. Items from previously validated rape myth acceptance (RMA) scales and data from qualitative research informed the development of 50 items, which were administered to Vietnamese 18-24-year-olds (n = 2,756 total, n = 1,798 cisgender women) via an anonymous link in February 2021. We used factor analysis to explore and test factor structure and multi-group factor analysis to assess measurement equivalence across gender. We calculated item-level discrimination and difficulty parameters and visualized information curves using item response theory analysis, informing the development of a short form. Four hypothesized subconstructs identified in the qualitative data emerged as factors: (1) "He didn't mean to"; (2) "She asked for it"; (3) "It wasn't really rape"; and (4) "Rape is a deviant event." A fifth factor, "She didn't protect herself," included four items from formative data. Confirming formative findings and prior literature, cisgender women had lower RMA than cisgender men, particularly on items related to victim-blaming. The Vietnamese Rape Myths Acceptance Scales were internally consistent and equivalent between cisgender men and women, capturing elements specific to the Vietnamese context and providing a tool for campus climate surveys and evaluations of sexual violence prevention programs.

Access to low vision rehabilitation services in Australia: practitioner perspective

ABSTRACT Clinical relevance The burden of vision loss is both personal and economic. Having reduced vision can restrict access to education, job opportunities, and other activities, and patients can require substantial government funds for treatment and rehabilitation. An in-depth investigation of barriers and enablers is required to improve access to low vision rehabilitation services. Background Several clinical trials have demonstrated the effectiveness of low vision rehabilitation services, leading to improved clinical and functional abilities. However not all patients make use of these resources. Methods A purposive sample of primary eyecare practitioners (optometrists and orthoptists who held a variety of roles in clinical practice, academia and low vision specific organisations) were invited to participate in focus groups that were audio-recorded and transcribed verbatim. The resulting data were de-identified, cleaned, independently coded by two researchers and compared. Data were analysed using an interpretative phenomenological approach that included inductive thematic analysis. Results Of the 21 practitioners attending the five focus groups, 67% were female and 33% were male. The participants were optometrists and orthoptists with a wide range (4 to 20+ years) of clinical experience in eyecare service delivery. Four major themes emerged from the analysis: three themes focus on identifying barriers, while one theme highlighted potential enablers. These themes encompassed barriers impacting referral frequency, practitioner knowledge, patient experience, and enablers that suggest improvement options for enhancing low vision services. Conclusion Miscommunication between service providers, miscommunication between patients and clinicians, late referral, cost of services and social stigma were major barriers preventing patients from receiving low vision services. Most practitioners admitted limited knowledge of the scope of services provided by low vision organisations, suggesting there is a need for enablers such as professional development, improved communication between service providers, enhanced referral guidelines and increased public awareness.

Public preferences and concerns regarding automated vehicle-based transportation services: a mechanism analysis from a Kentucky survey

ABSTRACT Prior research on Automated Vehicle (AV) transportation services has largely concentrated on specific cases, leading to a narrow comprehension of wider public mobility requirements in AV deployment. Additionally, the impacts of socio-demographics on AV transportation preferences remain underexplored, hindered by limitations in current modeling methodologies. Moreover, mediating roles of safety between socio-demographics and AV transportation preferences lack quantitative validation. This study aims to uncover the reasons behind public preference for AV-based services and investigate safety’s mediating effects on these preferences. In a survey conducted in Kentucky, USA, with 673 responses, the most preferred uses for AV services were post-alcohol rides, airport shuttles, and long-distance travel. Urban areas showed a higher preference for AV services. Age, gender, urbanization, affordability, travel needs, and exposure to AV technology significantly influenced these preferences. The study underscores a high demand for AV services while validating safety concerns as a major barrier to their widespread adoption.

Communication and collaboration skills training in radiation oncology: A quantitative validation survey.

Communication and collaboration are integral in radiation oncology practice. A recently published qualitative study identified several deficiencies in skills development for Australian/New Zealand trainees. We aim to validate these findings to guide curriculum development. A quantitative survey was developed through an iterative process, using themes identified in the previous qualitative investigation. This survey was distributed to radiation oncologists and trainees across Australia and New Zealand via email. Data collection and management utilised the REDCap system. Question types varied to maximise richness of data, including ranking, likert-scales and free-text questions. Results are primarily reported descriptively. Totally 35 participants submitted completed survey responses with broad representation across geography, gender and clinician seniority. To learn communication, participants reported strong preferences towards informal observation (60% agreement) and self-reflection (49% agreement), and against online learning (77% disagreement) methodologies. Nearly 35% acknowledge poor communication at least weekly, with time pressure being a major barrier (63% agreement). Clinical uncertainty and existing patient/family assumptions (both 74% agreement) contribute to difficulties in breaking bad news, with online learning being the only negatively perceived training modality (23% agreement). No participants reported any formal training/mentoring in multi-disciplinary team (MDT) engagement. Conflict was commonly witnessed/experienced (97%) and 26% of participants avoid MDTs due to difficulties experienced. This study validates the themes previously identified. We identified a strong preference for informal learning methodologies and against online modules, discordant to published literature. Effective collaboration within MDTs is identified as a particular area of need. We recommend future curriculum modification considers these results to maximise efficacy.

The relationship between health literacy and adherence to personal protective anti-COVID-19 measures in health workers and their relatives: A mixed methods design.

In the fight against the COVID-19 pandemic, the importance of health literacy in individuals' attitudes has increased. This study aimed to show whether there is a relationship between health literacy and adherence to personal protective anti-COVID-19 health behaviors in health workers and their relatives and to evaluate the barriers to adherence to personal protective anti-COVID-19 health behaviors. Designed as a cross-sectional mixed-methods study. Participants were asked to fill in an online survey form containing questions designed to determine their sociodemographic data, health literacy, adherence to protective anti-COVID-19 health behaviors, and barriers to adherence. The research results were evaluated with a confidence interval of 95% and margin of error of 0.05. Thematic content analysis was used to evaluate participants' answers to the open-ended questions. In this study, data collected from 393 participants were analyzed. In the Disease Prevention and Health Promotion Subscale, the group of participants who adhered to wearing masks "at all times" obtained a higher average score from the Turkey Health Literacy Scale than other participant groups, while the participant group that "always" complied with hand washing and social distancing obtained higher average scores from the Turkey Health Literacy Scale and its two subscales compared to other participant groups. As a result of the thematic content analysis carried out in order to determine the situations that prevent the participants from complying with personal protective anti-COVID-19 health behaviors, the main themes were determined as "forgetting/not wearing the habit of wearing a mask," "mask ergonomics" and "noncompliance with social distance." This study shows that there is a positive relationship between health literacy and adherence to protective anti-COVID-19 health behaviors among health workers and their relatives and revealed major barriers to adherence to protective anti-COVID-19 health behaviors among health workers and their relatives.

Neuropsychological Assessment for Early Detection and Diagnosis of Dementia: Current Knowledge and New Insights.

Dementia remains an underdiagnosed syndrome, and there is a need to improve the early detection of cognitive decline. This narrative review examines the role of neuropsychological assessment in the characterization of cognitive changes associated with dementia syndrome at different states. The first section describes the early indicators of cognitive decline and the major barriers to their identification. Further, the optimal cognitive screening conditions and the most widely accepted tests are described. The second section analyzes the main differences in cognitive performance between Alzheimer's disease and other subtypes of dementia. Finally, the current challenges of neuropsychological assessment in aging/dementia and future approaches are discussed. Essentially, we find that current research is beginning to uncover early cognitive changes that precede dementia, while continuing to improve and refine the differential diagnosis of neurodegenerative disorders that cause dementia. However, neuropsychology faces several barriers, including the cultural diversity of the populations, a limited implementation in public health systems, and the adaptation to technological advances. Nowadays, neuropsychological assessment plays a fundamental role in characterizing cognitive decline in the different stages of dementia, but more efforts are needed to develop harmonized procedures that facilitate its use in different clinical contexts and research protocols.

Optical Coherence Tomography in the Assessment and Management of Cardiac Allograft Vasculopathy.

Cardiac Allograft vasculopathy (CAV) is a major barrier to improving outcomes after heart transplantation. Coronary angiography has very low sensitivity to detect early CAV and intravascular ultrasound (IVUS) only improves it to some extent. In this article, we detail the current evidence surrounding use of Optical Coherence tomography (OCT) in patients with CAV. OCT has the ability to recognize CAV at earlier stages with intimal thickness < 150μm, can characterize CAV in almost pathologic / microscopic detail - plaque characteristics are better visualized and novel early features such as layered fibrotic plaques and microchannels have been identified. Progression of CAV can be monitored also, with promise shown in automated serial measurements also. OCT has significantly advanced our understanding of the pathophysiology-as well as permits precise monitoring and surveillance of the disease. Potential treatment options could also be evaluated using OCT.

Correlation of DAS 28 Score and Treatment Compliance with Depression and Anxiety in Rheumatoid Arthritis

Background: Rheumatoid arthritis (RA) is a chronic systemic autoimmune disorder characterized by synovial inflammation, joint destruction, and significant disability. Psychological factors, particularly depression and anxiety, are prevalent among RA patients and can impact disease management and treatment adherence. Understanding the relationship between disease activity, treatment compliance, and mental health is essential for comprehensive RA management. Objective: To investigate the correlation between Disease Activity Score 28 (DAS28) and treatment compliance with levels of depression and anxiety in patients with rheumatoid arthritis. Methods: This cross-sectional study was conducted at the Department of Rheumatology and Immunology, Sheikh Zayed Hospital, Lahore, over six months. A total of 130 RA patients were enrolled using non-probability convenience sampling. Inclusion criteria were adults aged 18 years and above, diagnosed with RA based on ACR/EULAR criteria, and compliant with medication for at least three months prior to the study. Exclusion criteria included other autoimmune diseases, significant concurrent medical conditions, history of substance abuse, and recent initiation of biologic treatments. Data collection involved demographic details, RA onset and duration, and assessments of depression and anxiety using the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) scales, respectively. RA disease activity was measured using DAS28, and systemic inflammation markers (ESR and CRP) were recorded. Data analysis was performed using SPSS version 25.0, employing descriptive statistics, correlation analysis, and regression analysis to determine the relationships between variables. Results: The study included 59 males (45.4%) and 71 females (54.6%), with a mean age of 49.69 years (SD = 18.82). The mean duration of RA diagnosis was 14.07 years (SD = 8.69). Higher PHQ-9 scores were associated with lower treatment adherence (B = -1.264, p &lt; 0.001), and higher GAD-7 scores also negatively impacted adherence (B = 0.870, p &lt; 0.01). The regression model explained 40.3% of the variance in treatment adherence (R² = 0.403, F(7, 122) = 11.779, p &lt; 0.001). Weak negative correlations were observed between DAS28 ESR and treatment adherence (r = -0.150), indicating that higher disease activity slightly reduced adherence. Conclusion: The study highlighted the significant role of mental health in the management of RA. Depression and anxiety were found to be major barriers to treatment adherence, underscoring the need for integrating psychological care into RA management. Addressing mental health issues could enhance treatment adherence and improve overall disease outcomes. Keywords: Rheumatoid Arthritis, DAS28, Treatment Adherence, Depression, Anxiety, Psychological Factors, Systemic Inflammation, PHQ-9, GAD-7, Chronic Disease Management, SPSS 25.0, Cross-Sectional Study, ACR/EULAR Criteria

Vacillant planning for creating green cities: The empirics of urban greenery in Kumasi, Ghana

Greeneries contribute enormously to the health and physical wellbeing of individuals and sustainability of cities. This notwithstanding, greeneries in African cities have significantly declined over time. There have thus been several calls, notably, to plan for and create green cities by incorporating greeneries in homes and urban neighbourhoods. Achieving this requires local understanding, acceptance and positive attitudes of residents toward planning for and integrating greeneries in homes and the environment. There is however dearth of research in Ghana on the knowledge and willingness of households and city officials to plan for the creation of green cities as well associated barriers. This paper responds to this gap by employing the multi-case approach, comprising of two suburbs (a high- [Nhyiaeso] and low-income [Aboabo] neighbourhoods) in Kumasi, Ghana. A total of 380 households and various relevant city planning agencies were engaged in semi-structured interviews. The findings show considerable but variegate understanding of green cities, which is influenced by several factors such as study community, residency status, housing typology and educational attainment. Most households in both communities indicated their willingness to incorporate greeneries in homes and neighbourhoods. However, resource constraints, nonchalant attitude of some residents and poor maintenance practices, were reported as major barriers that impede the efforts to incorporate greens in homes and communities. Several recommendations are proffered. The study concludes that promoting and achieving the benefits of green cities can be shaped by the knowledge of it; hence, the need to consciously and continually educate households on their importance.

The white-capped albatross: a new breeding record for the Diego Ramírez Islands, Chile

Albatrosses are renowned for their high philopatry, which has been proposed as a major barrier to their dispersal and hybridization with other albatross species. Except for shy-type albatross species from New Zealand, examples of colonization of new breeding sites and interbreeding with closely related species are rare. During the austral summer of 2022, while conducting land-based monitoring of resident Black-browed (Thalassarche melanophris) and Grey-headed (T. chrysostoma) albatross populations on the Diego Ramírez Islands, Chile (56 S), we documented the first (and southernmost) breeding record of a nesting pair of White-capped Albatross (T. steadi), a species endemic to the Auckland Islands, New Zealand (~ 7000 km away). The species identity was confirmed through molecular analysis. This discovery underscores the importance of Diego Ramírez and its surrounding waters as a hotspot for global albatross conservation.

IoT-Based Data Mining Framework for Stability Assessment of the Laser-Directed Energy Deposition Process

Additive manufacturing processes are prone to production errors. Specifically, the unique physical conditions of Laser-Directed Energy Deposition (DED-L) lead to unexpected process anomalies resulting in subpar part quality. The resulting costs and lack of reproducibility are two major barriers hindering a broader adoption of this innovative technology. Combining sensor data with data from relevant steps before and after the production process can lead to an increased understanding of when and why these process anomalies occur. In the present study, an IoT-based data mining framework is presented to assess the stability of processing Ti6Al4V on an industrial-grade DED-L machine. The framework employs an edge-cloud computing methodology to collect data efficiently and securely from various steps in the part lifecycle. During manufacturing, multiple sensors are employed to monitor the essential process characteristics in situ. Mechanical properties of the 160 printed specimens were obtained using appropriate destructive testing. All data are stored on a central database and can be accessed via the web for data analytics. The results prove the successful implementation of the proposed IoT framework but also indicate a lack of process stability during manufacturing. The occurring part errors can only be partially correlated with anomalies in the in situ sensor data.

Gastroenterologist and surgeon perceptions of recommendations for optimal endoscopic localization of colorectal neoplasms

National consensus recommendations have recently been developed to standardize colorectal tumour localization and documentation during colonoscopy. In this qualitative semi-structured interview study, we identified and contrast the perceived barriers and facilitators to using these new recommendations according to gastroenterologists and surgeons in a large central Canadian city. Interviews were analyzed according to the Consolidated Framework for Implementation Research (CFIR) through directed content analysis. Solutions were categorized using the Expert Recommendations for Implementing Change (ERIC) framework. Eleven gastroenterologists and ten surgeons participated. Both specialty groups felt that the new recommendations were clearly written, adequately addressed current care practice tensions, and offered a relative advantage versus existing practices. The new recommendations appeared appropriately complex, applicable to most participants, and could be trialed and adapted prior to full implementation. Major barriers included a lack of relevant external or internal organizational incentives, non-existing formal feedback processes, and a lack of individual familiarity with the evidence behind some recommendations. With application of the ERIC framework, common barriers could be addressed through accessing new funding, altering incentive structures, changing record systems, educational interventions, identifying champions, promoting adaptability, and employing audit/feedback processes. Future research is needed to test strategies for feasibility and effectiveness.

Determining factors and barriers to the uptake of climate change adaptation strategies of agriculture and aquaculture farm households in Myanmar

PurposeClimate change is an undeniable reality that threatens people’s livelihoods. Flooding and saltwater intrusion, along with the rising sea levels, are affecting agricultural and aquaculture livelihoods in Myanmar’s coastal areas. Although climate change adaptation is gaining popularity as a resilience strategy to cope with the negative effects of climate change, both agriculture- and aquaculture-farmers are more often deterred from implementing climate change adaptation strategies due to practical availability and socioeconomic barriers to adaptation. This study aims to evaluate the barriers and factors that influence farm household’ choice of climate change adaptation measures.Design/methodology/approachThis study was conducted with 599 farm households (484 rice-farmers and 115 fish farmers) based in the coastal areas of Myanmar during 2021–2022 to explore the farmer’s choice of climate change adaptation measures and the determining factors. The multinomial logit regression (MLR) model was used to examine the factors influencing the farmers’ choice of climate change adaptation strategies.FindingsThe study found out that farm households use a variety of adaptation methods at the farm level, with building embankment strategy (23.4%) in agriculture and net-fencing measure (33.9%) in fish farming being the most popular adaptation strategies. Farmers’ decisions to adopt climate change adaptation strategies are influenced by factors such as distance to market, education level of the household head, remittance income and the availability of early warning information, among others. The study also discovered that COVID-19 has had an impact on the employment opportunities of household members and the income from farming as well had a consequential effect on the adoption of climate change adaptation measures. Furthermore, lack of credit (42.4%), labor shortage (52.8%), pest and disease infestation (58.9%), high input costs (81%) and lower agricultural product prices (73%) were identified as major barriers to the adoption of climate change adaptation measures by both agriculture and aquaculture farm households.Originality/valueThis study demonstrates that the COVID-19 pandemic and farm-level barriers are the major factors influencing farm households’ choice of climate change adaptation measures, and that removing practical farm-level barriers and encouraging the adoption of adaptation techniques as potential COVID-19 recovery actions are required. This study also highlighted that the adaptive capacity of agriculture and aquaculture farm households should be strengthened through formal and informal training programs, awareness raising, the exchange of early warning information and the development of proper credit scheme programs.