Major Barrier Research Articles

Disparities in integrating non-invasive prenatal testing into antenatal healthcare in Australia: a survey of healthcare professionals

BackgroundNon-invasive prenatal testing (NIPT) has been clinically available in Australia on a user-pays basis since 2012. There are numerous providers, with available tests ranging from targeted NIPT (only trisomies 21, 18, and 13 +/- sex chromosome aneuploidy) to genome-wide NIPT. While NIPT is being implemented in the public health care systems of other countries, in Australia, the implementation of NIPT has proceeded without public funding. The aim of this study was to investigate how NIPT has been integrated into antenatal care across Australia and reveal the successes and challenges in its implementation in this context.MethodsAn anonymous online survey was conducted from September to October 2022. Invitations to participate were sent to healthcare professionals (HCPs) involved in the provision of NIPT in Australia through professional society mailing lists and networks. Participants were asked questions on their knowledge of NIPT, delivery of NIPT, and post-test management of results.ResultsA total of 475 HCPs responded, comprising 232 (48.8%) obstetricians, 167 (35.2%) general practitioners, 32 (6.7%) midwives, and 44 (9.3%) genetic specialists. NIPT was most commonly offered as a first-tier test, with most HCPs (n = 279; 60.3%) offering it to patients as a choice between NIPT and combined first-trimester screening. Fifty-three percent (n = 245) of respondents always offered patients a choice between NIPT for the common autosomal trisomies and expanded (including genome-wide) NIPT. This choice was understood as supporting patient autonomy and informed consent. Cost was seen as a major barrier to access to NIPT, for both targeted and expanded tests. Equitable access, increasing time demands on HCPs, and staying up to date with advances were frequently reported as major challenges in delivering NIPT.ConclusionsOur findings demonstrate substantial variation in the clinical implementation of NIPT in Australia, including in the offers of expanded screening options. After a decade of clinical use, Australian clinicians still report ongoing challenges in the clinical and equitable provision of NIPT.

Productivity susceptibility analysis in extremely data-poor scenarios: The case of Peruvian coastal groundfish

Coastal small-scale fisheries remain largely unassessed and unregulated worldwide, which leads to a high risk of overfishing. Availability and quality of data are major barriers to performing model-based assessments, particularly in low and middle-income countries. In that context, alternative assessment methods are key to defining priorities, as well as prompting and guiding management actions. In this study, we assessed the vulnerability to overfishing of 10 extremely data-poor species of coastal groundfish in Peru, by applying an adapted Productivity Susceptibility Analysis (PSA). We classified fisheries-related Susceptibility attributes and streamlined a process to assess and integrate multiple fisheries and gears into a single score for each attribute. The data quality scores regarding productivity and susceptibility were between “limited” and “no data”, across all stocks. Therefore, expert knowledge was key for completing the assessment. Stocks of four species presented extremely high Vulnerability to overfishing: broomtail grouper (V=2.57), grape-eye seabass (V=2.50), pacific goliath grouper (V=2.28) and galapagos sheephead wrasse (V=2.24). Three showed high Vulnerability to overfishing: black snook (V=2.13), harlequin wrasse (V=2.05) and chino (V=2.01). Two showed medium Vulnerability to overfishing: mulata (V=1.89) and pacific beakfish (V=1.89). Only the stock of bumphead parrotfish showed low Vulnerability to overfishing (V=1.73). We contrasted the resulting Vulnerability scores with the limited available information on the statuses of these stocks, to evaluate the accurateness of the overfishing probability thresholds proposed in PSA literature. We found that Vulnerability scores were mostly consistent with contrasted information and that the thresholds remain useful to inform fisheries management in extremely data-poor contexts. Our results shed light on the need for the implementation of fishing regulations and the generation of biological and fishery-related data on coastal groundfish in Peru.

Barriers to uptake of referral services from secondary eye care to tertiary eye care and its associated determinants in L V Prasad Eye Institute network in Southern India: A cross-sectional study-Report II.

To investigate the barriers to the uptake of referral services from secondary care centers (SC) to a higher-level tertiary care center (TC) in Southern India. A cross-sectional study was conducted in the Mahabubnagar district of Telangana, India, between February 1, 2018 to January 31, 2019 and all those referred from SC to TC between January 1, 2013 to December 30, 2016 were identified for interview. Based on inclusion criteria, of the 960 participants identified, 681 (70.9%) participated in the study. A validated study questionnaire was administered to all participants. Information collected were the demographic details, details related to their referral and barriers to referral. The participants that presented at TC were considered compliant and who did not, were non-compliant. Reasons for non-compliance was also collected. The mean age those interviewed was 46.1 years (SD: 17.3 years) and 429 (63%) were males and 252 (37%) were females. Overall, 516 (75.8%) were compliant, and 165 (24.2%) were non-compliant. The major factors for non-compliance were economic (16.4%) and attitudinal (44.2%) barriers. Within the attitudinal barrier category, the most prevalent individual attitudinal barriers were 'too busy to go to the eye center for treatment (16.4%)'and 'able to manage routine daily activities with current vision (12.1%)'. The multivariable analysis showed that the non-compliant participants had only visited the SC once prior to the referral (odds ratio: 2.82; 95% CI: 1.43-5.57) (p = 0.003). Participants with only one SC visit, were less likely to comply with referrals and the major barriers to compliance were economical and attitudinal. It is important to address these specific barriers to provide proper counseling to participants during referrals.

Simultaneous improvement of mechanical and castability properties of Al-Cu-Mn based alloys by Ca/Ni micro-alloying

Currently one major barrier for the design of cast high-strength and high-toughness Al alloys is hot tearing. In this work, a strategy of combination of squeeze casting and microalloying (Ca/Ni eutectic elements) in Al-Cu-Mn based alloys was employed to inherit the excellent mechanical properties of Al-Cu alloys whilst simultaneously reducing their tendency to hot tearing. The developed alloys exhibit comparable castability (fluidity and hot tear resistance) to A356, which is widely available commercially. However, their comprehensive mechanical properties far exceed those of A356. Trace Ca/Ni additions markedly reduce the grain size of the alloy and simultaneously increase the fraction of intergranular low melting point eutectic liquid phases, which is beneficial to the improvement of liquid feeding. The fine equiaxed grains have excellent thermal shrinkage coordination, while the high volume fraction eutectic liquid phase delays the development of grain cohesive skeleton. Accordingly, the localized shrinkage stress/strain at the hot spot is released timely, thus inhibiting the emergence and propagation of hot cracks in the brittle solidification interval. The diminished hot tearing susceptibility is attributed to the reduced load onset temperature and load values in the hot spot region. A new intergranular bridging mechanism is discovered in low-Ca alloys: based on compositional segregation-induced nucleation of an intergranular bridging skeleton, which strengthens the intergranular adhesive force and effectively reduces the hot tearing tendency of the alloys. The alloys with high-Ca/Ni additions, however, reduce the hot tearing tendency by healing cracks through eutectic liquid phase backfill. The results of the hot tearing experiments of the developed alloys are analyzed with the current hot tearing evaluation criteria. The results demonstrate that the predictions of the Kou's criterion provide guidelines for the design of alloys that are resistant to hot tearing.

PHYSICIANS’ PERCEPTION AND ADHERENCE TO CLINICAL GUIDELINES FOR THE MANAGEMENT OF ACUTE CORONARY SYNDROME IN VIETNAMESE HOSPITALS

Introduction: Understanding guideline acceptance related factors and barriers to guideline adoption may help improve guideline implementation. We aimed to investigate physicians’ perception and adherence to ACS guidelines in Vietnamese hospitals. Methods: This was a cross-sectional study. Physicians’ perception was collected through interviews, using a validated questionnaire. Physicians’ adherence to ACS guidelines was determined through medical records of ACS patients treated by interviewed doctors, using prescribing indicators. Data were analyzed using SPSS 20.0, with significant level of p < 0.05. Results: There were 33 cardiologists completed the interview (mean age 36.4, male 57.6%). Majority of physicians perceived that ACS guidelines were useful, reliable, and available. They definitely understood, would keep updating, and implementing those guidelines. About a third of physicians supposed that guideline adherence did not save treatment costs. Major barrier was lack of health insurance coverage. A total of 342 medical records of ACS patients (mean age 65.3, male 59.1%) was reviewed for physicians’ adherence. Patients with unstable angina/non-ST-elevation myocardial infarction accounted for the largest proportion. Statins were predominantly indicated (in 96.4% of patients), followed by aspirin (89.9%), ACEIs/ARBs (86.3%), P2Y12 inhibitors (84.7%), and beta-blockers (59.5%). Ultimately, 52.2% of patients were prescribed all four recommended medications. No differences in physicians’ characteristics, perception and barriers to guideline between high- and low-adherence doctors were found. Conclusions: Majority of physicians had positive perception towards ACS guidelines, but there were still certain barriers. Physicians’ prescribing practice was highly consistent with the guidelines, but the indication of beta-blockers and all four recommended medications were limited.

Insulin degludec in pregestational diabetes: evidence and perspectives

Pregestational diabetes is described when a woman with diabetes before the onset of pregnancy becomes pregnant and consequently she is vulnerable to higher risk for adverse outcomes in the embryo/foetus. Strict glycaemic control, with minimal glucose variability, starting from before conception and maintained throughout pregnancy decreases significantly adverse foetal and maternal outcomes; maternal hypoglycaemic episodes are the major barrier in achieving this goal. Insulin degludec is an ultralong-acting analogue, which has half-life of over 25 h and full duration of effect of more than 42 h, reaching a steady-state serum concentration after 2–3 days of its administration. It promotes flat, steady, peakless and predictable insulin concentrations, with minor intra-individual and inter-individual variability. It also exerts a low mitogenic/metabolic potency ratio. This review examines thoroughly all current evidence of the administration of insulin degludec in pregestational diabetes as well as its future role in this population.

Let’s (not) talk about sexual health: How sexual communication apprehension with healthcare providers and peer communication influence intentions to protect sexual health

ObjectiveThis study examined how patients’ clinical and peer interactions may affect their communication apprehension with healthcare providers, a major communication barrier to sexual health protective behaviors (SHPB). MethodsBetween January 2022 and February 2023, we conducted an online survey with 310 participants recruited through snowball sampling. Using structural equation modeling (SEM), we explored relationships among patient-provider interactions, peer communication about sex, communication apprehension with providers, and SHPB intentions. ResultsSignificant predictors of SHPB intentions included lower communication apprehension and more peer communication. Communication apprehension was a significant mediator in paths from peer communication and three types of patient-provider communication to SHPB intentions. ConclusionsOur study indicates the need to address communication barriers to increase patients’ SHPB intentions. Active patient involvement and patient-centered communication may open up discussions about sex in the clinical setting. Peer interactions, informed by scientific guidance, may reduce patients’ apprehension, leading to better health outcomes. Practice implicationsCommunication interventions are needed to promote collaborative patient-provider environments and peer sexual communication. Active involvement and evidence-based discussions can help patients navigate difficult conversations (e.g., like sex), improving SHPB.

Reversal of chronic surface degradation of Sr(Ti,Fe)O3 perovskite-based fuel cell cathodes by surface acid/base engineering

The major barrier to commercialization of solid oxide fuel cells (SOFCs) is to overcome long-term surface degradation during operation. Sr/Co-based perovskite cathodes have been recognized to suffer from two major sources of degradation: inherent Sr segregation and extrinsic Cr-impurities at the surface, respectively. Here, we demonstrate the ability to simultaneously reverse both surface degradation modes in SrTi0.65Fe0.35O3-δ (STF35), a model high performance perovskite cathode, via surface acid/base engineering via infiltration. The acidic nature of Cr-infiltration is found to induce surface electron depletion, while enhancing Sr segregation to the surface, leading to ∼40% drop in SOFC peak power. Subsequent infiltration of basic Ca-additives is demonstrated to not only neutralize these detrimental effects, but ultimately lead to 160% enhancement in peak power, thereby enabling Co-free operation. This approach holds great promise for extending the operating lives, more generally, of materials and devices for which the catalytic oxygen/solid interface reaction is central.

Veterinarians' Self-Reported Behaviors and Attitudes toward Spectrum of Care Practices.

Access to veterinary care for animal owners is an important part of keeping animals healthy and keeping pets and people together whenever that is appropriate. Insufficient financial and other resources to allocate to veterinary care are major barriers for pet owners to receiving preventative, sick, and emergency services. The veterinary community has begun to incorporate offering a range of diagnostic and treatment options more intentionally in response to clients' inability to pay and to a lesser extent to mitigate other barriers to care. Many veterinarians are nonetheless oriented toward providing specialized and more sophisticated care based on their training. This study sought to identify the self-reported behaviors, knowledge, attitudes, and beliefs of veterinarians about offering a spectrum of care options (SoC) to clients. The finding that many reported offering SoC is encouraging. However, veterinarians who report comfort and confidence in a variety of aspects of clinical care were most likely to offer SoC. Practitioners in the field for 20 or more years were less likely to offer SoC to clients with financial limitations. Rural veterinarians were more likely to offer SoC to any client compared to urban veterinarians. These results provide a point of reference and potential focus for veterinarians who are not currently offering SoC as well as an exploration of veterinarians' reported knowledge, behaviors, attitudes, perceptions, and concerns about SoC.

Service Provider Perspectives on Advance Care Planning Use in Rural Dementia Patients and Caregivers: A Qualitative Study

ABSTRACT Advanced care planning (ACP) utilization remains very limited in rural communities compared to urban areas. ACP earlier in the disease trajectory is particularly important for people with dementia (PWD) due to its progressive nature affecting their decision-making ability. Considering the well-documented benefits of ACP in improving the quality of end-of-life (EOL) care, the rural vs. urban disparity may indicate poorer EOL quality for rural PWD. This study aimed to explore barriers and current resources for ACP of PWD from the perspectives of health or social service providers serving rural communities. Using a qualitative approach, semi-structured face-to-face interviews were conducted with 11 health or social service professionals serving older adults and their caregivers in rural Alabama. Thematic analysis revealed three major barriers: (1) lack of knowledge, (2) psychosocial barriers, and (3) limited access to healthcare. Participants also showed misconception that a lawyer or a notary is required for ACP. Two themes arose in the participants’ recommendations to address the barriers: (1) providing ACP-relevant information and (2) addressing psychosocial stressors about ACP. This study highlighted an urgent need for social policy in ACP education for caregivers and service providers in rural settings.

Beyond individual responsibility: Exploring lay understandings of the contribution of environments on personal trajectories of obesity.

Reversing the upward trajectory of obesity requires responding by including the multiple influences on weight control. Research has focused on individual behaviours, overlooking the environments where individuals spend their lives and shape lifestyles. Thus, there is a need for lay understandings of the impact of environments as a cause and solution to obesity. This research aimed to understand the influence of environments on the adoption of health practices in adults with obesity and to identify lay strategies with which to address environmental barriers to behaviour change. Nineteen adults with a history of obesity living in the United Kingdom were interviewed through video conferencing between May 2020 and March 2021. Semi-structured interviews and socio-demographic questionnaires were used, and data analysed through hermeneutic phenomenology informed reflexive thematic analysis. Three main themes were created: living with convenience and normalcy: the increased accessibility of unhealthy food, people interacting with digital media for positive practice change, and the need to prioritise prevention in schools, the National Health Service and the food industry. The food environment was the major barrier, while interactions with social media was the most important opportunity to adopt healthy practices. The National Health Service was considered an obesogenic environment, something relevant since it has been traditionally recognised as an obesity management system. The perceptions from individuals with a history of obesity provide new suggestions on the influence of previously overlooked environments to design more adequate and effective interventions and policies that consider, more than in the past, the environments where people spend their lives.

“Every day you are working you have to prove it”: Navigating the costs of work and ableism with visual impairment

BACKGROUND: People with visual impairment often need many items that their sighted counterparts do not, such as assistive devices, transportation services, and other disability-related goods and services. Acquiring these items represents a major barrier to the employment of people with visual impairment. OBJECTIVE: This study aimed to explore the nature of disability-related employment costs as they relate to engagement in the labor market of people with visual impairment. METHODS: The research consisted of a qualitative analysis of interviews and focus groups with 15 visually impaired adults from the New York metro area. RESULTS: What emerged were the costs of accessing and maintaining employment— particularly related to meeting the expectations of expediency in the modern world— in areas like communication and transportation. These costs interacted with perceived ableism in the labor market and created a climate of job scarcity and anxiety, which came at additional cost to participants who felt stuck in low-paying work. CONCLUSIONS: Further research is needed on the impact of perceived ableism and disability-related employment costs, and on decreasing barriers to programs that may ameliorate these costs, such as vocational rehabilitation services. Such research would inform policy interventions geared toward enhancing disabled people’s participation in the labor market.

The differential impact of climate interventions along the political divide in 60 countries

A major barrier to climate change mitigation is the political polarization of climate change beliefs. In a global experiment conducted in 60 countries (N = 51,224), we assess the differential impact of eleven climate interventions across the ideological divide. At baseline, we find political polarization of climate change beliefs and policy support globally, with people who reported being liberal believing and supporting climate policy more than those who reported being conservative (Cohen’s d = 0.35 and 0.27, respectively). However, we find no evidence for a statistically significant difference between these groups in their engagement in a behavioral tree planting task. This conceptual-behavioral polarization incongruence results from self-identified conservatives acting despite not believing, rather than self-identified liberals not acting on their beliefs. We also find three interventions (emphasizing effective collective actions, writing a letter to a future generation member, and writing a letter from the future self) boost climate beliefs and policy support across the ideological spectrum, and one intervention (emphasizing scientific consensus) stimulates the climate action of people identifying as liberal. None of the interventions tested show evidence for a statistically significant boost in climate action for self-identified conservatives. We discuss implications for practitioners deploying targeted climate interventions.

Barriers to environmental education in Ethiopia: do they differ from a global analysis?

Environmental education in primary schools plays a critical role in fostering pro-environmental values and behavior among young children. However, multiple contextual barriers hinder the teaching of environmental issues in schools. Drawing on the evident gap observed in Ethiopian primary teachers’ beliefs and actual practices, the study elucidates the major barriers teachers encounter in teaching environmental issues. Interviews, grounded in phenomenology, were conducted with teachers in four primary schools. The analysis outlined four ranked categories: training and capacity, administrative and logistical, safety concerns, and attitudinal. Most teachers feel hindered by their lack of pedagogical knowledge for teaching children. While most of the barriers are common in global analyses, the current study also identified noble barriers. Suggestions for tackling the barriers and areas for further inquiry are discussed.

Needs Assessment of Musculoskeletal Ultrasound Training in North American Pediatric Rheumatology Fellowship Programs.

Musculoskeletal ultrasound (MSUS) is widely used in adult rheumatology practice for diagnosis of arthritis and procedural guidance; however, it is not yet common practice in pediatric rheumatology. MSUS is advantageous to the pediatric population because it lacks radiation and eliminates need for sedation. This study aims to assess interest in, access to, and barriers to MSUS training in pediatric rheumatology fellowship programs in North America. A survey was developed by pediatric rheumatology providers with experience in medical and/or MSUS education and distributed via REDCap anonymously in March 2022 (Supplementary Material). Eligible participants included current and recently graduated (<1 year) pediatric rheumatology fellows at a North American program. Descriptive statistics and bivariate analyses using design-based Pearson chi-squared tests were performed. Overall response rate was 78% (88/113), and 75% reported some form of MSUS training during fellowship. Only 36% indicated their program had a formal MSUS curriculum. Of those with MSUS training, 23% reported adult-only MSUS education. Eighty-four percent felt MSUS would be beneficial to their career. Major barriers to MSUS training included lack of MSUS-trained faculty, lack of time, and lack of hands-on MSUS sessions. Those who had access to MSUS training were significantly more interested in MSUS than those without (P = 0.0036). This study demonstrates that North American pediatric rheumatology fellows have a strong interest in learning MSUS, but they face significant challenges in accessing MSUS training (lack of MSUS-trained faculty, time, and access to hands-on training). MSUS should be incorporated into fellowship curriculum; however, implementation remains a challenge.

Impact of randomly assigned “pay-as-you-go” liquefied petroleum gas prices on energy use for cooking: Experimental pilot evidence from rural Rwanda

The disease burden related to air pollution from traditional solid-fuel cooking practices in low- and middle-income countries impacts millions of people globally. Although the use of liquefied petroleum gas (LPG) fuel for cooking can meaningfully reduce household air pollution concentrations, major barriers, including affordability and accessibility, have limited widespread adoption. Using a randomized controlled trial, our objective was to evaluate the association between the cost and use of LPG among 23 rural Rwandan households. We provided a 2-burner LPG stove with accessories and incorporated a “pay-as-you-go” (PAYG) LPG service model that included fuel delivery. PAYG services remove the large up-front cost of cylinder refills by integrating “smart meter” technology that allows participants to pay in incremental amounts, as needed. We assigned three randomized discounted prices for LPG to each household at ∼4-week intervals over a 12-week period. We modeled the relationship between randomized PAYG LPG price and use (standardized to monthly periods), analyzing effect modification by relative household wealth. A 1000 Rwandan Franc (about 1 USD at the time of the study) increase in LPG price/kg was associated with a 4.1 kg/month decrease in use (95 % confidence interval [CI]: −6.7, −1.6; n = 69 observations). Wealth modified this association; we observed a 9.7 kg/month reduction (95 % CI: −14.8, −4.5) among wealthier households and a 2.5 kg/month reduction (95 % CI: −5.3, 0.3) among lower-wealth households (p-interaction = 0.01). The difference in price sensitivity was driven by higher LPG use among wealthier households at more heavily discounted prices; from an 80 % to 10 % discount, wealthy households used 17.5 to 5.3 kg/month and less wealthy households used 6.2 to 3.1 kg/month. Our pilot-level experimental evidence of PAYG LPG in a rural low-resource setting suggests that further exploration of subsidized pricing varied by household wealth is needed to ensure future policy initiatives can achieve targets without exacerbating inequities.

Implementation of the strengths model of case management for people with a traumatic brain injury: a qualitative pre-implementation study

ABSTRACT Introduction People who sustain a traumatic brain injury (TBI) may have to live with permanent sequelae such as mental health problems, cognitive impairments, and poor social participation. The strengths-based approach (SBA) of case management has a number of positive impacts such as greater community integration but it has never been implemented for persons with TBI. To support its successful implementation with this population, it is essential to gain understanding of how the key components of the intervention are perceived within the organization applying the approach. Objectives Documenting the barriers and facilitators in the implementation of the SBA as perceived by potential adopters. Methods A qualitative pre-implementation study was conducted using semi-structured interviews with community workers and managers of the community organization where the SBA is to be implemented. Data were analyzed using a deductive approach based on the Consolidated Framework for Implementation Research (CFIR). Results The major barriers are associated with the intervention (e.g. adaptability of the intervention) and the external context (e.g. the impact of the pandemic). Perceived facilitators are mainly associated with the internal context (e.g. compatibility with current values). Conclusion The barriers and facilitators identified will inform the research team’s actions to maximize the likelihood of successful implementation.

Covalent Polymer-RNA Conjugates for Potent Activation of the RIG-I Pathway.

RNA ligands of retinoic acid-inducible gene I (RIG-I) are a promising class of oligonucleotide therapeutics with broad potential as antiviral agents, vaccine adjuvants, and cancer immunotherapies. However, their translation has been limited by major drug delivery barriers, including poor cellular uptake, nuclease degradation, and an inability to access the cytosol where RIG-I is localized. Here this challenge is addressed by engineering nanoparticles that harness covalent conjugation of 5'-triphospate RNA (3pRNA) to endosome-destabilizing polymers. Compared to 3pRNA loaded into analogous nanoparticles via electrostatic interactions, it is found that covalent conjugation of 3pRNA improves loading efficiency, enhances immunostimulatory activity, protects against nuclease degradation, and improves serum stability. Additionally, it is found that 3pRNA could be conjugated via either a disulfide or thioether linkage, but that the latter is only permissible if conjugated distal to the 5'-triphosphate group. Finally, administration of 3pRNA-polymer conjugates to mice significantly increases type-I interferon levels relative to analogous carriers that use electrostatic 3pRNA loading. Collectively, these studies have yielded a next-generation polymeric carrier for in vivo delivery of 3pRNA, while also elucidating new chemical design principles for covalent conjugation of 3pRNA with potential to inform the further development of therapeutics and delivery technologies for pharmacological activation of RIG-I.

"We all think boots are meant for men": A community-based participatory assessment of rural women's barriers to preventing podoconiosis in Rwanda.

Podoconiosis is a debilitating neglected tropical disease (NTD) that is possibly caused by prolonged exposure to irritant alkaline clay soil. It is endemic to East Africa and disproportionately affects rural female farmers. The condition can be prevented through foot hygiene and regular wearing of protective shoes. In Rwanda, there is limited information on the factors impacting rural female farmers' access to and utilization of boots while farming. Therefore, this community-based participatory study was conducted to explore the cultural, economic, and ergonomic factors affecting rural farmers' use of protective footwear. Sixteen audio-recorded focus group discussions were conducted with female and male farmers in four villages with the highest podoconiosis prevalence across four provinces of Rwanda. Transcripts were coded inductively using Dedoose (version 9.0.86) and analyzed through thematic content analysis. Participants expressed that wearing shoes protects against diseases and injuries but ability to afford a pair of protective footwear was a major barrier to accessing and wearing them. There were differences in women and men's shoe-wearing behaviors while farming, largely driven by the fact that women who wear boots face rumors and backlash. Findings highlight barriers hindering effective podoconiosis prevention among rural female farmers in Rwanda. Opportunities exist to strengthen podoconiosis and NTD prevention programs, through the integration of gender into existing community-based interventions and the inclusion of local communities into the co-designing of contextualized interventions.

Revolutionizing Heart Monitoring with Oximetry

Innovative medical gadgets are now critically needed to monitor and analyze the situation, especially in light of the COVID-19 pandemic. In light of this, a portable, affordable, IOT-based heart rate and SpO2/level sensor device with effective performance has been developed. In order to publish data to a software web page and display data on the OLED, the suggested system has an integrated LED with basic internet access. Its mobility, user-friendliness, and distinctive method of sending collected data are its key qualities. data online, enabling it to perform better than the solutions that are currently on offer in a number of ways. The project is designed in such a way that the analogue quantities which are to be recorded continuously are taken and converted into corresponding digital values using a six-channel ADC. Here we consider temperature and monitor the heart rate. The processed data from ADC is sent to the microcontroller. With the help of a six-channel ADC, the project's architecture transforms the analogue numbers that must be continuously recorded into equivalent digital values. Here, we keep an eye on the heart rate and take the temperature into account. The microcontroller receives the data from the ADC that has been processed. The microcontroller is designed to continuously monitor the status of the sensors. To transfer sensor data to the server web page in the form of a database, the microcontroller and the Wifi Module will be interfaced using serial connection. Monitoring physiological data, such as electrocardiogram (ECG) signals, offers a new avenue for ease of control and prevention in modern healthcare. Consequently, a new era of proactive, intelligent healthcare would emerge—especially considering the major barrier of scarce medical resources. It was shown how to use a mobile ECG monitoring service hosted in the cloud. With the use of a pulse oximeter and a wireless transmission method like WI-FI, these may identify ECG signals and display them on a screen. IOT based on ECG monitoring has been the subject of various works.