Primary Barrier Research Articles

Factors influencing willingness to participate in ophthalmic clinical trials and strategies for effective recruitment.

To explore the factors influencing individuals' willingness to participate in ophthalmic clinical trials. A questionnaire survey was conducted from January to April 2021 among patients and their family members at Zhongshan Ophthalmic Center, Sun Yat-sen University, in Guangzhou, China. The survey gathered data on respondents' willingness, demographic and socioeconomic profiles, as well as their reasons and concerns regarding engagement in clinical trials. Of the 1078 residents surveyed (mean age 31.2±13.1y; 65.8% females) in Guangzhou, 749 (69.5%) expressed a willingness to participate in future ophthalmic clinical trials. Specific characteristics associated with greater willingness included a younger age, lower annual income, higher education, prior participation experience, previous ophthalmic treatment, and a better understanding of clinical trials. With the exception of age, these characteristics were significantly linked to a higher willingness. The primary barrier to participation, expressed by 64.8% of those willing and 54.4% of those unwilling, was "Uncertain efficacy". In terms of motivations, the willing group ranked "Better therapeutic benefits" (35.0%), "Professional monitoring" (34.3%), and "Trust in healthcare professionals" (33.1%) as their top three reasons, whereas the unwilling participants indicated "Full comprehension of the protocol" (46.2%) as the key facilitator. This study reveals a substantial willingness to participate in ophthalmic clinical trials and demonstrates the predictive role of demographic and socioeconomic factors. Variations in motivators and concerns between willing and unwilling participants highlight the significance of tailored recruitment strategies. Importantly, the need for and trust in healthcare professionals stand out as powerful motivations, underscoring the importance of enhancing physician-patient relationships, adopting patient-centered communication approaches, and addressing individualized needs to improve accrual rates.

Towards promoting wound healing: A near-infrared light-triggered persistently antibacterial, synergistically hemostatic nanoarchitecture-integrated chitosan hydrogel

The skin, the primary barrier of the body, is inevitably broken. However, the development of materials that facilitate wound healing with sustained antimicrobial, hemostatic, and biocompatible properties remains a formidable challenge. In this article, we prepared a photopolymerizable composite hydrogel consisting of a hydrogel matrix, a hemostatic/antibacterial agent, and a photothermal therapy agent. The photopolymerizable hydrogel matrix was prepared by grafting the photoinitiator and polymerizable active monomer onto the chitosan chain segment, which exhibits excellent biocompatibility. Furthermore, linalool is adsorbed on the surface of halloysite nanotubes (HNTs) to form a hemostatic and antibacterial. Meanwhile, dopamine is employed as a coating material for hollow glass microsphere (HGM), which enables them to function as photothermal therapy agents. Upon exposure to near-infrared radiation, the PHA hydrogel releases linalool molecules from the surface of the HNTs, which diffuse into the hydrogel matrix, resulting in a sustained antimicrobial effect. At the same time, rapid curing of the photopolymerizable hydrogel under UV light forms a physical barrier that synergistically enhances the hemostatic properties of the HNTs. From the above, the results pave the way to develop a potential hemostatic antimicrobial dressing for clinical use in wound healing.

Study on the physical encapsulation mechanism of heavy metals in fly ash carbonation solidification based on synthetic pellets

The physical encapsulation mechanism prevents the leaching of heavy metals by forming calcium carbonate-encapsulated fly ash through the reaction of carbon dioxide and calcium oxide. However, current research in this area primarily involves qualitative analysis, focusing on various methods to enhance the fixation effect of heavy metals. There is a lack of quantitative description regarding how physical encapsulation solidifies heavy metals, and the solidification mechanism of heavy metals is challenging to verify through macroscopic experiments. In this paper, a method for synthesizing small fly ash particles into pellets is proposed to quantitatively study the mechanism of physically encapsulating heavy metals. The data from the carbonation reaction and leaching reaction are fitted using the shrinking core model. The depth of carbonation increases with the lengthening of carbonation time, and the physical encapsulation strengthens the immobilization of heavy metals. The leaching of heavy metals after carbonation can be categorized into three stages based on the shrinking core model: external diffusion, internal diffusion, and chemical reaction control. Synthetic pellets enhance all three stages, especially the external diffusion, which is not detectable with fly ash powder. The fitting results of the experimental data for the carbonation reaction of the enlarged synthetic pellets and the shrinking core model are both above 0.9. This indicates that the primary barrier to leaching of heavy metals is the physical encapsulation formed by the carbonation reaction following the shrinking core model. The physical encapsulation serves as the primary mechanism for the solidification of heavy metals during the carbonation process.

Adolescent, parent, and provider attitudes toward a machine learning based clinical decision support system for selecting treatment for youth depression.

Machine learning based clinical decision support systems (CDSSs) have been proposed as a means of advancing personalized treatment planning for disorders, such as depression, that have a multifaceted etiology, course, and symptom profile. However, machine learning based models for treatment selection are rare in the field of psychiatry. They have also not yet been translated for use in clinical practice. Understanding key stakeholder attitudes toward machine learning based CDSSs is critical for developing plans for their implementation that promote uptake by both providers and families. In Study 1, a prototype machine learning based Clinical Decision Support System for Youth Depression (CDSS-YD) was demonstrated to focus groups of adolescents with a diagnosis of depression (n = 9), parents (n = 11), and behavioral health providers (n = 8). Qualitative analysis was used to assess their attitudes towards the CDSS-YD. In Study 2, behavioral health providers were trained in the use of the CDSS-YD and they utilized the CDSS-YD in a clinical encounter with 6 adolescents and their parents as part of their treatment planning discussion. Following the appointment, providers, parents, and adolescents completed a survey about their attitudes regarding the use of the CDSS-YD. All stakeholder groups viewed the CDSS-YD as an easy to understand and useful tool for making personalized treatment decisions, and families and providers were able to successfully use the CDSS-YD in clinical encounters. Parents and adolescents viewed their providers as having a critical role in the use the CDSS-YD, and this had implications for the perceived trustworthiness of the CDSS-YD. Providers reported that clinic productivity metrics would be the primary barrier to CDSS-YD implementation, with the creation of protected time for training, preparation, and use as a key facilitator. Machine learning based CDSSs, if proven effective, have the potential to be widely accepted tools for personalized treatment planning. Successful implementation will require addressing the system-level barrier of having sufficient time and energy to integrate it into practice.

Perceived Barriers of Clinical Roles Towards Intensive Care Unit Mobility.

Background: There is overwhelming evidence of improved patient outcomes as a result of early mobilization in the intensive care unit (ICU). However, several barriers of ICU mobility remain understated with reference to clinical roles. The purpose of this study is to investigate the perceived barriers of early mobility of critically ill patients among ICU healthcare providers. Methods: In this cross-sectional study, the Mobilization Attitudes and Beliefs Survey (PMABS-ICU) was administered to ICU healthcare providers using an online survey. The study investigated barriers related to knowledge, attitudes, and behaviors regarding ICU mobility practices. These barriers were compared among different ICU clinical roles. Results: The survey yielded a total number of 214 healthcare providers with 41% female and 59% male. Respiratory therapists reported the highest perceived barriers to ICU mobility (M 39, IQR 36, 43) % compared to physical therapists (who reported the lowest barriers), occupational therapists, nurses, and physicians (p ≤ 0.05). ICU healthcare providers' behavior towards ICU mobility such as perceived benefits and safety is ranked as the primary barrier (M 49, IQR 42, 52) %. Professional experience did not significantly vary among all groups. Conclusion: Our findings highlight that ICU healthcare providers' perceptions, including both potential benefits and safety concerns regarding mobility, are significant barriers to implement mobility practices. ICU mobility barriers should be tackled by providing education and training. A focused effort to include RTs and nurses could advance interdisciplinary ICU mobility practice and reduce associated barriers.

Advances in skin gene therapy: utilizing innovative dressing scaffolds for wound healing, a comprehensive review.

The skin, serving as the body's outermost layer, boasts a vast area and intricate structure, functioning as the primary barrier against external threats. Disruptions in the composition and functionality of the skin can lead to a diverse array of skin conditions, such as wounds, burns, and diabetic ulcers, along with inflammatory disorders, infections, and various types of skin cancer. These disorders not only exacerbate concerns regarding skin health and beauty but also have a significant impact on mental well-being. Due to the complexity of these disorders, conventional treatments often prove insufficient, necessitating the exploration of new therapeutic approaches. Researchers develop new therapies by deciphering these intricacies and gaining a thorough understanding of the protein networks and molecular processes in skin. A new window of opportunity has opened up for improving wound healing processes because of recent advancements in skin gene therapy. To enhance skin regeneration and healing, this extensive review investigates the use of novel dressing scaffolds in conjunction with gene therapy approaches. Scaffolds that do double duty as wound protectors and vectors for therapeutic gene delivery are being developed using innovative biomaterials. To improve cellular responses and speed healing, these state-of-the-art scaffolds allow for the targeted delivery and sustained release of genetic material. The most recent developments in gene therapy techniques include RNA interference, CRISPR-based gene editing, and the utilization of viral and non-viral vectors in conjunction with scaffolds, which were reviewed here to overcome skin disorders and wound complications. In the future, there will be rare chances to develop custom methods for skin health care thanks to the combination of modern technology and collaboration among disciplines.

Understanding Barriers to Establishing Public JYNNEOS Mpox Vaccination Clinics in New Hampshire: Mpox vaccine clinic NH.

2022 - 2023 mpox outbreak necessitated rapid distribution of JYNNEOS vaccines from US Strategic National Stockpile to state and local public health agencies. New Hampshire's centralized public health structure required partnering with healthcare facilities to reach at-risk persons. Among the 67 organizations contacted to partner with, only 7 established public JYNNEOS vaccine clinics. The study objective was to identify barriers and resources needed for emergency public vaccination. In March 2023, mixed-method surveys were developed and sent to 20 non-participating organizations and 7 participating organizations ("vaccine-partners"). 35% (7/20) of non-participating organizations and 100% (7/7) vaccine-partners responded. Non-participating organizations (n = 5) identified lack of staffing (100%) and insufficient provider time or clinical resources (80%) as the most common barriers. Staffing needs reported by non-participating organizations included: administrative (100%); medical doctor or advanced practice practitioner (67%); and registered nurse, medical assistant, or licensed nursing assistant (67%). Vaccine partners reported similar staffing requirements. Estimated additional monthly funding needs were $3,750 for non-participating organizations and $1,680 for vaccine-partners. A minority of NH healthcare facilities established public JYNNEOS vaccination clinics. The primary barrier was insufficient staffing; additional resources and funding needs were modest. Success of the next emergency vaccination campaign depends on sustained advocacy, resources, and partnership.

Factors contributing in non-adherence to inhaler therapy among patients with obstructive airway diseases in a tertiary care setting

Medication adherence is crucial for managing respiratory conditions effectively. This study aimed to explore the multifaceted factors influencing medication adherence among patients with respiratory illnesses. A comprehensive analysis was conducted, focusing on patient demographics, characteristics, clinical factors, beliefs about medications, and reasons for irregular medication use. A cross-sectional design assessed medication adherence and beliefs in COPD patients through questionnaires. The study identified a middle-aged population (average age: 48.5 years) with high smoking prevalence, aligning with established COPD risk factors. Medication adherence scores indicated moderate levels (average ARMS score: 62.7), but with significant individual variation. Financial burden emerged as the primary barrier, with nearly 28% of participants reporting cost-related non-adherence, particularly impacting lower socioeconomic status (SES) patients. Social stigma regarding respiratory illness, a novel factor, influenced adherence, especially in urban areas (19.8% reported experiencing stigma). The study found a positive correlation between positive medication beliefs and adherence, highlighting the importance of fostering trust in treatment effectiveness. Additionally, a confirmed COPD diagnosis and specific inhaler devices (DPI, PMDI with spacer) were linked to improved adherence. This study identified significant factors impacting medication adherence in COPD, including financial constraints, social stigma, medication beliefs, and inhaler device type.

Patients' and Care Providers' Reported Barriers and Suggestions for Improving HIV Viral Load Testing in Tanzania: A Qualitative Study in Dar es Salaam.

The study explores barriers and suggestions for improving viral load testing (VLT) uptake in Tanzania, revealing that only 58% of patients receive VLT annually, contrary to the Tanzanian National Guidelines toward the 95-95-95 UNAIDS targets. Twelve individual interviews and three patient-focus groups were conducted as part of a qualitative study conducted in six human immunodeficiency virus (HIV) clinics in Dar es Salaam to identify potential suggestions for access enhancement, as well as barriers to VLT uptake. Using King's theory of goal attainment, we found that missing appointments was the primary individual barrier to VLT uptake, along with limited knowledge among individuals living with HIV. Participants also face system-level barriers, such as a lack of integrated care and evening service availability. The study suggests that, despite challenges, there is potential for improvement in the uptake and quality of VLT services in Tanzanian public health facilities through a holistic approach.

Original Research: Predictors of COVID-19 Vaccine Hesitancy Among Asian Indians in the United States: A Cross-Sectional Descriptive Study.

Although COVID-19 is a highly infectious disease, vaccine hesitancy remains a primary barrier to attaining full population inoculation. Numerous factors related to vaccine hesitancy have been identified. The aim of this study was to explore associations between select demographic variables and COVID-19 vaccine hesitancy among Asian Indians in the United States. The study used a cross-sectional, descriptive, correlational design. The sample consisted of 363 Asian Indians living in the United States who were 18 years of age or older and were literate in English. Vaccine hesitancy was assessed using an online survey. Both descriptive and inferential statistical analyses were conducted. Inferential tests included t tests, regression analyses, and analysis of variance (ANOVA) tests. As participant age increased, there was a statistically significant proportionate increase in the total vaccine hesitancy score ( P = 0.01). There were also statistically significant differences in the vaccine hesitancy scores of participants with no more than a high school degree compared to those with associate or bachelor's degrees, although this finding was based on just six participants. Although most participants had already been vaccinated, many identified reasons for feeling some degree of vaccine hesitancy. The reasons for vaccine hesitancy vary by individual and are often complex. The results of this study will help guide public health agencies and health care personnel in developing vaccination strategies tailored to the specific requirements of Asian Indians in the United States, which could reduce vaccine hesitancy in this population.

Histochemical and morphological evaluation of a glyoxal acid-free fixative

ABSTRACT The application of most chemical fixatives, such as formalin, in the anatomic pathology laboratory requires safety training and hazardous chemical monitoring due to the toxicity and health risks associated with their use. Consequently, the use of formalin has been banned in most applications in Europe; the primary exception is its use in the histology laboratory in lieu of a suitable and safer alternative. Glyoxal based solutions, several of which are available commercially, are the most promising alternative fixatives, because they are based on a mechanism of fixation similar to that of formalin. Unlike formalin, however, glyoxal based solutions do not dissociate from water and therefore do not require ventilation measures such as a fume hood. A primary barrier to the adoption of commercially available glyoxal based solutions is their low pH, which can produce undesirable morphological and antigenic tissue alterations; however, a recently available neutral pH glyoxal product (glyoxal acid free) (GAF) has been developed to mitigate the challenges of low pH. We compared the morphology and histochemistry among tissues fixed in 10% neutral buffered formalin, a commercially available acidic glyoxal product (Prefer), and GAF. Tissues fixed in formalin and Prefer exhibited similar morphology and staining properties; tissues fixed with 2% GAF exhibited deleterious effects.

Virtual Neuromuscular Training Among Physically Active Young Adults: A Feasibility Study.

Evidence indicates a 2 to 3 times increased risk of musculoskeletal injury after return to play from concussion. Undetected neuromuscular control deficits at return to play may relate to increased musculoskeletal injury risk. Rehabilitation to improve neuromuscular control may benefit patients with concussion, but access to rehabilitation professionals and/or poor adherence may limit efficacy. Our purpose was to determine the feasibility of an 8-week virtual neuromuscular training (NMT) program administered through a novel smartphone application among physically active, uninjured adults. Feasibility trial. Participants were instructed to complete an NMT program administered via a smartphone application and returned for follow-up questionnaires 8weeks later. They were instructed to complete 3 asynchronous self-guided workouts per week during the 8-week intervention period. Workouts included balance, plyometrics, strengthening, and dual-task exercises. The application provided instructions for each exercise using video, text, and audio descriptions. Our primary feasibility measure was participant adherence, calculated as the percentage of workouts completed out of the total possible 24 workouts. We recorded the average duration of each workout using start/stop/advance features within the application. Twenty participants were enrolled, of which 15 (age = 26.3 [2.7]y, 67% female) returned for follow-up (75% retention). Participant adherence was 57.2% (25.0%; range: 16.7%-91.7%). Participants spent 17.3 (8.0)minutes per workout (range: 7.4-37.9min). There were no adverse reactions or injuries. Most participants (60%) reported time availability as a primary barrier to intervention completion. Participants were moderately (>50%) adherent to a virtual NMT program, without any reported injuries. We identified several barriers to participation and pathways for improved adherence in the future. The virtual NMT program completed by uninjured adults provides evidence of its feasibility and future scalability to those with a recent concussion to address neuromuscular control deficits and reduce future injury risk.

Unmet healthcare needs in Southeastern Europe: a systematic review.

This study sought to systematically review the existing literature on self-reported unmet healthcare needs in Southeastern Europe. A systematic literature review of quantitative evidence in English and Bulgarian was performed in July 2023 using the following databases: Medline, Embase and EconLit. Publications were only included if they used self-reported unmet healthcare needs as an indicator of access to healthcare, concerned people living in Albania, Bosnia and Herzegovina, Bulgaria, Greece, Kosovo, Montenegro, Serbia, North Macedonia or Romania and if they were published after 2003. Quality assessment of the included publications was performed using the Appraisal tool for Cross-Sectional Studies (AXIS) tool. Twenty-three publications of varying quality were included in the review. Significantly more evidence was available for Greece, Bulgaria and Romania than for the rest of the region. Data collected through Pan-European surveys were commonly used, but almost half of the studies were only descriptive. Generally, the prevalence of unmet healthcare needs has decreased over the years. Unmet healthcare needs were higher among people of lower socioeconomic and educational status, ethnic minorities and migrants and high cost was consistently identified as the primary barrier to accessing healthcare. Unmet healthcare needs are more prevalent among already disadvantaged societal groups. A trend of a declining prevalence of unmet needs has been observed, but it is more notable in the more socioeconomically developed countries. Improving financial protection should be a priority for the healthcare systems.

Characteristics and Challenges of Providing Acupuncture and Chinese Herbal Medicine in Oncology Treatment: Report of Survey Data and Experience of Five Unique Clinical Settings.

Acupuncture is an integrative therapy with strong evidence to support its use in the oncology setting, yet barriers exist for implementation into conventional medical clinics. Though acupuncture is recommended in clinical practice guidelines for oncology, there is little data in the literature showing how acupuncture and other related therapies, including herbal medicine are successfully implemented in some oncology clinics, while others experience barriers to care. To characterize the current use of acupuncture (ACU) and herbal medicine (HM) in oncology clinics, we collected general demographic and usage data from 5 example clinics. In addition, to better understand the barriers faced by ACU and HM clinics in implementing acupuncture as a treatment modality, a survey was deployed to 2320 members of the Society for Integrative Oncology. This article examines the characteristics of oncology settings around the world, and shares data from the survey on the use of these therapies in the field of oncology. The primary barrier to acupuncture care, as reported by providers, was cost. With just under 70% of the oncologists reporting it as the most important obstacle. Additional barriers to implementation included concerns about competency and training, accessibility and safety of herbal medicine during treatment. Though acupuncture is being incorporated into more conventional oncology settings, organized strategies for implementation involving payers and policymakers is needed.

Pericytes Enrich the Basement Membrane and Reduce Neutrophil Transmigration in an InVitro Model of Peripheral Inflammation at the Blood-Brain Barrier.

Sepsis is the most lethal and expensive condition treated in intensive care units. Sepsis survivors frequently suffer long-term cognitive impairment, which has been linked to the breakdown of the blood-brain barrier (BBB) during a sepsis-associated "cytokine storm". Because animal models poorly recapitulate sepsis pathophysiology, human models are needed to understand sepsis-associated brain injury and to develop novel therapeutic strategies. With the concurrent emergence of tissue chip technologies and the maturation of protocols for human induced pluripotent stem cell (hiPSC), we can now develop advanced invitro models of the human BBB and immune system to understand the relationship between systemic inflammation and brain injury. Here, we present a BBB model of the primary barrier developed on the μSiM (microphysiological system enabled by an ultrathin silicon nanomembrane) tissue chip platform. The model features isogenically matched hiPSC-derived extended endothelial culture method brain microvascular endothelial cell-like cells (EECM-BMEC-like cells) and brain pericyte-like cells (BPLCs) in a back-to-back coculture separated by the ultrathin (100 nm) membrane. Both endothelial monocultures and cocultures with pericytes responded to sepsis-like stimuli, with increased small-molecule permeability, although no differences were detected between culture conditions. Conversely, BPLC coculture reduced the number of neutrophils that crossed the EECM-BMEC-like cell monolayer under sepsis-like stimulation. Interestingly, this barrier protection was not seen when the stimulus originated from the tissue side. Our studies are consistent with the reported role for pericytes in regulating leukocyte trafficking during sepsis but indicate that EECM-BMEC-like cells alone are sufficient to maintain the restrictive small-molecule permeability of the BBB.

PERFIL DE EGRESSOS DE PSICOLOGIA DE UMA UNIVERSIDADE DO INTERIOR CEARENSE

ABSTRACT The purpose of this study was to examine the demographic and professional characteristics of Psychology graduates from the Federal University of Ceará’s Sobral campus. Conducted via a self-administered questionnaire with 157 respondents, the survey found that a predominant number of participants were female, aged 20 to 30 years. Data analysis was performed using IBM SPSS software (version 22), generating descriptive statistics. Results indicated that most graduates originated from and resided within the Sobral/Ibiapaba macro-region, with a significant number employed as psychologists, particularly in clinical practice. The primary barrier to job market entry identified was limited professional experience. This study suggests that the decentralization of higher education contributes to social inclusion, promoting both access to education and the retention of professionals in less urbanized areas.

An initial study on common concrete, titanium dioxide and tungsten dioxide for shielding of a standard external photon beam radiotherapy room

High-energy ionizing radiations have several applications including the treatment of various types of cancer. Advanced techniques such as IMRT (Intensity Modulated Radiation Therapy) and VMAT (Volumetric Modulated Arc Therapy) using high-energy photon beams have been largely used for radiation therapy of cancer. An important issue in radiotherapy is the evaluation of the shielding of the walls of the facility room housing a linear accelerator that produces high-energy photon beams. In this study we performed an estimation of the thicknesses of a standard radiotherapy room considering three different materials: common concrete, titanium dioxide (TiO2) and tungsten dioxide (WO2). It is assumed that patients are treated with photon beams of energies varying from 4 to 30 MeV and considering two types of treatments, only conventional and conventional plus IMRT and VMAT treatment. Results have shown an overall growth of thicknesses with energy, workload, area and type of treatment. At 1,000 Gy/week and 30 MeV photon energy the primary barrier thickness using concrete as the shielding material showed to be substantially higher as compared to TiO2 (143%) and WO2 (1,360%). Results have also indicated an overall linear increasing of volumes with the area used to construct the facility room.

Enabling novel paradigms: a biological questions-based approach to human chemical hazard and drug safety assessment.

Throughput needs, costs of time and resources, and concerns about the use of animals in hazard and safety assessment studies are fueling a growing interest in adopting new approach methodologies for use in product development and risk assessment. However, current efforts to define "next-generation risk assessment" vary considerably across commercial and regulatory sectors, and an a priori definition of the biological scope of data needed to assess hazards is generally lacking. We propose that the absence of clearly defined questions that can be answered during hazard assessment is the primary barrier to the generation of a paradigm flexible enough to be used across varying product development and approval decision contexts. Herein, we propose a biological questions-based approach (BQBA) for hazard and safety assessment to facilitate fit-for-purpose method selection and more efficient evidence-based decision-making. The key pillars of this novel approach are bioavailability, bioactivity, adversity, and susceptibility. This BQBA is compared with current hazard approaches and is applied in scenarios of varying pathobiological understanding and/or regulatory testing requirements. To further define the paradigm and key questions that allow better prediction and characterization of human health hazard, a multidisciplinary collaboration among stakeholder groups should be initiated.

SUSTAINABILITY OF CARE COORDINATION FOR PEOPLE WITH DEMENTIA WHO LIVE ALONE: LESSONS FROM A FEDERAL GRANT PROGRAM

Abstract Approximately one-third of older adults with dementia or cognitive impairment in the US live alone. People living alone with dementia (PLAWD) are at high risk for undesirable outcomes including malnutrition and falls, and the absence of cohabitants—who typically coordinate care—can contribute to unnecessary hospitalization and institutionalization. Since 2014, the Administration for Community Living (ACL) within the US Department of Health and Human Services has required PLAWD-focused services in ACL’s Alzheimer’s Disease Program Initiative. As part of a larger study of PLAWD-focused service sustainability, we examined ACL project final reports (n=73) to describe care coordination services for PLAWD and their sustainability plans. We excluded projects without services for PLAWD (n=14) or care coordination services (n=29) and where the lead organization closed (n=2) or project director died (n=1). Of 27 project reports indicating PLAWD-focused services and care coordination services, most were community-based organizations (CBOs, 67%); others were health systems/medical centers (15%), universities (11%), and government agencies (7%). PLAWD-focused care coordination services commonly entailed identifying PLAWD, assessing their needs, developing care plans, connecting PLAWD to need-relevant services, and purchasing supportive equipment, and sometimes involved training volunteers. Most organizations (70%) planned to sustain PLAWD services. The primary sustainability barrier faced by CBOs was lack of funding, whereas for health systems and universities partnering with CBOs was key to sustainability. This review of ACL-supported care coordination services for PLAWD and their sustainability highlights the need for research on the effectiveness of care coordination services for PLAWD and of different approaches to service sustainability.

Public Acceptance of Water Reuse: Barriers and Facilitators in Yazd, Iran, in 2020

Introduction: Droughts and precipitation imbalances in various parts of the world have underscored the significance of alternative water resources. In recent years, recycled water has emerged as a viable alternative, with wastewater being treated to a safe level for diverse purposes. However, the public acceptance of water reuse plays a pivotal role in determining the success of recycling initiatives. This study aims to identify the barriers and facilitators influencing public acceptance of water reuse in Yazd, Iran, during 2020.
 Material and Methods: A descriptive cross-sectional study involving 384 individuals in Yazd city during 2020 was conducted. Participants were selected using the stratified sampling method. The data collection tool consisted of a researcher-made questionnaire, and the collected data were analyzed using descriptive statistics and the Pearson correlation test in SPSS software version 23.
 Results: The most crucial facilitator for acceptance was the concept of segregating drinking water and recycled water networks. The primary barrier to acceptance was the perceived risk of recycled water contamination and potential health hazards. Water reuse was most widely accepted for construction purposes, followed by toilet flush tanks and irrigation of green spaces in parks and sports fields. A positive correlation (r = 0.416) existed between facilitators and acceptance of water reuse, indicating that enhancing facilitators positively affected acceptance.
 Conclusion: To successfully implement water reuse projects, it is essential to consider key facilitators such as segregated water systems for different household uses, raising public awareness about the benefits of water reuse, and building public trust in recycled water safety.