Research Team Research Articles

Reorientación comunitaria de la atención primaria en un área de salud: proyecto ROCAP

AimEvaluate the effectiveness of an intervention to incorporate group and community activities on a sustained basis in all the Basic Health Zones (ZBS) of a health area. DesignDuring January and February 2019, two members of the research team traveled to each ZBS to interview the medical and nursing coordinators who had previously received an ad hoc initial assessment questionnaire (QAI) by email. PlaceThe scope is the 11 ZBS of a health area. ParticipantsThe study population is the ZBS and the respective teams represented by the medical and nursing coordinations. InterventionsPromote a community health commission, carry out training actions, record activities in clinical history and incorporate management objectives. Main measurementsQuantitative and qualitative analysis was carried out pre and post after the first year of intervention. ResultsIn the pre-evaluation: 6 primary care teams (EAP) reported having group activities, 4 were participating in local action projects, 4 had a professional referent for community activities, 3 participated in projects with populations in vulnerable situations and 4 stated have specific meetings on community health. After the intervention: 11 EAPs had group activities, 8 had a reference professional, 6 were participating in local action projects, 4 collaborated in projects with vulnerable populations and 5 held meetings on community health. ConclusionsThe intervention proved effective after its first year of implementation, since all the EAPs carried out group activities and collaborated with the local councils in the area; the majority had leading professionals in community care and, to a lesser extent, participation in local action projects and in vulnerable populations increased.

Compassion fatigue in palliative care: Exploring Its comprehensive impact on geriatric nursing well-being and care quality in end-of-life

BackgroundThis study examines the experiences of geriatric nurses in palliative care. It aims to understand how these experiences influence their well-being and the quality of care. MethodsConducted in the Alahsa region of Saudi Arabia, the study employs qualitative methods, utilizing in-depth interviews with 12 geriatric nurses. The analysis employs a thematic approach, enriched by iterative reflections within a multidisciplinary research team. ResultsThe analysis reveals main themes: 1) the deep emotional connections between nurses and their patients; 2) the challenges faced, including compassion fatigue, high patient mortality, and communication hurdles; 3) the impact of these challenges on the quality of care, highlighting issues like diminished empathy; 4) the coping strategies used by nurses, such as self-care practices and continuous education. ConclusionsThe study concludes that coping strategies, including self-care and ongoing professional development, are vital for sustaining the nurses' well-being and ensuring the continued provision of high-quality care to Older Adults patients.

Increasing Gender Integration inU.S. Marine Corps Recruit Training: Policy Recommendations andRationales From an Interdisciplinary Study.

This article describes alternate models and policy recommendations created by an interdisciplinary team of researchers to increase gender integration at U.S. Marine Corps (USMC) recruit training. The USMC requested a study to analyze current approaches to gender integration at recruit training and provide alternate models that maximize integration, while continuing to train marines to established standards. USMC remains the only service that segregates recruits by gender at the lowest unit level (e.g., platoon) in recruit training and maintains gender-segregated drill instructor teams (i.e., same-gender teams train platoons of same-gender recruits). A mixed-method, interdisciplinary approach was used to capture multiple perspectives and informed recommendations and alternate models for gender integration. The team studied select USMC, army, navy, air force, and coast guard recruit training locations, between June and November 2021. At each site, the team collected qualitative, quantitative, and administrative data as well as physical performance metrics and human performance outcomes. Study participants included recruits, drill instructors, training cadre, service leaders, and subject matter experts on gender integration in military services. Each alternate model was designed to maximize the feasibility of implementation within current USMC training conditions. The research team developed three alternate models and several policy recommendations. Alternate model 1 proposed a methodology for mixed-gender drill instructor teams within the Integrated Company model, USMC's current integrated training model. Alternate model 2 proposed an Integrated Company Plus model which increases the number and types of gender-integrated training events at or below the platoon level within the Integrated Company model. Alternate model 3 outlined an integrated platoon model where recruits fall out into integrated training platoons after their morning routine, with two options of varying integration based on USMC priorities for integration. The team also proposed a set of policy recommendations independent of the three alternate models to support current and future gender integration efforts at the Marine Corps Recruit Depots. Gender-integrated military training has been shown to positively alter perceptions and evaluations of women in military settings over detrimental aspects developed by gender-segregated training. The study team recommended USMC train recruits in the Integrated Company model with mixed-gender drill instructor teams (alternate model 1) and integrate more training events following the priority tiers outlined in the Integrated Company plus model (alternate model 2). The combined execution of these two alternate models would provide USMC recruits increased exposure to direct, sustained training from opposite-gender drill instructors and deliver intentional training opportunities for male and female recruits to work together and interact in meaningful ways. The integrated platoon model (alternate model 3) would offer USMC recruits the most direct exposure to training and working with members of the opposite gender, but it requires substantial changes to current logistics, accountability, and training procedures.

Mathematics teachers and learners as collective agents of change

In this article, we report on findings from the Primary Maths and Social Justice research project, a recent collaboration between the three authors and six teacher researchers from two culturally diverse primary schools in London, UK. The project aimed to develop strategies for addressing issues of social justice in the mathematics classroom, and operationalising the recently developed theoretical concept of socio-mathematical agency, defined as learners’ capacity to apply mathematics in arguing collectively for social change. The teacher researchers’ experiences, as captured through audio recordings of research team meetings and interviews, form the basis of our data analysis. Our findings highlight the processes that enabled teachers to reflect critically on existing practice, prompting them to adopt more collaborative, discursive and inclusive problem-solving approaches that resulted in significantly higher levels of student engagement in mathematical activities. The teacher researchers found that cross-curricular projects provided more opportunities to apply mathematical knowledge in tackling social justice issues than the prescriptive and content-focused mastery-style mathematics schemes of work in place. They reported how students embraced opportunities to use mathematics in more meaningful contexts and in presenting arguments for change. We argue that a focus on developing socio-mathematical agency has the potential to enhance the role of teachers and learners as agents of change, an important element that is often underdeveloped in culturally responsive teaching.

Calculating the social impact of home automation for people with disability: A social return on investment study.

Home automation can deliver important outcomes for people with disabilities, including enhanced independence. Despite the millions of dollars spent on home automation in Australia and other developed nations, to date, there has been no economic evaluation of this type of assistive technology. A social return on investment analysis of home automation study was undertaken. Primary data were collected using qualitative interviews with home automation consumers and other key stakeholders, including occupational therapists, a spinal rehabilitation physician, peer support advocate, and managers and technical personnel from home automation providers (n = 17). The analysis was supported by (1) secondary data from a scoping review on outcomes from home automation and (2) additional literature searches to identify suitable financial proxies and to make estimates of the proportion of home automation users expected to experience each outcome. A scenario approach was used with three home automation scenarios developed with increasing complexity and costs to calculate the social return on investment. Eight outcomes from the use of home automation were identified, including reduced reliance on carers and family members, increased independence, and improved energy and comfort. The social return on investment ranged from $38.80 (low cost) to $15.10 (high cost) for every $1 invested across a 10-year benefit period, with the financial proxy for reduced care attendant hours contributing the most to the social return ratio. Even the highest cost scenario was repaid in social value within the first year of the benefit period. This study suggests that home automation represents a sound investment and has a significant impact on the overall quality of life of people with disabilities. Focusing on the financial savings in care attendant hours alone should be compelling evidence for funders to recognise home automation's value and continue to fund this assistive technology. A consumer representative was a member of the project steering group, which supported the research team at all stages of the project. When people get injured, their disability can stop them doing things around the home that they used to be able to do. Technology can help people with disabilities do things like open and close doors and turn off taps by pressing a button, so they do not have to wait for someone to help them. This technology can be expensive, but no one has looked at if it is worth the money. We spoke to some people with disabilities who used this type of technology, and they told us their lives were better now they used this technology. For example, they told us they were able to do things for themselves, they did not need carers as much, and they had better mental health. We spoke to businesses about the costs of different types of technology that can be used in the home. We then put a dollar value on the ways people with disabilities told us their lives were better. For example, for better mental health, we worked out how much it would cost to see a psychologist for 1 year. We found that the dollar value of the ways in which people with disabilities' lives were improved was at least 15 times more than the costs of the technology. This study therefore shows that this technology is worth the money and improves the lives of people with disabilities following serious injury.

Recruitment and Retention Issues in a Technology-Based Intervention Among Korean American Midlife Women With Depressive Symptoms'.

The number of health technology-based intervention studies has grown significantly. However, issues in the recruitment and retention for such studies, especially of Asian Americans, have rarely been discussed. The purpose of this paper was to discuss issues in the recruitment and retention of a specific group of Asian Americans-Korean American midlife women with depressive symptoms-into a technology-based intervention study using computers and mobile devices with a measurement device and to provide directions for future participant recruitment and retention in technology-based intervention studies. The written memos of research team members and the written records of research team meetings were analyzed using a content analysis. The issues in the recruitment and retention process included (1) low recruitment and retention rates; (2) the perceived long intervention period; (3) strict inclusion/exclusion criteria; (4) concerns related to the use of a measurement device; and (5) the perceived adequacy of monetary incentives. Based on the issues identified in the study, several suggestions are made for future recruitment and retention of racial/ethnic minorities in technology-based intervention studies (eg, appropriate intervention period, innovative and creative motivation strategies, acceptable measurement scales and devices, and adequate monetary reimbursement).

Inclusion, Diversity, Equity and Access: Online Teaching Strategies and Institutional Support

ABSTRACT Research on online teaching and learning has increased however there is still a need for research to focus on inclusion, diversity, equity and access in online teaching and learning. This qualitative case study aims to identify inclusion, diversity, equity and access strategies for design, facilitation, assessment and of online courses. In addition, it also examines the institutional support and policies that currently exist or are needed for online instruction. Twenty one instructors who taught online at a southeastern university were interviewed. Through two rounds of coding and categorizing, the research team identified several themes. For design and facilitation, the emerging IDEA themes included freedom and autonomy, diversity as a course topic, diverse perspectives, flexibility, and building relationships. For assessment and evaluation, the themes that emerged included assessment design, learner participation, soliciting student feedback, evaluation criteria, and instructor commitment. For institutional support and policies, themes that emerged included need for integrated support, and the need for policies and evaluation criteria. The findings from this study have implications for online instructors, instructional designers, administrators, students, and researchers to integrate inclusion, diversity, equity and access effectively in online courses.

Protocol for the development of a tool to map systemic sclerosis pain sources, patterns, and management experiences: a Scleroderma Patient-centered Intervention Network patient-researcher partnership

IntroductionSystemic sclerosis (SSc) is a rare, complex autoimmune rheumatic disease with multiple factors that contribute to pain. People with SSc emphasize the effect pain has on their quality of life, but no studies have systematically examined the frequency and relative importance of different SSc pain sources, patterns of pain from different sources, and pain management experiences. Our objectives are to (1) develop a tool, jointly with researchers, health care providers, and patients, to map sources of pain in SSc, determine patterns of pain from different sources, and understand pain management experiences; and (2) administer the final tool version to participants in the large multinational Scleroderma Patient-centered Intervention Network (SPIN) Cohort.MethodsFirst, we will use validated pain assessment tools as templates to develop an initial version of our pain assessment tool, and we will obtain input from patient advisors to adapt it for SSc. The tool will include questions on pain sources, pain patterns, pain intensity, pain management techniques, and barriers to pain management in SSc. Second, we will conduct nominal group technique sessions with people living with SSc and health care providers who care for people with SSc to further refine the tool. Third, we will conduct individual usability testing sessions with SPIN Cohort participants. Once the tool has been finalized, we will administer it to individuals in the multinational SPIN Cohort, which currently includes over 1,300 active participants from 54 sites in 7 countries. We will perform unsupervised clustering using the KAy-Means for MIxed LArge data (KAMILA) method to identify participant subgroups with similar profiles of pain sources (present or absent) and to evaluate predictors of subgroup membership. We will use latent profile analysis to identify subgroups of participants with similar profiles based on pain intensity scores for each pain source and evaluate predictors.DiscussionOnce completed, our pain assessment tool will allow our team and other researchers to map sources of pain in SSc and to understand pain management experiences of people living with SSc. This knowledge will provide avenues for studies on the pathophysiology of pain in SSc and studies of interventions to improve pain management.

Scientific research entangled in the context of social needs. A practical example of the implementation of the evaluation criterion social impact: original research project Popular Legal Culture

The article addresses the issue of evaluating the scientific activities of universities in Poland and around the world in relation to the new, third evaluation criterion: the qualitatively measured impact of scientific activities on the functioning of society and the economy. The context of the text is a broadly understood critical analysis of universities' policies towards contemporary social problems: exclusion, poverty, helplessness, ignorance of rights and obligations. Social impact, as one of the three criteria for assessing scientific units, has a chance to become a tool for eliminating social inequalities. It is an idea of broadly understood social policy to involve universities in social life. Thanks to the new tasks given to researchers, they have a real chance to improve the world around them and look at local problems and challenges. The text will present the original idea of a research team whose aim is to spread the legal awareness of students of pedagogy and social work, as well as teachers working in schools and social workers working with the socially excluded.

A comparative study between curb-65 and psi/port score as predictors for ICU admission and mortality in community acquired pneumonia patients presenting to a tertiary care hospital

Despite recent advances in clinical medicine, mortality due to CAP has remained relatively the same. Therefore, early recognition for ICU admission plays a pivotal role in management of CAP. PSI/PORT (Pneumonia Severity Index/ Pneumonia Patient Outcome Research Team) score and CURB-65 (Confusion, Uremia, Respiratory rate, BP, Age > 65 years) are the two severity assessment scores that have extensively been used by the clinicians to distinguish between high risk and low risk patients. This study aims at comparing the predictive value of these two scores for ICU admission and mortality. The information required for calculating CURB-65 and PSI was extracted with careful history taking, patient assessment and necessary investigations. Patients with >18 years of age, diagnosed clinically and radiologically with CAP were included in the study.CURB-65 and PSI scores were determined in a total of 131 patients on admission. Based on careful clinical assessment and judgment of treating physician 60 patients were admitted in ICU whereas 71 patients were admitted in medical ward. Out of 60 patients admitted in ICU 23 died. The ability to predict ICU admission was almost similar for PSI/PORT score (AUC 0.9605; 95% CI 0.9277-0.9933) and CURB-65 (AUC 0.9694; 95% CI 0.9368-1.9714). The ability to predict mortality was almost similar for PSI/PORT score (AUC 0.9196; 95% CI 0.8670-0.9722) and CURB-65 (AUC 0.9214 95% CI 0.8696-0.9732). CURB-65 score was found almost similar in predicting ICU admission amongst patients coming with CAP to our hospital when compared to PSI/PORT score and when predicting mortality in patients with community-acquired pneumonia, CURB-65 and PSI/PORT score appear to have comparable specificity and sensitivity. Considering the simplicity, CURB-65 score could be preferred over PSI/PORT score. However, larger studies are required to know the exact Indian scenario. Despite of recent advances in the field of medical science the mortality due to CAP has remained relatively the same. Therefore, early diagnosis and admission to ICU with standard treatment play a pivot role in management of patients with CAP. Two scoring system, PSI/PORT score and CURB-65 score, are widely being used to differentiate between low risk and high risk patients. We undertook this study for comparing the predictive value of these two scores for ICU admission and mortality.

Bio-inspired design of hard-bodied mobile robots based on arthropod morphologies: a 10-year systematic review and bibliometric analysis.

This research presents a 10-year systematic review based on bibliometric analysis of the bio-inspired design of hard-bodied mobile robot mechatronic systems considering the anatomy of arthropods. These are the most diverse group of animals whose flexible biomechanics and adaptable morphology, thus, it can inspire robot development. Papers were reviewed from two international databases (Scopus and Web of Science) and one platform (Aerospace Research Central), then they were classified according to: year of publication (January 2013 to April 2023), arthropod group, published journal, conference proceedings, editorial publisher, research teams, robot classification according to the name of arthropod, limb's locomotion support, number of legs/arms, number of legs/body segments, limb's degrees of freedom, mechanical actuation type, modular system, and environment adaptation. During the screening, more than 33000 works were analyzed. Finally, a total of 174 studies (90 journal-type, 84 conference-type) were selected for in-depth study: Insecta - hexapod (53,8%), Arachnida - octopods (20.7%), Crustacea - decapods (16,1%), and Myriapoda - centipedes and millipedes (9,2%). The study reveals that the most active editorials are the Institute of Electrical and Electronics Engineers Inc., Springer, MDPI, and Elsevier, while the most influential researchers are located in the USA, China, Singapore, and Japan. Most works pertained to spiders, crabs, caterpillars, cockroaches, and centipedes. We conclude that "arthrobotics" research, which merges arthropods and robotics, is constantly growing and includes a high number of relevant studies with findings that can inspire new methods to design biomechatronic systems.

Studying Health and Illness Experience using Linked Data (SHIELD): Empowering customers to donate shopping data for chronic pain research

Introduction & BackgroundChronic pain is considered a priority in healthcare and a threat to well-being across the globe, it is thus crucial to accurately measure the national levels of pain conditions and their impacts on workplace productivity and well-being. Chronic pain has traditionally been studied in isolation with either self-reported survey data or standalone shopping records. The former are limited in scale and can be marred by response biases, while the latter lack ‘ground truths’: what research teams can measure are usually the purchase patterns of pain relief products, but neither the severity nor types of pain conditions. Objectives & ApproachData donation tools offer a novel approach to study chronic pain by linking the two aspects and establish statistical relationships between medicine consumptions and the multiple facets of pain experience. In a survey, we asked participants (N = 953) to share their loyalty card data with us, which is made possible with the data portability tool provided by Tesco (i.e., the largest supermarket chain in the United Kingdom) as part of the General Data Protection Regulation (GDPR). Based on questions adopted from popular inventories used in health research (e.g., EQ5D Health States, ONS4 Well-being, WEMWBS scales), we also asked participants to report the details of their pain conditions, hours of employment, and both general and mental health states. This allowed us to associate chronic pain - both subjective and objective (i.e., reflected by medicine consumption) - with its economic and personal consequences. Data collection was conducted via research panel providers, thus should approximate national representativeness. Relevance to Digital FootprintsThis work links digital footprints data donated by individuals to self-reported survey data, also develops an infrastructure for these data to be collected and safely stored. Conclusions & ImplicationsOne key value of this project is to pioneer a measure of chronic pain that can be applied to transactional records that are much bigger in scale in future analytic works. Our research team has access to an array of different digital footprints data, including longitudinal transactional data provided by a major pharmacy chain (~20 million customers and ~429 million baskets). In order to utilise these data to associate them with regional workplace productivity measures and well-being data released by the Office for National Statistics, a metric must be defined to extract the prevalence of chronic pain from shopping data, which is informed by the patterns found by the data donation project.

An ecological dynamics approach to promote physical literacy and well-being of primary school children: a cluster randomised controlled trial study protocol

BackgroundLittle is known about the impact of an ecological dynamics (ED) intervention (EDI) on primary school children’s physical literacy and well-being in the Hong Kong context. The aim of this...

Clinical research self-efficacy in academic veterinary clinicians in the United States.

Clinical research is a growing part of the academic clinician's job, and documenting areas of low self-efficacy can inform training initiatives. 182 US academic veterinary clinicians. A survey of academic veterinary clinicians was distributed to 31 US institutions. Self-efficacy was assessed with a modified Clinical Research Appraisal Instrument-12. The relationship between research self-efficacy and completion of formal research training and years of experience was evaluated. Respondents were predominantly junior to midcareer faculty. The lowest reported confidence was in performing advanced statistical analyses (3; 0 to 10). Other low-confidence tasks included designing a qualitative methods study (4; 0 to 10), terminating a collaboration that isn't working (5; 0 to 10), describing a funding agency's review/award process (5; 0 to 10), establishing a timeline for a grant application (5; 0 to 10), establishing collaborator and consultant agreements (5; 0 to 10), and asking staff to leave the project team (5; 0 to 10). Completion of a formal research training program was significantly associated with improved self-efficacy in many tasks. Years of experience was also associated, especially in project management and interpersonal interactions. These results highlight the need for targeted training opportunities for academic veterinary clinicians in biostatistical support, qualitative study design methods, and aspects of communication and interpersonal skills that are important for developing and leading effective research teams. Range of confidence suggests that development opportunities in all domains will improve self-efficacy for some clinicians. Future studies should focus on the impact of formal training sessions on various domains of self-efficacy and on targeted mentoring in supporting confidence in more experiential learning domains.

Developing a multimedia patient-reported outcomes measure for low literacy patients with a human-centered design approach.

Almost all patient-reported outcomes measures (PROMs) are text-based, which impedes accurate completion by low and limited literacy patients. Few PROMs are designed or validated to be self-administered, either in clinical or research settings, by patients of all literacy levels. We aimed to adapt the Patient Reported Outcomes Measurement Information System Upper Extremity Short Form (PROMIS-UE) to a multimedia version (mPROMIS-UE) that can be self-administered by hand and upper extremity patients of all literacy levels. Our study in which we applied the Multimedia Adaptation Protocol included seven phases completed in a serial, iterative fashion: planning with our community advisory board; direct observation; discovery interviews with patients, caregivers, and clinic staff; ideation; prototyping; member-checking interviews; and feedback. Direct observations were documented in memos that underwent rapid thematic analysis. Interviews were audio-recorded and documented using analytic memos; a rapid, framework-guided thematic analysis with both inductive and deductive themes was performed. Themes were distilled into design challenges to guide ideation and prototyping that involved our multidisciplinary research team. To assess completeness, credibility, and acceptability we completed additional interviews with member-checking of initial findings and consulted our community advisory board. We conducted 12 hours of observations. We interviewed 17 adult English-speaking participants (12 patients, 3 caregivers, 2 staff) of mixed literacy. Our interviews revealed two distinct user personas and three distinct literacy personas; we developed the mPROMIS-UE with these personas in mind. Themes from interviews were distilled into four broad design challenges surrounding literacy, customizability, convenience, and shame. We identified features (audio, animations, icons, avatars, progress indicator, illustrated response scale) that addressed the design challenges. The last 6 interviews included member-checking; participants felt that the themes, design challenges, and corresponding features resonated with them. These features were synthesized into an mPROMIS-UE prototype that underwent rounds of iterative refinement, the last of which was guided by recommendations from our community advisory board. We successfully adapted the PROMIS-UE to an mPROMIS-UE that addresses the challenges identified by a mixed literacy hand and upper extremity patient cohort. This demonstrates the feasibility of adapting PROMs to multimedia versions. Future research will include back adaptation, usability testing via qualitative evaluation, and psychometric validation of the mPROMIS-UE. A validated mPROMIS-UE will expand clinicians' and investigators' ability to capture patient-reported outcomes in mixed literacy populations.

Development of a web-based patient decision aid for myopia laser correction method

BackgroundIn the context of healthcare centered on the patient, Patient Decision Aids (PtDAs) acts as an essential instrument, promoting shared decision-making (SDM). Considering the prevalent occurrence of myopia, the objective of this study is to furnish exhaustive and easily comprehensible information to assist patients in making well-informed decisions about their options for myopia laser correction.MethodThe research team developed a decision guide for myopia patients considering laser correction, aiming to facilitate informed decisions. The study followed the first four stages of the IPDAS process model: “scope/scoping,” “design,” “prototype development,” and “alpha testing.” Ten semi-structured interviews with patients (n = 6) and corneal specialist ophthalmologists (n = 4) were conducted to understand the challenges in selecting a laser correction method. Online meetings with 4 corneal specialists were held to discuss challenging cases. A comparison table of harms and benefits was created. The initial prototype was developed and uploaded on the internet portal. User feedback on software and text aspects was incorporated into the final web software, which was reviewed by a health education expert for user-friendliness and effectiveness.ResultEducational needs assessment revealed concerns such as pain, daily life activities, return to work, the potential need for glasses (‘number return’), eye prescription stability, and possible complications. These shaped the decision aid tool’s content. Expert consensus was achieved in several areas, with some items added or extended. In areas lacking consensus, comments were added for clarity. Five clients assessed the web app (PDAIN), rating it 46/50 in user-centricity, 47/50 in usability, and 45/50 in accuracy and reliability, totaling 138/150. Post-piloting, software errors were documented and rectified. During the trial phase, five myopic users interacted with the software, leading to modifications. User feedback indicated the tool effectively enhanced understanding and influenced decision-making.ConclusionPDAIN, serves as a facilitative tool in the process of selecting a corneal laser correction method for myopic patients. It enabling Nearsighted patients to make informed decisions.

Study on the evaluation and influencing factors of contracted residents on the coordination of primary medical institutions.

The implementation of family doctor contract service is a pivotal measure to enhance primary medical services and execute the hierarchical diagnosis and treatment system. Achieving service coordination among various institutions is both a fundamental objective and a central element of contract services. The study aims to assess residents' evaluations and determining factors related to the coordination of health services within primary medical institutions across different regions of Shandong Province. The findings intend to serve as a reference for enhancing the coordination services offered by these institutions. The study employed a multi-stage stratified random sampling method to select three prefecture-level cities in Shandong Province with different economic levels. Within each city, three counties (districts) were randomly sampled using the same method. Within each county (district), three community health service centers and township health centers implementing family doctor contract services were selected randomly. Face-to-face questionnaire surveys were conducted with contracted residents using the coordination dimension of the revised Primary Care Assessment Tools Scale (PCAT) developed by the research team. Data analysis was conducted using such methods as one-way analysis of variance and multiple linear regression. The sample included 3,859 contracted residents. The coordination dimension score of primary medical institutions averaged 3.41 ± 0.18, with the referral service sub-dimension scoring 3.60 ± 0.58 and the information system sub-dimension scoring 3.34 ± 0.65. The overall score of the referral service sub-dimension surpassed that of the information system sub-dimension. Regression results indicated that the city's economic status, the type of contracted institutions, gender, education, marital status, income, occupation, health status, and endowment insurance payment status significantly influenced the coordinated service score of primary medical institutions (p < 0.05). The coordination of primary medical institutions in Shandong Province warrants further optimization. Continued efforts should focus on refining the referral system, expediting information infrastructure development, enhancing the service standards of primary medical institutions, and fostering resident trust. These measures aim to advance the implementation of the hierarchical diagnosis and treatment and two-way referral system.

Response of hydrogen charging diffusion of the austenitic stainless steel AISI 310s

The subject of hydrogen embrittlement seems to be more and more up-to-date and needed to be explored. World research teams working on this issue have not developed a clear method of preventing this process. The conclusion is that this issue should be approached individually, depending on the type of material, its structure and operating conditions. The problem will escalate in the near future as a result of the planned replacement of the traditional energy sources used so far with hydrogen energy. The paper presents the method of electrochemical hydrogenation, which reflects the conditions of galvanic coating of metallic materials used in the automotive industry. The aim of the research was to determine the influence of the time of hydrogenation on the properties and microstructure of austenitic steel.

Centering relationships to place for more meaningful research and engagement

Research has the potential to simultaneously generate new knowledge and contribute meaningful social–ecological benefits; however, research processes and outcomes can also perpetuate extractive patterns that have manifested the climate, biodiversity, and social justice crises. One approach to enhance the societal value of research processes is to strengthen relationships with places of study and the peoples of those places. Deepening relational engagement with the social–ecological context and history of a place can lead to more accurate results and improved public trust in the scientific process and is particularly important for natural scientists who work at the interface of nature and society. We provide three actionable pathways that range from individual to systemic change to enhance place-based relationships within research systems: 1) deepen reflection and communication about relationships with places and peoples; 2) strengthen collaboration among research teams and partners; and 3) transform systems of knowledge creation to foster place-based roots. Action on any of these proposed pathways, but especially action taken across all three, can build empathy and connections to place and people, strengthening the meaningful impact of research both locally and globally.

Co-production of a systematic review on decision coaching: a mixed methods case study within a review

BackgroundCo-production is a collaborative approach to prepare, plan, conduct, and apply research with those who will use or be impacted by research (knowledge users). Our team of knowledge users and researchers sought to conduct and evaluate co-production of a systematic review on decision coaching.MethodsWe conducted a mixed-methods case study within a review to describe team co-production of a systematic review. We used the Collaborative Research Framework to support an integrated knowledge translation approach to guide a team through the steps in co-production of a systematic review. The team agreed to conduct self-study as a study within a review to learn from belonging to a co-production research team. A core group that includes a patient partner developed and conducted the study within a review. Data sources were surveys and documents. The study coordinator administered surveys to determine participant preferred and actual levels of engagement, experiences, and perceptions. We included frequency counts, content, and document analysis.ResultsWe describe co-production of a systematic review. Of 17 team members, 14 (82%) agreed to study participation and of those 12 (86%) provided data pre- and post-systematic review. Most participants identified as women (n = 9, 75.0%), researchers (n = 7, 58%), trainees (n = 4, 33%), and/or clinicians (n = 2, 17%) with two patient/caregiver partners (17%). The team self-organized study governance with an executive and Steering Committee and agreed on research co-production actions and strategies. Satisfaction for engagement in the 11 systematic review steps ranged from 75 to 92%, with one participant who did not respond to any of the questions (8%) for all. Participants reported positive experiences with team communication processes (n = 12, 100%), collaboration (n = 12, 100%), and negotiation (n = 10–12, 83–100%). Participants perceived the systematic review as co-produced (n = 12, 100%) with collaborative (n = 8, 67%) and engagement activities to characterize co-production (n = 8, 67%). Participants indicated that they would not change the co-production approach (n = 8, 66%). Five participants (42%) reported team logistics challenges and four (33%) were unaware of challenges.ConclusionsOur results indicate that it is feasible to use an integrated knowledge translation approach to conduct a systematic review. We demonstrate the importance of a relational approach to research co-production, and that it is essential to plan and actively support team engagement in the research lifecycle.