Adaptation of solar energy in the Global South: Prospects, challenges and opportunities

The Global South comprising economically disadvantaged regions of the world face various challenges such as limited access to electricity, clean water, industrialization, and food security. Solar energy, as a sustainable and abundant resource, holds great potential to address these challenges. Despite its immense potential, the Global South encounters hurdles related to technology adoption, infrastructure, and financial constraints. This review examines the history, classifications, global statistics, merits, and demerits of solar technology in the Global South. Furthermore, it delves into various applications of solar energy, including extreme environments, residential electricity generation, transportation, and industrial usage in this region. This study concludes by providing new insighths and highlighting the significant role solar energy can play in shaping the future of the Global South if challenges are adequately addressed, and opportunities are embraced.

Navigating the Genetic Frontier for the Integration of Genetic Services into African Healthcare Systems: A scoping review

Background

The integration of genetic services into African healthcare systems is a multifaceted endeavor marked by both obstacles and prospects. This study aims to furnish evidence-based recommendations for policymakers and healthcare entities to facilitate the effective assimilation of genetic services within African healthcare systems.

Methods

Employing a scoping review methodology, we scrutinized peer-reviewed studies spanning from 2003 to 2023, sourced from PubMed, Scopus, and Africa-wide databases. Our analysis drew upon eight pertinent research studies conducted between 2016 and 2023, encompassing diverse genetic topics across six African nations, namely Cameroon, Kenya, Nigeria, Rwanda, South Africa, and Tanzania.

Results

The reviewed studies underscored numerous challenges hindering the implementation of genetic services in African healthcare systems. These obstacles encompassed deficiencies in disease awareness and education, impediments to genetic testing, resource scarcities, ethical quandaries, and issues related to follow-up and retention. Nevertheless, the authors also identified opportunities and strategies conducive to successful integration, emphasizing proactive measures such as community engagement, advocacy, and the fostering of supportive networks.

Conclusion

The integration of genetic services in Africa holds promise for enhancing healthcare outcomes but also poses challenges and opportunities for healthcare and biotechnology enterprises. To address gaps in disease awareness, we advocate for healthcare providers to invest in educational initiatives, forge partnerships with local institutions, and leverage digital platforms. Furthermore, we urge businesses to innovate and devise cost-effective genetic testing models while establishing online forums to promote dialogue and contribute positively to African healthcare.

Drivers of cervical cancer prevention and management in sub-Saharan Africa: a qualitative synthesis of mixed studies

BACKGROUND

Cervical cancer is a public health concern in the sub-Saharan Africa region. Cervical cancer screening is one of the strategies for detecting early precancerous lesions. However, many women have poor access to and utilization of screening services in the region. This review aimed to synthesize evidence on the challenges and opportunities of screening, early detection and  management of cervical cancer in sub-Saharan Africa.

METHODS

We conducted a structured narrative review of studies published in English. We included studies published from 1 January 2013 to mid-2022. Studies were selected following Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Key search terms (detractors and enablers, cervical cancer screening, sub-Saharan Africa) were employed to identify studies from three electronic databases (HINARI, Science Direct, and PubMed). We also conducted searches on Google Scholar to identify relevant grey literatures. A thematic analysis was conducted and themes were identified, then explained using a socio-ecological framework (intrapersonal, interpersonal, organizational, community, policy levels).

RESULTS

We identified 60 studies in the final review. Cervical cancer screening and early detection and management programmes are influenced by drivers at multiple levels. Individual-level drivers included a lack of knowledge about cervical cancer and screening literacy, and a low risk in perception, attitude, susceptibility and perceived fear of test results, as well as sociodemographic characteristics of women. Interpersonal drivers were community embarrassment, women's relationships with health workers, support and encouragement, the presence of peers or relatives to model preventive behaviour, and the mothers' networks with others. At the organizational level, influencing factors were related to providers (cervical cancer screening practice, training, providers' profession type, skill of counselling and sex, expert recommendation and work commitments). At the community level, drivers of cervical cancer screening included stigma, social-cultural norms, social networks and beliefs. System- and policy-level drivers were lack of nearby facilities and geographic remoteness, resource allocation and logistics management, cost of screening, promotion policy, ownership and management, lack of decentralized cancer policy and lack of friendly infrastructure.

CONCLUSIONS

There were several drivers in the implementation of cervical cancer screening programmes at multiple levels. Prevention and management of cervical cancer programmes requires multilevel strategies to be implemented  across the individual level (users), community and organizational levels (providers and community users), and system and policy levels. The design and implementation of policies and programmes need to address the multilevel challenges.

Opportunities and barriers for prehospital emergency medical services research in the Netherlands; results of a mixed-methods consensus study

INTRODUCTION

Quality improvement in prehospital emergency medical services (EMS) can only be achieved by high-quality research and critical appraisal of current practices. This study examines current opportunities and barriers in EMS research in the Netherlands.

METHODS

This mixed-methods consensus study consisted of three phases. The first phase consisted of semi-structured interviews with relevant stakeholders. Thematic analysis of qualitative data derived from these interviews was used to identify main themes, which were subsequently discussed in several online focus groups in the second phase. Output from these discussions was used to shape statements for an online Delphi consensus study among relevant stakeholders in EMS research. Consensus was met if 80% of respondents agreed or disagreed on a particular statement.

RESULTS

Forty-nine stakeholders participated in the study; qualitative thematic analysis of the interviews and focus group discussions identified four main themes: (1) data registration and data sharing, (2) laws and regulations, (3) financial aspects and funding, and (4) organization and culture. Qualitative data from the first two phases of the study were used to construct 33 statements for an online Delphi study. Consensus was reached on 21 (64%) statements. Eleven (52%) of these statements pertained to the storage and use of EMS patient data.

CONCLUSION

Barriers for prehospital EMS research in the Netherlands include issues regarding the use of patient data, privacy and legislation, funding and research culture in EMS organizations. Opportunities to increase scientific productivity in EMS research include the development of a national strategy for EMS data and the incorporation of EMS topics in research agendas of national medical professional associations.

A rapid review of opportunities and challenges in the implementation of social prescription interventions for addressing the unmet needs of individuals living with long-term chronic conditions

BACKGROUND

People with long-term chronic conditions often struggle to access and navigate complex health and social services. Social prescription (SP) interventions, a patient-centred approach, help individuals identify their holistic needs and increase access to non-clinical resources, thus leading to improved health and well-being. This review explores existing SP interventions for people with long-term chronic conditions and identifies the opportunities and challenges of implementing them in primary healthcare settings.

METHODS

This rapid review followed the Preferred Reporting Items for Systematic Review and Meta-analysis guidelines and searched relevant articles in three databases (PubMed/MEDLINE, EMBASE, and Web of Science) by using subject headings and keywords combined with Boolean operators. The search encompassed articles published between January 2010 and June 2023. Two authors independently conducted study screening and data abstraction using predefined criteria. A descriptive synthesis process using content analysis was performed to summarise the literature.

RESULTS

Fifteen studies were included, with all but one conducted in the United Kingdom, and revealed that social prescribers help guide patients with long-term chronic conditions to various local initiatives related to health and social needs. Effective implementation of SP interventions relies on building strong relationships between social prescribers and patients, characterised by trust, empathy, and effective communication. A holistic approach to addressing the unmet needs of people with long-term chronic conditions, digital technology utilisation, competent social prescribers, collaborative healthcare partnerships, clinical leadership, and access to local resources are all vital components of successful SP intervention. However, the implementation of SP interventions faces numerous challenges, including accessibility and utilisation barriers, communication gaps, staffing issues, an unsupportive work environment, inadequate training, lack of awareness, time management struggles, coordination and collaboration difficulties, and resource constraints.

CONCLUSION

The present review emphasises the importance of addressing the holistic needs of people with long-term chronic conditions through collaboration and coordination, training of social prescribers, community connections, availability of local resources, and primary care leadership to ensure successful interventions, ultimately leading to improved patient health and well-being outcomes. This study calls for the need to develop or utilise appropriate tools that can capture people's holistic needs, as well as an implementation framework to guide future contextual SP interventions.

Access to oncology care in Mali: a qualitative study on breast cancer

BACKGROUND

Breast cancer is the most common cancer in terms of incidence and mortality among women worldwide, including in Africa, and a rapid increase in the number of new cases of breast cancer has recently been observed in sub-Saharan Africa. Oncology is a relatively new discipline in many West African countries, particularly Mali; thus, little is known about the current state of cancer care infrastructure and oncology practices in these countries.

METHODS

To describe the challenges related to access to oncology care in Mali, we used a qualitative approach, following the Consolidated Criteria for Reporting Qualitative Research (COREQ). Thirty-eight semistructured interviews were conducted with health professionals treating cancer in Mali (n = 10), women with breast cancer (n = 25), and representatives of associations (n = 3), and 40 participant observations were conducted in an oncology unit in Bamako. We used the theoretical framework on access to health care developed by Levesque et al. a posteriori to organise and analyse the data collected.

RESULTS

Access to oncology care is partly limited by the current state of Mali's health infrastructure (technical platform failures, repeated strikes in university hospitals, incomplete free health care and the unavailability of medicines) and exacerbated by the security crisis that has been occurring the country since 2012. The lack of specialist doctors, combined with limited screening campaigns and a centralised and fragmented technical platform in Bamako, is particularly detrimental to breast cancer treatment. Women's lack of awareness, lack of information throughout the treatment process, stereotypes and opposition to amputations all play a significant role in their ability to seek and access quality care, leading some women to therapeutically wander and others to want to leave Mali. It also leaves them in debt and jeopardises the future of their children. However, the high level of trust in doctors, the involvement of international actors, the level of social support and the growing influence of civil society on the issue of cancer also represent great current opportunities to fight cancer in Mali.

CONCLUSION

Despite the efforts of successive Malian governments and the commitment of international actors, the provision of health care is still limited in the country, entrenching global inequalities in women's bodies.

Master's degree in sexual and reproductive health: enhancing career development opportunities for midwives in Mali

BACKGROUND

Midwives' contribution to improving outcomes for women and newborns depends on factors such as quality of pre-service training, access to continuing professional development, and the presence of an enabling work environment. The absence of opportunities for career development increases the likelihood that health professionals, including midwives, will consider leaving the profession due to a lack of incentives to sustain and increase motivation to remain in the field. It also limits the opportunities to better contribute to policy, training, and research. This study aimed to assess the influence of a Master in Sexual and Reproductive Health (SRH) at the INFSS on midwives' career progression in Mali.

METHODS

This mixed methods study was conducted using an online questionnaire, semi-structured interviews, and a document review. The study participants included graduates from two cohorts (N = 22) as well as employers, managers, and teachers of the graduates (N = 20). Data were analysed according to research questions, comparing, and contrasting answers between different groups of respondents.

RESULTS

The study revealed that graduates enrolled in the programme primarily to improve their knowledge and skills in management and public health. The graduates' expected roles are those of programme and health project manager and participation in planning and monitoring activities at national or sub-national level. The managers expected the programme to reflect the needs of the health system and equip midwives with skills in management and planning. The Master enhanced opportunities for graduates to advance their career in fields they are not usually working in such as management, research, and supervision. However, the recognition of the master's degree and of the graduates' profile is not yet fully effective.

CONCLUSION

The master's degree in SRH is a capacity building programme. Graduates developed skills and acquired advanced knowledge in research and management, as well as a postgraduate degree. However, the master programme needs to be better aligned with health system needs to increase the recognition of graduates' skills and have a more positive impact on graduates' careers.

Opportunities for standardization in emergency scenarios in the European Union

OBJECTIVE

Despite current standardization actions towards the unification between European Union (EU) countries, there is still much work to do. In this context, this paper aims to offer a comprehensive analysis of the limitations of the EU concerning emergency situations, specifically in cross-border, cross-hierarchical, and cross-sectorial emergencies, as well as the analysis of emergent opportunities for improvement. The final goal of this analysis is to serve as an initial step for pre-standardizing these opportunities.

MATERIALS AND METHODS

This work, performed in the context of the EU H2020 VALKYRIES project, first analyzed existing gaps from three dimensions: technological, procedural, collaboration, and training. Each gap was obtained from the literature, professional experience within VALKYRIES, or a consultation process on EU emergency agencies. This research subsequently obtained a list of opportunities from these limitations, aggregating those opportunities with similarities to ease their study. Then, this work prioritized the opportunities based on their feasibility and positive impact, performing an additional consultation process to EU emergencies for validation. Finally, this investigation provided a roadmap for pre-standardization for the five top-ranked opportunities per dimension.

RESULTS

This paper presents a set of 303 gaps and 255 opportunities across technological, procedural, collaboration, and training dimensions. After clustering the opportunities, this work provides a final set of 82 meta opportunities for improving emergency actions in the EU, prioritized based on their feasibility for adoption and positive impact. Finally, this work documents the roadmaps for three top-ranked opportunities for conciseness.

CONCLUSION

This publication highlights the limitations and opportunities in the EU concerning emergency agencies and, more specifically, those existing in cross-border and multi-casualty incidents. This work concludes that there is still room for improvement despite the current measures toward harmonization and standardization.

Millets: The future crops for the tropics - Status, challenges and future prospects

Millets are small-grained nutritious minor cereal crops that are resistant to different abiotic stresses resulting from climate change. Despite their many benefits, millets have received limited attention in agricultural research, policies, and markets. Considering the importance of millets, recently the government many tropical countries including India and Bangladesh give more emphasis to millets cultivation and improvement. Moreover, Food and Agricultural Organization of the United Nations (FAO) declared 2023 to be the "International Years of Millets". In these connections, a details and updated review of the pros and cons of millets cultivation and its improvement in this region warrant due attention. The review therefore, examines the potential and main barriers to the adoption and promotion of millet cultivation in this region. These include limited research and development efforts, inadequate infrastructure and inputs, weak market linkages and demand, and insufficient awareness and knowledge about millets' nutritional and environmental benefits. This review also highlighted the prospects and strategies for scaling up millet cultivation in this region especially in Bangladesh. These include increasing public and private investment in research and extension services, strengthening farmers' organizations and market linkages, promoting millet-based value chains and products, and integrating millets into nation's food policy. The review concludes that millets might support equitable and sustainable agricultural growth, which would contribute to global food and nutritional security and could help attain the sustainable development goals (SDGs). However, achieving this potential will require concerted efforts from multiple stakeholders, including farmers, researchers and policymakers. The review emphasizes the need for a multi-disciplinary and multi-stakeholder approach that prioritizes innovation, inclusiveness, and sustainability. Lastly, the review highlights more investigation into the socioeconomic, environmental, and nutritional effects of millet production in this region with special emphasis on Bangladesh in order to support evidence-based policies and practices.

"We must help them despite who they are…": healthcare providers' attitudes and perspectives on care for young gay, bisexual and other men who have sex with men in Nairobi, Kenya

BACKGROUND

Compared to young heterosexual men, young gay, bisexual and other men who have sex with men (YMSM) face a disproportionate burden of sexual health conditions. This disparity is occasioned by factors such as criminalization and stigmatization of same-sex practices, YMSM's limited access to non-judgmental and non-discriminatory health services, and challenges associated with healthcare delivery. We explored the attitudes and perspectives of tertiary academic institution-based healthcare providers (HCPs) toward provision of services to YMSM in Nairobi, Kenya.

METHODS

In September 2021, six in-person focus group discussions (FGDs) were held with 36 HCPs drawn from six public tertiary academic institutions within the Nairobi metropolis. HCPs were drawn from six cadres: front office staff, nurses, clinicians, counsellors, laboratory technologists, and pharmaceutical technologists. Discussions were conducted in English, transcribed verbatim and analyzed thematically using NVivo version 12.

RESULTS

Analysis showed that despite expressing disapproval of same-sex practices, HCPs recognized their professional duty to provide care to YMSM, voiced challenges they experienced when providing care to YMSM, and suggested possible strategies for improving care for YMSM. Disapproval of same-sex practices mainly stemmed from HCPs' personal values, societal norms and religious beliefs, though some HCPs identified religious principles such as the golden rule of "treating others as one would want to be treated" as motivation to providing care to YMSM. HCPs did not perceive criminalization of same-sex practices as a barrier to providing care to YMSM. Healthcare delivery challenges included inadequate knowledge and skills, a desire to "convert" YMSM's perceived deviant homosexual to the normative heterosexual orientation, secondary stigma from other HCPs, and healthcare settings that did not support YMSM to disclose same-sex practices. Suggestions for improving care comprised sensitization and training of HCPs, encouraging more HCP-YMSM interaction, providing YMSM-friendly and inclusive services, and advocacy for YMSM services.

CONCLUSION

There is need for interventions to improve HCPs' knowledge of YMSM's health needs, build skills to respond to these needs, and foster affirming attitudes toward same-sex practices. By so doing, YMSM can hopefully be able to access services that meet their needs, and are non-discriminatory, non-stigmatizing and non-judgmental.

Experiences with SARS-CoV-2 (Covid-19) in Trinidad and Tobago, a small island developing state: realities and opportunities

The COVID-19 pandemic has exerted significant global challenges that are expressed in a variety of socio-politico-economic scenarios, depending upon individual countries' preparedness and resilience. The impact COVID-19 in Small Island Developing States (SIDS), most of which are categorized as Lower and Middle-Income Countries, has been pronounced. Furthermore, many of these SIDS possess specific vulnerabilities to global threats. This paper contextualizes the experience of Trinidad and Tobago from some perspectives of geoeconomics, healthcare, and international relations. In many ways, the experience is similar to that of other SIDS with the inherent nuances of a post-colonial world. Trinidad and Tobago was ranked number one by the Oxford University COVID-19 Government Response Tracker (OxCGRT) "Lockdown rollback checklist: Do countries meet WHO recommendations for rolling back lockdown?". Despite the significant political support to combat the disease, by the end of 2022, the country had recorded over four thousand deaths and just over 50% of the population is vaccinated. This paper seeks to discuss the successes and challenges faced by this twin island state.

In Silico Study of Enzymatic Degradation of Bioplastic by Microalgae: An Outlook on Microplastic Environmental Impact Assessment, Challenges, and Opportunities

Microplastics are tiny pieces of non-biodegradable plastic that can take thousands of years to break down. As microplastics degrade, they release harmful compounds into the environment, which can be found in the surroundings. The microplastics found in the environment are hard to detect and remove because of their small particle sizes. Microplastics cannot decompose naturally, so they accumulate in the environment and cause pollution. As a result, bioplastics can be produced from a vast array of substrates, including biopolymers, citrus peels, leather, and feather wastes. Blue-green microalgae namely Arthrospira platensis (spirulina) contains enzymes such as laccase and catalase which can be responsible for the degradation of bioplastics. In our study, we performed molecular docking to identify the binding affinities of different enzymes such as laccase and catalase with different substrates, focusing on determining the most suitable substrate for enhancing enzyme activity for degradation of bioplastics. The analysis revealed that veratryl alcohol is the most suitable substrate for laccase, whereas lignin is the more preferred substrate for catalase with the highest binding affinity score of - 5.9 and - 8.1 kcal/mol. Moreover, degradation, challenges, opportunities, and applications of bioplastics in numerous domains such as cosmetics, electronics, agriculture, medical, textiles, and food industries have also been highlighted.

Applications, opportunities, and challenges in using Telehealth for burn injury management: A systematic review

INTRODUCTION

Burns are global public health devastating and life-threatening injuries. Telehealth can be an appropriate answer for the effective utilization of health care resources, prevention referrals and reduce socio-economic burden of burns injuries. Thus, this study aimed to systematically evaluate the applications, opportunities, and challenges of using telehealth in burn injuries management.

METHODS

A structured search was conducted according to PRISMA statement guidelines in the Web of Science, PubMed, Scopus, and Science Direct as well as the Google Scholar for studies published until June 28, 2022. Of the total 2301 yielded studies, 36 articles were included in the final review. Quality appraisal was done according to the Mixed Methods Appraisal Tool (MMAT) version 2018. Thematic analysis was applied for data analysis.

RESULTS

Patient triage, transfer, and referral (38.9%) follow-up (22%), care (22%), consultation (9%), education (3%), and rehabilitation (3%) were the most prevalent application of telehealth, respectively. Our findings identified 72 unique concepts, eight initial themes, and two clinical and administrative final themes for opportunities of using telehealth in burn injury management. Furthermore, we identified 27 unique concepts, three initial themes, and two clinical and administrative final themes for remaining challenges.

CONCLUSIONS

Despite providing pivotal opportunities such as improving burn injury diagnosis and quality of care, increasing patient and provider satisfaction, and cost containment using telehealth in burn injuries management, the concept faces challenges such as the impossibility of the physical examination of patients and technological difficulties. Our findings provide valuable information for policymakers and decision-makers infield of burn injuries and effective planning for using telehealth technology.

Proceedings from the CIHLMU 2022 Symposium: "Availability of and Access to Quality Data in Health"

Data is an essential tool for valid and reliable healthcare management. Access to high-quality data is critical to ensuring the early identification of problems, the design of appropriate interventions, and the effective implementation and evaluation of health intervention outcomes. During the COVID-19 pandemic, the need for strong information systems and the value of producing high-quality data for timely response and tracking resources and progress have been very evident across countries. The availability of and access to high-quality data at all levels of the health systems of low and middle-income countries is a challenge, which is exacerbated by multiple parallels and poorly integrated data sources, a lack of data-sharing standards and policy frameworks, their weak enforcement, and inadequate skills among those handling data. Completeness, accuracy, integrity, validity, and timeliness are challenges to data availability and use. "Big Data" is a necessity and a challenge in the current complexities of health systems. In transitioning to digital systems with proper data standards and policy frameworks for privacy protection, data literacy, ownership, and data use at all levels of the health system, skill enhancement of the staff is critical. Adequate funding for strengthening routine information systems and periodic surveys and research, and reciprocal partnerships between high-income countries and low- and middle-income countries in data generation and use, should be prioritized by the low- and middle-income countries to foster evidence-based healthcare practices.

Decentralization of Clinical Trials: Opportunities, Risks and Development Paths

The pandemic period represented, from many points of view, an opportunity for the updating of research processes, simplifying paths and highlighting the need to reflect on new ways of designing and organizing clinical trials. Starting from a literature analysis, a multidisciplinary working group composed of clinicians, patient representatives, university professors, researchers and experts in the field of health policy, ethics applied to health, digital health, logistics confronted with respect to the positive aspects, critical issues and risks that decentralization and digitalization can imply for the different target groups. The working group proposed feasibility guidelines of decentralized protocols for Italy, developing reflections that may be relevant also for other European countries.

The Conditional Analysis of the Agentive Modals: a Reply to Mandelkern et al

A proper understanding of agentive modals promises to clarify issues to do with free will, know how, and other philosophically interesting topics. In this paper I identify one constraint on, and one structural feature of, trying-based versions of the conditional analysis of the agentive modals. I suggest that the constraint and structural feature together provide a novel account of why the famous Lehrer-Chisholm objection to conditional analyses of ability modals is so powerful. I argue that Mandelkern et al.'s 'Agentive Modals' (Philosophical Review, 126/3, 301-343, 2017) conditional analysis of the agentive modals fails to avoid this problem. I also identify two further problems for their account. I close by summarising a number of criteria which any successful semantic analysis of the agentive modals should satisfy.

Feeding back of individual genetic results in Botswana: mapping opportunities and challenges

PURPOSE

We explored the views of Botswana stakeholders involved in developing, implementing and applying ethical standards for return of individual study results from genomic research. This allowed for mapping opportunities and challenges regarding actionability requirements that determine whether individual genomic research results should be fed back.

METHODS

Using in-depth interviews, this study explored the views of sixteen (16) stakeholders about the extent, nature and timing of feedback of individual genomic research findings, including incidental findings that arise in the context of African genomics research. Coded data was analyzed through an iterative process of analytic induction to document and interpret themes.

RESULTS

Overall, respondents were of the view that feedback of actionable individual genomic results was an important outcome that could benefit participants. However, a number of themes surfaced that pointed to opportunities and challenges that exist in Botswana that could help in planning for feeding back of individual genomic results that were mapped. Some of the opportunities cited by the respondents included the existence of good governance; democracy and humanitarianism; universal healthcare system; national commitment to science; research and innovation to transform Botswana into a knowledge-based economy; and applicable standard of care which could promote actionability. On the other hand, contextual issues like the requirement for validation of genomic research results in accredited laboratories, high cost of validation of genomic results, and linkage to care, as well as lack of experts like genomic scientists and counselors were considered as challenges for return of individual results.

CONCLUSION

We propose that decisions whether and which genomic results to return take into consideration contextual opportunities and challenges for actionability for return of results in a research setting. This is likely to avoid or minimize ethical issues of justice, equity and harm regarding actionability decisions.

Perspectives of adolescents with disabilities and their parents regarding autonomous decision-making and self-determination

BACKGROUND

Parents' promotion of autonomous decision-making (PADM) is essential for adolescents with disabilities and constitutes the basis for maturation of self-determination (SD). SD develops based on adolescents' capacities and the opportunities offered to them at home and at school, to make personal decisions regarding their life.

AIM

Examine the associations between the PADM and SD of adolescents with disabilities from their own perspective and that of their parents.

METHOD

Sixty-nine adolescents with disabilities and one of their parents completed a self-report questionnaire including PADM and SD scales.

OUTCOMES

The findings showed associations between parents' and adolescents' reports of PADM, and opportunities for SD at home. PADM was associated with capacities for SD among adolescents. Gender differences were also apparent, with both adolescent girls and their parents reporting higher ratings of SD than adolescent boys.

CONCLUSIONS

Parents who promote autonomous decision-making among their adolescent children with disabilities start a virtuous circle by offering greater opportunities for SD within the home. In turn, these adolescents rate their SD as higher, and communicate this perspective to their parents. Consequently, their parents offer them more opportunities for autonomous decision-making at home, thus enhancing their SD.

How to become a pediatric neurosurgeon in Latin America: training opportunities, current status, and future challenges

PURPOSE

To provide an analysis of pediatric neurosurgery educational opportunities in Latin America in order to characterize and evaluate the strengths, weaknesses, and limitations to assume a career in pediatric neurosurgery.

METHODS

An online survey was distributed to pediatric neurosurgeons in Latin America to assess aspects of pediatric neurosurgical education, working conditions, and training opportunities. The survey was open to neurosurgeons that treat pediatric patients, whether or not they had completed fellowship training in pediatrics. A descriptive analysis was done with a subgroup analysis stratified the results among certified pediatric neurosurgeons and non-certified pediatric neurosurgeons.

RESULTS

In total, 106 pediatric neurosurgeons completed the survey, of whose the vast majority completed their training in a Latin American pediatric neurosurgery program. A total of 19 accredited academic programs in pediatric neurosurgery were found in Latin America distributed in 6 different countries. On average, the pediatric neurosurgical training in America Latina has a duration of 278 years, ranging from 1 to > 6 years.

CONCLUSIONS

This study is the first of its kind to review pediatric neurosurgical training in Latin America, in which both pediatric and general neurosurgeons provide neurosurgical care to children in the continent; however, we found that in the majority of the cases, children are treated by certified pediatric neurosurgeons, of whose the vast majority were trained in Latin American programs. On the other hand, we found areas of improvement in the specialty in the continent, including regulation of training opportunities, increased support for funding, and more opportunities for education among all countries.

Oral health providers' views of oral health promotion in Jazan, Saudi Arabia: a qualitative study

BACKGROUND

Oral health promotion (OHP) is a crucial aspect of dental care, as it aims to improve and protect oral health of individuals. This study aimed to qualitatively explore views of oral health providers in Jazan, Saudi Arabia, on their perceptions of their responsibilities for OHP, as well as the barriers and potential opportunities for implementing health promotion in dental practice.

METHODS

A convenience sample of 11 oral health providers from Ministry of Health (MOH) facilities were recruited and participated in virtual one-on-one semi-structured interviews, which were transcribed and analyzed using inductive thematic analysis with N-Vivo software.

RESULTS

The results showed that the providers recognized the significant role and responsibility of OHP in improving oral health. However, several barriers hindered their OHP efforts, including a lack of training, funding, time, and a lack of interest in OHP. Potential opportunities for improvement included increasing recruitment of new oral health providers and educators, developing more training programs for providers and the community, and expanding support in terms of finances and logistics.

CONCLUSION

The findings of the study suggest that oral health providers are aware of OHP, but that both patients and organizations will need to shift their behaviours and perspectives for OHP to be successfully implemented. Further research on OHP in the Kingdom of Saudi Arabia (KSA) is needed to validate these findings.

The needs and opportunities for housing improvement for malaria control in southern Tanzania

BACKGROUND

Malaria disproportionately affects low-income households in rural communities where poor housing is common. Despite evidence that well-constructed and mosquito-proofed houses can reduce malaria risk, housing improvement is rarely included in malaria control toolboxes. This study assessed the need, magnitude, and opportunities for housing improvement to control malaria in rural Tanzania.

METHODS

A mixed-methods study was conducted in 19 villages across four district councils in southern Tanzania. A structured survey was administered to 1292 community members to assess need, perceptions, and opportunities for housing improvement for malaria control. Direct observations of 802 houses and surrounding environments were done to identify the actual needs and opportunities, and to validate the survey findings. A market survey was done to assess availability and cost of resources and services necessary for mosquito-proofing homes. Focus group discussions were conducted with key stakeholders to explore insights on the potential and challenges of housing improvement as a malaria intervention.

RESULTS

Compared to other methods for malaria control, housing improvement was among the best understood and most preferred by community members. Of the 735 survey respondents who needed housing improvements, a majority needed window screening (91.1%), repairs of holes in walls (79.4%), door covers (41.6%), closing of eave spaces (31.2%) and better roofs (19.0%). Community members invested significant efforts to improve their own homes against malaria and other dangers, but these efforts were often slow and delayed due to high costs and limited household incomes. Study participants suggested several mechanisms of support to improve their homes, including government loans and subsidies.

CONCLUSION

Addressing the need for housing improvement is a critical component of malaria control efforts in southern Tanzania. In this study, a majority of the community members surveyed needed modest modifications and had plans to work on those modifications. Without additional support, their efforts were however generally slow; households would take years to sufficiently mosquito-proof their houses. It is, therefore, crucial to bring together the key players across sectors to reduce barriers in malaria-proofing housing in endemic settings. These may include government subsidies or partnerships with businesses to make housing improvement more accessible and affordable to residents.

Affordances as experienced by university faculties during and after the sudden transition to online teaching

The ravaging effect of COVID-19 has been felt in all spheres of life. While countries are easing their restrictions, the remnants of COVID on education remain, with most universities formally embracing online teaching. Faculty have had to deal with this sudden and enduring transition to online teaching. Although some developments have been made with online education, enormous challenges are simultaneously reported in the literature. This mixed-method study aims to assess the essence of a faculty's bionetwork of lived experience after the sudden shift to online teaching due to the pandemic. Affordance theory was used as a theoretical lens to study the benefits, challenges, and opportunities associated with online education during and post-COVID. The study data comes from faculty members at one institution (n = 170) and follow-up interviews with a smaller subset of participants from the same pool (n = 10). Path analysis and mediation analysis revealed significant differences between the participants based on nationality and gender. While the findings supported two hypotheses, the third hypothesis was not supported. Overall, the findings showed both convergence and divergence between the qualitative and quantitative data. The study incorporates recommendations for online teaching, faculty well-being, and further research based on the results.

Opportunities and challenges of virtual reality-based interventions for patients with breast cancer: a systematic review

BACKGROUND

Breast cancer is one of the most common cancers diagnosed worldwide and the second leading cause of death among women. Virtual reality (VR) has many opportunities and challenges for breast cancer patients' rehabilitation and symptom management. The purpose of this systematic review is to look into the benefits and drawbacks of VR interventions for breast cancer patients.

METHODS

A systematic search was conducted on PubMed, Web of Science, Scopus, IEEE, and the Cochrane Library, from inception until February 6, 2022. The inclusion criteria were: (1) original studies without restriction in study design; (2) a study population consisting of patients with breast cancer; (3) any type of VR-based interventions (immersive and non-immersive); and (5) studies published in English. To assess the risk of bias, the Effective Public Health Practice Project (EPHPP) Tool was used.

RESULTS

Eighteen articles were included in this systematic review. The result showed that VR could provide many opportunities for patients with breast cancer, including reducing anxiety, time perception, pain, fatigue, chemotherapy-related symptom distress levels, and depression severity, as well as improvement in the range of motion, strength, and function. Cybersickness symptoms, the weight of headsets and helmets, the quality of the visual image, and the cost of the equipment are some of the challenges in using this technology on these patients.

CONCLUSIONS

The systematic review showed that VR interventions have opportunities and challenges for patients with breast cancer. VR can be effective for rehabilitation and symptom management and is used in different stages of treatment to improve the condition of patients with breast cancer. However, before using it, the researcher should consider its challenges.

Universal Health Coverage in Iran: A Review of Strengths, Weaknesses, Opportunities, and Threats

Background

Universal health coverage (UHC) aims to provide access to basic health services with no financial constraints. In Iran, the major challenges to the implementation of the UHC plan include aggregation and augmentation of resources, something which could threaten the dimension of population coverage and health service delivery. Therefore, this study reviews the strengths and weaknesses of the internal environment as well as the opportunities and threats of the external environment in the UHC plan to help policymakers and decision-makers of the health system.

Methods

In this review study, reputable databases were searched for all the relevant papers on UHC to collect data. After that, the strengths, weaknesses, opportunities and threats (SWOT) analysis was conducted to organize, collect, and analyze data. The SWOT analysis is a process that has 4 components and 2 dimensions. The 4 components are strengths, weaknesses, opportunities, and threats. In fact, strengths and weaknesses are considered internal factors and organizational features, whereas opportunities and threats are considered external factors and environmental features. The listed items were then categorized for clarification and transparency within the framework of the 6 building blocks of the World Health Organization (WHO).

Results

The relevant studies were reviewed to analyze the strengths and weaknesses of internal environments as well as the opportunities and threats of external environments. The necessary points for better planning and policymaking were then presented.

Conclusion

The success of Iran's UHC plan can be guaranteed by regular capacity building, ongoing education, and empowerment of society in addition to improving intersectoral collaboration and acquiring political commitment to develop more effective and more accountable systems matching variable and dynamic health requirements.

Artificial Intelligence Applied to clinical trials: opportunities and challenges

Background

Clinical Trials (CTs) remain the foundation of safe and effective drug development. Given the evolving data-driven and personalized medicine approach in healthcare, it is imperative for companies and regulators to utilize tailored Artificial Intelligence (AI) solutions that enable expeditious and streamlined clinical research. In this paper, we identified opportunities, challenges, and potential implications of AI in CTs.

Methods

Following an extensive search in relevant databases and websites, we gathered publications tackling the use of AI and Machine Learning (ML) in CTs from the past 5 years in the US and Europe, including Regulatory Authorities' documents.

Results

Documented applications of AI commonly concern the oncology field and are mostly being applied in the area of recruitment. Main opportunities discussed aim to create efficiencies across CT activities, including the ability to reduce sample sizes, improve enrollment and conduct faster, more optimized adaptive CTs. While AI is an area of enthusiastic development, the identified challenges are ethical in nature and relate to data availability, standards, and most importantly, lack of regulatory guidance hindering the acceptance of AI tools in drug development. However, future implications are significant and are anticipated to improve the probability of success, reduce trial burden and overall, speed up research and regulatory approval.

Conclusion

The use of AI in CTs is in its relative infancy; however, it is a fast-evolving field. As regulators provide more guidance on the acceptability of AI in specific areas, we anticipate the scope of use to broaden and the volume of implementation to increase rapidly.

Gender Perspectives of Responses to Climate Variability and Change among Farm Households in Southeast Nigeria

It has been argued that gender affects climate change response especially among farming communities yet literature is scant on gender perspectives of response. In recognition of this, the study examined responses with the associated challenges and opportunities across gender in the South East (SE) Nigeria. A mixed research approach including a participatory research approach (PRA), field observation and household questionnaire survey was used to collect data. The survey sample included 300 (150 men and women each) farm household heads from six villages in the region. Data were analyzed and presented using principal component analysis (PCA), non-parametric and descriptive statistics. The study found that men and women-headed households differed in their use of strategies like migration from affected areas and livelihood diversification (p < 0.05). Women have more challenges of insufficient improved farming knowledge than men. The challenges for men were majorly insufficient technologies like mechanization. Components of these challenges include technology, environmental-related challenges among others. Response opportunities for men and women include digital/mobile telecommunications and learning by doing respectively. Compared to men, women had less participation in opportunities for the development of human capital through training (p < 0.05). The study recommends that more opportunities should be provided for the training of farmers especially women on climate change response.

Radiopharmacy in Africa: current status and future directions

This report is a summary of the first SRS-Africa meeting that was held virtually on the 15th of October 2021, to gain information on the status of radiopharmaceutical sciences in Africa. Registration data included information on participants' qualifications and field of work. An independent survey performed in Africa prior to the meeting elicited details of available staff in different countries, facilities and equipment, radionuclides and radiopharmaceuticals used, research undertaken and difficulties experienced. We present here a brief overview of this meeting's topics of discussion, including ongoing research, gaps and challenges, and local opportunities.

Predictors of physical activity promotion in clinical practice: a cross-sectional study among medical doctors

BACKGROUND

Physical activity is a major determinant of physical and mental health. International recommendations identify health professionals as pivotal agents to tackle physical inactivity. This study sought to characterize medical doctors' clinical practices concerning the promotion of patients' physical activity, while also exploring potential predictors of the frequency and content of these practices, including doctors' physical activity level and sedentary behaviours.

METHODS

A cross-sectional study assessed physical activity promotion in clinical practice with a self-report questionnaire delivered through the national medical prescription software (naturalistic survey). Physical activity and sedentary behaviours were estimated using the International Physical Activity Questionnaire (short form). Indicators of medical doctors' attitudes, knowledge, confidence, barriers, and previous training concerning physical activity promotion targeting their patients were also assessed. Multiple regression analysis was performed to identify predictors of physical activity promotion frequency by medical doctors, including sociodemographic, attitudes and knowledge-related variables, and physical activity behaviours as independent variables.

RESULTS

A total of 961 medical doctors working in the Portuguese National Health System participated (59% women, mean age 44 ± 13 years) in the study. The majority of the participants (84.6%) reported to frequently promote patients' physical activity. Five predictors of physical activity promotion frequency emerged from the multiple regression analysis, explaining 17.4% of the dependent variable (p < 0.001): working in primary healthcare settings (p = 0.037), having a medical specialty (p = 0.030), attributing a high degree of relevance to patients' physical activity promotion in healthcare settings (p < 0.001), being approached by patients to address physical activity (p < 0.001), and having higher levels of physical activity (p = 0.001).

CONCLUSIONS

The sample of medical doctors approached reported a high level of engagement with physical activity promotion. Physical activity promotion frequency seems to be influenced by the clinical practice setting, medical career position and specialty, attitudes towards physical activity, and perception of patients´ interest on the topic, as well as medical doctors' own physical activity levels.

Promises and pitfalls in implementation science from the perspective of US-based researchers: learning from a pre-mortem

BACKGROUND

Implementation science is at a sufficiently advanced stage that it is appropriate for the field to reflect on progress thus far in achieving its vision, with a goal of charting a path forward. In this debate, we offer such reflections and report on potential threats that might stymie progress, as well as opportunities to enhance the success and impact of the field, from the perspective of a group of US-based researchers.

MAIN BODY

Ten mid-career extramurally funded US-based researchers completed a "pre-mortem" or a group brainstorming exercise that leverages prospective hindsight to imagine that an event has already occurred and to generate an explanation for it - to reduce the likelihood of a poor outcome. We came to consensus on six key themes related to threats and opportunities for the field: (1) insufficient impact, (2) too much emphasis on being a "legitimate science," (3) re-creation of the evidence-to-practice gap, (4) difficulty balancing accessibility and field coherence, (5) inability to align timelines and priorities with partners, and (6) overly complex implementation strategies and approaches.

CONCLUSION

We submit this debate piece to generate further discussion with other implementation partners as our field continues to develop and evolve. We hope the key opportunities identified will enhance the future of implementation research in the USA and spark discussion across international groups. We will continue to learn with humility about how best to implement with the goal of achieving equitable population health impact at scale.

Challenges and Opportunities in Using Twitter as a Pedagogical Tool in Pathology and Laboratory Medicine Education

OBJECTIVES

Even though the benefits of using Twitter for teaching and information exchange within the pathology community are primarily undisputed, a fair number of users refrain from sharing educational content on this social media platform. The survey aims to identify challenges in using Twitter as a pedagogical tool and discuss ways of converting those challenges into opportunities.

METHODS

We performed a cross-sectional survey-based study involving 174 participants from the pathology community on Twitter.

RESULTS

The results demonstrated that procurement of content was the major challenge faced by 36.2% of the participants, with most participants being concerned or very concerned regarding institutional policies and Health Insurance Portability and Accountability Act issues. Content procurement concerns were followed by social media inertia, stated by 23% of the participants as an obstacle to posting educational content on Twitter.

CONCLUSIONS

The report helps elicit some common obstacles faced by the pathology and laboratory medicine community and allows us to recommend solutions to overcome these obstacles.

Constraints and opportunities of sweet sorghum (Sorghum bicolor L.) silage production and utilisation by smallholder milk production sector in Zimbabwe

The objective of the scoping research was to evaluate the current situation, constraints and opportunities of sweet sorghum (Sorghum bicolor L.) silage production and utilisation by the smallholder dairy farmers in Zimbabwe. Cross sectional surveys were conducted from 61 households of six milk producers' associations (MPAs) in Chipinge, Gokwe, Mutasa, Seke, and Umzingwane districts, which were in different agro-ecological regions of Zimbabwe. Purposive and stratified random sampling was done to select households to administer structured questionnaires so as to collect data on socio-economic characteristics and dairy production. Key informant' interviews, case studies, and focus group discussions were the other data collection tools used. Total MPA dairy herd size mean differed (P < 0.05) in all MPAs averaging 16, ranging from 1 to 41 herd. Mafumise MPA had the least (P < 0.05) dairy herd size (7), whilst Gokwe, Tsonzo, Marirangwe, Claremont, and Umzingwane MPAs, had similar herd sizes (P > 0.05). There were positive (P < 0.001) relations between MPAs by seasonal milk yields, lactation days, calving intervals, dry days for different dairy breeds. Milk yields across MPAs and breeds were seasonally sensitive, being high in the wet season than dry season. All farmers (100%) had access to formal milk markets such as Milk Collection Centres, large dairy processors, and parallel markets. Farmers indicated non preference of sweet sorghum silage by their cattle as well as recurring drought affected their maize silage production. Farmers lacked knowledge on how to improve utilisation of sweet sorghum silage by using yeast, and bacteria and this justifies the need to use these probiotics in mitigating utilisation challenges for sustainable milk production.

Time for African youth in science

Africa is a continent with impressive human and natural resources. Astonishingly, its contribution to the current science is very limited. Here, after addressing impeding issues in research in Africa, we highlight some facts that will certainly encourage youth to engage in science and innovation.

Framework for advancing equity in academic medicine and science: Perspectives from early career female faculty during the COVID-19 pandemic

Early-career female faculty, both physician scientists and basic researchers, have disproportionately experienced negative professional, financial, and personal consequences associated with the novel coronavirus disease 2019 (COVID-19) pandemic. This career phase represents a critical time for establishing a network of mentors and collaborators, demonstrating professional independence, and balancing new teaching, research, and service duties while simultaneously navigating personal and familial responsibilities. Persistent gender inequality perpetuated by adherence to traditional gender roles place early-career women faculty at a further disadvantage. Women in academic medicine and research do not attain promotion, leadership positions, and other established markers of success at the same rate as their male counterparts. This disparity was the impetus for the creation of a Recruitment and Retention action group within the Center for Women in Medicine and Science (CWIMS) at the University of Minnesota Medical School (UMN). This perspective piece is written from the viewpoint of a group of female-identifying early-career faculty participating in a career development program for early-stage and newly appointed faculty at UMN, sponsored by the Recruitment and Retention CWIMS action group and our Office of Faculty Affairs. We describe areas of stress exacerbated by the COVID-19 pandemic: work, financial, and work-life well-being, and propose an adapted diversity, equity and inclusion (DEI) model to guide the response to future challenges within a faculty competency framework. We offer recommendations based on the DEI-competency framework, including opportunities for lasting positive change that can emerge from this challenging moment of our collective history.

The current status, challenges and prospects of using biomass energy in Ethiopia

Despite enormous challenges in accessing sustainable energy supplies and advanced energy technologies, Ethiopia has one of the world's fastest growing economies. The development of renewable energy technology and the building of a green legacy in the country are being prioritized. The total installed capacity for electricity generation in Ethiopia is 4324.3 MW as on October, 2018. Renewable energy accounts for 96.5% of total generation; however, despite the county's enormous biomass energy potential, only 0.58% of power is generated using biomass. Ethiopia has surplus woody biomass, crop residue and animal dung resources which comprise about 141.8 million metric tons of biomass availability per year. At present the exploited potential is about 71.9 million metric tons per year. This review paper provides an in-depth assessment of Ethiopia's biomass energy availability, potential, challenges, and prospects. The findings show that, despite Ethiopia's vast biomass resource potential, the current use of modern energy from biomass is still limited. As a result, this study supports the use of biomass-based alternative energy sources without having a negative impact on the socioeconomic system or jeopardizing food security or the environment. This finding also shows the challenges, opportunities and possible solutions to tackle the problem to expand alternative energy sources. The most effective techniques for producing and utilizing alternate energy sources were also explored. Moreover, some perspectives are given based on the challenges of using efficient energy production and sustainable uses of biomass energy in Ethiopia as it could be also implemented in other developing countries. We believe that the information in this review will shed light on the current and future prospects of biomass energy deployment in Ethiopia.

Challenges in conducting epidemiological field studies evaluating associations between heat stress and renal health among workers in informal sectors: experiences from India

Well-designed Environmental Epidemiological Studies (EES) play a crucial role in quantifying the influence of environmental exposures and their associated risks on health in the wider population. They provide critical research evidence for identifying and developing interventions to avert adverse health consequences from those exposures. However, uncertainty and variability inherent to any field based EES could hinder the nature and magnitude of association between an exposure and health outcome. This is particularly pronounced in resource limited settings and resource-tight research projects. The present study evaluated the association between occupational heat stress and renal health among informal work sectors in India which had some significant challenges. Informal workers exposed to chronic occupational heat stress had significantly higher adverse renal health outcomes than the unexposed workers. Our field challenges included gaining access and permissions to conduct the study, participant recalls bias and attrition, accurately estimating exposures, confounding from causes of both exposure and disease, and to a large extent tight-funding. Though opportunities are abundant, we must ensure field conditions are optimized to attain study objectives. A keen understanding and sensitivity towards the cultural and work settings is essential for successful project completion. Based on our experiences, we provide strategies to adopt to improve fieldwork and provide recommendations to help overcome the field challenges and achieve better results for future EES studies in developing country settings.

Interoperability opportunities and challenges in linking mhealth applications and eRecord systems: Botswana as an exemplar

Background

Significant investments have been made towards the implementation of mHealth applications and eRecord systems globally. However, fragmentation of these technologies remains a big challenge, often unresolved in developing countries. In particular, evidence shows little consideration for linking mHealth applications and eRecord systems. Botswana is a typical developing country in sub-Saharan Africa that has explored mHealth applications, but the solutions are not interoperable with existing eRecord systems. This paper describes Botswana’s eRecord systems interoperability landscape and provides guidance for linking mHealth applications to eRecord systems, both for Botswana and for developing countries using Botswana as an exemplar.

Methods

A survey and interviews of health ICT workers and a review of the Botswana National eHealth Strategy were completed. Perceived interoperability benefits, opportunities and challenges were charted and analysed, and future guidance derived.

Results

Survey and interview responses showed the need for interoperable mHealth applications and eRecord systems within the health sector of Botswana and within the context of the National eHealth Strategy. However, the current Strategy does not address linking mHealth applications to eRecord systems. Across Botswana’s health sectors, global interoperability standards and Application Programming Interfaces are widely used, with some level of interoperability within, but not between, public and private facilities. Further, a mix of open source and commercial eRecord systems utilising relational database systems and similar data formats are supported. Challenges for linking mHealth applications and eRecord systems in Botswana were identified and categorised into themes which led to development of guidance to enhance the National eHealth Strategy.

Conclusion

Interoperability between mHealth applications and eRecord systems is needed and is feasible. Opportunities and challenges for linking mHealth applications to eRecord systems were identified, and future guidance stemming from this insight presented. Findings will aid Botswana, and other developing countries, in resolving the pervasive disconnect between mHealth applications and eRecord systems.

Opportunities and threats to contact lens practice: A global survey perspective

AIM

To understand the views of contact lens (CL) practitioners across the globe regarding what they perceive as opportunities and threats in CL practice.

METHODS

A self-administered anonymised questionnaire, constructed in English and translated in six more languages, was distributed through reputed international professional bodies and academic institutions worldwide. The questionnaire included items on demographic characteristics, type of practice, and questions designed to explore practitioners' perspective on the future of their CL practice over the next five years.

RESULTS

A total of 2408 valid responses were analysed. Multifocal CLs for presbyopia, CLs for myopia control, use of daily disposable (DD) CLs for occasional wear, and biocompatible materials to improve comfort were identified as promising areas of opportunities by practitioners (all 8/10). Respondents from North America, and Europe valued DDCLs for occasional wear moderately more favourable (Median: 9/10 for all) as compared to colleagues in Asia (Median: 8/10, p < 0.001), South America (Median: 8/10, p < 0.01), and Africa (Median: 8/10p < 0.01). Multifocal CLs for presbyopia was perceived as a better opportunity by practitioners in North America and Europe (Median: 9/10 for both), as well as in Australasia (Median: 8/10), in comparison to Asia, Africa, and Middle East (for all Median: 6/10, p < 0.001). Practitioners expressed concerns about the availability of CLs and CL prescriptions online without direct professional involvement (both 9/10).

CONCLUSIONS

Overall, the most appealing opportunities for CL practice growth were identified in occasional use of DD CLs, biocompatible materials to reduce CL discomfort, multifocal CLs for presbyopia correction and management of myopia control with CLs. Lack of regulation in CL sales, especially online, seemed to be a constant threat. The insights from this study can be used to design targeted strategies to enhance CL practice across the globe and in specific geographical areas.

Drivers, opportunities and best practice for sustainability in dentistry: A scoping review

OBJECTIVE

To undertake a comprehensive scoping review of the literature to address the research question 'What is the current state of environmental sustainability in general dental practice?' To provide an effective baseline of data that will consider the drivers, opportunities and recommendations for the implementation of sustainable practice.

DATA & SOURCES

The scoping review was conducted for all published literature in the English language that addresses this topic up to the 31st April 2021. The method of the PRISMA-ScR (PRISMA extension for Scoping Reviews was followed. 128 papers included in this scoping review consisted of: Commentary [Letters, editorials, communication and opinion] (n=39); Research (n=60); Literature reviews (n=25); Reports [Policy and legislation] (n=4). Each included record was analysed for emerging themes that were further classified according to their general relevance. The scoping review is considered over two manuscripts, with this second paper focusing on the opportunities, recommendations and best practice to develop and engage with sustainable practice.

CONCLUSIONS

Drivers, opportunities and recommendations for best practice to achieve environmentally sustainable goals in oral health care: The lack of public and professional awareness is the greatest driver to engage with a positive change of behaviour and attitudes. Awareness through education is key at all levels and this should be the bedrock of future strategies. Reduction in staff and patient commuter travel through a reduction of the incidence of preventable oral diseases, improved patient care logistics and IT. Reducing waste and increase recycling opportunities, especially for SUPs. Engagement with legislation and policy makers. Engagement with key stakeholders across the dental materials/products supply chain for the management of manufacturing, distribution, procurement, clinical use and waste management.

Long axial field of view PET scanners: a road map to implementation and new possibilities

In this contribution, several opportunities and challenges for long axial field of view (LAFOV) PET are described. It is an anthology in which the main issues have been highlighted. A consolidated overview of the camera system implementation, business and financial plan, opportunities and challenges is provided. What the nuclear medicine and molecular imaging community can expect from these new PET/CT scanners is the delivery of more comprehensive information to the clinicians for advancing diagnosis, therapy evaluation and clinical research.

Sustainable intensification of indigenous village chicken production system: matching the genotype with the environment

The multi-purpose indigenous village chickens (IVCs) are kept in low- and middle-income countries. IVCs are hardy and are resilient to disease, hostile environment, global warming, and climate change. The IVCs are a little impacted by anthropogenic effects; consequently, they possess high genetic and phenotypic diversity. Likewise, the genetic structure of IVCs is principally shaped by natural selection, which enables them to accumulate high genetic polymorphism and to adaptively radiate. Regardless of this, the genetic wealth of IVCs has been eroded by indiscriminate crossbreeding. Emerging infectious and non-infectious diseases, flawed assumptions, predation, inadequate nutrition, poorly maintained night enclosures, and underdeveloped market infrastructure, and the overlooked multiple-use values and unique attributes of IVCs have threatened their mere survival. The IVCs lay a few eggs and produce less meat, which cannot meet the growing (existing) demand. However, the demand for IVC products is growing attributable to the flavor and texture of eggs and meat, and they are well-aligned with the subsistence farming system. The several use values and ecosystem services provided by IVCs have been increasingly realized. Enhanced production can be attained through sustainable use of local (genetic) resources and by scaling up and out best practices. Genetic improvement needs to mainly rely upon IVC genetic resources and should have to match the genotype with the environment. Moreover, it has to maintain the genetic polymorphism that has been accumulated for time immemorial to respond to unanticipated changes in the production system and consumers' demand. In this review, enhanced management, selection strategies, and genetic crosses including the crossing of commercial chickens with red junglefowl have been proposed to sustainably intensify the IVC production system.

Challenges and opportunities in developing prospective primary school teachers' affective dispositions: the case of Amhara region, Ethiopia

The purpose of this paper was to investigate the possible opportunities and challenges in developing desirable affective dispositions (DADs) and weakening undesirable affective dispositions (UADs) of primary school prospective teachers in three teacher education colleges (TECs) of Amhara region. To achieve these purposes, a qualitative inquiry research method was used. The data were collected from purposively selected college leaders, teacher educators, and prospective teachers using interview, FGD, and open-ended questionnaire. The data were analyzed qualitatively using thematic analysis supported by frequency count percentage. The results revealed that there are different challenges and opportunities in each of the sample TECs in the process of developing DADs and weakening UADs of prospective teachers. The investigated opportunities and challenges were themed as hidden, societal, and official curriculum-related factors. This implies that prospective teachers’ DAD development and UAD weakening in the sample colleges was the function of these three curriculum forms.

Challenges and opportunities from the COVID-19 pandemic in medical education: a qualitative study

INTRODUCTION

Since the onset of the COVID-19 pandemic, many higher education and health centers have faced challenges. Educational leaders have tried to manage the new situation, but the human infrastructure was not ready for such an event. This study aims to explain the challenges and opportunities of the COVID-19 pandemic for medical education.

METHOD

This qualitative study used conventional content analysis to collect data from face-to-face and semi-structured interviews. The interviews continued until data saturation was reached. The participants were 12 students and 14 faculty members at Shiraz University of Medical Sciences. To ensure data rigor, we used member checks, peer checks and an external observer.

RESULTS

Three main categories and 15 subcategories were extracted. The findings showed that four subcategories, e.g. perception on feasibility of e-learning, standardizing of e-learning, dedicated teaching, and networking and interdisciplinary collaborations, affected the development of medical e-learning. The main opportunities from the COVID-19 pandemic for medical education were classified into five subcategories: attitudes to e-learning and adaptability, preventing students' separation from the educational environment, documentation and monitoring education, take control of own learning, and increasing perceived usefulness. The main challenges were divided into four subcategories, e.g. noncompliance with virtual classroom etiquette, inadequate interactions, time limitations, and infrastructure defects and problems. Finally, participants believed that methods of evaluation in e-learning were more suitable for diagnosis and formative evaluations. Generally, two subcategories were extracted, e.g. formative and summative.

CONCLUSION

Medical schools have necessarily moved towards e-learning to compensate for the interruption in classroom education, such that traditional classes have been replaced with e-learning. These rapid, extensive changes in teaching and learning approaches have consequences for medical schools.

White paper on challenges and opportunities for TB elimination with focus on COVID & Post-COVID era developed through scientific roundtable resolutions at NATCON 2020

A group of TB experts with vast clinical and epidemiological experience were drawn from a pool of doctors, epidemiologists and scientists participating in NATCON 2020 Conference in a closed-door session to discuss, highlight, and prioritize key resolutions that are most pertinent at present to eliminate TB from India and other developing countries in the Covid and post-COVID era. These Scientific experts were non-industry persons who met on 17th December, 2020 and used the prevailing scientific literature along with 2019 Joint Monitoring Mission document as a starting point of the discussion on this specific topic to build an agreement upon the resolutions. After the meeting on the virtual platform, all the attending doctors gave a set of recommendations on rebuilding TB Elimination programme in the Covid and Post-Covid era. Focused scientific roundtable discussion on rebuilding TB Elimination Post-Covid. Develop actionable recommendations for the scientific community and the government leadership to consider in moving forward. To prioritize the recommendations in the categories of Build-Prevent-Detect-Treat.

Challenges and opportunities for quality densitometry in Latin America

Latin America and the Caribbean region account for 8% of the world's total population. Experts from 18 countries were invited to contribute to this article to provide the best available data on the number, types, and quality of densitometry, DXA experts, the local/national incidence and prevalence of osteoporosis and fragility fractures, and other uses and information on the challenges and opportunities for quality densitometry with examples of local initiatives. Osteoporosis is the primary reason for densitometry in our region, which is not a priority for public health in most countries. Access and quality are major challenges, and there is a clear trend to concentrate on densitometry services in the largest cities. Urgent action is needed to face the rapidly increasing burden of osteoporosis in our region, including robust and up to date epidemiology, access to health professionals, and quality densitometry. Health professionals require better access to training, courses, and other activities at a more local or regional level.

Artificial intelligence in healthcare: opportunities and risk for future

OBJECTIVE

This study aimed to find out the opportunity of artificial intelligence (AI) and the risk in health service.

METHOD

A comprehensive literature search was collected from three databases (Web of Science, Google Scholar, and EBSCOhost) to identify articles studied Implementing AI in improving in health services. Two reviewers independently assessed the quality of studies using the Joanna Briggs Institute.

RESULTS

The application will improve diagnostics, prevention, and treatment of patients, increasing cost efficiency and equality and equality in health services. For the challenge, there is no AI adoption in public sector, patients' privacy, patient autonomy rights become problems in AI applications.

CONCLUSIONS

Implementation of AI is needed in the efficiency of health service management as well as making medical decisions. The challenge is facilitating early adoption and ongoing implementation in the health care system, and we consider some of the ethical problem lists faced by AI clinical application.

Pharmacy response to COVID-19: lessons learnt from Canada

When the first wave of COVID-19 hit in March 2020, health care professionals across Canada were challenged to quickly and efficiently adapt to change their work practices in these unprecedented times. Pharmacy professionals, being some of the very few front-line health care workers who remained accessible in person for patients, had to rapidly adopt critical changes in their pharmacies to respond in the best interest of their patients and their pharmacy staff. As challenging and demanding as such changes were, they provided pharmacists with invaluable lessons that would be imperative as the country enters a potentially more dangerous second wave. This article seeks to identify and summarize opportunities for improvement in pharmacy as learnt from the pandemic’s first wave. Such areas include but are not limited to handling of drug shortage and addressing drug hoarding and stockpiling, providing physical and mental support for staff, timing of flu vaccine and COVID-19 screening/testing, collaboration between different health care sites as well as collaboration with patients and with other health care professionals, telemedicine and willingness to adopt innovative ideas, need for more staff training and more precise research to provide accurate information and finally the need for more organizational and workplace support. Learning from what went well and what did not work in the early stages of the pandemic is integral to ensure pharmacy professionals are better prepared to protect themselves and their patients amidst a second and possibly subsequent waves.

Reacting to crises: The COVID-19 impact on biostatistics/epidemiology

Most crises, though difficult and challenging to address, offer opportunities for change and for development of new perspectives or approaches to deal with traditional strategies. The reaction to and the managing of the COVID-19 pandemic has provided a platform for evaluating how we quantify disease prevalence, incidence, time courses and sequellae as well as how well we plan, design, analyze and interpret health care associated data, including clinical trials and electronic medical records and health claims data. Whether the Covid-19 crisis provides opportunities to advance the fields of biostatistics and epidemiology in select ways remains to be seen. This article describes three areas of crises experienced by the author during a career in the regulation of pharmaceutical products and how they were responded to. Some suggestions for potential future opportunities in reaction to the Covid-19 crises are provided.

Identifying opportunities for antimicrobial stewardship through a point prevalence survey in an Indian tertiary-care teaching hospital

OBJECTIVES

Unregulated and inappropriate use of antimicrobial agents has been a major driver of antimicrobial resistance with a dangerous impact on health issues in developing nations. We report an audit of antimicrobial use patterns in a tertiary-care teaching hospital in order to identify opportunities for antimicrobial stewardship.

METHODS

A point prevalence survey was conducted to study the use of ten selected antibiotics in various adult inpatient facilities. Patient characteristics as well as indications and patterns of antibiotic prescription were recorded.

RESULTS

A total of 188 patients received any one of the survey antibiotics, accounting for 43% of patients admitted under the study specialties. Of the 188 patients, 59% were admitted in non-intensive care unit settings. The median (interquartile range) duration of hospitalisation during the survey was 8 (4.75) days. Intra-abdominal infections (75; 40%) and respiratory infections (41; 22%) were the most common reasons for admission. Empirical antibiotic use was observed in 66% of patients. Antimicrobial use without any microbiological test was evidenced in 32 patients (17%). Significant differences were noted between medical and surgical specialties in choice of antibiotic, dosage and utilisation of microbiological tests.

CONCLUSIONS

High empirical antibiotic use, poor transition from empirical to rational use, and underutilisation of microbiological tests were noted. The choice of antibiotics differed among specialties. Inappropriate dosing was greater in surgical specialties, especially with aminoglycosides. Adherence to local antibiotic policy, optimal dosing and audit of reserved antibiotic use can be useful approaches to strengthen antimicrobial stewardship programmes.

Opportunities and challenges for thoracic organ transplantation in government institutions

The first successful heart transplant in India was performed by Panangipalli Venugopal on 3 August 1994 at the All India Institute of Medical Sciences, New Delhi. Twenty-five years later, only seven government institutions are performing heart transplants and only one government hospital has an established heart transplant program in India. Only one lung transplant has been performed in a government institution all over the country. This article reviews the history and current status of thoracic organ transplant in India. The authors discuss the factors responsible for the dismal progress of thoracic organ transplant in government hospitals, opportunities available in government institutions for widening the scope of transplant program, and the steps taken by the Government of India to improve healthcare in the country.