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Community Perspectives on Inequalities in the Provision of Basic Healthcare Services for the Most Vulnerable Populations in the Eastern Congo:A Qualitative Study
No full textBackground There is a notable lack of evidence regarding the factors that shape the provision of essential healthcare services in post-conflict settings.Purpose This study aimed to explore and describe the factors influencing the provision of basic health care services for the most vulnerable populations in the Eastern Congo.Method Employing a qualitative research approach, twenty individual interviews with community members and thirteen focus group discussions were conducted. Participants were drawn from three geographically and demographically diverse locations with a history of decades-long armed conflicts in the Congo. Inductive thematic coding used the Health System Dynamics Framework categories (i.e. goals and outcomes, values and principles; service delivery; the population; the context; leadership & governance; and the organization of resources (finances; human resources; infrastructure and supplies; knowledge and information), while allowing for additional themes.Results Our findings are presented thematically according to these ten categories. The following factors were perceived as key areas enabling or hindering healthcare provision to the community: (1) the context for organizing basic healthcare service delivery is complex and challenging; (2) the population plays a crucial role as an active producer of health and potential change agents; (3) there is a poor strategic policy framework to guide local-level communities in the provision of basic healthcare services; (4) several critical barriers and facilitators related to effective healthcare service delivery were identified; (5) the classification of basic health service delivery methods to meet the healthcare needs of the vulnerable population; (6) the healthcare system is pluralistic and consists of multiple overlapping systems and providers; and (7) service providers and potential service users still consider access to basic healthcare services challenging, potentially resulting in reduced coverage.Conclusion These findings suggest that substantial changes in the factors contributing to the provision of basic healthcare services are necessary to ensure the delivery of basic healthcare services to the most vulnerable populations in the Eastern Congo. Consequently, there is a critical need to reconsider the healthcare delivery system, specifically addressing these contributing factors in the context of the Eastern Congo
Bone Health of Female Elite Cyclists Is Characterized by Impaired Cortical and Trabecular Microarchitecture
No full textPurpose: Many elite road-race cyclists have low areal bone mineral density (aBMD) as previously shown by dual-energy X-ray absorptiometry (DXA). However, aBMD provides limited insight into bone quality. Therefore, this cross-sectional study aimed to assess volumetric BMD (vBMD), bone microarchitecture, and bone strength in elite road-race cyclists using high-resolution peripheral computed tomography (HR-pQCT), along with aBMD measured by DXA. Methods: Twenty female elite (Tier 3/ 4) road-race cyclists (21±2 y; BMI 20.8±1.6 kg/m 2) had DXA scans at the hip, lumbar spine, and total body to assess aBMD, and HR-pQCT scans at the distal radius and tibia to assess vBMD, bone microarchitecture, and failure load. Z-scores were calculated for all outcomes, with Z-scores <-1 considered as low or impaired. The risk of low energy availability was assessed using the Low Energy Availability in Females Questionnaire (LEAF-Q). Results: Low aBMD was observed in 20%, 25%, 35%, and 10% of the participants at the hip, femoral neck, lumbar spine, and total body, respectively. Low total vBMD was present in 45% and 40% at the distal radius and tibia, respectively. With regard to bone microarchitecture, the tibial cortical area and tibial cortical thickness were low in 40% and 60% of the participants, respectively, and number and thickness of trabeculae at the tibia were low in 40% and 30% of the participants. The impairments were less pronounced at the distal radius. Failure load was low in 15% (radius) and 20% (tibia) of the participants. Conclusions: Along with low aBMD, a substantial proportion of female elite cyclists had impaired bone microarchitecture, mainly characterized by a low cortical area and thickness and low trabecular number and thickness, especially at the distal tibia.</p
Assessing the composition of myofibrillar and muscle connective protein fractions within skeletal muscle tissue
No full textABSTRACT (195 WORDS): It has been suggested that different nutritional stimuli are required to augment myofibrillar versus muscle connective protein synthesis rates. To study such different aspects of skeletal muscle remodeling, researchers often isolate myofibrillar or connective protein fractions from muscle tissue samples. However, the composition of these muscle protein fractions remains poorly defined. Here, we evaluated the amino acid profiles and protein compositions of the myofibrillar and muscle connective protein fractions within skeletal muscle tissue. The muscle connective protein fraction was shown to contain ∼70% of the total mixed muscle collagen content, with 4.4 ± 0.9% collagen relative to total protein content. This was 3–4 fold greater than the collagen content in mixed muscle tissue (1.2 ± 0.2%; p < 0.05). Myofibrillar proteins, such as actin and myosin, accounted for 39% of the myofibrillar protein fraction and 32% of the muscle connective protein fraction. The muscle connective protein fraction contained a higher proportion (42%) of key scaffolding proteins compared to the myofibrillar protein fraction (11%). In conclusion, the muscle connective protein fraction contains an enriched proportion of collagen among a large proportion of intra- and extracellular scaffolding and cell adhesion proteins, all of which are far less abundant in the myofibrillar protein fraction.</p
The occurrence and histopathological recognition of atypical endometriosis in patients with ovarian endometriosis - a retrospective cohort study
No full textOBJECTIVE: - Atypical endometriosis (AE) is considered a potential precursor of endometriosis-associated ovarian carcinoma (EAOC). Despite this, AE identification currently lacks established clinical implications and is not routinely incorporated in histopathological examinations of endometriosis. This study aimed to determine the interobserver variability in AE diagnosis and to classify the features that may attribute to consistent AE identification and diagnosis. METHODS: - Cases of ovarian endometriosis, collected between 1985 and 2017 at the Radboud University Medical Centre Nijmegen, were identified using the PALGA database. Pathology reports were reviewed for descriptions of atypical features and mentions of AE. Using a predefined set of criteria adapted from the literature, two independent pathologists re-evaluated the 266 most recent ovarian endometriomas for AE. After revision, the pathologist revised cases with AE to reach consensus when discrepancies occurred. RESULTS: - Among 266 cases of ovarian endometriosis, AE was reported in 31 (11.7%) cases. The revising pathologists identified AE in 48 cases (18%), a number that was reduced to 19 cases (7.1%) after a consensus meeting between the pathologist. After consensus was reached, the diagnostic criteria, adapted from the literature, were adjusted. DISCUSSION/FUTURE DIRECTIONS: - High interobserver variability likely reflects AE's heterogeneous presentation, the uncertain role of inflammation-driven atypia and AE's undefined clinical significance. However, given AE's association with malignant transformation, consistent identification may be essential. Stricter criteria were developed for AE in order to encourage uniform identification. Furthermore, we encourage adequate documentation of AE in order to increase the insight in endometriosis behavior by linking endometriosis subtypes to clinical progression
The Moderating Role of Dementia-Related Fear in the Relationship Between Perceived Cognitive Decline and Motivation for Dementia Risk Reduction Behaviors in Community-Dwelling Middle-Aged and Older Adults
No full textOBJECTIVE: With the increasing incidence of dementia, lifestyle interventions are key for long-term risk reduction. Understanding the psychological factors affecting lifestyle change motivation is crucial to developing effective policy strategies for dementia risk reduction. This study explores the moderating role of dementia-related fear on the relationship between perceived cognitive decline and engagement in dementia risk reduction behaviors. METHODS: A cross-sectional study was conducted among 200 Chinese community-dwelling middle-aged and older adults. Hierarchical regression and simple slope analysis were used to assess the moderating effect of dementia-related fear on the relationship between perceived cognitive decline and motivation to engage in dementia risk reduction behaviors. RESULTS: A significant correlation was found between perceived cognitive decline and increased motivation to engage in dementia risk reduction behaviors (r = 0.44). Dementia-related fear acted as a significant moderator; motivation was positively associated with low to moderate levels of fear, whereas this association diminished and became non-significant at higher levels of fear. CONCLUSIONS: The findings suggest that while lower levels of dementia-related fear may be linked to increased motivation for engaging in risk reduction behaviors, elevated levels of fear do not appear to support such engagement. Rather than emphasizing the negative impacts of dementia, public health strategies should empower individuals with actionable messages to engage in dementia risk reduction behaviors
Effectuation at work in universities:Using what is at hand to support social entrepreneurs
No full textUniversities play an important role in creating social impact through supporting social entrepreneurs. While existing literature primarily focuses on the educational aspect of nurturing social entrepreneurs, there is a gap in understanding the diverse and heterogeneous initiatives undertaken by universities. Recognizing the call for a nuanced exploration of universities' distinct approaches, we adopt an effectuation theory as an interpretive framework to investigate how universities, with varying scale and scope, support social entrepreneurs. Through 37 in-depth interviews and 5 focus group discussions at four universities, we offer an empirically grounded typology of four distinct support logics: embedded, auxiliary, opportunity-driven, and boundary-spanning. These categories reflect divergent institutional responses to uncertainty, internal capability, and stakeholder engagement. Our findings challenge the conventional narrative of homogeneity in university initiatives, emphasizing that support systems are shaped by a dynamic interaction of structural elements and individual decision-making processes. This research expands the theoretical discourse on university support for social entrepreneurs by bridging structure and agency and demonstrating how universities act as both integrators of resources and ecosystem enablers. By leveraging internal strengths and cultivating external partnerships, universities create multifaceted, adaptable support mechanisms that reflect the uniqueness of their institutional context and their contributions to the social entrepreneurship ecosystem. The study contributes to evolving debates on the university's roles in entrepreneurial ecosystems and provides a conceptual foundation for future theorization and comparative analysis. It offers actionable insights for university management, social entrepreneurs, and policymakers, advocating for a more nuanced understanding of the role universities play in creating social impact through entrepreneurial ecosystems
Nonparametric efficiency and artificial intelligence techniques in higher education:a systematic literature review and bibliometric analysis
No full textIn a sector that needs to work as efficient as possible, artificial intelligence (AI) can guide the efficiency improvements of higher education institutions (HEIs). This paper explores both the AI literature and the efficiency literature as applied to HEIs following the Preferred Reporting Items for Systematic Review guidelines. The goal is to identify the relevant research that uses nonparametric efficiency and AI techniques within the HEI sector by examining articles published up to March 2025. Our findings provide a powerful mix of bibliometric and systematic literature review results that identify the main trends common to these two strands of research. The analysis highlights a long-standing tradition of applying nonparametric efficiency analysis to the sector, as it is attracting the increasing attention of AI scholars. We outline the substantial evidence that reveals much room for improvement in efficiency in the HEI sector, and how the application of AI may be well-suited. This is particularly evident as AI can support efficiency evaluations, particularly in handling tasks that traditional efficiency techniques alone cannot perform. A key contribution of this work is the identification of the opportunities for further research focus within this critical intersection between the two fields, which can inform both HEI administrators and policymakers
Preference research is underutilized in health prevention
No full textIntroduction: Preference research is crucial in shaping effective patient-centered preventive healthcare strategies. Preventive measures such as vaccinations, screenings, and proactive treatment of asymptomatic high-risk conditions aim to reduce future health risks, often in healthy individuals. Understanding patient preferences in these contexts is vital to ensure that interventions are clinically effective, acceptable, and actionable. Failing to consider patient preferences when developing preventive strategies may result in low uptake and adherence to prevention programs, ultimately limiting their impact on patient and population health
Can you beat the music? Validation of a gamified rhythmic training in children with ADHD
No full textNeurodevelopmental disorders like ADHD can affect rhythm perception and production, impacting performance in attention and sensorimotor tasks. Improving rhythmic abilities through targeted training might compensate for these cognitive functions. We introduce a novel protocol for training rhythmic skills via a tablet-based, serious game called Rhythm Workers (RW). This proof-of-concept study tested the feasibility of using RW in children with ADHD. We administered an at-home longitudinal protocol across Canada. A total of 27 children (7 to 13 years) were randomly assigned to either a finger-tapping rhythmic game (RW) or a control game with comparable auditory-motor demands but without beat synchronization (active control condition). Participants played the game for 300 min over 2 weeks. We collected data (self-reported and logged onto the device) on game compliance and acceptance. Further, we measured rhythmic abilities using the Battery for the Assessment of Auditory Sensorimotor and Timing Abilities (BAASTA). The current findings show that both games were equally played in duration, rated similarly for overall enjoyment, and relied on similar motor activity (finger taps). The children who played RW showed improved general rhythmic abilities compared to the controls; these improvements were also positively correlated with the playing duration. We also present evidence that executive functioning improved in those who played RW, but not in the controls. These findings indicate that both games are well matched. RW demonstrates efficacy in enhancing sensorimotor skills in children with ADHD, which may benefit their executive functioning. A future RCT with extended training and sample size could further validate these skill transfer effects
A survey on skein modules via braids
No full textIn this paper we present recent results on the computation of skein modules of 3-manifolds using braids and appropriate knot algebras. Skein modules generalize knot polynomials in S^3 to knot polynomials in arbitrary 3-manifolds and they have become extremely essential algebraic tools in the study of 3-manifolds. In this paper we present the braid approach to the HOMFLYPT and the Kauffman bracket skein modules of the Solid Torus ST and the lens spaces L(p,1) and S^1\times S^2