搜索结果：Navigate

Contraceptive access is a critical component of sexual and reproductive health and rights, as well as an indicator of health system performance and broader commitments to gender equity. While global frameworks like Family Planning 2030 emphasize the need for equitable and rights-based access to contraception, Libya's centralized yet fragmented health system, compounded by political instability and weak national monitoring, has contributed to gaps in contraceptive service delivery and limited understanding of how women navigate access in practice. This study examines women's contraceptive decision-making in Libya, and the social, political, and institutional factors that shape women's access to and use of contraceptive methods. We conducted a multi-method qualitative study in 2023-2024 in three major cities in Libya: Tripoli, Benghazi, and Sabha. We conducted 17 in-depth interviews with women of reproductive age, 9 focus group discussions with 60 women, and 11 key informant interviews with healthcare providers and program managers. We analyzed these data sources for content and themes using an iterative approach. Three intersecting themes emerged: 1) Intense societal and familial pressure to bear children, especially sons, exists; 2) The politicization and moral scrutiny of contraception in Libya leads to conditional and uneven access; and 3) Women covertly navigate contraceptive use as a result of risk and stigma. Contraception was more socially tolerated when framed through marriage, spacing, or religiously acceptable purposes, while other forms of use were more heavily scrutinized. Despite persistent barriers, some women described making pragmatic reproductive decisions in response to economic hardship and ongoing instability. Efforts to improve contraceptive access in Libya must move beyond availability toward inclusive, system-strengthening, and rights-based approaches that acknowledge normative and structural barriers. Our findings show that in Libya, contraceptive access is shaped not only by health system gaps, but also by the conditional social and political acceptability of contraception.

Pneumatic artificial muscle has a high payload-to-weight ratio and rapid response with rich form factors and great design flexibility, making it a promising candidate for muscle-driven bioinspired robots. Here, we propose a perceptive pneumatic artificial muscle (PPAM) with self-length sensing via a seamlessly integrated double-helix conductive fiber coil. The double-helix coil fiber restricts the radial expansion of the silicone tube to achieve axial extension in actuation and measures its own length with a resolution of 10 μm by monitoring its self-inductance. A perceptive multimodal locomotion robot using three PPAMs as a bundle was developed, with crawling, turning, lateral movement, and rolling capabilities. By applying machine learning to analyze the three-channel inductance changes caused by body deformation under different loading conditions, the PPAM-based soft robot can recognize different external stimuli with an average accuracy of 99.28%. It is demonstrated that the soft robot can recognize a deep pit and bypass it automatically, change its gait amplitude to crawl through a low-roof tunnel, and sense its body posture change when a side flip occurs and automatically rolls back to its original position. In summary, the robot can perceive its own state and environment like a biological worm and can actively adjust its locomotion gait/mode to navigate itself through diverse terrains.

Many physicians feel uncomfortable caring for patients with intellectual and developmental disabilities (IDD). This discomfort can be a barrier to individuals with IDD accessing age-appropriate and high-quality health care. One well-established strategy for improving comfort with individuals with IDD is based on contact theory: increasing interactions with dissimilar people can lead to decreased negative attitudes towards that population. Drawing on contact theory, we implemented interactive art sessions with medical residents and artists with IDD. The purpose of this study was to explore the impact of these sessions on residents' comfort treating patients with IDD. Semistructured interviews were conducted with residents who participated in the interactive art sessions, and a qualitative thematic analysis was conducted. Interviews yielded the following four themes: (1) additional exposure to people with IDD helped increase participants' comfort caring for patients with IDD; (2) art sessions helped participants learn how to navigate challenges related to clinical interviewing, assessment, and patient communication; (3) the format of the art sessions created an environment that facilitated connection; and (4) participants were able to acknowledge biases. Utilizing contact theory led to a successful program where resident physicians gained the opportunity to engage with adults with IDD in a unique way, allowing them to gain experience communicating with this population and see them as dynamic individuals rather than solely patients. This led to increased comfort treating patients with IDD.

Set against the backdrop of a competitive and demanding academic environment in China, this study reconceptualizes the small talk of early-career female academics through a sociocultural psychological lens. Moving beyond linguistic taxonomy, this study investigates how these informal interactions function as culturally situated tools for psychosocial adaptation. Using a thematic analysis informed by a conversation-analytic transcription approach, approximately 11.5 h of naturalistic conversations within a close-knit friendship group were recorded and transcribed. The analysis identified eight recurrent interactional patterns: co-commiseration, collaborative exploration, identity affirmation, relationship-centric boundary management, protective deflection, humorous norm-policing, intellectual sparring, and co-constructing moral stances. The findings suggest that small talk serves as a critical, peer-mediated psychological resource, enabling participants to collectively navigate institutional pressures and gendered expectations while constructing a shared world of meaning and resilience. This research highlights the need for academic institutions to recognize and foster such organic, informal support systems.

There is ongoing tension in healthcare where certain types of knowledge are privileged above others to the detriment of patient outcomes. This hierarchy marginalizes nursing knowledge and patient perspectives, reinforcing systemic inequities in care delivery. Revisiting Stein's (1967) "doctor-nurse game," in which nurses were expected to influence care indirectly while preserving physician authority, this paper examines how hierarchical patterns of communication and knowledge recognition continue to shape practice. Nursing standpoint theory serves as a framework for critically examining power dynamics within the healthcare setting, providing a means to critically examine how power operates within healthcare structures and interprofessional relationships. Applying nursing standpoint theory reveals how systemic power imbalances shape provider interactions and affect the ability of nurses to advocate for patients. The analysis demonstrates that nurses' embeddedness in patient care positions them uniquely to recognize and respond to gaps in care. Understanding the ways nurses and physicians are situated in relation to power helps explain persistent tensions and offers a path toward more equitable care delivery. Rather than treating advocacy as an individual reactive task, centering the nursing standpoint reframes it as a relational and structural practice that depends on reciprocal recognition of professional knowledge. Empowering nurses to navigate and reshape power relations is therefore essential to improving outcomes. This theoretical reorientation benefits patients, teams, and health systems by shifting the "game" from deference to deliberation in support of patient-centered care.

Gastric sleeve stenosis (GSS) occurs in 0.7% to 4% of cases after laparoscopic sleeve gastrectomy and can lead to leaks, fistulas, refractory reflux, regurgitation, and diet intolerance. It is classified into 2 subtypes: helical and nonhelical. Although stent placement and pneumatic dilation may help with nonhelical stenosis, they often do not produce sufficient results for helical stenosis. Recently, a modified gastric peroral endoscopic myotomy (G-POEM) technique (tunneling stricturotomy) has been introduced as a salvage treatment for GSS. In this case series, we present 3 cases of patients with helical sleeve stenosis treated with modified G-POEM as the initial approach. All patients in this series underwent under-saline solution tunneling, which helped navigate a swirling, challenging submucosal space. The article offers techniques and tips for successfully completing the procedure. The procedure was successfully performed in all patients, who experienced significant clinical improvement and were able to tolerate a low-residue diet. No adverse events were reported. Although our case series demonstrates that tunneling stricturotomy was safe and effective as a primary treatment for gastric sleeve helical stenosis, additional data are needed to evaluate its safety and long-term effectiveness compared with other endoscopic treatments.

Clinical trials are essential for validating the safety and efficacy of traditional medicines; however, their conduct in Africa is significantly hindered by resource constraints, a lack of standardized regulatory frameworks, and insufficient guidance for navigating complex ethical review processes. This study addresses the knowledge gap regarding the practical experience of obtaining multi-country regulatory and ethical approvals for herbal clinical trials. A qualitative case study design was employed to document the regulatory and ethical review processes for a randomized controlled trial of Moringa oleifera Lam. leaf supplementation in HIV-positive adults receiving antiretroviral therapy. Data were synthesized from institutional correspondence, ethical reviews, and communication records with the University of KwaZulu-Natal in South Africa, Aminu Kano Teaching Hospital, and the National Agency for Food and Drug Administration and Control in Nigeria. This study highlights the challenges of managing multi-country regulatory systems, particularly in the absence of harmonized guidelines for herbal research. The findings suggest that inter-institutional collaboration and adherence to rigorous Good Clinical Practice (GCP) standards are critical for the successful conduct of herbal trials. The review process revealed significant differences in turnaround times, documentation requirements, and query complexities across the involved institutions. In conclusion, this study emphasizes the need for regionally harmonized, risk-based regulatory frameworks for herbal medicines. Sharing practical experience is vital for building capacity. This enables researchers to better navigate institutional bureaucracies and advance high-quality clinical research in developing countries.

A 37-year-old nulliparous woman was admitted to the hospital for mild bleeding. Intrauterine fetal death and placental abruption were diagnosed. The patient had a severe form of preeclampsia associated with fetal growth restriction and anuric renal failure. The delivery was associated with significant blood loss. Immediately after the termination of pregnancy by emergency caesarean section, the patient's condition required hospitalization in the intensive care unit and temporary dialysis. In parallel with the demanding care of the patient's physical health, early perinatal palliative intervention was initiated, i.e. accompanying the family after the death of the child. SPIKES communication protocol makes it easier to navigate a difficult conversation in limited time. Commonly established hospital processes may not be prepared for such a complex and demanding situation and require exceptional involvement of the staff from all departments. Sharing our communication skills improves the cooperation with an aggressive patient. Presence of her family is beneficial for communication during difficult times.

Chronic pain and PTSD (CP + PTSD) have a high rate of co-prevalence. Existing frameworks and models have driven the development of few simultaneous treatment approaches, though the prevailing psychological models and treatments for this comorbidity are pathogenic, incomplete, and fail to consider the whole-person impact of CP + PTSD. This warrants consideration of novel treatment perspectives and approaches. Salutogenesis offers an alternative paradigm and is a transdiagnostic and transdisciplinary perspective that addresses the complex, multifaceted dimensions of CP + PTSD and supports whole-person well-being. We present the Connectedness, Optimism and hope, Mind-body regulation, Purpose and values, Awareness of the body, Self-efficacy, and Safety (COMPASS) framework to illustrate how a person with CP + PTSD can use yoga practices to navigate experiences perceived as threatening, in order to cultivate safety and resilience. The discussion highlights ways the COMPASS framework can be foundational to interdisciplinary care and utilized by healthcare and research professionals to deliver a whole-person approach to CP + PTSD. We conclude by suggesting next steps for applying COMPASS in clinical and research settings.

Implementing evidence-informed healthcare services is typically approached as a structured, time-limited project, focused largely on what to do. Less well understood is how implementation actually unfolds in practice: the ways in which those involved navigate change and generate solutions in diverse community settings. Without understanding how implementation happens in unique contexts, implementation failure may remain poorly understood. The aim was to understand what it means for kidney care team providers, information technology staff, and patients to engage in implementing an evolving virtual kidney care service in a large, sparsely populated rural and remote region. We interviewed eight kidney care service providers, two information technology specialists, and 17 patients in northern British Columbia, Canada, for their experiences in implementing, delivering, and receiving virtual kidney care and how their practices changed with COVID-19. Through an inductive, reflexive process of analysis and hermeneutic interpretation, we identified patterns in how virtual kidney care was implemented. The analysis showed six hermeneutic principles of implementation at work in the everyday practices of the kidney care and information technology teams: acknowledging central concerns, creating new common understandings, collectively acting, surfacing tensions, being responsive to context, and engaging in ongoing dialogue. Rather than discrete, technical, and time-limited, we found implementation to be an ongoing, evolving, relational, generative, and iterative process that is inextricably connected to its context, and that never fully ends. Attending to the how revealed dimensions of implementation practice that are seldom visible in conventional implementation research. A hermeneutic sensibility, marked by openness, humility, and dialogue, with a commitment to understanding, responsiveness, and relationship-building, is key to implementation, especially in the ever-changing contexts of rural and remote areas. The findings point to the value of a hermeneutic approach in implementing, sustaining, and researching innovations in dynamic healthcare systems and rural settings.

Multimorbidity and multicomplexity are increasingly becoming the norm in geriatric clinical practice, with a recent Indonesian multicentre study revealing that 80.7% of older outpatients present with multiple coexisting conditions. This editorial discusses the limitations of conventional single-disease guidelines when applied to complex older adults, where simultaneous treatments often lead to polypharmacy, cumulative anticholinergic burdens, and potential adverse outcomes. Highlighting findings from a recent study in Acta Medica Indonesiana, which found polypharmacy in 43.9% of Indonesian geriatric outpatients but a low rate of high anticholinergic burden (1.8%), the editorial underscores the concept of "appropriate polypharmacy" under close clinical monitoring. To effectively navigate multicomplexity defined by the intricate interactions between pathophysiology, treatment effects, functional status, and social context, clinicians must look beyond rigid numerical targets and adopt patient-centered frameworks such as the Geriatrics 5Ms. Central to this approach is the art of judicious deprescribing, utilizing validated criteria like the AGS Beers or STOPP/START to optimize care and minimize harm. Ultimately, modern geriatric care requires a fundamental shift from merely extending lifespan to enhancing health span, focusing on "What Matters Most" to the patient. Integrating these competencies into medical education is vital to prepare future frontline clinicians for the realities of aging populations.

Black men attending predominantly White institutions (PWIs) face numerous challenges related to navigating racially and gendered hostile environments. These difficulties can lead to increased mental distress and negatively impact their experiences. Recent studies highlight the positive effects of creating supportive spaces within PWIs and the role of microaffirmations in enhancing the well-being of minoritized student populations. Using the rigorous and accelerated data reduction technique for qualitative analysis and guided by the microaffirmations framework, this study aimed to explore how Black male college students described and internalized microaffirmations and their relation to mental health experiences at a PWI. Data were collected from four focus groups conducted as part of an intervention program addressing the mental health pressures and social needs of young Black men, with 27 participants analyzed. Participants reported mental distress stemming from racism and microaggressions at their university. They expressed a desire for counterspaces dedicated to supporting Black men and microaffirmations that would enhance their sense of belonging, confidence, and mental well-being. Participants described experiences of microvalidations, microsupport, and microprotections that helped them navigate their negative experiences at the PWI. The findings underscore the importance of creating intentional counterspaces that empower Black men to connect, share, and validate their experiences. Microaffirmations in these spaces have a profound positive impact on their mental health and can be used to support Black male college students effectively. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

The increasing prevalence of type 1 diabetes underscores the need for health literacy responsiveness, as effective self-management depends on understanding and using health information. The Ophelia process supports identifying diverse strengths and needs among people with type 1 diabetes. To systematically identify health literacy strengths, needs, and preferences among individuals with type 1 diabetes attending specialized outpatient care using a mixed methods approach guided by phase 1, step 1 and 2 of the Ophelia process. Adults (≥18 years) with type 1 diabetes or subtypes (MODY/LADA) at a Danish specialist diabetes center were invited to complete a survey including the Health Literacy Questionnaire (HLQ) and three scales from the electronic HLQ (eHLQ). Cluster analysis and in-depth interview were integrated for the development of representative vignettes. Of 1,193 eligible patients, 238 participated (response rate 19.9%). The mean age was 54.2 years and 52% were men. HLQ and eHLQ scores revealed a wide diversity in health literacy strengths and needs. Health literacy profiles ranged from higher health literacy with active self-management to lower health literacy with low engagement and high reliance on family support. Vignettes vividly illustrated archetypal patient experiences, supporting a tailored understanding of health literacy challenges in clinical practice. Seven distinct health literacy profiles were identified among adults with type 1 diabetes, showing significant variation in health literacy and low health literacy among nearly one fifth, with difficulties navigating the health care system being common. The findings underscore the necessity of developing tailored, person-centered, and health literacy responsive interventions to strengthen diabetes self-management and advance equity in health care access. This study examined health literacy among adults with type 1 diabetes in Danish outpatient care. Seven health literacy profiles with varying strengths and needs were identified. Nearly one in five experienced low health literacy, particularly in navigating health care. These findings advance insight by highlighting the need for tailored, health literacy responsive care to support equitable diabetes self-management.

Pulmonary angiosarcoma is a rare and aggressive tumour arising from the endothelial cells of the pulmonary vasculature. The average survival from time of diagnosis is 9 months. This cancer presents challenges due to small nodules, pleural effusion, and hemoptysis often being confused for benign diagnosis. We present a case of primary pulmonary angiosarcoma with similar diagnostic challenges and a rapidly declining functional status. Our patient had a non-diagnostic CT-guided lung biopsy and iliac crest bone biopsy. Definitive diagnosis was achieved by robotic navigational bronchoscopy of a 2.5 cm left lingula nodule, which identified tumour cells positive for CD31, consistent with epithelioid angiosarcoma. Despite transient improvement with supportive care, the patient's condition deteriorated, culminating in cardiac arrest and death. Our study reviews clinical courses, diagnostic tools, and treatment available for pulmonary angiosarcoma and highlights the importance of robotic biopsy as an earlier diagnostic tool for such aggressive pulmonary cancers.

Family caregivers provide essential support to older adults, yet those caring for individuals who face language discordance may experience added challenges affecting their psychological well-being. To synthesize the existing literature on the psychological impact of caregiving in contexts of language discordance, focusing on stress, anxiety, depression, burnout, and coping strategies. A scoping review was conducted across six electronic databases from 2000 to 2025 to identify studies examining caregivers of culturally and linguistically diverse individuals in healthcare and community settings. Quantitative and qualitative study characteristics were summarized via frequencies, and qualitative studies were additionally analyzed using content analysis. Preliminary results were reviewed with patient and family partners to inform discussion, interpretation, and implications for optimizing caregiver supports. A total of 7590 citations were retrieved, with 53 full text reviews. Ten studies were included, primarily composed of qualitative studies. Key themes include the emotional and cognitive burden of acting as interpreters, advocates, and system navigators; filial obligations, gendered expectations, and stigma on caregiving experiences; and the protective role of language-concordant or ethno-specific services. Language-discordant caregiving was closely tied to cultural norms. Fragmented and unilingual healthcare systems, unmet service needs, and system-level barriers increased caregiver distress, whereas culturally tailored supports and coping strategies provided mitigation. Caregivers supporting individuals who face language barriers experience significant psychological strain. Routine screening for caregiver burden, integration of professional interpreters, and expanded access to multilingual and culturally appropriate supports are recommended. Future research should employ quantitative and mixed-method designs to quantify psychological impact, investigate the intersection of language, gender, and other aspects of identity, and evaluate interventions that reduce caregiver burden. Addressing both linguistic and cultural dimensions is essential for improving caregiver well-being and promoting equitable healthcare delivery.

Grasping objects such as handles, mice, and phones plays a central role in human-machine interaction, yet the contact surfaces of the hand, despite their exquisite tactile sensitivity, are rarely exploited as channels for information transfer. Here, we introduce transdermal all-directional targeting (TADT), a static-contact interface design strategy that converts passive grip surfaces into active tactile displays, allowing users to grasp stably while receiving spatially and temporally evolving information on the fingertips. TADT enhances sub-actuator-pitch energy delivery by integrating a microtextured skin-coupling interface with phase-controlled vibrotactile actuation, thereby generating steerable three-dimensional tactile foci beneath the skin, enabling >200-hertz vibration and sub-actuator-pitch spatial super-resolution. Psychophysical experiments show that TADT lowers detection thresholds by 30% and reduces power consumption by 80% compared with designs without TADT. Using static grip alone, users reliably identified six directional cues and completed nonvisual indoor navigation and virtual reality interaction tasks, demonstrating a compact, energy-efficient modality for expressive tactile communication.

暂无摘要（点击查看详情）

Pedicle screw loosening is a common and clinically significant complication of instrumented lumbar fusion and is reported in 15%-30% of screws in osteoporotic patients. Dual-energy X-ray absorptiometry (DEXA)-based bone mineral density (BMD) has long served as the standard preoperative assessment tool; however, its well-recognized limitations in the degenerative spine and its modest correlations with fixation strength have prompted growing interest in computed tomography (CT)-derived bone quality metrics as complementary alternatives. This study aims to synthesize the current evidence based on CT-derived Hounsfield unit (HU) measurements as preoperative predictors of pedicle screw insertional torque and postoperative screw loosening in degenerative lumbar fusion surgery, with a specific focus on trajectory-specific techniques. A narrative review of studies indexed in PubMed and MEDLINE (1990-2026) was conducted using the following search terms: 'Hounsfield units pedicle screw,' 'CT bone quality lumbar fusion,' 'screw loosening BMD,' 'trajectory HU insertional torque,' and 'vertebral bone quality score.' Studies were included if they reported quantitative bone quality metrics in adult patients undergoing lumbar instrumented fusion with outcomes of insertional torque or radiographic screw loosening. Non-human or cadaveric-only studies were excluded unless they were directly relevant to clinical threshold derivation. Multiple retrospective studies consistently demonstrated that trajectory-specific HU, measured within a cylindrical or single-slice region of interest matched to the planned screw trajectory, outperformed lumbar and femoral DEXA in correlating with insertional torque (r=0.75 vs. r=0.55-0.59) and predicting 12-month screw loosening. Three-dimensional trajectory HU and single-slice measurements both showed clinical utility, with proposed exploratory thresholds of 110-123 HU, although these values were derived from single-center, heterogeneous CT acquisition protocols and were not validated across institutions. The magnetic resonance imaging-based Vertebral Bone Quality score demonstrated comparable performance to vertebral body HU for overall loosening prediction, although trajectory-specific comparisons have not yet been published. The evidence supports an emerging framework for transitioning from systemic DEXA-based BMD to localized, trajectoryspecific CT-HU assessment as a complementary tool for preoperative pedicle screw planning. Prospective validation, standardization of measurement protocols, cross-scanner calibration, and integration into surgical navigation platforms are the critical next steps before clinical translation can be recommended.

Protein Data Bank Japan (https://pdbj.org/) is the Asian hub of three-dimensional (3D) macromolecular structure data and a founding member of the global Protein Data Bank (PDB) network. Over two decades, we have curated and distributed experimentally determined structures, complementing international collaborations with Research Collaboratory for Structural Bioinformatics (RCSB) PDB, Biological Magnetic Resonance Data Bank, Protein Data Bank in Europe (PDBe), and Electron Microscopy Data Bank. In response to user demand for integrated structural and chemical data, we developed a new PubChem Portal that enables interactive exploration of compound-protein interactions. Users can view ligand binding poses in 3D via our Web Graphics Library (WebGL)-based Molmil viewer, with key interactions highlighted and key residues displayed in semi-transparent stick models, enhanced through integration with secondary databases (e.g., Dynamics DB, eF-site) for advanced insights into molecular dynamics and electrostatics. The system supports filtering by UniProt ID, Enzyme Commission (EC) number, Pfam ID, or PROSITE ID to identify structurally related compounds and visualizes protein-ligand interactions. A dynamic two-dimensional (2D) Japan Agency for Medical Research and Development representation enables real-time atom-level navigation, with clickable atoms linking to 3D structures. This tool allows users to explore compound-protein interaction landscapes, identify potential binding modes, and guide experimental design, such as mutagenesis or crystallization. The portal offers a comprehensive, user-centered ecosystem that bridges chemical and structural data, enhancing access to biological insights through integrated visualization and analysis.