Aristotle is often named as the first zoologist or biologist because of his writings on animals. Although Aristotle’s major intention in these books was to illustrate his ideas of how knowledge and understanding might advance, at least one modern biologist (C. Darwin) has recognized Aristotle's depth and breadth as being of surviving merit. Of greater surprise is the ongoing attention that his works continue to receive, including publications in contemporary scientific journals. This review identifies 38 peer-reviewed papers on various topics from Aristotle’s biological writings that have been published during the last 50 years. These papers are described according to content , specific creatures , publication outlet, distribution over the fifty year period surveyed, and visible trends in the topics studied. It is concluded that, in the highly-competitive field of peer-reviewed scientific publication and citation, Aristotle's biology continues to excite the interest of scientists and remains salient to modern science itself. Cuvier Gotthelf .1 When hs Faria, 010, workDarwin's comment about Aristotle was made in 1882. More recently, there has been a renewal of interest in what might (from a contemporary perspective) be called Aristotle’s biological writings in the last 50 years or so by two sets of authors with distinct motivations Tipton , 2014. FAlthough Tipton  claims tThis paper is concerned with only the first group of publications mentioned above  in order to ascertain how Aristotle’s biology is being made relevant to twenty-first-century biologists and to students of the history of biology.strictu sensu because the influence and intensity of discussion of this work on the side of the sciences is still greater than in classics and philosophy.While the influence that his work on biology had on Aristotle’s overall research program (when acknowledged) has, in previous decades, often been interpreted in a dichotomous pattern  focused upon the scientific relevance of Aristotle’s biology, (2) not concerned with philosophical aspects of his model of scientific inquiry, and (3) truly aimed at bringing the value of Aristotle’s biology to the attention of the modern reader in science and in the history of biology itself. First , a sear Shields  also proa or b (first or second columns), page numbers, and line numbers  for examples, using the Work title, Book number, and Bekkeri line notation, which denotes the columns as  Bekkeri .genetics; de Magalhaes and Costa . Föllinger  general problems like speciation and classification. They also link Aristotle’s biological works to the rest of his writing.specific topics in Aristotle’s biology. Several key areas in which such papers have been written are summarized below to provide a flavor of the kind of writing about Aristotle’s biology that has occurred during the last fifty years of relevant scientific literature.Although these papers focus upon more general aspects of Aristotle’s writing on biology, they are relevant to the papers on specific topics (described below) because they cover what might loosely be termed the epigenetics, first coined by Waddington and defined as “derived from the Greek word epigenesis, which Aristotle used for the theory that development is brought about through a series of causal interactions between the various parts” , then “a stockperson’s primary role is to promote the good of the animals in their care, ensuring that their needs, wants and desires are satisfied.”2224Perhaps due to his experiences as a child Shields ,20 AristAristotle asserted that, if a hen bird has mated with a cock and is pregnant, then if “she be trodden by another cock, the whole brood of chicks turn out like the second cock.”26Gross  describe29,32,Although it was published just before the search period (1970–2020), an earlier paper by Clarke and Stannard deserves mention because its authors present several arguments explaining why Aristotle reported that the brain occupied only the front of the head,30Aristotle is considered by many as “the founder of comparative anatomy,” although much of his work was based upon animals  because he did not perform dissections of humans Blits , p. 59.3material, form, origin of motion (or efficient), and end , and in doing so, provided a model of anatomy that went well beyond a simple description of parts, but also included the reasons for why those parts are as they are and how they might differ across species. This individual variety of animals’ form and function led Aristotle to state that “each and all will reveal to us something natural and something beautiful.”37Perhaps the strongest basis for the high opinion in which anatomists hold Aristotle is his focus upon function.Clinical Anatomy in 2007, Crivellato and Ribatti divert their discussion away from “many of his physiological concepts (that) turned out to be wrong” and instead focus on Aristotle’s development of a “precise topographical terminology” that cast the body into “a bipartite, symmetrical architecture,” including the front and back of the body, its top and what lay below, and its right and left sides (Crivellato and Ribatti organon) as an instrumental and functional part of the body , Tipton evaluates the accuracy of Aristotle’s descriptions of the habitat, diet, spawning, sexual dimorphism, and eggs of these fishes,Tipton describes Aristotle as a philosophical biologist for whom the two disciplines were intermingled Tipton , p. 370.Mullus surmuletus), a much-fancied eating fish in Ancient Greece and still today (“in antiquity a great delicacy … and continues to be a highly-prized fish today”)  appearing in Aristotle, Voutsiadou et al.’s work is comprehensive in its tabulation and description. They conclude that “All marine animal anhaima encountered in Aristotle’s zoological works are correlated with current marine invertebrate taxa”  focus on the sponges of the Mediterranean, confirming Aristotle’s comments about the diversity, nature, external morphology, symbiotic relationships, habitat, and value to humankind,, p. 1763The third relevant paper by Ganias et al.  replicatAristotle commented that “in Pharos and other places, the bite of the scorpion is not dangerous; elsewhere—in Scythia, for instance … the sting is fatal to man or beast.”History of Animals, including its appetite,Historia Animalium and other biological works, is not only extraordinarily detailed but in most cases accurate as well” . Similarly, classics journals have also published some of these papers on Aristotle’s observations of animals . However, there are twenty publications in scientific journals that do not purport to discuss historical issues . From a slightly different perspective, twenty-eight (or 73.7%) of the papers appear in science journals or journals devoted to the history of science, but only ten (or 26.3%) are published in history or classics journals. These data suggest that almost three-quarters of this selection of modern literature about Aristotle’s observation of animals was written for the specific consumption of scientists, while the remaining one-quarter could be intended to interest historians or classicists. On the basis that all these papers were peer-reviewed, it may be claimed that there is a reasonably active interest shown by scientists, historians, and classicists in Aristotle’s observations of animals.Second, the selection of publication outlets also provides an insight into the goals of these authors who comment on Aristotle’s relevance to modern science. As shown in Table Third, it is also of interest to note the distribution over time of the papers identified for review. Figure Finally, when the content and year are combined to detect any observable trends over time, as shown in Table While the relative status of Aristotle as a natural scientist vis-a-vis his traditional image as a philosopher has only relatively recently started to be debated in classical studies, his reception in modern science has steadily grown over the last five decades. Based on the papers reviewed here, plus the brief summary of their content, outlets, and timing of publication over a fifty-year period, it is argued that Aristotle’s observations of animals not only continue to excite interest in modern scientists but remain of relevance to modern biology and contribute to the general history of biology itself. Evidence of this claim is the extent to which highly-competitive publication space in mainstream historical, classics, and scientific journals is being given to papers that highlight Aristotle’s exact and voluminous output in what is now termed “biology,” his ability to demonstrate the principles of precise observation and hypothesis-formulation, and his fluid and informative communication with his audience. The fact that each of the 38 papers described herein was peer-reviewed by other researchers in the general fields of history, classics, and biology, and judged by them to be not only of relevance but also of sufficient scientific standing as indicators of an ancient but enormously comprehensive and still informative piece of work, further affirms the relevance of Aristotle’s work to modern science. As a statement about the ongoing history of biology itself, these papers also argue for the worth of an accumulative set of observations and deductions in the general field of biology, even from very long ago.


In their attempt to raise money from investors, venture capital firms further fuel this development by discursively creating an ‘agri-food tech investment rush’—similar to the land and gold rushes of the past. Investments in agri-food tech startups, however, are presented to investors as both a profitable investment opportunity as well as a moral obligation, allowing for food production to cope with neo-malthusian and environmental threats. This paper contributes to our understanding of digitization as a socio-technical project, which includes the active envisioning and promotion of desirable agri-food futures.Over the past decade, investments in agricultural and food technology startups have grown to previously unknown dimensions. Mushrooming agri-food tech startups that promise to solve critical issues in the agri-food system through technological innovation are increasingly perceived as an attractive new investment opportunity for venture capitalists and investors. This paper investigates how digital agri-food technologies are narrated, constructed, and promoted for financial investment. Through qualitative content analysis of agri-food tech industry reports, articles, and commentaries we trace the logic, rationales, and narratives of this most recent investment rush, and reveal its immanent techno-finance fixes. We conceptualize the agri-food imaginaries produced within the agri-food tech discourse as  If we believe the recent agri-food tech talk, we are currently ‘on the cusp of a global food revolution’ UBS , p. 8. AIndeed, over the past decade, the digitization of agri-food has picked up pace rapidly, and investments in new digital agricultural and food technology startups have grown to previously unknown dimensions. The annual investment in agri-food tech startups increased from US$ 2.9 billion in 2012 to US$ 26.1 billion in 2020 AgFunder . Agri-fofinancialized imaginaries, as they present current agri-food challenges and their desirable food future counterparts in ways that specifically target financial investors. Following Eve Chiapello, we consider the construction of these agri-food imaginaries as part of ongoing financialization, understood ‘as a specific process of transforming the world, objects, organizations and the problems we encounter, by the introduction of “financialized” practices, theories and instruments’ imagining and thereby bringing about food futures. Recognizing the agri-food imaginaries produced in the agri-food tech discourse as financialized imaginaries is important in order to take them for what they are—not real-life, ‘everyday’ scenarios of our food future but rhetorical means to attract investment for this new investment space.Lastly, we contend that the recent ‘agri-food tech hype’ needs to be examined in the broader context of the financialization of agri-food. Stepping out of its traditional function of providing farmers and agriculture with capital, over the past decade finance has gained a new role in the agri-food system and has started to reshape the power relations between agri-food actors. From agricultural derivatives trading and index-based agricultural insurances to the construction of agriculture based asset classes and the promotion of new farmer subjectivities, financial logics and rationalities have started to alter global agri-food relationships in profound ways . We explore the project character of the agri-food tech discourse specifically in regard to its interplay with Forney and Dwiartama’s notion of ‘everyday digitization’, which points to the domestication of, and everyday experience with, digital technologies. We argue that while the everyday is seemingly absent—and arguably even needs to be concealed—within the digitization project, the project itself entails as well as produces its very own, peculiar ‘everyday-ness’.for finance. We identify five key elements in this discourse: (1) the construction of a ‘problem’, namely the food system in crisis; and (2) its counterpart, the suggestion of a technologically driven ‘solution’; which is (3) simultaneously presented as an investment opportunity (‘techno-finance fix’); (4) reinforced by the creation of an ‘agri-food tech investment rush’; and combined with (5) moral incentives. We conclude by reflecting on the significance of these agri-food imaginaries, and what they tell us about the interplay between ‘project’ and ‘everyday’ digitization.The remainder of this paper is organized as follows. The next section depicts the ‘financial cultures’ of startups and venture capital firms as crucial actors within the emerging agri-food tech scene. We then sketch out our methodology and give some background information on key actors we investigated as part of our discourse analysis. This is followed by a presentation of the narratives and imaginaries employed within the agri-food tech discourse in which food is produced Finance can be understood as an industry that produces, collects, and distributes money Ortiz , p. 5. BStartups are companies in their initial or early business stages. They concentrate on the development of a single product or service they believe is of value or in demand, and which they seek to bring to market, but lack capital to do so . Startup entrepreneurs are thus focused on ‘pitching’ the growth potential of their product or service to different funders, such as venture capitalists, angel and impact investors, or other private individuals. This focus on rapid and scalable growth is a key feature of startups, which, in the words of startup ‘guru’ Steve Blank, makes a startup ‘a temporary organization designed to search for a repeatable and scalable business model’ Ready . StartupEnglish-Lueck, who studied the emerging Silicon Valley startup scene and its ‘ecosystem’ of incubators, accelerators, and pitches, described their ‘entrepreneurial cultures’ as revolving around ‘techno-optimism’ and ‘technolust’ , the business model of startups is to attract investment from venture capitalists as well as, more recently, so called ‘impact’ and ‘angel’ investors. Venture capital is a form of financial capital specialized in providing capital to startups and other small companies considered as showing potential for exponential growth. This focus on exponential growth is part of venture capital’s portfolio strategy Hellman , p. 109.Venture capital’s financial strategy on rapidly growing risky startups combines with a particularly enthusiastic and optimistic language and ethos, as well as with features such as ‘speculative valuations’ and ‘gut judgements’ Hellman , p. 99. ‘Venture capitalists present themselves as adventuresome, risk-taking pioneers, operating at the cutting edge of technological innovation and driving the motor of progress. In the field of cleantech, this self-image becomes closely linked to technological salvation—by investing in the most innovative, most “disruptive” clean technologies, venture capitalists are working to reshape our world, to commercialize the technosocial foundations of a better, cleaner economy.’ . Silicon Valley based, AgFunder was founded in 2013 to invest specifically in agriculture and food technologies. With its annual investment reports on the industry, newsletters, and hosted events, the firm and its media outlet AgFunderNews is a major driver of the agri-food tech space, setting the tone for new trends as well as writing the sector’s history. Further examples are venture capital firms such as SVG Ventures, s2g ventures, or Finistere Ventures. We included these firms in our analysis because they are listed among the most active accelerator funds and venture capital fund managers in the sector determined by the number of companies they have invested in AgFunder . AdditioWe used the qualitative data analysis software MaxQDA to code and analyze our data following critical discourse analysis  and eat more animal protein (8 pounds of grains are needed for 1 pound of beef). To meet the demand for food, fuel and fiber from a growing and increasingly affluent population, experts predict that we will need to double global crop production over the next 35 years’  and soil health, as well as the social costs associated with scarce resources like water and energy’ UBS , p. 11.As ‘we are nearing the world’s natural limits’ UBS , p. 11, Given the urgency and planetary scale of the problem, how can our food system be ‘saved’? As mentioned above, problematization, as an important part of financialization, also includes the identification of an appropriate ‘solution’ to the problem. These solutions need to be made ‘tangible’ by giving ‘embodiment’ to the suggested visions. ‘Tangibilization’ usually involves the production of knowledge and expertise about the new area of investment, such as its qualities and risks, as well as some form of quantification, such as figures and models that lend ‘credibility to the theory that they are worthy of investment’ . ‘Widespread adoption of precision technology’ will allow for farming to become ‘truly automated’ and ‘factory-like with robots on the ground as well as in the air’ UBS , p. 33. However, such substantial change will not be achieved with only one innovation or product—what is needed is rather a full makeover of the system  as a key driver of operational efficiency, sustainability, and, perhaps in the current climate and most importantly, resiliency. [L]arge investors are seeing climate risk as a fundamental threat to their portfolios, and therefore their investors’ money. [I]mpact capital is beginning to flow into food and agriculture like never before’ food is interesting because it really sits at the base of Maslow’s hierarchy of needs. And when you can strengthen that foundation, you get leverage to move economies and make societies more resilient’ . First, our paper illuminates the ambiguity between project and everyday digitization as mutually relying on, as well as concealing one another. Within the agri-food discourse we investigated in this paper, the everyday, the mundane, the messy, and the uncontrolled aspects of digital food futures are largely absent. Nowhere in our data did we learn about the ‘everyday’ of agri-food tech, be it its concrete applications, regional differences, challenges within specific situations, or farm level details. The agri-food discourse sits at the ‘macro’ level, its playing field is the globe, its aspirations are big and universal—it does not know of nor require any concrete locations, materialities, or fixations. This, we suggest, is no coincidence, as the everyday struggles, setbacks, and failures arguably need to be concealed within this discourse to make the project of digitization work. Even more so, the complications of the everyday are not only a hindrance to the digitization project, but especially to its financial driving force. The discursive construction of the digitization project lives off the illusion it creates that hides and obscures the messiness of the everyday as much as any other hint of uncertainty or lack of control.financialized imaginaries, as we suggest in this paper, their main objective is to attract capital to this new field of technology development. Financialized imaginaries, in other words, are geared towards envisioning future worlds in ways that open them up to, and make them accessible to, financial investment and its logics and return generating mechanisms. If such imaginaries become part of our ‘everyday imagination’ of food futures, we need to be careful to not misconstrue them as ‘realistic’ depictions of our future world as their function first and foremost remains to raise capital, and not to provide us with real-life, ‘everyday’ scenarios of what our food future will look like. Financialized imaginaries are part of the digitization project and not of its everyday realization, and thus should not be mistaken as such. By highlighting the possibilities, necessities, and constraints that the financial culture of venture capital and startups forces on the discourse of the digital agricultural ‘revolution’ , this paper has emphasized the significant gap between the promises of digitization as a revolutionary and disruptive project and the realities that ‘everyday digitization’ holds for food and agriculture today as well as in the future.Second, if the food future imaginaries we identified in this paper are indeed constructed for finance, what does this mean for our everyday imaginaries of the future of food, and the role that digitization can play within this? How should we engage with the food future imaginaries produced by the agri-food tech scene, which have arguably already started to capture our collective imaginations of how we envision the future of agri-food? Studying imaginaries allows us to become aware of the role and purpose that imaginaries play within specific societal projects. Imaginaries are never neutral but closely intertwined with particular environmental or societal undertakings and endeavors, as underlying implicit understandings or explicit drivers of envisioned futures (Sippel and Visser


Uterine sarcomas are rare subtypes of primary urogenital tumours and need tailored treatment. This study aimed to examine the impact of diagnosis and treatment on health-related quality of life (HRQoL) in patients with uterine sarcoma and measures available to assess HRQoL in this group.Thirteen patients with uterine sarcoma and 23 health care professionals were purposively sampled from sarcoma reference centers and participated in a semi-structured interview exploring HRQoL. Patients were also asked to review the EORTC QLQ-C30 and EORTC QLQ-EN24 for relevance. Data were analysed using thematic analysis and descriptive statistics.The most commonly reported physical health issues were related to sexual dysfunction and urological symptoms. Hormone-related issues and gastrointestinal symptoms were also identified. Cancer-generic issues such as functional problems, fatigue, pain, and treatment-related adverse effects were also reported. Regarding mental health, fears , altered body-image, and dealing with lacking knowledge regarding sarcoma had an impact on HRQoL. Social health issues were related to the impact on relationships with others, limitations in undertaking activities, loss of independence, changes in work or study capacity, and financial difficulties. Most of the items of the EORTC QLQ-C30 and EORTC QLQ-EN24 questionnaires were rated as relevant. Questions about lack of knowledge about sarcoma, shock of diagnosis, and menopausal symptoms were lacking from existing measures.Uterine sarcoma patients experience a variety of concerns covering the physical, mental, and social domains of HRQoL that are in the main EORTC instruments, but not all of them. Combining cancer-generic, location- and sarcoma-specific items is recommended to assess HRQoL in this patient group.Trial registration NCT04071704.The online version contains supplementary material available at 10.1186/s12955-022-01971-5. Being diagnosed with and treated for sarcoma has a significant impact on health-related quality of life (HRQoL) , 2. HoweSTS account for only a small proportion of primary urogenital tumours, i.e. 3% of all uterine malignancies. Data on urogenital sarcomas as a group are hardly available and limited survival rates are reported for these rare sarcoma locations, with the exception of uterine sarcoma. In this group, survival greatly varies depending on histological subtypes with uterine leiomyosarcoma that has a 5-year relative survival across all stages of 42%, compared to 72% for endometrial stromal tumours  So I swam one kilometer the other day. And then I do feel the pressure on my chest and what not.” .Some patients complained of shortness of breath or respiratory symptoms that only occurred during exertion: ““I've got a big lump in my stomach, and occasionally that’s a bit sore.” , but also back pain related to bone marrow stimulation during chemotherapy. Patients had postoperative pain, needed pain medication, and had to deal with its side-effects as well: “had constipation and can’t no longer manage it through home remedies as used to before.” .Pain also occurred in various circumstances and locations. Women had pain caused by the tumour itself: “hernias or incisional issues long term because of the size and extent of the incisions”  or lymphedema. Positively, patients could experience a relief of symptoms, caused by the local effects of a large uterine tumour: “The quality of life is improved enormously after the surgery. Because people get really sick from that sometimes, from those large tumours. Just literally get sick from it. And after the surgery they feel fitter and better and so on.” .HCPs described that extensive surgery for uterine STS could have both negative and positive consequences. Negatively, patients might need a colostomy, urostomy, or nephrostomy, or they can suffer from  herniation: Other treatment-specific issues reported by patients with uterine STS included feeling ill or having flu-like symptoms, lower resistance to infections, hair and nail problems, eye and mouth problems, and skin changes during chemotherapy treatment. After radiation therapy for uterine sarcoma, women had a burning, painful skin, or blisters. Another patient had developed an ulcer near the anus.Finally, women with metastatic tumours reported problems related to metastases or local treatment for sarcoma, such as difficulty eating and speaking, and removal of teeth because of metastasis in the jaw. Another patient mentioned being more sensitive to smell after lung surgery and weight gain as exercise was limited after treatment for a pelvic bone metastasis.And as [the baby] was born, they found what they thought was just like a little nodule in my womb, which they said is probably nothing. Everyone has these, it’s kind of like endometriosis or something similar to that, nothing to worry about. Yada yada yada. And then we went through further research on it, it actually turned out it was sarcoma. It came completely out of the blue because at no point had I any kind of symptoms and actually the surgeon even said, unfortunately this type of sarcoma is often symptomless. If we wouldn’t have found it because of this, you would probably have found it two weeks later and there would be nothing I could do.” . HCPs acknowledged this phenomenon as well and also emphasized that earlier misdiagnosis can have long-term effects on patients’ mental well-being: “She has really struggled from a psychological point of view, partly because of earlier misdiagnosis, and she had that sort of protracted time to diagnosis and treatment. That’s brought with her a lot of anxiety, she’s had a change in career. She’s had a lot of psychological burden that she’s carried with her.” .Many patients experienced the diagnosis of cancer and moreover, a rare cancer, as a shock. They did not expect a sarcoma diagnosis because of a lack of symptoms or supposed benign cause of symptoms: ““And I think I still don’t quite understand what the difference between sarcoma and so-called normal cancer is. Also, specifically to sarcoma, because the other thing that you hear a lot from the doctors, it’s not your typical cancer, so what is typical cancer and how.."  or because there is less information about this rare type of cancer available: “Because the population is so small, it’s just understanding how big are the risks if you do this or you don’t do that? Because there’s just not a lot of data, there’s not a lot of knowledge, it’s hard to understand myself, but it’s also hard to almost talk about it, because you’re not quite sure.” . One patient mentioned she felt the need to have contact with fellow patients to better understand how she was doing herself: To have some sort of comparison: what’s the deal? What does that do to you? To compare a bit where you stand as well, or something. [..] somewhere you feel the need to sort of.. check”. .Patients with uterine STS described feeling distressed because of the lack of knowledge about sarcoma, either because they did not understand the disease themselves Yes. Well yes, yes. To the extent that it is effective, you also don’t know how long it will take before it comes back” . Furthermore, patients with uterine sarcoma didn’t know what to expect in the future: “And obviously, you know I’m only 39, I think just understanding what that means for your future life. I think that’s been the biggest blow for me and also because it’s not… It’s just so hard to digest but it’s also hard to know what questions to ask.” .Being diagnosed with uterine STS also caused uncertainty regarding treatment, related to the morbidity of surgery or effectiveness of treatment: “But every day I am afraid that I am going to start feeling something related to cancer again. So there is always dust over the beautiful things. And that is very big.”  The anxiety often culminated at the moment of the next follow-up scan: “Every time I go for a scan it is again the anxiety builds up until the diagnosis, I mean until the results come I am a bit anxious. That week is quite stressful going through the scans” . HCPs indicated that this is specific to patients with uterine sarcoma, because of the initial delay in diagnosis and/or unexpected news of suffering from a malignant disease. Patients also worried about the impact of their illness on loved ones. Some even decided not to tell family or friends about the severity of their situation: “But in [country of origin] because they're far away we thought it best not to discuss and that's what I want. And I don't think it will make much difference. They would simply worry there.” .Women frequently experienced fear of recurrence, tainting the enjoyment of things in life: ““I have an intense fear of causing vaginal bleeding again, and am embarrassed to discuss the issue with my physician.” . HCPs underlined the latter issue and recognized that concerns related to sexual issues are rarely brought up by patients themselves during appointments.Patients also reported being worried about having sex again, however they felt hesitant to discuss this with their medical team “And then there was before the radiation there was this issue with fertility if there should be an operation, I think an colorectal operation to change her ovary location or not. And she already had a child but then there was the issue if you want to have another and she had to discuss the pros and cons with her husband and her family.” . According to HCPs, some patients experienced having to undergo fertility preservation as an additional burden: “in women [fertility preservation] can delay [treatment] quite a bit. And that actually is a psychological burden, because ‘you say that I have a good prognosis, I want to have children, but I also want to be treated for this’.” .HCPs mentioned that women of reproductive age experience distress because they are faced with challenging decisions about having children as there is a high risk that treatment would cause infertility: . HCPs recognized this issue in their patients as well and reported this has great impact on patients’ self-esteem: “I think, probably, having a hysterectomy and if there were other surgery, can affect their perception of themselves or the feeling that something is missing. So, that can also have effects on the psyche,” .Treatment for sarcoma also had an impact on the patients’ body image: women with uterine STS reported feeling less attractive compared with before being diagnosed: “for the psychological aspect I still get post traumatic. [..] Yes, probably women come with heavy periods and [as their GP]I'm sending them for operation it just gets me the flashback of what I've gone through. Especially with women who are menopausal.” .Patients with uterine STS reported feeling more emotional or sad since diagnosis. Furthermore, they felt constantly reminded about their (previous) illness, either because of physical impairments or the psychological impactI would maybe think twice about meeting someone of an evening if that was the day my eyes seemed to be bright-red and pouring, just because it’s not very pleasant.” . This problem was also affirmed by HCPs. Side-effects of chemotherapy and radiation therapy also hampered social activities with others “During chemotherapy and because of treatment side effects I chose to lower my engagement with others, diarrhea and nausea were the main causes.” . Patients also had to give up leisure activities, hobbies, or activities with their (grand) children “Swimming is not possible because of infections, this is important because this is "quality time" with my daughter.” .Patients with uterine STS mentioned that their illness has had massive implications in their life and the activities they did or relations they had were significantly affected. For many patients, the effects of treatment caused limitations in participating in activities outside the house: ““I've got a few close friends, but I've got one close friend who initially was really upset, and I wasn’t. I felt I was helping him more, and I was like, yes, you’ve just got to accept it.”  or how people react to hearing about their illness. In some cases, they even lost contact with friends and women with uterine sarcoma felt isolated from others.The diagnosis also changed relationships with friends or family, due to a lack of understanding “I'm a bit worried about that, how I'm going to end up, or whether I should live with my family, or I might just save to move away. Luckily, I've got those options. I can do that financially, but I worry about whether I need to be near my family forever now, if you see what I mean.”  or mobility “I still can’t drive a car at this time. So the mobility, going somewhere, the freedom of going somewhere, the autonomy, the independence, is taken away.” .Patients with uterine STS also had to deal with loss of independence, either regarding housing “I reduced the workload, I used to do a lot of out of hours and all, I've reduced that” . They felt it gave them the opportunity to focus on their recovery and to relax more. Others were forced to stop working entirely or chose to stop working. One patient experienced financial difficulties due to medical costs: “I have a lot of financial problems due to the disease, I have far less money, only 250 euros for living.” .Patients often experienced limitations in continuing their studies or their original work, and often had to interrupt or adjust their working activities: The majority of HRQoL issues identified from the interview data are covered by the EORTC QLQ-C30 and EN-24 , a changed body-image, and dealing with a lack of knowledge of sarcoma had a strong impact on HRQoL. Social health issues were related to changes in relationships with others, limitations in undertaking activities, loss of independence, changes in work or study capacity and financial difficulties.Physical health issues reported by uterine sarcoma patients in our study overlap with issues in other gynaecological cancers. Similar to other female cancers , women wThe HRQoL issues in the psychosocial domain are similar between patients with uterine STS and other gynaecological cancers. Patients recalled the sarcoma diagnosis coming as a shock. A survey conducted among gynaecological sarcoma patients by the British sarcoma charity showed a similar pattern in the diagnostic trajectory, with 53% of respondents going into surgery without suspecting their problem might be cancerous . HCPs thA variety of cancer-generic HRQoL issues were reported as well, such as fatigue, pain, chemotherapy- and radiotherapy-related toxicities, feeling tense or anxious, and impact on work, finances, and social life. These issues have been well described in the cancer population in general and are mostly covered by the EORTC QLQ-C30 questionnaire .For the majority of the items of the EORTC QLQ-EN24, uterine sarcoma patients gave relevance scores higher than the cut-off values. The cut-off value for relevance was lower than the example (i.e. mean > 2.0) given in the EORTC QLG module development guidelines to be more inclusive for issues in the current explorative analysis , but neeThis study provides insight in HRQoL issues experienced by uterine STS patients, following the HRQoL conceptual model that is used in oncological clinical trials and health care , 31. AltAlthough this is the first study to investigate HRQoL in this patient group specifically, some limitations need to be taken into account. First, the sample size of uterine sarcoma patients is small. Furthermore, no gynaecologists were interviewed despite their involvement in some countries in follow-up care for women treated for localized uterine STS. This is caused by the fact that the larger mixed method study, in which the current data was collected, was aimed at the heterogeneous sarcoma population and HCPs working in sarcoma care . SystemaThe aforementioned insights in specific HRQoL issues experienced by uterine sarcoma patients will help create awareness in HCPs caring for patients with uterine sarcomas, improve provision of information to patients, and facilitate personalized supportive care. Our findings also offered guidance for the development of a flexible measurement strategy for HRQoL assessment in sarcoma patients, using existing cancer-generic and location-specific questionnaires combined with tailored item lists. The next phase of this mixed-method study is currently ongoing , in whicPatients with uterine STS experience a variety of issues in the physical, mental, and social domain that impact their HRQoL. Some issues were specific for the tumour location, others were related to the rare sarcoma diagnosis specifically. The majority of items in the existing EORTC QLQ-C30 and EORTC QLQ-EN24 questionnaires were relevant for HRQoL, although some additional issues were missing. For future research, a flexible measurement strategy combining cancer-generic, location- and sarcoma-specific items is recommended to assess HRQoL in uterine sarcomas.Additional file 1. Interview guides.Additional file 2. COREQ checklist.Additional file 3. Quotes from interviews.


Public perceptions of water-related issues are still under-researched topics. The current paper intends to explore a local community’s perceptions regarding household water purification (HWP) strategies, namely before and after trying a new method: moringa seeds powder (moringa-teabag).N = 65) assessing perceptions about the usefulness of Moringa oleifera Lam (Moringaceae) as a HWP method , and questionnaires (N = 104) evaluating successes and identifying difficulties . Participants were all women aged over 18 years, living in Ondame, Biombo region, Guinea-Bissau. Data were analyzed using qualitative and quantitative approaches.In September 2020, six focus group discussions  reported treating water before consumption. Nevertheless, these results are not consistent with our field notes. Participants demonstrated a strong belief in the capacity of moringa-teabags to purify water and even consider them better or much better (81%) than other methods. Participants asked for more information on moringa-teabag for household water purification.More information on water treatment and water safety would help to raise public awareness about waterborne diseases. These findings could be used to promote greater adherence to moringa-based HWP as an alternative to household water treatment.The online version contains supplementary material available at 10.1186/s12889-022-14344-w. Escherichia coli [Safe and readily available water is a public health priority, whether it is used for drinking, domestic use, food production, or recreational purposes . Historihia coli . Residenhia coli . A tubewhia coli . These thia coli , indoor hia coli , the conhia coli , and lachia coli . Moreovehia coli .Moringa oleifera Lam (Moringaceae), hereafter referred as moringa, has recently been recommended for water treatment [reatment , especiareatment . Due to reatment –19. Coagreatment . New metA considerable amount of research has focused on attempting to understand how water quality is perceived by the communities . FindingThe research comprised two approaches: (i) a qualitative analysis using focus group discussions (FGD) before the moringa-based HWP trial , to disclose perceptions on HWP strategies, including with moringa, and (ii) a quantitative analysis using a one-to-one questionnaire assessing perceptions regarding moringa as a HWP, following a one-week moringa-based HWP trial. FGDs provided the participants the opportunity to expand on any ideas, not offered in the quantitative questionnaire, that are critical to identify unsuspected obstacles to moringa-teabag use; in turn, the questionnaire allowed an objective assessment of the adherence to the proposed trial and the related perceptions .The study was conducted in Ondame , a rural area in the Biombo region of Guinea-Bissau. Two reasons supported the selection of Ondame: (i) absence of a water supply system, (ii) geographical proximity and similarity to Quinhamel  – whose water quality data was previously reported, suggesting a high risk of fecal contamination in drinking water in Ondame –33 and tSix FGDs were conducted and audio recorded, to qualitatively assess communities’ perceptions. Participants were all at least 18 years-old. Each FGD lasted 30 to 45 min and written transcripts of the responses to the various questions were made (in addition to the audio-recordings). FGD sessions were conducted in a roundtable format gathering a minimum of 4 and a maximum of 12 individuals, as recommended –33. SeleFGD participation’s informed consent was given verbally and audio-recorded as part of the discussion since the level of literacy of the participants is very low. Participants in FGDs were asked confidentiality about all that was discussed in the sessions. The meetings were held at a time and place convenient to the participants, i.e., mostly in the mornings and in a village’s community hall. All participants volunteered to join the study. At the end of each session there was a socializing party, and this gathering of the participants was encouraged by the research team. The study was approved by the ethics committee (090/CNES/INASA/2020) from the National Institute of Public Health (INASA), Guinea-Bissau.moringa-based—new HWP method) and 13 adapted essential perceptions  was validated in the dengue context, revealing a correlation between having the essential perceptions and adhere to the proposed preventive behavior . In this study the Essential Perceptions Framework was adopted and adapted to the waterborne disease setting . FollowiEscherichia coli, Pseudomonas aeruginosa, Salmonella typhi, Staphylococcus aureus, and methicillin-resistant Staphylococcus aureus (MRSA) [A post-test-only design was performed, to assess perceptions one week after the moringa-based HWP trial. The fine moringa seed powder (moringa-teabag) was previously produced by Diocesan Caritas of Bissau. Then, moringa-teabags were prepared by us, each containing 2 g of moringa seed powder, to be diluted in 20 L of water  for 5 min, which has the potential to eliminate 99.9% of several pathogenic bacterial strains (s (MRSA) .Each participant received seven moringa-teabags to use for one week, and the questionnaire was presented in the following week (late November 2020).Questionnaires applied through one-to-one interviews were then used to extract in-depth information from 104 participants (65 from FGD plus those who did not have the opportunity to participate in the FGD) in Ondame’s villages. A semi-structured format was employed to collect data, exploring various aspects such as their belief in moringa's capacity to purify water . Participation in the face–to–face questionnaire was based only on verbal consent since the level of literacy is very low. The surveys were performed by trained personnel (leading researcher) during October and beginning of November 2020. The study was approved by the ethics committee (090/CNES/INASA/2020) from the National Institute of Public Health (INASA), Guinea-Bissau.The topics addressed concerned: General perception, Water sensory evaluation, Moringa adherence, and Comparison between moringa-based and other HWP Table .Table 2TResearchers coded the obtained data, as it is the most appropriate strategy to analyze FGD data , and the1p ≤ 0.05).After the survey was completed, data was transferred to a secure server and a descriptive statistical analysis was carried out using SPSS v. 27.0 program SPSS Statistics software . A chi-square (χ2) and binomial tests –38 were The socio-demographic characteristics of the sample are described in Table Out of those 65 had previously participated in the FGDs sessions, comprising an average of ten participants . Demographic information concerning the respondent community is given in Table “some bacteria can be in the water and you do not know and you are going to drink that water and you get sick, but if you drink good water, you will not get diseases” . Those who knew an example of waterborne diseases described “diarrhea, vomiting and many diseases in the water” . However, others were unable to name a correct example of waterborne disease “well I do not know, it is you who will tell us ”. Regarding mortality/morbidity, participants did not recognize the severity of waterborne diseases. They perceive the loss of family members due to illness, although they are not able to identify if that was due to water consumption, and in some cases they do not even know what the cause was – “we may have lost family members and we do not know that it is because of the water, except when it was a cholera outbreak, then we knew that it was because of the water” . On the other hand, they were aware that diarrhea is a sign of illness and that it can cause damage to our health – “diarrhea is a very big disease” .Participants showed awareness of the medical importance of waterborne diseases: they are conscious that water can transmit diseases and some were able to give a correct description of a waterborne disease. For example, “the water from tubewell is better than from the shallow well, yes, because it is clean, while the water from the shallow well is dirty” . One participant declared having no concern at all with the tubewell water – “I have no concern with tubewell water and as we now have it within our reach and we are going to get it, and we spare the tiring boiling” . Despite confidence in the safety of their water, namely from tubewells, some participants were aware of its potential contamination with rainwater – “when it rains that cloudy, red water will go into the well” . Yet, some raised concerns about the shallow water – “when you are seeing an open shallow well water without lid, you know right away that it is not clean” . Others consider that they drink shallow well water due to the lack of alternatives, even though they are aware that it can be dangerous (contaminated). Although some participants recognize a higher risk in shallow wells, some believe it is safe since their ancestors already drank that water. A participant shared her thoughts: “you cannot say that this water we drink is not good, because since we were born, this is the water that we have been drinking, as we have not found any other pump (tubewell) here and this is the one we live with” .The perception of water quality in Ondame varies according to the type of water source . Ondame’s tubewell water is perceived as cleaner and safer than shallow well water – I do not know” , and some defined it as “contaminated water, it is dirty water that is contaminated water” . Nevertheless, they perceive contamination more as a transmission mode from person to person – “contamination is when I have diarrhea and vomiting and if a get visits from my colleague, he/she can get sick through my illness” . Participants correctly identify rainwater as the main cause of contamination – “when it rains that cloudy, red water will go into the well” .Not all participants revealed an understanding of what water contamination is – “by bleach, or boiling or even lemon drop, or another if you have” . Participants perceive that treating water at the home level is important and reported that they do it – “I use a cloth to filter, when I cannot filter, I normally put a drop of bleach” . For those who do not treat the water, the reason is that they feel safe – “before we had the tubewell, we used to filter the water, but after there was the tubewell, I just wash the basin/bowl, clay pot, and lid very clean, and remove the water and put it into a clay pot and cover it with cloth” .In FGDs, a wide variety of comments arose regarding HWP. Respondents commented that they already use some traditional methods to treat water before drinking it – “As we do not have time for that, while we are working in the fields, we drink from shallow” ; another participant reported that “some do not like to use bleach because of the smell, that is why they do not use it” . In addition, one participant said: “In fact it is very difficult for anyone here to put bleach in the water, it is just because of this quarantine (covid-19) that has arrived that people are now putting bleach in, if it was not for this it is difficult to see anyone putting bleach in the water” . Participants perceive different needs to treat water according to their water source and aim. For drinking, they collect from tubewell, whilst a shallow well is used for cooking or bathing. The overall impression the participants gave was the need for a tubewell – “if there is a tubewell, we avoid all that, it is just going and getting the water as it is not necessary to filter, but if you are tired and arrive at night and you are thirsty, you will get the water and drink it without filtering” .Although participants mentioned that they treat water, they pointed out the barriers such as price, smell, time, and taste – “yes, it is a surprise, as we have never done it and we do not even know about it and we have it here in abundance” . They showed great readiness to accept the moringa-teabag as an alternative for HWP water purification at the household level – “yes, we will because you have shown us that it can remove the bacteria” . Several participants were very positive about their ability to carry out the process of using the moringa-teabags. They were interested in sharing information regarding the process, claiming that the main difficulty might be to implement the process. The request for information was consistent in all the groups – “just tell us, if you explain to us and if it is something to help us, we will do it because what we want is to get rid of these diseases” . There was also great interest in having a moringa-teabag to test the method – “I think everyone will accept it because if there was no interest, we would not be here” . Further, one participant illustrated that its future use would depend on the results from the first uses – “if you bring it to us once and we feel it is good, even if you do not bring it anymore for us, we will keep doing it because we have it here” . The examples of relevant citations for each topic of interest can be seen in the supplementary material  treat their drinking water before consumption; more than a quarter (32%) do not. The majority of the participants considered the tubewell as the main water source for drinking and other household uses Fig. .Fig. 1PeBelief in moringa can be defined by three broad categories: nutritional, medicinal, and chemical aesthetic attributes. In this study, the focus was on the chemical aesthetic attributes, and the participants were asked about their general impressions after using the moringa-teabag. Overall, households (93%) indicated that they were “Satisfied”, “Slightly satisfied” or “Extremely satisfied” with this water treatmentFig.  However,Figure Respondents were asked to evaluate the quality of the moringa-teabag treated water, based on two sensory characteristics (color and taste). More than half of the households (55%) indicated that their drinking water color was changed; among these, 93% said the water became cloudy. Around 65% of the participants reported that the water taste was changed; it tasted either sweet (89%), sour (8%) or salty (3%) Fig. .Fig. 4PeRespondents were asked to rate the importance of using moringa-teabags for HWP, how easy/difficult was it, and what type of difficulties were found. The majority 95%) strongly believed that using moringa-teabag for HWP is very important or quite important, while the remainder said it is somewhat important or not important . The findings show that Fig. , among tResearch Hypothesis 1—The proportion of people who purify water before drinking equals that of people who do not (H0); H1—The proportion of people who purify water before drinking is different from the proportion of people who do not. According to the results, the null hypothesis cannot be rejected (P > 5%) and it is concluded that the proportion of those who purify water before drinking equals that of those who do not ; H1—the proportion of people who use water as soon as they collect it differs from that of people who do not do that. The results showed that the null hypothesis is rejected, so we can conclude that there is no difference between the two groups (Table ps Table .Research hypothesis 3 (relation of water treatment with schooling).0); H1—there is a difference between high schoolers and non-high schoolers regarding water purification practices. There was no difference between the two subgroups (P = 0.70) and, therefore, the literacy level does not influence the procedures concerning the purification of water before its consumption (Table There is no difference between high schoolers and non-high schoolers regarding water purification practices (Hon Table .Research hypothesis 4 (relation of water treatment practices with age).The relationship between household water purification and household characteristics was analyzed using chi-square tests (χ2), while a binomial test was carried out to test dichotomous variables.0); H1—there is a difference between young adults and adults regarding water purification. There was no difference between the two subgroups (P = 0.463) and, so, age did not influence the practices concerning the purification of water before its consumption.There is no difference between young adults and adults regarding water purification (HP ≤ 0.05). In a second analysis, by considering two broad age groups (young adults and adults), the null hypothesis can be rejected with much more confidence , with young people tending to purify water before consumption, but with a very tight statistical significance P ≤ 0.0. In a seQualitative and quantitative methods employed in this study allowed to gain insight into people's perceptions regarding the health effects of drinking water and household water purification practices in rural Guinea-Bissau households. Both approaches helped to identify key factors that influence the acceptance of the proposed methods, the water quality and its sustainability. Most traditional HWP methods (such as bleach or boiling) in the study area are reactive  rather than proactive (autonomous and well-planned by communities).Several studies have confirmed that water conservation attitudes (WASH) and behaviors are closely related , 40. TheFor most of the participants, the concept of medical importance might not have been well understood. However, they know that water is a route for disease transmission, although few can name such diseases. They recognize the loss of a family member but do not know if it related to a waterborne disease, or to which one. As in the study carried out by Nazareth et al.  on the iThe risk of well water differs, depending on the type of source . In general, respondents perceive that Ondame's tubewell water is safe, and show a high appreciation for tubewell water quality. Similar perceptions have been reported by Wu et. al  in theirHousehold water purification is an important and effective part of the multi-barrier approach to ensure water quality and safety , 44. ParIn the questionnaire, the change in color or taste was also evidenced, although most participants considered that water’s taste improved after the use of moringa-teabag. A variety of treatment methods was reported, with almost half of respondents treating water with bleach followed by cloth filtering, or using more than one method. This result (cloth filtering) is also found in other studies on households depending on water wells  –48. HoweConcerning moringa-teabag application, most participants believe in its capacity to purify water and show great willingness to use it for this purpose, considering it even much better than other methods and definitely recommending others to use it. This belief is supported by their knowledge of moringa as a medicinal and nutritionally valuable plant . It shouThe teabag for water purification can be an affordable and important practice to reduce waterborne diseases and to improve the quality of life for a large proportion of poor populations , 53. TheHowever, it should be noted that during this study there were no outbreaks (history factor) that could jeopardize the study. The fact that respondents were only women (selection factor) does not influence the results, because women are the ones who take care of water at home. The study period (maturation factor) was not long, but the fact that two methodologies were applied and that the FGD participants also participated in the questionnaires may have influenced their acceptance of the use of the moringa-teabag. There was no loss of participants  during this study, but this is not a controllable situation and, over time, mortality might occur.i) community perceptions regarding waterborne diseases in Guinea-Bissau, ii) community perceptions regarding moringa-based HWP as a water treatment strategy, and iii) a successful pilot study on moringa use as a household water purification method.To sum up, this study provides three innovative pieces of information: i) community perceptions regarding waterborne diseases in Guinea-Bissau, ii) community perceptions on the use of moringa as a water treatment strategy, and iii) studies on actual moringa use as a household water purification method. This makes our findings pioneer/innovative and crucial due to the absence of sustained treated water supply or strategy in countries such as Guinea-Bissau, and to the disadvantages of the more common HWP methods. This study indicates that the participants were willing to try the moringa-teabag as HWP and after having tried it they were very satisfied with the results. Nevertheless, it is apparent that certain beliefs may influence some perceptions, such as the fact that they drink the same water for many years and think it is not contaminated, or the fact that they do not use chlorine because of the smell.To date, there is no evidence in the literature reporting: Correct perception of water contamination and risk are the key factors influencing water-use behavior. The majority of the respondents have misconceptions about water treatment, representing a high risk of waterborne diseases.This paper demonstrates the importance of this new contribution to knowledge, providing detailed information to understand the correct perception of water contamination and risk correlated with water-use behavior. The results of this research can support the implementation of collaborative social innovation in order to understand how moringa seed powder will impact the environment and the social behavior along the water supply chain in rural areas. They can also be seen as new approaches to the practical objectives of identifying main barriers hampering the effective implementation of social innovation, and better understanding how moringa-teabags packaging innovation might impact the environment and various stakeholders across the water quality supply chain, especially as it relates to public health, infrastructure, cleaning of formal and informal water collectors, consumers, and policy.These findings could be used to inform future campaigns to promote moringa as an alternative for household water treatment, in communities without water supply systems, with the potential for greater community engagement than current HWPs.Table S1 Sample of results from thematic analysisAdditional file 1: Additional file 2:


Mobile devices and mobile applications facilitate access to clinical evidence at the point-of-care. Medical libraries play an important role in medical trainees' education, by subscribing to quality resources and by providing help and guidance on what apps to use. This study’s goal was to explore medical trainees' mobile applications use in the clinical setting to help inform collection development’s decisions and to provide insight on educational outreach. Perceived barriers and benefits of medical app use by clinical trainees was also explored.A brief online survey (English and French) was sent to all University of Ottawa clerkship medical students and residents. The questionnaire consisted of multiple choices, Likert-scale, and open-ended questions.208 English and 9 French responses were received. UpToDate was the most frequently used app, followed by MedCalc, Spectrum (CHEO) and Medscape. Respondents used medical apps mostly before and after meeting with patients and rarely while interacting with patients. Main benefits identified of medical app use were helping with decision-making, quick access to trustworthy clinical information, help with diagnosis and treatment options . Main barriers identified were costs, appearing unprofessional, lack of Canadian content and spotty hospital WiFi.Libraries' involvement in providing access to trustworthy clinical resources to medical trainees is important to help shape trainees' development as medical professionals. Outreach to learners in the clinical setting is crucial to educate on what apps are available to them through the library collection. Mobile devices and mobile applications (apps) allow medical students and residents to access clinical evidence at the point-of-care. In a recent study, all medical students completing their first year of clinical placement surveyed owned a smartphone and almost all students were using technology daily for educational purposes . The terApps that are considered “medical” are found in the thousands . Not allClarke et al. observed that most medical students used their mobile devices for entertainment, communication, and social media in addition to m-learning, while completing their clinical placement . This noDespite these barriers, many studies have highlighted the positive and important impact of mobile device usage by medical trainees. These include enhanced learning by providing access to important clinical knowledge at the point-of-care ,5,9-10, Medical libraries subscribe to many online resources, which often also include an app version. A 2014 pan-Canadian study found that participants  mostly used mobile devices to find drug information, to make clinical calculations, and to take notes . When asA 2019  study suAt the University of Ottawa, there has been a constant increase in price in the last few years for subscriptions, and although there is a healthy collection budget, choices have to be made every year on what resources should be kept or cut. Knowing what apps are used by residents and medical students can help inform library collection decision-making and what educational outreach is needed. It appears no studies have explored mobile app use by medical trainees in Canada in the last eight years.Therefore, the purpose of this article is to explore the practices of clerkship students  and residents using mobile medical apps in clinical settings. Of particular interest was exploring the perceived usefulness, barriers, and benefits of using these apps.Do residents and clerkship medical students use clinical mobile apps?If so, which ones do they use, and how do they rate them for helping to answer clinical questions?What are the perceived benefits and barriers of using mobile apps in the clinical setting?Research questions included:It is hoped that the results from this study will inform what and how mobile apps are used by medical trainees on a local level, and in turn, influence library collection decisions to better reflect trainee’s needs and support educational outreach programming.This study was approved by the University of Ottawa in December 2019 (Ethics File Number: H-12-19-5245). The brief bilingual (French and English) survey was comprised of 14 questions, including multiple choice, Likert-scale, and open-ended questions,  for medical students (years 3 and 4), and 21% (n=149) for residents.Participants were asked if they use their mobile device in the clinical setting. 88% (n=191) of the survey’s participants answered, “all the time” or “often”, 11% (n=23) stated “sometimes” and 1% (n=3) “never”. The participants who answered “never” were thanked for their participation and the questionnaire ended for them at that point.https://app.spectrum.md/.) Many other apps were mentioned only by a handful of participants, such as Epocrates , and didn’t make the cut to the top 10. A complete list of apps mentioned can be found in Online Supplement, As previously mentioned, the number of times the following apps were mentioned by participants was calculated, regardless of their position in the top three. UpToDate was mentioned by 76% (n=166) of participants, followed by MDCalc , Spectrum , Medscape  and MD on Call . Lexicomp and DynaMed were respectfully mentioned by 6% (n=14) and 5% (n=13) of participants see .  and “suggested by a friend or colleague”  the most.Another open-ended question inquired into what apps they use for drug information. The three main apps mentioned were UpToDate , Lexicomp  and CPS .We asked participants the frequency of which they used specific mobile apps. UpToDate was used “often” or “all the time” by 74% (n=157) of respondents. There was a drop in usage for all other apps. Lexicomp and CPS were used “often” or “all the time” by 28% (n=62) and 8% (n=17) of our respondents.Participants were also asked to rate these apps in helping answer clinical questions with “1” being not helpful at all for clinical decision support, and “5” being extremely helpful for clinical decision support. Participants could choose “don’t know”, which many selected.Participants were asked what apps the library should subscribe to, to help with their learning. Respondents mainly answered UpToDate , followed by Lexicomp , CPS  and Dynamed .Participants were also asked when they use medical apps: before, during or after their interactions with patients. Most participants used medical apps before  and after  meeting with patients, and only a fraction while interacting with patients .Participants had the opportunity to share what they believed to be the benefits and barriers of using medical apps in clinical settings in an open-ended question. 85% of participants (n=185) answered.Quick and easy access to evidenced-based, reliable and updated clinical knowledge;Checking medication doses and interactions;To prepare before meeting with patients, form a clinical plan, or help differential diagnosis;Better patient care, safer prescribing, reducing medical errors.Four themes emerged regarding benefits:Noteworthy quotes that represent well respondents’ answers include: “Mobile applications let me access resources more easily and readily than poor hospital infrastructure ”; “It's impossible to be knowledgeable about all areas of medicine and apps help tremendously with problems outside my area of expertise”; “Learn as you go, make more accurate plans before discussing with supervisors, understand your patients better”; “Helps me feel more prepared”.Negative perception from patients and supervisors ;Costs;Spotty hospital WiFi;Lack of Canadian content;Data plan limitations, phone’s storage limit, battery life.Five themes emerged in relation to participant-identified barriers:Respondents stated the following: “Optics of being on phone appearing like you don't know things you maybe should”; “Stigma of pulling out your phone in clinic”; “I avoid using my phone as I worry that staff and residents will assume I am not using it for clinical purposes”; “Sometimes it takes a while to pull up, poor internet connection; patients may not feel confident in your medical knowledge if used in front of them”; “cost of some of the useful apps.”The first research question addressed whether residents and clerkship medical students use clinical mobile apps. 99% n=214) of participants identified that, yes, they used medical apps for clinical decision support. This led to the question of what apps are being used by these Ottawa based clerkship students and residents and how they rate them. UpToDate as the preferred app was surprising since only a few of the hospital libraries in the region subscribe to it, and it is not available through the University of Ottawa collection. Previous research is conflicting. Some have demonstrated the popularity of UpToDate among students, residents and physicians , 14. Whe of partiAt the University of Ottawa, the collection decision was made to subscribe to DynaMed to provide equivalent point-of-care clinical information to clerkship learners and residents as UpToDate, but very few participants demonstrated using DynaMed. The University of Ottawa also subscribes to CPS but not to Lexicomp, and the results showed that more people were using Lexicomp compared to CPS. These results were surprising in a large part because the library provides training to third year medical students and first year family medicine residents on different apps available to them via the library.Furthermore, since the results showed that clinicians’ opinions appear to influence learner’s app selection, one could tentatively argue that UpToDate and Lexicomp have been the resource of choice by many clinicians since their debut - even if competitors have risen in the last few years (e.g. DynaMed). As one participant commented “I wish we got a legitimate tutorial on how to use the apps during clerkship - the ones I use are the ones doctors showed me they like” which sums this up well. The library subscribes to resources, which learners don’t use either because they didn’t know they had access to them, or because they use the ones their supervisors have suggested.Participants also rated UpToDate and Lexicomp higher than DynaMed and CPS overall. This is presumably because since both UpToDate and Lexicomp were used a lot more by participants than DynaMed and CPS, they had little experience of these resources’ functionalities. This presumption aligns partly with Bradley-Ridout et al. findings, who studied UpToDate and DynaMed use and comfort level by residents . AnecdotThe last research question was intended to find out the perceived benefits of and barriers to the use of apps in the clinical setting. As shown in the results, respondents are preoccupied by the negative perception of unprofessional behaviour when using their mobile device in the clinical setting. This aligns with recent findings by Clarke and Dimond ,7. HowevLearners’ concerns regarding looking unprofessional are perhaps the consequence of a generational gap. It is clear however that this is a barrier for these learners to improving their clinical knowledge and perfecting their diagnosis skills while in the clinical setting where mobile devices are a quick method of accessing reliable clinical knowledge. Educating hospital staff and patients might be the key to solving this issue by raising awareness of mobile device use for educational purposes (m-learning) and not for pleasure or entertainment. A recent study found that: “…newly qualified doctors recognized that the way they were using their phone was important. By sharing the resources with patients, their mobile phone facilitates patient centered care, but it also avoided the potential for criticism and uncertainty. Providing explanation, to patients or ward staff, as to why a mobile phone was being used within a work space usually enabled the doctors to proceed with confidence” .Another obstacle highlighted by participants is the cost of medical apps. In the Ottawa region and in Canada, hospital library closures have and continue to occur, and those that remain often have limited budget preventing these libraries from providing institutional access to point-of-care apps . As for As for the benefits identified by our respondents, ; they align with what has been reported by previous studies ,5,7,9-12Although this research project experienced limitations , it is hoped that the results of this study will help inform current research in the Canadian context as well as decision making in various library areas such as collection development, education and outreach, promotion etc.These results showed that even if there are some library educational sessions on point-of-care apps already in place for medical students and residents, learners are not using the resources available through the library collection. As stated earlier, the University of Ottawa Library has a healthy budget, but still cannot subscribe to all point-of-care apps. As a next step, the library will be looking at re-evaluating and exploring apps that would best suit learners. As well as re-imagining educational sessions and putting the emphasis on Canadian-content, and apps available to them. Providing outreach to additional resident groups, and offering educational training to hospital staff and physicians on the value of m-learning and on Canadian-centric apps could perhaps help re-orient learners’ app selection and use in return.Furthermore, the results showed that participants’ use medical apps very frequently before and after meeting with patients and sometimes during patient consults. They also see the benefit of using these apps for rapid access to trustworthy clinical information. It seems fair to say that mobile devices and point-of care mobile apps have their place in the learner’s toolkit. Although there are barriers to their use, point-of-care apps are useful to learners in the fast-paced clinical environment. Education is key and remains important in shaping learners’ habits in what resources to use. Future research could focus on hospital staff and clinician’s perceptions of mobile device use by medical trainees to better understand the challenges learners encounter and learn how to help change these negative perceptions. Also, exploring why learners choose one app over another would perhaps provide a better understanding of apps’ selection by medical trainees.This study provides a current picture of medical app use by learners in the clinical environment, in Ottawa, but the findings do have limitations. A relatively low response rate and having surveyed members of only one institution render the extrapolation of results to all medical learners in Canada difficult. Demographic details were asked at the end of the survey, and since unfinished questionnaires were included in the analysis this resulted in 29% of participants not disclosing if they were a medical student or a resident. This prevented further division of the results by demographic.