The correlation coefficient was p < 0.01) in differentiating between normotensive and hypertensive subjects using PPG signals. For the dataset at hand, only two synchrony measures are able to convincingly distinguish hypertensive subjects from normotensive control subjects, i.e., ffDTF and dDTF. From PDC, DTF, ffDTF, and dDTF, a consistent, a strong significant causality from ABP→PPG was found. When all synchrony measures were combined, an Arterial Blood Pressure (ABP) and photoplethysmography (PPG) are both useful techniques to monitor cardiovascular status. Though ABP monitoring is more widely employed, this procedure of signal acquisition whether done invasively or non-invasively may cause inconvenience and discomfort to the patients. PPG, however, is simple, noninvasive, and can be used for continuous measurement. This paper focuses on analyzing the similarities in time and frequency domains between ABP and PPG signals for normotensive, prehypertensive and hypertensive subjects and the feasibility of the classification of subjects considering the results of the analysis performed. From a database with 120 records of ABP and PPG, each 120 s in length, the records where separated into epochs taking into account 10 heartbeats, and the following statistical measures were performed: Correlation ( For decades, cardiovascular diseases (CVD) have been a major cause of mortality and morbidity around the world. Moreover, the number of patients suffering from CVD increases year by year. One of the major risk factors for the development of of CVD is chronic hypertension which is characterized by elevated baseline blood pressure over long periods of time. Chronic hypertension also increases the risk of cerebral vascular accidents and renal failure ,2. ThereThere are two types of methodologies for BP monitoring: invasive and noninvasive. Depending on the clinical situation, either continuous or intermittent blood pressure monitoring is employed. For continuous monitoring, invasive (intravascular) central monitoring is employed which has potential risks to patients such as infection, site bleeding, arterial obstruction and distal limb ischemic damage and vascular damage. There are also clinical situations where invasive arterial monitoring may be difficult if not impossible to be performed safely. Therefore, a method of non-invasive continuous blood pressure monitoring may be valuable clinically.There are many methods that can be used to noninvasively assess arterial blood pressure (ABP) waveforms; however, they are not user-friendly in practical applications. The photoplethysmogram (PPG) produces an optic signal related to arterial volumetric blood pulsations and has wide potential in clinical applications due to its simplicity and noninvasiveness ,4. RecenHypertension detection using cuff-based BP monitoring has been useful for the prevention of cardiovascular diseases for years. Some studies based on the measurement of PPG have reported suitable performance for the correct classification of patients when taking into account the cardiac variability ,12,13. HIn the literature there are two approaches for determining BP using PPG signals: synchronicity-dependent approach  and asynchronicity-dependent approach  . HoweverThe main objective of this paper is to validate the potential use of PPG signals for BP evaluation. The proposed approach examines the similarity between PPG and ABP morphologies in time and frequency domains, as well as the changes that exist between normotensive, prehypertensive and hypertensive subjects. In order to establish the robustness of the PPG signal for BP monitoring with different types of patients and the feasibility of the classification of subjects considering the results of the analyses performed, which we describe below.Our database, which is publicly available , called For the purpose of this study, three groups were formed: Normal  is correlated with the ABP amplitude, then the PPG amplitude can replace ABP for measuring BP.H2: If the PPG morphology  is correlated with the ABP morphology, then the PPG waveform morphology holds valuable information that can be used for evaluating BP.H3: If the PPG waveform and the ABP have mutual information and coherence , then the PPG waveform morphology holds valuable information that can be used for evaluating BP.In the literature, there are two approaches for determining BP using PPG signals: synchronicity-dependent approach  and asynchronicity-dependent approach  . HoweverNote that H1, and H3 are out-phase analyses  while H2 is an in-phase analysis . The in-phase and out-phase analyses are described below.r can be calculated by Equation , Partial Coherence (pCOH), Partial Directed Coherence (PDC), Directed Transfer Function (DTF), Full Frequency Directed Transfer Function (ffDTF) and Direct Directed Transfer Function (dDTF). These metrics aim to determine coupling, direct coupling, direct causality, directed connectivity, and direct and indirect connection as functions of frequency . Their vp was calculated with the Bayesian criterion and was fixed the same for all the epochs per group. The AR model can be expressed in matrix form as For each epoch, an autoregressive (AR) model was estimated , where tWith the identity matrix Equation  can be rThe power spectral matrix of signals is given byjth column of The PDC is defined by  in the fThe DTF was introduced in  and is dj to i. It is calculated asThe ffDTF is a modification of the DTF concerning the normalization of the function in such a way as to make the denominator independent of frequency and is given byThese analyses were calculated by taking into account the maximum value in the frequency range of 1–10 Hz per epoch, and the results of epochs per subject were averaged.Two statistical nonparametric tests were performed with the results obtained from the analyses in the time and frequency domains to find any differences between the groups of normotensive (NT), prehypertensive (PHT), and hypertensive (HT): Wilcoxon Rank Sum test  with five Granger’s measures defined as follows: COH, PDC, DTF, ffDTF, dDTF, and all five measures combined as one feature set.We tested the H1 hypothesis, which is the out-phase analysis, to see if the PPG amplitude is correlated with the ABP amplitude. If correlated, then the PPG amplitude can replace ABP for measuring BP. We extracted the amplitude of each PPG waveform and the amplitude of its corresponding ABP waveform, and then scattered these amplitudes to examine correlation. As the MIMIC database was created and collected from different sources and used different clocks , we spliThe rejection of the H1 hypothesis confirms and validates testing the H2 and H3 hypothesis. The results of the H2 hypothesis, which is in-phase analyses, to determine the time-domain correlation between the ABP and PPG morphologies when aligned, are shown in On average, the correlation coefficient ined see , and thep-value of the Wilcoxon test corresponds to where the difference was found in comparing NT vs. PHT and NT vs. HT, while Kruskall–Walllis test for comparing NT vs. PHT vs. HT. As can be seen in p-values for all comparisons, with a significant difference  can be differentiated even when the similarity-causality between the signals is high in all groups. Based on the out-phase analysis shown During the out-phase analysis, it was assumed that, since the ABP and PPG signals were simultaneously collected , the signals were also synchronized. Many papers published results using the MIMIC database and assumed that all signals were collected at the same time and synchronized ,30,31,32Several algorithms can be used to calculate the BP based on the PPG signal along with other biosignals ,34. WhilOur main goal here was to examine the similarities between PPG and ABP waveforms. We did not focus on optimizing the classifier or evaluating BP using PPG signals. One of our next steps is to estimate blood pressure from PPG waveform based on the findings of this paper.The main limitations of the files used in this paper were the lack of demographic and clinical data, as well as a lack of more detailed information on the equipment used and the relative calibrations for the records. We did the analysis without looking into any confounding factors. On the other hand, although many papers have published results using the MIMIC database and it is assumed that all the signals were collected at the same time and synchronized, this is not the case, which made it impossible to perform further frequency analyses. As future work, we would like to apply the methodologies proposed in other databases and even in data acquired by us to have precise control of the gains of the sensors, and propose a metric for the calculation of the SBP and DBP from the PPG signal that goes according to our analysis.From the results of the analyses carried out, it can be concluded that there is a similarity between the PPG and ABP morphologies. This is reflected in the correlation coefficient calculated in the time-domain in-phase analysis. From the frequency domain analysis, it can be concluded that, as the BP increases, the synchronicity of the signals also increases, in addition to the higher causality is given ABP → PPG, which already mentioned above has congruence for the physiological relevance of the registration of the signals. Finally, the results of the classification analysis with the combination of the most two informative frequency measures suggest that PPG signal can be used to determine if a patient is normotensive or hypertensive similar to the ABP signal. The main conclusion of this work is that BP monitoring through PPG is a very promising for evaluating BP and it is a potentially feasible replacement for invasive ABP.


Given the significance of the results, the research must be extended to larger samples.Numerous interventions propose mindfulness training as a means of improving empathy. Our aim is to analyse the relationship between mindfulness practice and empathy through the mediating process of trait mindfulness. This sample comprised 264 undergraduate students ( Over the past decade, mindfulness-based interventions have been seen to offer promising therapeutic results throughout the life cycle, from infancy to senescence –3.Within this field, clinical and health-related studies enjoy the greatest proliferation, although at present mindfulness practice is becoming increasingly prevalent in other settings, such as organizations, schools and in the world of sport –8.In contrast, research relating mindfulness and college studies is scarce. The current systematic reviews of scientific production over the last ten years (2007–2017), based on the Web of Science, indicate a total of 652 articles published in any language, of which 96 articles are related to Social Science Research within the field of education. However, the studies linking mindfulness to university students have dropped to a total of 23 articles in which a total of 3,835 students have participated [In this field, some studies  demonstrRegarding the concept of empathy, it can be defined as an important component of social cognition that contributes to our ability to understand and respond adaptively to the emotions of others, to succeed in emotional communication and to promote prosocial behavior .While definitions have changed according to different approaches and perspectives, recent research emphasizes the distinction between cognitive and emotional components . The agrThe main theoretical contributions and research on empathy and its relationship with mindfulness show that the human being is born with a biological predisposition to be empathetic, being the environment in which one evolves the one that determines one’s level of development. Educating in empathy opens the possibility of moving towards a society of understanding .At a biological level, Lutz et al.  found thmindfulness construct [Many studies indicate that training in mindfulness leads to an increase in the different aspects of empathic attitude . Thus, monstruct . Researconstruct  concludeWe found evidence of recent interventions that propose training in mindfulness as a means of working on and improving empathy –25 as itHowever, some results suggest contradictions about its effects, and in this sense Dekeyser et al.  in theirTo date there have been many studies that attempt to explain this relationship through correlation and regression analyses –24. Howemindfulness construct. The study focuses on its practice in informal contexts or environments–during leisure activities, at meditation centers or in mindfulness-related courses–which have been largely ignored in previous studies.The main objective of this study is to further the understanding of why mindfulness practice impacts on empathic processes, by analyzing the mediating effects of the cognitions that derives from We have conceptualized empathy as a mainly emotional process that does not depend on a cognitive understanding, although it is considered that it can facilitate both understanding and action .mindfulness construct. In other words, that mindfulness practice (conduct) modifies the mindfulness cognitions -hypothesis 2- and that this improves empathy (emotion) -hypothesis 3-, with the direct effect of mindfulness practice on empathy disappearing in the presence of this mediating variable -hypothesis 4-.Thus, in accordance with the results of other investigations, we hope to confirm that mindfulness practice improves empathy -hypothesis 1-. However, our hypothesis considered that this total effect would be mediated by the changes that practicing mindfulness engenders in the cognitions of the Afterwards, the indirect effects of each facet of mindfulness construct are studied to determine which mediators have the greatest impact in terms of improving empathy -hypotheses 5 to 7- through mindfulness practice.A non-probabilistic convenience sample of 264 volunteer students from Sheffield Hallam University, South Yorkshire, England, was used. The gender distribution was 48 males and 216 females, from the Faculty of Psychology, with an average age of 24.13 years . With regard to the gender distribution, although there is a marked bias towards the female population, this proportion is representative of the university population in the field of studies analyzed, the OECD indicators  on higheWith regard to the practice of mindfulness, the participants answered the following question: “Have you had any mindfulness training?”. Thus, the sample was divided into two groups: those who had never practiced mindfulness before and those who had practiced it in informal contexts, that is, outside closed programs with a predetermined number of sessions.The instruments used were the Five Facet Mindfulness Questionnaire, FFMQ  and ToroToronto Empathy Questionnaire. The TEQ  is a brihttp://dx.doi.org/10.17504/protocols.io.w8qfhvw.The detailed protocol can be found at: Based on the internal validity of the study, quasi-experimental design is used, as an attempt to control the influence of extraneous variables on the results. According to the number of evaluations it is a transverse study, since the participants are evaluated in a single temporary moment.The written informed consent of the study participants was obtained, ensuring the confidential treatment of the data collected. The purpose and characteristics of the research were explained to them. The students completed the questionnaires with an average time of 25–30 minutes. The team members collected the information in one phase. The study complied with the ethical values required in research with people, respecting the fundamental principles included in the Declaration of Helsinki, in its updates, and in the regulations in force. This study was specifically approved by the Bioethics Committee at the University of Burgos, Spain, (IR 15/2018).The main objective of this work is to confirm, from the total measurement of the cognitions of the mindfulness construct, the relationship between practicing mindfulness  and improving empathy.To test the proposed model , we usedThe PROCESS macro (Model 4) was used to test Hypothesis 1, which established that mindfulness practice impacts on empathy.For this hypothesis, the results reflecting the total effect of mindfulness practice (IV) on empathy (DV) confirm that practicing mindfulness improves empathy .As regards Hypothesis 2, we also confirmed, as expected, that mindfulness practice improves mindfulness cognitions . Furthermore, as proposed in Hypothesis 3, the improvement in empathy relates to changes in mindfulness cognitions included in the FFMQ .The results in respect of Hypothesis 4 suggest that the positive direct effect of mindfulness practice on empathy  disappears if the mediation of mindfulness cognitions in that relationship is taken into account, as considered in our exposition .In The second objective is to determine which facets of mindfulness play a mediating role in the total effect between practicing mindfulness and empathy.To verify which dimensions of mindfulness play a mediating role in the relationship between mindfulness practice and empathy  we used As seen, only the indirect effects of the mediation models in which the mediating variables are observing, describing and non-reactivity to inner experience are significant. Therefore, we can consider that the facets acting with awareness and non-judging of inner experience do not play a mediating role in the relationship established between the practice of mindfulness and empathy.Our analysis of the significant indirect effects  revealedAs regards Hypothesis 4, we found that mindfulness practice impacts on describing  and this capacity in turn impacts on empathy . However, this mediation is partial, and the direct effect is significant .As regards Hypothesis 7, we found that mindfulness practice impacts on non-reactivity to inner experience , with a concomitant effect on empathy . However, this mediation is also partial, and the direct effect is significant .The findings found in this paper seem to indicate that mindfulness practices in informal settings involve modifications in mindfulness cognition, and that these also influence the development of empathy.Its importance and the confirmation of a positive relationship between both variables has been pointed out in the review carried out, although we intend to advance with the study of the mediating effects of mindfulness thought in relation to empathy. A growing body of research on the benefits of mindfulness has begun to show its potential as an intervention strategy for improving mental health and overall performance.However, Shapiro et al  considerIn addition, research with university students points to the need to increase investigation into positive aspects of functioning .The study presented aims to respond to both shortcomings, on the one hand to provide new data in the university and non-therapeutic field that reaffirm the importance of this relationship; and on the other hand, having detected the lack of studies on the mediating effects of mindfulness, to shed some light on the underlying process.Numerous studies have found a correlation between the practice of mindfulness and empathy, yet most of the literature collects results from structured mindfulness programs, carried out in professional or therapeutic contexts applied mainly in health contexts , as wellThe meta-analysis conducted by Konrath , which aStudies carried out applying a program of meditation among the university population  in orderBarbosa et al.  have poiThe theoretical relationship between the two constructs could be in the Grossman et al.  definitiConcurring with Viciana et al.  on the cThe findings of the second objective indicate that the observing dimension is the most robust mediator between the practice of mindfulness and empathy. And, although to a lesser extent, the describing and the non-reactivity of the internal experience dimensions also mediate in this relationship.Further work is therefore needed to establish that mindfulness programs that aim to improve empathy should focus on these three components.One of the limitations of this work arises from the unequal gender distribution of the sample, in which there is a bias towards the female gender. However, as stated before, we consider that it is a sample that represents in its composition the distribution of the population studied.Another possible limitation to the study derives from self-reported measures as the only measure for mindfulness and empathy, although the instruments used have proven reliability and validity and are constructed from a factorial analysis of the most relevant scales on both constructs. Some authors point out the difficulty of differentiating subjective perception or actual increase, and propose, for example, to complement the results by means of a situational assessment of empathy—using execution measures or biological markers such as oxytocin—in order to differentiate between exact and subjective empathy , 49 mind


The IDRC ‘Strengthening Equity through Applied Research Capacity building in eHealth’ (SEARCH) funded seven research projects in Bangladesh, Burkina Faso, Ethiopia, Kenya, Lebanon, Peru and Vietnam that sought to answer questions or test solutions related to the use of Internet or mobile phone technology in strengthening health systems. The evaluation accompanied these projects over two years to answer, among others, the question how cross-grant learning interactions influenced project outcomes.The evaluation team conducted repeated interviews and on-line questionnaire surveys with the research teams and analysed the information exchanges among researchers on a SharePoint site established by IDRC.The expectations of the SEARCH program in terms of cross-project learning were only partially realized. The diversity of themes, language barriers and differences in context were cited as main reasons. Non-facilitated active cross-grant networking was only observed between two teams working in English on thematically similar issues. However, networking among all projects was active during two program workshops organized by IDRC.Networking among research teams can increase the quality and the applicability of health systems research and potentially promote knowledge translation. Spontaneous networking across language barriers is, however, difficult. Effective global research networks require dedicated human and financial resources to keep them vibrant and alive.e-health, refugees An earlier meta-analysis of the citation impact of 442 publications resulting from 22 research networks found a complex relationship between the intensity of collaboration as measured by the interactions within networks, and the quality of scientific outputs as measured by the citation ratio. Networks with a high level of interaction were associated with high consistency in the quality of publications. While the quality of scientific outputs in low intensity networks was less consistent, they generated publications with both the highest and the lowest citation ratios.2 The findings suggest that researchers and institutions with high research capacity do not necessarily require peer networks to generate quality publications. However, in the context of research capacity building, close networking contributes to consistency in quality and lowers the risk that any research team is left behind.In 2012, a commentary in the journal ‘Nature’ observed a fundamental shift in the geography of science through the rise of research networks.3Support to networking is at the core of the International Development Centre’s (IDRC) approach to funding research in developing countries. In 2004/05, IDRC carried out a strategic review of its support to networks in a series of evaluation studies looking at network coordination, governance, sustainability and development outcomes. The findings of this review informed the IDRC annual learning forum in 2005 which defined networks as ‘social arrangements of organizations and/or individuals linked together around a common theme or purpose, working jointly but allowing members to maintain their autonomy as participants’.4 Research networks need investment and nurturing to reach their optimal value.The IDRC review of network governance, coordination and outcomes in 2005 found, not surprisingly, that networks distinguish themselves from other organizational forms by their level of participation. It also highlighted the important role of a coordinating network member to manage expectations and facilitate the direction of network activities.5Under the IDRC SEARCH program, seven research projects were funded in Bangladesh, Burkina Faso, Ethiopia, Kenya, Lebanon, Peru and Vietnam that sought to answer questions or test solutions related to the use of Internet or mobile phone technology in strengthening health systems. The four program objectives were to (i) strengthen, redesign and improve health system processes; (ii) support key health system operations essential for equity; (iii) generate evidence for decision-making; and (iv) increase social participation, accountability and transparency. Networking for joint learning and knowledge sharing ‘to reduce research silos and to encourage dialogue and enrich discussions’ was an additional program objective.6Network coordination is to some extent implicit in the IDRC approach to research funding, which includes close follow-up and mobilization of capacity support for all funded projects. The IDRC program officers thereby act as network hubs within their programs, transmitting lessons from one project to another and facilitating the exchange of information among funded projects. No additional network coordinator was appointed for SEARCH, although it was raised as an option by the participants of the SEARCH proposal development workshop.7 Final project outcomes could, of course, not be evaluated when the evaluation contract ended in 2016 because all seven teams were still in the process of analysing data and preparing reports. But the evaluation team monitored information exchanges among the researchers. In two rounds of interviews with the Principal Investigators in 2015 and 2016, the team explored the extent to which researchers engaged in cross-grant learning without the presence of a formally appointed network leader. The main data limitation was that networking exchanges among evaluation team members other than the Principal Investigators were not captured in the interviews. A Microsoft SharePoint site was established by IDRC to facilitate network exchanges, allowing teams to post documents, announce events such as workshops or conference presentations, and to engage in discussion fora which were, however, used sparingly.Instead, the projects funded under SEARCH were encouraged to network among themselves according to the needs and resources of each research team. At the same time, hera, a health consulting agency, was contracted to accompany the program in a learning evaluation over two years from 2014 to 2016. One of the five questions to be answered by the evaluation was: ‘How have the cross-grant learning interactions within SEARCH influenced project outcomes?’8 The analysis was conducted using NodeXL Excel Template Version 1.0.1.342; Social Media Research Foundation.9The evaluation team assessed the patterns, types and intensity of exchanges among researchers through social network analysis. The most intensive network exchanges occurred during workshops or were directly mediated by IDRC program staff. These were removed from the analysis as they reflected the usual IDRC practice. The seven projects and the SharePoint site were retained as the eight network actors. The following metrics were calculated: Degree centrality ; betweenness centrality (whether actors served as bridges in the shortest paths between two actors); closeness centrality (how close one actor is to another actor); and closeness .The result of the network analysis is presented in the graphic in which each of the seven projects is identified by the national flag. The proximity of the symbols indicates the number of exchanges that occurred between projects, and the opacity of the connecting line indicates the self-reported usefulness of the exchanges.The expectations of the SEARCH program in terms of cross-project learning beyond the traditional mode of IDRC mediated exchanges and organized workshops were only partially realized. There was active networking between the two projects in Bangladesh and Kenya as can be seen by the proximity of the two icons in the graphic. These two projects were thematically similar, both working on national frameworks for eHealth policy, and the two research teams worked in English.The project on access to health services for women, children and people living with HIV in Burkina Faso used the SharePoint site to post and retrieve materials, but as the only research team working in French, its interactions with the other teams were limited, including with the team in Vietnam which was closest in thematic terms. Language was also a constraint for the only Spanish-speaking team studying information systems in Peru. The research teams in Ethiopia and in Lebanon had relatively few interactions with the other teams or with the SharePoint site, which may be related to the subjects of their research themes which had little overlap with any other of the seven projects.While spontaneous networking among the research teams was limited, information exchanges using the traditional modality of IDRC-managed networking were very active. The teams met and discussed common challenges and experiences during two program workshops. They participated actively in a web-based training on gender analysis. IDRC program officers used site visits and feedback on progress reports to link project outputs to overarching program objectives. In repeated survey responses, program workshops, conferences and other face-to-face interactions were consistently ranked as the preferred platforms for information exchange.The integration of eHealth in health systems raises many issues. There are common questions, for instance on privacy, data security and the interactivity of technological platforms that were extensively discussed in program workshops. However, the technology itself, i.e. the ‘e’ in eHealth, does not provide a sufficiently common platform for information exchange that is useful for all. When there are commonalities in the research themes, as for instance between the studies in Kenya and in Bangladesh, the research teams will use opportunities to spontaneously exchange information.Networking among research teams can increase the quality and the applicability of health systems research and potentially promote knowledge translation. But networking has a cost. It may happen spontaneously when a platform is provided, but it is much more active and potentially useful when it is supported by dedicated human and financial resources to keep the network alive. All seven research teams wanted to exchange information, but they wanted organized venues such as workshops or webinars.Spontaneous networking across language barriers is difficult. The barriers can be overcome by a network manager such as IDRC in the case of the interactions between the francophone, hispanophone and anglophone research teams in SEARCH workshops and webinars. But it is not evident that it happens spontaneously without such facilitation.The evaluation ended in 2016, too early to assess the quality and the impact of research conducted in the SEARCH network. Although not formally assessed, there is emerging evidence in 2018 that research conducted under the SEARCH grants left a footprint in eHealth research that was arguably enhanced by networking among the seven teams. In total, 12 research papers have already been published in peer-reviewed journals with more currently under review. In 2016 the project in Burkina Faso, and in 2017 the project in Vietnam received awards from the Fondation Pierre Fabre’s Global South e-Health Observatory; and eHealth solutions researched and piloted by SEARCH projects in Peru and Vietnam were adopted and scaled up in national or provincial health systems.Several lessons about research networking and cross-project learning can be drawn from the SEARCH experience:This work was made possible by a grant from the International Development Research Centre.


Traffic congestion, especially during peak hours, has become a challenge for transportation systems in many metropolitan areas, and such congestion causes delays and negative effects for passengers. Many studies have examined the prediction of congestion; however, these studies focus mainly on road traffic, and subway transit, which is the main form of transportation in densely populated cities, such as Tokyo, Paris, and Beijing and Shenzhen in China, has seldom been examined. This study takes Shenzhen as a case study for predicting congestion in a subway system during peak hours and proposes a hybrid method that combines a static traffic assignment model with an agent-based dynamic traffic simulation model to estimate recurrent congestion in this subway system. The homes and work places of the residents in this city are collected and taken to represent the traffic demand for the subway system of Shenzhen. An origin-destination (OD) matrix derived from the data is used as an input in this method of predicting traffic, and the traffic congestion is presented in simulations. To evaluate the predictions, data on the congestion condition of subway segments that are released daily by the Shenzhen metro operation microblog are used as a reference, and a comparative analysis indicates the appropriateness of the proposed method. This study could be taken as an example for similar studies that model subway traffic in other cities. Urban traffic congestion has produced enormous challenges for both the daily lives of people and the stable development of societies and economies . The allThe forecasting of traffic flow has always been an important research content of sensor networks. Previous studies on the forecasting of traffic flow and the prediction of congestion have used various methods. These methods can be divided into several categories, specifically linear, nonlinear, and traffic simulation models. Early studies employed primarily linear models, such as nearest neighbor (NN)  and histNonlinear models are data-driven ; that isIn fact, a growing number of studies have combined various methods to make use of their respective advantages ,32,33. TTo address this problem, a hybrid method that combines a static traffic assignment model with an agent-based dynamic traffic simulation model is proposed in this study to predict recurrent congestion in a subway system during peak hours. In this study, Shenzhen, China, where the subway system has become the major mode of transportation, is taken as a case study. The residence and workplace data in this city are collected and taken as the OD matrix, with which the information on the trips of the residents can be generated by calling Baidu Map Services (BMS). An agent-based framework  is develStatic traffic assignment methods distribute traffic demand to a network with the preconditions of fixed origins and destinations. This study focuses on commuting behavior during the morning peak hours ,45,46 onA trip, which consists of a departure time, a travel mode, the related stations and a transfer plan, determines the travel behavior of travelers. Some studies have concentrated on the acquisition of the trips of travelers. For example, Me et al.  extracteThe Baidu Map development platform (BMDP) provides access to a series of BMS that can be used by registered map developers. The two map services that are used to generate trips with an OD matrix are Geocoding and Routing and Transportation. The original OD matrix stores the homes and workplaces of citizens in the form of detailed addresses. The encoding service transforms these addresses into coordinates in a specific geographic coordinate system, usually WGS84. Next, taking the coordinate pairs as inputs, the Routing and Transportation service searches for optimal solutions that enable a traveler to reach his or her destination. A trip can be created with this solution that includes the necessary travel information. In consideration of the popularization of map apps and the convenience of the travel solutions they provide, the generated trips have high consistency with reality.Subway traffic congestion is a phenomenon in which passenger flow volumes exceed the capacity of subway infrastructure over short periods, and time is a crucial parameter that cannot be reflected by static traffic assignments. Hence, a dynamic traffic simulation model that represents the temporal and spatial variations in subway passenger flow on the basis of the generated trips, is introduced in the next section.As described by Ferber , an agenIn this study, an agent-based traffic simulation framework is designed and implemented to explore the distribution characteristics of subway passenger flows during peak hours to predict recurrent congestion. In this framework, “simulation environment” refers to the subway network, and traffic entities are modeled as agents; thus, a multi-agent system (MAS) can be established. The framework takes the trips generated above as its inputs and it has a four-tier architecture, as shown in The constructed MAS includes three types of agents, person agents, station agents and vehicle agents, and is an action-driven system. The actions for subway vehicle agents include (1) entering a subway station and (2) departing from a subway station. In addition, the actions for person agents are (1) setting out, (2) arriving at a subway station, (3) leaving a subway station, (4) boarding the subway, (5) disembarking from the subway, and (6) arriving. An event comprises an action and the related time attributes.The system is motivated by a global event queue, which stores series of events in chronological order. Many events are generated during each simulation, and each event has the “start time” and “finish time” attributes. When an event occurs, its finish time will be calculated, and the start time of the next event for the associated agent will be assigned. For example, when a person sets out, a “person set out event” is created, and its start time can be calculated according to the empirical travel time. This event will be performed when the system time reaches its start time, and the next event for this person could be “person arrive at station event” is created and inserted into the event queue in chronological order. The system continues to run through fetching events from the event queue to perform and inserting newly generated events (if they exist) until the stopping conditions that all of the travelers reach their destinations or the elapsed time reaches a specified value are satisfied.The simulation workflow used in the proposed framework is presented in With the proposed framework and the generated trips, it is possible to simulate the whole traffic process, and the distribution patterns of the passenger flow can be extracted. In addition, the congested segments in a subway system can be detected by examining the passenger flow distribution and calculating the values of specific traffic indexes.The features of passenger flow distributions within specified periods can reveal subway traffic congestion directly and effectively. In In In the following descriptions, i is the ordinal enumeration of the stations and segments. For example, segment 1 in Segment passenger flow (SPF) is defined as the passenger flow volume of a segment. Formulas (1)–(4) can be used to calculate the SPF of subway lines for the whole travel process when all of the passengers have reached their destination.Many factors have been used to reflect the congestion situation of public transportation. Examples include vehicle speed and the ratio of distance and time. In view of the features of subway transit, the load factor of subway vehicles is used in this method to reflect the congestion state of the segment. β denotes the load factor of subway vehicles, where2, and the population of Shenzhen is nearly 10.78 million, meaning that Shenzhen is among the most densely populated cities. Shenzhen is the first special economic zone in China and is regarded as a window on the reform and opening up; thus, it occupies a significant economic position. In addition, Shenzhen contains 10 districts that are shown in Shenzhen is used as an example in this study. Shenzhen  is a coaShenzhen opened its first subway line in December 2004 and became the sixth city in China with a subway system. The system is operated by Shenzhen Metro Corporation (SZMC) and MTR <Shenzhen>. The subway system of Shenzhen presently includes eight subway lines  and 168 stations, and the total length of the subway lines is 285 km. The subway network covers six districts, including Luohu, Futian, Nanshan, Bao’an, Longhua, and Longgang. In 2017, the daily passenger flow volume of the URT system in Shenzhen was 4.53 million person-trips and grew at a rate of 27.54%. The maximum daily passenger flow volume for the subway system of Shenzhen is 5.61 million trips. The total number of planned subway lines is 32, and the total length of these lines will be 1142 km by 2030. Undoubtedly, the subway system is receiving additional urban traffic volume in terms of both quantity and proportion, which increases the need to predict traffic congestion in this system. Commuting is a behavior in which people travel between their homes and workplaces and back again, and the term “subway commuters” means those who commute by subway. Because this study does not consider multimodal traffic, the target travelers exclude people who transfer between the subway and other modes of public transportation. Considering the service radius of subway stations, people whose homes and workplaces are both located within 1000 m of a station were selected for examination in this experiment. A spatial buffer analysis  based onDetailed travel plans made up of walking distances, subway routes and directions, stations, transfer strategies and empirically determined travel times are needed to guide travelers to their destinations. The trip generation method is described in Step 1. Depart and walk 772 m from home to Shangsha Station.Step 2. At Shangsha Station, take Line 7 to Shixia Station.Step 3. Transfer, walking 94 m.Step 4. At Shixia Station, take Line 3 to Shaibu Station.Step 5. Walk 644 m from Shaibu Station to arrive at the workplace.A sample traveler was presented to describe the travel plan shown in The empirically determined travel time returned by BMS is 53 min 15 s. All of the travelers involved in the experiment have their generated trips in the same way, and the trips are utilized in dynamic traffic simulations in the next section.An agent-based traffic simulation framework was designed and developed to simulate the travel process of the chosen 370,033 travelers taking the trips described above. The proposed framework aimed to simulate the behaviors of all of the traffic entities chronologically. Because the situation examined here involves urban subway commuters going to work during the morning peak hours, the essential restraint was not being late. Thus, all of the travelers were required to arrive at their workplaces before a specific time (9:00 a.m.).Multiple iterations were executed before the system reached a relaxed state. The departure time for each traveler was calculated using the empirically determined travel time returned by BMS in the first iteration. For example, when the empirically determined travel time was 1 h, then the departure time should have been 8:00 a.m. to avoid being late. The departure time needed to be adjusted when a late arrival occurred.In this experiment, 116 iterations were carried out before the system reached a relaxed state. Traffic characteristics, such as times and the events performed, were output and analyzed to extract passenger flow characteristics and estimate congestion using the calculation methods discussed in The passenger flow distribution generated from the traffic simulation results reflected the passenger flow volume in subway segments during morning peak hours, and the load factors of the subway vehicles could be calculated using Formula (5), which indicates the degree of congestion for every segment. The number of passengers selected for evaluation in the experiment was nearly 40% of the real number of daily subway passenger-trips made during the morning peak hours; therefore, μ was assigned to be 0.4. In addition, our simulation needed to fully include the peak hours in our simulation period. It takes a certain amount of time for the traveler to travel from the departure to the stop and from the stop to the work place. So according to empirical data, the simulation extended from 6:30 a.m. to 9:00 a.m.The parameters related to the Shenzhen subway operation are shown in Statistics on the congestion conditions of the subway segments have been extracted from the daily morning peak hours’ congestion information released by the Shenzhen metro operation microblog see  in orderHere, d represents the number of days for which congestion information was collected; this value is set to 15 here. According to the results in Yitian Station to Futian Station (three stations) is labeled as smooth in both the reference data and the predicted results.Laojie Station to Mumianwan Station (seven stations) is labeled as congested in both the reference data and the predicted results.Danzhutou Station to Shuanglong Station (11 stations) is labeled as smooth in both the reference data and the predicted results.Futian Station to Laojie Station (six stations) is labeled as smooth in the reference data and crowded in the predicted results.Mumianwan Station to Danzhutou Station (two stations) is labeled as congested in the reference data and crowded in the predicted results.There are also two inconsistent segments:According to the reference data, the segments from Laojie Station to Danzhutou Station on Line 3 are frequently congested, and the proposed method successfully detects this behavior. (1)Bitou Station to Ma’an Hill Station (four stations) is labeled as smooth in both the reference data and the predicted results.(2)Fuyong Station to Houhai Station (seven stations) is labeled as crowded in both the reference data and the predicted results.(3)Houhai Station to Futian Station (three stations) is labeled as smooth in both the reference data and the predicted results.There is also one inconsistent segment:Ma’an Hill Station to Fuyong Station (three stations) is labeled as smooth in the reference data and crowded in the predicted results.The predicted results for Line 11 are promising. The major crowded segments are well detected, and only three segments are incorrectly assessed.The values of the matching ratio are relatively low for Lines 4 and 7. (1)As noted above, the prediction of congestion in the subway system of Shenzhen is based on the simulation of subway commuting behaviors. One significant assumption is that the commuting passenger flow makes up a large proportion of the total flow, and non-commuting passenger flow can be neglected. This assumption is reasonable for the subway lines other than Line 4, which includes Shenzhen North subway station that connects to Shenzhen North railway station (SZNRS). SZNRS serves a huge number of passengers traveling in and out of Shenzhen. Therefore, Shenzhen North subway station is constantly over capacity; its year-round passenger volume reached 67 million in 2015, ranking first among all of the stations. In contrast, in this experiment, the passenger flow volume for the Shenzhen North Station is 1027 and ranks 117th. Line 4 is the major subway line that connects Futian District (the downtown area) with SZNRS; thus, it carries a very large non-commuting passenger flow. This study does not consider the influence of non-commuting passenger flows, and the overall congestion conditions are underestimated for Line 4.(2)The OD information used in this study was collected in 2012. The LongHua New District has developed rapidly in recent years, and many people have moved there. Shenzhen Line 4 is the only subway line that reaches LongHua New District, and this line connects the LongHua New District with downtown. Thus, the demand for travel on Line 4 has increased rapidly in recent years, which may have produced this inconsistency.(3)Line 4 is the only one operated by MTR <Shenzhen>; the others are operated by SZMC. Different operation and management practices may have some influence on the passenger flow characteristics.The comparison shown in The comparison shown in (1)promising results are obtained by the proposed method;(2)data on the workplaces and homes of residents can be utilized to forecast passenger flows in public transportation systems; and(3)the predicted congested subway segments and the corresponding causes can be provided for use in traffic management-related decision support.The prediction of subway congestion is a significant issue, and such predictions can be used to guide the travel of residents and provide decision support for traffic managers and transit operators. In this study, a hybrid method that combines a static traffic assignment model with an agent-based dynamic traffic simulation model is proposed and tested in a case study city. The proposed method includes two major stages. For the traffic assignment stage, the trips of the subway commuters are generated from the OD information by calling BMS. During the prediction stage, an agent-based framework is developed, and an agent-based traffic simulation model is applied to simulate the travel process for all of the trips mentioned above. The predictions are then compared with the reference data. The experimental results show thatTraffic congestion, especially during peak hours, has become a challenge for transportation systems in many metropolitan areas. Many studies have examined the prediction of congestion; however, these studies focus mainly on road traffic, and subway transit has seldom been examined. This study provides a feasible method to predict subway traffic congestion during peak hours. Compared with the actual congestion situation of the subway during the morning peak hours, the results of our study are encouraging.The forecasting of traffic flow has always been an important research content of sensor network. Dynamic traffic simulation models are often used to predict traffic flow. However, the method is hard to do in subway traffic prediction due to the lack of information on the origins and destinations of passengers. A hybrid method that combines a static traffic assignment model with an agent-based dynamic traffic simulation model proposed in this study can make it feasible. The method of constructing an OD matrix from commuters’ home addresses and work places and assigning them to the subway transportation network makes up for the shortcomings in the data. It provides a new idea in the case of using OD information which is relatively easy-to-obtain data to predict subway traffic flow. This study could be taken as an example for similar studies that model subway traffic in other cities.In addition, the actual simulation scenario in this study is slightly idealized. The flow of non-commuting passenger during peak hours is not taken into account. In the future, unexpected factors, such as accidents and the effects of weather; passengers stop or delay in situations of actual congestion, will be taken into consideration to permit improvement of the proposed method. This study only considers commuting by subway. Prediction of the occurrence of congestion in multimodal traffic, including subways, buses, and taxis, will also be explored in our future work.In addition, the proposed approach has a drawback, in that the flow of non-commuting passengers during peak hours is not taken into consideration.Compared with the actual congestion situation of the subway during the morning peak hours, the results of our study are encouraging. The inconsistent lines have also been reasonably explained based on the actual situation. The research results show that it’s reasonable and effective for predicting congestion in a subway system during peak hours by the hybrid method to estimate recurrent congestion in this subway system. This study provides a feasible method to predict subway congestion. It can provide a new idea in the case of using relatively easy-to-obtain data such as OD information.In addition, the actual simulation scenario in this study is slightly idealized. In the future, unexpected factors, such as accidents and the effects of weather; passengers stop or delay in situations of actual congestion, will be taken into consideration to permit improvement of the proposed method. This study only considers commuting by subway. Prediction of the occurrence of congestion in multimodal traffic, including subways, buses, and taxis, will also be explored in our future work.


Background: The reporting rate of adverse drug reactions (ADRs) by healthcare professionals is low. ADR interventional programs may improve the reporting rate by the medical team. Our literature search revealed that only a few interventional studies among the pediatric population have been published.Objective: We aimed to create an interventional program in order to improve the reporting rate of ADRs during the interventional period compared to the control period, detect which drugs frequently lead to ADRs and determine the most serious ADRs.Design: A 3-month prospective intervention study compared with one year prior to the intervention (control period). ADR data was also collected for the year following the study period. Healthcare professionals were encouraged to report ADRs and an ADR reporting system was created for them.Setting: Pediatric Division at Shamir Medical Center (Assaf Harofeh), a tertiary care medical center.Results: The study population included 3,753 admitted patients with 1,323 prescriptions during the study period. During the period before the intervention was started, the ADR reporting rate was null. During the study period, 46 reports were collected: 46% from the general pediatric department, 26% from the pediatric neurology department, and 22% and 6% from the pediatric and neonatal intensive care units, respectively. Antiepileptic medications, IVIG, steroids and antibiotics were frequently reported to induce ADRs. Serious ADRs were also reported in 5 cases. One year of follow up after the intervention revealed a significant decline in the reporting rate.Conclusion: It is important to periodically encourage healthcare professionals to report any ADRs in order to increase knowledge about medication safety and prevent fatal harm. ADRs have a considerable adverse impact on the health of the population since a significant proportion of them are life-threatening or fatal. In a meta-analysis of 39 prospective studies from US hospitals, it has been shown that ADRs rank from the fourth to sixth leading cause of death . ADRs alA new medicine must pass three hurdles before its approval by the national drug regulatory authority. Sufficient evidence is required to show the new drug to be of good quality, effective, and safe. Whereas the first two criteria must be met before considering approval, the issue of safety is less certain. Safety is not absolute, and it can be judged only in relation to efficacy, requiring judgment on the part of the regulators in deciding on acceptable safety limits. There is the possibility that rare yet serious adverse events will not be detected during the pre-registration development of the drug because of multiple reasons such as younger patients in comparison to the post marketing stage, a limited number of medications that are taken for a short period of time and a small sample size which is insufficient for presenting results with significant statistics.National and international pharmacovigilance programs, intended to detect post marketing adverse drug reactions (ADRs), are based on spontaneous reports of ADRs by medical professionals. While spontaneous reporting remains a cornerstone of pharmacovigilance in the regulatory environment, and is vital for detection, more systematic and robust epidemiological methods that take into account the limitations of spontaneous reporting are required.In hospitals, reports of ADRs have become an important component of monitoring and evaluating activities performed. This information may be useful for identifying and minimizing preventable ADRs, while generally enhancing the ability of prescribers to manage ADRs more effectively .In Israeli hospitals, as in many other countries, reporting of severe or life threatening ADRs by doctors is compulsory. Doctors are required to report ADRs to the Ministry of Health, and ADRs in hospitals must be reported to the hospital pharmacy. In Israel, reports to the Ministry of Health can be sent by mail, or by filing a web based form on an ADR reporting site manned by the Israeli Society of Clinical Pharmacology, to which the Ministry of Health has access. Well established sites like the FDA Medwatch are lacking in Israel . ADR intAn adverse drug reaction (ADR) is defined by the World Health Organization (WHO) as any noxious, unintended, or undesired effect of a drug that occurs at doses used in humans for prophylaxis, diagnosis, or therapy . A serioThe research was approved by the Helsinki Committee of Shamir Medical Center (Assaf Harofeh) and took place in the Pediatric Division. Shamir Medical Center (Assaf Harofeh) is an 850-bed teaching hospital in central Israel, treating an urban and rural population of approximately 1 million people. The Pediatric Division is a comprehensive 100-bed childcare facility comprising general pediatric units, pediatric sub-specialties, pediatric general and orthopedic surgery units, a daycare clinic and a general pediatric intensive care unit. In addition, there is a 72-bed regular care new born nursery, a 30-bed newborn special care department , and a unique pediatric neurology and rehabilitation referral center. The average annual number of children hospitalized in the Pediatric Division is approximately 15,000 . The staff involved in the study included 33 physicians and 98 nurses. The intervention was made in the hospital so the patients that included were only hospitalized. The monthly number of prescriptions in the Pediatric Division is around 450.A prospective study was conducted for 3 months . The interventional program included: placing posters in medical team rooms and nurse stations; supplying nurses with forms requiring them to fax reports of ADRs including minimum information ; presenting a 45-minute lecture about the importance of pharmacovigilance to doctors and nurses in the Pediatric Division; distributing papers summarizing the main topics of the lecture to the medical team and nurses and; inserting a reporting paper into the patient’s medical record Table 1.The first part of the presentation included definitions of pharmacovigilance and ADRs; a review of international studies on drug-related morbidity and mortality, hospital admissions, and cost to health systems and patients; and a description of the methods used in pharmacovigilance and in spontaneous reporting systems, explaining that underreporting constitutes the system’s principal limitation. The second part addressed the attitudes associated with underreporting, emphasizing that only 5 min are required to complete the report form. In addition, a reminder card similar to the report form and containing the principal messages of the presentation was distributed to approximately 90% of the physicians attending the sessions.via a text message every week. Emails were sent to the network members (every nurse and physician in the pediatric division who has an outlook email), amusingly and pleasantly reminding them to report ADRs. The letters were written attractively using colors, different fonts, rhymes, idioms, etc. They also contained information on one or two of the latest ADRs reported, emphasizing the lesson learned from each report. The emails were sent to a group established on the Outlook Mailing Software, listing all the members of the network, at no particular time of day, and on no particular day of the month. Clinical meetings with hospital healthcare professionals raised awareness of ADR monitoring and its importance.The medical staff was encouraged to report anything they suspected, even if the ADR was common or mild in nature or uncertain. During the study period, notifications were sent The details required for reporting were the patient’s name, ID number and a short description of the ADR.The reports were sent to the Unit of Pediatric Pharmacology, as was customary before the study period. A trained pharmacist was in charge of documenting all the ADRs on the patient’s chart and the pharmacy plan of action. The Pediatric Pharmacology Unit subsequently sends the reports to the Israeli Ministry of Health. The ADRs reported during the study period (February to April 2016) were compared to the ADRs reported during the year prior to and after the study period. The rates of reporter role (doctors vs. nurses), type of ADR , severity of ADR (mild vs. moderate vs. severe) and ADR in accordance with specific medication classes were examined.The study was conducted in a number of departments in the Pediatric Division: General Pediatric Department, Pediatric Neurology Department, Pediatric Intensive Care Unit (ICU) and Neonatal Intensive Care Unit (NICU). The study population included 3,753 admitted patients with 1,323 prescriptions during the intervention period. There was no significant difference of the occupancy and the number of prescriptions in the pediatric departments before, during and after the intervention period.During the year before the intervention period no ADR was reported. In the study period, the rate of reporting ADRs rose significantly to 46 reports (mean of 15.3 reports per month). During 6 months after the study period, the ADR reporting rate was 20 (mean of 3.3 reports per month). In the period 6–12 months after the intervention period, no ADR reports were received Table 2.The reported ADRs were classified as neurologic, gastrointestinal, allergic, laboratory and other reactions. The most reported ADRs were allergic reactions and neurologic adverse drug reactions Figure 1via a slow intravenous infusion, 30 min later apnea and desaturation were observed, the IVIG infusion was stopped and the infant was transferred to the NICU for monitoring. During his stay at the NICU no clinical events were observed. A similar scenario was also observed in the second case, which was treated with IVIG for early jaundice. The neonate developed cyanosis and apnea that required mechanical ventilation, the IVIG infusion was stopped. In addition, 3 cases of ataxia, shivering and dizziness were reported after using Clobazam (Frisium®) at doses recommended in the literature. In 2 cases, the medication was stopped and in the third case the dose was reduced and the ADRs passed immediately after.Reports of serious adverse reactions included two cases of apnea when using intravenous immunoglobulins (IVIG). In one case IVIG was administered as a treatment for immune neonatal jaundice that developed during the first hour of life. The IVIG was received This study showed a dramatic increase in reporting ADRs during the intervention period, a trend that decreased gradually and returned to the baseline after 1 year of follow up. The most reported ADRs were allergic reactions and neurologic adverse drug reactions; 7.5% of the ADRs were severe. The most common drugs involved were antiepileptic, antibiotic and sedative drugs.During the intervention period, doctors became aware more than before about the importance of preventing errors in prescribing medications. During the medical meeting, medical prescribing errors were presented, and the doctors discussed actions needed to prevent these errors. Nurses began to examine the medical prescriptions and detected errors, most of the time, before the medications were given to the patients. Interestingly, the reports decreased significantly after the intervention period, suggesting the need for persistent acts to increase the awareness of the medical and paramedical team in terms of ADRs.In another interventional study conducted by Recently, a meta‐analysis tried to find factors responsible for underreporting and found; ignorance (only severe ADRs need to be reported), diffidence (fear of appearing ridiculous for reporting merely suspected ADRs), lethargy (lack of time or other excuses), indifference , insecurity (it is nearly impossible to determine whether a drug is responsible for an adverse reaction), and complacency , followed by nervous system medications and respiratory system medications (up to 35% each) . In the This study has limitations due to the short period of intervention and the lack of assessment of unreported ADRs during the intervention period. Information about causality is also lacking (it is a descriptive study) and a small number of reports were obtained. However, this study is one of the few studies that have been designed as interventional on a pediatric population. An additional strength of this study is that a structured intervention was established in the hospital and a follow-up period was implemented.In this study, an increased reporting rate of ADRs was observed during the interventional period. The reports then decreased gradually after this period when the interventions were ceased. Twelve months from the study period, no spontaneous ADR reports were received by the medical team. These results emphasize the importance of conducting interventions regularly in order to encourage medical staff to report ADRs spontaneously.The datasets generated for this study are available on request to the corresponding author.This study was approved by the ethical committee of Shamir Medical Center (Assaf Harofeh).MB, MS-P, and IA-K contributed to conception and design of the study. NK and SG contributed to data collection. RK, AL, MG, HB and TZ-B contributed to data analysis and interpretation. NK, SG, RK, AL, MG, HB, MS-P and TZ-B contributed to drafting the paper. MB and IA-K contributed to critical revision of the paper for important intellectual content. All authors read and approved the final version of the manuscript.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.


Research shows that there are inadequate interventions in resource-limited settings that could enable women of reproductive age to access and use health services in those settings. The main objective of this scoping review is to map the evidence on access to healthcare information by women of reproductive age in LMICs.The primary search will include Google Scholar, Science Direct, PubMed, EBSCOhost , Emerald, Embase, CDSR, PsycINFO, published and peer review journals, organisational projects, conference papers, reference list, grey literature sources, as well as reports related to this objective will be included in the study. Identified keywords will be used to search articles from the studies. The articles and abstracts will be screened by two independent reviewers (JS and TPMT). Inclusion and exclusion criteria will be considered to guide the screening. A thematic content analysis will be used to present the narrative account of the reviews, using NVivo computer software (version 11).The scoping review will focus on women of reproductive age in LMICs. We anticipate finding relevant literature on the interventions aimed at accessing health care services in LMICs. The study findings will help reveal research gaps to guide future research.Not registered with PROSPERO (not needed).This scoping review was not registered. There is a global commitment to achieve universal health coverage (UHC). Universal health coverage is defined as ensuring that all people have access to needed health services  of sufficient quality to be effective while also ensuring that the use of these services does not expose the user the financial hardship , 2. PeopThe lifetime risk of death for women in high-income countries, where health services are more accessible is 1 in 2400, but in low-income countries, it is 1 in 180 and under conditions of fragility and conflict, it is even high with 1 in every 54 women dying due to complications related to pregnancy , 7. The A key function of health systems is implementing interventions to improve health, but coverage of essential health interventions remains low in low-income countries. Implementing interventions can be challenging particularly if it entails complex changes in clinical routines, in collaborative patterns among different health care and disciplines, in the behaviour of providers, patients or other stakeholders or in the organisation of care . BarrierThe Sustainable Development Goal (SDG) 3 which is focused on good health and well-being is aiming to ensure healthy lives and promote well-being for all ages . The incA scoping review of the literature regarding the evidence on access to healthcare information by women of reproductive age in low- and middle-income countries is to be conducted. Evidence on interventions which are currently used by different countries in low- and middle-income countries is needed to benchmark and to recommend similar interventions to those countries who are not practising them. The main objectives of this literature are to map the literature on access to healthcare information by women of reproductive age in low- and middle-income countries. The second reason for conducting this specific scoping review is to examine broad areas to identify gaps on access to healthcare information by women of reproductive age in low- and middle-income countries, clarify key concepts and report on the types of evidence that address and inform practice on this topic area . A third reason, it is to provide a map of the range of available evidence that can be undertaken as a preliminary exercise prior to the conduct of a systematic review , 16.The main objective of this literature is to map the evidence on access to healthcare information by women of reproductive age in Low-and-Middle-Income Countries.This study is part of a larger study aimed at assessing the barriers and challenges to access and utilise maternal healthcare information provided to young women during pregnancy in the Ohangwena Region, Namibia. We will conduct a scoping review, which will be guided by PRISMA–ScR . The PRISMA-ScR follows the following steps: protocol and registration, eligibility criteria, information sources, search, selection of sources of evidence, data charting process, data items, critical appraisal of individual sources of evidence and synthesis of results. Results will include the following steps: Selection of sources of evidence, characteristics of sources of evidence, results of individual sources of evidence and synthesis of results. The last components will be Discussion which involves summary of evidence. Limitations and Conclusion are the last two steps of this methodology .Identify the research questionA scoping review requires a broad question to help you investigate what has been done in the field . The typMain research question: What is the evidence on access to healthcare information by women of reproductive age in low- and middle-income countries?Sub-questions: What factors contribute to women of reproductive age in LMICs to not access health care information?Studies will be selected according to the “population-concept-context (PCC)” framework recommended by the Joanna Briggs Institute for scoping reviews as stipulated under Table The lower- and middle-income countries under the context will be determined by the World Bank list of economies  which haA suitable team with content and methodological expertise will be assembled to ensure successful completion of the study. A literature search will be conducted from the following databases: Scholar, Science Direct, PubMed, EBSCOhost , Emerald, Embase and Cochrane Database of Systematic Review (CDSR) published and peer-reviewed journals, organisational projects, conference Google papers, reference list, grey literature, as well as reports related to this objective will be included in the study , 24.Researchers will keep record of the number of publications retrieved and the search dare after each session. Databases will be searched for the data on evidence on access to healthcare information by women of reproductive age in low- and middle-income countries The following keywords will be used: Access, Health care information, Women of reproductive age, Low and Middle Income Countries.The researcher will search the articles’ titles using keywords search in the following databases: Google Scholar, Science Direct, PubMed, EBSCOhost , Emerald, published and peer-reviewed journals, organisational projects, conference papers, reference list, grey literature, as well as reports related to this objective will be included in the study , 24.This study will be conducted using a three-stage mapping strategy. The first stage will include comprehensive title screening which will include comprehensive title screening which will be done by one reviewer. All eligible studies will be uploaded onto Covidence computer software and duplicates will be removed. The final Covidence library will be shared among the review team. The second and third stage which will comprise of an abstract and full article screening, respectively, will be conducted by two independent reviewers (J.S and TPMT) guided by the inclusion and exclusion criteria. A form with questions will be developed to screen the abstract based on the eligibility criteria . CovidenInclusion criteria:Study will include women of reproductive ageWomen ranging between the ages of 14–49 yearsEvidence from the period 2004 to recentStudy contacted in lower- and middle-income countriesAll study designs with relevant interventionsStudies that focus on interventions enabling access to health servicesGrey literature resources include government and non-governmental organisation reports and academic dissertationsAll studies will be included irrespective of their study designsTo be included, studies must meet the following criteria:Exclusion criteria:Studies that do not focus on interventions aimed at enabling access to health servicesStudies that do not focus on health servicesWomen below 13 years old and above 49 years old will not be included in the studyStudy done earlier than 2004Studies reporting on non-health interventionsPublications reporting on the following will be excluded:The research team will collectively develop the data charting form and determine which variables to extract in order to answer the research question. Furthermore, the form will be piloted by two independent reviewers (JS and TPMT). A random sample of 10 included studies will be used for consistency. Based on the feedback from the two reviewers, the data extraction form will be modified as required. Data charting form are being developed and variables and themes to be extracted will be determined in order to answer the research objective , 19, 24.The data charting form will include a mixture of general information about the study and specific information related to the study population, the type of intervention, outcome measures employed and the study design. The information will include the following: author(s), year of publication, journal full reference, aims or research questions, participant characteristics, recruitment context, sampling method, study design, theoretical background, data collection method, data analysis, intervention, intervention outcome, most relevant findings, conclusion and comments . The NViThe quality of the evidence obtained from the studies will be assessed to make sure that the study design is appropriate for the research objectives, to eliminate risk of bias and that the studies are reported well . We willThe narrative account will be produced in two ways: First, attention will be given to basic numerical analysis of the extent, nature and distribution of the studies included in the review. Tables and charts mapping will be produced. This will include the distribution of studies geographically and for the different care recipient groups, the range of interventions included in the review, the research methods adopted and the measures of effectiveness used , 24, 29.Secondly, the literature will be organised thematically, according to the two interventions  mentioned above. This stage will be divided into 3 steps: (1) Analysis  will be conducted. (2) The results will be reported and the outcome will be produced that will refer to the overall purpose or research question. (3) The meaning of the findings will be considered as they relate to the overall study purpose; the implications for future research, practice and policy will be discussed .A synthesis plan will be clearly outlined. A narrative summary will be provided. For collating and summarising results, a consistent approach to reporting the findings will be implemented. The researchers will conduct a content thematic analysis on included studies  and presScreening results will be reported using the adapted Preferred Reporting Items for Systematic Review and Meta-analysis guidelines (PRIMA) Displaying the dataIdentifying key patterns in the data and identify sub-themesSummarisingThe processes below will be followed , 34:CodThe aim of the study is to map the literature that indicates the evidence on interventions aimed at enabling access to health care information in LMICs. This study preceded the larger study aimed at assessing the barrier and challenges to access and utilise maternal healthcare information in one of the region in Namibia. Getting prior information on the available studies conducted on the topic in LMICs will strengthen the necessity of conducting the main study. It will also enlighten new researchers to conduct more research study on the topic if it found that less study was conducted in return that new knowledge will be generated. This is in support of the Sustainable Development Goal (SDG) 3 which is focused on good health and well-being aiming at ensuring the healthy lives and promotes the well-being of all ages . SustainWe anticipate finding relevant literature on the distribution of interventions aimed at enabling access to health care information in LMICs. The study findings will help pave way for the systematic review and it will reveal research gaps to guide future research. At the same time, the outcome of the study will be used to determine the type of systematic review to be conducted. Other scholars who are going to do scoping review in this area of study will also benefit by using the outcome of the study. Planners and policy makers in LMICs may find these findings useful during planning and decision-making.Additional file 1: PRISMA-P Checklist.Additional file 2: Result of Pilot search in journals.


Work ability research started in Finland in the 1990s due to the challenges of work force aging. The employment rates of older workers (55+) were below 40% and early retirement and work disability rates were rather common in many European countries. The work ability concept and methods were developed and broad international research activities started in the 1990s. A comprehensive promotion model for work ability was created aiming to prevent work ability from declining during aging. However, to be able to impact the work ability is a complicated and difficult task, and requires effects on human resources, work arrangements, and management. Therefore, only a limited number of intervention studies have shown an improvement of work ability during aging. This article introduces some possibilities regarding how to make work ability interventions more successful. Population and work force aging were the main reasons for starting the work ability research in the early 1980s, and a comprehensive concept for occupational health research was developed by the Finnish Institute of Occupational Health (FIOH) ,3. AdditThe basis for the work ability research and construction of the work ability index , as well as a follow-up study of Finnish municipal employees (1981–2009) .Between 1990 and 1999, the promotion concept of work ability was developed based on the results of an 11-year follow-up study . WAI in Between 2000 and 2009, the concept called “work ability house” was created based on the Finnish National Survey of work ability . The imphttps://www.inqa.de/EN/Home/home.html).In 2010, the work ability house model was updated . New insSeveral scientific papers were published from the Finnish Longitudinal Study of Ageing Municipal Employees (FLAME) study in collaboration between FIOH, University of Jyväskylä, and University of Tampere, Finland. The collaboration between occupational health research and gerontology had started.Most of the research activities of work ability has been focused in occupational health research, epidemiology, and ergonomics, and recently, in occupational gerontology. Our understanding of factors affecting work ability has been improved significantly. The interactions between human resources and work are intensive and dynamic. These interactions are changing due to the life course and aging. The balance between the human resources  and work  is crucial. A poor balance decreases the work ability in physical, mental, and mixed work, both among men and women . This isThe complexity of interactions explains why many intervention studies for the promotion of work ability have been less promising than expected. The recent meta-analysis of 17 randomized control trials showed a small positive effect, suggesting that workplace interventions might improve work ability . The autBehind the challenge of effective interventions is the knowing–doing (K-D) gap . The K-DAccording to my experiences of intervention studies over decades in several countries, at least three main reasons explain why the K-D gaps are growing. The first one is the lack of prioritization of the actions needed. For example, a work ability survey will easily produce a long list of factors that have negative relationships to work ability. Changing all the significant variables is not possible or feasible. Therefore, prioritization is needed. The next question is: Who is going to decide about the prioritization of measures? My opinion is that the steering group making prioritization should be representatives of the organization . The next question is: How should they prioritize? It should be based on dialog, where everybody in the steering group can give and explain his or her own arguments. An external facilitator takes care that no one can dominate; everyone’s comments will be noticed according to the rules of dialogue; and finally, a consensus will be created. This procedure is not easy and demands a new culture of communication within the steering group and company. In best cases, a long list of necessary measures can be reduced markedly, and the implementation becomes more feasible.The second reason for less-effective interventions could be the low participation rates of the people involved. Often the targets are to improve human resources through behavioral changes. For example, improving physical fitness using exercise might interest mostly those who are already active compared to those with more passive habits. The effects of exercise should be significant before effects on work ability can be expected. If only 60% of the intervention group improve their fitness, the 40% who are more passive dilutes the effects of the intervention group markedly. The same happens in competence training. Participation rates in learning new skills and competencies is seldom 100%. The same is true for the training of supervisors. There is often a lack of evidence that the training has been effective. The most difficult task is to change the attitude and behavior of supervisors and foremen. Therefore, at least regarding what should be controlled, is how actively the intervention group has participated in the training. If we accept only those who have been affected by the training in the intervention group, the improvements of their WAI can be significant compared to a control group .The third concern is the outcome variable, which should be sensitive enough for changes. The WAI has been widely used as an outcome for interventions. Originally, the WAI was constructed so that health-related items played an important role in scoring the individual WAI. In other words, if the intervention has a significant effect, the WAI will probably improve. However, without significant health effects items 3, 4, 5, and 6, the potential for improvement is rather limited. On the other hand, improvements in management skills and work arrangements should be powerful enough to improve WAI, but it is not easy to improve managerial skills so significantly that the knowledge is transferred into practice. WAI as an outcome variable requires significant improvements in both the health behavior of employees and the leadership behavior of supervisors. In summary, WAI is a very challenging outcome to achieve for interventions, especially among older workers who easily face the age-related changes in personal resources and health. Besides the WAI, broader measurements of outcomes are often necessary .For the large Good Work–Longer Career Program of the Finnish Technology industry (2010–2015), new methods to evaluate work ability were developed . The surThe second instrument of Work Ability 2.0, namely the Work Ability–Company Radar, is directly focused toward making the interventions more successful. With the help of this method, the actions will be prioritized and a concrete plan will be made. Both prioritization and an implementation plan are created with the help of a dialog process among a representative steering group. Only 1–3 targets with the highest priorities will be taken for interventions, and the intervention should focus on only one dimension at time . This process follows the guidelines of the Metal Age project . The comThe comprehensive, dynamic concept of work ability offers possibilities for work organizations to support longer and better working lives. Work ability management is a new potential area of development for supervisors, covering both health and age management. As soon as work ability management becomes one of the core functions of supervisors, the implementation of survey results will be more effective. The commitment of supervisors toward work ability management can be improved using annual evaluation of their results. In Finland, about 30% of supervisors are responsible for work ability management . The chaWork ability should also be on the agenda of social partners. Collective agreements are welcome because both employers and employees are the winner; better work ability and workplace well-being leads to better productivity, which is a win-win situation. The Finnish Program in the Technology Industry was based on an agreement between the Employer Association and the four largest trade unions; in Germany, the work ability project by a private bus company in the city of Hamburg was based on a similar agreement . Work abToday’s trend in several European countries is the improvement of workplace well-being. Workplace well-being can be conceptualized in many ways, but my impression is that it should emphasize the qualitative aspects of work ability. For example, if the balance between work and human resources creates positive effects on values, attitudes, and motivation of the staff, both the work ability and workplace well-being will be improved. Indicators for a better workplace well-being can be found in the updated work ability house model (third floor), which utilizes appreciation, trust, fair treatment, and support. In my understanding, workplace well- being cannot be created without work ability (see the legend for The discussions in the scientific committee Ageing and Work (ICOH) in the beginning of 2000 strongly supported the need to bridge the gap between occupational health research and gerontology . One impTherefore, there are common motivations toward understanding the role of work life and the transfer to the third age. In occupational gerontology, the scientist could develop a method that would take into account both work-related aspects and aspects of daily living, such as that suggested by Nygård and Rantanen . Investm