Chinese medical dialogue information extraction via contrastive multi-utterance inference.

Medical Dialogue Information Extraction (MDIE) is a promising task for modern medical care systems, which greatly facilitates the development of many real-world applications such as electronic medical record generation, automatic disease diagnosis, etc. Recent methods have firstly achieved considerable performance in Chinese MDIE but still suffer from some inherent limitations, such as poor exploitation of the inter-dependencies in multiple utterances, weak discrimination of the hard samples. In this paper, we propose a contrastive multi-utterance inference (CMUI) method to address these issues. Specifically, we first use a type-aware encoder to provide an efficient encode mechanism toward different categories. Subsequently, we introduce a selective attention mechanism to explicitly capture the dependencies among utterances, which thus constructs a multi-utterance inference. Finally, a supervised contrastive learning approach is integrated into our framework to improve the recognition ability for the hard samples. Extensive experiments show that our model achieves state-of-the-art performance on a public benchmark Chinese-based dataset and delivers significant performance gain on MDIE as compared with baselines. Specifically, we outperform the state-of-the-art results in F1-score by 2.27%, 0.55% in Recall and 3.61% in Precision (The codes that support the findings of this study are openly available in CMUI at https://github.com/jc4357/CMUI.).

A stage-dependent seed defense response to explain efficient seed transmission of Xanthomonas citri pv. fuscans to common bean.

Although seed represents an important means of plant pathogen dispersion, the seed-pathogen dialogue remains largely unexplored. A multiomic approach was performed at different seed developmental stages of common bean (Phaseolus vulgaris L.) during asymptomatic colonization by Xanthomonas citri pv. fuscans (Xcf), At the early seed developmental stages, we observed high transcriptional changes both in seeds with bacterial recognition and defense signal transduction genes, and in bacteria with up-regulation of the bacterial type 3 secretion system. This high transcriptional activity of defense genes in Xcf-colonized seeds during maturation refutes the widely diffused assumption considering seeds as passive carriers of microbes. At later seed maturation stages, few transcriptome changes indicated a less intense molecular dialogue between the host and the pathogen, but marked by changes in DNA methylation of plant defense genes, in response to Xcf colonization. We showed examples of pathogen-specific DNA methylations in colonized seeds acting as plant defense silencing to repress plant immune response during the germination process. Finally, we propose a novel plant-pathogen interaction model, specific to the seed tissues, highlighting the existence of distinct phases during seed-pathogen interaction with seeds being actively interacting with colonizing pathogens, then both belligerents switching to more passive mode at later stages.

Misplaced Divides? Discussing Political Disagreement With Strangers Can Be Unexpectedly Positive.

Differences of opinion between people are common in everyday life, but discussing those differences openly in conversation may be unnecessarily rare. We report three experiments (N = 1,264 U.S.-based adults) demonstrating that people's interest in discussing important but potentially divisive topics is guided by their expectations about how positively the conversation will unfold, leaving them more interested in having a conversation with someone who agrees versus disagrees with them. People's expectations about their conversations, however, were systematically miscalibrated such that people underestimated how positive these conversations would be-especially in cases of disagreement. Miscalibrated expectations stemmed from underestimating the degree of common ground that would emerge in conversation and from failing to appreciate the power of social forces in conversation that create social connection. Misunderstanding the outcomes of conversation could lead people to avoid discussing disagreements more often, creating a misplaced barrier to learning, social connection, free inquiry, and free expression.

Enhancing cervical cancer knowledge among women of reproductive age: a dialogue-based community health education intervention in rural Kisumu County, Kenya.

BACKGROUND: Cervical cancer is a leading cause of cancer death among women of reproductive age despite being treatable if it is diagnosed early. Early diagnosis is possible through regular screening through the public health system. However, screening rates remain low in many low- and middle-income countries, including Kenya, where the screening rate currently stands at 16-18%. The low screening rates are attributed to, among other factors, low knowledge about cervical cancer and the available screening options among women of reproductive age. The current study evaluated the effectiveness of dialogue-based community health education by trained community health volunteers (CHVs) in improving cervical cancer knowledge among women of reproductive age (WRA) in rural Kisumu County. METHODS: This was a longitudinal pre- and post-intervention study with a control group. The knowledge of women of reproductive age was assessed at baseline in both the intervention and control groups, followed by dialogue-based community health education in the intervention arm. A final end-line knowledge assessment was performed. The scores at baseline and at the end of the study were compared to assess changes in knowledge due to the intervention. The proportion of WRA with improved knowledge was also calculated, and statistical significance was considered at p ≤ 0.05. RESULTS: There was no significant difference between the participants in the two arms, except for the level of education (p = 0.002). The knowledge of the WRA in the intervention arm improved significantly (p < 0.001) following the dialogue-based educational intervention by the trained CHVs. None of the demographic characteristics were associated with knowledge. CONCLUSION: Dialogue-based educational intervention significantly improved the knowledge of the WRA in the intervention arm, showing its potential to address the knowledge gap in the community.

Exploring the potential of ChatGPT in medical dialogue summarization: a study on consistency with human preferences.

BACKGROUND: Telemedicine has experienced rapid growth in recent years, aiming to enhance medical efficiency and reduce the workload of healthcare professionals. During the COVID-19 pandemic in 2019, it became especially crucial, enabling remote screenings and access to healthcare services while maintaining social distancing. Online consultation platforms have emerged, but the demand has strained the availability of medical professionals, directly leading to research and development in automated medical consultation. Specifically, there is a need for efficient and accurate medical dialogue summarization algorithms to condense lengthy conversations into shorter versions focused on relevant medical facts. The success of large language models like generative pre-trained transformer (GPT)-3 has recently prompted a paradigm shift in natural language processing (NLP) research. In this paper, we will explore its impact on medical dialogue summarization. METHODS: We present the performance and evaluation results of two approaches on a medical dialogue dataset. The first approach is based on fine-tuned pre-trained language models, such as bert-based summarization (BERTSUM) and bidirectional auto-regressive Transformers (BART). The second approach utilizes a large language models (LLMs) GPT-3.5 with inter-context learning (ICL). Evaluation is conducted using automated metrics such as ROUGE and BERTScore. RESULTS: In comparison to the BART and ChatGPT models, the summaries generated by the BERTSUM model not only exhibit significantly lower ROUGE and BERTScore values but also fail to pass the testing for any of the metrics in manual evaluation. On the other hand, the BART model achieved the highest ROUGE and BERTScore values among all evaluated models, surpassing ChatGPT. Its ROUGE-1, ROUGE-2, ROUGE-L, and BERTScore values were 14.94%, 53.48%, 32.84%, and 6.73% higher respectively than ChatGPT's best results. However, in the manual evaluation by medical experts, the summaries generated by the BART model exhibit satisfactory performance only in the "Readability" metric, with less than 30% passing the manual evaluation in other metrics. When compared to the BERTSUM and BART models, the ChatGPT model was evidently more favored by human medical experts. CONCLUSION: On one hand, the GPT-3.5 model can manipulate the style and outcomes of medical dialogue summaries through various prompts. The generated content is not only better received than results from certain human experts but also more comprehensible, making it a promising avenue for automated medical dialogue summarization. On the other hand, automated evaluation mechanisms like ROUGE and BERTScore fall short in fully assessing the outputs of large language models like GPT-3.5. Therefore, it is necessary to research more appropriate evaluation criteria.

Enhancing the delivery of comprehensive care for people living with HIV in Canada: insights from citizen panels and a national stakeholder dialogue.

BACKGROUND: People living with human immunodeficiency virus (HIV) are living longer with health-related disability associated with ageing, including complex conditions. However, health systems in Canada have not adapted to meet these comprehensive care needs. METHODS: We convened three citizen panels and a national stakeholder dialogue. The panels were informed by a plain-language citizen brief that outlined data and evidence about the challenge/problem, elements of an approach for addressing it and implementation considerations. The national dialogue was informed by a more detailed version of the same brief that included a thematic analysis of the findings from the panels. RESULTS: The 31 citizen panel participants emphasized the need for more prevention, testing and social supports, increased public education to address stigma and access to more timely data to inform system changes. The 21 system leaders emphasized the need to enhance person-centred care and for implementing learning and improvement across provinces, territories and Indigenous communities. Citizens and system leaders highlighted that policy actions need to acknowledge that HIV remains unique among conditions faced by Canadians. CONCLUSIONS: Action will require a national learning collaborative to support spread and scale of successful prevention, care and support initiatives. Such a collaborative should be grounded in a rapid-learning and improvement approach that is anchored on the needs, perspectives and aspirations of people living with HIV; driven by timely data and evidence; supported by appropriate decision supports and aligned governance, financial and delivery arrangements; and enabled with a culture of and competencies for rapid learning and improvement.

Similar gaze behaviour during dialogue perception in congenitally deaf children with cochlear Implants and normal hearing children.

BACKGROUND: Perceptual and speech production abilities of children with cochlear implants (CIs) are usually tested by word and sentence repetition or naming tests. However, these tests are quite far apart from daily life linguistic contexts. AIM: Here, we describe a way of investigating the link between language comprehension and anticipatory verbal behaviour promoting the use of more complex listening situations. METHODS AND PROCEDURE: The setup consists in watching the audio-visual dialogue of two actors. Children's gaze switches from one speaker to the other serve as a proxy of their prediction abilities. Moreover, to better understand the basis and the impact of anticipatory behaviour, we also measured children's ability to understand the dialogue content, their speech perception and memory skills as well as their rhythmic skills, that also require temporal predictions. Importantly, we compared children with CI performances with those of an age-matched group of children with normal hearing (NH). OUTCOMES AND RESULTS: While children with CI revealed poorer speech perception and verbal working memory abilities than NH children, there was no difference in gaze anticipatory behaviour. Interestingly, in children with CI only, we found a significant correlation between dialogue comprehension, perceptual skills and gaze anticipatory behaviour. CONCLUSION: Our results extend to a dialogue context of previous findings showing an absence of predictive deficits in children with CI. The current design seems an interesting avenue to provide an accurate and objective estimate of anticipatory language behaviour in a more ecological linguistic context also with young children. WHAT THIS PAPER ADDS: What is already known on the subject Children with cochlear implants seem to have difficulties extracting structure from and learning sequential input patterns, possibly due to signal degradation and auditory deprivation in the first years of life. They also seem to have a reduced use of contextual information and slow language processing among children with hearing loss. What this paper adds to existing knowledge Here we show that when adopting a rather complex linguistic context such as watching a dialogue of two individuals, children with cochlear implants are able to use the speech and language structure to anticipate gaze switches to the upcoming speaker. What are the clinical implications of this work? The present design seems an interesting avenue to provide an accurate and objective estimate of anticipatory behaviour in a more ecological and dynamic linguistic context. Importantly, this measure is implicit and it has been previously used with very young (normal-hearing) children, showing that they spontaneously make anticipatory gaze switches by age two. Thus, this approach may be of interest to refine the speech comprehension assessment at a rather early age after cochlear implantation where explicit behavioural tests are not always reliable and sensitive.

Co-constructed communication therapy for individuals with acquired brain injury: A systematic review.

BACKGROUND: Meaningful, varied, joyful conversation is an important therapy target for adults with language or cognitive-communication disorders following acquired brain injury (ABI). However, the complexity of daily communication is often reduced to component parts within intervention programmes, with mixed evidence of generalization to everyday conversation. Interventions targeting co-construction of communication within a dyad offer a structured way in which to retain and treat elements of everyday conversation for individuals and their communication partner (CP). Such interventions exist but they are variably labelled, target different ABI populations and have not been synthesized. AIMS: To identify the nature, scope and effects of intervention studies targeting co-constructed communication in adults with ABI. METHOD: This systematic review was completed using PRISMA Guidelines. Six databases (MEDLINE, Embase, CINAHL, Scopus, LLBA, PsychInfo) were searched and 1210 studies were screened. Data were extracted and studies were rated for methodological quality and completeness of reporting. Outcome measures and effects of treatment were collated through descriptive synthesis. MAIN CONTRIBUTION: This review highlights an emerging evidence base in relation to an intervention approach that targets everyday communication. Co-constructed communication interventions have been reported by 13 studies, from a total of 206 participants with post-stroke aphasia, traumatic brain injury and progressive language impairments. These interventions take a range of formats, including referential communication tasks, retell/recount therapies and communication training programmes. Methodological quality evaluation indicated mostly low-level study designs. Heterogeneity was identified in primary outcome measures, with 28 unique primary outcome measures reported across studies. Most studies demonstrated change in task-specific or broad communication outcome measures. CONCLUSIONS: Co-constructed communication interventions may offer clinicians a systematic, protocolized, replicable way to target everyday communication for adults with ABI. More high-quality, experimental designs with complete reporting and psychometrically sound outcome measures are needed to strengthen the evidence base. WHAT THIS PAPER ADDS: What is already known on this subject Everyday conversation is an important therapy target for adults with ABI, but there is mixed evidence of therapy gains generalizing to everyday life. Many interventions reduce conversation to component parts such as naming or sentence construction. A different approach is needed to capture the social, dyadic, interactive and multifaceted nature of conversation. We propose the term 'co-constructed communication interventions' as a therapy genre targeting semi-structured dialogue. These interventions retain elements of everyday conversation (such as multimodal communication and situating tasks within dyads), combined with experimental elements (where stimuli prompt interactions and responses can be scored against normative data). What this paper adds to existing knowledge This review proposes and describes a distinct genre of discourse intervention within the current evidence base with a novel operational definition of 'co-constructed communication'. What are the potential or actual clinical implications of this work? Co-constructed communication interventions directly target elements of everyday communication by situating the therapy goals within a dyadic, interactive, multimodal task. A range of intervention tasks have been identified, including collaborative storytelling and problem-solving. This review will be of interest to clinicians working with adults with ABI; co-constructed communication interventions may offer a useful, replicable way to target aspects of everyday communication. This synthesis of the current evidence base encourages clinicians' informed, evidence-based decisions around these interventions.

A Mood Semantic Awareness Model for Emotional Interactive Robots.

The rapid development of natural language processing technology and improvements in computer performance in recent years have resulted in the wide-scale development and adoption of human-machine dialogue systems. In this study, the Icc_dialogue model is proposed to enhance the semantic awareness of moods for emotional interactive robots. Equipped with a voice interaction module, emotion calculation is conducted based on model responses, and rules for calculating users' degree of interest are formulated. By evaluating the degree of interest, the system can determine whether it should transition to a new topic to maintain the user's interest. This model can also address issues such as overly purposeful responses and rigid emotional expressions in generated replies. Simultaneously, this study explores topic continuation after answering a question, the construction of dialogue rounds, keyword counting, and the creation of a target text similarity matrix for each text in the dialogue dataset. The matrix is normalized, weights are assigned, and the final text score is calculated. In the text with the highest score, the content of dialogue continuation is determined by calculating a subsequent sentence with the highest similarity. This resolves the issue in which the conversational bot fails to continue dialogue on a topic after answering a question, instead waiting for the user to voluntarily provide more information, resulting in topic interruption. As described in the experimental section, both automatic and manual evaluations were conducted to validate the significant improvement in the mood semantic awareness model's performance in terms of dialogue quality and user experience.

Early Movement Restriction Affects FNDC5/Irisin and BDNF Levels in Rat Muscle and Brain.

Interaction with the environment appears necessary for the maturation of sensorimotor and cognitive functions in early life. In rats, a model of sensorimotor restriction (SMR) from postnatal day 1 (P1) to P28 has shown that low and atypical sensorimotor activities induced the perturbation of motor behavior due to muscle weakness and the functional disorganization of the primary somatosensory and motor cortices. In the present study, our objective was to understand how SMR affects the muscle-brain dialogue. We focused on irisin, a myokine secreted by skeletal muscles in response to exercise. FNDC5/irisin expression was determined in hindlimb muscles and brain structures by Western blotting, and irisin expression in blood and cerebrospinal fluid was determined using an ELISA assay at P8, P15, P21 and P28. Since irisin is known to regulate its expression, Brain-Derived Neurotrophic Factor (BDNF) levels were also measured in the same brain structures. We demonstrated that SMR increases FNDC5/irisin levels specifically in the soleus muscle (from P21) and also affects this protein expression in several brain structures (as early as P15). The BDNF level was increased in the hippocampus at P8. To conclude, SMR affects FNDC5/irisin levels in a postural muscle and in several brain regions and has limited effects on BDNF expression in the brain.

A conversation analysis of therapist repeats in open dialogue network meetings.

Writings on Open Dialogue approaches to working with families experiencing mental distress emphasize the importance of the therapist repeating the family's words back to them verbatim. Repeats are theorized to display the therapist's listening and to encourage elaboration without imposing the therapist's own interpretations or conclusions on the family. These recommendations have not been subjected to rigorous interactional investigation. In this study, we used conversation analysis to analyze 160 examples of therapists repeating the prior talk of the family from 14 h of video-recorded Open Dialogue sessions. We found that these repeats had similar functions to those previously described in conversation analysis research such as initiating repair, marking receipt, and requesting elaboration as well as examples of therapist repeats occurring in overlap with the talk of the client. Open Dialogue writings thus present an oversimplified account of how repeats are utilized in clinical Open Dialogue sessions. Consistent with dialogical writings, repeats can elicit elaboration with limited input from the therapist, however repeats reflect selectivity and function to direct and guide the conversation to some extent. So, while therapist authority can be mitigated by repeating clients' words, when a therapist chooses to employ a repeat actively shapes the direction of the interaction.

Patient-authored medical record II: A not-knowing approach to psychiatric nursing.

A patient-authored medical record (PAMR) is a narrative-based prescription that is written by a psychiatric patient with help from a nurse. It is a tool specifically designed and developed for psychiatric nursing. We have reported its notable therapeutic effects for Japanese patients and found that the patients had accurate views of how to improve their illness. The present paper, which broadens the scope of this examination, includes the entire process of using this tool, including both patient-authored medical records and follow-up dialogue. We aim to demonstrate how a patient's potentials are leveraged and expanded through the interpretation of such texts through dialogue, in which interpretation takes the form of a conversational question based on not-knowing. Follow-up meetings facilitate the therapeutic process and team collaboration for patients, medical staff, and families. We also reaffirm the soundness and legitimacy of psychiatric patients writing their own prescription with help from a nurse.

[Anxiety and depression in adolescents]. / Angst und Depression bei Jugendlichen.

Anxiety and depression among young people had already increased in the years before the COVID-19 pandemic and then experienced a significant increase again during the pandemic. In this article the different clinical forms of expression of these emotional syndromes are presented in detail and the developmental paths of a combination of both disorders are also explained. Even subclinical forms of anxiety and depression already have clear clinical implications and impair the developmental tasks of adolescence. The "avolitional depression" (depression with severe drive disorders) is mentioned as a special form. Pathogenetic building blocks-from genetic vulnerability to psychosocial stressors-come up for discussion in light of the fact that anxiety and depression are about twice as common in adolescent females as in males. The embedding of the disorders in current events shows the special importance of the self-reflective emotion of shame in the adolescent development process. The scarcity and dysfunctionality of emotional dialogue between significant caregivers and children must be cautioned against. Its role in adolescents' self-regulation and affect regulation should not be underestimated. Finally, an overview of the most important therapeutic measures for anxiety and depression in adolescence is presented.

Shared decision making with frail people with intellectual disabilities in the palliative phase: A process evaluation of the use of the In-Dialogue conversation aid in practice.

BACKGROUND: This study reports the process evaluation of the In-Dialogue conversation aid to facilitate shared decision-making with people with intellectual disabilities in the palliative phase. METHODS: Training for In-Dialogue was evaluated by 53 support staff members through questionnaires. The use of In-Dialogue in four residential care facilities for frail people with mild to severe intellectual disabilities was evaluated with semi-structured interviews with five relatives, nine support staff and three people with intellectual disabilities. RESULTS: Most participants considered the training helpful to apply shared decision-making. Sixty-three people with intellectual disabilities participated in In-Dialogue conversations. Almost all interviewees stated that these conversations provided additional insight into people's concerns and preferences. Involvement of people with profound intellectual disabilities and their relatives appeared to be challenging. CONCLUSION: Conversations about illness and the end of life appeared to be feasible with the In-Dialogue conversation aid and provided insight into people's experiences and preferences.

Living ethics: a stance and its implications in health ethics.

Moral or ethical questions are vital because they affect our daily lives: what is the best choice we can make, the best action to take in a given situation, and ultimately, the best way to live our lives? Health ethics has contributed to moving ethics toward a more experience-based and user-oriented theoretical and methodological stance but remains in our practice an incomplete lever for human development and flourishing. This context led us to envision and develop the stance of a "living ethics", described in this inaugural collective and programmatic paper as an effort to consolidate creative collaboration between a wide array of stakeholders. We engaged in a participatory discussion and collective writing process known as instrumentalist concept analysis. This process included initial local consultations, an exploratory literature review, the constitution of a working group of 21 co-authors, and 8 workshops supporting a collaborative thinking and writing process. First, a living ethics designates a stance attentive to human experience and the role played by morality in human existence. Second, a living ethics represents an ongoing effort to interrogate and scrutinize our moral experiences to facilitate adaptation of people and contexts. It promotes the active and inclusive engagement of both individuals and communities in envisioning and enacting scenarios which correspond to their flourishing as authentic ethical agents. Living ethics encourages meaningful participation of stakeholders because moral questions touch deeply upon who we are and who we want to be. We explain various aspects of a living ethics stance, including its theoretical, methodological, and practical implications as well as some barriers to its enactment based on the reflections resulting from the collaborative thinking and writing process.

Editorial Perspective: On the need for clarity about attachment terminology.

Part of the appeal of attachment language is that it feels near to our everyday experience, as terms like 'attachment', 'security' or 'disorganisation' feel readily recognisable. Yet, not one of these terms is used by academic attachment researchers in line with ordinary language. This has hindered the evidence-based use of attachment in practice, the feedback loop from practice to research and the dialogue between attachment researchers in developmental psychology and in social psychology. This paper pinpoints the difficulties arising from the existence of multiple versions of 'attachment theory' that use exactly the same terms, held by communities that assume that they are referring to the same thing and with little infrastructure to help them discover otherwise. When we talk past one another, the different communities with a stake in knowledge of attachment are obstructed from genuinely learning from one another, drawing on their respective strengths and pursuing collaborations. One factor contributing to this situation has been the use of attachment terminology with technical meanings, but often without setting out clear definitions. We here introduce a guide to attachment terminology used by the academic community, which has recently been published on the website of the Society for Emotion and Attachment Studies. The guide is meant for researchers, clinicians and everyone concerned with attachment to increase understanding of the technical meaning of important terminology used by researchers, and support the quality of discussions between researchers, and between researchers and clinicians and other publics.

Understanding computational dialogue understanding.

In this paper, we first explain why human-like dialogue understanding is so difficult for artificial intelligence (AI). We discuss various methods for testing the understanding capabilities of dialogue systems. Our review of the development of dialogue systems over five decades focuses on the transition from closed-domain to open-domain systems and their extension to multi-modal, multi-party and multi-lingual dialogues. From being somewhat of a niche topic of AI research for the first 40 years, it has made newspaper headlines in recent years and is now being discussed by political leaders at events such as the World Economic Forum in Davos. We ask whether large language models are super-parrots or a milestone towards human-like dialogue understanding and how they relate to what we know about language processing in the human brain. Using ChatGPT as an example, we present some limitations of this approach to dialogue systems. Finally, we present some lessons learned from our 40 years of research in this field about system architecture principles: symmetric multi-modality, no presentation without representation and anticipation feedback loops. We conclude with a discussion of grand challenges such as satisfying conversational maxims and the European Language Equality Act through massive digital multi-linguality-perhaps enabled by interactive machine learning with human trainers. This article is part of a discussion meeting issue 'Cognitive artificial intelligence'.

Using environmental health dialogue in a Diné-centered approach for individualized results reporting in an environmental exposure study following the Gold King Mine Spill.

BACKGROUND: On August 5, 2015, the Gold King Mine Spill (GKMS) resulted in 3 million gallons of acid mine drainage spilling into the San Juan River impacting the Diné Bikeyah (traditional homelands of the Navajo people). The Gold King Mine Spill Diné Exposure Project was formed to understand the impacts of the GKMS on the Diné (Navajo). Reporting individualized household results in an exposure study is becoming more common; however, materials are often developed with limited community input with knowledge flowing in one direction - from researcher to participant. In this study we examined the development, dissemination, and evaluation of individualized results materials. METHODS: In August 2016, Navajo Nation Community Health Representatives (Navajo CHRs) sampled household water, dust, and soil, and resident blood and urine for lead and arsenic, respectively. From May-July 2017, iterative dialogue with a wide range of community partners and a community focus groups guided the development of a culturally-based dissemination process. In August 2017, Navajo CHRs reported individualized results and they surveyed the participants on the report-back process at that time. RESULTS: All of the 63 Diné adults (100%) who participated in the exposure study received their results by a CHR in person and 42 (67%) completed an evaluation. Most of those participants (83%) were satisfied with the result packets. Respondents ranked the individual and overall household results as the most important information they received (69% and 57%, respectively), while information on metals exposures and their health effects were the least helpful. CONCLUSIONS: Our project illustrates how a model of environmental health dialogue, defined by iterative, multidirectional communication among Indigenous community members, trusted Indigenous leaders, Indigenous researchers, non-Indigenous researchers, can improve reporting individualized study results. Findings can inform future research to encourage multi-directional environmental health dialogue to craft more culturally responsive and effective dissemination and communication materials.

Talking Trials: An arts-based exploration of attitudes to clinical trials amongst minority ethnic members of the South Riverside Community of Cardiff.

INTRODUCTION: Clinical trials must include diverse participants to ensure the wide applicability of results. However, people from ethnic minorities are included in clinical trials at rates lower than expected given their share of the population. Working with South Riverside Community Development Centre (SRCDC), Talking Trials used public engagement to foster discussions around the underrepresentation of those from minority ethnic communities in clinical trials and to identify and address concerns surrounding trial participation. METHODS: We conducted three workshops with 13 co-researchers from minority ethnic backgrounds. We explored perceptions and understanding of clinical trials alongside participatory art activities to help move away from verbocentric methods of communication. These artworks formed an exhibition that was presented to the community, prompting further discussions and engagement. FINDINGS: Co-production workshops were an effective tool to introduce the public to trial research. With little knowledge of clinical trials at the beginning of the process, our co-researchers formed a cohesive group, sharing initial fears and mistrust towards trials. As conversations progressed these attitudes clearly shifted. Artwork produced during the workshops was incorporated into an exhibition. Quotes and creative pieces from the group were included to reflect the themes identified. Presenting the exhibition at Riverside Festival enabled further engagement with a wider diverse community. The focus on co-production helped build a network of individuals new to research and keen to become involved further. CONCLUSION: Inclusive and democratic co-production, enriched by participatory art practices, provided a powerful means of enabling our group to create new insights and foster new relationships. Projects like Talking Trials can diversify the research process itself-for example, four co-researchers have commenced lay research partner roles on trial management groups and a lay advisory group is in development. PATIENT OR PUBLIC CONTRIBUTION: Three members of staff at SRCDC were on the project delivery group and involved in the initial project design, subsequently helping to connect us with members of the Riverside community to work as co-researchers. Two of the SRCDC staff are co-authors of this manuscript. The project had 13 public co-researchers guiding the direction of this research and creating the artwork displayed in the art exhibition.

Rural health dialogue for the sustainability of help-seeking behaviors among older patients: grounded theory approach.

BACKGROUND: Help-seeking behaviors (HSBs) are essential for disease prevention and health promotion. Dialogues with peers and medical professionals can improve HSBs, both qualitatively and quantitatively. Rural communities lacking healthcare resources require effective HSBs for healthcare sustainability. The current study aimed to investigate the effect of health dialogues between medical professionals and rural citizens on their HSBs. METHODS: All procedures complied with the Declaration of Helsinki and its subsequent amendments. The Unnan City Hospital Clinical Ethics Committee approved the study protocol (No. 20,220,002). A grounded theory approach was employed for the health dialogue participants in rural communities. Health dialogues with family physicians were conducted once a month at rural community centers. The dialogues and focus group interviews were recorded and coded to investigate changes in participants' perceptions and behaviors regarding HSBs. RESULTS: Twenty-one dialogues were conducted in two rural community centers, with a total of 112 participants. The average age of the participants was 70.2 years (standard deviation = 5.4), with 24% being males. Analysis of the grounded theory approach revealed four themes, namely joy-driven dialogue driving the realization of HSBs, reflection on personal HSBs through learning from others, revising HSBs based on rural social resources, and familiarity with physicians, hence motivating safe and secure HSBs. CONCLUSIONS: Mitigation of barriers between citizens and medical professionals and improvement of psychological safety in communities can drive effective HSBs in rural communities.