Enhancing Rural Water Utility Sustainability Through Creative Financing Mechanisms

To identify the gait parameters used to assess gait disorders in children with bilateral spastic cerebral palsy (CP) and evaluate their responsiveness to treatments. A systematic search within PubMed, Web of Science, and Scopus (in English, 2000-2016) for randomized controlled trials of children with bilateral spastic CP who were assessed by instrumented gait analysis (IGA) was performed. Data related to participants and study characteristics, risk of bias, and outcome measures were collected. A list of gait parameters responsive to clinical interventions was obtained. Twenty-one articles met the inclusion criteria. Eighty-nine gait parameters were identified, 56 of which showed responsiveness to treatments. Spatiotemporal and kinematic parameters were widely used compared to kinetic and surface electromyography data. The majority of responsive gait parameters were joint angles at the sagittal plane (flexion-extension). The IGA yields responsive outcome measures for the gait assessment of children with bilateral spastic CP. Spatiotemporal and kinematic (at sagittal plane) parameters are the gait parameters used most frequently. Further research is needed to establish the relevant gait parameters for each clinical problem. Fifty-six responsive gait parameters for children with bilateral spastic cerebral palsy were identified. Most responsive gait parameters belong to joint angles time-series at sagittal plane. Spatiotemporal and kinematic parameters are widely used compared to kinetic and surface electromyography parameters.

Is prior conditioning of dentin necessary in restoration with glass-ionomer cement? A systematic review and network meta-analysis

The rate of maternal and perinatal complications increases after 39 weeks' gestation in both unselected and complicated pregnancies. The aim of this study was to synthesize quantitatively the available evidence on the effect of elective induction of labor at 39 weeks on the risk of Cesarean section, and on maternal and perinatal outcomes. PubMed, US Registry of Clinical Trials, SCOPUS and CENTRAL databases were searched from inception to August 2018. Additionally, the references of retrieved articles were searched. Eligible studies were randomized controlled trials of singleton uncomplicated pregnancies in which participants were randomized between 39 + 0 and 39 + 6 gestational weeks to either induction of labor or expectant management. The risk of bias of individual studies was assessed using the Cochrane Risk of Bias Tool. The overall quality of evidence was assessed according to the GRADE guideline. Primary outcomes included Cesarean section, maternal death and admission to the neonatal intensive care unit (NICU). Secondary outcomes included operative delivery, Grade-3/4 perineal laceration, postpartum hemorrhage, maternal infection, hypertensive disease of pregnancy, maternal thrombotic events, length of maternal hospital stay, neonatal death, need for neonatal respiratory support, cerebral palsy, length of stay in NICU and length of neonatal hospital stay. Pooled risk ratios (RRs) were calculated using random-effects models. The meta-analysis included five studies (7261 cases). Induction of labor was associated with a decreased risk for Cesarean section (moderate quality of evidence; RR 0.86 (95% CI, 0.78-0.94); I2 = 0.1%), maternal hypertension (moderate quality of evidence; RR 0.65 (95% CI, 0.57-0.75); I2 = 0%) and neonatal respiratory support (moderate quality of evidence; RR 0.73 (95% CI, 0.58-0.95); I2 = 0%). Neonates born after induction weighed, on average, 81 g (95% CI, 63-100 g) less than those born after expectant management. No significant effects were found for the other outcomes with the available data. The main limitation of our analysis was that the majority of data were derived from a single large study. A second limitation arose from the open-label design of the studies, which may theoretically have affected the readiness of the attending clinician to resort to Cesarean section. Elective induction of labor in uncomplicated singleton pregnancy at 39 weeks' gestation is not associated with maternal or perinatal complications and may reduce the need for Cesarean section, risk of hypertensive disease of pregnancy and need for neonatal respiratory support. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.

Communication plays a crucial role in the generation, management, and prevention of medication errors. It is vital in preventing and managing medication errors. Evidence suggests that poor communication of medical information at transition points of care often results in medication errors. Objectives of the systematic review were to identify the impact of poor communication to medication errors in healthcare settings, highlight the key factors that link bad communication to an increase in medication errors, and address the communication strategies to mitigate the occurrence of medication errors in clinical practice with improved patient outcomes. Eligibility criteria: – Inclusion criteria: published and unpublished descriptive and evaluative studies, randomized control trials, surveys, chapters, and conference papers were part of the systematic review. Exclusion criteria: Unpublished studies and articles other than English language were excluded from the systematic review. Information sources: MEDLINE, Google Scholar CINAHL, PsycINFO, and Cochrane from 2004 to 2024 and reference list of eligible articles and reviews. Study risk of bias assessment: In this systematic review, the assessment of the risk of bias was not reported due to less trials and quantitative data. However, the risk of selection bias is considered due to the exclusion of studies other than English language. Interpretation of the various ideas and literature were retrieved and summarized in an organized manner from the articles, textbook chapters, observational studies, and surveys indexed in Google Scholar, PubMed, Scopus, and Research Gate databases. Hence, the readers would access the list of challenges and strategies together in one pool of review. Population, Intervention, Comparison, Outcome framework was applied for the systematic review. Most of the communication breakdown found between patients and healthcare professionals, absence of active listening to the patient concerns by their respective physicians and healthcare professionals, poor handover by nurses, absence of medication history in the past, confusion in different substitute of medications being prescribed by the doctor and administered by the nurse. The role of communication training in medication error prevention is crucial across various healthcare settings and specialties, emphasizing the need for tailored training programs to address specific communication challenges in different contexts. The provision of involving training in communication and interpersonal relationships as a part of continuous medical education/continuous nursing education in the healthcare organizations would contribute a lot to connecting these dots. Key components of effective communication training include active, practice-oriented strategies, joint training of healthcare professions, and tailored communication based on the situation and individuals involved.

This study aimed to review the effects of beta-alanine supplementation on cognitive performance in adult individuals. This review was carried out according to the PRISMA guidelines, using PubMed, Google Scholar, and Scopus databases, retrieving articles published between 2014 and 2024. Eligibility criteria followed the PICOS tool: healthy adult individuals of both sexes, isolated supplementation of beta-alanine, use of intervention and control groups, results of validated tests to assess cognitive capacity, and randomized controlled studies with parallel or crossover designs. Seven studies were included in this work, totaling 86 participants and using seven cognitive tests. The methodological quality and risk of bias were assessed using the PEDro and Cochrane Risk of Bias 2.0 scales, respectively. Most studies were considered good quality and had a low risk of bias. The analysis and interpretation of the studies demonstrated contradictory results of beta-alanine supplementation on cognitive performance regardless of the test protocols used. In four studies, this supplementation did not produce a significant effect, and in another three, an improvement was observed in cognitive tests after supplementation. It can be concluded that there is still insufficient evidence to guarantee that beta-alanine supplementation can improve the cognitive performance of adult individuals.

To evaluate the methodological quality of recent systematic reviews of interventions for children with cerebral palsy in order to determine the level of confidence in the reviews' conclusions. A comprehensive search of 22 databases identified eligible systematic reviews with and without meta-analysis published worldwide from 2015 to 2019. We independently extracted data and used A Measurement Tool to Assess Systematic Reviews-2 (AMSTAR-2) to appraise methodological quality. Eighty-three systematic reviews met strict eligibility criteria. Most were from Europe and Latin America and reported on rehabilitative interventions. AMSTAR-2 appraisal found critically low confidence in 88% (n=73) because of multiple and varied deficiencies. Only 7% (n=6) had no AMSTAR-2 critical domain deficiency. The number of systematic reviews increased fivefold from 2015 to 2019; however, quality did not improve over time. Most of these systematic reviews are considered unreliable according to AMSTAR-2. Current recommendations for treating children with CP based on these flawed systematic reviews need re-evaluation. Findings are comparable to reports from other areas of medicine, despite the general perception that systematic reviews are high-level evidence. The required use of current widely accepted guidance for conducting and reporting systematic reviews by authors, peer reviewers, and editors is critical to ensure reliable, unbiased, and transparent systematic reviews. What this paper adds Confidence was critically low in the conclusions of 88% of systematic reviews about interventions for children with cerebral palsy (CP). Quality issues in the sample were not limited to systematic reviews of non-randomized trials, or to those about certain populations of CP or interventions. The inclusion of meta-analysis did not improve the level of confidence in these systematic reviews. Numbers of systematic reviews on this topic increased over the 5 search years but their methodological quality did not improve.

ObjectivesIncreased popularity of stepped-wedge cluster randomised trials (SW-CRT) highlights the importance of understanding and appropriate mitigation of sources of bias within this trial design. While current evidence suggests that ‘conventional’ cluster randomised controlled trials (RCTs) are at a higher risk of recruitment bias than individually randomised trials, this review aims to estimate the risk of recruitment bias in SW-CRTs.DesignSystematic review with search conducted on four databases. Risk of bias (RoB) was assessed using subdomain 1a (randomisation process) and 1b (timing of identification or recruitment of participants) of the Cochrane RoB tool 2.0 (extension for cluster RCTs).Data sourcesMEDLINE, Embase, CINAHL, Cochrane Library were searched on 9 February 2024.Eligibility criteria for selecting studiesSW-CRTs published in 2023 were included.Data extraction and synthesisTwo independent reviewers screened and extracted all eligible papers. RoB was assessed with the Cochrane RoB tool.ResultsOverall, 808 papers were screened, and 64 studies were included in the review. Most studies were deemed to have a high RoB (n=35, 55%), some concerns were noticed in 20 studies (31%), and 9 (14%) were considered to have a low RoB. The description of the randomisation process in the included papers was sometimes poorly reported (in 15 studies (23%) problems with the randomisation process were identified), and 21 studies (33%) had issues with sampling strategy (recruiting participants after randomisation by unmasked staff).ConclusionsThe review revealed that SW-CRTs are prone to recruitment bias, but the risks are comparable to cluster RCTs. When SW-CRTs are unable to recruit prior to randomisation, mitigation strategies could be implemented to reduce bias. A separate tool for RoB assessment in SW-CRTs is required to address the complexities of this trial design.

Predicting the future for financial gain is a difficult, sometimes profitable activity. The focus of this book is the application of biologically inspired algorithms (BIAs) to financial modelling. In a detailed introduction, the authors explain computer trading on financial markets and the difficulties faced in financial market modelling. Then Part I provides a thorough guide to the various bioinspired methodologies neural networks, evolutionary computing (particularly genetic algorithms and grammatical evolution), particle swarm and ant colony optimization, and immune systems. Part II brings the reader through the development of market trading systems. Finally, Part III examines real-world case studies where BIA methodologies are employed to construct trading systems in equity and foreign exchange markets, and for the prediction of corporate bond ratings and corporate failures. The book was written for those in the finance community who want to apply BIAs in financial modelling, and for computer scientists who want an introduction to this growing application domain.

Public-Private-Partnership (PPP) models are in demand for infrastructure development all over the world. Road transport is an important infrastructure for the economic development of the country. Commonly adopted PPP models by the National Highways Authority of India in road projects are Build-Operate-Transfer (BOT) toll, BOT—annuity, Hybrid Annuity Model (HAM), toll-operate-transfer, operate–maintain–transfer, Engineering Procurement Construction (EPC). HAM is a combination of the traditional EPC and BOT—annuity model. HAM considers the involvement of both the parties that is the public and private sector. Mixed initial investment and different risk allocations make HAM distinct from other PPP models. PPP models are often long-term in nature, which makes both the parties check project’s financial viability. This study aims to develop a financial risk model using Net Present Worth (NPW)-at-risk method. From the literature, financial key risk parameters are identified. A case study is selected and cash flows from the public’s perspective are prepared. Probability distributions are allocated to risk parameters and Monte Carlo simulation is carried out using @Risk tool. The study also compares central and state policies of HAM. The findings from the developed financial model show variation of NPW as well as critical risk parameters. This financial model can be used as a decision tool for public authority and certain mitigation techniques can be applied to optimize project characteristics for the identified critical risk parameter.KeywordsFinancial risk modelHybrid annuity modelNet present worth-at-riskPublic-private-partnership

Across the world, millions of people are incarcerated every year, while hundreds of thousands of them are released back into their home communities. Despite several alternatives within the criminal justice system, incarceration is still considered as the most natural method of correction. This can lead to different types of unsustainable pathways within a society. Despite the growing importance and increasing use of digital technologies, there are relatively few scientific studies related to the implementation of digital technologies in corrections. Therefore, the present paper aims to assess the sustainable policy measures based on the implementation of digital technologies in corrections, namely electronic monitoring (EM). The originality of our paper is supported by unique primary data gathered during the first national survey on the assessment of sustainability measures of EM in Slovakia. Our research reveals that EM implementation contributes to individual and institutional resilience in a socio-economic context; the requirements for a conditional release of serious offenders with mandatory EM seem to have created sustainable conditions for the use of this form of the EM “back door” scheme. EM programs are aimed at suppressing crime through increased accountability and monitoring, which leads to their sustainability. Maintaining social and family ties, reducing risk of imprisonment and undesirable new ties, and keeping working habits are the main sustainable policy measures of EM that support better social inclusion of offenders. Assessment of the sustainable policy measures based on the implementation of digital technologies in corrections, namely electronic monitoring (EM) uncovered in the present paper, creates space for further research and policy implications. Data protection, automated data processing and artificial intelligence in the implementation of digital technologies in corrections are important topics that deserve much more attention in research.

Background Telegenetic counseling has attracted attention as a preventive measure against the recent COVID-19 pandemic. This systematic review compared telegenetic counseling using videoconferencing versus face-to-face counseling for hereditary cancer. Objective This study aimed to evaluate the effectiveness of telegenetic counseling using videoconferencing versus face-to-face counseling for people with suspected hereditary cancer. Methods A comprehensive literature search was carried out in December 2021 using the databases of the Japan Medical Abstracts Society, PubMed, CINAHL, PsycInfo, EMBASE, and the Cochrane Library. The eligibility criteria were studies in which randomized controlled trials (RCTs) or cluster RCTs were conducted among patients with suspected hereditary cancer and their families, comparing telegenetic counseling using videoconferencing with face-to-face genetic counseling. The Cochrane risk-of-bias tool was used to assess the risk of bias of each RCT study. This study was reported according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines. Results Two studies comprising a total of 191 participants were included and used for meta-analysis. Participants were individuals who lived in rural areas or in areas without genetic counselors and were suspected to have breast, colon, ovarian, multiple, or genetic cancer. All outcomes were assessed in only 1 study and their effects could not be discussed explicitly. In one study, there were no significant differences in satisfaction, psychological distress, or a number of genetic tests between face-to-face genetic counseling and telegenetic counseling. The cost per patient for genetic counseling was $106.19 for the telegenetics group and $244.33 for the in-person group. The risk of bias was high in both studies, with a high risk of performance bias, detection bias, and attrition bias. Conclusions The results of the two RCTs were described qualitatively. However, the evidence is limited because of the small number of RCT studies on telegenetic counseling and the high risk of bias. Further accumulation of studies is needed in the future. Conflicts of Interest None declared.

Deep vein thrombosis (DVT) and pulmonary thromboembolism are high in the setting of neurosurgery causing significant mortality and morbidity. Incidence of venous thromboem- bolism among neurosurgery patients is very high (approximately 23%) in the absence of prophylaxis. There is no consensus among surgeons regarding. A systematic review following preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines for design, conduct and reporting was conducted to find out the evidences for DVT prophylaxis among neurosurgery patients and to develop an evidence-based protocol for prevention of DVT. Eligibility criteria was to include studies done among adult patients who had undergone craniotomies or spinal cord. Data were summarized in a pre-defined data extraction form. Summarized information on study characteristics such as design and year, author information, sample size, prophylactic method used, outcome, side effects, investigations done and the timing of prophylactic method used. Risk of bias for randomised controlled trials (RCT) were assessed using predefined Cochrane risk of bias tool. Observational studies were assessed for risk of random and systematic bias. All the studies except one are having high risk of bias. The total participants of included studies were 2811. The incidence of symptomatic DVT ranged from 0.01-0.6 percent. Asymptomatic DVT incidence ranged from 4-29.4 percent. The prophylactic methods used were pneumatic compression devices, low molecular weight heparin (LMWH), nadroparin, venacaval filter, elastic compression stockings and physiotherapy. There was no significant difference between the chemo prophylactic and mechanical prophylactic group. Chemoprophylaxis was used post-operatively after 12 hours to 5-6 days. The pneumatic compression device and elastic crepe bandage were used peri-operatively. The incidence of post-operative bleeding and hematoma with the use of LMWH and nadroparin was 0.4 to 1.8 percent, which is within the limits of usual post-operative risk of bleeding. The use of compression device was associated with minor skin irritations. These findings suggest that pharmacological and mechanical prophylaxis can be combined to prevent DVT among neurosurgery patients without increased bleeding risk or discomfort.

Objective To determine the diagnostic accuracy of serological tests for coronavirus disease-2019 (covid-19). Design Systematic review and meta-analysis. Data sources Medline, bioRxiv, and medRxiv from 1 January to 30 April...

Mortality and morbidity in non-transfusable and transfusable patients: A systematic review and meta-analysis.

Persistent malnutrition and food insecurity in sub‐Saharan Africa demand creative experimentation beyond conventional financing and interventions. Impact investing merits consideration. Small and medium enterprises (SMEs) shape diets and health outcomes in Africa and may present an investment opportunity. The Nutritious Food Financing Facility (N3F) aims to harness blended impact investing for improved nutrition. We describe this novel approach to enhancing food environments using as a model the N3F, which provides financial and technical support to SMEs to increase the availability and affordability of more nutritious foods in domestic food environments. We consider both the opportunities and challenges of this approach.