Evaluation Approach Research Articles

Sampling volume evaluation of seven electromagnetic soil moisture sensors

The sampling volume of electromagnetic (EM) soil moisture sensors is of significant interest due to the diverse applications for which they are utilized. However, this volume can vary considerably based on multiple factors, including the number, spacing, and length of sensor rods, as well as the operational frequency. The sensor's volume of influence is dictated by electric field lines or ‘fringing fields’ that develop between pairs of powered electrodes. This study involved the development of an accurate sensor positioning system employed to characterize the EM sensor's electrical fringing field in 3-directional - x, y, and z space. Sensor outputs were recorded at mm increments beginning with the sensor positioned 20 mm above the air-water interface followed by incremental immersion into a water bath until the maximum sensor output was achieved. For each measurement cycle, the sensor was repositioned to test signal output approaching the air-water interface in −x, +x, −y, +y, −z, and +z orientations. The sensor sampling volume was determined based on the normalized 99% output value, which was assumed to represent the sensor position relative to an air-water interface where the sensor fringing field just begins to ‘sense’ or to become impacted by the air phase, thereby reducing the signal amplitude. Our results vary somewhat from other studies using a similar evaluation approach, leading us to conclude that EM-sensor sampling volume determination is both complex and imprecise as a result of the global sensor market's varied circuits and electrode configurations. EM soil moisture sensors evaluated in this study exhibited sampling volumes of 386 cm3 (TDR-315), 66 cm3 (TDR-310H), 398 cm3 (CS655), 45 cm3 (EC-5), 40 cm3 (HydraProbe II), 148 cm3 (WET150), and 49 cm3 (TEROS 12), which were smaller than manufacturer reported volumes.

From restriction to relaxation: the impact of fertility policy on household savings across countries

This paper presents a quantitative assessment of the impact of fertility policy adjustments on household saving rates using a panel data policy evaluation approach. We examine seven Asian regions that initially implemented restrictive fertility policies and later relaxed them, providing a unique empirical context for understanding the economic impact of such policy shifts. The analysis indicates that early restrictive fertility policies had a significant impact on the household saving rate, resulting in increases ranging from 4 to 21 percent across countries. However, the subsequent relaxation of these policies had mostly insignificant effects on household savings rates, with the exception of Japan. Specifically, the implementation of fertility restriction policies in China, Hong Kong (China), Malaysia, and Singapore is associated with a 4-10 percent increase in the household saving rate. In Korea, these policies lead to an increase of 18.3 percent, and in Iran, the effect is most pronounced, with a 21 percent increase in the household saving rate. In contrast, the relaxation of family planning policies in Japan resulted in a 6.4 percent decrease in the household savings rate. These results provide new quantitative evidence on the impact of fertility on household saving rates, support the life-cycle theory of saving, and provide explanations for the differential impact of such policy adjustments.

Wear energy approach for evaluation of tribological properties of Cr2O3-TiO2 coating

Abstract In the present work, Cr2O3-TiO2 ceramic coating was deposited by atmospheric plasma spray (APS) method. Tribological response of coating was thoroughly examined using two different sizes of SiC abrasives under four distinct loads. Coatings were characterized by Scanning Electron Microscopy, Energy Dispersive Spectroscopy, X-Ray Diffraction, Raman spectroscopy and X-Ray Photoelectron Spectroscopy. The coating experienced 31–40% lower friction coefficient at coarser particle size whereas 1.4–1.6 times lower wear rates were obtained at finer particle size. Results were explained on the basis of adhesion-abrasion components of friction. Consequences of formation of a tribo-oxide film and its implications on specific energy for material removal along with wear mechanisms are also discussed. A modified wear energy parameter (WEP) is used and showed good correlation with experimentally measured wear rates and friction coefficient of the coating.

Process evaluation of an urban piped water supply infrastructure improvement programme in Uvira, Democratic Republic of the Congo

Major investments in water supply infrastructure will be required to achieve Sustainable Development Goal (SDG) 6. Safely managed water services are also central to global cholera and diarrhoeal diseases prevention strategies. However, evidence remains scarce on how to efficiently improve piped water services in complex settings where infrastructure investments are most needed. We conducted a process evaluation of a large-scale water supply infrastructure improvement programme in Uvira, Democratic Republic of the Congo, in parallel to a pragmatic trial. Considering three evaluation domains–context, implementation, and population response–, we assessed the validity of the programme’s theory of change and underlying assumptions. Information sources included construction works documentation, operational and billing records from the water utility, and household surveys. The evaluation covers the period 2014–2021. Trial results are not within the scope of this manuscript. The programme did not achieve expected improvements in the water supply service during the evaluation period. Out of 16 assumptions underlying the theory of change, six remained valid, seven partially valid, and three turned out to be invalid. Contextual challenges included extreme flooding in 2020 and the Covid-19 pandemic, which disrupted construction works. Issues related to electricity supply and the rise of Lake Tanganyika emphasise the need for cross-sectoral approaches and consideration of climate change in the planning of water supply infrastructure. Implementation challenges underlined the importance of capacity strengthening alongside infrastructure improvements. Population response elements suggest that affordability and informal practices such as tap sharing should be taken into account. The programme was a good example of early engagement with researchers and provides unique insights into the implementation of large-scale infrastructure improvements in a complex, low-income setting. Pragmatic evaluation approaches should be adopted for the generation of scientific evidence from complex programmes in order to optimise future infrastructure investments contributing to progress towards SDG6.

Validity and reliability of the physical fitness test instrument for retired martial art athletes

Background and Study Aim. Developing exercise programs to maintain the fitness and health of retired athletes is crucial as a preventive measure against common health problems in this population. Equally important is the creation of an exercise evaluation tool to assess the effectiveness of these programs. This study aims to test the validity and reliability of a physical fitness test instrument for retired martial arts athletes. Material and Methods. This study used an evaluation approach with data collected through tests and measurements. A total of 147 subjects participated. For validity testing, there were 35 retired male martial arts athletes and 37 retired female athletes. For reliability testing, there were 36 retired male and 39 retired female martial arts athletes. The instruments used included body mass index (BMI) measurements with digital scales, flexibility measurements with the sit-and-reach test, muscle strength measurements with a leg and back dynamometer, and cardiovascular endurance measurements with the Cooper test. Validity was assessed using a concurrent validity approach. Reliability was tested using the test-retest method. The Pearson product-moment correlation was used for validity analysis, while Cronbach's alpha was used to assess reliability. The JASP software was used for the analysis. Results. For male athletes, the r-values for each test item exceeded the r-table value of 0.275, confirming the validity of the body mass index (BMI), sit-and-reach test, leg and back dynamometers, and the Cooper test. Similarly, female athletes demonstrated r-values above the r-table value of 0.267, confirming the validity of all test items. The reliability of each item was confirmed by Cronbach’s alpha values, which were above the 0.7 threshold for both male and female athletes. The Cronbach's alpha value for BMI was 0.998 for both male and female athletes, indicating excellent reliability. Other test items, such as flexibility and muscle strength, also showed strong reliability, with Cronbach’s alpha values ranging from 0.742 to 0.985. Conclusions. The study highlights the importance of developing valid and reliable instruments to assess the physical fitness of retired martial arts athletes. Such instruments are essential for monitoring the effectiveness of training programs aimed at maintaining the health and fitness of retired athletes. The findings of this research confirm the value of structured fitness tests. These tests effectively evaluate key physical components such as body composition, flexibility, muscle strength, and cardiovascular endurance.

EAACI guidelines on the management of IgE-mediated food allergy.

This European Academy of Allergy and Clinical Immunology (EAACI) guideline provides recommendations for the management of IgE-mediated food allergy and was developed using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. Following the confirmation of IgE-mediated food allergy diagnosis, allergen avoidance and dietary advice (with support of a specialised dietitian, if possible) together with the provision of a written treatment plan, education on the recognition of allergic symptoms and prescription of medication including adrenaline using an auto-injector are essential. Patients with significant anxiety and requirement for coping strategies may benefit from support from a clinical psychologist. As immunomodulatory interventions, omalizumab is suggested for treatment of IgE-mediated food allergy in children from the age of 1 and adults; and oral allergen-specific immunotherapy is recommended for children and adolescents with peanut allergy and suggested for milk and egg allergies (generally after 4 years of age for milk and egg). Sublingual and epicutaneous immunotherapy are suggested for peanut allergy but are not yet available at the point of care. Future research into disease modifying treatments for IgE-mediated food allergy are highly needed, with standardised and patient-focused protocols and outcomes.

Evaluation of the Violence Victim Recovery Program at Uptd Ppa East Kalimantan Province in 2022-2023

The recovery of victims of violence at the Regional Technical Implementation Unit for Women and Children Empowerment (UPTD PPA) of East Kalimantan Province is designed to provide support and rehabilitation services to victims of violence. The program aims to restore the physical, emotional, and social well-being of victims and prevent further violence. This study aims to evaluate the effectiveness of the recovery program implemented by the UPTD PPA of East Kalimantan Province, assess the achievement of program objectives, and identify challenges and opportunities for improvement. This study uses a qualitative descriptive evaluation approach. Data was collected through in-depth interviews with UPTD PPA staff, as well as analysis of program documents. The findings of the study show that the recovery program at UPTD PPA has been successful in several aspects, including the provision of counseling services, legal support, and social rehabilitation. However, there are several challenges such as limited resources, lack of coordination between institutions, and difficulties in reaching victims in remote areas. In addition, evaluations showed that victims' satisfaction levels with the services received varied, with some victims reporting improved well-being while others felt that services still needed to be improved. The violence victim recovery program at the East Kalimantan Province UPTD PPA has shown a positive impact in supporting violence victims, but still needs improvement in terms of resources, coordination, and service coverage.

Implementing Feedforward-based Collaborative Assessment at Higher Education

The study examines the use of feedforward-based collaborative assessment (FbCA) for students majoring in foreign languages at a tertiary institution in Vietnam. A mixed-method research approach was utilized to collect both quantitative and qualitative data from 306 English major students and eight teachers. Research instruments such as questionnaires, reflective diaries, observations, and interviews were employed to assess the perceptions of students and instructors regarding the significance of implementing FbCA, its impact on students' learning engagement and academic achievement, and students' expectations for changes in assessment mechanisms to ensure the effective use of FbCA. The findings highlighted several benefits of FbCA in terms of skill, knowledge, and practice development. This evaluation approach enhanced students' learning motivation and positively contributed to their academic performance. However, the qualitative data also revealed various challenges related to the effective implementation of assessment practices and the maintenance of academic integrity. Based on these findings, recommendations were made for improving teaching, learning, and assessment practices. Keywords: academic performance, collaborative assessment, feedforward assessment, foreign language-majored students, learning motivation

A neural network approach for unstructured mesh quality evaluation

PurposeThe quality of the unstructured mesh has a considerable impact on the stability and accuracy of aerodynamic simulation in computational fluid dynamics (CFD). Typically, engineers spend a significant portion of their time on mesh quality evaluation to ensure a valid, high-quality mesh. The extensive manual interaction and a priori knowledge required to undertake an accurate and timely evaluation process have become a bottleneck in the idealized efficient CFD workflow. This paper aims to introduce a neural network-based quality evaluation approach for unstructured meshes to enable higher efficiency and the level of automation.Design/methodology/approachThe paper investigates the capability of deep neural networks for the quality evaluation of unstructured meshes. For training the network, we build a training dataset for mesh quality learning algorithms. The dataset contains a rich variety of unstructured aircraft meshes with different mesh sizes, densities, cell distribution, growth ratios and cell numbers to ensure its diversity and availability. We also design a neural network, AircraftNet, to learn the effect of mesh quality on the convergent properties of the numerical solutions. The proposed network directly manipulates raw point data in mesh source files rather than passing it to an intermediate data representation. During training, AircraftNet extracts non-linear quality features from high-dimensional data spaces and then automatically predicts the overall quality of the input unstructured mesh.FindingsThe paper provides a series of experimental results on GPUs. It shows that AircraftNet is able to effectively analyze the quality-related features like mesh density and distribution from the extracted features and achieve high prediction accuracy on the proposed dataset with even a small number of training runs.Research limitations/implicationsBecause of the limited training dataset, the research results may lack generalizability. Therefore, researchers are encouraged to test the proposed propositions further.Originality/valueThe paper publishes a benchmarking dataset for mesh quality learning algorithms and designs a novel neural network approach for unstructured mesh quality evaluation.

Potential novel HIV-1 reverse transcriptase inhibitors: a modeling and evaluation approach

Human immunodeficiency viru (HIV) is the causative agent of acquired immunodeficiency syndrome (AIDS), a disease that severely weakens the immune system and makes patients more susceptible to infections. Although there is no definitive cure for HIV, advances in drug development offer promising prospects. In this study, we targeted HIV-1 reverse transcriptase by performing virtual screening (VS) to identify novel candidate compounds. From a database of compounds similar to the inhibitor thymidine-5'-triphosphate (TTP), three compounds (CID441663, CID123650073, and CID123789980) were selected for their docking scores, which outperformed those of the reference compound TTP (-6.2302 kcal/mol). These compounds were then subjected to ADMET, PASS, and DFT analyses. Interestingly, all three ligands showed a broad spectrum of predicted antiviral activity, including targets related to human herpes virus and HIV. Specifically, while TTP primarily targets HIV-1 reverse transcriptase, the top three ligands were predicted to target HIV-1 integrase, with CID441663 and CID123789980 displaying higher confidence in this target compared to CID123650073. These findings suggest that the candidate ligands should undergo further in vitro validation to determine their precise roles as inhibitors or antagonists, and to confirm their selective targeting of HIV-related proteins.

Enhancing healthcare operations: a systematic literature review onapproaches for hospital facility layout planning.

The appropriate physical layout of hospital services can help resolve management problems by streamlining the work of medical teams, improving the flow of patients between specific areas and the medical support environment. Nevertheless, the academic literature lacks structured research into how the physical layout of hospitals might be improved. Our study aims to fill this research gap, providing information for researchers and professionals who intend to guide the hospital facility layout planning (HFLP) from the steps and prescribed approaches found in the literature. This study analyzes the current literature status and concerning approaches that support HFLP and identifies their strengths and weaknesses. The literature was classified using the following criteria: approaches for layout generation, approaches for layout evaluation and healthcare facility layout outcomes. The hospital facility layout outcomes achieved for each phase served as a basis for identifying a list of strengths and weaknesses for the hospital layout facility generation and evaluation approaches. Readers can refer to this paper to identify the approach that best fits the desired goal and the HFLP step. This is a contribution to current studies into HFLP, and it provides guidelines for selecting the approach to be utilized based on the desired outcome. The paper describes how to conduct an HFLP and lists the strengths and weaknesses of each approach. The research may be used as a strategy for determining which tool is most suited based on the practitioner's target purpose.

Who's at the Table? A Scoping Review of Stakeholder Engagement in Medical Education Program Evaluation.

Program evaluation is essential for medical schools to demonstrate social accountability and identify areas for improvement in medical education (MEd). Although stakeholder engagement is crucial in program evaluation, no previous review has specifically examined the stakeholders involved in MEd program evaluation. This scoping review addresses this gap by identifying the stakeholders, their roles, and their levels of engagement in evaluating MEd programs, along with the facilitators and barriers to their participation. Through a systematic search across four databases, we identified 53 relevant studies out of 7206 screened. Our findings reveal seven primary stakeholder groups, with students and program directors being the most frequent participants. However, a significant gap exists in the representation of community members and patients, indicating a need for greater inclusion of these key stakeholders. Additionally, we found that stakeholders are primarily engaged as passive participants providing feedback rather than actively shaping the evaluation process. Facilitators and barriers to participation were identified from the participants' perspective, highlighting the need for further research to understand the viewpoints of active stakeholders, such as faculty and administrators. Future studies should also explore the impact of different evaluation approaches on stakeholder engagement to develop more inclusive and effective MEd program evaluations.

A tumorigenicity evaluation platform for cell therapies based on brain organoids

BackgroundTumorigenicity represents a critical challenge in stem cell-based therapies requiring rigorous monitoring. Conventional approaches for tumorigenicity evaluation are based on animal models and have numerous limitations. Brain organoids, which recapitulate the structural and functional complexity of the human brain, have been widely used in neuroscience research. However, the capacity of brain organoids for tumorigenicity evaluation needs to be further elucidated.MethodsA cerebral organoid model produced from human pluripotent stem cells (hPSCs) was employed. Meanwhile, to enhance the detection sensitivity for potential tumorigenic cells, we created a glioblastoma-like organoid (GBM organoid) model from TP53−/−/PTEN−/− hPSCs to provide a tumor microenvironment for injected cells. Midbrain dopamine (mDA) cells from human embryonic stem cells were utilized as a cell therapy product. mDA cells, hPSCs, mDA cells spiked with hPSCs, and immature mDA cells were then injected into the brain organoids and NOD SCID mice. The injected cells within the brain organoids were characterized, and compared with those injected in vivo to evaluate the capability of the brain organoids for tumorigenicity evaluation. Single-cell RNA sequencing was performed to identify the differential gene expression between the cerebral organoids and the GBM organoids.ResultsBoth cerebral organoids and GBM organoids supported maturation of the injected mDA cells. The hPSCs and immature mDA cells injected in the GBM organoids showed a significantly higher proliferative capacity than those injected in the cerebral organoids and in NOD SCID mice. Furthermore, the spiked hPSCs were detectable in both the cerebral organoids and the GBM organoids. Notably, the GBM organoids demonstrated a superior capacity to enhance proliferation and pluripotency of spiked hPSCs compared to the cerebral organoids and the mouse model. Kyoto Encyclopedia of Genes and Genomes analysis revealed upregulation of tumor-related metabolic pathways and cytokines in the GBM organoids, suggesting that these factors underlie the high detection sensitivity for tumorigenicity evaluation.ConclusionsOur findings suggest that brain organoids could represent a novel and effective platform for evaluating the tumorigenic risk in stem cell-based therapies. Notably, the GBM organoids offer a superior platform that could complement or potentially replace traditional animal-based models for tumorigenicity evaluation.

An accurate roughness prediction in milling processes through analytical evaluation and KNN regression approach

An accurate roughness prediction in milling processes through analytical evaluation and KNN regression approach

Evaluation of the Interdisciplinary Care Home-bAsed Reablement Program (I-CHARP) for People Living With Cognitive Impairment and Dementia in Care Homes.

Major knowledge and practice gaps exist in aged care home services to support independence of older people with dementia. This research evaluates an adaptation of a community-based rehabilitation model for care homes, namely Interdisciplinary Care Home-bAsed Reablement Program (I-CHARP), by examining whether (and, if so, how) I-CHARP produces its intended effects and how this programme can be practicably implemented, sustained and scaled up across care homes in Australia. I-CHARP is a 4-month bio-behavioural-environmental rehabilitation model of care, integrated in care home services, supported through the deployment of an implementation strategy, the Research Enabled Aged Care Homes (REACH) network. It consists of (1) 8-12 full individual sessions and additional eight brief follow-ups per resident, tailored to the resident's needs, delivered primarily by a team of an occupational therapist, registered nurse and other allied health staff; (2) environmental modifications/assistive devices up to the value of $400 per resident; and (3) engagement of intervention care home staff, managers and regular visitors. An overarching evaluation approach is participatory action research using a cluster quasi-experimental design and mixed methods. It involves testing of the implementation strategy (REACH network and other approaches) while observing/gathering information on the intervention (I-CHARP) and related outcomes in three cycles. Participants include residents (aged ≥ 60 years with early stages of dementia) and care staff from 16 care homes. Care quality indicators, health care costs, field notes and semi-structured interviews/focus groups with intervention site staff, regular visitors and managers will provide further insights into I-CHARP processes and implementation issues. In the final phase of the project, an Agile Implementation Playbook will be developed for the delivery of reablement care that can be used in routine practice across care homes in Australia. The study findings will also inform future policy development and strategic directions for dementia care in care homes. Australian New Zealand Clinical Trial Registry, ACTRN12623000885695 Registered 16 August 2023, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=386088. 1.0 dated 20 July 2023.

Assessing the Environmental Impact of Municipal Waste on Energy Incineration Technology for Power Generation Using Life Cycle Assessment Methodology

The life cycle assessment methodology is a comprehensive environmental impact evaluation approach rooted in the “cradle-to-grave” concept. This study takes a municipal solid waste incineration power plant in central China as an example to comprehensively explore the potential ecological and environmental impacts of municipal solid waste incineration power generation through life cycle assessment methods. Burning one ton of waste can recover 7342 joules of thermal energy. Compared with traditional landfill, incineration can reduce greenhouse gas emissions by about 30%, with a potential global warming impact of −0.69 kg of carbon dioxide equivalent. Amongst environmental impacts, land, freshwater, and marine ecosystems possess the greatest potential toxicity, followed by the harmful effects on human health and the influence of ozone-producing photochemical pollution. Lastly, there comes terrestrial acidification, whereas other types of effects can be relatively disregarded in comparison. In the process of waste incineration power generation, the potential impacts of global warming, ionizing radiation, and fossil resource scarcity are less than zero, indicating that this is an environmentally friendly process. In response to the above-mentioned environmental impacts, it is necessary to pay attention to improving incineration efficiency, optimizing leachate treatment, reducing coal use, and controlling acidic gas emissions in the process of urban solid waste incineration power generation. This research offers insights into advancing environmentally sustainable technologies for utilizing waste as an energy resource.

Integrated models for concurrent disorders from a Public Mental Health lens: a Systematic Review

Abstract Concurrent disorders (COD), historically defined by the World Health Organization as the simultaneous presence of a psychoactive substance use disorder and another psychiatric disorder within the same individual, pose a significant challenge to public mental health. In today’s global landscape of mental health services, the prevalence of COD is on the rise, underscoring the need for an integrated approach to management. This review aims to provide an overview of existing global models and the evaluation approaches. This systematic review examined research evidence in PubMed, Scopus and Web of Science up to 2023 regarding integrated management systems for COD. Following PRISMA guidelines, we included articles describing specific models and evaluating the effectiveness of integrated versus non-integrated approaches. Quality assessment was conducted using the appropriate scales. Out of 7700 screened articles, 18 were included, all of fair or good quality. A diverse array of patient care models, programs, and interventions addressing comorbidities between mental health and substance use disorders emerged. The majority of studies focused on clinical outcomes, particularly alcohol and drug dependence, with global mental health consequences also under examination. Psychodiagnostics and social outcomes were also considered in a significant portion of the research, shedding light on health services utilization patterns. The integrated model for concurrent disorders in psychiatry stands as an effective approach, yet its implementation encounters challenges. This study showcases successful integration examples, providing valuable insights for policymakers and healthcare professionals to enhance existing models or develop new ones, particularly within European healthcare reforms like Italy’s restructuring of primary care, where they could serve as a criterion for the setting and organization of community houses. Key messages • COD, involving both substance use and psychiatric disorders, present a significant challenge to public mental health. Rising prevalence underscores the need for integrated management approaches. • Insights from successful integration examples offer valuable guidance for healthcare professionals and policymakers, particularly within healthcare reforms like Italy’s restructuring of primary care.

Educational programmes for improving medication adherence among older adults with coronary artery disease: a systematic review and meta-analysis

Abstract Background Coronary artery disease (CAD) is the leading cause of death worldwide. Adhering to CAD medications is the priority of its treatment. However, medication adherence is suboptimal among older adults with CAD. Educational programmes are widely used and recommended in improving medication adherence among older adults with CAD. However, the evidence about the effects of educational programmes on medication adherence among older adults with CAD is limited. Aim To evaluate the best available research evidence on the effects of educational programmes designed for improving medication adherence among older adults with CAD. Methods 12 English databases and five Chinese databases were searched from inception to January 2024. Randomised controlled trials or quasi-experimental studies examining the effects of educational programmes for improving medication adherence among older adults with CAD were included. The educational programmes included a set of planned activities aiming at improving the knowledge, attitudes, and skills of medication adherence. The outcome of medication adherence was measured by either objective or subjective methods. The quality of the included studies was assessed by the Cochrane Risk of Bias Tool v2 or the Risk of Bias In Non-randomised Studies of Interventions tool. Meta-analysis was conducted using random-effect models as appropriate. Narrative synthesis was conducted if the results of the included studies were not appropriate or possible for meta-analysis. The Grading of Recommendations, Assessment, Development, and Evaluation Approach was used to assess the certainty of evidence. Results 5,607 records were retrieved and 5,599 records were excluded. Seven studies including six randomised controlled trials and one quasi-experimental study were included. Two studies were rated as low risk of bias. Five studies were rated as some concerns or moderate risk of bias due to inadequate information on blinding, allocation concealment, and the analysis of data according to the intention-to-treat principle. The results showed that the educational programmes were associated with significant improvements in medication adherence at immediately post-intervention (Standardised mean difference (SMD): 1.61, 95% CI: 0.03 to 3.19, P=0.05, Low quality of evidence), and at one to six months post-intervention (SMD: 1.13, 95% CI: 0.33 to 1.94, P=0.006, Moderate quality of evidence). Narrative synthesis found that the educational programmes potentially improved medication adherence over six months post-intervention. Conclusions The results show that the educational programmes could improve medication adherence among older adults with CAD. Designing the educational programmes with theoretical frameworks would be helpful to address the complex health needs of the older adults with CAD. More rigorous evaluation of the effectiveness of the programmes on long-term medication adherence of the older adults is warranted.Figure 1.Immediate post-interventionFigure 2.Medium-term post-intervention

Neoadjuvant chemoradiation for down staging of locally-advanced rectal cancer, and assessment of clinical response with digital rectal examination, magnetic resonance imaging and colonoscopy

Background: In this era of total neoadjuvant treatment (TNT) followed by rectal preservation non-operative management (NOM) or wait and watch (WW) approach for non-metastatic locally-advanced rectal cancer (LARC), reliable and reproducible response evaluation to neoadjuvant therapies forms the cornerstone. Through this study, we try to evaluate clinical response of locally-advanced rectal cancer to neoadjuvant chemoradiation (CRT) in terms of downstaging and total mesorectal excision (TME), and the accuracy of digital rectal examination (DRE), magnetic resonance imaging (MRI) and colonoscopy in the assessment of clinical response to neoadjuvant CRT. Methods: Histologically proven locally advanced rectal adenocarcinoma patients, after pretreatment evaluation, were considered for neoadjuvant chemoradiation, i.e., intensity-modulated radiation therapy (IMRT) with 5-fluorouracil (5-FU) and leucovorin-based concurrent chemotherapy. Patients were evaluated 6-8 weeks after completion of CRT and clinical response assessed by means of DRE, colonoscopy and MRI of pelvis. Following surgery, pathological response was assessed on the final histopathological examination (HPE). Results: Twenty-two patients were accrued for this protocol, of which, 15 (68.2%) were male and 7 (31.8%) were female. Downstaging and TME was achieved in 90.9% of the patients. The sensitivity of DRE, colonoscopy and MRI to detect a complete response was 66.67% and specificity was 94.74%. There were no severe toxicities or deaths reported. Conclusions: Neoadjuvant concurrent chemoradiotherapy with bolus 5-FU and leucovorin is an accepted modality of treatment for locoregionally-advanced rectal cancer, which offers higher rates of downstaging and TME. Digital rectal examination, colonoscopy and MRI together can be reliably used to assess response following neoadjuvant CRT.

Left ventricular pressure-strain loops for the assessment of myocardial work in a low-risk community-based cohort: associations with long-term prognosis

Abstract Background Non-invasive left ventricular (LV) pressure-strain loop analysis is a novel technique for the evaluation of global myocardial work (GMW) that provides additional insights on LV contractility and energetics beyond traditional metrics, such as ejection fraction (EF) and global longitudinal strain (GLS). Despite its established value in numerous cardiac diseases, there remains limited data on its predictive power in a low-risk population. Purpose Our objective was to determine the long-term prognostic value of GMW in a population-based screening sample comprising low-risk adult individuals. Methods We retrospectively identified 1562 volunteers from a population-based screening program (mean age 54±15 years, 59% female), with a median follow-up time of 11 years. All subjects underwent 2D echocardiography to measure LV EF, GLS, peak atrial longitudinal strain (PALS), GMW index (GMWI), global wasted work (GWW), and GMW efficiency (GMWE). The primary endpoint was all-cause mortality. Results 191 subjects (12,2%) met the primary endpoint. Subjects who experienced adverse outcomes exhibited significantly lower LV EF (dead vs. alive; 49.7±8.3 vs. 52.7 ±6.4 %, p<0.001), GLS (-18.7±4.1 vs. -20.4±3.6 %, p<0.001), PALS (33.6±15.7 vs. 44.2±15.2 %, p<0.001), and GMWI (2181.7±591.3 vs. 2286.8±482.5 mmHg%, p=0.008). Furthermore, subjects with adverse outcomes had significantly higher GWW (132.6±249.4 vs 95.1±113.4 mmHg%, p<0.001) and, consequently, lower GMWE (0.95±0.05 vs. 0.96±0.03, p<0.001). Univariate Cox regression analysis revealed GMWI to be a significant predictor of mortality (hazard ratio for 100 units 0.957 [95% CI: 0.929-0.986], p=0.004), alongside GMWE (hazard ratio for 1 percent 0.940 [95% CI: 0.912-0.968], p<0.001), and GWW (hazard ratio for 100 units 1.124 [95% CI: 1.063-1.188], p<0.001). By multivariable Cox regression encompassing age, sex, GMWI, LVEF, GLS, PALS, and systolic blood pressure, GMWI remained an independent predictor of all-cause mortality (hazard ratio 0.932 [95% CI: 0.874-0.995], p=0.035), while GLS was not an independent predictor. Moreover, integrating the Atherosclerosis Risk in Communities (ARIC)-HF risk factors (age, sex, race, coronary artery disease, antihypertensive medication, blood pressure, diabetes mellitus, body mass index, heart rate, and smoking status), we constructed a multivariate model with GMWI. GMWI was still an independent predictor of mortality (hazard ratio for 100 units 0.941 [95% CI: 0.903-0.980], p=0.004). Using the GMWI cut-off value of 1576 mm Hg% (based on a large-scale healthy population study), the population was divided into 2 groups. Using Kaplan-Meier curves (Figure), the outcomes of the groups differed significantly (log-rank p<0.001). Conclusions GMW provides added value in clinical outcome prediction, even in low-risk individuals. Myocardial work analysis is a promising approach for a comprehensive evaluation of cardiac function and for cardiovascular risk stratification.