Assessment Of Value Research Articles

Monitoring disease activity and treatment response in ankylosing spondylitis: a retrospective study of hematologic inflammatory markers.

Hematological markers such as the neutrophil-lymphocyte ratio (NLR), monocyte-lymphocyte ratio (MLR), and platelet-lymphocyte ratio (PLR) are reliable indicators of inflammation. This study aims to investigate the potential role of these markers in assessing disease activity and treatment response in biologic-naive Ankylosing Spondylitis (AS) patients following the initiation of biological agents. We designed this study as a retrospective cohort study with data obtained from a single center. The Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and The Bath Ankylosing Spondylitis Functional Index (BASFI) were used to evaluate disease activity and functional status of AS patients. Laboratory results at baseline, 3rd, 6th, and 12th months were documented. We calculated hematologic inflammatory markers for each visit. Mean platelet volume (MPV) and red cell distribution width (RDW) were also noted. 54 biologic-naive patients with AS were included in this study. These inflammatory markers, except RDW, decreased over time. BASDAI, BASFI, CRP and ESR were significantly lower at 3rd, 6th, and 12th months compared to baseline values (all p < 0.001). Furthermore, NLR, PLR, and MLR showed a statistically significant decrease at 3rd, 6th, and 12th months compared to baseline values (all p < 0.001). However, when comparing the values at the 3rd, 6th, and 12th months, no statistically significant differences were observed. We also found no correlation between hematological inflammatory markers and BASDAI scores, despite observing some correlations between hematological markers and acute phase reactants. These markers could be valuable assessment tools for indicating disease activity and monitoring patients with AS after initiating biological treatment.

The Clinical Significance and Prognostic Value of ALDH1 Expression in Non-small Cell Lung Cancer: A Systematic Review and Meta-analysis.

The results of the association between aldehyde dehydrogenase 1 (ALDH1) expression and prognosis of non-small cell lung cancer (NSCLC) are contradictory. We conducted this meta-analysis to investigate the clinical significance and prognostic value of ALDH1 in NSCLC. The databases PubMed, Web of Science, EMBASE, the Cochrane Library, Wanfang, and CNKI were systematically queried to identify eligible studies. The retrieval time was from database establishment to August 2023. We evaluated the correlation between ALDH1 expression and clinical features of NSCLC by employing odds ratios (ORs) and 95% confidence intervals (95% CIs). In addition, we used hazard ratios (HRs) and 95% CIs to evaluate the role of ALDH1 expression in the prognosis of NSCLC. Our study included 21 literatures involving 2721 patients. The expression of ALDH1 in NSCLC was higher than that in normal tissues (OR = 6.04, 95% CI: 1.25-29.27, P = 0.026). The expression of ALDH1 was related to TNM stage (OR = 1.81, 95% CI: 1.06-3.09, P = 0.029), tumor grade (OR = 0.29, 95% CI: 0.17-0.48, P < 0.0001), lymph node metastasis (OR = 2.60, 95% CI: 1.52-4.45, P = 0001) and histological subtype (OR = 0.67, 95% CI: 0.52-0.86, P = 0.002). In patients with NSCLC, we found that the over-expression of ALDH1 was significantly associated with poor overall survival (OS) (HR = 1.44, 95% CI: 1.15-1.81, P = 0.002) and disease-free survival (DFS) (HR = 1.74, 95% CI: 1.45-2.10, P < 0.0001). The expression of ALDH1 is closely associated with the clinicopathologic characteristics and prognosis of NSCLC. ALDH1 may serve as a valuable clinical assessment tool and prognostic predictor in NSCLC.

Evaluating Sleep in Autism Using CSHQ and CSHQ-Autism - A Perspective Through the Cultural Lens.

The Child Sleep Hygiene Questionnaire (CSHQ) and its adapted version for autistic children, known as CSHQ-Autism, have gained recognition as essential tools for studying pediatric sleep patterns. 67 autistic children were evaluated using these questionnaires. 52 children screened positive on the CSHQ while 18 were screened positive on the CSHQ-Autism. Notably, both tools showed elevated ratings in the domains of sleep anxiety and co-sleeping, which may hinder their ability to accurately distinguish sleep disturbances. However, the prevalence of sleep anxiety/co-sleeping in Indian culture was found to be linked to more severe sleep disorders, while also serving as a protective factor against separation anxiety and sudden infant death syndrome (SIDS). Therefore, while the CSHQ and CSHQ-Autism serve as valuable assessment tools, their scores may be inflated by ingrained cultural norms in the Indian context.

Added value of pre-procedural magnetic resonance angiography in transarterial embolization for refractory musculoskeletal pain.

Transarterial microembolization (TAME) is a minimally invasive treatment for chronic musculoskeletal disorders. Identifying angiogenesis and the supplying vessels of the target joint is important but challenging. Although magnetic resonance imaging (MRI) is commonly used to diagnose musculoskeletal diseases, it typically excludes vascular imaging. Dynamic contrast-enhanced magnetic resonance angiography (DCE-MRA) has the ability to visualize lesion angiogenesis, identify supplying vessels, and evaluate the vasculature anatomy. We propose that incorporating DCE-MRA into pre-procedural assessments can help identify the culprit vessels, arterial anatomy, and variant assessment of the target joint before TAME. We investigated six cases, each presenting pain in different body parts: shoulder adhesive capsulitis, trapezius myalgia, combined tennis and golf elbow, knee osteoarthritis, refractory knee pain after osteotomy, and plantar fasciitis. All patients underwent MRI with DCE-MRA before undergoing TAME. DCE-MRA was performed using either 1.5 T or 3 T MRI scanners, employing 3D-TRICKS or 4D-TRAK XD techniques. The numerical rating scale for pain was evaluated at one, three, and six months after the procedure, and any adverse events were recorded over the entire six-month follow-up period. Pre-procedural DCE-MRA helped to visualize angiogenesis at the lesion site in all patients and identify the supplying vessels, arterial vasculature anatomy, and branching variants. These findings corroborated the subsequent digital subtraction angiography (DSA) findings obtained during TAME. All patients experienced pain reduction and functional improvement after TAME without any complications. The average pain score reduced significantly after TAME treatment (p < 0.05). Two patients underwent a second MRI and DCE-MRA at the six-month follow-up and showed a significant reduction in angiogenesis. DCE-MRA offers a valuable pre-procedural assessment tool for TAME procedures by facilitating the visualization of angiogenesis at the lesion site, supplying vessels, and arterial anatomic variants, including the variable orifice of the supplying branches. This information can potentially improve patient selection and pre-procedural planning, leading to better outcomes and reduced risk of complications.

Recommendations on the Use of Structured Expert Elicitation Protocols for Healthcare Decision Making: A Good Practices Report of an ISPOR Task Force

Healthcare decision making, including regulatory and reimbursement decisions, is based on uncertain assessments of clinical and economic value. This arises from the evidence supporting those assessments being uncertain, incomplete, or even absent. Qualitative, structured expert elicitation (SEE) is a valuable tool for extracting expert knowledge about an uncertain quantity and formulating that knowledge as a probability distribution. This creates a useful input to decision modeling and support, particularly in areas with limited evidence, such as advanced therapy products, precision medicine, rare diagnoses, and other areas with high uncertainty.Structured SEE protocols are used to improve the transparency, accuracy, and consistency of quantitative judgments from experts, limiting the effect of heuristics and biases. This task force report introduces 5 commonly used protocols for SEE (Sheffield elicitation framework; modified Delphi method; Cooke’s classical method; investigate, discuss, estimate, aggregate protocol; and the Medical Research Council reference protocol). It describes the common elements of SEE, discusses how these protocols differ in their implementation of those elements and illustrates the use of the protocols.The report then reviews the relevant constraints on implementing SEE within the context of healthcare decision making and considers the strengths and weaknesses of these protocols in light of those considerations. Because this is an introductory report on an emerging topic, specific recommendations on practice are not made. However, there are broad recommendations based on the suitability of the different protocols in various decision contexts. The report concludes with recommendations for further research to better guide future practice.

Anticipatory postural adjustment deficits in children with developmental coordination disorder during a self-induced prehension task while standing on one leg

Effective postural control is essential for motor skill development, yet the specific nature of anticipatory control in children with Developmental Coordination Disorder (DCD) remains poorly understood for complex or dynamic stability tasks. This study investigated anticipatory postural adjustments (APA) during a self-initiated dynamic stability task. The Can Placement Task (CPT)—a self-initiated dynamic stability task—was performed by 23 children with DCD and 30 typically developing (TD) children aged 9–12 years. The task involved standing on one leg while also repositioning a can on the floor. Center of pressure (COP) movement was recorded by two force platforms during the five phases of the movement. The ground reaction force measured external support during both descent to pick up the can and ascent after replacing the can. The study used a mixed-design approach with group (DCD, TD) as a between-subject factor and condition (can position close or far) and phase of movement as within-subject. Distinct movement control characteristics were shown for children with DCD including a greater range of COP movement and higher COP velocity in the anterior-posterior direction prior to movement initiation compared with TD. The DCD group also relied more on external support during both the downward and upward phases of the CPT and needed more trials to complete the task. Only two significant interaction effects involving Group and the within-subject factors emerged. Children with DCD swayed significantly more at specific phases of the task, especially when coming up and restoring balance, and did not adapt COP velocity as a function of reaching distance. Dynamic control of posture in children with DCD is impaired as they struggle to generate the effective APAs necessary to maintain dynamic stability which leads to greater reliance on external support and more corrective movements. The CPT provides a valuable assessment of posture and dynamic balance control during a complex prehension movement performed on one leg; the task highlights distinct movement patterns between children with and without DCD.

Gait performance in older adults across the cognitive spectrum: Results from the GAIT cohort.

Gait performance can provide valuable insights into cognitive functioning in older adult and may be used to screen for cognitive impairment. However, the optimal test condition and spatiotemporal parameter for accuracy have not yet been determined. This study aims to determine the gait measure with the highest accuracy identifying cognitive decline. A total of 711 participants were recruited, including 332 cognitively healthy individuals, 264 with mild cognitive impairment (MCI), and 115 with dementia, with a mean age of 72 years (interquartile range 69-76), and 43% (n = 307) of women. The participants underwent gait assessment in three different conditions, including a single task and dual tasks of counting backward by ones and naming animals. Gait performance was deteriorated as cognitive impairment progressed. The gait test performed during naming animals condition was the most accurate in differentiating between cognitive groups. Specifically, the naming animals gait speed was more accurate in discriminating control participants from those with cognitive impairment (area under the curve [AUC] = 76.9% for MCI and 99.7% for people with dementia with control group as reference). The coefficient of stride length variability while naming animals was the most effective parameter in discriminating between MCI and dementia groups (AUC = 96.7%). The naming animals dual-task gait test can be a valuable assessment for screening cognitive impairment in older adults, regardless of their cognitive abilities. The test is useful in clinical settings for subjects with a range of cognitive profiles.

Spatial Assets Value Extraction and Integrated Utilization of Old Communities: Case of Central Guangzhou, China

Extracting the economic value by the integrated utilization of space in old communities is crucial for encouraging independent participation from enterprises and residents, reducing reliance on government leadership and fiscal investment. This study starts from the active perspective of spatial assets and constructs a value activation framework for old communities by balancing “endogenous demand” and “exogenous opportunities”. By enhancing the “economic value” through the “use value”, five methods for value extraction and overall project utilization paths are proposed, guided by a dynamic “cost-revenue” balance. Using multi-source data, we identify the spatial assets of 1096 old communities in central Guangzhou and apply a market comparison method for an economic value assessment. Additionally, this study offers recommendations on the timing and project portfolios for regeneration efforts, along with strategies for establishing a coordinating implementation entity and fund account. This research provides strategic insights for advancing the regeneration of old communities by tapping into their macro-level economic potential.

Socio-economic transformation follows environmental change on Svalbard

The European Arctic, which includes the Svalbard archipelago, is situated in one of the areas showing most notable changes due to global warming and associated cascade events and processes. The main driving factor, temperature rise, is continuing to cause a large-scale overall decline in ice, from glacier retreating, less coastal land-fast ice to thinning and shrinking of open-sea pack ice. This, together with increased inflow of Atlantic waters, is causing profound changes in the local fauna, food web and biodiversity. In parallel, changes in landscape are also notable, mainly due to increasing coastal erosion and glacial melt. Over the past decades, both the traditional hunting-trapping lifestyle and mining have declined almost to the point of non-existence. At the same time, destination tourism and scientific research have become the major industries, both associated with an increase in the size of the main settlement of Longyearbyen, and thus also service jobs and local administration. Along with the shrinking of the glaciated Arctic landscape, the archipelago exemplifies the broadest level of nature protection in Europe. Strict environmental regulations that restrict and even prohibit human activities in large areas contribute to Svalbard being one of the best formally protected wilderness environments in the entire Arctic. Thus, as Svalbard marine ecosystems continue to change, they also are becoming more accessible to humans, and so also anthropogenic pressures are both changing and increasing in extent. We provide a compilation of both ecosystem components and human activities, together with indications of how these are, in parallel, changing. This forms the basis for future ecosystem and societal valuation assessments.

A multi-step regularity assessment and joint prediction system for ordering time series based on entropy and deep learning

Customer maintenance is of vital importance to the enterprise management. Valuable assessment and efficient prediction for customer ordering behavior can offer better decision-making and reduce business costs significantly. According to existing studies about customer behavior regularity segment and demand prediction most focus on e-commerce and other fields with large amount of data, making them not suitable for small enterprises and data features like sparsity and outliers are not mined when doing regularity quantification. Additionally, more and more complex network structures for demand prediction are proposed, which builds on the assumption that all the samples have predictive value, ignoring the fine-grained analysis of different time series regularity with high cost. To deal with the above issues, a multi-step regularity assessment and joint prediction system for ordering time series is proposed. For extracting features, comprehensive assessment of customer regularity based on entropy weight method with the result of predictability quantification using K-Means clustering algorithm, real entropy, LZW algorithm and anomaly detection adopting Isolation Forest algorithm not only gives an objective result to ‘how high the regularity of customers is’, filling the gap in the field of regularity quantification, but also provides a theoretical basis for demand prediction models selection. Prediction models: Random Forest regression, XGBoost, CNN and LSTM network are experimented with sMAPE and MSLE for performance evaluation to verify the effectiveness of the proposed regularity quantitation method. Moreover, a merged CNN-BiLSTM neural network model is established for predicting those customers with low regularity and difficult to predict by traditional machine leaning algorithms, which performs better on the data set compared to others. Random Forest is still used for prediction of customers with high regularity due to its high training efficiency. Finally, the results of prediction, regularity quantification, and classification are output from the intelligent system, which is capable of providing scientific basis for corporate strategy decision and has highly extendibility in other enterprises and fields for follow-up research.

Chinese Version of the Nonverbal Pain Assessment Tool: Critical Patient Reliability and Validity.

To translate and validate the Nonverbal Pain Assessment Tool. Timely assessment of the pain degree of nonverbal intensive care unit (ICU) patients can provide humanistic care. However, there is a lack of pain assessment tools that can meet the needs of patients who cannot use language in ICUs in China. A cross-sectional survey. We conducted forward-backward translation of the Nonverbal Pain Assessment Tool. A total of 300 critically ill patients in the intensive care unit who could not communicate verbally completed the Chinese version of the Nonverbal Pain Assessment Tool and the Critical Care Pain Observation Tool. Exploratory and confirmatory factor analyses were performed to verify structural validity, and content validity and reliability analyses were also conducted. The Nonverbal Pain Assessment Tool demonstrated high internal consistency (α = 0.901) and interrater reliability (intraclass correlation coefficient = 0.981), with good split-half reliability. Content validity was established through acceptable item-level content validity index and scale-level content validity index scores. Exploratory factor analysis showed a single factor explaining 71.79% of total variance, and confirmatory factor analysis confirmed good model fit. The Spearman rank correlation coefficient was 0.917 between the Nonverbal Pain Assessment Tool and the Critical Care Pain Observation Tool. The Chinese Nonverbal Pain Assessment Tool demonstrated significant differences in scores between different states of consciousness and illness severity, supporting its known-groups validity. The Chinese version of the Nonverbal Pain Assessment Tool is a reliable and valid tool for nonverbal pain assessment in ICU patients in China. The Chinese version of the Nonverbal Pain Assessment Tool can assess the pain of patients who cannot use language in ICU, which provides a new valuable assessment tool for Chinese clinicians and nurses in pain assessment and management. Our study followed the STROBE Checklists. Patients actively cooperated and participated in data collection during the implementation of the study.

Advancing Digital Education Technologies by Empowering Nurses With Point-of-Care Ultrasound: Protocol for a Mixed Methods Study.

Bedside ultrasonography, also known as point-of-care ultrasound (PoCUS), is a promising technological tool that enhances clinical assessment, enriching diagnostic capabilities and clinical reasoning. Its use in nursing spans various patient populations and health care settings, providing nurses with a valuable health assessment tool to improve care quality and patient safety. Despite its growing integration into clinical practice, PoCUS training has mainly focused on physicians, leaving a gap for trained nurses who demonstrate similar proficiency in conducting scans and interpreting images. Previous research highlights the value of digital tools in PoCUS training, showing their role in improving professionals' and students' knowledge, image interpretation skills, and clinical acumen. This study aimed to (1) establish an assessment instrument gauging nurses' competency milestones in PoCUS and evaluate its content and appearance validity, (2) develop a series of 5 educational videos focused on PoCUS and assess their content and appearance validity, and (3) construct an online learning environment tailored to nurses' PoCUS training needs and evaluate its content and appearance validity. We will conduct a methodological study of technological production guided by Rogers' diffusion of innovations theory. Subproject 1 will design and validate a comprehensive assessment tool for evaluating nurses' competency milestones in PoCUS use. For this purpose, a scoping review will be conducted. The review will be based on JBI Collaboration guidelines and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extended for Scoping Reviews (PRISMA-ScR) checklist. Subproject 2 involves an evaluation of content and appearance validity for a series of 5 educational videos on PoCUS, designed specifically for nurses about applying peripherally inserted central catheter lines, inserting nasogastric feeding tubes, assessing gastric residual volume, assessing pressure injuries and soft tissue conditions, and assessing muscle mass to monitor patient nutritional status. In subproject 3, a comprehensive online learning environment dedicated to PoCUS training for nurses will be developed and validated. The launch of an online learning environment represents a cornerstone of our dissemination strategy, scheduled to coincide with the inaugural Brazilian PoCUS symposium for nurses, an event organized by the project members. This platform will serve as a pivotal resource for continuous learning and professional development. Subproject 1 will start in the second half of 2024 and is expected to be completed by mid-2025. Subproject 2 is currently ongoing and is expected to be completed in early 2026. Subproject 3 is set to begin in early 2025 and is planned to be completed by 2026. Through these concerted efforts, the project aims to bridge the existing gap in PoCUS training for nurses, thereby fostering their proficiency and enhancing patient care outcomes. PRR1-10.2196/58030.

Development and Validation of the Emergency Medical Technicians Occupational Stress Scale

Introduction. The population of interested workers for this study included Emergency Medical Technicians (EMTs) in the United States. This group of workers was chosen because of the nature of their work, which requires their presence at the scenes of life and death situations. Certainly, their work conditions can have an effect on their psychological well-being. Yet, the work of these workers, with all of its stressors, has not been adequately studied through the use of appropriate measuring instruments. Emergency Medical Technicians are not unknown in occupational stress research. This report discusses previous studies on EMT workers and occupational stressors and explains the curative process through the development and validation of an EMT Occupational Stress Scale. The report also highlights the psychometric investigation of this scale. Paramedics/EMTs face increased risk of physical and psychological stress due to the nature of their work. It is crucial to understand the stressors affecting their well-being in order to develop appropriate management strategies. Research suggests that EMTs may lack preparation for their roles, requiring additional training in empathy and emotional intelligence. The relationship between stressors experienced and clinical service provided needs further investigation. Standardized measures of stress for paramedics/EMTs are lacking and more comprehensive instruments are needed. This report aims to develop a comprehensive stress scale specifically for EMTs/paramedics, addressing validation concerns and incorporating environmental stress within a larger theoretical framework. Methods. This study was This study was conducted using a mixed-methods approach to develop and validate the Emergency Medical Technicians Occupational Stress Scale. The scale was pilot tested with a sample of EMTs to ensure reliability and validity. by the ethics committee and is based on a literature review. The Canadian EMT Job Satisfaction Questionnaire was used to measure organizational stress levels of EMTs. The questionnaire was reviewed by professionals and academics, resulting in the inclusion of five new items. The final item list consisted of 58 questions. Permission was obtained. Results. The outcomes and findings obtained from the comprehensive study conducted on the Development and Validation of the Emergency Medical Technicians Occupational Stress Scale have shed light on significant discoveries pertaining to the intricate realm of stress levels experienced by our dedicated EMT professionals. Conclusion. The rapidly evolving scope of Emergency Medical Services (EMS) practice has placed increasing demands on the relatively small professional community that consists of EMTs and paramedics. An Occupational Stress model was developed to examine interpersonal work stressors unique to the EMT role, and a measure was developed to assess the construct. Initial results suggest that the OSM is an accurate, reliable, and potentially valuable assessment tool. High levels of interpersonal stress may influence the EMTs to cope with their daily activities by seeking outlets for tension and depression through increased use of alcohol, legal drugs, and caffeine. Alcohol is used more frequently than other legal drugs are to modify interpersonal stress symptoms. The EMTs are in a prime position to help each other identify these symptoms when arising and offer assistance. Staff stress management programs are essential in solving and preventing occupational stress. A move toward prevention rather than reaction to such stress, which for many results in alcoholism, drug addiction, or job related emotional illness, will serve to preserve the health of the EMTs. The medical community has a vested interest in the health of these dedicated professionals. Not only does such prevention attempt to manage the human tragedy of alcoholism, legal drug addiction, and job related emotional illness, but it also prevents the more tangible, but no less important cost factors to the EMT.

Using the IFASIS (Inventory of Factors Affecting Successful Implementation and Sustainment) to Advance Context-Specific and Generalizable Knowledge of Implementation Determinants: Case Study of a Digital Contingency Management Platform.

Contingency management (CM) is the most effective treatment for stimulant use disorder but is underutilized by opioid treatment programs (OTPs), despite the high prevalence of stimulant use in this setting. As part of a state-wide initiative, we piloted a novel assessment, the Inventory of Factors Affecting Successful Implementation and Sustainment (IFASIS), to examine determinants of implementation of a digital CM platform across a set of OTPs. We describe how the IFASIS was used to elucidate both generalizable and context-specific implementation determinants, and to guide the provision of implementation facilitation. Six OTPs received a multi-level implementation strategy (including facilitation) to promote programmatic uptake of a digital CM platform. Pre-implementation, OTPs completed the IFASIS, a 27-item questionnaire that assesses both the valence (positive/negative) and importance of determinants across 4 domains: outside the organization, within the organization, about the intervention, and about intervention recipients. OTP staff completed the IFASIS as a team, identifying consensus ratings during recorded discussions. Transcripts of IFASIS recordings were analyzed using rapid qualitative analysis. Quantitative IFASIS results were aggregated into medians and ranges within and across organizations. Implementation facilitation meeting notes were analyzed to examine how the IFASIS was used to guide facilitation. Quantitative ratings and qualitative feedback revealed common barriers to implementation of the digital CM platform, including a lack of sustainable funding sources, absence of external and organizational policies, insufficient higher-level leadership support, and mixed attitudes among staff members toward CM. Common implementation facilitators included enthusiasm and commitment among organization leadership and the perception that the digital CM platform would reduce the workload and burden on OTP counselors. The IFASIS was used to guide facilitation in several ways, including stimulating discussion about barriers and facilitators, brainstorming strategies to address barriers rated as "very important", and identifying facilitators that could be harnessed as part of implementation efforts. The IFASIS identified important determinants of CM implementation in OTPs and was instrumental in shaping facilitation. The IFASIS may be a valuable assessment for the implementation science community to identify and address generalizable and context-specific implementation determinants.

State-of-the-Art on the Impact of Bimodal Acoustic Stimulation on Speech Perception in Noise in Adults: A Systematic Review.

Bimodal stimulation (BS), which combines the use of a cochlear implant (CI) in one ear and a hearing aid (HA) in the opposite ear, is an established strategy to treat hearing loss by exploiting the unique capabilities of each device. CIs stimulate the auditory nerve by bypassing damaged hair cells, while HAs amplify sounds by requiring a functional hearing residual. The aim of this systematic review is to investigate the advantages and disadvantages of BS such as speech perception in noise. We examined clinical studies published from October 2020 to July 2024, following the PRISMA guidelines, focusing on the advantages and disadvantages of BS on speech perception in noise in adulthood. BS in adult patients significantly improves speech perception in quiet and noisy environments, especially for those with increased residual hearing. Unilateral CIs and BS perform similarly in quiet conditions, but BS significantly improves speech discrimination in noisy environments if loudness between the two devices is appropriately balanced. Directional microphones and programming software are new technologies that succeed in reducing environmental noise and improving verbal perception outcomes, although their features in the literature are controversial. In addition, the individuals using BS may face temporal mismatches mainly due to differing device latencies, affecting sound localization. Compensating for these mismatches can enhance localization accuracy. However, modulated noise remains a significant obstacle to verbal perception in noise. Valuable assessment tools such as music tests provide further information on hearing performance and quality of life. More research is needed to define certain selection criteria.

Adding value for clients during work disability assessments: A qualitative exploration from the perspective of medical examiners.

Value-based healthcare delivery focuses on optimizing care provided by measuring the healthcare outcomes which are most important to the clients relative to the total care costs. However, the understanding of what adds value for clients during work disability assessment is lacking. To explore what medical examiners (MEs) perceive as valuable during the work disability assessment process, by exploring possible: 1) facilitators, 2) barriers and 3) opportunities to add value for the client during the work disability assessment. For this explorative qualitative study, 7 semi-structured interviews were conducted with MEs in the Netherlands. Thematic coding was performed for all interviews. A large variety of facilitators (n = 22), barriers (n = 17) and opportunities (n = 11) were identified and inductively subdivided into four main themes: 1) coherent process, including all time related aspects, 2) interdisciplinary collaboration, including all aspects related to the collaboration between the ME and other professionals, 3) client-centred interaction, including all aspects related to the supportive interplay from the ME towards the client, and 4) information provision on all aspects during the work disability assessment process towards the client to ensure a valuable work disability assessment process. The overview of identified possible facilitators, barriers and opportunities to add value for clients from the perspective of the ME may stimulate improvement in the current work disability assessment practice and to better match the client needs.

Simulating multi-scale optimization and variable selection in species distribution modeling

Species distribution modeling (SDM) is a fundamental tool in theoretical and applied ecology. However, relatively little is known about the performance of different approaches for scale optimization, model selection, and algorithmic prediction in the context of nonlinear, multiscale and interactive relationships between environmental variables and species occurrence. Modelers often struggle to optimize a tradeoff between ecological relevance, model robustness, complexity, and overfitting. In this paper, we investigated several methods designed to optimize spatial scale and variable selection in SDMs, in each case evaluating model fitness, parsimony and predictive performance. We used a simulation approach to produce a large pool of alternative underlying habitat relationships that reflect a broad range of realistic habitat associations. We also compared several different modeling algorithms, including logistic regression with a generalized linear model (GLM), Lasso and Elastic-Net Regularized GLMs (GLMNet), and random forest (RF), as well as alternative variable and scale selection methods. We found that GLM methods employing all-subsets dredge routines for variable selection were consistently the best predictors based on all criteria of our model performance assessment and across all attributes of the simulated underlying relationship, including nonlinearity and interaction. We had expected machine learning approaches, such as random forest, to perform better in these more complex forms of species-environment relationships. GLM using dredge variable selection was also the method that included the fewest spurious covariates and included the most correct predictors as a proportion of all predictors. We found that univariate scaling was the most robust method of variable and scale selection, along with Minimal Redundancy Maximal Relevancy (MRMR) which performed equivalently. The simulation experiment presented here provides a robust assessment of simulated multi-species distribution model performance, complexity and fidelity. By simulating a large range of potential habitat relationships with varying spatial scale, effect sizes, linearity, and interactions, we comprehensively evaluated model performance across gradients of complexity of the underlying relationships and violations of classical statistical assumptions. This study provides a valuable assessment and a broader example of the power and utility of controlled simulation experiments in habitat relationships and other ecological spatial predictive modeling.

Revealing regional variations in scleral shear modulus in a rabbit eye model using multi-directional ultrasound optical coherence elastography

The mechanical properties of the sclera play a critical role in supporting the ocular structure and maintaining its shape. However, non-invasive measurements to quantify scleral biomechanics remain challenging. Recently introduced multi-directional optical coherence elastography (OCE) combined with an air-coupled ultrasound transducer for excitation of elastic surface waves was used to estimate phase speed and shear modulus in ex vivo rabbit globes (n = 7). The scleral phase speed (12.1 ± 3.2 m/s) was directional-dependent and higher than for corneal tissue (5.9 ± 1.4 m/s). In the tested locations, the sclera proved to be more anisotropic than the cornea by a factor of 11 in the maximum of modified planar anisotropy coefficient. The scleral shear moduli, estimated using a modified Rayleigh-Lamb wave model, showed significantly higher values in the circumferential direction (65.4 ± 31.9 kPa) than in meridional (22.5 ± 7.2 kPa); and in the anterior zone (27.3 ± 9.3 kPa) than in the posterior zone (17.8 ± 7.4 kPa). The multi-directional scanning approach allowed both quantification and radial mapping of estimated parameters within a single measurement. The results indicate that multi-directional OCE provides a valuable non-invasive assessment of scleral tissue properties that may be useful in the development of improved ocular models, the evaluation of potential myopia treatment strategies, and disease characterization and monitoring.

Validation of the Pediatric Spatial Hearing Questionnaire.

Spatial hearing is necessary for adequate sound awareness and speech perception abilities; however, research indicates that children have difficulties on these spatial hearing tasks that affect functioning in their daily environment. The purpose of this study was to validate a pediatric version of the Spatial Hearing Questionnaire (P-SHQ) for determining binaural hearing benefits and spatial hearing ability in children. We recruited parents and guardians of 68 children ages kindergarten through eighth grade to participate. Parents completed the P-SHQ, the Speech, Spatial and Qualities of Hearing Scale-Parent version, and a demographic questionnaire. To determine the factor structure of the P-SHQ, we conducted an exploratory factor analysis and reliability was assessed by calculating correlation coefficients. Three factors emerged during factor analysis: Factor 1 = sound localization, Factor 2 = speech-in-noise perception, and Factor 3 = speech perception in quiet. The P-SHQ has good internal consistency reliability (α = .97), and high item-total correlations were found. The correlation between scores from the P-SHQ questionnaire and the SSQ-Spatial subscale questionnaire provides evidence for the construct validity of the P-SHQ. The P-SHQ is a reliable and valid questionnaire to assess spatial hearing ability in children. This quick-to-administer tool can be incorporated into audiological care to determine the spatial hearing skills of a child and assist in counseling, making it a valuable assessment for hearing health care professionals.

Willingness to pay for a tobacco-free life: a contingent valuation assessment.

Tobacco, being an established risk factor for significant mortality and morbidity, causes over 7 million annual deaths globally. India is a country with over 270 million active tobacco users. On the one hand, although the willingness to quit amongst tobacco users is as high as 55.4%, the actual quit rates translate to less than 20%. Taking a cue from the economic principle of commitment and consistency, paying a nominal fee can serve as a form of public commitment and motivation to decrease the dropout rate amongst those committed to quitting. This study uses contingent valuation assessment to determine the willingness to pay (WTP) values for an effective tobacco cessation service across individuals with different socio-demographic characteristics. A cross-sectional observational study with multistage cluster sampling in Rajasthan was conducted to recruit 360 active tobacco users from 8 districts. Q-Q plots were used to determine the non-parametric distribution, and statistical differences between median WTP values were compared using Mann-Whitney U and Kruskal-Wallis H tests, considering a p-value less than 0.05 to be statistically significant. The majority of participants were males (57.78%) between the ages of 26 and 35 (40.28%), married (82.50%), and with children (65.83%), with an annual income between USD 7500-10,000 (23.61%) and graduate-level education (40.56%). Exclusive smokers formed the majority of the cohort (48.06%), and 50.83% were willing to quit as well as willing to pay for cessation. Median WTP values were maximum for males (USD 54.05; p<0.05), age group 26-35 years (USD 54.05; p<0.05), post-graduates (USD 81.08; p<0.05), and annual income above USD 20,000 (USD 121.62; p<0.05). Weak positive and significant correlations were observed between WTP and annual spending on tobacco, annual spending on health, and annual income. The study emphasizes the critical importance of early-age interventions for effective tobacco cessation prior to transitioning into dependency, resulting in reduced financial parity for availing health services. These are the first such WTP values from the Southeast Asian region, tailored for different population subsets, specifically for tobacco cessation. Our findings contribute to the growing body of evidence to support innovative approaches to enhance tobacco cessation efforts through financial commitments.