Critical Areas For Improvement Research Articles

Commercial devices for monitoring symptoms in Parkinson's disease: benefits, limitations and trends

Parkinson's disease (PD) is a neurodegenerative disorder that significantly affects patients' quality of life. Treatment of PD requires accurate assessment of motor and non-motor symptoms, which is often complicated by subjectivity in reporting symptoms, and the limited availability of neurologists. Commercial wearable devices, which monitor PD symptoms continuously and outside the clinical setting, have appeared to address these challenges. These devices include PKG™, Kinesia 360™, Kinesia U™, PDMonitor™ and STAT-ON™. These devices use advanced technologies, including accelerometers, gyroscopes and specific algorithms to provide objective data on motor symptoms, such as tremor, dyskinesia and bradykinesia. Despite their potential, the adoption of these devices has been limited, due to concerns about their accuracy, complexity of use and the lack of independent validation. The correlation between the measurements obtained from these devices and traditional clinical observations varies, and their usability and patient adherence are critical areas for improvement. Validation and usability studies with a sufficient number of patients, standardised protocols and integration with hospitals' IT systems are essential to optimise their usefulness and improve patient outcomes.

Laser Weeding Technology in Cropping Systems: A Comprehensive Review

Weed infestations pose significant challenges to global crop production, demanding effective and sustainable weed control methods. Traditional approaches, such as chemical herbicides, mechanical tillage, and plastic mulches, are not only associated with environmental concerns but also face challenges like herbicide resistance, soil health, erosion, moisture content, and organic matter depletion. Thermal methods like flaming, streaming, and hot foam distribution are emerging weed control technologies along with directed energy systems of electrical and laser weeding. This paper conducts a comprehensive review of laser weeding technology, comparing it with conventional methods and highlighting its potential environmental benefits. Laser weeding, known for its precision and targeted energy delivery, emerges as a promising alternative to conventional control methods. This review explores various laser weeding platforms, discussing their features, applications, and limitations, with a focus on critical areas for improvement, including dwell time reduction, automated navigation, energy efficiency, affordability, and safety standards. Comparative analyses underscore the advantages of laser weeding, such as reduced environmental impact, minimized soil disturbance, and the potential for sustainable agriculture. This paper concludes by outlining key areas for future research and development to enhance the effectiveness, accessibility, and affordability of laser weeding technology. In summary, laser weeding presents a transformative solution for weed control, aligning with the principles of sustainable and environmentally conscious agriculture, and addressing the limitations of traditional methods.

A Proof of Concept Using BLE to Optimize Patients Turnaround Time (PTAT) in Health Care

In 2022, Malaysia's Ministry of Health (MOH) acknowledged that government hospitals continue to face challenges in delivering high-quality patient care. A significant issue is the absence of a Real-Time Patient Location Monitoring and Tracking Solution, which prevents doctors from efficiently tracking patients within medical facilities. This lack of real-time tracking contributes to a decline in service quality, creating an urgent need for optimization in patient monitoring and tracking solutions. Implementing an effective tracking system can significantly enhance patient care quality, improve resource utilization management, and boost staff productivity, ultimately saving costs, time, and resources for hospitals. One critical area for improvement is the Patient Turnaround Time (PTAT), which refers to the duration a patient spends being processed at a hospital before being discharged. PTAT is currently prolonged in many hospitals due to the complex processes involved and patients becoming untraceable while waiting for their turn. To address these challenges, we have developed an Internet of Things (IoT) solution utilizing Bluetooth Low Energy (BLE) technology to optimize PTAT. This solution enables hospital staff to track patient movements and localize them in real-time. By using wearable devices, the system measures the distance from patients to various Access Points (AP) spread throughout the hospital based on the dBm value. This paper presents comprehensive experimentation for the Proof of Concept (POC) and pilot testing of this BLE-based solution. The results demonstrate the accuracy of using the Received Signal Strength Indicator (RSSI) to optimize patient turnaround times in hospitals. By implementing this BLE solution, hospitals can reduce the time patients spend waiting for treatment, thereby improving overall patient satisfaction and hospital efficiency. The ability to monitor patient locations in real-time will ensure that patients receive timely care, reducing the likelihood of them wandering off and becoming untraceable. This technology represents a significant step forward in modernizing patient care and streamlining hospital operations in Malaysia.

Climate change education in Indonesia’s formal education: a policy analysis

This article conducts a comprehensive analysis of climate change education within the framework of climate change policy and education policy in Indonesia. Employing thematic analysis on twenty climate change policy texts, twelve K-12 education policy texts, and seventeen expert interview transcripts, our study explores the congruency of climate change education in both policy domains. Despite the critical need for coordinated policies to optimise the design and implementation of climate change education, the analysis reveals a significant discrepancy between Indonesia’s climate change policy and education policy regarding this crucial aspect. Four key themes emerged: the marginalisation of climate change education, the lack of synergies between relevant policies and stakeholders, the predominant economic values, and the optimistic future outlook. The study also assesses the alignment between Indonesia’s approach and global trends in climate change education. The findings shed light on critical areas for improvement and development in the integration of climate change education within the Indonesian policy landscape.

A Systematic Literature Review of Income Inequality in Central–Eastern European Countries

AbstractThis review offers a comprehensive perspective on income inequality literature in Central–Eastern European (CEE) nations, with a specific focus on six countries: Bulgaria, Romania, Poland, Hungary, Czechia, and Slovakia. By thoroughly examining existing research, this review uncovers the underlying factors and root causes contributing to varying income inequality levels and trends across CEE countries. The investigation is conducted through a systematic literature review and network analysis, focusing on the literature published since 1990, mainly on recent studies. The review is structured around three thematic frameworks (concept and measures, evidence, and causes). These three strands of the literature review not only offer a comprehensive picture of income inequality in CEE countries but also identify critical research gaps for further studies. The review underscores several critical areas for improvement within CEE studies. These include addressing gaps in geographical and temporal coverage, utilizing alternative measurements of income inequality, and investigating the causes of diverging trends in income inequality among CEE countries. Moreover, there is a pressing need to expand the understanding of the determinants influencing income inequality in these nations, which presents a significant opportunity for future research.

Urbanization and its Mental Health Implications in the Philippines

The objective of this research is to examine the effectiveness of integrated mental health services in urban settings within the Philippines, with a particular focus on the challenges posed by rapid urbanization. The study aims to develop a comprehensive framework that assesses the availability, accessibility, and efficacy of mental health services in metropolitan areas, thereby contributing to the improvement of public health strategies in urban environments. Utilizing a robust methodological approach, the research evaluates several key components of mental health services, including intervention strategies, community engagement, and policy implementation. The results indicate that while there are numerous services available, significant gaps in service accessibility and effectiveness remain. Factor analysis identified five critical areas for improvement: 1) Community Awareness and Stigma Reduction; 2) Integration of Mental Health into Primary Health Care; 3) Enhanced Training for Mental Health Professionals; 4) Strengthened Support Networks; 5) Policy and Infrastructure Development. The study also highlights the importance of aligning service provision with the specific cultural and socioeconomic contexts of Filipino urban populations. The findings underscore the need for a multi-disciplinary approach to mental health care that includes both governmental and community-level involvement.

Analysis Of Customer Satisfaction With Packaged Drinking Water Products Using Service Quality (SERVQUAL) And Importance Performance Analysis (IPA) Methods

PT. XYZ is a bottled mineral water manufacturer in Gresik, striving to deliver customer satisfaction and stay competitive. This study aims to quantify consumer satisfaction with PT. XYZ's product quality. We collected data through a questionnaire and analyzed it using the Servqual method and Importance Performance Analysis (IPA). The questionnaire included nine quality attributes, categorized into five dimensions. IPA was utilized to prioritize service quality attributes. The Servqual method revealed a negative gap, indicating suboptimal service. The Cartesian IPA diagram highlighted two critical areas for improvement: enhancing staff interaction during service and improving personnel demeanor, specifically their politeness, and friendliness. These improvements are vital as they align with consumer expectations and are essential for enhancing overall service quality at PT. XYZ. Keywords: Service Quality, Importance Performance Analysis (IPA), SERVQUAL

Improvements in Rock Mass Description for Stope Design by Geophysical and Geochemical Methods

Stope design is an important part of mine planning, and it aims to balance ore recovery, ore dilution, and production costs without compromising the safety aspects. This paper summarizes the main results from the research, which aims to introduce new techniques to describe the ore body and surrounding rock mass at the tunnel face prior to stope excavation. The research comprises a literature review and a survey among mining professionals to assess current stope design practices. The study identifies geotechnical data, software improvements, and integration of design into mine planning as the most critical areas for improvement. The empirical part of the study proposes new techniques for fast data acquisition. The laser-induced breakdown spectrometry (LIBS) technique is developed for measurements at the tunnel face and from core boxes to provide mineralogical and geometallurgical data. Ground-penetrating radar (GPR) studies are conducted to improve discontinuity characterization, and rapid photogrammetric methods are proposed for efficient tunnel geometry characterization. The techniques discussed in this paper already have many industrial applications. This study reveals their potential to be adopted and further developed to serve ore and rock mass characterization for stope design.

Assessing primary healthcare disaster preparedness: a study in Northern Italy.

The aim of this paper is to outline the steps taken to develop an operational checklist to assess primary healthcare (PHC) all-hazards disaster preparedness. It then describes a study testing the applicability of the checklist. A PHC approach is an essential foundation for health emergency and disaster risk management (H-EDRM) because it can prevent and mitigate risks prior to disasters and support an effective response and recovery, thereby contributing to communities' and countries' resilience across the continuum of the disaster cycle. This approach is in line with the H-EDRM framework, published by the World Health Organization (WHO) in 2019, which emphasizes a whole-of-health system approach in disaster management and highlights the importance of integrating PHC into countries' H-EDRM. Nevertheless, literature focusing on how to practically integrate PHC into disaster management, both at the facility and at the policy level, is in its infancy. As of yet, there is no standardized, validated way to assess the specific characteristics that render PHC prepared for disasters nor a method to evaluate its role in H-EDRM. The checklist was developed through an iterative process that leveraged academic literature and expert consultations at different stages of the elaboration process. It was then used to assess primary care facilities in a province in Italy. The checklist offers a practical instrument for assessing and enhancing PHC disaster preparedness and for improving planning, coordination, and funding allocation. The study identified three critical areas for improvement in the province's PHC disaster preparedness. First, primary care teams should be more interdisciplinary. Second, primary care services should be more thoroughly integrated into the broader health system. Third, there is a notable lack of awareness of H-EDRM principles among PHC professionals. In the future, the checklist can be elaborated into a weighted tool to be more broadly applicable.

The Built Environment’s Role in Supporting Dementia Inclusive Communities: A Case Study of Canterbury‐Bankstown City

AbstractBackgroundInclusive and enabling cities are fundamental to the wellbeing of people impacted by dementia. How we implement these ideals in multicultural communities through the built environment remains understudied. The experience of place must be considered in the context of dementia‐friendly community (DFC) models to fully enable people experiencing dementia to remain autonomous, integrated, and connected. This study aimed to explore how diverse individuals with dementia perceive the built environment and its impacts on everyday activities using a mixed methods approach.MethodThis study was set in Canterbury‐Bankstown, New South Wales, Australia where a high proportion of people impacted by dementia speak English, Arabic, and/or Vietnamese. Seventeen people experiencing dementia, their care partners, and former carers (English: n = 7; Arabic: n = 5; Vietnamese: n = 5) were recruited for a semi‐structured interview, and two of these dyads (English: n = 1; Vietnamese n = 1) audited a local shopping centre and hospital using the DFC‐environmental assessment tool (DFC‐EAT). Interviews and audits were conducted in‐language with bilingual researchers, who then transcribed the data into English for analysis. Similarities and differences were identified across the interview transcripts and audit data to identify issues with the existing built environment and improvement opportunities.ResultWe found that participants would limit or avoid going outdoors for everyday activities because of safety concerns (especially when using paths and carparks). Furthermore, overwhelming indoor experiences were characterised by unfamiliar designs and fittings (particularly with bathroom facilities), unsupported movement and way‐finding due to excessive or insufficient signage, poor lighting, and high noise. Participants recommended greater access to door‐to‐door transport that caters to people experiencing dementia, establishing quiet resting areas, and improving navigation through signage that uses standardised symbols (e.g., for toilet facilities).ConclusionPeople experiencing dementia and carers reported an array of issues concerning built environment design and accessibility features that excluded them from everyday activities. These findings were translated into an implementation plan that informed the City of Canterbury‐Bankstown Council’s community planning efforts and the shopping centre’s facility operations. Critical areas for improvement in the built environment would benefit from co‐design practices that are inclusive and representative of the community.

대학교 신입생은 어떤 교육서비스를 원하는가

This study aims to prioritize educational services for university freshmen using ImportancePerformance Analysis (IPA). I assess how freshmen rate the importance and performance of various educational services factors. From a survey of 1,082 freshmen in a University in Chungbuk, 18 factors across four areas (academics, adaptation, campus activities, and job support) are derived. Results indicate that the importance of all factors exceeded their performance, with statistically significant differences observed. Major knowledge acquisition, job preparation, and practical skills enhancement are identified as critical areas for improvement. Conversely, areas like senior relationships, student activities, counseling support, and volunteering need policy reconsideration. The significance of this study is that it provides foundational data for university policy makers to plan, operate, and modify freshman support programs.

Application of an Automated System for Converting Waste Cooking Oil into Aromatherapy Candles

This research focuses on the development of an automated system for the production of aromatherapy candles using waste cooking oil. The study addresses the challenges faced in small-scale production, including limited capacity, manual processes, and inconsistent product quality. To overcome these challenges, an automated machine is proposed to improve efficiency and productivity. The homogenization process and heating time were identified as critical areas for improvement. A sequential control system was successfully implemented, enabling the conversion of waste cooking oil into aromatherapy candles with a production capacity of 10.5 liters per unit run. The motor control system utilized On-Off control with modified power input to minimize vibration issues, operating the motor at 50-60 RPM. The temperature heater control system employed a PID control method, specifically the Ziegler-Nichols type 2 method, with Kp and Ki values of 247.5 and 1.104, respectively. The chosen PID parameters demonstrated satisfactory performance, including a rise time of 22.95 minutes, maximum overshoot of 2.85%, and a dead time of 510 seconds. The implemented system was controlled using an Arduino controller, ensuring a fast response and stable operation.

Additive Manufacturing of Polymer/Bioactive Glass Scaffolds for Regenerative Medicine: A Review.

Tissue engineering (TE) is a branch of regenerative medicine with enormous potential to regenerate damaged tissues using synthetic grafts such as scaffolds. Polymers and bioactive glasses (BGs) are popular materials for scaffold production because of their tunable properties and ability to interact with the body for effective tissue regeneration. Due to their composition and amorphous structure, BGs possess a significant affinity with the recipient's tissue. Additive manufacturing (AM), a method that allows the creation of complex shapes and internal structures, is a promising approach for scaffold production. However, despite the promising results obtained so far, several challenges remain in the field of TE. One critical area for improvement is tailoring the mechanical properties of scaffolds to meet specific tissue requirements. In addition, achieving improved cell viability and controlled degradation of scaffolds is necessary to ensure successful tissue regeneration. This review provides a critical summary of the potential and limitations of polymer/BG scaffold production via AM covering extrusion-, lithography-, and laser-based 3D-printing techniques. The review highlights the importance of addressing the current challenges in TE to develop effective and reliable strategies for tissue regeneration.

A Critical Review on Factors Affecting the User Adoption of Wearable and Soft Robotics.

In recent years, the advent of soft robotics has changed the landscape of wearable technologies. Soft robots are highly compliant and malleable, thus ensuring safe human-machine interactions. To date, a wide variety of actuation mechanisms have been studied and adopted into a multitude of soft wearables for use in clinical practice, such as assistive devices and rehabilitation modalities. Much research effort has been put into improving their technical performance and establishing the ideal indications for which rigid exoskeletons would play a limited role. However, despite having achieved many feats over the past decade, soft wearable technologies have not been extensively investigated from the perspective of user adoption. Most scholarly reviews of soft wearables have focused on the perspective of service providers such as developers, manufacturers, or clinicians, but few have scrutinized the factors affecting adoption and user experience. Hence, this would pose a good opportunity to gain insight into the current practice of soft robotics from a user's perspective. This review aims to provide a broad overview of the different types of soft wearables and identify the factors that hinder the adoption of soft robotics. In this paper, a systematic literature search using terms such as "soft", "robot", "wearable", and "exoskeleton" was conducted according to PRISMA guidelines to include peer-reviewed publications between 2012 and 2022. The soft robotics were classified according to their actuation mechanisms into motor-driven tendon cables, pneumatics, hydraulics, shape memory alloys, and polyvinyl chloride muscles, and their pros and cons were discussed. The identified factors affecting user adoption include design, availability of materials, durability, modeling and control, artificial intelligence augmentation, standardized evaluation criteria, public perception related to perceived utility, ease of use, and aesthetics. The critical areas for improvement and future research directions to increase adoption of soft wearables have also been highlighted.

The Successful Use of a Virtual Application to Enhance Formative Feedback- and Competency-Based Assessments in Surgical Training

INTRODUCTION: This study aimed to use a customized phone and computer application to improve formative feedback in surgery and assess competency over time. METHODS: General surgery residents at a single institution were enrolled in a prospective cohort study from August 2021 to February 2022. A survey was conducted at the beginning and conclusion of the study period to assess perceptions on feedback regarding technical skills. Afterwards, a customized phone application was used to assess competency using the Zwisch scale and a dictation feature. Salient features of the app included 15 core operations (appendectomy, cholecystectomy, hernia repair, laparotomy, etc) broken into 7-10 key steps, objective structured assessment of technical skills (OSATS), components that went well, and areas for improvement. RESULTS: Twenty-two surgery residents submitted 260 virtual feedback-forms over a six-month period. After the study, residents’ perception that they were receiving valuable, weekly feedback regarding technical skills increased from 27.2% to 100.0% (p < 0.001). The application also allowed the program to track competency over time and provide insight into critical areas for improvement (Fig. 1). Two of the most commonly dictated phrases by faculty included “make better use of your left hand,” and “remain aware of providing adequate counter-tension.” 90.9% of residents stated that the use of the virtual application enhanced their operative experience and would recommend its continued use for feedback and competency-based assessments.CONCLUSION: Phone applications greatly enhance formative, technical feedback for residents. These virtual applications can also be effectively used to assess improving competency over core operations in general surgery training.

Outcomes of Pediatric Oncology Patients Admitted to An Intensive Care Unit in a Resource-limited Setting.

Improved survival and intensified treatment protocols in pediatric oncology have resulted in an increased need for intensive care. However, in resource-constrained settings, the higher morbidity and mortality of these patients raises sensitive issues around the optimal use of limited critical care resources. Single-center, 10-year retrospective review of pediatric oncology patients admitted to the pediatric intensive care unit (PICU). Of the 117 admissions, 70.1% had solid tumors, 61.5% were admitted electively, and 76.1% were admitted for noninfective indications. PICU mortality of oncology patients was 18.8% relative to the PICU mortality of all patients in the same period of 10.5%. In a multivariable analysis, factors shown to be independently associated with PICU mortality were infective indications for admission (relative risk=3.83, confidence interval: 1.16; 12.6, P=0.028) and vasoactive support (relative risk=7.50, confidence interval: 1.72; 32.8, P=0.0074). The increased mortality associated with sepsis, organ dysfunction and need for organ support underscores the need for earlier recognition of and intervention in pediatric oncology patients requiring intensive care. Further prospective studies are needed to identify the most critical areas for improvement in the referral of these children to PICU, to optimize care and improve outcomes.

Evaluating the Correlation Between Nursing Practice and Electronic Nursing Records Using Importance-Performance Analysis.

This study aimed to analyze the importance and performance of nursing task items in the standard guidelines for comprehensive nursing services and confirm whether they are reflected in the nursing records. A total of 120 nurses from three hospitals were surveyed for the importance-performance analysis of standard nursing services and their correlation with nursing records. The average scores for importance, performance, and correlation to nursing records were 3.65, 3.31, and 3.08, respectively, demonstrating a significant positive correlation. Regarding the correlation between nursing tasks and nursing records, spiritual and emotional assessment, mobilization, education and counseling, and escaping and suicide prevention items had moderately low scores. In the importance correlation to the nursing records of the task items matrix, 10 items in quadrant 1 were strengths. Conversely, in quadrant 2, suicide and escape prevention require critical areas for improvement. The other six items were low-priority items in quadrant 3, and the three items in quadrant 4 were hygiene, elimination, and nutrition, which required excessive effort. It is necessary to evaluate the electronic nursing records system periodically according to the nursing environment and modify and supplement the records if required.

Techno-economic analysis and life cycle assessment of a biorefinery utilizing reductive catalytic fractionation.

Reductive catalytic fractionation (RCF) is a promising approach to fractionate lignocellulose and convert lignin to a narrow product slate. To guide research towards commercialization, cost and sustainability must be considered. Here we report a techno-economic analysis (TEA), life cycle assessment (LCA), and air emission analysis of the RCF process, wherein biomass carbohydrates are converted to ethanol and the RCF oil is the lignin-derived product. The base-case process, using a feedstock supply of 2000 dry metric tons per day, methanol as a solvent, and H2 gas as a hydrogen source, predicts a minimum selling price (MSP) of crude RCF oil of $1.13 per kg when ethanol is sold at $2.50 per gallon of gasoline-equivalent ($0.66 per liter of gasoline-equivalent). We estimate that the RCF process accounts for 57% of biorefinery installed capital costs, 77% of positive life cycle global warming potential (GWP) (excluding carbon uptake), and 43% of positive cumulative energy demand (CED). Of $563.7 MM total installed capital costs, the RCF area accounts for $323.5 MM, driven by high-pressure reactors. Solvent recycle and water removal via distillation incur a process heat demand equivalent to 73% of the biomass energy content, and accounts for 35% of total operating costs. In contrast, H2 cost and catalyst recycle are relatively minor contributors to operating costs and environmental impacts. In the carbohydrate-rich pulps, polysaccharide retention is predicted not to substantially affect the RCF oil MSP. Analysis of cases using different solvents and hemicellulose as an in situ hydrogen donor reveals that reducing reactor pressure and the use of low vapor pressure solvents could reduce both capital costs and environmental impacts. Processes that reduce the energy demand for solvent separation also improve GWP, CED, and air emissions. Additionally, despite requiring natural gas imports, converting lignin as a biorefinery co-product could significantly reduce non-greenhouse gas air emissions compared to burning lignin. Overall, this study suggests that research should prioritize ways to lower RCF operating pressure to reduce capital expenses associated with high-pressure reactors, minimize solvent loading to reduce reactor size and energy required for solvent recovery, implement condensed-phase separations for solvent recovery, and utilize the entirety of RCF oil to maximize value-added product revenues.

How can we improve priority-setting for investments in health research? A case study of tuberculosis

BackgroundAlthough enhanced priority-setting for investments in health research for development is essential to tackling inequalities in global health, there is a lack of consensus on an optimal priority-setting process. In light of the current surge in tuberculosis (TB) research investment, we use TB as a case study.MethodsWe investigated two critical aspects of a research prioritisation process, namely the criteria that should be used to rank alternative research options and which stakeholders should be involved in priority-setting. We conducted semi-structured interviews with 24 key informants purposively selected from four distinct groups – academia, funding bodies, international policy or technical agencies, and national disease control programmes. Interview transcripts were analysed verbatim using a framework approach. We also performed a systematic analysis of seven diverse TB research prioritisation processes.ResultsThere was consensus that well-defined and transparent criteria for assessing research options need to be agreed at the outset of any prioritisation process. It was recommended that criteria should select for research that is likely to have the greatest public health impact in affected countries rather than research that mainly fills scientific knowledge gaps. Some interviewees expressed strong views about the need – and reluctance – to make politically challenging decisions that place some research areas at a lower priority for funding. The importance of taking input from stakeholders from countries with high disease burden was emphasised; such stakeholders were notably absent from the majority of prioritisation processes we analysed.ConclusionsThis study indicated two critical areas for improvement of research prioritisation processes such that inequalities in health are better addressed – the need to deprioritise some research areas to generate a specific and meaningful list for investment, and greater involvement of experts working in high disease-burden countries.

Minority recruitment trends in phase III prostate cancer clinical trials (2003-2014): progress and critical areas for improvement

PurposeU.S. minority groups have been historically underrepresented in phase III prostate cancer clinical trials despite often having higher risk disease. This study analyzes enrollment trends of major U.S. racial/ethnic groups in phase III prostate cancer trials between 2003-2014 compared to Surveillance, Epidemiology, and End Results (SEER) incidence data. Materials and MethodsPhase III prostate cancer trials primarily enrolling patients from the U.S. were identified in the ClinicalTrials.gov database. Enrollment trends were analyzed for major racial/ethnic groups. Prostate cancer incidence data from the SEER registry was used to identify enrollment targets. The enrollment difference was determined by calculating the absolute difference between the percentage of a racial/ethnic subgroup in the SEER registry population and the percentage of that subgroup in the phase III prostate cancer trial population. ResultsAmong 39 studies identified, African American enrollment in therapeutic trials increased across the study period (p<0.001). The enrollment difference for African Americans was -9.0% (95% CI, -7.6 to -10.5; p<0.001) in 2003-05 and 1.4% (95% CI, 0.2 to 2.6; p = 0.020) in 2012-14. However, African American men were under-enrolled in metastatic disease trials (enrollment difference = -5.8%; 95% CI, -4.8 to -6.8; p<0.001). Latino and Asian American men were consistently under-enrolled in all trial types. ConclusionsU.S. minority groups were largely under-enrolled in phase III prostate cancer trials between 2003-2014. While recruitment efforts may have had an impact, as demonstrated by increased enrollment of African American men, there remains a need to expand recruitment efforts to achieve diversity in trials.