Group Evaluation Research Articles

Cross-sectional survey study of the natural history of LAMA2-related dystrophy

BackgroundLAMA2-related dystrophies (LAMA2-RD) are a rare group of neuromuscular disorders with a broad spectrum of phenotype severity, ranging from mild to severe. We performed a cross-sectional study of LAMA2-RD through motor function and pulmonary tests to establish the disease's natural history. MethodsForty-four individuals with LAMA2-RD were included and evaluated once through functional outcome measures including Motor Function Measure 32 (MFM32), Revised Upper Limb Module (RULM), goniometry, and Forced Vital Capacity (FVC). Fixed Effect Regression Model (ERM) and Kaplan-Meier curve were used for calculating the rate of the disease progression ResultsPatients were between 2 and 25 years old (mean 11.4), the most frequent phenotype presentation was non-ambulant (N=36, 81.8%) while eight patients (18,2 %) were ambulant. The non-ambulant group presented a more severe progression of the disease. Non-ambulant patients had a 1.85 % decrease in FVC/year against 1.32 %/year among ambulant patients. In the non-ambulant group, there was a 4.2 % drop/year in the MFM32-D2 domain (p<0.00001), a 2.6 % drop/year in the D3 domain (p<0.0001), and a 2.7 % drop/year in the MFM32 global assessment (p<0.0001). However, the non-ambulant group's evaluation of upper limb function through the RULM scale did not show a statistically significant reduction. In the non-ambulant group, elbow and knee retractions worsened 3.22 degrees/year (p=0.00087) and 1.92 degrees/year, respectively. While in those patients who acquired gait, elbow and knee retractions worsened 2.45 degrees/year (p=0.0003) and 1.73 degrees/year (p=0.01), respectively. ConclusionThis study confirmed the progressive nature of LAMA2-RD, both in ambulant and non-ambulant patients. MFM32, FVC, and goniometry were identified as promising outcome measures for natural history studies and clinical trials in LAMA2-RD.

Correlations between bulk tank milk analysis with weather conditions in dairy farms under tropical environments

The consequences of climate change on agriculture have generated concern among researchers and decision-makers, especially regarding the effects it will have on this sector. The phenomenon is expected to affect the productivity of livestock systems, even more so in grazing livestock, where cattle and pastures are directly impacted by climatic variables. This study evaluated the climatic influence on bulk tank milk production and quality in 38 tropical dairy farms, using Pearson’s partial correlation and canonical correlation analyses. Farm production level and milk quality traits were merged with meteorological information obtained from climatological stations distributed around the Valle del Cauca department, Colombia. According to farms’ milk production levels, four evaluation groups (EG) were established for the analysis, and within each group, the available information between 2.0 and 8.5 years was included. Pearson’s partial correlations among productive and climatic variables were scarce and low (r <± 0.10) within each EG. On the other hand, canonical correlation analyses between productive and climatic variable sets presented a linear increase since the establishment of EGs from 1 to 4 (r ranging from 0.39 to 0.59). The magnitude of canonical correlation coefficients depended on bulk tank dairy farm production levels, being the most productive systems the most susceptible, especially for meteorological variables related to temperature and relative humidity. As a consequence, dairy farms with higher performances must define mitigation strategies to reduce the weather effects. Multivariate correlations are recommended to evaluate the relationship between milk production, composition, and environmental variables in grazing dairy systems of tropical areas. Highlights Livestock farming in the tropics are more vulnerable to climate change. Heat stress has an impact on the productivity of dairy cows. Dairy production systems not intensive under grazing conditions and adapted breeds of ecology zones are not affected by adverse meteorological conditions.

Collaborative clinical simulation in cardiologic emergency scenarios for medical students. An exploratory study on model applicability and assessment instruments.

Aims: This paper evaluates the feasibility of piloting the collaborative clinical simulation (CCS) model and its assessment instruments applicability for measuring interpersonal, collaborative, and clinical competencies in cardiologic emergency scenarios for medical students. The CCS model is a structured learning model for the acquisition and assessment of clinical competencies through small groups working collaboratively to design and perform in simulated environments supported by technology.Methods: Fifty-five students were allocated in five sessions (one weekly session) conducted with the CCS model within the course Cardiovascular Diseases. The applied practice aimed at the diagnosis and treatment of tachyarrhythmias in a simulated emergency department. In addition to the theoretical classes four weeks before the simulation sessions, students were sent a study guide that summarized the Guide to the European Society of Cardiology. For each simulation session, one clinical simulation instructor, one cardiologist teacher, and the principal investigator participated. Students were divided into three groups (3-5 students) for each-session. They designed, performed, role-played, and debriefed three different diagnoses.Three instruments to assess each group's performance were applied: peer assessment used by groups, performance assessment, created and applied by the cardiologist teacher, and individual satisfaction questionnaire for students.Results: The applicability of the CCS model was satisfactory for both students and teachers. The assessment instruments’ internal reliability was good, as was internal consistency with a Cronbach Alpha of 0.7, 0.4, and 0.8 for each section (Interpersonal, Clinical, and Collaborative competencies, respectively). The performance group’s evaluation was 0.8 for the two competencies assessed (Tachyarrhythmia and Electrical Cardioversion) and 0.8 for the satisfaction questionnaire's reliability. Conclusions: The CCS model for teaching emergency tachyarrhythmias to medical students was applicable and well accepted. The internal reliability of the assessment instruments was considered satisfactory by measuring satisfaction and performance in the exploratory study.

NCOG-20. AWAKE SURGERY FOR RIGHT FRONTAL LOBE GLIOMA CAN IMPROVE THE RESECTION RATE AND PRESERVE HIGHER COGNITIVE FUNCTIONS

Abstract OBJECTIVE Awake surgery is the standard treatment to preserve motor and language functions. The aim of this study is to evaluate the awake surgery for the patients with right frontal lobe (RFL) glioma on resection rate and preservation of higher cognitive functions. METHODS Out of the 139 cases that underwent awake surgery at our hospital between 2013 and 2019, 34 cases (mean age: 47.8 years) of RFL glioma were included in this study. The WHO classification was grade II, III, and IV for 15, 13, and 6 cases, respectively. We evaluated visual spatial cognition (VSC), spatial working memory (SWM), and social cognition (SC) before and after the surgery. These relevant areas were mapped intraoperatively. We did not map these areas in the cases in which the task could not be accomplished. Therefore, each function was divided into an intraoperative evaluation group (EG) and a non-evaluation group (NEG), and the resection rate and functional outcomes were compared. RESULTS The removal rate was significantly higher in the EG group for VSC and SC than that in the NEG (p= 0.0078 and 0.0024, respectively). The chronic disability rate of VSC was significantly lower in the EG than that in the NEG (5.6% vs. 31.3%, p= 0.043). None of the patients had postoperative disability of SWM in the EG which is significantly lower than that in the NEG (16.7%, p= 0.049). SC tended to have a lower disability rate (20.0%) in the EG compared to that in the NEG (45.8%). The probability that the posterior deep part of the middle frontal gyrus, which is the relevant area of VSC, was resected higher in the NEG (p= 0.0052). CONCLUSIONS We scientifically verified that the awake surgery for RFL glioma contributes to the improvement of resection rate and the preservation of higher cognitive functions.

Experts discuss cancer care and research in the age of COVID-19: Findings presented at the American Association for Cancer Research's virtual meeting could shift clinicians' thinking about immunotherapy and point to encouraging changes in the way that clinical trials are being conducted during the pandemic.

Experts discuss cancer care and research in the age of COVID-19: Findings presented at the American Association for Cancer Research's virtual meeting could shift clinicians' thinking about immunotherapy and point to encouraging changes in the way that clinical trials are being conducted during the pandemic.

Growing and Nurturing Your Evaluation Business When Your Independent Consultancy Becomes an Employer

AbstractLessons learned from 19 years building an evaluation consulting business can inform other business owners. The Improve Group has grown from a one‐woman consultancy to an employer of more than thirty people. Staying grounded in a mission and a clear set of values is a guiding principle that has guided and informed growth. Sharing power with staff—to operate democratically while also leveraging their great ideas—has also strengthened The Improve Group's evaluation practice and operations as an organization. Balancing short‐ and long‐term opportunities has helped the organization stay nimble and situate itself well for the future. Reflections on major organizational changes—including a team restructure and the addition of a more inclusive approach to evaluation—show the application of these guiding principles. Additional personal reflections on leadership shed light on what founder and CEO Leah Goldstein Moses has learned about her leadership style over nearly 20 years at the helm of The Improve Group.

Supply chain coordination under interruption based on supplier group evaluation

Supply chain disruption may bring huge blows to supply chain members. With the expansion of the enterprise scale, the original single supplier model has gradually become a supplier group model, and retailer's evaluation of the supplier group will have an impact on the retailer's decision. The increase in the status of the retailer has led retailers to impose more penalties on disrupted suppliers. Therefore, it is necessary to study the coordination problem of the supply chain when there is a supplier group's evaluation of the retailer and the supplier has the possibility of disruption. On this basis, this paper introduces the revenue sharing + second penalty contract and option contract, and compares the two contracts to provide guidance for contractual choices for supply chain members.

Retailer-led supply chain contract coordination with supplier group evaluation

With the expansion of the enterprise scale, the original single supplier model has gradually evolved into a supplier group model. The evaluation of the retailer by the supplier group will have a certain impact on the retailer's decision. At the same time, as the status of retailers increases, retailers gradually grasp the dominance of the supply chain and use their channel advantages to charge channel cost to suppliers. Therefore, it is necessary to study the coordination problem of the supply chain when there is a supplier group's evaluation of the retailer and the retailer is dominant. This paper establishes the supply chain coordination decision model under the stackelberg game model and finds that the wholesale price contract and the traditional revenue sharing contract cannot achieve the overall optimal supply chain.

Supply chain coordination under interruption based on supplier group evaluation

Supply chain disruption may bring huge blows to supply chain members. With the expansion of the enterprise scale, the original single supplier model has gradually become a supplier group model, and retailer's evaluation of the supplier group will have an impact on the retailer's decision. The increase in the status of the retailer has led retailers to impose more penalties on disrupted suppliers. Therefore, it is necessary to study the coordination problem of the supply chain when there is a supplier group's evaluation of the retailer and the supplier has the possibility of disruption. On this basis, this paper introduces the revenue sharing + second penalty contract and option contract, and compares the two contracts to provide guidance for contractual choices for supply chain members.

Retailer-led supply chain contract coordination with supplier group evaluation

With the expansion of the enterprise scale, the original single supplier model has gradually evolved into a supplier group model. The evaluation of the retailer by the supplier group will have a certain impact on the retailer's decision. At the same time, as the status of retailers increases, retailers gradually grasp the dominance of the supply chain and use their channel advantages to charge channel cost to suppliers. Therefore, it is necessary to study the coordination problem of the supply chain when there is a supplier group's evaluation of the retailer and the retailer is dominant. This paper establishes the supply chain coordination decision model under the stackelberg game model and finds that the wholesale price contract and the traditional revenue sharing contract cannot achieve the overall optimal supply chain.

Application of Presentation-Assimilation-Discussion teaching model in training for nursing students in operation room

Objective To explore the effects of the Presentation-Assimilation-Discussion (PAD) teaching model in training for nursing students in operation room. Methods A total of 34 nursing students who practiced in the Operation Room of Heilongjiang Provincial Hospital from January to June 2016 were selected as the control group, while another 39 nursing students who practiced between July and December 2016 were selected as the observation group by purposive sampling. Nursing students in the control group received conventional teaching, whereas nursing students in the observation group received the PAD teaching model. The theoretical and practical performance was compared between the two groups. The observation group's evaluation of teaching effects was also observed. Results The theoretical and practical performance of the observation group was (93.68±7.35) and (92.78±4.96) post training, both higher than that of the control group (t=-5.371, -4.740; P<0.01) , which was (86.24±4.26) and (87.52±4.45) , respectively. Nursing students in the observation group spoke highly of the PAD teaching model. Conclusions The PAD teaching model can improve the academic performance of nursing students in operation room, which is practical and worth promoting in clinical practice. Key words: Students, nursing; Clinical clerkship; Presentation-Assimication-Discussion

Application and evaluation of micro-lecture-CPT teaching method in pathology teaching

Objective To explore the effect of micro-lecture-CPT teaching method (case, problem and team-based learning, CPT) used in pathology teaching. Methods 236 medical imaging undergraduates from Grade 2015 were selected and divided into two groups equally. The experimental group (118 people) used the micro-lecture-CPT teaching method, and the control group (118 people) used the traditional teaching method. The students in the experimental group used the interactive platform on the internet to share the resource in combination with pathological theory and experiment, including curriculum, microlecture, multimedia courseware, clinical case and the related questions before class.In class, the questions were discussed in groups based on student centered, teacher guide. Questionnaire survey and test scores were used to collect data and analyze the differences between the two groups. SPSS 13.0 was applied to processing the data. Measurement data were expressed as mean plus or minus standard deviation, and t test was used in the comparison between groups. Results The average score of basic theoretical examination in the experimental group was lower than that of the traditional teaching group [(57.86±2.32) vs. (58.23±2.06)]; While the case score and experimental score in the experimental group were significantly higher than those of the traditional teaching group [(11.27±1.24) vs. (7.40±0.90); (18.04±0.87) vs. (14.75±0.93)]. And the differences were statistically significant (P<0.05). Questionnaire survey demonstrated that the experimental group students' evaluation on the learning of micro-lecture-CPT teaching was higher than the control group's evaluation on traditional teaching in the aspects of improving students' learning interest, promoting autonomous learning and problem solving skills, cultivating clinical thinking ability and team cooperation spirit. Conclusion Micro-lecture-CPT teaching method conforms to the trend of modern teaching reform and achieves good effect in pathology teaching, so it is worth recommending and popularizing. Key words: Micro-lecture-CPT teaching method; Pathology; Teaching reform; Evaluation

Application of WeChat public platform in pathological experiment teaching

Objective To explore the advantages and characteristics of pathology experimental teaching based on WeChat public platform. Method Through the establishment of homogeneous pathol-ogy experiment — WeChat public platform, the students of clinical medicine major of Class 1 and 2 of Grade 2014 who participated in the pathological experiment course were divided into two groups. The experimental group (65 people) used the auxiliary teaching based on the WeChat public platform, and the control group (65 people) used the traditional teaching method. The students in the experimental group used the WeChat public platform in combination with pathology experimental teaching, pushing the experimental teaching by WeChat public platform, including the change of specimen and eye diseases under the micro-scope of typical pictures and videos, and at the same time pushing the typical disease image and the related text introduction, and auxiliary pathology experimental teaching. The effect of teaching was evaluated by student experimental examination and electronic questionnaire. The data were collated after the entry of SPSS 19.0, and the data comparison was performed by t test. Result The average score of the experimental group (14.80±0.24) was significantly higher than that of the traditional teaching group (13.79±0.33), and the difference was statistically significant (P=0.031). The experimental group students' evaluation on the learning of WeChat based public platform was higher than the control group's evaluation on traditional teaching in the aspects of learning interest, reducing learning pressure and feedback. Conclusion The application of WeChat public platform for the teaching of pathological experiments is feasible compared with the traditional teaching model and can improve the teaching effect effectively, and solve the problems of the pathology experiment teaching sample being insufficient or the teaching sample being not typical, which creates conditions for students to study independently and use specimens and pictures. Key words: Pathology; Experimental teaching; WeChat public platform; Auxiliary teaching

International and multidisciplinary expert recommendations for the use of biologics in systemic lupus erythematosus.

Despite conventional immunosuppressants, active and steroid-dependent systemic lupus erythematosus (SLE) represents a therapeutic challenge. Only one biologic, belimumab, has been approved, but other biologics are sometimes used off-label. Given the lack of evidence-based data in some clinical situations encountered in real life, we developed expert recommendations for the use of biologics for SLE. The recommendations were developed by a formal consensus method. This method aims to formalize the degree of agreement among experts by identifying, through iterative ratings with feedback, the points on which experts agree, disagree or are undecided. Hence, the recommendations are based on the agreed-upon points. We gathered the opinion of 59 French-speaking SLE experts from 3 clinical networks dedicated to systemic autoimmune diseases (FLEUR, IMIDIATE, FAI2R) from Algeria, Belgium, France, Italy, Morocco, Switzerland and Tunisia. Represented medical specialities were internal medicine (49%), rheumatology (34%), nephrology (7%), dermatology (5%), pediatrics (3%) and cardiology (2%). Two methodologists and 3 strictly independent SLE expert groups contributed to developing these recommendations: a steering group (SG) (n=9), an evaluation group (EG) (n=28) and a reading group (RG) (n=22). Preliminary recommendations were drafted by the SG, then proposed to the EG. Each EG member rated the degree of agreement from 1 to 9 (1: lowest; 9: strongest) for each recommendation. After 2 rating rounds, the SG submitted a new version of the recommendations to the RG. With comments from the RG, the SG finalised the recommendations. A total of 17 final recommendations were formulated by the SG, considering all agreement scores and comments by the EG and RG members and the two methodologists. These recommendations define the subset of patients who require a biologic; the type of biologics to use (belimumab, rituximab, etc.) depending on the organ involvement and associated co-treatments; what information should be given to patients; and how to evaluate treatment efficacy and when to consider discontinuation. Overall, 17 recommendations for the good use of biologics in SLE were formulated by a large panel of SLE experts to provide guidance for clinicians in daily practice. These recommendations will be regularly updated according to the results of new randomized trials and increasing real life experience.

Challenging gender stereotypes: Theory of mind and peer group dynamics.

To investigate the social cognitive skills related to challenging gender stereotypes, children (N = 61, 3-6 years) evaluated a peer who challenged gender stereotypic norms held by the peer's group. Participants with false belief theory of mind (FB ToM) competence were more likely than participants who did not have FB ToM to expect a peer to challenge the group's stereotypes and propose that the group engage in a non-stereotypic activity. Further, participants with FB ToM rated challenging the peer group more positively. Participants without FB ToM did not differentiate between their own and the group's evaluation of challenges to the group's stereotypic norms, but those with ToM competence asserted that they would be more supportive of challenging the group norm than would the peer group. Results reveal the importance of social-cognitive competencies for recognizing the legitimacy of challenging stereotypes, and for understanding one's own and other group perspectives.

Successes We May Not Have Had: A Retrospective Analysis of Selected Weed Biological Control Agents in the United States

AbstractIn this paper, we describe five successful classical biological weed control agents released in the United States. For each of the five arthropod species, we compared data from prerelease studies that experimentally predicted the agent's host range with data collected postrelease. In general, experimental host range data accurately predicted or overestimated risks to nontarget plants. We compare the five cases with insects recently denied for introduction in the United States and conclude that none of the discussed agents would likely be approved if they were petitioned today. Three agents would be rejected because they potentially could attack economic plants, and two because of potential attack on threatened or endangered plants. All five biocontrol agents have contributed significantly to the successful management of major weeds with no or minimal environmental risk. We believe that the United States may miss opportunities for sustainable and environmentally benign management of weeds using biological control if the regulatory framework only considers the risks of agents as potential plant pests and treats any host-range data regarding economic or threatened and endangered species as a binary decision (i.e., mandates rejection if there is any chance of feeding or development). As a way forward we propose the following: (1) the addition of risk and benefit analyses at the habitat level with a clear ranking of decision-making criteria as part of the U.S. Department of Agriculture Animal and Plant Health Inspection Service Technical Advisory Group's evaluation process of biocontrol agents; (2) recognition of the primacy of realized host range data for potential agents that considers the insect's host selection behavior instead of emphasizing fundamental host range data during release evaluations, and (3) development of formalized postrelease monitoring of target and nontarget species as part of the release permit. These recommendations may initially be advanced through reassessment of current policies but may in the longer term require the implementation of dedicated biocontrol legislation.

Stroke and Heart Disease Prevention Education via Telenovela: A Focus Group's Evaluation

To evaluate a telenovela, "La Familia Nutritiva y Balanceada," for cultural context and its efficacy as an educational tool to promote positive health behaviors in Latino families. Ethnography was employed to interpret cultural health behaviors of 12 Latinas through a focus group after viewing the telenovela, a culturally accepted form of entertainment education. Analysis of the transcribed interview revealed three recurrent themes: Not all fat is bad; add fruits and vegetables daily to diet; and children need to be involved. The group purported that the inclusion of children in the marketing and preparation of the food would translate into better food habits. Participants demonstrated basic knowledge between food and health, and acknowledged that they gained an appreciation for good fat in the diet. The group related the telenovela would be a good tool for clinics, health fairs, and schools. Latinos are at high risk for cardiovascular disease and stroke. Health education messages need to incorporate cultural norms into an intervention that supports a behavior change, such as improved nutrition. Studies support that Latinos connect to media, such as telenovela and interpersonal communication, which make these appropriate choices for health education tools.

A serious bleeding complication with injury of the corona mortis with the TVT-Secur procedure: two cases of contact of TVT-S with the corona mortis during cadaver study

Dear Editor,Recently, Larsson et al. [1] reported a case bleeding fromcorona mortis during tension-free vaginal tape (TVT)-Securprocedure. As is stated in their article, the tape at the leftside was correctly placed at the second attempt. After thesurgery, early laparotomy was performed due to suspicionof haemorrhage—which was confirmed, and the bleedingcorona mortis was ligated.Our team performed several cadaver studies in order todescribe possible complications that might occur duringnew methods for treatment of stress urinary incontinence.One of the methods evaluated is TVT-S in the U position.We have witnessed and well documented two cases of verynear proximity (could be described as almost direct contact)of the TVT-S inserter and the vessels communicatingbetween obturator vessels and external iliac or deepepigastric vessels.The first contact we witnessed in the group forevaluation of TVT-S in the U position that consists of 19formalin-embalmed bodies. Due to the rigidity of theformalin-embalmed bodies, the legs needed to be placedin 30° flexion in the hip joint and in 30° abduction in thehip joint. For that reason, we have also included a group offresh frozen bodies, where the legs were positioned asrecommended in standard procedure. In this group of sixbodies, we have witnessed also one contact with the coronamortis after placing TVT-S in the U position.As can be seen on the attached pictures, the near contactwith the corona mortis is well shown and it would be amatter of fortune if those vessels will start bleeding aftertouching them with a scalpel-shaped inserter.We assume that the injury of the corona mortis describedby Larsson and colleagues [1] happened during the firstattempt to place the TVT-S and it seems to us that the firstattempt was made more upwards similar to the TVT-S inthe U position.For the first time, we thought that the direct contact withthe corona mortis does not have to lead towards injury ofthe aforementioned corona mortis and that the correlationwith the cadaver study to the live surgery might be difficult;still, the description of the injury witnessed by Larsson ismore than clear proof that cadaver study might showpossible complications occurring during a normal urogyne-cological surgery.

Evaluating categorisation and clinical relevance of drug-related problems in medication reviews

We aimed to evaluate the categorisation and clinical relevance of DRPs identified by community pharmacists, and further, to assess the quality of interventions with the patients and the physicians as documented by the pharmacists. 23 Norwegian community pharmacies. Patients with type 2 diabetes were recruited by 24 community pharmacists who performed structured medication reviews based on the patients' drug profiles and patient interviews. The DRPs identified were subsequently categorised. An evaluation group (EG) retrospectively evaluated the reviews. Clinical/practical relevance of each DRP and quality of community pharmacists' intervention with patients and physician were scored. Average agreement between the EG and the community pharmacists was calculated. Internal agreement in the EG was calculated using a modified version of Fleiss' Kappa coefficient. A total of 73 patients were included (mean age 62 years, 52% female, on average prescribed 8.7 drugs). The pharmacists identified 88 DRPs in 43 of the patients. The most common DRPs were adverse drug reactions (22%) and wrong drug or dose used by patient (14%). Anti-diabetic drugs and lipid modifying drugs were associated with the most DRPs. The EG agreed with detection and categorisation of DRPs in more than 80% of the cases. The clinical/practical relevance of the detected DRPs was scored by the EG to be high or medium in 87% of the cases. The quality of the follow-up with patients and physicians was scored to be good or satisfactory in 93 and 98% of the cases, respectively. Pre-defined categories of DRPs supported by structured forms were reliable and valid tools for identifying DRPs. The evaluation demonstrated that community pharmacists were able to identify DRPs of high to medium clinical/practical relevance, and to perform follow-ups of the DRPs with the patients and the physicians with a good or satisfactory quality.

Exit Polls: Refugee Assessments of North Korea's Transition

Results from a survey of more than 1,300 North Korean refugees in China provide insight into changing economic conditions in North Korea. There is modest evidence of slightly more positive assessments among those who exited the country following the initiation of reforms in 2002. Education breeds skepticism; higher levels of education were associated with more negative perceptions of economic conditions and reform efforts. Other demographic markers such as gender or provincial origin are not robustly correlated with attitudes. Instead, personal experiences appear to be central: A significant number of the respondents were unaware of the humanitarian aid program and the ones who knew of it almost universally did not believe that they were beneficiaries. This group's evaluation of the regime, its intentions, and accomplishments is overwhelmingly negative - even more so than those of respondents who report having had experienced incarceration in political detention facilities - and attests to the powerful role that the famine experience continues to play in the political economy of the country.