Independent Monitoring Research Articles

Remarkable records of jaguars and Andean bears in northwestern Ecuador: Implications for human-wildlife conflicts

Jaguar populations (Panthera onca) on the Ecuadorian coast are critically endangered, with only a few dozen individuals remaining in the region. In some areas, no records have been documented for decades. Between November 2023 and January 2024, independent camera trap monitoring in northwestern Ecuador yielded evidence of the presence of a jaguar, marking a significant recovery after seven years of absence in Manduriacu and at least 15 years in Junín. The jaguar was observed moving through an area of approximately 25 km, traversing forested and human-altered zones. Furthermore, additional evidence from the Ecominga Foundation and the Cielo Verde community indicated the occurrence of livestock attacks, which aligns with the typical predatory patterns observed in jaguar behavior. The attack site was located approximately 8 km from where the jaguar was initially recorded, suggesting that both events refer to the same individual. In response, local authorities inspected the area and organized community workshops. Furthermore, an Andean bear was recorded in Manduriacu during the same sampling period, confirming the co-occurrence of both species in the area. The documented movement of this jaguar, along with the presence of other species, underscores the imperative need to continue research and conservation initiatives in the region. These initiatives will ensure the protection and coexistence of wildlife and human populations in this highly biodiverse region.

Developing a peripheral blood RNA-seq based NETseq ensemble classifier: A potential novel tool for non-invasive detection and treatment response assessment in neuroendocrine tumor patients receiving 177Lu-DOTATATE PRRT.

Neuroendocrine tumors (NETs) are presented with metastases due to delayed diagnosis. We aimed to identify NET-related biomarkers from peripheral blood. The development and validation of a multi-gene NETseq ensemble classifier using peripheral blood RNA-Seq is reported. RNA-Seq was performed on peripheral blood samples from 178 NET patients and 73 healthy donors. Distinguishing gene features were identified from a learning cohort (59 PRRT-naïve GEP-NET patients and 38 healthy donors). Ensemble classifier combining the output of five machine learning algorithms viz. Random Forest (RF), Extreme Gradient Boosting (XGBOOST), Gradient Boosting Machine (GBM), Support Vector Machine (SVM), and Logistic Regression (LR) were trained and independently validated in the evaluation cohort (n = 106). The response to PRRT was evaluated in the PRRT cohort (n = 46) and the PRRT response monitoring cohort (n = 16). The response to 177Lu-DOTATATE PRRT was assessed using RECIST 1.1 criteria. The Ensemble classifier trained on 61 gene features, distinguished NET from healthy samples with 100% accuracy in the learning cohort. In an evaluation cohort, the classifier achieved 93% sensitivity (95% CI: 87.8%-98.03%) and 91.4% specificity (95% CI: 82.1%-100%) for PRRT-naïve GEP-NETs (AUROC = 95.4%). The classifier returned >87.5% sensitivity across different tumor characteristics and outperformed serum Chromogranin A sensitivity (χ2 = 21.89, p = 4.161e-6). In the PRRT cohort, RECIST 1.1 responders showed significantly lower NETseq prediction scores after 177Lu-DOTATATE PRRT, in comparison to the non-responders. In an independent response monitoring cohort, paired samples (before PRRT and after 2nd or 3rd cycle of PRRT) were analyzed. The NETseq prediction score significantly decreased in partial responders (p = .002) and marginally reduced in stable disease (p = .068). The NETseq ensemble classifier identified PRRT-naïve GEP-NETs with high accuracy (≥92%) and demonstrated a potential role in early treatment response monitoring in the PRRT setting. This blood-based, non-invasive, multi-analyte molecular method could be developed as a valuable adjunct to conventional methods in the detection and treatment response assessment in NET patients.

Rationale and Design of the DEFIANCE Study: A Randomized Controlled Trial of Mechanical Thrombectomy Versus Anticoagulation Alone for Iliofemoral Deep Vein Thrombosis

BackgroundDeep vein thrombosis (DVT) is a common medical condition that is associated with clinically significant sequelae, including postthrombotic syndrome (PTS). Anticoagulation alone remains the guideline-recommended treatment for many patients with iliofemoral DVT. Recent technological advances have led to an increase in the use of mechanical thrombectomy for DVT, but mechanical thrombectomy-based procedures have not yet been compared with standard-of-care anticoagulation therapy in randomized studies. MethodsThe DEFIANCE study (ClinicalTrials.gov: NCT05701917) is an international and actively enrolling randomized controlled trial (RCT) in lower extremity DVT assessing an interventional strategy that includes mechanical thrombectomy with the ClotTriever System (Inari Medical, Irvine, CA) versus anticoagulation alone. Approximately 300 patients with unilateral iliofemoral DVT and symptom duration ≤12 weeks will be randomized 1:1. Study conduct includes an independent core laboratory for duplex ultrasound assessment, an independent medical monitor for safety adjudication, and evaluation of PTS severity on the Villalta scale using best clinical practices. The primary endpoint is a composite outcome structured as a hierarchal win ratio of 1) the occurrence of treatment failure or therapy escalation as adjudicated by the medical monitor, with failure defined as amputation or gangrene of the target leg or venous thromboembolism-related mortality, and 2) the assessment of PTS severity at the 6-month follow-up visit. In addition to being a component of the primary endpoint, the severity of PTS at 6 months is also evaluated as a stand-alone secondary endpoint. An additional secondary endpoint is a composite of outcomes at the 10-day visit and is structured as a hierarchal win ratio of 1) vessel compressibility on duplex ultrasound, 2) patient-reported pain, and 3) improvement of edema. The safety endpoints are access site complications requiring endovascular or surgical repair and the occurrence through the 30-day visit of mortality, major bleeding, or new symptomatic pulmonary embolism. ConclusionsDEFIANCE will be the first RCT to evaluate a mechanical thrombectomy-based interventional approach versus anticoagulation therapy alone for DVT. The results will inform the treatment of patients with iliofemoral DVT and the prevention of PTS-associated morbidity. Trial RegistrationDEFIANCE: RCT of ClotTriever System Versus Anticoagulation In Deep Vein Thrombosis (DEFIANCE), ClinicalTrials.gov: NCT05701917, URL: https://clinicaltrials.gov/study/NCT05701917?cond=Deep%20Vein%20Thrombosis&term=defiance&rank=1

Comorbid mental illness and intellectual disability: impact on employment

Objectives In the general population, studies have revealed that mental health concerns negatively impact employment. Research has also begun to reveal similar negative employment outcomes among individuals with an intellectual disability and co-occurring mental health disorder. This study sought to expand upon these findings and examine whether specific diagnoses relate to inclusive employment. Methods We conducted Chi-square tests to examine if reported diagnoses and challenging behaviors related to paid community employment among 378 individuals with an intellectual disability in Pennsylvania who participated in the Independent Monitoring for Quality program. We selected participants from a statewide database compiled via stratified random sampling and structured interview. Results We found statistically significant differences in community-based employment rates between those with and without a mood disorder (χ 2 (2) = 6.07; p = 0.01) and behavior challenges (χ 2 (2) = 5.04; p = 0.03). Anxiety disorders approached statistical significance (χ 2 (2) = 3.73; p = 0.05). Conclusions The significant relationships between employment and mental health is consistent with studies in the general population. We discuss diagnostic challenges and limitations of this study, proposing future research explore a transdiagnostic approach to targeting mental health concerns for those with an intellectual disability.

Spatiotemporal distribution of organochlorine pesticides in the upper La Antigua watershed, Veracruz Mexico

Even though the use of organochlorine pesticides has been prohibited since the last century their presence is still being recorded around the world. In the upper La Antigua watershed, Veracruz, Mexico we have reported concentrations of these contaminants in different compartments of the riverine ecosystems. This is of relevance due to their potential disruptive endocrine effect on the vertebrates drinking the water or feeding in the riverine area. In this study we evaluated concentrations of organochlorine pesticides (OCPs) in streams running throughout mountain cloud forest and two different types of land use, pasture lands and coffee plantations. Water and periphyton samples were collected during the wet and the dry seasons from streams located in independent micro-basins. Spatial explicit analyzes show that the concentrations measured are independent of the distribution of the streams in the geographical area sampled. However seasonal differences were found during the dry season in the water and during the rainy season in periphyton. While OCPs in water support the idea that micro-basins can be used as independent monitoring units, OCPs in periphyton can be indicators of the effect of different land use. Some concentrations of all the OCPs registered had values above the limits for tap water.

Redefining Hospital Accessibility: A Service Design Framework for Inclusive Healthcare

Abstract In the framework of becoming a carbon neutral city by 2030, Bologna faces challenges related to enhancing the quality and accessibility of its built environment to improve the quality of life and well-being of its residents. The IRCCS Azienda Ospedaliero-Universitaria Sant’Orsola Polyclinic is a key agent of change within this initiative. The hospital has initiated a comprehensive renovation project aligned with its commitment to the United Nations Sustainable Development Goals (SDGs), particularly SDG 3, which addresses Good Health and Well-being, and SDG 10, which addresses Reduce Inequalities. To address these goals, the hospital has engaged a research team from the University of Bologna to apply Service Design methodologies. The research aims to reshape accessibility and user experience systematically and sustainably, adhering to the principles of Design for All. The study maps diverse user groups, analyses circulation paths, and identifies physical and procedural barriers affecting vulnerable individuals, especially those with disabilities. The research introduces a novel approach by developing a comprehensive strategy rather than isolated solutions, focusing on interconnected accessibility services across pavilions. Dedicated hubs within each pavilion facilitate resource and support device exchange, improving users’ experiences. A pilot project, initially targeting wheelchair accessibility hubs, employs innovative technologies to enhance independent tool usage and monitor distribution and maintenance efficiently. The project is now entering a testing phase, during which the solution will be refined based on user feedback.

Evaluating progress and accountability for achieving COP26 Health Programme international ambitions for sustainable, low-carbon, resilient health-care systems.

A global initiative to develop low-carbon, resilient health systems-the COP26 Health Programme-launched at the UN Framework Convention on Climate Change 26th Conference of the Parties (COP26) in 2021. As of May, 2024, 83 nations have committed to participate in this initiative. This analysis evaluates the effectiveness of existing and proposed indicators towards public monitoring and accountability to these commitments. Our findings reveal substantial gaps in data availability and indicator relevance, with many countries reporting process indicators that do not reflect actual progress towards achieving sustainable health-care systems. We found a dearth of suitable indicators and an urgent need to develop robust ones that are adaptable to different health-care system contexts. These indicators should be designed to capture tangible outcomes, support policy making, and prevent greenwashing. Integration of more robust indicators into independent scientific monitoring can support systematic inclusion of health care in global climate strategies, thereby enhancing the overall effectiveness of the COP26 Health Programme.

Towards enhancing animal welfare standards in UK media: Part 1; insights from public opinion and attitudes

Abstract Animals are frequently used in the UK for film, television, and advertising, but numerous stakeholders, including charities and industry representatives, have significant concerns regarding their on- and off-set welfare. However, it is unclear to what extent the public can identify animal welfare issues on screen or whether they know where to report any incidents. This survey sought to answer three research questions: (1) What are the levels of awareness and concern around animals used in TV, film, and advertising among the general public? (2) Do people know where or how to report any concerns? (3) What would reassure people that animal welfare is safeguarded? We have analysed and presented the results from the 911 responses to paint a more detailed picture of where the public is on this issue and what mechanisms for improvement they would support. Overall, the results show a clear concern for the welfare of animals used in the media, especially once they had read the eight realistic scenarios of animal use in the survey. Yet the public feel disempowered to report these concerns and lack trust that positive change will result. There is clearly public appetite for better protection of animals used in the media, particularly stronger regulations, independent on-set monitoring of animals, qualified animal trainers, and an accreditation scheme.

In-season monitoring of harvest and effort from a large-scale subsistence salmon fishery in western Alaska

In-season management of salmon harvest requires real-time data. Specifically, following a brief period of open fishing, knowledge of harvest outcomes is useful when deciding the nature of subsequent fishing periods. This in-season management strategy is relatively new to the lower Kuskokwim River of western Alaska, where depressed salmon runs have caused restrictions to the subsistence fishery. We have developed an in-season monitoring program to rapidly inform managers about fishery outcomes from short-duration (6-24 hours) fishery openings. Completed trip information and one or more aerial surveys are combined to estimate daily effort and harvest from drift gillnet fishers spanning 11 communities and ~130 river kilometers. We present a re-analysis of the 40 monitored openers in June-July 2016-2023, and validate harvest estimates of Chinook, chum, and sockeye salmon by comparing them to post-season estimates derived from an independent long-term monitoring program. Our results indicate that the program has produced estimates of sufficient quality to inform in-season managers, although it will likely need alterations to be successful in years with less restricted fishing.

Analytical study for the assessment by Independent Monitoring Unit (IMU) for monitoring teaching effectiveness and physical facilities in Secondary Schools of Khyber Pakhtunkhwa

Analytical study for the assessment by Independent Monitoring Unit (IMU) for monitoring teaching effectiveness and physical facilities in Secondary Schools of Khyber Pakhtunkhwa

Komite Audit, Kualitas Audit dan Audit Tenure dalam Meningkatkan Kekuatan Integritas Laporan Keuangan: Studi Empiris pada Perusahaan BUMN Tahun 2021-2023

This research focuses on state-owned companies in 2021-2023 to evaluate the role of the audit committee, audit quality, and auditor tenure to improve the integrity of financial reports. The integrity of financial reports is a crucial aspect in business and finance because reliable and accurate reports are the basis for stakeholders in making economic decisions. This study was motivated by several cases in state-owned companies, such as PT Garuda Indonesia and PT Asuransi Jiwasraya, which showed dishonesty in financial reporting. This analysis is aimed at assessing the professionalism of the audit committee and the independent monitoring system on the performance taken for this research is secondary. With analysis tools using SPSS version 25. management to produce quality audits. Data a The research methodology involves analyzing data from 36 samples of state-owned companies using classic assumption tests, such as normality tests, multicollinearity tests, autocorrelation tests, and heteroscedasticity tests. The results of the analysis state that the audit committee variable, audit quality has a significant impact on the integrity of financial reports and audit tenure has no significant effect on the integrity of financial reports. The contribution of this analysis is the importance of the audit committee's role in improving the integrity of financial reports as reflected in effectiveness in a transparent and accountable manner, the selection of auditors who have a reputation and high competence ensures reliable financial reports, provides insight into the impact of long-term relationships between auditors and clients on the integrity of financial reports.

Comparative analysis of school food policies in Australian jurisdictions: Insights for more effective policy action.

School food policies in Australia have the potential to positively impact healthy eating in schools. While the policies are reviewed regularly, it is unknown if revised school food policies have incorporated the recommendations from a 2020 review of nutrition policies in publicly funded institutions. This review aims to examine the current state of Australian school food policy environment, including national-level guidelines, food safety, allergy, and anaphylaxis management policies. School food policy documents were identified by searching the federal government, and Departments of Health and Education websites of Australian jurisdictions. The L'Abbé framework for monitoring and evaluation of nutrition policies guided the data analysis. Eleven policies/guidelines from Australian national and state/territory governments were reviewed in 2023. Four state/territory policies had major updates since 2020. The consistency of nutrition standards improved across five jurisdictions, although a common nutrient classification system would have allowed better comparison. Implementation guides/tools and supporting resources were provided in all policies although their comprehensiveness varied. Policy monitoring and evaluation guide/tools, and local food procurement were incorporated in two additional policies. School principals were responsible for policy implementation and schools for independent compliance monitoring. Continued improvement in monitoring and evaluation plans, policy review timelines, and support systems for schools is needed to enhance implementation and impact of school food policies. External stakeholder support may help school leadership in more effective policy implementation. SO WHAT?: Limited progress in incorporating recommendations into current school food policies calls for additional support and strategies to enhance policy implementation and monitoring.

High-dose hyperfractionated simultaneous integrated boost radiotherapy versus standard-dose radiotherapy for limited-stage small-cell lung cancer in China: a multicentre, open-label, randomised, phase 3 trial

For the past 20 years, twice-daily thoracic radiotherapy with concurrent chemotherapy has been the treatment of choice for limited-stage small-cell lung cancer (LS-SCLC), which has a poor prognosis. We aimed to assess the efficacy and safety of high-dose, accelerated, hyperfractionated, twice-daily thoracic radiotherapy (54 Gy in 30 fractions) versus standard-dose radiotherapy (45 Gy in 30 fractions) as a first-line treatment for LS-SCLC. This open-label, randomised, phase 3 trial was performed at 16 public hospitals in China. The key inclusion criteria were patients aged 18-70 years, with histologically or cytologically confirmed LS-SCLC, who had an Eastern Cooperative Oncology Group (ECOG) performance status of 0-1, and who were previously untreated or had received one course of cisplatin or carboplatin and etoposide. Eligible patients were randomly assigned (1:1) to receive volumetric-modulated arc radiotherapy (VMAT) of 45 Gy in 30 fractions to the gross tumour volume or VMAT with a simultaneous integrated boost of 54 Gy in 30 fractions to the gross tumour volume starting 0-42 days after the first chemotherapy course. Both groups received 10 fractions of twice-daily thoracic radiotherapy per week. The planning target volume was 45 Gy in 30 fractions in both groups. Patients with responsive disease received prophylactic cranial radiotherapy (25 Gy in 10 fractions). Randomisation was performed using a centralised interactive web response system, stratified by ECOG performance status, disease stage, previous chemotherapy course, and chemotherapy choice. The primary outcome was overall survival in the intention-to-treat population. Safety was analysed in the as-treated population. This study was registered at ClinicalTrials.gov, NCT03214003. From June 30, 2017, to April 6, 2021, 224 patients (102 [46%] females and 122 [54%] males; median age 64 years [IQR 58-68]) were enrolled and randomly assigned to the 54 Gy group (n=108) or 45 Gy (n=116) group. The median follow-up was 46 months (IQR 33-56). The median overall survival was significantly longer in the 54 Gy group (60·7 months [95% CI 49·2-62·0]) than in the 45 Gy group (39·5 months [27·5-51·4]; hazard ratio 0·55 [95% CI 0·37-0·72]; p=0·003). Treatment was tolerable, and the chemotherapy-related and radiotherapy-related toxicities were similar between the groups. The grade 3-4 radiotherapy toxicities were oesophagitis (14 [13%] of 108 patients in the 54 Gy group vs 14 [12%] of 116 patients in the 45 Gy group; p=0·84) and pneumonitis (five [5%] of 108 patients vs seven [6%] of 116 patients; p=0·663). Only one treatment-related death occurred in the 54 Gy group (myocardial infarction). The study was prematurely terminated by an independent data safety monitoring board on April 30, 2021, based on evidence of sufficient clinical benefit. Compared with standard-dose thoracic radiotherapy (45 Gy), high-dose radiotherapy (54 Gy) improved overall survival without increasing toxicity in a cohort of patients aged 18-70 years with LS-SCLC. Our results support the use of twice-daily accelerated thoracic radiotherapy (54 Gy) with concurrent chemotherapy as an alternative first-line LS-SCLC treatment option. Chinese Society of Clinical Oncology-Linghang Cancer Research, the Wu Jieping Medical Foundation, and Clinical Research Fund For Distinguished Young Scholars of Peking University Cancer Hospital and Beijing Municipal Administration of Hospitals Incubating Program.

Human Rights in the Context of Global Migration

Purpose: The general objective of the study was to explore human rights in the context of global migration. Methodology: The study adopted a desktop research methodology. Desk research refers to secondary data or that which can be collected without fieldwork. Desk research is basically involved in collecting data from existing resources hence it is often considered a low cost technique as compared to field research, as the main cost is involved in executive’s time, telephone charges and directories. Thus, the study relied on already published studies, reports and statistics. This secondary data was easily accessed through the online journals and library. Findings: The findings reveal that there exists a contextual and methodological gap relating to human rights in the context of global migration. Preliminary empirical review revealed that global migration is deeply intertwined with significant human rights issues that vary across different regions and migrant populations. Migrants, regardless of their reasons for moving or legal status, frequently faced exploitation, discrimination, inadequate access to essential services, and social exclusion. The study emphasized that these human rights violations were often systemic and influenced by broader socio-political and economic structures. It highlighted the pervasive nature of rights violations at multiple stages of the migration process and pointed out substantial gaps in the implementation and enforcement of international frameworks designed to protect migrants. Specific groups, such as women, children, and undocumented migrants, were identified as particularly vulnerable, necessitating tailored interventions. The study argued that protecting migrants' human rights was both a moral and pragmatic necessity for fostering inclusive societies and called for a renewed commitment from all stakeholders to work collaboratively towards this goal. Unique Contribution to Theory, Practice and Policy: The Human Rights Theory, Push- Pull Theory of Migration and Social Capital Theory may be used to anchor future studies on global migration. The study recommended further development of migration and human rights theories to account for the complexities of contemporary migration flows, suggesting interdisciplinary approaches to enhance theoretical frameworks. Practically, it underscored the need for targeted support services for vulnerable migrant groups, the creation of safe migration pathways, and the establishment of specialized services addressing their unique needs. Policy recommendations included the adoption of comprehensive national and international policies that uphold the rights of all migrants, the enforcement of anti-discrimination laws, and the establishment of independent monitoring bodies. The study advocated for enhanced international cooperation to address migration challenges and suggested investing in data collection and research for informed policy-making. It also recommended promoting public awareness and education campaigns to foster inclusive attitudes towards migrants and counteract negative stereotypes, aiming to create a more just and humane global migration system.

Effect of high versus standard protein provision on functional recovery in people with critical illness (PRECISe): an investigator-initiated, double-blinded, multicentre, parallel-group, randomised controlled trial in Belgium and the Netherlands

Increased protein provision might ameliorate muscle wasting and improve long-term outcomes in critically ill patients. The aim of the PRECISe trial was to assess whether higher enteral protein provision (ie, 2·0 g/kg per day) would improve health-related quality of life and functional outcomes in critically ill patients who were mechanically ventilated compared with standard enteral protein provision (ie, 1·3 g/kg per day). The PRECISe trial was an investigator-initiated, double-blinded, multicentre, parallel-group, randomised controlled trial in five Dutch hospitals and five Belgian hospitals. Inclusion criteria were initiation of invasive mechanical ventilation within 24 h of intensive care unit (ICU) admission and an expected duration of invasive ventilation of 3 days or longer. Exclusion criteria were contraindications for enteral nutrition, moribund condition, BMI less than 18 kg/m2, kidney failure with a no dialysis code, or hepatic encephalopathy. Patients were randomly assigned to one of four randomisation labels, corresponding with two study groups (ie, standard or high protein; two labels per group) in a 1:1:1:1 ratio through an interactive web-response system. Randomisation was done via random permuted-block randomisation in varying block sizes of eight and 12, stratified by centre. Participants, care providers, investigators, outcome assessors, data analysts, and the independent data safety monitoring board were all blinded to group allocation. Patients received isocaloric enteral feeds that contained 1·3 kcal/mL and 0·06 g of protein/mL (ie, standard protein) or 1·3 kcal/mL and 0·10 g of protein/mL (ie, high protein). The study-nutrition intervention was limited to the time period during the patient's ICU stay in which they required enteral feeding, with a maximum of 90 days. The primary outcome was EuroQoL 5-Dimension 5-level (EQ-5D-5L) health utility score at 30 days, 90 days, and 180 days after randomisation, adjusted for baseline EQ-5D-5L health utility score. This trial was registered with ClinicalTrials.gov (NCT04633421) and is closed to new participants. Between Nov 19, 2020, and April 14, 2023, 935 patients were randomly assigned. 335 (35·8%) of 935 patients were female and 600 (64·2%) were male. 465 (49·7%) of 935 were assigned to the standard protein group and 470 (50·3%) were assigned to the high protein group. 430 (92·5%) of 465 patients in the standard protein group and 419 (89·1%) of 470 patients in the high protein group were assessed for the primary outcome. The primary outcome, EQ-5D-5L health utility score during 180 days after randomisation (assessed at 30 days, 90 days, and 180 days), was lower in patients allocated to the high protein group than in those allocated to the standard protein group, with a mean difference of -0·05 (95% CI -0·10 to -0·01; p=0·031). Regarding safety outcomes, the probability of mortality during the entire follow-up was 0·38 (SE 0·02) in the standard protein group and 0·42 (0·02) in the high protein group (hazard ratio 1·14, 95% CI 0·92 to 1·40; p=0·22). There was a higher incidence of symptoms of gastrointestinal intolerance in patients in the high protein group (odds ratio 1·76, 95% CI 1·06 to 2·92; p=0·030). Incidence of other adverse events did not differ between groups. High enteral protein provision compared with standard enteral protein provision resulted in worse health-related quality of life in critically ill patients and did not improve functional outcomes during 180 days after ICU admission. Netherlands Organisation for Healthcare Research and Development and Belgian Health Care Knowledge Centre.

The nature and extent of the Taliban’s involvement in the drug trade before and after the regime change (1994–2022): insights from experts

ABSTRACT This article considers what experts know about the nature and extent of the Taliban’s involvement in the drug trade from 1994 until 2022. The findings indicate that the Taliban has been consistently involved in the drug trade in various roles and capacities. This involvement, fortified by familial and tribal connections with key drug trade actors, allows the Taliban to establish local legitimacy and strengthen its influence in rural areas. Despite the Taliban’s transition from insurgency to governance in August 2021, factions within the group have remained involved in the drug trade, and some drug traffickers hold official positions in the Taliban-led government. Study findings reveal that the Taliban’s opium ban serves strategic objectives, which include gaining political recognition and increasing opium prices. These findings underscore the importance of independent and comprehensive monitoring of the Taliban’s counternarcotics policies and urge caution in any engagements regarding counternarcotics initiatives with the Taliban-led government.

Operator independent continuous ultrasound monitoring of diaphragm excursion predicts successful weaning from mechanical ventilation: a prospective observational study

BackgroundIn mechanically ventilated patients, diaphragm ultrasound can identify diaphragm weakness and predict weaning failure. We evaluated whether a novel operator-independent ultrasound-based medical device allowing continuous monitoring of the diaphragm (CUSdi) could reliably (1) measure diaphragm excursion (EXdi) and peak contraction velocity (PCVdi), (2) predict weaning outcome, and (3) approximate transdiaphragmatic pressure (Pdi).MethodsIn 49 mechanically ventilated patients, CUSdi was recorded during a 30-min spontaneous breathing trial (SBT), and EXdi and PCVdi were measured. In subgroups of patients, standard ultrasound measurement of EXdi and PCVdi was performed (n = 36), and Pdi derived parameters (peak and pressure time product, n = 30) were measured simultaneously.ResultsThe agreement bias between standard ultrasound and CUSdi for EXdi was 0.1 cm (95% confidence interval -0.7–0.9 cm). The regression of Passing-Bablok indicated a lack of systematic difference between EXdi measured with standard ultrasound and CUSdi, which were positively correlated (Rho = 0.84, p < 0.001). Weaning failure was observed in 54% of patients. One, two and three minutes after the onset of the SBT, EXdi was higher in the weaning success group than in the failure group. Two minutes after the onset of the SBT, an EXdi < 1.1 cm predicted weaning failure with a sensitivity of 0.83, a specificity of 0.68, a positive predictive value of 0.76, and a negative predictive value of 0.24. There was a weak correlation between EXdi and both peak Pdi (r = 0.22, 95% confidence interval 0.15 – 0.28) and pressure time product (r = 0.13, 95% confidence interval 0.06 – 0.20). Similar results were observed with PCVdi.ConclusionsOperator-independent continuous diaphragm monitoring quantifies EXdi reliably and can predict weaning failure with an identified cut-off value of 1.1 cm.Trial registration clinicaltrial.gov, NCT04008875 (submitted 12 April 2019, posted 5 July 2019) and NCT03896048 (submitted 27 March 2019, posted 29 March 2019).

Cognitive Behavioral Therapy: A Quasi-Experimental Study of Self Care Activity with Type 2 Diabetes Mellitus Patients

Individuals diagnosed with diabetes mellitus require a multi-faceted approach to treatment. Key aspects of self-care for these patients include maintaining a proper diet, engaging in regular physical activity, adhering to prescribed medications, consistently monitoring blood glucose levels, caring for the legs, and managing smoking habits. Among the therapeutic interventions used in nursing, Cognitive Behavioral Therapy (CBT) is noteworthy. The purpose of this study was to examine the impact of CBT on self-care behaviors in patients with Type 2 diabetes mellitus. Utilizing a quasi-experimental design, this study implemented a pre and post-test control group methodology. A total of 32 participants were selected based on specific criteria and probability sampling methods were employed to determine the sample. Data was gathered using the Summary of Self-Care Diabetic Activity questionnaire. Findings from the study indicate that CBT significantly enhanced dietary compliance (p-value = 0.02), increased physical activity (p-value = 0.001), and improved independent blood glucose monitoring (p-value = 0.003). Additionally, CBT enhanced adherence to medication (p-value = 0.004), leg care (p-value = 0.004), and reduced smoking behaviors (p-value = 0.021). CBT effective in enhancing various self-care activities among diabetic patients by fostering changes in mindset and encouraging positive behavioral shifts

Home-monitoring for neovascular age-related macular degeneration in older adults within the UK: the MONARCH diagnostic accuracy study.

Most neovascular age-related macular degeneration treatments involve long-term follow-up of disease activity. Home monitoring would reduce the burden on patients and those they depend on for transport, and release clinic appointments for other patients. The study aimed to evaluate three home-monitoring tests for patients to use to detect active neovascular age-related macular degeneration compared with diagnosing active neovascular age-related macular degeneration by hospital follow-up. There were five objectives: Estimate the accuracy of three home-monitoring tests to detect active neovascular age-related macular degeneration. Determine the acceptability of home monitoring to patients and carers and adherence to home monitoring. Explore whether inequalities exist in recruitment, participants' ability to self-test and their adherence to weekly testing during follow-up. Provide pilot data about the accuracy of home monitoring to detect conversion to neovascular age-related macular degeneration in fellow eyes of patients with unilateral neovascular age-related macular degeneration. Describe challenges experienced when implementing home-monitoring tests. Diagnostic test accuracy cohort study, stratified by time since starting treatment. Six United Kingdom Hospital Eye Service macular clinics (Belfast, Liverpool, Moorfields, James Paget, Southampton, Gloucester). Patients with at least one study eye being monitored by hospital follow-up. Detection of active neovascular age-related macular degeneration by an ophthalmologist at hospital follow-up. KeepSight Journal: paper-based near-vision tests presented as word puzzles. MyVisionTrack®: electronic test, viewed on a tablet device. MultiBit: electronic test, viewed on a tablet device. Participants provided test scores weekly. Raw scores between hospital follow-ups were summarised as averages. Two hundred and ninety-seven patients (mean age 74.9 years) took part. At least one hospital follow-up was available for 317 study eyes, including 9 second eyes that became eligible during follow-up, in 261 participants (1549 complete visits). Median testing frequency was three times/month. Estimated areas under receiver operating curves were < 0.6 for all index tests, and only KeepSight Journal summary score was significantly associated with the lesion activity (odds ratio = 3.48, 95% confidence interval 1.09 to 11.13, p = 0.036). Older age and worse deprivation for home address were associated with lower participation (χ2 = 50.5 and 24.3, respectively, p < 0.001) but not ability or adherence to self-testing. Areas under receiver operating curves appeared higher for conversion of fellow eyes to neovascular age-related macular degeneration (0.85 for KeepSight Journal) but were estimated with less precision. Almost half of participants called a study helpline, most often due to inability to test electronically. Pre-specified sample size not met; participants' difficulties using the devices; electronic tests not always available. No index test provided adequate test accuracy to identify lesion diagnosed as active in follow-up clinics. If used to detect conversion, patients would still need to be monitored at hospital. Associations of older age and worse deprivation with study participation highlight the potential for inequities with such interventions. Provision of reliable electronic testing was challenging. Future studies evaluating similar technologies should consider: Independent monitoring with clear stopping rules based on test performance. Deployment of apps on patients' own devices since providing devices did not reduce inequalities in participation and complicated home testing. Alternative methods to summarise multiple scores over the period preceding a follow-up. This trial is registered as ISRCTN79058224. This award was funded by the National Institute of Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 15/97/02) and is published in full in Health Technology Assessment; Vol. 28, No. 32. See the NIHR Funding and Awards website for further award information.

Damage detection in wind turbine blades using embedded radar networks

To ensure the availability and operational safety of wind turbine blades, regular inspections are required according to specified maintenance intervals. As with all periodic inspections, damage that develops between two inspection dates remains undetected until the next inspection. In recent years, monitoring systems have therefore been developed that enable independent structural health monitoring (SHM) with permanently installed sensors. The most important representatives here include vibration analysis, acoustic emission testing and ultrasonic methods. In addition, it is necessary for an SHM system to distinguish between signal changes resulting from damage or changing environmental and operating conditions. The present work presents a new approach for the in-situ assessment of wind turbine blades via embedding radar networks in the frequency band from 58 to 63.5 GHz. Therefore, 40 FMCW (frequency-modulated continuous wave) radar sensors have been embedded into a wind turbine blade during manufacturing. This contribution provides additional information related to the hardware design of the sensor nodes, its preliminary testing and the specific implementation of the radar network during a fullscale fatigue test of a 31m long wind turbine blade [1]. Damage indicators can be formulated relative to baseline conditions to see the development of fatigue damage over time. Reference: [1] Simon, J.; Kurin, T.; Moll, J.; Bagemiel, O.; Wedel, R.; Krause, S.; Lurz, F.; Nuber, A.; Issakov, V. &amp; Krozer, V., Embedded Radar Networks for Damage Detection in Wind Turbine Blades: Validation in a Full-scale Fatigue Test, Structural Health Monitoring, 2023, https://doi.org/10.1177/14759217231152815