Low Enrollment Rates Research Articles

Girls’ Education and Literacy in Marginalized Areas and its Impact on Sustainable Economic Development: The Interlink Between Gender Equality and Women’s Socio-Economic Empowerment: Turkana South Sub-County, Kenya

Education is the pillar of any development, (UNESCO, 2010) and is also anchored in the Sustainable Development Goals (Goal 4: Quality Education). In Kenya, targeted interventions have been by the government in the education sector to bridge gender disparities but they are but they are still observed and evident at all levels (Leal Filho et al., 2019). Furthermore, Turkana County lags behind and was ranked second last in adult literacy (KNBS, 2019). Specifically, the study sought to establish the socio-cultural, economic and infrastructural determinants of enrolment, transition and retention among boys and girls. The study was guided by Sara Longwe's 1995 analytical framework on women's economic empowerment model. It was further guided Friedman’s 1992 dis empowerment theory. The study established that the overall primary school enrolment rate for the study area was 0.9343 (mean enrolment of 213.1 for boys and 199.1 for girls). The study also established that there were large fluctuations in the number of girls enrolled in schools. The difference in enrolment rates between boys and girls were statistically significant. The number of pupils in each primary school was about 200 hundred and less than 200 for secondary schools hence the conclusion that 100 per cent transition is not possible. Girls had lower enrolment rates as compared to the boys. Girls from regions practicing farming/pastoralism registered higher enrolment rates as compared to those from trade/pastoralism regions hence the conclusion that economic factors contribute to educational outcomes in the study area. The findings also indicate that the school feeding programs have been a motivation for attendance benefitting both parents and pupils. The study makes recommendations for future research, policies and programs.

Status and associated factors of health insurance enrollment among women in Nepal

AbstractThe Government of Nepal (GoN) introduced a Health Insurance Program (HIP) in 2016 aiming to ensure quality healthcare for all Nepalese citizens without financial hardship. However, the HIP has not attracted as many people as expected. It shows low enrollment and high dropout rates. Studies on this issue are scarce, particularly regarding women. To identify the factors associated with women enrollment in health insurance (HI), this study utilized a cross‐sectional design, analyzing secondary data (n = 14,845) from the Nepal Demographic and Health Survey 2022. Chi‐square test and logistic regression were used to identify associations with women participation in the HIP. Women enrollment in HI was positively and significantly associated with province, age, ethnicity, educational level, religion, place of residence, ecological region, wealth index, women's autonomy in household decisions, household head status, and current employment (p < 0.01). Socioeconomic and demographic factors of the respondents, such as being over 35 years old (aOR = 1.98; 95% confidence interval [CI]: 1.65–2.39), having a secondary or higher education (aOR = 2.96; 95% CI: 2.43–3.64), being currently employed in a paid job (aOR = 1.31; 95% CI: 1.17–1.47), and belonging to the richest wealth status (aOR = 5.64; 95% CI: 4.33–7.34), were more likely to be enrolled in the HIP compared to their respective reference groups. In conclusion, being of privileged socioeconomic status, belonging to a specific ethnic group, having a higher educational level, being employed, and living in the Mountain region are all associated with women enrollment in HIP. Policymakers may consider these findings when planning and implementing future interventions.

Improving learning outcomes for out-of-school children: evidence from a randomized evaluation of an accelerated learning program in Liberia

ABSTRACT Children in Liberia receive 2.2 learning-adjusted years of schooling, one of the lowest levels of educational attainment in the world. We study one approach to address low enrollment and low rates of learning: a 10-month accelerated learning program run by the Luminos Fund to help out-of-school children catch up to grade level. We conducted a randomized evaluation of the program across 100 communities in Liberia. We find that the program had large effects on reading and numeracy skills for out-of-school children, and that children in the program catch up to the learning levels of children in government schools.

Core Components of Cardiac Rehabilitation Programs: 2024 Update: A Scientific Statement From the American Heart Association and the American Association of Cardiovascular and Pulmonary Rehabilitation.

The science of cardiac rehabilitation and the secondary prevention of cardiovascular disease has progressed substantially since the most recent American Heart Association and American Association of Cardiovascular and Pulmonary Rehabilitation update on the core components of cardiac rehabilitation and secondary prevention programs was published in 2007. In addition, the advent of new care models, including virtual and remote delivery of cardiac rehabilitation services, has expanded the ways that cardiac rehabilitation programs can reach patients. In this scientific statement, we update the scientific basis of the core components of patient assessment, nutritional counseling, weight management and body composition, cardiovascular disease and risk factor management, psychosocial management, aerobic exercise training, strength training, and physical activity counseling. In addition, in recognition that high-quality cardiac rehabilitation programs regularly monitor their processes and outcomes and engage in an ongoing process of quality improvement, we introduce a new core component of program quality. High-quality program performance will be essential to improve widely documented low enrollment and adherence rates and reduce health disparities in cardiac rehabilitation access.

Development of the Better Research Interactions for Every Family (BRIEF) intervention to support recruitment for neonatal clinical trials: an intervention mapping guided approach

BackgroundRecruitment for neonatal clinical trials can be particularly challenging. Low enrollment rates bias the research population and decrease generalizability of findings. We identified a critical need for an intervention to improve how researchers recruit for neonatal clinical trials. Working within the US neonatal research context, we developed the Better Research Interactions for Every Family (BRIEF) Intervention, which had two overarching goals: to improve the recruitment experience for all parents, focusing on minoritized populations, and to increase participation, focusing on decreasing disparities in research participation.MethodsWe used intervention mapping (IM) to guide all steps of intervention development. IM is a planning framework that provides a systematic process and detailed protocol for step-by-step decision-making for intervention development, implementation, and evaluation.ResultsWe performed IM’s six steps. In step 1, we convened two stakeholder groups, a parent panel and an expert panel, who provided guidance through development of all BRIEF components. Through a recent systematic review, empirical data collected by our team, and consultations with the panels, we identified key determinants (barriers and facilitators) of low enrollment rates and research team members as change agents. In step 2, we iteratively refined our list of key factors to include and linked determinants of behavior changes to these performance objectives. In step 3, we chose three theories (social cognitive theory, theory of information processing, and the trans-theoretical model), methods from identified practical applications suitable for the population (research team members) and the context (busy research NICU teams). In step 4, we developed and refined the intervention components, including self-guided pre-work and a single in-person session. In step 5, we identified the Darbepoetin plus slow-release intravenous iron trial as our partner study in which to pilot BRIEF. In step 6, we developed a multi-stage evaluation plan that included five distinct levels of outcomes.ConclusionsThis manuscript shares our rationale and processes for the creation of a research team member-facing intervention aiming to improve recruitment processes for neonatal clinical trials. Our approach can inform those aiming to improve recruitment for neonatal clinical trials and those who may be considering use of IM within similar contexts.

Prolonged exposure for posttraumatic stress disorder following spinal cord injury: A randomized controlled trial.

Individuals with a spinal cord injury (SCI) may experience posttraumatic stress disorder (PTSD) at a higher rate, which is associated with worse psychiatric comorbidity, decreased quality of life, and greater disability. Yet, effective PTSD interventions remain understudied for individuals with SCI. We conducted the first randomized controlled trial (RCT) of an evidence-based psychotherapy (prolonged exposure [PE]) with survivors of SCI during acute rehabilitation. We examined the efficacy, feasibility, and secondary outcomes. Participants (n = 29) were adults recruited from 2018 to 2021 1-month postinjury with PTSD randomized into either PE therapy or treatment as usual. The primary outcome was PTSD assessed at baseline, 6, 10, and 32 weeks postenrollment. An overall group-by-time interaction was not statistically significant (p = .102), but effect sizes demonstrated moderate and large improvements in PTSD for the PE group at 6 (-19.4 vs. -9.7) and 10 (-25.8 vs. -5.7), respectively. Similarly, moderate to large effect sizes were observed for depression, maladaptive posttraumatic cognitions, disruptive nocturnal behaviors, SCI-related quality of life, and risky alcohol consumption. Low rates of enrollment (50%) and treatment completion (25%) suggest feasibility challenges; however, treatment completers did report high satisfaction (100%). Results suggest that individuals who received PE had a quicker and clinically meaningful reduction in PTSD symptoms, but delivery during acute rehabilitation is not feasible for many individuals. Future research should examine abbreviated versions of PE for PTSD to enhance the feasibility of treatment in this setting. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Pupils’ gendered experiences in the mathematics classroom: “When you’re in a class with such dominant boys, it’s not easy to put yourself forward”

Many studies worldwide conclude that there are no significant differences between the academic performance of boys and girls in school mathematics. In fact, girls are often found to outperform boys in several countries. However, girls and women continue to participate less in mathematics classrooms and have lower enrolment rates in STEM-related subjects. To investigate this paradox, we utilise the theoretical framework of figured worlds (Holland, Lachicotte, Skinner, and Cain in Identity and agency in cultural worlds, Harvard University Press, 1998) and examine how a group of three boys and a group of four girls experience participation in the mathematics classroom. All children had attended the same 9th grade (ages 14–15) in Norway. Based on focus-group and individual interviews with the children, this study identifies three themes around which children construct their experiences: (a) gendered participation in the mathematics classroom, (b) what it means to be a ‘good’ mathematics pupil, and (c) the teacher’s role in fostering pupil participation. In closing, we discuss implications of our work and make recommendations for future research.

Ambulation During Neuraxial Analgesia in Obese Patients: A Pilot Study

Objective: Obese patients are known to have prolonged labors and an increased risk of cesarean delivery in comparison to their normal weight counterparts. Movement has previously been shown to have beneficial effects on the labor process; however, neuraxial analgesia is often recommended in obese women and in common practice limits mobility. The benefits of continuing to ambulate during neuraxial analgesia are not known. As prior studies have postulated a soft tissue dystocia as a potential etiology for prolonged labor among obese patients, ambulation and encouraged movement throughout the labor process may be of particular benefit for these patients. The purpose of this study was to evaluate the feasibility of ambulation with neuraxial analgesia in nulliparous obese patients admitted for labor. Study Design: This is a pilot study conducted at a single tertiary care center. Patients with a BMI of >=35 were approached if they were nulliparous, term, and planned vaginal trial of labor. Patients were excluded if there were contraindications to ambulation, including magnesium administration. Participants were identified at >=34 weeks estimated gestational age through clinic templates and induction of labor schedules, and were approached either in person or with a standard phone consent. Combined spinal-epidural analgesia was initiated per our institution’s policy, with the exception that during the latter portion of the study the test dose was eliminated in order to decrease the immediate motor block from this dose. Following epidural catheter placement, serial blood pressure measurements and motor assessments were completed to ensure safety including a straight leg test and a step stool test. Patients who passed these assessments were enrolled in the trial. Patients were encouraged to ambulate for 20 minutes of every hour while maintained on fetal and uterine telemetry. Ambulation was discouraged after complete dilation. Demographics and delivery outcomes were collected. Results: 105 patients were identified for consent for the trial, of whom 20 were ineligible for the study, 20 were not approached, and 40 declined study participation, leaving 25 patients who were consented. Of those 25, 14 completed the study. Reasons for not completing the study included ineligible by motor assessment, BMI less than 35 at time of delivery admission, preterm delivery, withdrawal, complete dilation at time of epidural without time to ambulate, magnesium administration during labor. A total of 14 participants were enrolled in the pilot trial, of which 11 were able to ambulate. The average BMI of participants was 43 kg/m2. Patients received epidural analgesia at a median cervical dilation of 4 cm and the average time from initiation of epidural analgesia to delivery was 15.4 hours. 65% of patients enrolled had a cesarean delivery. Of the 5 patients with a vaginal delivery, there was 1 shoulder dystocia. The median time spent ambulating was 58.5 minutes, with a range of 20-230 minutes. No patients fell during the trial. While one patient developed a spinal headache, it was not thought to be related to ambulation. Conclusions: A pilot trial of ambulation during neuraxial analgesia demonstrated no safety concerns among an obese nulliparous population. This pilot study was underpowered and is not designed to determine if there is an effect of ambulation with neuraxial analgesia on mode of delivery. Strengths of this study were interdisciplinary collaboration and biologic plausibility of decreased cesarean delivery through ambulation. Limitations included a low enrollment rate and the COVID pandemic, which halted the study as well as limited patients from being able to ambulate in the hallways. A larger study is needed to assess the efficacy of this intervention.

The National Health Insurance Scheme (NHIS) in Nigeria: current issues and implementation challenges

The National Health Insurance Scheme (NHIS) in Nigeria, despite its critical role in aiming for Universal Health Coverage, faces significant challenges. Initiated in 2005 with the goal of universal healthcare access by 2015, the scheme has struggled with low enrolment rates, fluctuating numbers of healthcare professionals, and substantial out-of-pocket expenditures for citizens. Current statistics indicate less than 5% of Nigerians are enrolled in NHIS, while 70% still finance their healthcare independently. Major issues include inefficient service delivery, inadequate healthcare infrastructure, and poor resource management, leading to substandard care quality. Recommendations for improvement focus on enhancing hospital efficiency, motivating and retaining healthcare workers, adopting appropriate technology, and clarifying prepayment mechanisms. Increased state contributions and robust evaluation metrics are also suggested to facilitate better adaptation to Nigeria’s diverse and growing population. Addressing these challenges is crucial for achieving the intended goals of the NHIS and moving closer to universal health coverage in Nigeria. Extensive discussions and strategic policy adjustments are essential to overcome these barriers, ensuring effective healthcare service delivery and financial protection for the Nigerian population.

Racial disparity in prostate cancer: an outlook in genetic and molecular landscape.

Prostate cancer (PCa) incidence, morbidity, and mortality rates are significantly impacted by racial disparities. Despite innovative therapeutic approaches and advancements in prevention, men of African American (AA) ancestry are at a higher risk of developing PCa and have a more aggressive and metastatic form of the disease at the time of initial PCa diagnosis than other races. Research on PCa has underlined the biological and molecular basis of racial disparity and emphasized the genetic aspect as the fundamental component of racial inequality. Furthermore, the lower enrollment rate, limited access to national-level cancer facilities, and deferred treatment of AA men and other minorities are hurdles in improving the outcomes of PCa patients. This review provides the most up-to-date information on various biological and molecular contributing factors, such as the single nucleotide polymorphisms (SNPs), mutational spectrum, altered chromosomal loci, differential gene expression, transcriptome analysis, epigenetic factors, tumor microenvironment (TME), and immune modulation ofPCa racial disparities. This review also highlights future research avenues to explore the underlying biological factors contributing to PCa disparities, particularly in men of African ancestry.

Reframing Communication about Fall Prevention Programs to Increase Older Adults' Intentions to Participate.

Falls and fall-related injuries in community-dwelling older adults are a growing global health concern. Despite effective exercise-based fall prevention programs (FPPs), low enrollment rates persist due to negative connotations associated with falls and aging. This study aimed to investigate whether positive framing in communication leads to a higher intention to participate in an FPP among community-dwelling older adults. We conducted a two-sequence randomized crossover study. We designed two flyers, a standard flyer containing standard terminology regarding FPPs for older adults, and a reframed flyer highlighting fitness and activity by reframing 'fall prevention' as an 'exercise program' and 'old' as 'over 65 years'. With a Mann-Whitney U test, we investigated group differences regarding the intention to participate between the flyers. A sensitivity analysis and subgroup analyses were performed. We conducted qualitative thematic analysis on open-ended answers to gain a deeper understanding of participants' intention to participate. In total, we included 133 participants. Findings indicated a significantly higher intention to participate in the reframed flyer (median = 4; interquartile range = 1-6) compared to the standard flyer (median = 2; interquartile range = 1-4) (p = 0.038). Participants favored more general terms such as 'over 65 years' over 'older adults'. Older adults who were female, not at high fall risk, perceived themselves as not at fall risk, and maintained a positive attitude to aging showed greater receptivity to positively-framed communications in the reframed flyer. Additionally, already being engaged in physical activities and a lack of practical information about the FPP appeared to discourage participation intentions. The results in favor of the reframed flyer provide practical insights for designing and implementing effective (mass-)media campaigns on both (inter)national and local levels, as well as for interacting with this population on an individual basis. Aging-related terminology in promotional materials hinders engagement, underscoring the need for more positive messaging and leaving out terms such as 'older'. Tailored positively framed messages and involving diverse older adults in message development are essential for promoting participation in FPPs across various population subgroups to promote participation in FPPs among community-dwelling older adults.

A Human-Centric Approach towards Equity and Inclusion in AI Education

Artificial Intelligence (AI) has become pervasive in modern lives, with AI generative tools driving further transformation. However, a notable issue persists: the underrepresentation of females and individuals from ethnic and racial minorities in the tech industry. Despite generally positive attitudes toward technology among young students, this enthusiasm often does not extend to aspirations for careers in the field. To address this disparity, many schools in the United States are now offering computer science and AI courses at the high school level. Nevertheless, students from underrepresented groups often feel disconnected from these subjects, leading to low enrollment rates. Research underscores that students' career aspirations are solidified between the ages of 10-14 yrs, highlighting the importance of engaging them with computer science and computing skills during this formative period. Leveraging the Bourdieusian concept of social capital, this paper proposes educational interventions tailored for elementary schools. By nurturing students' technical social capital, these interventions aim to foster an inclusive ecosystem from an early age, when aspirations are taking shape. Ultimately, the goal is to enhance the accessibility of computer science education and related skills, empowering young students from underrepresented groups to pursue higher studies and careers in computer science and AI fields.

Evaluating the real-world implementation of the Family Nurse Partnership in England: a data linkage study.

The Family Nurse Partnership is an intensive home visiting programme for adolescent mothers. We aimed to evaluate the effectiveness of the Family Nurse Partnership on outcomes up to age 7 using national administrative data. We created a linked cohort of all mothers aged 13-19 using data from health, educational and children's social care and defined mothers enrolled in the Family Nurse Partnership or not using Family Nurse Partnership system data. Propensity scores were used to create matched groups for analysis. One hundred and thirty-six local authorities in England with active Family Nurse Partnership sites between 2010 and 2017. Mothers aged 13-19 at last menstrual period with live births between April 2010 and March 2019, living in a Family Nurse Partnership catchment area and their firstborn child(ren). The Family Nurse Partnership includes up to 64 home visits by a family nurse from early pregnancy until the child's second birthday and is combined with usual health and social care. Controls received usual health and social care. Indicators of child maltreatment (hospital admissions for injury/maltreatment, referral to social care services); child health and development (hospital utilisation and education) outcomes and maternal hospital utilisation and educational outcomes up to 7 years following birth. Family Nurse Partnership Information System, Hospital Episode Statistics, National Pupil Database. Of 110,520 eligible mothers, 25,680 (23.2%) were enrolled in the Family Nurse Partnership. Enrolment rates varied across 122 sites (range: 11-68%). Areas with more eligible mothers had lower enrolment rates. Enrolment was higher among mothers aged 13-15 (52%), than 18-19 year-olds (21%). Indicators of child maltreatment: we found no evidence of an association between the Family Nurse Partnership and indicators of child maltreatment, except for an increased rate of unplanned admissions for maltreatment/injury-related diagnoses up to age 2 for children born to Family Nurse Partnership mothers (6.6% vs. 5.7%, relative risk 1.15; 95% confidence interval 1.07 to 1.24). Child health and developmental outcomes: there was weak evidence that children born to Family Nurse Partnership mothers were more likely to achieve a Good Level of Development at age 5 (57.5% vs. 55.4%, relative risk 1.05; 95% confidence interval 1.00 to 1.09). Maternal outcomes: There was some evidence that Family Nurse Partnership mothers were less likely to have a subsequent delivery within 18 months of the index birth (8.4% vs. 9.3%, relative risk 0.92; 95% confidence interval 0.88 to 0.97). Younger and more vulnerable mothers received higher numbers of visits and were more likely to achieve fidelity targets. Meeting the fidelity targets was associated with some outcomes. Bias by indication and variation in the intervention and usual care over time and between areas may have limited our ability to detect effects. Multiple testing may have led to spurious, significant results. This study supports findings from evaluations of the Family Nurse Partnership showing no evidence of benefit for maltreatment outcomes measured in administrative data. Amongst all the outcomes measured, we found weak evidence that the Family Nurse Partnership was associated with improvements in child development at school entry, a reduction in rapid repeat pregnancies and evidence of increased healthcare-seeking in the mother and child. Future evaluations should capture better measures of Family Nurse Partnership interventions and usual care, more information on maternal risk factors and additional outcomes relating to maternal well-being. The study is registered as NIHR CRN Portfolio (42900). This award was funded by the National Institute of Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: 17/99/19) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 11. See the NIHR Funding and Awards website for further award information.

Examining the roles of traditional leaders in promoting quality education in Ghana

PurposeThe government of Ghana since independence has undertaken steps to develop educational infrastructure setup. This notwithstanding, the educational sector is beset with challenges such as low-quality education and low enrolment rates in Senior High Schools (SHS) of children from large households, among others. Given the myriad of challenges bedevilling the education sector, there have been calls for collaboration among public leaders to promote education. The paper, therefore, examines traditional leaders' roles in promoting quality education in Ghana.Design/methodology/approachThrough a desk review approach, the study examines the role of traditional leaders in promoting quality education in Ghana. This approach was adopted due to its flexible nature.FindingsThe study found that traditional leaders have provided educational materials and resources to deprived schools. They have established scholarship schemes for needy but brilliant students, promoted gender parity in education, constructed educational facilities and promoted a healthy teaching environment.Practical implicationsThe paper provides stakeholders in Ghana’s educational sector with the opportunity to review educational policies and include traditional leaders to influence educational policies. The recommendations call for support from the GETFUND and Scholarship Secretariat of Ghana to assist community-initiated projects and scholarship schemes established by traditional leaders.Originality/valueThe paper provides evidence to support the importance of traditional leadership, which has come under criticism from a democratisation perspective in contemporary times.

South Africa: Wealth Gap, Employment Imbalance, and Education Inequality in South Africa

This study uses changes in education and work between men and women to estimate the impact of gender inequality on the wealth gap in South Africa. Although the low enrollment rate of males in primary education continues to occur, social factors of gender inequality led to higher graduation rates and unemployment rates for females than for males, even though they have higher enrollment rates. These findings prove that gender inequality in society leads to job and income imbalances. for this paper, the innovation lies in the logical analysis of the three factors together, rather than the research on the influence of one element. Interestingly, even with the promotion of women's rights in South African society, gender bias has been affecting people's behaviour and subconsciousness at work, making people ignore that South African women have higher learning and skilled workability, which can improve the social economy more than men.

Examining adverse childhood experiences and Black youth's engagement in a hospital-based violence intervention program using administrative data.

Stemming from poverty and systemic racism, Black youth are disproportionately represented in hospital-based violence intervention programs (HVIPs) due to greater violence exposure. HVIPs are a critical intervention that have been shown to reduce rates of reinjury in urban hospitals and trauma centers across the United States; however, they are plagued by low enrollment and engagement rates. Few studies have examined factors related to engagement, particularly among Black youth. Guided by Trauma Theory and Critical Race Theory, this study uses a retrospective cohort design. Between-group differences of adverse childhood experiences (ACEs) among engaged youth compared to nonengaged youth who were violently injured and recruited for a HVIP were examined using chi-square and logistic regression. ACEs were approximated using a novel approach with administrative data. Results indicated that the total ACE score was not significantly associated with engagement status. Individual ACEs were tested across age groups. This study highlights a novel approach to understanding ACEs among a hard-to-reach population and illuminates the significant level of ACEs faced by violence-exposed Black youth at young ages. Considering theory, Black families may be more reluctant to engage due to fear and past harms in social service systems stemming from systemic racism. Though ACEs did not predict engagement in this study, considering the high rates of ACEs experienced by Black youth and their families in the context of systemic racism suggests that HVIPs should acknowledge historical harms and foster trauma-informed and healing-centered interactions during recruitment and later stages of engagement.

Quantitative evaluation of the impact of relaxing eligibility criteria on the risk-benefit profile of drugs for lung cancer based on real-world data.

Restrictive eligibility criteria in cancer drug trials result in low enrollment rates and limited population diversity. Relaxed eligibility criteria (REC) based on solid evidence is becoming necessary for stakeholders worldwide. However, the absence of high-quality, favorable evidence remains a major challenge. This study presents a protocol to quantitatively evaluate the impact of relaxing eligibility criteria in common non-small cell lung cancer (NSCLC) protocols in China, on the risk-benefit profile. This involves a detailed explanation of the rationale, framework, and design of REC. To evaluate our REC in NSCLC drug trials, we will first construct a structured, cross-dimensional real-world NSCLC database using deep learning methods. We will then establish randomized virtual cohorts and perform benefit-risk assessment using Monte Carlo simulation and propensity matching. Shapley value will be utilized to quantitatively measure the effect of the change of each eligibility criterion on patient volume, clinical efficacy and safety. This study is one of the few that focuses on the problem of overly stringent eligibility criteria cancer drug clinical trials, providing quantitative evaluation of the effect of relaxing each NSCLC eligibility criterion. This study will not only provide scientific evidence for the rational design of population inclusion in lung cancer clinical trials, but also establish a data governance system, as well as a REC evaluation framework that can be generalized to other cancer studies.

Managing Educational Barriers: Innovative Solutions for Female Secondary Education in Pakistan

Education is a fundamental human right and a crucial factor in promoting social and economic development. In Pakistan, female education has been a longstanding issue, with low enrollment rates, high dropout rates, and persistent gender disparities in educational access and outcomes. This research aims to explore the problems and countermeasures of female secondary education in the city district area of Tando Allahyar, Pakistan. The study used quantitative surveys to gather data from female students, teachers, experts, and community members. The results exhibited that poverty, limited access to quality education, and socio-cultural barriers were the main problems faced by female secondary education. Many female students and their families face significant financial challenges, which prevent them from attending school and completing their education. To address these problems, the study concluded that a range of countermeasures, including community engagement and awareness-raising campaigns, targeted investments in infrastructure and resources, and policies that prioritize girls' education and support their access to secondary education. It also concluded that women receive a better education if they are to be included in the productive labor force, which accounts for approximately half of the population. Policy interventions must be tailored to the specific needs of girls and must address the barriers that prevent girls from attending school and completing their secondary education.

Cardiothoracic surgery training in Africa: History and developments

ObjectiveCardiovascular disease is the leading cause of death globally, responsible for 17.5 million deaths each year, 80% of which occur in low- and middle-income countries, including countries in Africa. Cardiothoracic surgery, with its heavy financial outlay, is unavailable in many African countries. Many African healthcare givers are under the erroneous impression that the cardiovascular surgical landscape of Africa is blank. This review aims at describing the cardiothoracic surgery practice in Africa, the different training programs in the region, and its future prospects. MethodThrough a literature review, the authors elaborate on key points, such as healthcare and cardiothoracic surgery in Africa, African cardiothoracic practice and training, and the future of cardiothoracic surgery in Africa. ResultsAfrican countries with established cardiothoracic surgery capacity and training programs still face several challenges across multiple levels, including a persistent low enrollment rate in residency programs, insufficient local expertise, a lack of financial resources, an inadequate health infrastructure, and a skewed health insurance reimbursement system. Thus, there is still a growing burden of surgically correctable cardiovascular disease in these countries. ConclusionsCardiothoracic surgery in Africa has faced great challenges due to resource constraints, but it has demonstrated resilience and growth through diverse models and initiatives. The burden of cardiovascular diseases in Africa remains high, yet the capacity to provide cardiothoracic surgery is limited. With investment, support, and the implementation of comprehensive healthcare policies, cardiothoracic surgery practice can improve in this region and this can make a significant impact on the health and well-being of its population.

Stress Detection and Mitigation through Discovery of Optimal Lecture Delivery Method for STEM-Enrolled University Students

The high availability of technology-related jobs is currently not fulfilled by enough supply of technology graduates, specifically the ones coming from science, technology, engineering, and mathematics (STEM) courses. This is related to the low enrolment rate of STEM-based courses at Universities. The notion that STEM subjects are intense and difficult to pass could be the reason of such phenomena. This research experimented different lecture delivery methods comprising of different seating arrangements, inclusion or exclusion of break, group size, and room size to investigate the generated levels of stress among STEM students, so that the method that would induce minimum stress could be discovered. The analysis of the generated heart rates as stress indication concludes that the level of difficulty of STEM subject’s topic is the one that most affected students’ level of stress, while inclusion of break during class is imperious to destress students. Class arrangement with far seating was discovered to be potentially more stressful for certain students indicated by the high level of resting heart rate in one of the experiments. Importantly, it was also found that regardless of lecture delivery method, STEM subjects in general remained challenging that was suggested by the consistently high recorded heart rates, which was also a sign of active learning engagement - besides implying the level of stress. Finally, gender-wise, there is no visible data pattern that could hint that certain gender is more vulnerable to stress when handling STEM subjects.