Measurable Results Research Articles

The Influence of Electronic Health Records on Nursing Practice within Hospital Settings

Usability issues with electronic health records (EHRs) represent a growing threat to the health of nurses and patients, despite the fact that few studies have examined these correlations in depth. The purpose of this study was to investigate how the use of electronic health records has affected nursing practice in hospital settings. EHR adoption and care quality have yet to be extensively studied. The American Hospital Association (AHA) data, state patient discharges, and a survey of nurses were all used to conduct cross-sectional studies. The sample includes 1 281 848 surgical patients, 12 004 nurses, and 343 hospitals. Logistic regression models were used for uncontrolled, randomized studies examining the correlation between EHR usability and outcomes. Using logistic regression models, we analyzed the relationship between nurse-assessed quality of care outcomes and the use of even the most fundamental electronic health record systems. Nurses who worked in facilities equipped with even the most basic EHRs reported significantly fewer incidences than their colleagues at hospitals without EHRs; they had worse results in patient security and other quality measures. Implementing even a minimal EHR could improve the quality of nursing care, facilitate more effective care coordination, and boost patient safety

Flexible Stacked Partial Least Squares for Mid-Infrared Spectroscopy Glucose Detection

In this work, we propose a data fusion regression approach for quantitative analysis of glucose using mid-infrared (IR) spectra. First, the approach computes the variable score index. Several submodels are then generated in terms of the index from the calibration set. Finally, the ensembled regression model is created by combining these submodels. In addition, five different regression approaches from the literature are comparatively assessed. Our research shows that one model proposed achieves good performance (with a correlation coefficient of 0.94). our conclusion is that the data fusion model can provide an accurate and robust prediction result for IR glucose measurements.

The Utility of Bone Burring for the Clearance of Locally Advanced Scalp Malignancies: A Scoping Review.

A literature search was conducted systematically using MEDLINE, Embase, and PubMed. Articles were reviewed for inclusion, and eligible studies were analyzed for study design, patient and intervention details, and outcome measures. A formal statistical analysis was not conducted. The original search yielded 1506 unique results, and eight studies met the inclusion criteria: four case series, two retrospective analysis of records, two case reports. A number of tumor types were identified, but the burring method used was consistent in all studies. Despite reassuring primary outcome measure results, specifically in terms of local control rates, the overall evidence quality is limited by the nature of the included studies. Few adverse events were reported. Evidence for the oncological efficacy of scalp bone burring remains limited. Although the technique seems relatively safe, further investigation is required into its utility and drawbacks. Future studies should aim to report more technical details and more information about outcomes. It may also be worth comparing burring to alternatives such as outer cortical splitting, curettage, and high-dose curative radiotherapy.

Management by Results in Public Works and its Relation to the Quality of Life of the Population of the Department of Amazonas

Purpose: The purpose of the study is to examine the evidence and substantive contributions of managing for results in public works projects and their impact on quality of life.
 
 Theoretical framework: It is based on the results-based management approach, which refers to the allocation of resources based on the achievement of measurable and quantifiable results. Also mentioned is the PRISMA statement, which sets out guidelines for conducting a systematic literature review.
 
 Design/Methodology/Approach: The study is based on a systematic literature review of descriptive typology. It follows the guidelines set out within the PRISMA statement to ensure a rigorous and replicable approach. Inclusion and exclusion criteria were established to select relevant papers, which were then synthesised into a matrix to conduct a content analysis by year, country of resource, areas of knowledge and substantive contributions of the review.
 
 Findings: The findings indicate that results-based management contributes significantly to the improvement of public works projects and to the overall quality of life. Evidence is cited from the perspectives of both specialists and those within government units. However, deficiencies in budget implementation capacity and weak budget execution are also identified, which have affected the achievement of sustainable development goals.
 
 Social, practical and research implications: At the social level, the study highlights the importance of efficient results-based management to improve the quality of life of society at large. In practical terms, it identifies gaps in budget implementation capacity that need to be addressed to achieve significant impact. In terms of research implications, the need for further study and evaluation of the relationship between results-based management, quality of life and sustainable development is highlighted.
 
 Originality/value: Workers at the Regional Planning and Budgeting Office of the Regional Government of Amazonas - Headquarters have a generally positive view of budget results and quality of spending, but a more negative view of budget management due to a number of shortcomings in budget execution capacity.

A Comparison of Clinical Outcomes in Patients of Mandibular Condyles Fractures Treated with Open Versus Close Reduction

Aim: The absence of a widely acknowledged and conclusive therapy for condylar fractures is a matter of contemporary debate and contention, with the issue of whether surgical or conservative approaches are better suitable for managing such fractures being unresolved. This study investigates several methodologies pertaining to the conservative, closed, and open surgical interventions for the treatment of condylar fractures. The standardization of fracture classification systems and treatment techniques is necessary to provide a clear and optimum strategy for individual individuals and their respective fractures. Objectives: The objectives of the study are to compare clinical outcomes in patients of mandibular condyles fractures treated with open versus close reduction. Method: A total of 84 individuals diagnosed with subcondylar fractures of the mandible were assessed. All fractures seen in the study exhibited displacement, with either angulation ranging from 10° to 35° or a reduction in length of the ascending ramus by more than 2 mm. A comprehensive assessment, including both clinical and radiographic examination, was conducted at the 6-month mark after the occurrence of the trauma. The clinical criteria assessed in this study included mouth opening, temporomandibular joint (TMJ) discomfort, mandibular deviation, malocclusion, facial damage, and scar formation. Results: The findings indicated a statistically significant difference between the two groups, with a p-value of less than 0.05. The findings suggest that open reduction was found to be more efficacious than closed reduction in enhancing mouth opening, mandibular deviation, TMJ discomfort, and malocclusion. Conversely, closed reduction was shown to be more beneficial than open reduction. Conclusion: The study findings indicate that the open treatment approach yields superior progress compared to closed techniques, and these differences are statistically significant. Patients who had open reduction demonstrated considerably superior results in all functional measures, with the exception of facial nerve damage and scar formation, when compared to those who underwent closed reduction. Keyword: Mandibular fracture, open reduction, closed reduction, clinical outcome

Generalised Hausdorff measure of sets of Dirichlet non-improvable matrices in higher dimensions

Let psi :mathbb {R}_{+}rightarrow mathbb {R}_{+} be a non-increasing function. A pair (A,{textbf{b}}), where A is a real mtimes n matrix and {textbf{b}}in mathbb {R}^{m}, is said to be psi -Dirichlet improvable, if the system ‖Aq+b-p‖m<ψ(T),‖q‖n<T\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\\begin{aligned} \\Vert A{\ extbf{q}} +{\ extbf{b}}-{\ extbf{p}}\\Vert ^m<\\psi (T), \\quad \\Vert {\ extbf{q}}\\Vert ^n<T \\end{aligned}$$\\end{document}is solvable in {textbf{p}}in mathbb {Z}^{m},{textbf{q}}in mathbb {Z}^{n} for all sufficiently large T where Vert cdot Vert denotes the supremum norm. For psi -Dirichlet non-improvable sets, Kleinbock–Wadleigh (2019) proved the Lebesgue measure criterion whereas Kim–Kim (2022) established the Hausdorff measure results. In this paper we obtain the generalised Hausdorff f-measure version of Kim–Kim (2022) results for psi -Dirichlet non-improvable sets.

Speed of Cognitive Processing Within a Test of Executive Functions and Information Integration

Rapid Automatic Naming (RAN) has been widely recognized as a reliable predictor of reading proficiency. Although RAN represents the speed of cognitive processing, there are few studies that have addressed RAN as a cognitive process in its own right Furthermore, RAN performance of ELL (English Language Learners) has been less frequently investigated. We have two parts to this study. First, we examine the factor structure of an enlarged composite measure of speed measure by adding four additional tests comprising color naming, and two number naming tasks to the traditional RAN of digit and letter naming. In the second part, we determine the association of Speed with broad cognitive processes comprising Executive Functions, and Information processing. Participants were students in English medium schools in India. They were divided into two age groups (8–14 and 15–20) for statistical analyses of six Speed measures Results show a strong unitary speed factor in the 8 to 14 age group. In contrast, in the 15 to 20 group RAN tests comprising digits and letters showed a very small loading on the same factor. Addressing the second objective, which is the impact of speed on various cognitive tasks, the results show that response speed has a minimal influence on Nonverbal Configurations (simultaneous) tasks, and tasks of executive functions comprising Working Memory, and Visual-Spatial Processing. These tests will enable us to isolate specific cognitive deficiencies from response speed. In a re-examination of the relation between Reading &amp; RAN-type tests, we could suggest that serial articulation is the common and essential feature that binds rapid naming tasks and reading fluency.

Determinants of Renal Micro-Perfusion as Assessed with Contrast-Enhanced Ultrasound in Healthy Males and Females.

(1) Background: The renal microcirculation is essential to maintain the renal function, but its determinants in humans have been poorly studied. Contrast-enhanced ultrasound (CEUS) allows the non-invasive quantification of the cortical micro-perfusion at the bedside using the perfusion index (PI). The aims of this study were to assess whether differences exist in PI between healthy males and females and to identify clinical determinants associated with cortical micro-perfusion. (2) Methods: Healthy, normotensive volunteers (eGFR > 60 mL/min/1.73 m2, no albuminuria) underwent CEUS under standardized conditions with the destruction-reperfusion (DR) technique. The mean PI of four DR sequences was reported as the primary outcome measure (3) Results: A total of 115 subjects (77 females and 38 males) completed the study; the mean ± SD age was, respectively, 37.1 ± 12.2 and 37.1 ± 12.7 years in females and males, and the mean eGFR was 105.9 ± 15.1 and 91.0 ± 17.4 mL/min/1.73 m2. The PI (median) was higher in females than in males, i.e., 2705 (IQR 1641-3777) vs. 1965 (IQR 1294-3346) arbitrary units (a.u), p = 0.02). A correlation analysis showed positive associations between PI and eGFR, female sex, heart rate, plasma renin activity (PRA) and plasma aldosterone concentrations (PAC), negative associations with potassium, bicarbonate and systolic blood pressure, and no associations with age, body mass index and renal resistive index (RRI). In a multivariate linear regression analysis, only PRA remained significantly associated with PI. (4) Conclusions: Although the PI was higher among females, this association was no longer significant after adjustment for covariates. There was no difference in females tested during the follicular or the luteal phases. In conclusion, the PI was only weakly influenced by classic clinical variables, but was positively associated with PRA, suggesting that the renin-angiotensin system plays a role in the regulation of the cortical micro-perfusion in humans. Identifying which other factors contribute to the large variations in micro-perfusion across individuals needs further study.

The Need for a Motor Assessment Tool for Children with Autism—An Opinion Article

There is a lot of evidence that early developmental therapy achieves impressive therapeutic results for those who require it. Therefore, developmental follow-up, which includes the process of monitoring the child’s development over time, makes it possible to identify possible developmental problems and treat them from a young age. This assumption is true in relation to all children with developmental difficulties but is mainly true in the context of children with a diagnosis of autism. However, despite the abundance of developmental scales for the neurotypical population, there are currently no valid scales for assessing motor function for children with autism. The current article focuses on the presentation of the motor delay, identified according to the literature, in many of the children with autism and requires the provision of professional and compatible treatment for these children. This motor delay and the lack of a motor assessment tool for children with autism raises the need for an adapted motor developmental assessment tool, which will produce measurable results, to enable the monitoring of the aforementioned disability and the receiving of tailored treatment from the physiotherapists who deal with the development of children with autism at an early age. The article reviews common existing assessment tools for use in assessing normal development in children with autism, presents the limitations and the challenges that arise when using these assessment tools with children on the autism spectrum and presents the need for a new developmental assessment tool that will be built and validated specifically for children with autism.

Measurement Of Aluminium Alloy 6061 Diameter Results Using Profile Projector

The writing of this study was conducted to measure the circle of variations of aluminum alloy 6061 with a diameter of 20mm, 25mm and 30mm, respectively the speed on the CNC frais engine is different, among others, low speed 500 Rpm, medium speed 700 Rpm and high speed of 1000 Rpm. In addition, the results of frais CNC 3 Axis machine are validated using Profile Projector measuring tool that has a higher accuracy rate compared to other measuring instruments.The purpose of the study was to determine the effect of CNC engine speed with low, medium and high speeds on the dimensions of diameters of 20mm, 25mm and 30mm. and to find out the results of the deviation measure and accuracy of the hole work process by using frais CNC machine and Digital Caliper measuring instrument and Profile Projector.The result of this study was that the variation values of sample measurements using Varnier Caliper Digital and Profile Projector were heavily influenced by machine speed, and the result of the average deviation value was very pharmaceutical. Keywords: Measurement of aluminum alloy diameter 6061, frais CNC machine Results 3 Axis with speeds of 500, 700, and 1000 Rpm, with Profile Projector measurement

Age and gender differences in narcissism: A comprehensive study across eight measures and over 250,000 participants.

Age and gender differences in narcissism have been studied often. However, considering the rich history of narcissism research accompanied by its diverging conceptualizations, little is known about age and gender differences across various narcissism measures. The present study investigated age and gender differences and their interactions across eight widely used narcissism instruments (i.e., Narcissistic Personality Inventory, Hypersensitive Narcissism Scale, Dirty Dozen, Psychological Entitlement Scale, Narcissistic Personality Disorder Symptoms from the Diagnostic and Statistical Manual of Mental Disorders, Version IV, Narcissistic Admiration and Rivalry Questionnaire-Short Form, Single-Item Narcissism Scale, and brief version of the Pathological Narcissism Inventory). The findings of Study 1 (N = 5,736) revealed heterogeneity in how strongly the measures are correlated. Some instruments loaded clearly on one of the three factors proposed by previous research (i.e., Neuroticism, Extraversion, Antagonism), while others cross-loaded across factors and in distinct ways. Cross-sectional analyses using each measure and meta-analytic results across all measures (Study 2) with a total sample of 270,029 participants suggest consistent linear age effects (random effects meta-analytic effect of r = -.104), with narcissism being highest in young adulthood. Consistent gender differences also emerged (random effects meta-analytic effect was -.079), such that men scored higher in narcissism than women. Quadratic age effects and Age × Gender effects were generally very small and inconsistent. We conclude that despite the various conceptualizations of narcissism, age and gender differences are generalizable across the eight measures used in the present study. However, their size varied based on the instrument used. We discuss the sources of this heterogeneity and the potential mechanisms for age and gender differences. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

A novel microcoring technology: A completely new concept of enlarged pore treatment.

Enlarged facial pores are a common dermatological and cosmetic concern, which are difficult to treat because their pathogenesis is multifactorial. Many technological treatments have been developed to treat enlarged pores. Despite these efforts, enlarged pores remain problematic for many patients. Microcoring technology has recently been developed to treat pores and serve as a leading primary treatment option to address these concerns. Three patients underwent a single treatment of rotational fractional resection. The 0.5 mm diameter rotating scalpels were used to resect the skin pores in the cheek region. The resected site was evaluated 30 days after treatment, and the patients underwent scanning in bilateral 45° views at 60 cm from the face with the same brightness setting. The three patients improved in terms of enlarged pores and had no severe skin-related adverse effects. Furthermore, the three patients showed satisfactory treatment outcomes after 30 days of follow-up. Rotational fractional resection is a new concept that produces measurable permanent results for enlarged pore removal. These cosmetic procedures produced promising outcomes in a single treatment. However, the current clinical procedures trend demands minimally invasive treatment for enlarged pores.

Incidence of idiopathic nephrotic syndrome during the Covid-19 pandemic in the Paris area (France) and in the Netherlands

BackgroundThe aetiology of idiopathic nephrotic syndrome (INS) remains partially unknown. Viral infections have been associated with INS onset. Since we observed fewer first onset INS cases during the Covid-19 pandemic, we hypothesised that lower INS incidence was the result of lockdown measures. Therefore, the aim of this study was to evaluate the incidence of childhood INS before and during the COVID-19 pandemic in two independent European INS cohorts.MethodsChildren with new INS in the Netherlands (2018–2021) and Paris area (2018–2021) were included. We estimated incidences using census data for each region. Incidences were compared using two proportion Z-tests.ResultsA total of 128 and 324 cases of first onset INS were reported in the Netherlands and Paris area, respectively, corresponding to an annual incidence of 1.21 and 2.58 per 100,000 children/year. Boys and young children (< 7 years) were more frequently affected. Incidence before and during the pandemic did not differ. When schools were closed, incidence was lower in both regions: 0.53 vs. 1.31 (p = 0.017) in the Netherlands and 0.94 vs. 2.63 (p = 0.049) in the Paris area. During peaks of hospital admissions for Covid-19, no cases were reported in the Netherlands or Paris area.ConclusionsIncidence of INS before and during the Covid-19 pandemic was not different, but when schools were closed during lockdown, incidence was significantly lower. Interestingly, incidences of other respiratory viral infections were also reduced as was air pollution. Together, these results argue for a link between INS onset and viral infections and/or environmental factors.Graphical abstractA higher resolution version of the Graphical abstract is available as Supplementary information

Novel Functional Soft Magnetic CoFe2O4/Fe Composites: Preparation, Characterization, and Low Core Loss.

In this study, composites CoFe2O4/Fe were successfully synthesized by in situ oxidation, and their composition, structure, and magnetic properties have been investigated. According to the analysis of X-ray photoelectron spectrometry measure results, the cobalt ferrite insulating layer was completely coated on the surface of Fe powder particles. The evolution of the insulating layer during the annealing process has been discussed, which is correlated to effects on the magnetic properties of the composites CoFe2O4/Fe. The amplitude permeability of the composites reached a maximum of 110, and their frequency stability reached 170 kHz with a relatively low core loss of 253.6 W/kg. Therefore, the composites CoFe2O4/Fe has potential application in the field of integrated inductance and high-frequency motor, which is conducive to energy conservation and carbon reduction.

Spectral properties of a class of Moran measures on [formula omitted

Given a pair (R,D), where R={Ri}i=1∞ is a sequence of expanding matrix (i.e., all the eigenvalues of Ri have modulus strictly greater than 1), and D={Di}i=1∞⊆Z2. It is well known that there exists an infinite convolution generated by (R,D) which satisfies μR,D≔δR1−1D1∗δ(R2R1)−1D2∗⋯,we say that μR,D is a Moran measure if it convergent to a probability measure with compact support in a weak sense, where δE=1#E∑d∈Eδd is the uniformly discrete measure on E. In this paper, we consider the spectral properties of the Moran measure μR,D with R=b100b2, and #Di=p, where 1<b1,b2∈R and p is a prime number, supi∈N,d∈Di|d|<∞. Let B(p):≡{1pjk:1≤j,k≤p−1} and Z(δˆE)={x∈R2:δˆE(x)=0}. We show that under the conditions that Z(δˆDi)=⋃k=1φ(i)Zk(p)for some φ(i)∈N, where Zk(p)⊆B(p)+Z2 with (Zk(p)−Zk(p))∖Z2⊆Zk(p), and Zk(p)⁄⊆B(q)+Z2 for 0<q<p, 1≤k≤φ(i), {x∈[0,1)2:|δˆDi(x)|=1}={00}. Then μR,D is a spectral measure if and only if R=pk100pk2 for some k1,k2∈N. This extends the results of Sierpinski-type measure considered by Dai et.al [ACHA,2021]. Also some sufficient conditions for μR,D being a spectral measure when p is not a prime number are given.

Young versus older subject diffusion magnetic resonance imaging data for virtual white matter lesion tractography.

White matter hyperintensity (WMH) lesions on T2 fluid-attenuated inversion recovery (FLAIR) magnetic resonance imaging (MRI) and changes in adjacent normal-appearing white matter can disrupt computerized tract reconstruction and result in inaccurate measures of structural brain connectivity. The virtual lesion approach provides an alternative strategy for estimating structural connectivity changes due to WMH. To assess the impact of using young versus older subject diffusion MRI data for virtual lesion tractography, we leveraged recently available diffusion MRI data from the Human Connectome Project (HCP) Lifespan database. Neuroimaging data from 50 healthy young (39.2 ± 1.6 years) and 46 healthy older (74.2 ± 2.5 years) subjects were obtained from the publicly available HCP-Aging database. Three WMH masks with low, moderate, and high lesion burdens were extracted from the WMH lesion frequency map of locally acquired FLAIR MRI data. Deterministic tractography was conducted to extract streamlines in 21 WM bundles with and without the WMH masks as regions of avoidance in both young and older cohorts. For intact tractography without virtual lesion masks, 7 out of 21 WM pathways showed a significantly lower number of streamlines in older subjects compared to young subjects. A decrease in streamline count with higher native lesion burden was found in corpus callosum, corticostriatal tract, and fornix pathways. Comparable percentages of affected streamlines were obtained in young and older groups with virtual lesion tractography using the three WMH lesion masks of increasing severity. We conclude that using normative diffusion MRI data from young subjects for virtual lesion tractography of WMH is, in most cases, preferable to using age-matched normative data.

The growth of periodic orbits with large support

In this paper, we study the role of periodic measures with large support in the sense of density in invariant measures and the exponential growth for systems with periodic shadowing property or periodic approximate product property. These results are more refined versions of the Sigmund’s density result of periodic measures and Bowen’s entropy formula between the growth of periodic measures and entropy. Furthermore, we provide an abstract framework such that the results also hold for general homoclinic classes and shifts with non-uniform structure.

Canadian pediatric eating disorder programs and virtual care during the COVID-19 pandemic: a mixed-methods approach to understanding clinicians’ perspectives

BackgroundAs a result of the public health measures put in place during the COVID-19 pandemic in Canada, many health services, including those for the treatment of eating disorders, were provided at a distance. This study aims to describe the adaptations made in specialized pediatric eating disorder programs in Canada and the impact of these adaptations on health professionals’ experience of providing care.MethodsA mixed-methods design was used to survey healthcare professionals working in specialized pediatric eating disorder programs about adaptations to treatment made during the pandemic and the impact of these adaptations on their experience of providing care. Data were collected between October 2021 and March 2022 using a cross-sectional survey comprising 25 questions and via semi-structured interviews. Quantitative data were summarized using descriptive statistics and qualitative data were interpreted using qualitative content analysis.ResultsEighteen healthcare professionals in Canada completed the online survey, of whom six also participated in the semi-structured interviews. The cross-sectional survey confirmed that, unlike in pre-pandemic times, the majority of participants provided medical care (15/18) and mental health care (17/18) at a distance during the pandemic, with most participants using telephone (17/18) and videoconferencing (17/18). Most (16/18) health professionals indicated that virtual care would continue to be used as a tool in pediatric ED treatment after the pandemic. Participants used a combination of virtual and in-person care, with most reporting weighing patients both in clinic (16/18) and virtually (15/18). Qualitative content analysis generated five themes: (1) responding to increased demand with insufficient resources; (2) adapting to changes in care due to the COVID-19 pandemic; (3) dealing with uncertainty and apprehension; (4) virtual care as an acceptable and useful clinical tool, and (5) optimal conditions and future expectations. Most interview participants (5/6) had globally positive views of virtual care.ConclusionsProviding virtual multidisciplinary treatment for children and adolescents with eating disorders seemed feasible and acceptable to professionals during the pandemic. Moving forward, focusing on health professionals’ perspectives and providing appropriate training in virtual interventions is essential given their central role in successful implementation and continued use of virtual and hybrid care models.

Determining minimal clinically important differences in the North Star Ambulatory Assessment (NSAA) for patients with Duchenne muscular dystrophy.

The North Star ambulatory assessment (NSAA) is a functional motor outcome measure in Duchenne muscular dystrophy (DMD), widely used in clinical trials and natural history studies, as well as in clinical practice. However, little has been reported on the minimal clinically important difference (MCID) of the NSAA. The lack of established MCID estimates for NSAA presents challenges in interpreting the significance of the results of this outcome measure in clinical trials, natural history studies and clinical practice. Combining statistical approaches and patient perspectives, this study estimated MCID for NSAA using distribution-based estimates of 1/3 standard deviation (SD) and standard error of measurement (SEM), an anchor-based approach, with six-minute walk distance (6MWD) as the anchor, and evaluation of patient and parent perception using participant-tailored questionnaires. The MCID for NSAA in boys with DMD aged 7 to 10 years based on 1/3 SD ranged from 2.3-2.9 points, and that on SEM ranged from 2.9-3.5 points. Anchored on the 6MWD, the MCID for NSAA was estimated as 3.5 points. When the impact on functional abilities was considered using participant response questionnaires, patients and parent perceived a complete loss of function in a single item or deterioration of function in one to two items of the assessment as an important change. Our study examines MCID estimates for total NSAA scores using multiple approaches, including the impact of patient and parent perspective on within scale changes in items based on complete loss of function and deterioration of function, and provides new insight on evaluation of differences in these widely used outcome measure in DMD.

On-chain global maintenance services: technical, legal and managerial implications

Facility management deals with all activities that are not core business for a company and are consequently outsourced to specialized companies. Maintenance is a fundamental activity in facility management and it is often handled by Global Maintenance Services (GMS) where some maintenance activities are delegated by the company to service providers and are remunerated according to measurable results expressed as Key Performance Indicators. In this context, it would be desirable to have information systems trustable by all involved actors. In this paper, we discuss the design of a blockchain solution capable to support a GMS on-chain. We first introduce the GMS concept and how it is related to the Principal-Agent relationship, and then we show a reference architecture to implement GMS on-chain. We discuss a use case and a proof-of-concept of on-chain GMS in a hospital showing how smart contracts and oracles can be used in this context. We finally discuss the main legal and managerial implications of the proposed approach.