Multiple Design Research Articles

Development and Validation of an Assessment-Driven Behavioral Intervention for Primary Complex Motor Stereotypies in Young Children.

Complex motor stereotypies are rhythmic, repetitive, fixed, and non-goal directed movements (e.g., bilateral flapping/waving movements of the hands/arms). Movements typically begin in early childhood and can occur in otherwise normally developing ("primary") or autistic ("secondary") children. Stereotypies persist, occur multiple times a day, have prolonged durations, can be socially stigmatizing, and may lead to bullying and isolation. Prior behavioral treatment studies have focused on older children (ages 6-12) and report modest reductions in stereotypy (i.e., between 14% and 33%). The current study involves the functional assessment and treatment of five children with Primary Complex Motor Stereotypy using a modified awareness training procedure, differential reinforcement of other behavior, and schedule thinning in a nonconcurrent multiple baseline design. Results suggest a 99% reduction of motor stereotypy from baseline across all participants.

Application of the VDI 2221 method in the design of an air-to-water converter device

Indonesia's drought and water crisis problems have grown significantly in importance in recent years, especially in light of the country's fast population expansion, urbanization, and growing awareness of the effects of climate change. By 2040, there may be a clean water crisis in every region along Java's north coast, from Banten to Surabaya, according to projections made by the Indonesian Institute of Sciences (LIPI). The water crisis could be a major worldwide concern and will be a highly complicated issue. One approach to resolving the water shortage is to design an air-to-water converter device. The purpose of this research is to design a device that can efficiently and effectively convert air into water through condensation processes. The design will be based on the VDI 2221 Method. The rationale behind selecting the VDI 2221 Method is that it is a methodical approach to design that can help a designer generate and guide multiple design options. The primary mechanism of this apparatus is condensation, which turns air into dew points. The author utilized Solidworks 2020 to create the air-to-water conversion device. Through the stages of VDI 2221, the finest design outcomes were obtained from this design. The air-to-water converter mechanism in this design is constructed by version 2, which was chosen as the best option. Based on ASTM A36 material, theoretical calculations on the frame produced a safety factor of 1.45 and a maximum stress of 1.72414 × 108 N/m2. Based on the turbine shaft calculation, the maximum stress of 1.07235 × 108 N/m2 and the safety factor of 2.57379 were obtained using Aluminum 6061 material

Peer-Mediated Social Skills Interventions in Primary School Settings for Autistic Children in the Light of the ICF Bio-psycho-social Model. A Systematic Review.

This systematic review expands the current knowledge about Peer-Mediated Interventions (PMIs) for children with Autism Spectrum Disorder, focusing exclusively on primary school age (6-12years). The study has three aims: (1) describing the main features of the PMI programs; (2) discussing the PMIs efficacy on autistic children's social skills; (3) analyzing whether the PMIs were coherent with the bio-psycho-social model promoted by the International Classification of Functioning, Disability and Health (ICF) classification system, by referring to the person-environment interaction and to the concepts of body functions and structures, environmental factors, and activity and participation. The systematic review followed the PRISMA-P method. The literature search was conducted in August 2024 through PsycInfo, PsycArticles, Education Source, and PubMed databases. A total of 558 articles were generated; 1 study was later added. Twenty-four articles were finally included. Most of the studies used a multiple baseline design across subjects and proved to be effective. Yet, only 5 studies included a follow-up assessment, which showed contrasting results. PMIs partly fit the ICF bio-psycho-social vision, even if they were not designed for this purpose. Our analysis arises from the belief that systematically including the perspective of individual-environment interaction could better guarantee the intervention efficacy.

Exploring co-creator’s experiences: a multiple case study addressing workplace sedentary behaviour

Abstract Co-creation is an innovative approach for addressing complex public health issues. Co-creator’s experience of participating in co-creation can impact engagement yet research investigating co-creation experience is limited. A better understanding of co-creation experiences can inform optimal design and implementation of the co-creation process. This study’s objective was to conduct a cross-case analysis of co-creator’s experiences from 3 co-creation processes aimed at addressing workplace sedentary behaviour within 3 different small-to-medium sized companies in Scotland. Thirty-one co-creators were involved in the case study companies from Oct 2022 to Jun 2023. Data sources included observations, interviews, and researchers’ reflections. A multiple case study design enabled the exploration of co-creator’s experience across cases. A within-case thematic analysis was conducted to develop a deep understanding of cases before comparing findings between cases using Miles and Huberman’s guide to cross-case analysis. Preliminary findings indicate co-creation experiences are associated with events occurring before, during and after the co-creation process and are influenced by company context (i.e., company structure, resources and demands) and co-creation context (i.e., design and facilitation of the process). Co-creators had various motivations for their involvement. During the co-creation process there was a range of common experiences such as a sense of belonging, enjoyment and frustration. After co-creation, there was an overall sense of satisfaction accompanied by positive outcomes, including an intention to adopt healthier behaviours. Insights into co-creator’s experiences support the use of co-creation for addressing workplace sedentary behaviour. The findings have implications for researchers planning co-creation processes at small-to-medium sized companies. Tailoring co-creation to co-creator’s needs and wider company context can enhance its innovative potential. Key messages • This study’s significance lies in its qualitative cross-case analysis of co-creation experiences which enhances research rigour and enables contextualised generalisation. • The innovative potential of co-creation can be enhanced by tailoring it to meet the needs and preferences of the co-creators and considering the wider company context.

Harnessing Available Evidence in Single-Case Experimental Studies: The Use of Multilevel Meta-Analysis.

The use of multilevel models to combine and compare the results of multiple single-case experimental design (SCED) studies has been proposed about two decades ago. Since then, the number of multilevel meta-analyses of SCED studies steadily increased, together with the complexity of multilevel models used. At the same time, many studies were done to empirically evaluate the approach in a variety of situations, and to study how the flexibility of multilevel models can be employed to account for many complexities that often are encountered in SCED research, such as autocorrelation, linear and nonlinear time trends, specific designs, external event effects, multiple outcomes, and heterogeneity. In this paper, we give a state-of-the-art of the multilevel approach, by making an overview of basic and more extended models, summarizing simulation results, and discussing some remaining issues.

Crisis times and school education: is teacher agency changing?

ABSTRACT This article explores how educators dealt with an unprecedented educational crisis using remote teaching and delve into the characteristics of teacher agency in crisis situations. Employing a multiple case study design, the study explores diverse school experiences in the Metropolitan Region of Santiago, Chile. Data were gathered from three schools, comprising 24 interviews (18 teachers and six administrators) and analysed using grounded theory. Findings suggest that teachers demonstrate the ability to reconstruct the affected dimensions when faced with a lack of pedagogical resources for emergency remote teaching (fracture in the iterative dimension) and uncertainty about the future (fracture in the projective dimension). Moreover, the agentic transition can explain the practical-evaluative dimension in crises. Across three stages, agentic transition outlines a journey for teachers, from grappling with an unprecedented crisis with limited resources to normalising their practices with technical expertise in the context of new remote teaching scenarios. The present article introduces key concepts and models and delves into implications and future projections.

Exploring the Role of Business Incubators to Sustainable Startups: A Systematic Literature Review

Business incubators play a crucial role in fostering the sustainability and growth of early-stage startups. They provide access, financial support, training, infrastructure, connections with investors, and more. However, many business incubators do not effectively maximize startup potential. This study aims to systematically review and analyze the key characteristics contributing to the role of business incubators in promoting sustainable startups. The study will follow the PRISMA statement (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and employ document analysis integrating multiple research designs, based on established standards. It will compile and analyze 68 articles from global sources, utilizing open-access articles and accessing primary databases such as Web of Science (WoS) and Scopus for article retrieval. Through content analysis, this study identified fifteen main categories that significantly impact startup businesses: (1) financial support, (2) business support and services, (3) networking support, (4) mentoring activities, (5) infrastructure, (6) human capital, (7) access to knowledge and information, (8) social values and environment, (9) marketing capabilities and support, (10) technology support, (11) entrepreneurship education (courses and curriculum), (12) programs, projects, and events, (13) research and development support, (14) government policy support, and (15) legitimacy involvement. The findings highlight five main aspects—financial, business, networking, mentoring, and infrastructure—as crucial for effective startup support and implementation. From an economic sociology perspective, these articles discuss the dynamic roles of business incubators, emphasizing urgent factors and essential designs for success in the face of future challenges.

Supporting adherence to a home practice reading program using self-monitoring in persons with aphasia: a single case experimental design study

ABSTRACT Background Impairments in reading comprehension impact participation in daily activities for persons with aphasia. Home practice programs can be used by speech-language pathologists to extend treatment by providing additional practice to support recovery. However, adherence to home programs is often low and factors that enhance adherence to home programs are poorly understood. Aims We sought to examine if using self-monitoring practice with an aphasia-friendly logbook and a timer is an effective mechanism to support home program adherence and to explore the perception of this technique by individuals with aphasia. Methods & procedures This non-concurrent multiple baseline single case experimental design was completed during the COVID-19 Pandemic. Procedures were completed virtually or in person. If in person, assessments were done in the clinic or in the participant’s home. The participants (n = 6) were at least six months post-stroke, diagnosed with aphasia, and reported interest in practicing reading. There were five males and one female. During the baseline phase, participants received training on a mobile reading comprehension application on an iPad. They were instructed to practice reading 80 minutes seven days a week, and were not provided with self-monitoring supports, but were given a single cue card that indicated the practice expectation. The number of data points in the baseline phase was at least five and increased across participants. At the end of baseline, participants received training on the use of a timer and an aphasia-friendly logbook for self-monitoring minutes of practice. They were instructed to continue practicing for 80 minutes every day. In both phases, participants received weekly check-ins to ensure the technology was working. Outcomes & results The primary outcome measures were minutes of practice and percent adherence. Three out of the six participants demonstrated an effect with the self-monitoring intervention with more minutes of practice or greater percent adherence during the intervention phase. Responders typically had higher self-efficacy for exercise scores and a shorter baseline phase. Three participants did not demonstrate an effect of the self-monitoring intervention. The logbook was reported as one of the two most helpful features of the intervention by all the participants with weekly technology check-ins and iPad training as the least helpful elements. Conclusions Self-monitoring with an aphasia-friendly logbook and timer can support some individuals with aphasia in achieving a greater amount of home program practice. Additional research with a larger more diverse sample that incorporates timing and self-efficacy for exercise is warranted.

Treating narcolepsy-related nightmares with cognitive behavioural therapy and targeted lucidity reactivation: A pilot study.

Nightmares are a common symptom in narcolepsy that has not been targeted in prior clinical trials. This study investigated the efficacy of Cognitive Behavioural Therapy for Nightmares (CBT-N), adapted for narcolepsy, in a small group of adults. Given the high prevalence of lucid dreaming in narcolepsy, we added a promising adjuvant component, targeted lucidity reactivation (TLR), a procedure designed to enhance lucid dreaming and dream control. Using a multiple baseline single-case experimental design, adults with narcolepsy and frequent nightmares (≥3/week, N = 6) were randomised to a 2 or 4 week baseline and received seven treatment sessions (CBT-N or CBT-N + TLR). Across the groups, there was a large effect size (between-case standardised mean difference [BC-SMD] = -0.97, 95% CI -1.79 to -0.14, p < 0.05) for reduced nightmare frequency from baseline (M = 8.38/week, SD = 7.08) to posttreatment (M = 2.25/week, SD = 1.78). Nightmare severity improved significantly with large effect sizes on sleep diaries (BC-SMD = -1.14, 95% CI -2.03 to -0.25, p < 0.05) and the Disturbing Dream and Nightmare Severity Index (z = -2.20, p = 0.03, r = -0.64). Treatment was associated with a reduction for some participants in sleep paralysis, sleep-related hallucinations, and dream enactment. NREM parasomnia symptoms (z = -2.20, p = 0.03, r = -0.64) and self-efficacy for managing symptoms (z = -2.02, p = 0.04, r = -0.58) improved significantly with large effect sizes. Participants who underwent TLR (n = 3) all recalled dreams pertaining to their rescripted nightmare. In interviews, participants noted reduced shame and anxiety about sleep/nightmares. This study provides a proof of concept for the application of TLR as a therapeutic strategy with clinical populations, as well as preliminary evidence for the efficacy of CBT-N in treating narcolepsy-related nightmares.

A Presentation Framework to Simplify the Development of Java EE Application Thin Clients

Java Enterprise Edition (Java EE) is the most widely adopted platform for developing enterprise-grade applications. This paper presents the design and implementation of a web-based presentation framework for Java EE applications, aimed at simplifying the development process of thin clients. The framework introduces enhancements over existing Java EE frameworks by streamlining repetitive development tasks and integrating multiple design patterns like MVC-2, Service-to-Worker, and Intercepting Filter. A comprehensive evaluation showcases the framework's ability to improve flexibility, reusability, and maintainability, making it a practical choice for enterprise applications.

Improving Social Communication in Autistic Adolescents Through a Clinic-Home-School Collaboration.

Differences in social communication are common in highly verbal autistic adolescents and can interfere with development of friendships as well as lead to other co-occurring challenges. The purpose of this initial study was to assess whether targeted areas of social communication would improve following the implementation of a manualized social communication package with parent participation and school coordination. Autistic adolescents who demonstrated challenges with social communication participated in this study in the context of a rigorous concurrent multiple baseline experimental design. Weekly intervention targeting social communication was implemented over a period of six to seven weeks (depending on preintervention scores). Additionally, parents and participants completed standardized assessments of anxiety and depression and a post-intervention questionnaire was administered to assess their satisfaction with the intervention. This study demonstrated that social communication could be improved with a short-term intervention program with parent and school participation. All participants showed improvements in social communication, which was maintained at follow-up. Also, all participants and their parents reported high satisfaction with the program. These findings corroborate a growing literature base suggesting that support in the area of social communication is needed and can benefit autistic adolescents.

Technology for helping people with neuromotor, intellectual, and speech disabilities engage in leisure and communication activities: a proof-of-concept study.

We extended the assessment of our recently developed technology to help people with neuromotor, intellectual, and speech disabilities access (listen to) music, communicate with distant partners, and answer questions. The technology included a tablet (1) fitted with an Internet connection, a SIM card, WhatsApp Messenger, and MacroDroid application, and (2) interfaced with different pairs of response sensors. Six participants were included in the study, which was carried out according to a nonconcurrent multiple baseline design across participants. During the baseline phase (5-8 sessions carried out over 1-2 weeks), participants were unable to access music, make video calls, or answer questions using a regular tablet. During the intervention phase (50-102 sessions carried out with the technology over 2-4 months), however, they activated means of 4.7-7.6 songs and 0.4-3.6 video calls per session. Moreover, they answered correctly a mean of 69-96% of the questions presented to them. These results suggest that our technology solution is a viable and potentially valuable resource for people with extensive disabilities.

Examining Stakeholders’ Prospects on the Implementation of Equity-Based Strategies in Public Secondary Schools in Tanzania

The desire to address equity issues in the education sector is a shared philosophy by a number of countries, including Tanzania. As a result, Tanzania as a country is striving to address the issue of equity in its education system through the implementation of various equity strategies. This paper therefore sought to examine stakeholders’ prospects on the implementation of equity-based strategies in public secondary schools in Tanzania. Precisely, the interest of the researchers was to explore what was being done in the selected public secondary schools to implement equity-based strategies. A mixed-methods research approach combining both qualitative and quantitative analysis approaches was employed. The study also used a multiple case study design, which allowed the selection of two case study areas i.e. Dodoma City representing the urban setting, and Kondoa district representing the rural setting. A total of One Hundred Forty-Four (144) participants from seven (7) public secondary schools were involved in the study. Data were collected through interviews and questionnaires. Quantitative data were analyzed through descriptive analysis and presented in numerical and graphical form while qualitative data were analyzed through inductive content analysis and presented in thematic form and narratives. Study findings revealed that the selected study schools were indeed implementing a number of activities towards the realization of equity and thus the prospects for implementing equity based strategies in these schools was found to be positive. For instance, activities such as the use of common and understandable language i.e., English and Kiswahili; ensuring that schools have qualified teaching staff, ensuring a supportive learning environment as well as strengthening and supporting school leadership were being implemented. Nevertheless, the study also noted that the implementation of some key factors critical for realization of equity in the schools such as incentive provision to teachers, use of appropriate technology and use of different learning styles was still weak and thus needed improvement.

Myths and Realities of Rural Schools. The Voice of Families and Teachers

Introduction. By invoking Shakespeare’s famous query, ‘to be or not to be, that is the question,’ this study examines rural schools by exploring the beliefs and myths surrounding them and contrasting these perceptions with the realities of daily life in 6 unitary rural schools located in the northwest of Spain. Aims. This study aims to listen to and shed light on the perspectives and feelings of families and teachers in rural schools with multi-grade classrooms. Method. Using a multiple case study design and triangulating qualitative instruments (photovoice, incomplete sentence prompts, and observation), we analyzed the evaluations and experiences of 76 families and 18 teachers concerning the context, the educational practice, and the internal sphere of rural schools. The data were processed through content analysis using ATLAS.ti 22 software, resulting in the identification of 8 categories and 3 dimensions: space and resources, coexistence, teaching and learning in rural schools. Results. The findings reveal several myths and idealizations held by teachers and families regarding the following aspects: the natural rural environment; facilities, infrastructures, resources, and services; coexistence; individualisation, multi-grade classrooms, and academic performance in rural schools. Conclusions. The study concluded that some of these myths do not align with the actual conditions of the studied environment. Rural schools can offer authentic, high-quality learning experiences on equal terms with other educational institutions, dependent on the mediation of the teaching teams that work in them. The study allows for reflection and provides information not only to visibility of rural schools and empower them but also to make decisions enable their educational improvement.

Longitudinal Analysis of Natural History Progression of Rare and Ultra-Rare Cerebellar Ataxias Using Item Response Theory.

Degenerative cerebellar ataxias comprise a heterogeneous group of rare and ultra-rare genetic diseases. While disease-modifying treatments are now on the horizon for many ataxias, robust trial designs and analysis methods are lacking. To better inform trial designs, we applied item response theory (IRT) modeling to evaluate the natural history progression of several ataxias, assessed with the widely used scale for assessment and rating of ataxia (SARA). A longitudinal IRT model was built utilizing real-world data from the large autosomal recessive cerebellar ataxia (ARCA) registry. Disease progression was evaluated for the overall cohort as well as for the 10 most common ARCA genotypes. Sample sizes were calculated for simulated trials with autosomal recessive spastic ataxia Charlevoix-Saguenay (ARSACS) and polymerase gamma (POLG) ataxia, as showcased, across multiple design and analysis scenarios. Longitudinal IRT models were able to describe the changes in the latent variable underlying SARA as a function of time since ataxia onset for both the overall ARCA cohort and the common genotypes. The typical progression rates varied across genotypes between relatively high in POLG (~ 0.98 SARA points/year at SARA = 20) and very low in COQ8A ataxia (~ 0.003 SARA points/year at SARA = 20). Smaller trial sizes were required in case of faster progression, longer trials (~ 75-90% less with 5 years vs. 2 years), and larger drug effects (~ 70-80% less with 100% vs. 50% inhibition). Simulating under the developed IRT model, the longitudinal IRT model had the highest power, with a well-controlled type I error, compared to total score models or end-of-treatment analyses. The established longitudinal IRT framework allows efficient utilization of natural history data and ultimately facilitates the design and analysis of treatment trials in rare and ultra-rare genetic ataxias.

Increasing the speed of digital devices using the ASMD-FSMD method using non-blocking operators

The ASMD-FSMD method for designing digital devices is considered, which consists of constructing a block diagram of an algorithmic state machine with a data path (ASMD), which describes the behavior of the device, and creating project code in Verilog in the form of a finite state machine with a data processing path. (finite state machine with datapath – FSMD). One of the directions for the development of the ASMD-FSMD methodology is the use of features of the hardware description language (HDL). A hypothesis has been put forward: in the ASMD-FSMD technique, it is possible to apply several non-blocking assignment operators to the same variable in one synchronization cycle, which will lead to an increase in device performance. The hypothesis put forward was investigated in the design of synchronous multipliers that implement the classical multiplication algorithms c and d. Experimental studies have confirmed the validity of the put forward hypothesis, while the speed of the multipliers increases two to three times, and the cost of implementation in most cases decreases compared to the traditional approach.

An intensive eye-tracking intervention in children with dyskinetic cerebral palsy: a multiple case study

This study aimed to explore the effects of a four-week intensive eye-tracking intervention on children with dyskinetic cerebral palsy (DCP), focusing on goal attainment, communication competencies, stress levels, subjective workload, and caregivers’ perception of psychosocial impact. A multiple case study design with non-concurrent, staggered multiple baselines was employed, involving three children aged 7, 12, and 13 years. The study included a randomized baseline period of two or three weeks, an intensive eye-tracking intervention, and a six-month follow-up. Two individual eye-tracking goals were identified and assessed using the Goal Attainment Scale, while communication competencies were evaluated with the Augmentative and Alternative Communication Profile: A Continuum of Learning. Stress levels were monitored through Heart Rate Variability measured by the Bittium Faros 360° ECG Holter during eye-tracking tasks. Subjective workload and psychosocial impact were assessed using pictograms and the Psychosocial Impact of Assistive Devices Scale, respectively. Descriptive statistics were applied for analysis. All participants attained and retained their eye-tracking goals, regardless of their initial functional profiles or prior experience with eye-tracking technology. Post-intervention improvements in communication competencies were maintained at the six-month follow-up. Variations in stress levels, subjective workload, and psychosocial impact were observed among participants across different phases of the study, aiding the interpretation of the results. The study concludes that a structured, tailored, four-week intensive eye-tracking intervention can yield successful results in children with DCP, irrespective of their baseline communication abilities or functional profile. Recommendations for future research, including more robust methodologies and reliable computerized tests, are provided.

V-spline design for enhanced performance in turbine blade internal cooling

Abstract Past experiments have consistently shown that V-shaped rib turbulators are among the best in heat transfer performance. While there is literature on the V rib design in various experimental studies, there is no literature that shows the V rib design applied on any current turbine blades. Instead, the straight and angled rib design are used. The V rib only offers a marginally better heat transfer performance over the angled rib, but it has a severe stress concentration at the rib tip. In this research, multiple design augmentations were analyzed, with the addition of a spline at the center of the V exhibiting alleviation of the tip stress concentration. The results show that the presence of the spline not only resolves the fatigue issues but also increases the heat transfer performance by 4.3% and 8.2% against the V rib and angled rib design respectively. With a better heat transfer performance, the creep analysis shows that the turbine blade with a V-spline rib design can operate at temperatures 203°C hotter than an angled rib at the same fluid power. Given the dependence of engine thermal efficiency on turbine inlet temperature, this simple design shows good potential for heat transfer augmentation.

The impact of cultural practices on the outcome of IT risk management implementation

PurposeThe objectives of this research are two-fold. The first is to explore, describe and explain the relevance of the concept of Information Technology risk management (ITRM) implementation processes. In this regard, we were required to understand the interaction between contextual issues, the ITRM framework itself, IT individual interpretations toward them and their effect on implementation. The second objective is to develop a theoretical model for use in guiding the design and analysis of the proposed empirical work. The study introduces a fresh perspective to an established research area. It is argued that without more emphasis on the dynamic nature of the implementation process, an incomplete understanding of the problem will result.Design/methodology/approachThe study adopts an interpretive methodology to a multiple case study design gathering and analysing qualitative evidence. A series of three case studies was designed around 22 semi-structured in-depth interviews conducted to investigate IT individuals’ role in facilitating a successful ITRM implementation.FindingsThe findings provide new insights in relation to ITRM implementation by considering IT individual culture. The research develops a substantive theory involving a schematic model involving a set of theoretical propositions. These findings suggest a dynamic approach to implementing IT risk management framework — one that considers the interaction over time of intentions, context, process and action around risk management frameworks.Research limitations/implicationsThis study makes important theoretical contributions to the understanding of organizational implementations by taking a dynamic view of implementation, identifying different individual IT culture archetypes, emphasizing the role of social aspects and developing a set of key factors and contextual conditions.Practical implicationsThis model offers managers an understanding of how IT individual culture and the factors and contextual conditional work together over time to ensure a successful ITRM implementation. Meanwhile, it sheds some light on how managers treat IT individuals with different levels of experience differently.Originality/valueWe theorize IT individual culture and the factors and contextual conditional and show their effects on ITRM implementation success, thus making an essential contribution to the information systems and implementation research and practice. Moreover, we provide a novel methodology to conceptualize ITRM implementation as a cultural process through which IT people socially construct the meanings and purposes of their work activities. This research answers scholars’ call to construct more accurate explanations of innovation outcomes in an increasingly IS implementation world.

Economic Burden of Community-Acquired Antibiotic-Resistant Urinary Tract Infections: Systematic Review and Meta-Analysis.

Antibiotic resistance (ABR) poses a major burden to global health and economic systems. ABR in community-acquired urinary tract infections (CA-UTIs) has become increasingly prevalent. Accurate estimates of ABR's clinical and economic burden are needed to support medical resource prioritization and cost-effectiveness evaluations of urinary tract infection (UTI) interventions. This study aims to systematically synthesize the evidence on the economic costs associated with ABR in CA-UTIs, using published studies comparing the costs of antibiotic-susceptible and antibiotic-resistant cases. We searched the PubMed, Ovid MEDLINE and Embase, Cochrane Review Library, and Scopus databases. Studies published in English from January 1, 2008, to January 31, 2023, reporting the economic costs of ABR in CA-UTI of any microbe were included. Independent screening of titles/abstracts and full texts was performed based on prespecified criteria. A quality assessment was performed using the Integrated Quality Criteria for Review of Multiple Study Designs (ICROMS) tool. Data in UTI diagnosis criteria, patient characteristics, perspectives, resource costs, and patient and health economic outcomes, including mortality, hospital length of stay (LOS), and costs, were extracted and analyzed. Monetary costs were converted into 2023 US dollars. This review included 15 studies with a total of 57,251 CA-UTI cases. All studies were from high- or upper-middle-income countries. A total of 14 (93%) studies took a health system perspective, 13 (87%) focused on hospitalized patients, and 14 (93%) reported UTI pathogens. Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa are the most prevalent organisms. A total of 12 (80%) studies reported mortality, of which, 7 reported increased mortality in the ABR group. Random effects meta-analyses estimated an odds ratio of 1.50 (95% CI 1.29-1.74) in the ABR CA-UTI cases. All 13 hospital-based studies reported LOS, of which, 11 reported significantly higher LOS in the ABR group. The meta-analysis of the reported median LOS estimated a pooled excess LOS ranging from 1.50 days (95% CI 0.71-4.00) to 2.00 days (95% CI 0.85-3.15). The meta-analysis of the reported mean LOS estimated a pooled excess LOS of 2.45 days (95% CI 0.51-4.39). A total of 8 (53%) studies reported costs in monetary terms-none discounted the costs. All 8 studies reported higher medical costs spent treating patients with ABR CA-UTI in hospitals. The highest excess cost was observed in UTIs caused by carbapenem-resistant Enterobacterales. No meta-analysis was performed for monetary costs due to heterogeneity. ABR was attributed to increased mortality, hospital LOS, and economic costs among patients with CA-UTI. The findings of this review highlighted the scarcity of research in this area, particularly in patient morbidity and chronic sequelae and costs incurred in community health care. Future research calls for a cost-of-illness analysis of infections, standardizing therapy-pathogen combination comparators, medical resources, productivity loss, intangible costs to be captured, and data from community sectors and low-resource settings and countries.