Original Purpose Research Articles

PRIORiTize-TAVI might predict more than transcatheter aortic valve replacement waiting list priorities

Abstract Background PRIORiTize-TAVI (Predicting moRtalIty Or uRgent TAVI on waiting list) is a novel scoring system targeting identification of patients at risk of urgent hospitalization or death whilst waiting for transcatheter aortic valve replacement (TAVR) (1). Patients are divided into those with low (<2 points), intermediate (3-4 points) and high (>5) waiting risk. Given the novelty of the score, additional research is required to further validate it. However, being compiled of parameters applied in everyday practice that are readily available, the application of the score might have the potential to go beyond its original purpose. Purpose We aimed to investigate whether PRIORiTize-TAVI score can predict postprocedural complications and survival following TAVR. Methods We conducted a registry-based study including patients who underwent TAVR at our institution from 2018 to 2023. PRIORiTize-TAVI was calculated summarizing points according to NYHA status, left ventricular ejection fraction (LVEF), NTproBNP, mean pressure gradient (meanPG) and Charlson comorbidity index (CCI) at the time of patient placement onto TAVR waiting list. Results This registry-based study included 252 patients with median age 80 (interquartile range (IQR) 76-84) years, 50% female. Median PRIORiTize score was 5 (IQR 3-7). There were 41 (16%) low, 51 (20%) intermediate and 160 (64%) high risk patients. High risk patients had more frequently atrial fibrillation and ischaemic stroke, had lower LVEF and estimated glomerular filtration rate (eGFR), higher NTproBNP levels and CCI (Table 1). MeanPG also statistically differed between intermediate risk group and low risk group, but not with high risk group (Table 1). TAVR waiting time was significantly shorter in high-risk patients in comparison to intermediate risk patients. There was no statistical difference regarding baseline characteristics between the three groups (Table 1). There was no statistical difference in post-TAVR complications between the three groups. Survival significantly differed depending on PRIORiTize risk stratification (P=.023), as shown in Figure 1. Median survival time for high risk patients was 49 months (IQR 42-49), whereas the median survival time for intermediate and low risk patients could not be reached. High risk patients had lower survival probability compared to both intermediate (HR 4.089; CI 1.91-8.73) and low risk (HR 2.078; CI 0.77-5.59) patients. Intermediate risk patients had a higher survival probability compared to low risk patients (HR 0.508; CI 1.67-1.54). Length of TAVR waiting time had no significant association with overall survival (P=.891). Conclusions Our data show that PRIORiTize-TAVI has a potential to be used as a prognostic tool to predict survival probability post-TAVR. Our results suggest that prolonged time on TAVR waiting list did not negatively impact patient postprocedural complications nor survival.Table 1Figure 1

4.D. Scientific session: From policy to implementation: Learnings around health system reforms and Universal Health Coverage

Abstract In this session, the authors and audience have the opportunity to engage in discussions around health policy integrity and reform implementation. Introducing and implementing health system reform has been a perennial issue for countries around the world over the past number of decades. Recently, the introduction and implementation of Universal Health Coverage (UHC) has been of particular focus, with 193 countries committed to introducing UHC by 2030. At the same time, European countries that previously established national health systems are introducing new reforms in the hope of making their health systems more efficient and equitable. However, there are a number of challenges along the path of policy development and implementation with which all countries must grapple, and how individual countries go about reforming their health systems depends on their social, political, cultural and economic contexts. Learnings from around the world have highlighted that reforms can be challenged or stalled in both the design and implementation phases. This workshop, which conceptualises implementation as the “acid test” of a policy, thus explores, through three case studies, the factors that facilitate or challenge the implementation of reforms. At the same time, we discuss policy integrity, exploring reasons for why policies pivot away from original design and intent. Furthermore, we discuss the implications of health reform on equity, cognisant that the primary objective of this collective reform work is to reduce the financial burden of healthcare on households and improve access. The first presentation will provide the framework for audience discussions, outlining international lessons in relation to UHC reforms and equity. The second presentation will provide a snapshot of the Finnish experience of introducing a “big bang” structural reform. The third presentation highlights lessons from the Portuguese experience of primary healthcare reforms, the opportunity these offer for creating patient-centred care and the integral role that politics and governance play in the reform process. Finally, the Irish case study highlights the experiences of a High Income County attempting to introduce UHC much later than its European counterparts, and negotiations between the public and private sectors. Through this, we hope to hold the tensions and stimulate debate about policy robustness and resilience, and reform implementation. Each presenter will be given a strict deadline of 10 minutes each by the chair and then the audience will be invited to debate the problems identified and strategies proposed to discuss: (i) what are the facilitators and barriers to reform implementation, (ii) what are the factors that encourage policy integrity and change and (iii) whether greater cooperation across Europe regarding health reforms can be more effective in supporting robust health systems. Key messages • For reforms to be facilitated, there must be cohesion and commitment across the political, social, economic and cultural systems, and no fragmentation across health system functions. • As policy implementation is attempted, there is a tension between remaining true to key values and adapting to new circumstances.

The meta-governance of quality registries for public health

Abstract Issue/problem Healthcare-related planning and policy requires evidence, which in turn requires data. Generating sensitive, high-quality data is expensive. Given the constraints of routine or study-related data for quality monitoring, quality registries are commonly used. But when is it adequate, from a public health meta-governance point of view, to establish dedicated quality registries? Description of the problem Many countries have established public patient registries over time. The lack of a meta-governance framework complicates decision-making for establishing and funding dedicated quality registries. Simultaneously, legal advancements like the European Health Data Space may enhance the use of routine data in healthcare policy, potentially transforming both registry and meta-governance practices. Results We identified key meta-governance challenges, such as setting criteria for the creation, modification, or closure of registries, deciding on public funding and choosing between routine and specially collected data. We argue against using absolute thresholds like disease prevalence, advocating for a scorecard approach that evaluates epidemiologic reasoning, policy relevance, healthcare impact and factors like data availability and registry synergies. Lessons The EHDS will enable enhanced secondary data use, necessitating decisions on when to use routine versus specifically collected data. Decision-makers must consider sustainability, ethics, practicability and data linkability, while recognizing risks such as data quality limitations and potential bias from original data collection purposes. Key messages • The necessity for quality registries varies by case, serving specific policy questions. Optimizing funds and avoiding arbitrary decisions require a strategy based on a meta-governance framework. • With the introduction of EHDS, the focus may shift more toward data curation and quality control, making it critical to align registry efforts with the broader health information system.

Consumer Confusion: The Sole Focus of Trademark Law

Abstract: In recent years, the expansion of the global marketplace, driven by the digital revolution, has led to a growing complexity in trademark disputes. The balance between protecting intellectual property and preventing consumer confusion has become increasingly delicate. Traditionally, trademark law was designed primarily to prevent consumer confusion and ensure fair competition. However, with the introduction of the dilution concept, this focus has shifted, resulting in expanded trademark rights that can inhibit innovation and free competition. This paper revisits the original intent of trademark law, advocating for a refocus on consumer confusion as the core principle. Through an examination of legislative intent, theoretical underpinnings, and case law, this paper demonstrates the need to reorient trademark protections to ensure they serve the broader goal of market fairness and economic development. This research highlights that excessive protection of trademark rights can lead to monopolistic practices, which ultimately harm both consumers and market competition. It contributes to the ongoing discussion about how to balance trademark rights with consumer protection, aiming to guide future legal reforms that foster both innovation and competition.

The concept map as a tool for analyzing museum objects

AbstractThis paper discusses using the concept map to study museum objects. The tool's original purpose, which was created in the 1970s by Joseph Novak, was to graphically represent the construction of knowledge of scientific topics by learners, particularly children. Concept maps start from the premise that new knowledge is always built on previous knowledge and allow the representation, organization, and relationship between concepts, which are seen as the primary elements of knowledge. Novak recognized that its potential is insufficiently explored and encouraged its application in different disciplines and fields that deal with concepts and their relationships. This incentive led the Museum of Astronomy and Related Sciences (Rio de Janeiro, Brazil) to adopt the concept map on an experimental basis to analyze objects in its collection. At first, the tool sought to emphasize the conceptual potential of museum objects and shed more light on their trajectory in time and space and the numerous possible connections with events, institutions, concepts, people, and other objects. In the initial experimental phase, the maps were included in papers presented at academic events and discussed with professionals dedicated to science and technology collections and other specialists in Museology and Information Science. In the second stage, maps began to be produced in greater numbers and on demand, focusing on objects selected for a temporary exhibition. Based on the assumption that museum objects are both unique and representative of a class of objects that share the same name and function, the maps constructed were based on Ingetraut Dahlberg's Theory of Concept, which distinguishes between general and individual objects and concepts.

Design by Transitional Committee: learning from the Green Climate Fund

ABSTRACT In 2022 at the UN climate conference in Sharm el-Sheikh (COP27), countries agreed to establish a new fund for loss and damage. This decision was one of the most significant outcomes of the COP, and something Small Island Developing States had spent the previous three decades calling for. The approach taken to realize this new funding arrangement includes many similarities to that taken to create a similarly significant new fund twelve years earlier – the Green Climate Fund (GCF) – including its design by a Transitional Committee. The aim of this article is to assess the extent to which the ambitions for the GCF have been realized, with a view to informing the ongoing design and early implementation of the new fund. To do this, the article compares the GCF’s present-day outcomes to its original intentions as described by the COP16 decision text. This paper finds that the GCF’s operation today only partially reflects the ambitions expressed at COP16. While the ambition for a Board with equal representation by developing and developed countries has been achieved, ambitions to expand the sources of finance and increase funding for adaptation have been mixed. The influence of the World Bank was a key point of tension over the GCF’s Transitional Committee period, and the Bank continues in the Trustee role today. The role of the Committee’s Technical Support Unit – the group of staff seconded from various international development banks and agencies to provide technical and administrative support to the GCF’s Transitional Committee – had an outsized influence on the shape of the GCF, such that these organizations continue to receive the bulk of GCF funding today. These findings suggest a greater plurality of voices providing such technical inputs would enhance the design of new funding bodies. The creation of new international finance institutions is relatively rare, so understanding the history of the GCF’s design is important for contextualising discussions about other climate finance options.

The covert and overt role of art in landscape partnership

Although in recent history the arts have received substantial attention as a conduit for memorable artworks to draw attention to issues that may be coincidental to the artists original intention, this does not acknowledge the arts as equal partner in a shared enterprise but more to facilitate the accessibility of difficult concepts. This essay explores the capability for the visual arts to increase understanding of issues as disparate as the loss of rural landscape to urban development and the incremental effects of sea level rise upon coastal communities. With increased specialisation of disciplinary practice there is an incapacity to address the multi-dimensional character of practical challenges, particularly in the matter of the societal impacts of environmental change. This demands greater flexibility in approach to policy and an understanding that the increasing frequency of unforeseen events beg the question of our cultural preparedness to evolve a new paradigm for knowledge sharing.

Task-oriented EEG denoising generative adversarial network for enhancing SSVEP-BCI performance.


The quality of electroencephalogram (EEG) signals directly impacts the performance of brain-computer interface (BCI) tasks. Many methods have been proposed to eliminate noise from EEG signals, but most of these methods focus solely on signal denoising itself, disregarding the impact on subsequent tasks, which deviates from the original intention of EEG denoising. The main objective of this study is to optimize EEG denoising models with a purpose of improving the performance of BCI tasks.
Approach.
To this end, we proposed an innovative Task-Oriented EEG Denoising Generative Adversarial Network (TOED-GAN) method. This network utilizes the generator of GAN to decompose and reconstruct clean signals from the raw EEG signals, and the discriminator to learn to distinguish the generated signals from the true clean signals, resulting in a remarkable increase of the signal-to-noise ratio (SNR) by simultaneously enhancing task-related components and removing task-irrelevant noise from the original contaminated signals.
Main results.
We evaluated the performance of the model on a public dataset and a self-collected dataset respectively, with canonical correlation analysis (CCA) classification tasks of the steady-state visual evoked potential (SSVEP) based BCI. Experimental results demonstrate that TOED-GAN exhibits excellent performance in removing EEG noise and improving performance for SSVEP-BCI, with accuracy improvement rates reaching 18.47% and 21.33% in contrast to the baseline methods of convolutional neural networks, respectively
Significance.
This work proves that the proposed TOED-GAN, as an EEG denoising method tailored for SSVEP tasks, contributes to enhancing the performance of BCIs in practical application scenarios.

Informed consent in the age of smart technologies

Technology is increasingly being brought into the home care of older people. Digitalization is seen as an enabler for efficient and resource-saving operations. In the use of technology, informed consent is considered an ethical practice and part of a responsible home care service system. The aim of this article is to describe the problem of informed consent in situations where emerging technologies, such as artificial intelligence (AI) and mass data, are used as part of welfare services and home care for older people. The article discusses principles and ways to better integrate informed consent as an ethical practice into a responsible home care service system. A qualitative study was carried out to gather the views of experts in the field of elderly care and ethics. A content analysis of a semi-structured focus group was used to explore perceptions of the changing nature of informed consent. According to our findings, the informed consent model requires updating. The key is to embrace the idea that consent is a living process designed to respect people's autonomous choices and protect them from risk. If the nature of the use of the data collected from individuals changes significantly in the future, the consent should also be updated to reflect this change. This aspect is important because new technologies will change the nature of the collection and use of the data. Mass data collection combines multiple databases so that the resulting data can be used even far from the original purpose or context in which it was collected. Therefore, consent should always be tailored to the context, allowing sufficient time for the person seeking and giving consent to clarify the content of the consent. This process highlights the importance of understanding the agency of the consent giver.

Modelado de paredes de mampostería confinada: revisión de métodos y aplicación utilizando macroelemento discreto

One of the main challenges assessing masonry structures is numerical simulation. An overview and classification of the current developments and available techniques for nonlinear analysis of confined masonry structures is presented. As an exploratory study, an application of a numerical model using a Discrete Macro Element Method was carried out. It consisted on the calibration of mechanical parameters for representing the capacity curve and damage progression of a confined masonry wall tested under quasi static cyclic load. Then a sensitivity analysis was carried out. It has been found that global behavior is well captured by the model regarding strength and deformation. However, failure mode at confining elements was not consistent with the observed damage. Calibration has been made only for one experimental test; thus, conclusions are only valid for this set of experimental results. It is considered that the Discrete Macro Element Method is suitable not only to reproduce the global behavior of complete buildings, which is its original purpose, but also it may be used to study element behavior with appropriate modifications. ILIA: Investigaciones Latinoamericanas en Ingeniería y Arquitectura, No. 01, 2024: 108-114.

Object-Oriented Fixpoint Programming with Datalog

Modern usages of Datalog exceed its original design purpose in scale and complexity. In particular, Datalog lacks abstractions for code organization and reuse, making programs hard to maintain. Is it possible to exploit abstractions and design patterns from object-oriented programming (OOP) while retaining a Datalog-like fixpoint semantics? To answer this question, we design a new OOP language called OODL with common OOP features: dynamic object allocation, object identity, dynamic dispatch, and mutation. However, OODL has a Datalog-like fixpoint semantics, such that recursive computations iterate until their result becomes stable. We develop two semantics for OODL: a fixpoint interpreter and a compiler that translates OODL to Datalog. Although the side effects found in OOP (object allocation and mutation) conflict with Datalog's fixpoint semantics, we can mostly resolve these incompatibilities through extensions of OODL. Within fixpoint computations, we employ immutable algebraic data structures (e.g. case classes in Scala), rather than relying on object allocation, and we introduce monotonically mutable data types (mono types) to enable a relaxed form of mutation. Our performance evaluation shows that the interpreter fails to solve fixpoint problems efficiently, whereas the compiled code exploits Datalog's semi-naïve evaluation.

Penolong yang Sepadan menurut Kejadian 2:18 terkait Perdebatan Kepemimpinan Wanita dalam Gereja

The text of Genesis 2:18 is one of the passages debated by Complementarians and Egalitarians regarding the role of women as "helpers." Complementarians believe that the role of a helper indicates the functional subordination of women to men. According to them, Adam and Eve are spiritually equal, but Eve is not equal to Adam in function because she is his helper. For this reason, Complementarians refuse to place women in positions of leadership in the church. On the other hand, Egalitarians believe that women should have the same opportunities as men, including in church leadership. This study aims to analyze Genesis 2:18 in relation to the debate on women's leadership in the church. The method used is exegesis, to uncover the meaning according to the original author's intent when the text was written. The results of this study indicate that the helper provided by God is not a subordinate, but a partner. Women were created as partners to help their husbands so that God's mandate could be fulfilled through the unity of the two. This context applies to the household, not the church. Therefore, this role should not be used to prohibit women from teaching and leading in the church.

초등학교 디지털 기반 교육의 외재성 비판 및 시사점 탐색: 아이들의 흥미는 어디에서 오는가

The purpose of this study is to criticize the problems of digital-based education, which is actively discussed in the elementary school field, and to derive educational implications based on Dewey's concept of ontological interest. As a research method, the core ideas were summarized by analyzing Dewey's primary works and secondary studies with a syntopical reading method. As a result of the study, digital-based education promoted in the field of elementary school had a risk of external goods. As an educational implication for solving this problem, first, digital materials and teaching aids should be used as a medium for realizing educational interest beyond simple curiosity or impulse. Second, in the case of digital textbooks, it should be used as a place for the development of intellectual thinking through inquiry based on intrinsic interest. Third, regarding the use of digital platforms, it was discussed that the original purpose of education can only be realized by utilizing ontological interests in virtual and real spaces. Digital education in elementary schools will be established as an education that can develop the power to continue to grow when efforts and thinking are integrated based on the ontological interests of children.

20th-Century World Built Heritage Facing Water: Conservation of Fallingwater and Boa Nova Tea House

The conservation of 20th-century architectural heritage presents unique challenges due to the modern materials and construction techniques used by pioneering architects. This paper investigates the preservation challenges of iconic architectural works exposed to water environments, focusing on Fallingwater by Frank Lloyd Wright and the Boa Nova Tea House by Álvaro Siza Vieira. These structures, situated in natural settings with significant exposure to water, serve as case studies for examining conservation methods and their broader implications. This study explores archival documents, interviews with conservation experts, and literature reviews to highlight the main degradation phenomena related to the impact of environmental conditions on the material’s integrity. Despite limited specific data on monitoring and maintenance, this research underscores the importance of ongoing conservation efforts. Fallingwater’s case highlights the necessity of restoration techniques, while the Boa Nova Tea House illustrates minimal intervention strategies to maintain authenticity. This study concludes that the effective conservation of 20th-century built heritage necessitates a balance between preserving original design intents and adapting to environmental challenges. It emphasizes the need for innovative conservation strategies, adherence to international guidelines, and the establishment of comprehensive management and monitoring plans to safeguard the integrity and authenticity of culturally significant architecture.

Agronomic dataset on potato growth and yield in the Netherlands

Data was collected at two field locations in the Netherlands: on the clayey soils in Lelystad and the sandy soils of Vredepeel during 2019 and 2020. The original aim of this dataset was to calibrate and evaluate crop growth models for estimating potential, water-limited and nitrogen-limited yield levels for modern potato cultivars. Therefore, treatments include different cultivars, irrigation regimes, nitrogen fertilization, and light interception. During the two seasons extensive data was collected either passively, via non-destructive or via destructive measurements. Passive measurements consisted of weather and soil moisture data and were taken continuously throughout the season. Non-destructive data was collected on photosynthesis, reflection/light intensity, SPAD chlorophyll values, plant height, crop phenology, and groundwater level roughly every other week throughout the seasons. Destructive measurements were taken on biomass (leaves, stems and tubers), leaf area, NPK content (leaves), and the number of tubers between five and seven times per season. Additionally, during the final harvest data was collected on the tuber size distribution, marketability, and NPK content of the tubers.

Public health as critique: examining the caste of filth and disease in Katherine Mayo’s Mother India

Drawing on Dalit writer Kanwal Bharti’s 2019 translation of Katherine Mayo’s Mother India (1927), this essay argues that through the employment of a radical anti-caste reading practice, the original text yields a powerful critique of Hindu caste structures and Hindu supremacist ideologies that assume a new significance in contemporary India. An against-the-grain reading of Mayo’s emphasis on life and health as opposed to casteized purity, when unmoored from the author’s original intentions, offers a vision of public health that operates in conjunction with the social, and can be reclaimed to the advantage of the marginalized and dispossessed. In its emphasis on the impact of colonial modernity on marginalized lives in colonial India, the text finds an intriguing alignment with radical anti-caste politics. This solidarity between what is widely recognized as a colonialist critique on the one hand, and radical anti-caste thought on the other, I argue, is a reminder of the uneasy relationship between colonial politics, Hindu nationalism, and anti-caste politics that sought to use colonial rule to strategically counter Hindu supremacy.

153 Use of probiotics in feedlot diets

Abstract The Food and Agricultural Organization of the United Nations and World Health Organization classifies probiotics as live microorganisms that have health benefits when fed to animals. While the original purpose of probiotic use in beef cattle was to enhance rumen health and to establish a healthy gastrointestinal tract microflora in young calves, probiotic use in finishing cattle has been steadily increasing. The reason for this increase in use of probiotics in feedlot cattle diets is primarily due to public health concern with antimicrobial resistance from the use of antimicrobial technologies in feedlot cattle diets to improve performance and reduce the incidence of disease. Feedlot cattle consuming high concentrate diets for extended periods of time can experience shifts in rumen microflora that may be detrimental to rumen health which can impact overall animal performance. There are several different strains of probiotics (e.g., lactic acid producing, lactic acid utilizing bacteria,) that can function to optimize the microbial populations within the gastrointestinal tract to improve gut health. With improved gut health, improvements in nutrient digestion, absorption, immune function, and barrier function are possible. Several recent experiments supplementing feedlot cattle with probiotics have reported improved ADF digestibility, increased ruminal pH, improved ruminal lactic acid clearance, inhibited C. perfringens Types A and C growth in vitro, increased red blood cell superoxide dismutase activity, and improved average daily gains during certain portions of the feeding period. However, other probiotic supplementation experiments have not observed improvements in growth and health responses in feedlot cattle. The reason for the discrepancies between the experiments may be due to differences in animal production scenarios, the ingredient and nutrient composition of the basal diet, dosage of the probiotic, and the bacterial composition of the probiotic. Future research investigating the impact of individual strains of probiotics and combinations of different probiotic bacteria is warranted.

On The Politics of Arabic Literary Translation

This paper examines the external factors influencing the selection and reception of literary texts in translation, with a focus on the representation of Arab culture in the West. Drawing on Andre Lefevere's (1992) concept of patronage, the author discusses how patrons, including institutions and individuals, shape the translation and publication of Arabic literary works and explores their impact on the representation of Arab culture in the West. The paper gives examples of several translated Arabic works, reading through the external factors that have influenced their selection, translation, and reception in their target culture. The study contends that the translation of Arabic literature is often driven by ideological and financial motivations, resulting in a restrictive representation of Arab culture that perpetuates stereotypes and exoticism. Furthermore, the paper argues that the “decontextualization” of translated texts leads to a loss of their original identity and purpose, as they are re-inserted within their new context and reinterpreted according to the socio-cultural background of the target audience. By shedding light on the complex dynamics governing literary translation from Arabic, this study highlights the need for understanding the external factors that shape the translation and representation of Arabic literature in the West.

Oral sodium lactate ingestion does not increase blood lactate concentrations and is accompanied by moderate to severe gastrointestinal side effects.

Lactate has diverse roles in biology and has been implicated in the control of energy intake. A variety of methods (i.e., exercise, ingestion, infusion) have been used to study its effects on different metabolic outcomes and the original intent of this project was to explore the effect of oral sodium lactate (Na-Lactate) ingestion on appetite regulation. During piloting we were unable to show that Na-Lactate could increase blood lactate concentrations, thus the purpose of the brief manuscript is to highlight that oral Na-Lactate ingestion is not an effective method to study lactate metabolism. Five male participants (26 ± 3 y, 82.4 ± 3.8 kg, 25.4 ± 1.6 kg∙m-2) completed 15 experimental sessions where Na-Lactate solutions were consumed with assessment of blood lactate pre-ingestion, 30 min, 45 min, and 60 min post-ingestion. Oral Na-Lactate ingestion did not increase blood lactate concentrations (Pre: 0.9±0.2; 30 min: 1.2±0.7; 45 min: 1.0±0.5; 60 min: 0.9±0.4 mmol∙L-1). Additionally, there were moderate-severe gastrointestinal (GI) side effects (e.g., vomiting, diarrhea) following ingestion. Taken together our data suggest that oral ingestion of Na-Lactate is not an effective method to study lactate's role on metabolism as it did not increase blood lactate concentrations and was accompanied by problematic GI side effects.

Is the Silfverskiöld Test a valid tool for evaluating calf muscles spastic overactivity in patients with stroke? A retrospective observational study.

Spastic equinus (plantar flexed) foot is a common postural pattern in patients who suffer from post-stroke spasticity. To date, some clinicians use the Silfverskiöld Test in their practice to differentiate between gastrocnemius and soleus muscle overactivity in patients with spastic equinus (plantar flexed) foot. This use of the Silfverskiöld Test goes beyond its original aim, which was to distinguish isolated gastrocnemius contracture in patients with equinus deformity. The aim of this study was to investigate the Silfverskiöld Test validity for evaluating spastic equinus (plantar flexed) foot (i.e., differentiation between gastrocnemius and soleus muscle overactivity) by checking its outcome against those of selective diagnostic nerve block of tibial motor nerve branches to the soleus, gastrocnemius and tibialis posterior muscles. The design of the study was retrospective observational. The study was set in a university hospital. Sixty-seven adult stroke patients with spastic equinus (plantar flexed) foot. Each patient underwent selective diagnostic nerve block of tibial motor nerve branches to the soleus, gastrocnemius and tibialis posterior muscles. All patients were evaluated before diagnostic nerve block by means of the Silfverskiöld Test which was considered positive when ankle joint passive dorsiflexion was greater with the knee flexed than extended. Furthermore, they were assessed before and after nerve block by means of the modified Ashworth Scale and the Tardieu Scale. Our sample included 41 males and 26 females (mean age 57.6 years) suffering from spastic equinus (plantar flexed) foot due to chronic stroke (mean time from onset 2.4 years). Forty-eight patients out of 67 presented with positive Silfverskiöld Test. The χ2 test showed no association between the Silfverskiöld Test and spastic overactivity of the gastrocnemius (P=0.253), soleus (P=0.605) and tibialis posterior (P=0.462) muscles as evaluated by serial selective diagnostic block of the tibial nerve motor branches. Our findings do not support the Silfverskiöld Test as a valid tool for evaluating spastic equinus (plantar flexed) foot to differentiate between gastrocnemius, soleus and tibialis posterior spastic muscle overactivity in adult patients with stroke. The choice for an appropriate management of spastic equinus (plantar flexed) foot in adults with stroke should not be mainly defined on the base of Silfverskiöld Test.