Assessment Program Research Articles

Implementing Core Entrustable Professional Activities in Undergraduate Medical Education: A Psychometric Study.

This study examines the feasibility and psychometric results of an assessment of entrustable professional activities (EPAs) as a core component of the clinical program of assessment in undergraduate medical education, assesses the learning curves for each EPA, explores the time to entrustment, and investigates the dependability of the EPA data based on generalizability theory (G theory) analysis. Third-year medical students from the University of Minnesota Medical School in 7 required clerkships from May 2022 through April 2023 were assessed. Students were required to obtain at least 4 EPA assessments per week on average from clinical faculty, residents supervising the students, or assessment and coaching experts. Student ratings were depicted as curves describing their performance over time; regression models were used to fit the curves. The complete class of 240 (138 women [58.0%] and 102 men [42.0%]) third-year medical students at the University of Minnesota Medical School (mean [SD] age at matriculation, 24.2 [2.7] years) participated. There were 32,614 EPA-based assessments (mean [SD], 136 [29.6] assessments per student). Reliability analysis using G theory found that an overall score dependability of 0.75 (range, 0-1) was achieved with 4 assessors on 4 occasions. The desired level of entrustment by academic year end was met by all 240 students (100%) for EPAs 1, 6, and 7, 237 (98.8%), 236 (98.3%), and 218 (90.8%) students for EPAs 2, 5, and 9, respectively, 197 students (82.1%) for EPA 3, 178 students (74.2%) for EPA 4, and 145 students (60.4%) for EPA 12. The most rapid growth was for EPA 2 (β0 = .286), followed by EPA 1 (β0 = .240), EPA 4 (β0 = .236), and EPA 10 (β0 = .230). The study findings suggest that EPA ratings provide reliable and dependable data to make entrustment decisions about students' performance.

Helping Educators Learn Pediatric Pain Assessment and Intervention Needs Program (HELP PAIN): Program Development with Community Partners

Background/Objectives: This paper details the development of the Helping Educators Learn Pediatric Pain Assessment and Intervention Needs (HELP PAIN) program. Methods: HELP PAIN is an 8 h live training program for school providers (e.g., school nurses and social workers) to use evidence-based nonpharmacologic pediatric pain management tools. The program’s scope reflected the reach of the participating intermediary community organizations, resulting in focused training in rural northwest Michigan due to the Health Department of Northwest Michigan’s service in that region and statewide reach due to the broad representation of members from the Michigan Association of School Nurses. Results: We describe the development of the HELP PAIN program, drawing on evidence-based nonpharmacologic (e.g., cognitive behavioral and mindfulness meditation) strategies for pediatric pain management. Conclusions: In partnership with the key community organizations and community partners, we developed, interactively refined, and delivered this training program.

Assessing Drug Product Shelf Life Using the Accelerated Stability Assessment Program: A Case Study of a GLPG4399 Capsule Formulation

Objective: To evaluate and project the shelf life of GLPG4399, an early-phase clinical drug formulation by applying the Accelerated Stability Assessment Program (ASAP) approach. Methods: Forced degradation conditions were implemented to identify the stability-limiting degradation product. The drug and its degradation products were separated using a validated liquid chromatography method. Then, the selected clinical capsule formulation was placed in a glass vial and exposed to accelerated short-term conditions of combinations of high- and low-level heat and humidity in an open state for 5 weeks. The liquid chromatography results were evaluated using the ASAP, which is based on the moisture-modified Arrhenius principle. The resulting data were fitted using a suitable diffusion kinetics method. Results: The developed model was applied to predict the shelf life of the drug product when using clinically appropriate primary packaging (high-density polyethylene container). The derived stability parameters of the moisture-modified Arrhenius equation were the Arrhenius collision frequency, activation energy, and humidity sensitivity constant. The goodness of fit parameters R2 (>0.95) and goodness of prediction Q2 (>0.80) parameters for the selected model were acceptable. The results of the accelerated, short-term stability study were verified against real-time, long-term 12-month data. Conclusions: We demonstrated the application of the ASAP approach to evaluate the shelf life of a GLPG4399 solid capsule formulation. The studied ASAP approach can be extended to evaluate the stability and shelf-life estimations of other early-phase clinical formulations.

Identifying stakeholder preferences for communicating impact from medical research: a mixed methods study

BackgroundDocumentation of research outcomes using impact case studies (ICS) is increasingly required to demonstrate the wider societal benefits of research. However, there is limited evidence of the best way to communicate research outcomes using ICS, especially when highlighting research impact that is not part of a research assessment programme. This study aims, for the first time, to analyse expectations, and methods of communicating impact from medical research across a varied set of stakeholders relevant to the Medical Research Council (MRC).MethodsImpact narratives about outcomes and impact from MRC research were evaluated using an online survey and in depth semi-structured interviews. Participants were recruited from internal MRC databases and included early career and senior management academics as well as representatives from industry, healthcare, charities, and the government. Informed consent was gained prior to data collection and the study was approved by the university’s research ethics committee. Qualitative and quantitative analysis determined stakeholder preferences for ICS content, language and presentation as well as capturing themes and perspectives on the concept of research impact.Results193 participants responded to the online survey exploring definitions of impact and methods of communicating medical research outcomes. The work uncovered expectations of improved health and wellbeing as well as knowledge generation via publications and citations. In depth interviews with sixteen participants demonstrated preferences for clear, easy to read content that focused on facts and evidence and avoided both academic and hyperbolic language. Emergent themes from this work revealed that ICS need to quickly capture imagination and grab attention, while the views and expectations are quite different to press releases and are audience specific.ConclusionsThe content of ICS often focuses on non-academic impacts; however this work highlighted that evidence of academic impacts were outcomes highly valued by stakeholders relevant to the MRC. This work examined a new typology of ICS attributes, which emphasised that the language and presentation of impact narratives can influence the perception of research outcomes, providing useful information for individuals and organisations using ICS to showcase their research. It also shows that if ICS attempt to communicate challenges and issues around achieving impact from research, they may be more credible and useful to their intended audience.

Application of Inspection Programs for Risk Assessment by Factory Control Laws

Presently, there is still a high risk of non-compliance with the law in many factories, including cases where factories have risk control measures and have high accident statistics or complaints that come from impacts on communities and the environment at a high rate. The study aims to design and develop a factory inspection program and apply it to analyze and assess compliance risks with factory control laws. Data was collected from 50 factories to collect the risk assessment for compliance with the laws. The program's components consist of inspection to ensure compliance with factory control laws and risk assessment. The study found that the inspection processes and risk assessment compliance with the laws can be improved by using the Lean Work Improvement Principle with the Eliminate, Combine, Rearrange, and Simplify (ECRS) technique, resulting in increased efficiency at an average of 50% and for the conformity verification process by the factory control laws. Applying the factory inspection program according to the factory control laws reduced the audit time by an average of 9.17 hours (Productivity Up to 79%) from using the sample groups. This study has demonstrated the potential and benefits of using a risk assessment program in in-depth analysis for factory control. It can be used as an essential reference for future program development research. The satisfaction assessment results of the sample groups were very high. Besides, experts' comments strongly agreed to implement an inspection program after their usage, instilling confidence in its validity.

Assessing Equity and Emotional Wellbeing: A Critical Look at NAPLAN in Australian Schools

The National Assessment Program - Literacy and Numeracy (NAPLAN) is a pivotal educational reform in Australia that aims to assess students' literacy and numeracy skills. Since its introduction in 2008, NAPLAN has sparked significant debate regarding its effectiveness and equity. This paper critically examines the promises and pitfalls of NAPLAN, focusing on its impact on educational equity, the socio-emotional well-being of students, and school management practices. While NAPLAN is designed to address inequalities and improve educational outcomes, research suggests that it may inadvertently exacerbate disparities between schools, particularly affecting students from disadvantaged backgrounds. Furthermore, the high-stakes nature of the test can induce anxiety among students and educators, particularly in low-performing schools. This paper also includes a case study of Croydon Community School, an alternative secondary school in Melbourne, to illustrate the diverse impacts of NAPLAN on student performance, socio-educational advantage, and cultural diversity. In conclusion, while NAPLAN provides valuable data on student performance, it must be complemented by broader assessment practices and policies that prioritize diversity and inclusion to fully address its limitations.

Cardiovascular disease risk in people with diabetes in the era of universal diabetes screening

Abstract Background/Introduction Traditionally, most people with diabetes have been considered at high cardiovascular disease (CVD) risk and CVD preventive treatment has been recommended for almost all patients after diagnosis. However, guidelines are increasingly recommending a more stratified approach to preventive treatment informed by predicted CVD risk. In the early 2000’s, New Zealand initiated the world-first national diabetes screening programme, as a component of a national CVD risk assessment programme, and by 2016, approximately 90% of eligible New Zealand adults had been screened. We hypothesised that in the era of universal diabetes screening, many recently diagnosed patients will be at low CVD risk and that contemporary CVD risk prediction equations would be required to accurately assess their risk. Purpose We aimed to develop sex-specific 5-year CVD risk prediction models in people with diabetes in New Zealand using a contemporary natural-population based cohort, and to characterise the distribution of CVD risk. Methods De-identified individual-level linkage of multiple health administrative datasets was undertaken to establish a cohort of almost all adults with diabetes in the northern region of New Zealand (one-third of the national population), without CVD or heart failure, and aged 30–74 years on January 1, 2014, with follow-up linkage to hospitalisations and mortality until December 31, 2018. Sex-specific models were developed to estimate the 5-year risk of CVD hospitalisation or death, with 15 pre-defined predictors, including sociodemographic variables, diabetes-related and renal function measures. Results 64,645 participants (median age: 57 years [IQR: 49–65]) were included in the final cohort, of whom 4,992 had first CVD events during 301,272 person-years follow-up. Models calibrated well in both women and men (Figure 1). Overall, increasing age; high deprivation level; smoking-related hospitalisations or use of smoking cessation medications; history of atrial fibrillation; high levels of haemoglobin A1c, total cholesterol to HDL cholesterol ratio, and albumin-to-creatinine ratio; use of blood pressure-lowering medications and insulin were associated with elevated CVD risk. Median 5-year CVD risks were 4.9% (IQR: 2.9%–8.1%) in women and 7.7% (4.8%–12.0%) in men. There was a wide range of predicted 5-year CVD risk, with 51% of women and 27% of men having a predicted risk below 5%, and 6% of women and 16% of men having a risk of 15% or above (Figure 2). Conclusions This study demonstrated marked heterogeneity in predicted CVD risk in people with diabetes in an era of universal diabetes screening. As diabetes screening is increasingly undertaken as part of a routine CVD risk assessment, these findings will have important clinical implications for accurately targeting new but expensive CVD preventive medications to the highest risk patients.

Community Mobilisation for Human Sample Collection in Sensitive Communities: Experiences from Granular Mapping of Schistosomiasis and Soil-Transmitted Helminths in Ekiti State, South West, Nigeria

Community mobilisation is a vital process for raising awareness and increasing participation in healthcare interventions, research, and programmes that require human sample collection and mass management. In this report, we present the community mobilisation approach undertaken for the implementation of the operational mapping and assessment of granular schistosomiasis and soil-transmitted helminths in Ekiti State, Nigeria. The mobilisation was conducted in 177 communities/wards of the 16 local government areas. A total of 15,340 urine and stool samples were collected in 34 days. The efficacy and success of the strategy were evaluated through the following three performance metrics: community compliance rate, the participant response rate at the community level, and the overall compliance response rate of the four most sensitive LGAs. Community compliance was 93.7% as sample collection was denied in nine communities and two other communities demanded the return of the collected samples despite our mobilisation effort because of cultural bias and myths that connect the collection of stool and urine samples to ritual activities in the local context. The participant response rate at the community level was 86.7%. Three of the four sensitive LGAs (based on previous assessment programmes) demonstrated satisfactory compliance rates of 100%, while a response rate of 64.0% was computed for one of the LGAs. We believe our approach contributed to effective community mobilisation and awareness and that the developed model has the potential to improve participation rates in large healthcare assessments and intervention programmes.

The equivalence of a high-stakes objective structured clinical exam adapted to suit a virtual delivery format.

The COVID-19 pandemic necessitated rapid adaptation of clinical competence assessments, including the transition of Objective Structured Clinical Examinations (OSCE) from in-person to virtual formats. This study investigates the construct equivalence of a high-stakes OSCE, originally designed for in-person delivery, when adapted for a virtual format. A retrospective analysis was conducted using OSCE scores from the Internationally Educated Nurse Competency Assessment Program (IENCAP®). Data were collected from 15 exam administrations between January 2018 and June 2022, encompassing 2021 examinees (1936 in-person, 85 virtual). The Many-Facet Rasch Measurement (MFRM) model was employed to analyze the invariance of examinee ability, case difficulty, and criteria difficulty across in-person and virtual formats. Results revealed overall examinee ability estimates remained invariant regardless of the OSCE format, while invariant violations were identified in only three of the 15 cases (N = 20%) adapted to suit the virtual format. The most significant adaptation, namely the use of a verbal physical examination to suit the virtual context achieved equivalence to its hands-on in-person counterpart given evidence of invariance across criteria estimates. Interestingly, criteria scores in invariant violated cases displayed a higher level of stability or consistency across the virtual OSCE formats versus their in-person counterpart highlighting a potential benefit of the virtual versus in-person format and potentially linked to the verbal physical examination. The study found that while examinee ability and case difficulty estimates exhibited some invariance between in-person and virtual OSCE formats, criteria involving physical assessments faced challenges in maintaining construct equivalence. These findings highlight the need for careful consideration in adapting high-stakes clinical assessments to virtual formats to ensure fairness and reliability.

Developing and validating a self-assessment tool for assessing confidence of nurse-midwives against competency domains of the International Confederation of Midwives, in India.

While midwives are recognized as primary care-providers for maternal and new-born care in many parts of the world, India is transitioning to professional midwifery. The pathway to midwifery in India has been through integrated nursing and midwifery education. Since 2018, India has introduced an 18-month post nursing midwifery education programme. To establish a baseline for midwives' competence and measure progress, there is a need for a quick, easy-to-administer and low-cost tool that can be used at scale to guide programme efforts. This paper describes the process of validation and testing of a tool to assess the confidence of practicing nurse-midwives as a proxy indicator for competence against the seven competency domains of the International Confederation of Midwives (2013). A total of 2198 nurse-midwives, providing maternal and new-born services at the time of the study, from 442 public and private hospitals across six states in India, responded to a self-administered questionnaire. The tool is psychometrically sound and can potentially be used in low-middle-income countries to measure confidence of midwives and nurse-midwives against international competence standards. It is suitable for quick large-scale programmatic assessments within a short time period, providing evidence to inform midwifery strengthening initiatives. The tool can be contextualized to suit specific country contexts. Since it was tested in India, where a distinct cadre of midwives is not yet established and nurse-midwives provide maternity care, the tool can be easily adapted for use in other countries in the South East Asia Region with similar contexts.

Program Evaluation of Pancasila Student Profile Strengthening Project Using the CSE-UCLA Model

The research aims to evaluate the program of the Pancasila student profile strengthening project in elementary schools in Semarang Regency, Indonesia. This research method used the CSE-UCLA evaluation model with a qualitative approach that included the aspects of program assessment, program planning, program implementation, program improvement, and program certification. The data sources came from the school principal/curriculum teachers, classroom teachers, students, and the parents of students at Pangudi Luhur Ambarawa Elementary School and Tlompakan 1 Tuntang Elementary School in Semarang Regency. Data collection was through interviews, document studies, and observations. The data analysis technique used qualitative descriptive methods. The research results showed that in the Assessment program, P5 was implemented in accordance with the vision, mission, and objectives. The theme and project options were chosen based on environmental issues and the needs of the students, and the project was also supported by the parents; Program planning, both schools had goals to be achieved in P5 so that the project ran with a clear direction and purpose; Program implementation, teachers have good strategies in carrying out P5 but improvements were needed in the socialization of the P5 program; Program improvement, there needs to be enhancements in the documentation of monitoring and supervision results; Certification program, the goals of the P5 program were achieved and all parties were satisfied with the existence of the P5 program, which had a positive impact on the students. The P5 program was running well, and all stakeholders were satisfied. However, there was a need for improvement in documentation and communication with students' parents. In addition, it is necessary to broaden project options, support teachers, and encourage them to prioritize character development over tangible results.

Assessment of communication skills in health professions education; Ottawa 2024 consensus statement

Despite the increasing inclusion of communication skills in accreditation standards and an increase in time dedicated to teaching these skills, communication is often regarded as a separate skill and is therefore, not consistently represented in overall systems of assessment in Health Professions Education (HPE). The ascendence of competency-based medical education, programmatic assessment, artificial intelligence, and widespread use of telehealth, alongside changing patient expectations warrant an update in thinking about the assessment of communication skills in health professions education. This consensus statement draws on existing literature, expert pinion, and emerging challenges to situate the assessment of communication skills in the contemporary health professions education context. The statement builds on previous work to offer an update on the topic and include new developments related to assessment, particularly: the challenges and opportunities associated with systems of assessment; patient and peer perspectives in assessment; assessment of interprofessional communication, cross-cultural communication, digital communication; and assessment using digital technologies. Consensus was reached through extensive discussion among the authors and other experts in HPE, exploration of the literature, and discussion during an Ottawa 2024 conference workshop. The statement puts forward a summary of available evidence with suggestions for what educators and curriculum developers should consider in their planning and design of the assessment of communication.

Clinical and economic impact of pharmacist interventions to identify drug-related problems in multidisciplinary cancer care: a prospective trial.

The prescription of antitumor drugs has often been associated with drug-related problems. Pretherapeutic multidisciplinary risk assessment programs including pharmaceutical care have been established to secure the initiation of injectable and oral antitumor therapies. This prospective cross-sectional double-center study evaluated the clinical and economic impact of the pharmacist in detecting drug-related problems in patients initiating antitumor therapies. Following pharmaceutical consultations, pharmaceutical interventions were validated by a multidisciplinary team. A committee of independent clinical experts assessed the potential clinical impact of drug-drug interactions. The association of clinical variables with pharmaceutical interventions was tested using a multivariate logistic regression model. Pharmacist cost of the program was assessed by valuing pharmacists' time at their salaries and compared with potentially avoided costs. Four hundred thirty-eight patients with solid tumors were included: 62% males, mean age of 65 ± 13 years, and average of 6 medications. Half of the patients required at least one pharmaceutical intervention and independent factors associated with pharmaceutical interventions were the number of medications (5-9 vs <5: OR = 2.91 [95% CI 1.82-4.65], P < .001) and the type of antitumor treatment (immunotherapy vs intravenous chemotherapy: OR = 0.35 [95% CI 0.18-0.68], P = .002). One hundred seventy-four out of 266 pharmaceutical interventions (130 patients) involved clinically significant drug-drug interactions. Pharmacist costs were estimated to range between €4899 and €6125. Average costs were estimated at €11.4-14.3 per patient. Avoided hospitalization costs were estimated to be €180 633. Clinical pharmacists contribute to the cost-effective reduction of drug-related problems in pre-therapeutic assessment programs for patients with cancer.

Gesture Imitation Performance and Visual Exploration in Young Children with Autism Spectrum Disorder.

Most studies in children with autism spectrum disorder (ASD) support a decrement in imitation performance. Factors related to visual attention and motor execution have been proposed to explain this phenomenon in ASD. However, studies investigated imitation with various methods, leading to inconsistent findings. Here, we examine imitation performance related to visual attention and motor execution. We focused on the imitation of meaningful and meaningless gestures, consistently reported as more affected than imitation of actions with objects in ASD. The imitation eye-tracking task consisted of a video of an actor demonstrating gestures and prompting children to imitate them. The demonstrations comprised meaningful and meaningless hand gestures, and meaningless facial gestures. We measured the fixation duration to the actor' face during child-directed speech and gesture demonstrations. We video-recorded children to assess their performance. Our sample comprised 100 participants (3.55 ± 1.11years old), including 84 children with ASD. The ASD and typically developing groups displayed the same visual attention toward gesture demonstrations, although children with ASD spent less time looking at the face during facial stimuli. Visual exploration of actors' gestures did not influence imitation performance. Imitation of meaningful gestures was associated with less severe autistic symptoms, whereas imitation of meaningless gestures was correlated with higher non-verbal cognitive and fine-motor skills. These findings contribute to a better understanding of the complexity of imitation. We delineated the distinct nature of imitation of meaningful and meaningless gestures in children with ASD. We discuss clinical implications in relation to assessment and intervention programs.

Hybridity as a governmental technique for designing and delivering NAPLAN in Australian schools

AbstractThis paper explores the utility of hybrid governance as an analytical lens for understanding policy design and delivery in Australian schooling reform. Using the National Assessment Program in Literacy and Numeracy (NAPLAN) as a case study, we argue that its design and delivery processes exemplify hybridity in myriad dimensions. In a federal system in which national schooling reform relies upon negotiation and consensus building amongst a multiplicity of government and non‐government stakeholders, we argue that NAPLAN's hybridity serves as a governmental technique for managing and sustaining collaborative governance arrangements. Hybridity also supports the standardised implementation of the assessment across diverse schooling systems and sectors. While NAPLAN's hybridity generates strategic benefits for Australian governments, it also produces risks. A challenge for policymakers is to harness its benefits while ensuring transparent decision‐making and clear responsibilities and accountabilities. To address risks and leverage opportunities, we argue there are benefits to having a convening agency with authority to manage and sustain hybrid networks at the national scale.Points for practitioners Hybrid governance offers productive insights into how Australian governments work collaboratively to design and deliver national schooling reforms. The National Assessment Program in Literacy and Numeracy (NAPLAN) is an exemplary case study for examining hybrid governance in the Australian federation. Hybrid governance serves as a technique for managing and sustaining collaborative governance arrangements at the national scale and for ensuring NAPLAN's implementation is standardised across Australia's diverse subnational schooling systems and sectors. Hybridity creates risks and opportunities. A challenge for policymakers is to harness its benefits while ensuring transparent decision‐making and clear responsibilities and accountabilities. There are benefits to having a convening agency with authority to manage and sustain hybrid networks at the national scale.

Connecting through e-portfolio practice: trust, relationships and expertise

Trust, relationships, expertise, and connections are essential components in the practice of authentic, programmatic e-portfolio practice. The behind-the-scenes educational practices of Educational Designers, a Program Director and Academics in the implementation and design of student-curated, authentic programmatic assessments is definitely not well researched. Thus, our paper introduces, analyses, and reflects on the different aspects and layers of e-portfolio implementation into a bachelor degree. Through our personal lenses, we uncover some of the key lessons we have learned during this unique opportunity. The paper is not about addressing the technological implementation of the e-portfolio platform, nor simply pedagogical underpinnings; instead, we focus on the convergence of pedagogical practice relationships which are essential during the process of emerging, connecting and sustaining e-portfolios through an ongoing community of practice, within the learning lifecycle.

Safety Trends in the Automobile Industry in India

The automobile industry in India has experienced significant advancements in recent years, driven by rapid technological innovations and evolving consumer expectations. Safety has emerged as a critical focus area, with stakeholders ranging from government bodies to manufacturers and consumers increasingly emphasizing the need for stringent safety measures. This paper explores the key safety trends shaping the Indian automotive sector, including the adoption of advanced driver-assistance systems (ADAS), the implementation of new crash test standards, and the increased integration of passive and active safety features in vehicles. Additionally, it highlights the regulatory changes brought forth by the Indian government, such as the Bharat New Vehicle Safety Assessment Program (BNVSAP) and mandatory safety norms like airbags and anti-lock braking systems (ABS). The study also examines the role of technological innovations, including connected vehicle technologies and the potential of autonomous driving in enhancing road safety. By analyzing these trends, the paper aims to provide insights into how safety measures in the Indian automobile industry are evolving to meet global standards and reduce the rising number of road accidents in the country.

The usefulness of a rehabilitation programme for people with stress-related disorders - A case from a rehabilitation center in Estonia.

Background Rehabilitation programs help to improve people’s lives and reduce turnover rates in organisations. The current analysis revealed that dissatisfaction occurred among practitioners, doctors’ overlapping services, and fragmented plans. No comprehensive assessment and rehabilitation program currently exists for stress-related disorders in Estonia indicating an urgent need to conduct research and development programs for clients to reduce stress (Bugarski, Z, et al., 2016). This study research aimed to determine the usefulness of rehabilitation programs for individuals people with stress-related disorders. Method A qualitative approach was used. Methodology The sample included 10 individuals recruited from various rehabilitation centers in Estonia. Convenience sampling was used to select participants for this research. Open- and closed-ended questions were formulated using the 12 questions enclosed in this research. All transcribed interviews were formatted using the code. Extract codes within participant interviews were compared to identify similarities, differences, and closeness, and therefore formulated categories. Results The findings revealed that rehabilitation programs contribute to quality services, self-motivation, daily activities plan, self-control, recovery, attention and concentration, and coping skills, whereas traditional treatment can reduce symptoms but not change people’s lives. Conclusion This study suggests that rehabilitation programs are useful for individuals with stress disorders in the context of the Estonian healthcare system. The rehabilitation program is a useful intervention method revealed in the context of Estonia’s healthcare system, as it improves quality services, increases coping skills, self-control, and cognitive skills, and enhances recovery.

Factors Influencing the Timeliness and Completeness of Appropriate Staging Investigations for Patients with Stage I-III Lung Cancer in Southeastern Ontario.

(1) Background: Comprehensive and timely lung cancer (LC) staging is essential for prognosis and management. The Lung Diagnostic Assessment Program (LDAP) in Southeastern (SE) Ontario aims to provide rapid, guideline-concordant care for suspected LC patients. We evaluated factors affecting the completeness and timeliness of staging for stage I-III LC patients in SE Ontario, including the impact of LDAP management. (2) Methods: This was a population-based retrospective cohort study using the LDAP database (January 2017-December 2019), linked with the Ontario Cancer Registry, to identify newly diagnosed LC patients. A Cox model approach identified variables associated with staging completeness and timeliness. (3) Results: Among 755 patients, 459 (60.8%) were managed through LDAP. Optimal staging was achieved in 596 patients (78.9%), 23 (3.0%) had alternative staging, and 136 (18.0%) had incomplete staging. In the adjusted analyses, LDAP management was associated with a higher likelihood of complete staging (OR 2.29, p < 0.0001) and faster staging completion (β = -18.53, p < 0.0001). Increased distance to PET centres was associated with a longer time to complete staging (β = 8.95 per 100 km, p = 0.0007), as was longer time to diagnosis (β = 21.63 per 30 days, p < 0.0001). (4) Conclusions: LDAP management in SE Ontario significantly improved staging completeness and shortened staging time for stage I-III LC patients.

Failure evaluation of outdoor polymeric insulators based on statistical condition-assessment methods

Field aging of outdoor polymeric insulators results in unscheduled outages in power systems particularly in harsh climate conditions. In this paper, a strategic maintenance framework is proposed in order to prevent overhead line outages. The presented scheme is based on condition assessment of the real aged polymeric insulators. Data of tensile test, hardness test, thermogravimetric analysis (TGA), and Fourier transform infrared spectroscopy (FTIR) are used to extract critical features of the aged samples based on classification of fuzzy c-means clustering. Then, a lifetime prediction analysis is done based on Cox hazards analysis to develop further maintenance strategy. The proposed model is validated through numerical analyses on polymeric insulators for various validation evaluations including pollution severity analysis and hydrophobicity class (HC) measurement. Obtained results verify accuracy of the intelligent model to predict lifetime of the aged polymeric insulators. The presented strategic framework can be effectively applied to online monitoring, condition assessment and preventive maintenance programs of the power system utilities.