Quality Index Research Articles

A Novel Hybrid Prediction Model of Air Quality Index Based on Variational Modal Decomposition and CEEMDAN-SE-GRU

As the economy rapidly develops, the phenomenon of air pollution is occurring more frequently, impacting on human health and environmental ecosystems. The Air Quality Index (AQI) is an essential index for describing air pollution levels. Accurate AQI prediction provides reliable information for air pollution control and protect human health. Therefore, in this paper, the AQI data of Beijing-Tianjin-Hebei region from 20 May 2014 to 18 November 2023 are used. We propose two basic prediction models based on Complete Ensemble Empirical Modal Decomposition with Adaptive Noise (CEEMDAN) and Gated Recursive Unit (GRU) as well as an improved prediction framework combining Variational Modal Decomposition (VMD). The best mean coefficient of determination (R²) is 0.984, the mean absolute error (MAE) is 2.476, and the R² is more than 0.980 for the prediction of AQI in different regions. These results validate the reliability of this hybrid prediction model.

Enhancing water quality prediction with advanced machine learning techniques: An extreme gradient boosting model based on long short-term memory and autoencoder

Achieving carbon neutrality in the pulp and paper industry necessitates effectively recycling pulp and papermaking wastewater, where continuous monitoring of effluent quality indices is crucial. This study suggests a novel machine learning-based model named LSTMAE-XGBOOST that integrates the feature extraction capabilities of autoencoder, the sequential feature learning capabilities of LSTM, and the high prediction accuracy of XGBOOST. This model is capable of extracting the complex relationships, non-Gaussian characteristics, and time series features from the papermaking wastewater data, and it demonstrates superior predictive performance. Compared to traditional machine learning models, the proposed model exhibits higher prediction accuracy. Specifically, when contrasted with partial least squares regression, LSTMAE-XGBOOST achieves a 40% increase in R2 and a 35% reduction in RMSE. Further comparative assessments against other machine learning-based hybrid models with similar structures confirm the superiority of integrating LSTM and XGBOOST within the hybrid model approach. This study contributes a compelling methodology for modeling effluent quality indices, offering significant implications for environmental management in the pulp and paper industry.

Treatment of atopic dermatitis with abrocitinib in real practice in Spain: efficacy and safety results from a 24-week multicenter study.

Abrocitinib, a selective JAK 1 inhibitor, was recently approved in Europe. Despite its approval, real-world data on its efficacy and safety in treating moderate-to-severe atopic dermatitis (AD) remains limited. This study aimed to evaluate the short-term effectiveness and safety of abrocitinib in a real-life setting for patients with moderate-to-severe AD. We conducted a retrospective multicenter study involving adult patients with moderate-to-severe AD who started abrocitinib treatment between May 1, 2023, and September 30, 2023, in 15 Spanish hospitals. Treatment doses were 100 or 200 mg daily, based on clinical assessment. Data collection included patient demographics, AD history, comorbidities, previous treatments, and disease severity indicators such as SCORing atopic dermatitis (SCORAD), Eczema Area and Severity Index (EASI), body surface area, and Peak Pruritus NRS scores at baseline, 4, 12, and 24 weeks. Quality of life was measured using the Dermatology Life Quality Index (DLQI), and safety was assessed by monitoring adverse reactions and various biochemical parameters. The cohort comprised 76 patients with an average age of 33.93 years; 57.89% were male. Before abrocitinib, 36.84% were naïve to advanced therapies. The baseline mean scores were SCORAD 47.04, EASI 21.79, and DLQI 15.01. At Week 24, there were significant improvements: EASI was reduced to 2.81, and 70.58% of the patients achieved EASI 75. However, 18.42% discontinued treatment mainly due to inefficacy or adverse effects. The safety profile was favorable, with 22.37% reporting mild adverse events (AEs) and one serious case of cutaneous lymphoma. This first Spanish series assessing abrocitinib in real-world conditions reveals a significant improvement in AD symptoms and quality of life in a range of severity and prior treatment failures. Abrocitinib was well-tolerated, with few serious AEs, highlighting its potential as an effective treatment option for AD.

Correlates of perceived stress with anxiety symptoms sleep quality and academic performance among Moroccan students

IntroductionThe main objective of this study was to verify the association of perceived stress with anxiety, sleep quality, and academic performance among Moroccan medical students. MethodsThis cross-sectional study included 222 students enrolled at the Faculty of Medicine and Pharmacy of Fez in Morocco. An online self-administrated questionnaire, for the sociodemographic characteristics, Perceived Stress Scale (PSS-10), Test Anxiety Scale, and Pittsburgh Sleep Quality Index questionnaire were used for the assessment. A descriptive and correlational design was used in this investigation. ResultsOne hundred and thirty-two students completed the survey. A high level of stress was found. A significant positive correlation was observed between the stress level among our population and their levels of anxiety. Stress was also positively correlated with the decrease of students’ sleep quality and academic performance. ConclusionThe results of this investigation present worthy data that highlight the need for this subset of students to anti-stress programs that must be integrated into their curriculum to help them to better manage this psychological issue.

Patient and family burden in pediatric atopic dermatitis and its treatment pattern in Japan.

This study evaluated the level of burden in pediatric and adolescent atopic dermatitis (AD) patients in Japan, the associated burden on caregivers/families, and whether this burden varied with age. Data were drawn from the Adelphi Pediatric AD Disease Specific Programme (DSP)™, a cross-sectional survey of physicians and their patients conducted in Japan between July and December 2022. Physicians reported patient demographics, clinical characteristics, disease burden, and current/previous therapies. Patients and/or caregivers reported perceived disease severity and impact of AD, including the Children's Dermatology Life Quality Index (CDLQI) and Dermatitis Family Impact questionnaire (DFI). Overall, 55 physicians provided data for 537 AD patients aged ≤17. Mean (SD) overall scores for CDLQI, POEM, and DFI were 9.3 (6.3), 8.3 (6.8), and 11.7 (7.2), respectively. Age was associated with higher patient and/or caregiver-reported CDLQI scores, which increased by 0.543 points per year of age (P = 0.01). Patients with severe disease reported a more significant impact on quality of life factors compared with mild patients (P < 0.001). Age was associated with higher caregiver-reported burden, with DFI scores increasing by 0.325 per year (P = 0.01). Physician-reported impact on caregivers showed that age was significantly associated with increased burden on sleep, daily activities, work, and mood (P < 0.05), with disease severity associated with impact across all factors (P < 0.01). Both increasing age and disease severity were associated with the increased impact of AD on patients and their caregivers. Disease control/modification through appropriate therapeutic intervention at a younger age may relieve the burden of pediatric AD on patients and their families.

Enhancing Air Quality Index Activity Guidelines for Preventing Cardiovascular Events in the General Adult Population

BackgroundThe public health relevance of daily Air Quality Index (AQI) activity guidelines for the general adult public in the United States to prevent atherosclerotic cardiovascular disease (ASCVD) events is questionable. ObjectivesThe purpose of the study was to explore the utility of a policy tailoring activity guidance to calculated ASCVD risk rather than uniform recommendations to the general adult public as currently provided. MethodsWe calculated the number needed to treat (NNT) to prevent one ASCVD event per day by following activity recommendations across 10-year ASCVD risk scores (1% to 20%). Second, we modeled the benefits of tailoring recommendations to ASCVD risk. ResultsThe NNT decreased as ASCVD risk and/or AQI levels increased. At AQIs up to 151 (68% of days with AQIs above moderate in the United States), the NNTs remained untenably high (>2.7-55.3 million) across ASCVD risk. Under unhealthy conditions (AQIs 151-200), 28% of elevated AQIs, NNTs <1 million could be achieved by current guidance (15% exposure reduction), but only among the highest-risk individuals (ASCVD 18% to 20%) on the most polluted days (AQIs 192-200). Tailoring guidance to ASCVD risk could yield NNTs <1 million at risk thresholds of 7.5% and 10% if activity restrictions were more stringent (35% to 50% exposure reductions) during unhealthy conditions. ConclusionsASCVD risk has a major influence on the NNT to prevent cardiovascular events by following AQI guidance. It may be possible for a future policy to improve the utility of AQI activity guidance for the general adult public by tailoring activity recommendations to ASCVD risk.

Spatiotemporal Assessment of Groundwater Quality in the Oum Rbia Watershed Using GIS-Pro and Water Quality Indices

Spatiotemporal Assessment of Groundwater Quality in the Oum Rbia Watershed Using GIS-Pro and Water Quality Indices

Evaluation of the acute toxicity of IHPLUS® on the biomodel water quality indicator: Poecilia reticulata

La agricultura convencional depende de la aplicación de fertilizantes con el fin de lograr mayores rendimientos; sin embargo, es necesario encontrar un equilibrio entre sus beneficios y las alteraciones que pudieran producir a los ecosistemas. Organizaciones internacionales regulan su uso y comercialización teniendo en cuenta la eficacia y seguridad. IHPLUS®, producido por la Estación Experimental de Pastos y Forrajes “Indio Hatuey” (Cuba), ha mostrado ser efectivo en diferentes cultivos y es objeto en este estudio evaluar los efectos sobre la calidad del agua en el bioindicador Poecilia reticulata. Los peces fueron expuestos al producto, en régimen estático durante 96 h, a la concentración efectiva en la agricultura (6 %) o diluido hasta 106 UFC/ml según recomienda la EPA OPPTS 885.4000. Asimismo, se incluyó un grupo tratado con el producto al 6 %, pero esterilizado y un grupo control que no recibió tratamiento alguno. Se observaron durante 30 días posinoculación y se evaluó el peso, la mortalidad y otros efectos subletales. Posteriormente, se determinó la concentración letal media (CL50) y la influencia del pH sobre la mortalidad de los peces. Se pudo comprobar que al 6 % provocó eventos clínicos adversos y efecto letal en el biomodelo. Las lesiones histopatológicas se corresponden tanto para el producto activado como para el inactivado. La CL50 fue de 3.19 %, asociándose la toxicidad al pH ácido y no a la carga microbiana presente en el bioproducto. Se concluye que IHPLUS® es seguro para Poecilia reticulata a concentraciones inferiores al 3 %.

Discussion on effect of observation circumstances for image in digital radiography

The discriminability of the IQI in the film radiography is affected by the observation circumstance and the luminance of film viewer. ISO17636-2 states that the images of digital radiograph shall be examined in a dimmed room. However, it does not describe requirements for the observation environment in digital radiography, despite the fact that the environment is similar to that of a normal professional PC and the display of the images can be easily adjusted. In this report, the influence of the observation environment in digital radiography was compared as the parameters the wire diameter and the WL value of a display adjustment value when the minimum wire diameter of the image quality indicator (IQI) was percepted, using images of welded steel at t25mm and t50mm. For welded steel of t25mm, differences due to SNRN values and differences due to the observation environment of light and dark room were compared. For t50mm, differences due to the presence or absence of the observation mask for the single wire of wire IQI which is places in front of the display, differences due to the resolution and brightness of the PC monitor, and differences when the WL was adjusted arbitrarily or fixed were compared. For the Digital Radiographic testing (RT-D), the basic spatial resolutions (SRb) were obtained by measuring the profile and applying of visual observation with the duplex wire type IQI. On the other hand, when observing the image of wire type IQI, the observation ways that one was obtain the perceptible image for all wires and another was to get the perceptible single wire image by using the observation mask for watching each wire were applied. Moreover, the influence of window width (WW) and window level (WL) adjustment on the discrimination of wire-type IQI was examined by quantifying it as WW/WL. As a result, it was confirmed that the discriminality in the dimmed room and the adjustment of WW and WL were effective. In addition, using the observation a mask showed that the perception of the adjacent wire image affected observer cognition in IQI discrimination during image observation. When using viewer software profiling, SRb measurements were not affected by the observation environment, but the visual observation was affected by the environment, and when observing images in the dimmed room with RT-D, it was found that adjusting WW and WL had a greater effect on discrimination for images with low SNRN and low contrast.

Intelligent Sentinel satellite image processing technology for land cover mapping

Purpose. This article proposes to develop an intelligent Sentinel satellite image processing technology for land cover mapping using convolutional neural networks. The result will be an image with improved spatial resolution. Methodology. The paper presents a technology using a combination of biquadratic interpolation, histogram alignment, PCA transform, as well as a parallel residual architecture of convolutional neural networks. The technology increases the information content of Sentinel-2 optical images by combining 10 and 20-meter resolution data, resulting in primary 20-meter images with improved spatial resolution. Findings. The root mean square error (RMSE = 3.64) indicates a high accuracy in reproducing the spectral properties of the images. The correlation coefficient (CC = 0.997) confirms a high linear relationship between the estimated and observed images. The low value of Spectral Angle Mapper (SAM = 0.52) with the high Universal Image Quality Index (UIQI = 0.999) indicates high quality and structural similarity between the synthesized and reference images. These results confirm the proposed technology’s effectiveness in enhancing the spatial resolution of Sentinel satellite images. Originality. Traditional pansharpening methods of multispectral images developed for satellite images with panchromatic channels cannot be directly applied to Sentinel multispectral data, because these images do not contain a panchromatic channel. In addition, atmospheric conditions and the presence of clouds affect the quality of optical images, complicating their further thematic processing. The proposed technology, using biquadratic interpolation, histogram alignment, convolutional neural networks, and PCA transformation, removes clouds and enhances the spatial resolution of the primary 20-meter optical satellite image channels of Sentinel-2. This technology reduces color distortion and increases the detail of digital optical images, which allows for more accurate analysis of the state of the earth’s surface. Practical value. The results obtained can be used to improve the methods for processing Sentinel satellite images, which provide high spatial resolution and accurate preservation of spectral characteristics. It provides the foundation for the development of new geographic information systems for land cover monitoring.

The effect of sleep effectiveness on examination scores of first year osteopathic medical students

Medical students frequently encounter high levels of stress and pressure, which can negatively affect their mental health and sleep quality, a key determinant of cognitive function and academic success. This study assesses the relationship between sleep effectiveness and academic performance among medical students. An observational, cross-sectional survey took place at A.T. Still University - School of Osteopathic Medicine in Arizona (ATSU-SOMA), involving participants from the 2027 cohort. The Pittsburgh Sleep Quality Index (PSQI) questionnaire was used and exam scores from the second exam of the fourth block were analyzed. For the purpose of our inquiry, the “Sleep Effectiveness” component score of the PSQI was used for our analysis. The results indicated a significant inverse relationship between sleep effectiveness and exam performance (R² = 0.087, p =0.000262), demonstrating that increased sleep effectiveness was associated with lower exam performance. The study highlights the sheer amounts of confounding variables in the preconceived notion that “,Sleep is the key for academic success.” This research suggests that academic performance is best explained by multiple variables rather than simply one. Future studies should investigate the long-term effects of sleep deprivation and explore interventions beyond sleep hygiene, including stress and time management strategies. Understanding the broader impact of sleep on medical education is essential for fostering better outcomes for students in both academic and clinical settings.

Assessment of the efficiency of functioning of the environmental management system of enterprises

Purpose. A multifactor model is developed to assess the efficiency level of an enterprise’s environmental management system, depending on the effectiveness of organizational environmental measures. Methodology. The authors’ method for determining a comprehensive criterion for monitoring the effectiveness of the environmental management system, which characterizes the efficiency of operation and determines the level of environmental safety of enterprises, is proposed and used. To solve the tasks, a complex research method was also used, which included the analysis and generalization of literary and patent sources, and analytical, experimental research using computer and mathematical modeling methods. Findings. According to the studies and calculations of the generalized environmental quality indicator – 0.64, 0.66 and 0.66, the largest negative impact on the environment is caused by the activities of enterprises in the Pecherskyi, Podilskyi, and Solomianskyi districts of Kyiv, respectively. The obtained data testify to the relationship between the effectiveness of the implemented environmental measures (saving and rational use of resources, application of environmental technologies, advanced training, and environmental competence of employees) and the level of efficiency of the environmental management system of enterprises. Originality. As a result of the studies conducted using actual data, a system of indicators of the generalized environmental quality indicator has been proposed for the first time, which allows determining the environmental efficiency and effectiveness of the implemented environmental measures to assess the effectiveness of the functioning of the implemented environmental management system of the enterprise. Practical value. Based on the research results, a technique is proposed to assess the effectiveness of the environmental management system of enterprises by determining a generalized environmental quality indicator in terms of reducing the negative impact of the enterprise’s activities on the environment. Such an assessment system will help the management of the enterprise to promptly introduce corrective actions to improve the efficiency of the environmental management system and increase the level of environmental safety.

What is a “good” library? The measures are changing

PurposeStandardization of library performance measures started in 1994, when several handbooks describing performance indicators had already appeared. The 1st edition of the International Standard ISO 11620 was published in 1998, followed by an amendment 5 years later, both dealing with the traditional library. As indicators for the digital library services were still developing, a pre-standard technical report for such indicators was published separately in 2003. The second edition was published in 2008 and combined 45 indicators for traditional and digital services, if possible, as “hybrid” indicators. The 3rd edition appeared in 2013 with 52 indicators, presenting new topics such as preservation and digitization. For this edition, seven indicators had been eliminated as outdated. The 4th edition was edited in 2023, presenting 61 indicators, of which 14 new indicators and many revisions. The paper follows the subject areas and corresponding indicators over time and tries to define the present and possible future trends.Design/methodology/approachThe paper describes the development of library performance measurement as standardized in ISO 11620. It follows the changes, additions and deletions of indicators since the first edition in 1998 and compares them to the changes in libraries’ tasks and activities.FindingsThe analysis shows that indicators for changing tasks and technologies or for new fields of interest follow a few years after the changes, as the methods have to be developed and tested. New topics are often introduced from outside, following political trends and themes, such as cost-efficiency or support for special user groups. An important input came from other standards with quality indicators, especially ISO 21246 for museums and ISO 21248 for national libraries. An interesting issue is the changing role of indicators for the digital library in ISO 11620. Until the forthcoming edition, a simple increase in digital collections and services was often regarded as quality. The new concept is to regard the existence of digital services and collections in libraries as normal and to look for additional aspects, e.g. the use of a digitized collection.Research limitations/implicationsFor the first time, the forthcoming edition will contain a clause about impact assessment. Measuring the quality of library services should not stop with effectiveness and efficiency but should also include assessing the impact on individuals and society. Methods for assessing library impact are described in a separate standard, ISO 16439. However, there is evidently a borderland between evaluating the quality of library services and identifying their effect on users. The new edition of ISO 11620 tries to clarify this and includes some “border” indicators, such as measures for the awareness of libraries their services.Originality/valueThe overview of developments in the standardized performance measures will help to understand the relation of the indicators to the current goals and tasks of libraries and may further the use of the standard. As libraries’ tasks and activities will continue to develop and change, new topics will come up in the next few years, some of which can already be identified today.

Tracking Smart Beta indices during different market phases: A “smarter” option for passive investors?

Purpose This study aims to examine whether tracking Smart Beta (SB) indices during bullish, bearish and stagnant market phases is a better choice for passive investors compared to Cap-Weighted (CW) indices. As investors’ strategies differ with market movements, this study analyses how single-factor and multi-factor SB indices perform during different market phases, in relation to CW indices. It also attempts to determine which SB factors are more suitable for investors in these phases. Design/methodology/approach Using various return and risk indicators, this study analyses how SB indices perform vis-à-vis CW indices during bullish, bearish and stagnant phases. The authors also evaluate the upside and downside participation advantage of SB indices and assess their ability to capture upside returns and limit downside risk. The authors attempt to determine the cyclical or defensive nature of SB indices using Average Participation values. Findings This study found that SB indices outperform CW indices during the bearish and stagnant phases. Multi-factor SB indices have lower risk levels in all market phases, providing downside protection to risk-averse investors. Dividend, Low Volatility, Quality and multi-factor SB indices are defensive portfolios offering better payoffs during the down market phases, while Alpha, Beta, Equal Weight and Value SB indices provide higher payoffs during the up-market phases. Originality/value To the best of the authors’ knowledge, this is the first study that examines the performance of single-factor and multi-factor Indian SB indices in different market phases. It determines the suitability of various factors to passive investors during these phases and also identifies whether SB indices are cyclical or defensive.

Sleep Health Patterns in Romania: Insights from a Nationwide Cross-Sectional Online Survey

Background: Sleep is one of the most essential processes for sustaining cognitive, emotional, and physical health across all age groups. Insomnia or inadequate sleep significantly impacts health and poses economic burdens due to increased healthcare costs and reduced productivity. Objectives and Methods: This study aimed to investigate sleep quality in the Romanian active population using an online survey incorporating the Pittsburgh Sleep Quality Index (PSQI). Conducted over four months in 2023, the survey gathered 2243 complete responses from urban and rural residents over the age of 18. Results: The results highlight gender and urban–rural disparities in sleep quality, revealing that females and urban residents experienced poorer sleep compared to their counterparts. Additionally, sleep quality was found to significantly worsen with age, with elders (56+ years) reporting the highest PSQI scores, indicating greater sleep difficulties compared to middle-aged adults and youngsters. A high prevalence of sleep disturbances, daytime dysfunctions, and sleep medication use was reported. Common pre-sleep activities included using electronic devices and watching TV, while fewer participants engaged in reading books or consuming alcohol and caffeine. Additionally, participants’ bedding preferences were documented. Conclusions: Our study highlights the influence of various factors on sleep quality and emphasizes the need for targeted public health interventions to improve sleep health in Romania.

Assessment of the Quality of Borehole Water Collected Around Unlined Solid Waste Dumpsites within Awka Metropolis

Groundwater is an important natural resource that is essential to man and other living things. However, it can become polluted resulting from natural and anthropogenic conditions. The quality of selected groundwater samples collected from boreholes around abandoned and active dumpsites in Awka metropolis, Nigeria between January and March 2023, was assessed using water quality index (WQI) method. The samples were analyzed for their physico-chemical properties and some selected heavy metals using atomic absorption spectroscopy. The results of the physico-chemical analysis showed that the mean pH ranged from 5.75 – 6.71 in January as compared to 5.92 – 6.98 in February and 5.94 – 6.84 in March indicating slight acidity. Calcium and magnesium content ranged from 8 – 20mg/l of Ca2+ and 96 – 314 mg/l of Mg2+ ion. The concentration of heavy metals in the samples were all seen to be within the standard limits for potable water (Fe (0.057 – 2.384 ppm), Cu(0.00 – 0.185 ppm) except for mercury, lead and cadmium(Hg (0.00 – 0.248 ppm), Pb (0.00 – 0.051 ppm), Cd (0.006 – 0.39 ppm) for the month of February whereas heavy metal concentration for the month of March ranged from Fe (1.432 – 2.908 ppm), Cu (0.00 – 0.008 ppm), Hg (0.00 – 0.016 ppm), Pb (0.00 – 0.003 ppm), Cd (0.00 – 0.01ppm). Pollution Index of the sampled borehole water from the different locations shows that some were potable and can be consumed without treatment. The study shows that solid wastes contribute to the level of contamination caused by Heavy metals and some physico-chemical parameters in groundwater matrix.

Characteristics and correlated factors of preoperative sleep disorders in cardiac surgical patients

Objective: To investigate the clinical characteristics and correlated factors of preoperative sleep disorders in patients undergoing various types of cardiac surgery. Methods: The data of patients at the Structural Heart Surgery Center of Beijing Anzhen Hospital, Capital Medical University, from April 2023 to February 2024 were retrospectively collected. Patients were categorized into five groups based on cardiac surgical diagnosis: coronary heart disease, valvular disease, large vessel disease, congenital heart disease, and others. Each group was further subdivided into normal sleep (NS) and sleep disorder (SD) groups based on the Pittsburgh Sleep Quality Index (PSQI) scores. Demographic information, cognitive function, psychiatric symptoms, and other relevant data were collected. Clinical characteristics were compared between groups, and factors associated with preoperative sleep disorders were analyzed using multivariate logistic regression. Results: A total of 1 016 patients aged (58.6±12.7) years were included in the study, including 701 males and 315 females. The incidence of SD was 45.6% (463/1 016). Multivariate logistic regression analysis showed that aging was a risk factor for sleep disorders in patients with coronary heart disease (OR=1.050, 95%CI: 1.026-1.077) and valvular disease (OR=1.033, 95%CI: 1.013-1.053). High Self-rating Depression Scale (SDS) score was a risk factor for sleep disorders in patients with valvular disease (OR=1.050, 95%CI: 1.013-1.091). High score on the Montreal Cognitive Assessment (MoCA) subitem-abstraction ability was a protective factor for sleep disorders in patients with coronary heart disease (OR=0.695, 95%CI: 0.490-0.981). Conclusions: The risk factors of preoperative sleep disorders in cardiac surgery patients vary based on the type of cardiac disease. Aging, depression and abstraction ability correlate with sleep disorders in cardiac surgical patients.

Evaluation of the Interdisciplinary Care Home-bAsed Reablement Program (I-CHARP) for People Living With Cognitive Impairment and Dementia in Care Homes.

Major knowledge and practice gaps exist in aged care home services to support independence of older people with dementia. This research evaluates an adaptation of a community-based rehabilitation model for care homes, namely Interdisciplinary Care Home-bAsed Reablement Program (I-CHARP), by examining whether (and, if so, how) I-CHARP produces its intended effects and how this programme can be practicably implemented, sustained and scaled up across care homes in Australia. I-CHARP is a 4-month bio-behavioural-environmental rehabilitation model of care, integrated in care home services, supported through the deployment of an implementation strategy, the Research Enabled Aged Care Homes (REACH) network. It consists of (1) 8-12 full individual sessions and additional eight brief follow-ups per resident, tailored to the resident's needs, delivered primarily by a team of an occupational therapist, registered nurse and other allied health staff; (2) environmental modifications/assistive devices up to the value of $400 per resident; and (3) engagement of intervention care home staff, managers and regular visitors. An overarching evaluation approach is participatory action research using a cluster quasi-experimental design and mixed methods. It involves testing of the implementation strategy (REACH network and other approaches) while observing/gathering information on the intervention (I-CHARP) and related outcomes in three cycles. Participants include residents (aged ≥ 60 years with early stages of dementia) and care staff from 16 care homes. Care quality indicators, health care costs, field notes and semi-structured interviews/focus groups with intervention site staff, regular visitors and managers will provide further insights into I-CHARP processes and implementation issues. In the final phase of the project, an Agile Implementation Playbook will be developed for the delivery of reablement care that can be used in routine practice across care homes in Australia. The study findings will also inform future policy development and strategic directions for dementia care in care homes. Australian New Zealand Clinical Trial Registry, ACTRN12623000885695 Registered 16 August 2023, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=386088. 1.0 dated 20 July 2023.

Quality indicators of long-term care for older people in OECD countries; a rapid scoping review

Abstract Background The COVID-19 pandemic has exposed the vulnerability of older people living in long-term care facilities (LTCF), highlighting the urgent need for research on the quality of care for this group of the population. There is no universal definition for quality of care in LTCF, and yet, multiple tools and indicators have been developed to measure it. In this rapid scoping review, we aim to provide a comprehensive overview of the current knowledge on quality of care concepts and indicators for older people in LTCF in OECD countries. Methods This review follows the World Health Organization (WHO) guide for rapid reviews and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA-ScR) extension for scoping reviews, including protocol registration (https://doi.org/10.17605/OSF.IO/34B2S). The electronic bibliographic databases MEDLINE (PubMed), EMBASE, and CINAHL were searched in September 2023 for studies published between 2013 and 2023 for quality indicators in LTCF. Experts in quality of care in LTCF were contacted and consulted to retrieve sources of grey literature. Information on the definition or framework of quality of care, quality of care dimensions, measurement instruments, context and purpose of the measurement will be extracted. Results Of the 8,516 identified records, 6,449 were screened by title and abstract after removing duplicates. A total of 469 publications will be screened in full-text. Experts recommended 40 websites to be screened for quality indicators. The PRISMA flowchart diagram will be provided to describe the selection process. Conclusions This review aims to improve the quality of care for older people living in LTCF. Our results will identify which concepts and dimensions of care are currently being measured in OECD countries, whether they are backed by any definition and scientific framework of quality of care for older residents of LTCF, and whether there is consideration of closing gaps in quality measurement. Key messages • Quality of care is an understudied field in the context of long-term care facilities for older people. • In order to further improve quality in long-term care for older people, it is necessary to systematically review the current state of knowledge on quality concepts and indicators.

Timing of Palliative Care, End-of-Life Quality Indicators, and Health Resource Utilization.

Despite research supporting the benefits of early palliative care, timely initiation by gynecologic oncology patients is reportedly low, which may limit the effectiveness of palliative care. To investigate the association of the timing of palliative care initiation with the aggressiveness of end-of-life care using established quality indicators among patients with ovarian cancer. This population-based retrospective cohort study of ovarian cancer decedents used linked administrative health care data to identify palliative care provision across all health care sectors and health care professionals (specialist and nonspecialist) and end-of-life quality indicators in Ontario, Canada, from 2006 to 2018. Data analyses were performed July 12, 2024. The primary outcome was the associations between the timing of palliative care and end-of-life quality indicators, including emergency department use, hospital or intensive care unit admission in the last 30 days of life, chemotherapy in last 14 days of life, death in the hospital, and a composite measure of aggressive care. Late palliative care was defined as 3 months or less prior to death. There were 8297 ovarian cancer decedents. Their mean (SD) age at death was 69.6 (13.1) years, and their mean (SD) oncologic survival was 2.8 (3.9) years. Among 3958 patients with known cancer stage, 3495 (88.3%) presented with stage III or IV disease. One-third of patients (2667 [32.1%]) received late palliative care in the final 3 months of life. Results of multivariable regression analysis indicated that any palliative care initiated earlier than 3 months before death was associated with lower rates of aggressive end-of-life care (odds ratio [OR], 0.47 [95% CI, 0.37-0.60]), death in hospital (OR, 0.54 [95% CI, 0.45-0.65]), and intensive care unit admission (OR, 0.46 [95% CI, 0.27-0.76]). Specialist palliative consultation from 3 months up to 6 monts before death was associated with decreased likelihood of late chemotherapy (OR, 0.46 [95% CI, 0.24-0.88]). Findings from this cohort study suggested that early palliative care may be associated with less-aggressive end-of-life care than late palliative care. Implementation strategies for early palliative care initiation are needed to optimize care quality and health resource utilization at the end of life.