Real-world Impact Research Articles

Impact Location Dependence of Behind Armor Blunt Trauma Injury Assessed Using a Human Body Finite Element Model.

Behind armor blunt trauma (BABT), resulting from dynamic deformation of protective ballistic armor into the thorax, is currently assessed assuming a constant threshold of maximum backface deformation (BFDs) (44 mm). Although assessed for multiple impacts on the same armor, testing is focused on armor performance (shot-to-edge and shot-to-shot) without consideration of the underlying location on the thorax. Previous studies identified the importance of impacts on organs of animal surrogates wearing soft armor. However, the effect of impact location was not quantified outside the threshold of 44 mm. In the present study, a validated biofidelic advanced human thorax model (50th percentile male) was utilized to assess the BABT outcome from varying impact location. The thorax model was dynamically loaded using a method developed for recreating BABT impacts, and BABT events within the range of real-world impact severities and locations were simulated. It was found that thorax injury depended on impact location for the same BFDs. Generally, impacts over high compliance locations (anterolateral rib cage) yielded increased thoracic compression and loading on the lungs leading to pulmonary lung contusion (PLC). Impacts at low compliance locations (top of sternum) yielded hard tissue fractures. Injuries to the sternum, ribs, and lungs were predicted at BFDs lower than 44 mm for low compliance locations. Location-based injury risk curves demonstrated greater accuracy in injury prediction. This study quantifies the importance of impact location on BABT injury severity and demonstrates the need for consideration of location in future armor design and assessment.

Artificial Intelligence in Surgery: The Future is Now.

Background Clinical Artificial intelligence (AI) has reached a critical inflection point. Advances in algorithmic science and increased understanding of operational considerations in AI deployment are opening the door to widespread clinical pathway transformation. For surgery in particular, the application of machine learning algorithms in fields such as computer vision and operative robotics are poised to radically change how we screen, diagnose, risk-stratify, treat and follow-up patients, in both pre- and post-operative stages, and within operating theatres. Summary In this paper, we summarise the current landscape of existing and emerging integrations within complex surgical care pathways. We investigate effective methods for practical use of AI throughout the patient pathway, from early screening and accurate diagnosis to intraoperative robotics, post-operative monitoring and follow-up. Horizon scanning of AI technologies in surgery is used to identify novel innovations that can enhance surgical practice today, with potential for paradigm shifts across core domains of surgical practice in the future. Any AI-driven future must be built on responsible and ethical usage, reinforced by effective oversight of data governance, and of risks to patient safety in deployment. Implementation is additionally bound to considerations of usability and pathway feasibility, and the need for robust healthcare technology assessment and evidence generation. While these factors are traditionally seen as barriers to translating AI into practice, we discuss how holistic implementation practices can create a solid foundation for scaling AI across pathways. Key Messages The next decade will see rapid translation of experimental development into real-world impact. AI will require evolution of work practices, but will also enhance patient safety, enhance surgical quality outcomes, and provide significant value for surgeons and health systems. Surgical practice has always sat on a bedrock of technological innovation. For those that follow this tradition, the future of AI in surgery starts now.

Market Competition and Monopoly Power: Insights from Oligopoly Structure

In this context, the primary objective is to conduct a comprehensive investigation into the real-world implementation and impact of distinct economic models. Through the literature analysis, the paper sets out to examine product competition and corporate conduct within two contemporary markets. Through this meticulous approach, the aim is to unveil the nuanced distinctions and intriguing parallels that exist between Oligopoly and Oligopoly Competitive Markets. First, broad definitions and classifications of both oligopolistic and oligopolistically competitive markets are considered. Second, the subtle differences between the two markets will be shown through specific oligopoly examples (such as OPEC and mobile phone market). Third, detailed analysis of the features of the similarity between the two markets. Finally, the study found that, as two different market structures, the oligopoly market and the oligopoly competition market have completely different gaps in market control and price stability, but it is undeniable that the two markets have the same driving force in innovation.

Real-world impact on overall survival of oxaliplatin-based adjuvant chemotherapy in older patients with colorectal cancer in Mexico.

61 Background: Colorectal cancer (CRC) is one of the most commonly diagnosed cancer both in Mexico and worldwide, with the peak incidence in patients >65 years. The use of adjuvant chemotherapy (CT) improves the prognosis of high-risk CRC. The benefit from fluorouracil (FU)-based CT across all age groups is not questionable, but the use of oxaliplatin (Ox) is controversial. Methods: Original, retrospective, observational study. Included patients diagnosed with CRC adenocarcinoma treated at the Instituto Nacional de Cancerología México, between 2004 to 2022. Statistical analysis required: X2 and t-test, Kaplan Meier, Log Rank, and Cox Regression. Statistical significance differences were assessed when p was bilaterally <0.05. Results: From 1,238 patients with localized CRC, 275 patients were included in analysis and divided into 2 groups: young (≤ 30 years) (n = 54), and older (≥ 70 years) (n = 221). Most patients were female for both groups (55%). Comorbidities were observed in 2% of young patients and 51% of older patients (p < 0.001). Stages (S) were: II (31%; 39%), and III (59%; 47%). CT was received in 70% of young and 47% of older patients (p = 0.002). Regarding CT regimens, 56% and 21% of young and older patients respectively, had oxaliplatin (p < 0.001), while 21% of young and 32% of older patients did not complete the CT (p = 0.012). Overall survival (OS) analysis was performed considering age and S. S-II median-OS was not reached (NR) for both groups, while S-III median-OS was 170 months (m) for young versus NR for older (p = 0.690). When including CT in OS analysis, patients S-II median-OS was NR for all groups (p = 0.081), while S-III median-OS was 170 m with and 19 m without CT for young versus NR with and 89 m without CT for older, respectively (p = 0.010, 95% CI 0.059-0.123). In S-III older patients, a sub-analysis was performed considering Ox: 10-year-OS was 71% versus 60% for patients treated with and without Ox respectively (p = 0.030, 95% CI 0.25-0.93). In Cox-Regression analysis for patients with clinical stage III, regimen completion (p = 0.004; HR 0.38, 95% CI 0.201-0.745) and Ox (p = 0.022; HR 0.423, 95% CI 0.203-0.881) remained as predictor factors of OS. Conclusions: There are no studies which compare the administration of CT between young and older patients or the description of these populations in Mexico. Young patients are more likely to receive CT with Ox assumingly due to the lack of comorbidities and life expectancy. The benefit of CT on OS in young patients is not in question. An increase in OS was found in older patients who received CT with Ox, but a higher percentage of treatment discontinuation secondary to toxicity. As recommended by the literature, its essential to integrate assessment in older patients to determine which patients will benefit from complete CT regimens to increase their OS, apart from their chronological age.

Three-dimensional modeling of impact fractures in brittle materials via peridynamics

Accurate prediction of the impact fracture behavior of brittle materials is crucial in various industries. The paper employs the peridynamic method to model the penetration and damage in brittle materials during impact. The proposed three-dimensional peridynamic impact fracture model (3D-PDIFM) overpasses other numerical models by adopting a new computational technique to couple the impact collisions of different types of projectiles with the peridynamic method. Moreover, the 3D-PDIFM is highly efficient in impact fracture simulations by focusing on the effects of the projectile without simulating its particles, thereby saving more computational efforts. Validation through comparison with experimental measurements and observations ensures that the 3D-PDIFM accurately represents the real-world impact fracture behavior of brittle materials. The paper also highlights the efficiency of the 3D-PDIFM in comparison to traditional mesh-based numerical simulations. Therefore, the 3D-PDIFM can be significant for practical engineering applications as efficient simulations can save time and computational resources. Using the validated model, the impact fracture behavior of PMMA under various conditions, such as changes in panel thickness, impact area, and projectile velocity, is investigated. This analysis gains more insights into how these factors affect the brittle material's response to impact. Moreover, the impact fracture behaviors of tempered glass and float glass panels are examined under different conditions of impact loadings. This study also explains the penetration and impact fracture phenomena in brittle materials. Overall, using the 3D-PDIFM as a modeling and simulation tool can help engineers and researchers analyze the behavior of glass panels under various impact scenarios, thus allowing for optimization of design parameters to improve impact resistance.

A polygenic risk score added to a QRISK®2 cardiovascular disease risk calculator demonstrated robust clinical acceptance and clinical utility in the primary care setting.

The aim of the study was to assess the real-world feasibility, acceptability, and impact of an integrated risk tool for cardiovascular disease (CVD IRT, combining the standard QRISK®2 risk algorithm with a polygenic risk score), implemented within routine primary practice in the UK National Health Service. The Healthcare Evaluation of Absolute Risk Testing Study (NCT05294419) evaluated participants undergoing primary care health checks. Both QRISK2 and CVD IRT scores were returned to the healthcare providers (HCPs), who then communicated the results to participants. The primary outcome of the study was feasibility of CVD IRT implementation. Secondary outcomes included changes in CVD risk (QRISK2 vs. CVD IRT) and impact of the CVD IRT on clinical decision-making. A total of 832 eligible participants (median age 55 years, 62% females, 97.5% White ethnicity) were enrolled across 12 UK primary care practices. Cardiovascular disease IRT scores were obtained on 100% of the blood samples. Healthcare providers stated that the CVD IRT could be incorporated into routine primary care in a straightforward manner in 90.7% of reports. Participants stated they were 'likely' or 'very likely' to recommend the use of this test to their family or friends in 86.9% of reports. Participants stated that the test was personally useful (98.8%) and that the results were easy to understand (94.6%). When CVD IRT exceeded QRISK2, HCPs planned changes in management for 108/388 (27.8%) of participants and 47% (62/132) of participants with absolute risk score changes of >2%. Amongst HCPs and participants who agreed to the trial of genetic data for refinement of clinical risk prediction in primary care, we observed that CVD IRT implementation was feasible and well accepted. The CVD IRT results were associated with planned changes in prevention strategies.

Exploring the nexus of RFID and industry 4.0: Bibliometric analysis to investigate the strategic themes and thematic evolution

Purpose: This article aims to identify themes associated with RFID technologies (Radio Frequency Identification) and industry 4.0. Using key articles from the database developed for this study, the main themes underlying key technology features and their relationships will be uncovered.Design/methodology/approach: Systematic quantitative literature review is conducted to uncover hidden relationships between RFID and industry 4.0. The research methodology encompasses a systematic analysis of pertinent literature and resources, employing a structured approach to identify and categorize crucial topics and keywords that constitute the basis for our exploration. Subsequently, we delve into the relationships within these identified dimensions, aiming to synthesize a holistic interpretation of the connections between RFID and Industry 4.0.Findings: Through our rigorous analytical process, we have unveiled significant attributes embedded within the three delineated dimensions. These findings contribute to our capacity to construct a synoptic depiction that encapsulates all relevant associations between RFID technology and the Industry 4.0 paradigm. The synthesis of relationships between Radio Frequency Identification (RFID) technology and the Industry 4.0 framework, derived from our analysis of pivotal dimensions and keywords, offers a profound insight into the intricate interplay between these domains. As industries continue to evolve in the wake of technological advancements, this study contributes to the foundation of knowledge necessary to navigate the dynamic landscape of modern industrial systems.Research limitations/implications: Bibliometric network analysis offers a systematic approach to literature review, aiding researchers in identifying seminal works, influential authors, and emerging trends within a field. By visualizing the relationships between authors, journals, and keywords, bibliometric network analysis facilitates the mapping of academic disciplines, enabling researchers to comprehend the intellectual landscape. Network analysis highlights potential collaboration opportunities by revealing clusters of authors or institutions with closely related research interests and specific works related industry 4.0 and RFID, wans’t found, however, being a potential limitation, it proved to be a way to maintain the originality and necessity of this work we are presenting.Practical implications: The practical employs bibliometric research to explore the synergy between Industry 4.0 and Radio Frequency Identification (RFID), aiming to provide a comprehensive understanding and practical applicability of these interconnected themes. The study's findings offer practical implications such as facilitating technology integration, optimizing operations, guiding investment decisions, fostering collaborations, informing policy-making, supporting professional development, and enabling knowledge dissemination. These insights underscore the tangible real-world impact of academic research in enhancing industry practices and driving innovation within the context of Industry 4.0 and RFID integration.Originality/value: This study stands as one of the pioneering works to delineate the themes linked with both Radio Frequency Identification (RFID) technologies and the Industry 4.0 paradigm.

Tralokinumab Real-World Patient-Reported Outcomes in Moderate-to-Severe Atopic Dermatitis Adult Patients in the United States: 6-Month Interim Analysis

Introduction: Tralokinumab, an IL-13 targeted biologic approved in the United States (US) for adult patients with moderate-to-severe atopic dermatitis (AD), improved patient-reported outcomes (PROs) in clinical trials and after 4 weeks of use in the real-world setting. This 6-month interim analysis evaluated the real-world impact of tralokinumab on PROs in adult patients.
 Methods: This is an interim analysis of an ongoing 52-week patient survey study enrolling US AD patients from the AdbryTM AdvocateTM Program. Patients completed the baseline survey close to tralokinumab initiation. Data on demographics and PROs including weekly itch numeric rating scale (NRS), eczema-related weekly sleep NRS, Dermatology Life Quality Index (DLQI), and Treatment Satisfaction Questionnaire for Medication (TSQM-9) were collected. Percent and absolute changes from baseline to 6 months of treatment were calculated. Outcomes are stratified by previous dupilumab use. The percentage of patients experiencing minimal clinically important difference (MCID) was also calculated for itch NRS (3-point reduction) and DLQI (4-point reduction).
 Results: As of May 2023, 102 patients completed baseline, 1-month, and 6-month surveys. Of these, 59.8% were female, mean age was 44.2 years (SD=15.7), 82.4% were white, and 85.3% had private insurance. 84.3% were previously treated with topical corticosteroids (TCS) and 52.9% were dupilumab-experienced patients. Over 6 months, there was an improvement in the mean sleep interference NRS (40%), average weekly itch NRS (39%), worst weekly itch NRS (33%), PO-SCORAD (37%), and DLQI (52%). There were improvements in mean TSQM-9 global satisfaction (11.06 points), TSQM-9 convenience (3.92 points), and TSQM-9 effectiveness (14.60 points) scores. Median MCIDs were met by 57.1% on the sleep interference NRS, 51.7% of patients on the average weekly itch NRS, 50.0% on the worst weekly itch NRS, and 68.7% on the DLQI. Relative to the dupilumab-experienced cohort, the dupilumab-naïve patients showed markedly improved outcomes [median MCIDs of 65.6% v 48.4% on sleep NRS; 59.5% v 44.4% on average weekly itch NRS; 61.4% v 39.6% on worst weekly itch NRS; 61.4% v 35.3% on PO-SCORAD; and 75.6% v 61.9% on DLQI].
 Conclusion: This 6-month interim analysis shows that tralokinumab improved quality of life outcomes related to itch, sleep, and treatment satisfaction when used either in dupilumab-naïve or in dupilumab-experienced patients. These patients will continue to be followed for up to 52 weeks of treatment with tralokinumab.

Developing and Validating a Qualitative Tool for Playtesting Service Learning-Based Accessible Games: A Comprehensive Approach

INTRODUCTION: The complex accessibility needs of some players and, in particular, of people with Intellectual Disability (pwID) require greater attention from research due to the lack of tools to support playtesting, particularly those of a qualitative nature and suited to their diversity of experiences and motor and cognitive characteristics. OBJECTIVES: Recognizing the scarcity of research in media production, particularly games, the study pursues three objectives: firstly, to describe the accessible games developed through a multi-year service learning project involving students from the Videogames Bachelor’s Degree and pwID; secondly, to approach the validation of the Gaming Observation Grid (GOG), a qualitative tool for playtesting sessions; and thirdly, to reflect on service learning as a strategy for bridging the gap between academia and civil society in the context of game design. METHODS: The research employed a qualitative media ethnography-based approach involving students from the Videogames Bachelor's Degree. Over a span of three years and six consecutive semesters, 59 students actively participated in a service learning project, engaging with pwID and Non-Governmental Organizations (NGOs) in the field. All playtesting activities’ observations were based on GOG, with a total of 273 observed gaming sessions. RESULTS: The development of 18 videogames, spanning diverse genres and themes, prioritized accessibility based on adjustment settings. GOG emerged as a tailored and feasible instrument, valuable in the broader landscape of inclusive game development. In terms of service-learning outcomes, results highlight students' reflections on the real-world impact of game design and development, underscoring the pedagogical value of service learning in bridging theoretical knowledge and practical application. CONCLUSION: This study underscores the critical need for enhanced research attention to the complex accessibility requirements of players, particularly pw ID, while emphasizing the relevance of qualitative playtesting tools tailored to their diverse experiences and cognitive-motor characteristics, as well as the inherent value of the experience for the students involved.

From Attendance Data to Student Support: International Practices for Recording, Reporting, and Using Data on School Attendance and Absence

The recording, reporting, and use of data on school attendance and absence (DSAA) play a crucial role in understanding attendance and addressing absence in educational systems worldwide. However, a comprehensive grasp of the diverse approaches adopted across and within different countries has remained elusive. To address this knowledge gap, the International Network for School Attendance (INSA) facilitated this special issue providing an in-depth investigation into DSAA practices in 13 countries. This opening paper serves two purposes. First, it lays the conceptual groundwork for readers before they delve into the recording, reporting, and use of DSAA in different countries. Second, it presents key insights that emerge from the diverse array of contributions and a discussion of challenges and opportunities for the field. These include the substantial inconsistencies within and across countries; the pressing need for standardised best practices for recording, reporting, and using data; and the importance of embracing technological advancements to enhance the use of data. We envisage that the collective effort of the 40 authors involved in this special issue will enrich knowledge, enhance collaboration, and create real-world impact by enabling interested parties to develop, use, and evaluate data-driven strategies related to attendance and absence. By working together to address challenges and seize opportunities related to DSAA, we help young people access the education they rightfully deserve.

Beyond the headlines: On the efficacy and effectiveness of misinformation interventions

Research into how to best counter misinformation has enjoyed a great deal of popularity, but a discussion about how efficacy (successful lab studies) translates to effectiveness (real-world impact) is lacking. Lab studies have shown that many types of misinformation interventions are efficacious at achieving their intended outcomes (e.g., improving “discernment”, or the ability to distinguish true from false information). However, drawing on implementation science, we identify six challenges facing misinformation interventions research: (1) an overabundance of lab research and a lack of field studies; (2) testing effects which impede intervention longevity and scalability; (3) modest effects for small fractions of relevant audiences; (4) a reliance on item evaluation tasks (e.g., rating a series of headlines as true or false) as the primary efficacy measure of interest; (5) low replicability in the Global South and a lack of audience-tailored interventions; and (6) an underappreciation of potential unintended consequences of intervention implementation. We argue that it is time to look beyond item task performance as the primary outcome measure and to elevate both real-world outcomes and alternative measures of effectiveness (e.g., intervention attractiveness or user uptake) as equally important ways of assessing “what works”. We provide practical recommendations for addressing each challenge and improving intervention effectiveness.

EFFICIENT U-NET FOR INSIGHTFUL LUNG CANCER DIAGNOSIS

Lung cancer detection often relies on interpreting subtle nodules in CT scans, a task demanding precise segmentation tools beyond simple image classification models. While existing methods utilizing other architectures might achieve decent accuracy, they often struggle with limited CT scan datasets and scalability, hindering their real-world impact. Our paper addresses the imperative need for enhanced lung cancer detection by integrating the Efficient U-Net architecture, which is implemented to achieve better results on image classification tasks while using low computational resources, it means achieve high accuracy can be achieved with few parameters and makes computation less expensive compared to other models, with the Luna16 dataset. Our proposed model excels in feature extraction and overcoming vanishing gradients, ensuring sharper and more accurate nodule segmentation in CT scans. The Luna16 dataset, a diverse and annotated benchmark, facilitates comprehensive learning and adaptability to various nodule types and imaging conditions.

Generative AI Solutions for Faculty and Students: A Review of Literature and Roadmap for Future Research

Aim/Purpose: This paper aims to address the gap in comprehensive, real-world applications of Generative Artificial Intelligence (GenAI) in education, particularly in higher education settings. Despite the evident potential of GenAI in transforming educational practices, there is a lack of consolidated knowledge about its practical effectiveness and real-world impact. Background: This study addresses this gap by conducting a systematic literature review to collate and analyze real-life instances of GenAI applications in higher education, thus providing a nuanced understanding of its practical implementations and measurable outcomes. Methodology: The paper utilizes a systematic literature review methodology, adopting the PRISMA approach complemented by a thematic analysis procedure to ensure a comprehensive and in-depth evaluation of the literature. It synthesizes information from relevant articles from 2022 to 2024, focusing on the applications of GenAI in higher education. This analysis covers various aspects, including research settings, analysis scales, data types, collection tools, and analytical methods. Contribution: The paper contributes to the academic community by offering a comprehensive review of GenAI applications in education, highlighting the current precision level of these tools, and providing strategic recommendations for their effective use in academia. Furthermore, the research defines seven specific cases where Gen AI can be utilized as a reference for educational institutions in their adoption strategies. Findings: Key findings include the versatility of GenAI in generating teaching materials, enhancing skill development, supporting student tasks, academic performance evaluation, feedback delivery, and its role as a virtual assistant and in research support. Recommendations for Practitioners: Practitioners are advised to explore the integration of GenAI for diverse educational purposes, from content creation to student assessment, while being cognizant of its limitations and ethical considerations. Recommendation for Researchers: Future research should focus on addressing the gaps identified, such as the implications of GenAI in research roles, its application in various disciplines, and the exploration of newly developed AI tools tailored to specific educational needs. Impact on Society: The findings of this paper highlight the potential of GenAI in revolutionizing the educational sector, offering personalized learning experiences, and significantly influencing teaching methodologies and student engagement, but it also reveals significant deficiencies of Generative AI, known as hallucinations, which can impact the expected results. Future Research: Subsequent research should explore the evolving capabilities of GenAI models, their impact on various academic disciplines, and the development of pedagogical strategies to optimize their use in education.

Forecasting Energy Consumption with AI: A Review for Sustainable Energy Management

This paper provides a comprehensive review of the integration of artificial intelligence (AI) within the context of Industry 4.0, emphasizing its transformative impact on various industries and its specific applications in energy consumption forecasting for sustainable energy management. Beginning with a historical perspective on industrial evolution, from automation to the current cyber-physical systems era, the review highlights the pivotal role of AI in reshaping manufacturing processes. The article explores the diverse applications of AI in the energy sector, particularly its effectiveness in short-term load forecasting, demand response optimization, and accurate predictions for renewable energy sources like solar and wind. The growing complexity of power systems due to decentralization and the proliferation of grid-connected devices is discussed, underscoring the importance of effective information exchange facilitated by AI. Additionally, the review delves into various models used for energy forecasting, including supervised learning models, artificial neural networks, and deep learning models. The practical applications of AI in power system control, management, energy market pricing, and policy recommendations are outlined, showcasing its potential in optimizing energy efficiency and balancing electricity production and consumption. The practical examples of AI's role in improving predictions of supply and demand, such as Google's subsidiary DeepMind enhancing wind power output forecasts, highlight the real-world impact of these technologies. However, the abstract also acknowledges existing challenges, including insufficient theoretical background, practical expertise, and financial constraints hindering widespread AI adoption in the energy industry. In conclusion, the article offers valuable insights into the current state, challenges, and potential of AI in forecasting energy consumption, providing a roadmap for sustainable energy management across diverse industries.

Real-world effectiveness of fidaxomicin in patients at high risk of Clostridioides difficile recurrence.

Compare the real-world impact of fidaxomicin (FDX) and vancomycin (VAN) on Clostridioides difficile infection (CDI) recurrence in a high-risk patient population. A retrospective, matched-cohort study evaluating hospitalized patients with CDI from January 1, 2016, to November 1, 2022, within a tertiary academic medical center. Adult patients with at least 1 prior CDI case who received either FDX or VAN for non-fulminant CDI while admitted, and had at least 1 additional risk factor for recurrence. Risk factors included age >70, solid organ or bone marrow transplant recipients, broad-spectrum antibiotic use within 30 days, or receipt of chemotherapy/immune-modulating agents within 30days of admission. FDX and VAN patients were matched according to risk factors. A total of 415 patient admissions were identified. After the exclusion of 92 patients for fulminant CDI, diarrhea from another cause, or use of VAN taper therapy, and 15 unmatched patients, 308 patient admissions were included (68 FDX and 240 VAN patients). There were no significant differences in 4-week recurrence (26% vs 23%; OR 1.1; P = .51), 90-day CDI readmission (29% vs 23%; P = .65), or 90-day all-cause readmission (54% vs 53%; P = .91). There was a significant 17% decrease in 90-day mortality associated with the use of FDX (OR .3; P = .04). In a real-world high-risk patient population, the use of FDX compared to oral VAN did not result in decreased CDI recurrence within 4 weeks or fewer hospital readmissions within 90 days. Further research is needed to better assess the value of FDX in this patient population.

The relevance of life cycle assessment to decision-making in companies and public authorities

Life Cycle Assessment (LCA) is increasingly used, but studies about the influence on decision making and the actual impact of LCA are so far lacking. The goal of this study is therefore to present a first assessment of the influence of LCAs within decision-making and the real-world impact of LCAs. For this purpose, a semi-quantitative questionnaire and several qualitative interviews were performed with decision makers from industry and governmental agencies. The results show that half of the surveyed organizations use LCA frequently in decision-making, while the other half only implement LCA in a few decision situations. In companies, LCA is applied for product development and optimization as well as strategic decisions. The level of integration of LCA in decision-making processes showed a positive correlation with the consideration of LCA results and the impact of LCA results on decision outcomes. In public authorities (analysis restricted to Swiss authorities), environmental aspects are always considered during the development of new regulations, but the LCA results are not the only aspects influencing the decision outcome. Other aspects are the costs and the environmental awareness of the decision-maker. Three quarters of all organizations use climate change as one environmental indicator, mostly (in 68% of the responding organizations) in combination with other environmental indicators. Four main reasons limit the influence of LCA within decision-making: lower priority of environmental aspects compared to other decision criteria, complex LCA methods, complex results, and a lack of data to perform a reliable LCA. Future research could be conducted with a specific focus on an industrial sector, a country, or a specific application area to allow in-depth insights of decision-making practices.

Lattice Boltzmann Simulation of Mixed Convection Around a Heated Elliptic Block Cylinder within a Lid-driven Square Cavity

A numerical analysis of mixed convection flows and heat transfer in a square enclosure having a sliding wall containing an elliptical block heated by isothermal temperature has been carried out. The enclosure is full of air and cooling from its sides by a cold temperature, whereas the remaining walls of the enclosure are considered thermally insulated. The mixed convection impact is attained by the heating elliptic block and moving upper wall. The investigation of fluid’s hydrodynamic and thermal behavior was examined by using Lattice Boltzmann Method (LBM) at different locations and orientations of the interior elliptical block for Richardson number, Ri, varying from 0.01 to 100 while the Rayleigh number, Ra, is fixed at 104. The findings indicate that the temperature pattern and flow structure are very responsive to the position of the elliptical block and Richardson number. Also, it is found that the heat exchange is very important for the block placed vertically close to the left wall or horizontally close to the bottom wall. More precisely, for Ri = 0.01, by moving the vertical block from the center towards the vicinity of the left/ (the right) surface, the heat transfer rate increases from 5.44 to 11.06/(8.36) with an increase of 103.30%/(53.67%). On the other hand, it is noted that the horizontal elliptic block favors heat evacuation in comparison with the vertical one. This study’s real-world impact lies in the potential to improve our understanding and, consequently, design more efficient cooling systems for electronic devices.

Pilot randomized controlled trial of EMBOLDEN: a novel co-designed community-based intervention to enhance mobility in older adults.

Introduction: Physical mobility and social participation are essential for maintaining independence and improving quality of life with aging. These are also interrelated, with barriers to mobility leading to social isolation, as well as poor physical and mental health. Most mobility-enhancing interventions in older adults have been designed by researchers without public input and delivered in controlled settings. This traditional approach to intervention design and testing may not meet the needs of older adults or prove effective in real-world implementation. To have sustained real-world impact, a model aimed at improving mobility that is person-centred, supports social network engagement, and leverages existing community health and social services is more likely to realize impacts. The EMBOLDEN intervention is a novel evidence-informed and contextually relevant community program. A Strategic Guiding Council comprised of older adults and health and social service providers co-designed the 3-month, multi-component group-based program to enhance mobility in older adults living in neighbourhoods experiencing health inequities. In this analysis, we present the implementation results of our pilot randomized controlled trial (RCT).
 Aims & Methods: The pilot trial aimed to explore the feasibility and implementation of a multi-component intervention to improve mobility in older adults in preparation for a large effectiveness-implementation pragmatic RCT (EMBOLDEN, NCT05008159). Core intervention components include physical activity, healthy eating, socialization, and system navigation. Community-dwelling older adults (≥55 years) living in one neighbourhood in Hamilton, Canada, were randomized (2:1) to either: a weekly 90-minute virtual group program for 9 weeks (intervention) or continued normal routine (control). The intervention team integrated providers from recreation, primary care, and public health. A Community Advisory Board, including older adults and local providers, informed intervention modifications and implementation. Data were collected through participant quantitative surveys, study documentation, and qualitative interviews with participants and interventionists. Survey data were analyzed descriptively; survey open-text data, intervention team documentation, and transcripts were analyzed using content analysis. Process outcomes included program acceptability, intervention fidelity, implementation barriers and facilitators, and intervention feasibility/acceptability to participants and interventionists. 
 
 Results: 11 participants were enrolled; 10 were randomized (6 INT; 4 CON). Participant age ranged from 57-76 years. Most participants identified as female (73%), had a total household income of <$50,000 (73%) and lived alone (55%). Five participants received the allocated intervention. Quantitative and qualitative data collection are complete; analyses are underway. Intervention participants expressed perceived changes to their behaviours related to program outcomes: mobility and health; as well as increased awareness of community supports. Intervention group participants expressed positive experiences with the intervention and perceived impacts on their health and community connections. However, participants expressed a preference for in-person delivery. Interventionists gained experience delivering this multi-component intervention as a team. The COVID-19 pandemic impacted intervention duration (9 vs. 12 weeks), mode of delivery (virtual vs. in-person), and recruitment. Adaptations for the RCT include in-person delivery, longer duration, and new recruitment approaches.
 Conclusions: This pilot trial demonstrated that implementing the EMBOLDEN intervention was feasible and acceptable to participants and interventionists. The team gained important insight into modifications necessary for the larger, pragmatic RCT.

Scale-up Integrated Care for Chronic Diseases in Belgium: a process evaluation of policy dialogues and roadmap interventions

Background. The goal of more integrated care has been on the Belgium health care policy agenda since 2007 with the start of disease specific care trajectories, reports on chronic care and pilot projects at local level. While there is consensus on what needs to be done, the process of how it should be done is much more uncertain. Scale-up of integrated care is complex, because it requires multi-stakeholder action and intersectoral coordination at individual healthcare practice, organizational, and political/system levels, and tailoring to the context in which it is delivered. There is little research on how to scale-up such complex and adaptive interventions.
 The SCUBY project aimed to contribute to scale-up of integrated care through development of evidence-based roadmaps and policy dialogues. This evaluation study examines the SCUBY scale-up intervention, by looking at its implementation outcomes, mechanisms of impact and the interaction with the political, policy and societal circumstances in the Belgium context.
 Methods. The ‘process evaluation for complex interventions’ by the MRC was the evaluation framework. Policy dialogues were defined as the SCUBY-team engagements with key stakeholders to develop and implement roadmaps. They comprised structured formal events, one-to-one interactions with key stakeholders, workshops, consultations, and joining ongoing dialogues of stakeholder networks. The roadmap was a scale-up strategy and included activities, a timeline and a description of the evidence base and key partners/stakeholders involved (change team). Data collection tools included policy dialogue reporting forms and surveys, key informant interviews, policy document review and a project diary. Descriptive and thematic analyses are conducted, together with a policy mapping. 
 Results. The SCUBY team conducted 79 meetings classified as policy dialogues, most of them being small group meetings or network meetings organized by partners. SCUBY organized 6 major policy dialogues and invited a mix of beneficiaries, health system administration representatives, policy makers (from federal and regional level), health care providers and their representative organizations, people involved in organization and coordination of care, care users, and scientific stakeholders. Three themes emerged as being the most important areas for the roadmap: A) primary care practice organization (change management and advocating for primary care nurses); B) data and monitoring (chronic care indicators at primary care practice level and for population health management in Primary Care Zones); and C) healthcare financing (budget for chronic care that stimulates quality and new provider payment models). The roadmap comprised subthemes, with internal objectives (to be reached with our project resources) and external objectives (beyond out sphere of control) and activities. 
 Discussion. Our findings emphasize the importance of adopting a collaborative, networking approach via the organization of various small-size and bigger-size policy dialogues, in order to create real-world impact, by building synergies and coalitions and our researcher team generating boundary spanning skills, as more proximal outcomes. The variation in progress made per roadmap theme was anticipated because of our level of involvement, expertise and resources available. The change team had to find the right balance in the trade-off between relevance and feasibility of certain scale-up strategies.

OLDER ADULTS’ PERSPECTIVES ON ETHICAL ISSUES RELATED TO AGETECH

Abstract Most funding programs in the AgeTech sector emphasise the involvement of the end user in research and innovation activities in order to strengthen relevance, appropriateness and real-world impact. However, this engaged approach is still a work in progress and often remains a matter of tokenism with older adults. Involving older adults is seen as key when creating ethically appropriate and inclusive AgeTech for their age group. This paper based on the reflections from members of two AgeTech groups: AGE-WELL’s Older Adults and Caregivers Advisory Committee and the Research Group of Seniors 411 in Vancouver, BC. This paper highlights some ethical problems inherent in AgeTech, particularly how ageist assumptions can be built into technology-based healthcare, including the ongoing challenges of community participation, and presents a more radical agenda of older adults at the forefront of setting research priorities and shaping the development and implementation of AgeTech. Central to this is the building of community capacity; training to facilitate older adults’ engagement in the research process: mobilizing expertise within the community to address local needs; developing mechanisms for connecting older adults and researchers in an integrated knowledge mobilization process. The paper reflects on how this approach can have a significant impact on the lives of older people, and address the digital divide that marginalizes them. Remaining challenges include how to sustain older adults’ participation in innovation initiatives, and providing hard evidence to demonstrate that a more engaged approach has tangible benefits and impact in terms of developing new products and services.