Rigorous Design Research Articles

Customers' Acceptance and Willingness to Pay for Mandated Septage Management Services of Calamba Water District

Through its practical implications for the field, this study evaluated customer acceptance and willingness to pay for the mandated Septage Management Services provided by the Calamba Water District (CWD). The research, conducted with a rigorous descriptive correlational research design, focused on various factors: awareness and understanding, perceived importance, regulation compliance, and payment preferences. The ultimate goal was to develop an action plan to enhance customer awareness of the importance of septage management and foster a more informed, engaged, and accepting community. The study population comprised customers of the Calamba Water District, with respondents selected through simple random sampling. A total of 385 customers who had adequate awareness of wastewater management and had serviced their household septic tanks were included in the study. Descriptive statistics, including means and Likert scales, were used to describe customer acceptance and willingness to pay for septage management services. The Pearson Product-Moment Correlation was utilized to determine the relationship between customer acceptance and willingness to pay for these services. The findings revealed a significant relationship between customer acceptance and willingness to pay for CWD's mandated Septage Management Services. Specifically, higher levels of customer acceptance were associated with greater willingness to pay for the services. Conversely, as customer acceptance decreased, so did their willingness to pay.

Machine Learning Augmented Compact Modeling for Simultaneous Improvement in Computational Speed and Accuracy

In this article, we have presented the use of prior physics knowledge-based artificial neural networks (KBANNs) to improve the simulation speed and accuracy of compact models for circuit simulations. Multiple architectures such as source-difference artificial neural network (SD-ANN), prior knowledge input artificial neural network (PKI-ANN), and prior knowledge input with difference artificial neural network (PKID-ANN) have been developed to evaluate the best KBANN framework for runtime improvement, accuracy improvement as well as development (training) time improvement. In particular, the proposed PKID-ANN is the best KBANN since it matches the accuracy of rigorous physics-based technology computer-aided design (TCAD) solvers while exhibiting the most compact architecture, the fastest learning rate, and the fastest runtime. To the best of our knowledge, we have reported the first PKID-based architecture for device modeling in this article, as well as the fastest (simulation time) artificial neural network (ANN) compact model for FinFETs, which even outperforms conventional ANNs (C-ANNs) and industry standard compact models (BSIM-CMG) while retaining the physics and predictive accuracy. Moreover, the reported model also has the lowest training/development cost among all alternatives.

Effect Of Direct -Problem Based Learning On Critical Thinking In IBDP Students

Advancements in education are pivotal in enhancing a nation's global competitiveness by cultivating essential competencies, which are increasingly necessary in the rapidly evolving 21st century. The improvement of educational quality begins with the refinement of learning processes, particularly through the development of critical thinking skills among students, who must be equipped to navigate complex challenges. This study aims to develop and evaluate a direct problem-based learning model specifically designed for the Biology curriculum, with a particular focus on the topics of Conservation and Biodiversity, to enhance students' critical thinking skills. Employing a rigorous one-group pretest-posttest design, the research was conducted with a sample of 30 high school students from Cita Hati Christian School. Comprehensive data collection methods were utilized, including both standardized tests and structured questionnaires, to assess the impact of the intervention. Data analysis was meticulously conducted using normality tests, homogeneity tests, and paired sample t-tests to ensure the reliability and validity of the findings. The results unequivocally demonstrate that the direct problem-based learning model is both feasible and effective in significantly enhancing students' critical thinking skills, as evidenced by a statistically significant improvement (p-value 0.000 < 0.05). In conclusion, this study provides compelling evidence that the integration of direct instruction with problem-based learning within the context of biology not only enhances the acquisition of subject-specific knowledge but also fosters critical thinking skills.

Using Qualitative Questionnaires in Medical Education Research.

Most students in Health Profession Education courses are new to the world of qualitative research. Faced with the challenge of designing a research project, they are often drawn towards using the questionnaire as a data collection method, commonly assuming that utilising open-ended questions alone constitutes qualitative research design. Designing questionnaires that meet the standards of rigour is challenging, and this common assumption reflects inexperience with and misunderstandings of qualitative ontology, as well as the lack of methodological literature on designing and developing qualitative questionnaires. This paper is written with research supervisors as well as students in mind, as it is aimed to help elucidate the decision-making process and the justification for using a qualitative questionnaire. Drawing upon examples of research conducted by our students, and the wider literature, we demonstrate how qualitative questionnaires can produce rich and meaningful findings when they (1) prioritise qualitative research values, and (2) follow a rigorous design process when the questionnaire is developed. We conclude by offering a simple framework for developing rigorous qualitative questionnaires to those who may consider using this approach.

A systematic review of the evidence on the effectiveness of sexuality education interventions on young people's sexual and reproductive health outcomes in Nigeria

Poor sexual and reproductive health (SRH) outcomes among Nigeria's youth necessitate urgent interventions to meet the country's sustainable development goal (SDG) SRH target by 2030. This review evaluates Nigeria's SRH educational interventions, focusing on their effectiveness in improving young people's (YP) SRH outcomes. It highlights the global implications of these outcomes on achieving the SDG by 2030. The review, following PRISMA standards, analyzed peer-reviewed journals and gray literature (from January 2017-June 2023), using narrative synthesis and Joanna Briggs institute (JBI) quality appraisal checklists for quasi-experimental and cross-sectional studies. The search found 1021 studies, with 6 meeting inclusion criteria (4 quasi-experimental and 2 cross-sectional studies). All reported significant improvements in YPSRH outcomes, including knowledge and attitudes towards SRH themes, uptake of SRH and HIV/STI services, parental and societal support, and reduction in risky sexual behaviors. Quality assessment revealed several methodological flaws such as inadequate blinding and contamination measures. The review offers insights for YP interventions, but methodological flaws limit effectiveness. Further studies with rigorous designs and longer follow-up are needed. The absence of economic evaluation data is a knowledge gap with important implications for decision-makers.

Targeting Gut Microbiome With Prebiotic in Patients With CKD: The TarGut-CKD Study

IntroductionDisruption of gut microbiota underpins some of the metabolic alterations observed in chronic kidney disease (CKD). MethodsIn a non-randomized, open-label, 3-phase pilot trial, with repeated measures within each phase, we examined the efficacy of oligofructose-enriched inulin (p-inulin) in changing the gut microbiome and their metabolic products in 15 CKD patients. The stability of microbiome and metabolome was studied during the pre-treatment phase (8 weeks), a p-inulin treatment phase (12 weeks), and a post-treatment phase (8 weeks) of the study. ResultsStudy participants completed 373 of the 420 expected study visits (88.8%). Adherence to p-inulin was 83.4%. 16S rRNA sequencing was performed in 368 stool samples. A total of 1085 stool, urine, and plasma samples were subjected to untargeted metabolomic studies. P-inulin administration altered the composition of the gut microbiota significantly, with an increase in abundance of Bifidobacterium and Anaerostipes. Inter-subject variations in microbiome and metabolome were larger than intra-subject variation, indicating the stability of the gut microbiome within each phase of the study. Overall metabolite compositions assessed by beta diversity in urine and stool metabolic profiles were significantly different across study phases. Several specific metabolites in stool, urine and plasma were significant at FDR ≤ 0.1 over phase. Specifically, there was significant enrichment in microbial metabolites derived from saccharolysis. ConclusionResults from our study highlight the stability of the gut microbiome and the expansive effect of p-inulin on microbiome and host co-metabolism in CKD patients. Findings from this study will enable rigorous design of microbiome-based intervention trials.

Agroecological concepts and alternatives to the problems of contemporary agriculture: Monoculture and chemical fertilization in the context of climate change

The modernization of agriculture has transformed natural agrarian systems into other new conventional ones, making it possible to exponentially increase agricultural production. This leads to the destruction of ecological functions, and services, and has negative impacts on human health. This critical situation has given rise to a new model of agriculture called agroecology, which has emerged as a systemic approach that can understand the practices of traditional agricultural systems, as a scientific discipline that defines, classifies, and studies agrosystems from an ecological and socio-economic point of view. This paper explores the major problems of agriculture, including climate change, monoculture, and chemical fertilization at the local, regional and global scale. Equally, we defined the different concepts that bring together the agroecological approach. We based on agroecology as a scientific discipline, as a practice by defining the different agroecological practices and their scale of application, as well as the politico-economic aspect of this concept. Further, we have proposed the agroecological alternatives that can remedy the three problems recorded in the first section, based on several recent studies and research that can examine whether agroecological practices have positive results on monoculture, chemical fertilization, and climate changes. However, more advanced studies, using rigorous research design, such as case controls, longitudinal studies, and surveys in regions where agriculture is their main source of income, such as Morocco, are still needed. These investigations are suggested to fill the gap of data on such areas and fields of research.

On practicing magicine, from wonder to care: A systematic review of studies that apply magic in healthcare

RationaleMagic, traditionally perceived as entertainment, has been increasingly employed in healthcare to enhance health and well-being. Despite its potential benefits across various dimensions of health, including biological, psychological, and social, a comprehensive review highlighting its broad applications in healthcare remains unexplored. ObjectiveThis study aims to explore the diverse uses of magic within healthcare, progressing from entertainment to integral medical care, termed “magicine.” MethodsThis systematic review adopted a narrative synthesis approach, and an extensive database search was conducted including Embase Classic & Embase, MEDLINE (Ovid), Scopus, the Cochrane Collaboration Central Register of Controlled Clinical Trials, Cochrane Systematic Reviews, and CINAHL (EBSCOhost), from the earliest records to 22 June 2023. Potential applications of magic in healthcare were explored with an unrestricted search strategy. A quality assessment was conducted using the Mixed Methods Appraisal Tool. (Registration: PROSPERO number CRD42023417122.) ResultsThis review identified 82 journal articles, including 11 randomized controlled trials, four quasi-experimental designs, 10 pre-experimental designs, five qualitative studies, three mixed methods studies, two observational studies, five review articles, and 42 commentaries. The review resulted in the conception of “magicine ennead” — nine diverse areas where magic can be applied in healthcare including physical rehabilitation, cognitive training, psychotherapy, humor therapy, distraction therapy, social skills, health education, doctor-patient relationships, and surgical techniques. These applications demonstrate the potential of magic to enhance health outcomes for the general population and improve the clinical practice of healthcare professionals. ConclusionsMagic in healthcare shows potential for varied applications, and a deeper understanding of these applications could lead to optimized and cost-efficient intervention programs. Given the heterogeneity and varied methodological quality of the current research, future studies necessitate the adoption of rigorous designs with active controls.

A Preliminary Assessment of Short-Term Social and Substance Use-Related Outcomes Among Clients of Integrated Safer Opioid Supply Pilot Programs in Toronto, Canada

AbstractCanada is experiencing an ongoing overdose crisis, driven by a toxic unregulated drug supply. Integrated safer supply pilot programs offer pharmaceutical alternatives, coupled with comprehensive support services, to individuals using unregulated drug supply who are at high risk of overdose. We collected data from December 2020 to January 2023 on clients receiving safer opioid supply from five frontline service providers in Toronto, Canada, using interviewer-administered questionnaires. We assessed the incidence rate ratio of self-reported overdose comparing pre- and post-enrolment in the programs and examined changes in the prevalence of social and substance use outcomes post-enrolment. Forty-one participants were recruited, of whom 26 were followed up for a median of eight months (interquartile range, 5.0–11.7). The incidence rate ratio of overdose comparing post-enrolment to pre-enrolment was 0.20 (95% confidence interval, 0.09–0.43). Participants reported several positive social and substance use outcomes at follow-up, including a reduction in reliance on the unregulated supply and reduced criminal activity. Future implementation of integrated safer opioid supply pilot programs with larger sample sizes and rigorous epidemiological designs could help further illustrate the potential impacts of these programs in reducing overdose rates in Canada.

THE MRI-COMPATIBLE STIMULATION SYSTEM TO CHARACTERIZE THE SUPRASPINAL CONTROL OF GAIT IN AGING: A SYSTEMATIC REVIEW

Abstract The regulation of gait depends upon both peripheral and supraspinal elements. The characterization of these elements can provide insights into how aging and age-related conditions affect gait performance in older adults. Functional magnetic resonance imaging (fMRI) is one widely-used technique to sophisticatedly measure the supraspinal elements. However, people are required to stay motionless during MRI scan, it is thus challenging to characterize the supraspinal control of gait. To overcome this limitation, multiple MRI-compatible devices have been developed to apply the walking-related sensorimotor stimuli. Still, large variance in device design and observation exists, limiting their research applications. We here thus performed a thorough systematic review to comprehensively summarize the progress of this field. Seven electronic databases (e.g., PubMed) were searched. The information on device design, study protocol and neuroimaging observations of twenty-six studies using 13 types of devices was extracted. Specifically, three of these devices can induce somatosensory-only stimuli, eight for motion-only, and two for both types of stimuli. The results demonstrated that using these devices can successfully obtain valid and reliable fMRI data when participants experiencing sensorimotor stimulation. Multiple supraspinal regions, such as the sensorimotor regions, prefrontal cognitive and attention regions, and cerebellum were activated by the sensorimotor stimuli. The evidence level of these observations was still low due to small sample size of participants who were not explicitly screened. It is thus needed to further enhance the performance of these devices and to examine and confirm the findings via studies with more rigorous design (e.g., larger participant sample size).

Prospect of immunotherapy alone in patients with advanced NSCLC with high btmb: a review and a meta-analysis

Lung cancer is the most prevalent cancer in the world, and the main treatment for advanced non-small cell lung cancer is immunotherapy combined with chemotherapy. In recent years, bTMB has received increasing attention as an emerging metric for monitoring the efficacy of tumour immunotherapy in terms of its operability, accessibility and real-time nature. We envisaged whether immunotherapy alone could be used to reduce the side effects of chemotherapy in patients with high bTMB lung cancer. We thus did a meta-analysis in order to show that immunotherapy alone is feasible in patients with high bTMB NSCLC.Methods This study aims to compare the efficacy of PD- 1/PD-L1 inhibitors (namely, atezolizumab, pembrolizumab, nivolumab, or tislelizumab) versus chemotherapy in NSCLC patients. The search for relevant studies was conducted in three major databases (i.e., PubMed, Embase, and Medline) up until January 2023. Specifically, we identified studies that reported risk ratios (HRs) for reporting progression-free survival (PFS) or overall survival (OS), or objective remission rates (ORs) for immunotherapy alone versus chemotherapy in high bTMB and low bTMB patient groups. Given that NSCLC represents the predominant type of lung cancer, we exclusively focused on this subtype. Our analysis encompassed a meta-analysis of the identified literature, incorporating heterogeneity analysis and sensitivity analysis. The quality of the evidence is evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to ascertain the reliability and robustness of the findings.Result-We conducted a meta-analysis of seven randomised controlled trials including 4,755 patients with advanced non-small cell lung cancer (NSCLC) evaluated the efficacy of PD- 1 or PD-L1 monotherapy compared to chemotherapy alone. All patients were randomized to receive either PD- 1/PD-L1 treatment alone or chemotherapy alone as a control. In the high bTMB patient group, PD- 1/PD-L1 monotherapy resulted in significant improvements in overall survival (HR = 0.55, 95% CI 0.49–0.61, p = 0.77) and progression-free survival (HR = 0.74, 95% CI 0.68–0.81, p = 0.78) compared to chemotherapy alone. Conversely, in the low bTMB patient group, PD- 1 monotherapy or PD-L1 monotherapy failed to demonstrate significant improvements in overall survival (HR = 0.82, 95% CI 0.73–0.92, p = 0. 13) and progression-free survival (HR = 1.22, 95% CI 1.22- 1.45, p = 0.003) in advanced NSCLC. Conclusion Our analysis suggests that monotherapy with immunotherapy is a feasible option for patients with advanced NSCLC and high bTMB. However, the results have to be construed with caution because of the small sample size and the potential bias in the studies included. Therefore, further research with larger sample sizes and rigorous study designs is necessary to confirm the observed benefits of immunotherapy in this patient population.

Factors influencing teacher wellbeing and burnout in schools: A scoping review.

Teacher's wellbeing and mental health play a pivotal role in learning experiences and educational environment. For a better future, we need thriving teachers with strong wellbeing. The current scoping literature review aimed to explore the factors fostering wellbeing and causing burnout among school teachers. Applying appropriate search terms to relevant databases for the years 2016-2020 yielded 934 potentially relevant research articles which were further filtered to 102 articles. The findings of this review suggested that emotion regulation, positive workplace milieu and teacher self-efficacy (feeling successful as a teacher) are important factors fostering teachers' wellbeing whilst negative workplace environment and negative emotions along with feeling marginalized or bullied by coworkers are factors behind teacher burnout. The strengths of this study include a rigorous research design and relational analysis approach. Teacher wellbeing needs a workplace environment with minimum bullying and marginalization. An atmosphere of respect, inclusion, and mutual teacher support is needed to promote wellbeing.

The potential of psilocybin use to enhance well-being in healthy individuals – A scoping review

AbstractBackground and aimsThis scoping review employed a multifaceted conceptualization of well-being to examine how psilocybin use affects well-being and related sub-concepts in healthy individuals. It investigated which factors influence the relationship between psilocybin use and well-being, what research protocols have been employed, and what underlying mechanisms have been proposed in existing studies.MethodsA comprehensive literature search in line with the PRISMA guidelines was conducted. Scopus, PubMed, PsycINFO, Web of Science, and Google Scholar were searched for peer-reviewed articles about psilocybin and well-being in healthy populations.ResultsStudies were heterogeneous in regard to study objectives, study design, study procedure, sample size and psilocybin dosage. In all studies, psilocybin use led to positive well-being-related outcomes for the majority of participants. Facets of well-being positively affected by psilocybin use in this review were self-acceptance, positive relationships, and meaning/purpose in life.ConclusionsThis scoping review provided preliminary evidence for the beneficial effects of psilocybin on well-being and related sub-concepts such as self-acceptance, positive relationships, and meaning/purpose in life in healthy individuals. Ego-dissolution, unity, connectedness, and mystical-type experiences are interrelated concepts that seem to be crucial for explaining such positive well-being-related effects of psilocybin. Under conducive conditions, the use of psilocybin may contribute to healthy functioning, through broad and sustained improvements in a variety of well-being concepts. Due to the heterogeneous nature of the studies, more definite conclusions require further research with a rigorous and homogeneous design.

The Impact of Harnessing Total Quality Management Studies on the Performance of Smart Applications: A study in Public and Private Sectors in the UAE

This study explores the complex environment of smart applications technology in the UAE's public and private sectors, looking into the complex interactions between technological adaptability and accessibility as well as the effects of Total Quality Management (TQM) studies presented by policies and regulations. Data was collected by a multistage sampling strategy, mixing probability and non-probability methods, using a cross-sectional research design. To ensure impartial item creation and adherence to best practices, a pretested questionnaire underwent extensive examination. Through the revelation of unexpected results, the research tests and expands upon the Technology Acceptance Model (TAM). There is a request for an enlarged TAM framework because there is no substantial correlation found between accessibility and the performance of smart applications. A negative link is resulted, unexpectedly, between technology adaptation and TQM adoption, underscoring the necessity of a cautious integration strategy. The report also emphasizes how important TQM policies and regulations are to the functioning of smart applications, supporting the need for a thorough TAM framework that takes in regulatory dynamics into consideration. Practical implications for stakeholders, quality policymakers, and institutions are presented by the findings, which highlight several adoption aspects beyond accessibility. This research adds a contribution on smart application performance and develops theoretical models for integrating technology in organizational settings. The rigorous design of the methodology highlights the integrity of the study and guarantees the validity of the insights obtained from the investigation.

Resilience of metro tunnel structures: monitoring deformation due to surrounding engineering activities and effect of remediation treatment

Long term performance of urban metro tunnels requires that the tunnel structure maintains not only a sound structural state, i.e., free from significant damages, but also a minimal change in the physical shape. Over-deformation can cause structural damage but more importantly can affect the safe operation of the metro lines, therefore is a primary target of monitoring and intervention where it becomes necessary. This paper presents an overview of recent developments in field monitoring and assessment of metro tunnels in soft soil concerning over-deformation. In particular, the over-deformation of shield tunnel rings due to nearby construction activities, especially deep excavation, and its rectification using grout treatment is discussed on the basis of relevant field experiment and numerical modelling reported in recent publications. Key considerations in the development of a Material Point Method (MPM) based numerical modelling framework for simulating explicitly the grouting operations are highlighted, and the general performance of the numerical model is examined with reference to the field test data and characteristic parametric observations. Further research needs in terms of more rigorous assessment and design of grouting treatment, in conjunction with the continued development of numerical modelling capabilities, are discussed.

Assessing the Validity of Bulletproof Coffee’s Claims

‘Bulletproof Coffee’, a popular beverage composed of coffee, grass-fed butter, and medium-chain triglyceride oil, has gained significant attention for its purported benefits including cognitive enhancement, increased alertness and energy, appetite suppression, and improved metabolic outcomes. However, the scientific evidence supporting these claims remains limited. This review aims to evaluate the evidence and determine the validity of claims regarding Bulletproof Coffee. Studies published between 2010–2023 were retrieved and evidence pertaining to cognition, alertness and energy, hunger and satiety, serum cholesterol, and gastrointestinal tolerance and Bulletproof Coffee were evaluated. The findings suggest that the current evidence base is small, and overall, there is weak or insufficient evidence to support the claimed benefits of Bulletproof Coffee. In particular, there were no significant improvements in cognition, alertness, or energy levels from Bulletproof Coffee compared to regular coffee. The impact on hunger, satiety, resting energy expenditure, and fat oxidation appeared equivocal, with effects offset by the additional calorie intake of Bulletproof Coffee. Further research with more rigorous study designs, larger sample sizes, diverse populations, and standardized methodologies are required in addition to an examination of potential health risks associated with regular Bulletproof Coffee consumption.

Prognostic Biomarkers in Kidney Transplantation: A Systematic Review and Critical Appraisal.

Why are there so few biomarkers accepted by health authorities and implemented in clinical practice, despite the high and growing number of biomaker studies in medical research ? In this meta-epidemiological study, including 804 studies that were critically appraised by expert reviewers, the authors have identified all prognostic kidney transplant biomarkers and showed overall suboptimal study designs, methods, results, interpretation, reproducible research standards, and transparency. The authors also demonstrated for the first time that the limited number of studies challenged the added value of their candidate biomarkers against standard-of-care routine patient monitoring parameters. Most biomarker studies tended to be single-center, retrospective studies with a small number of patients and clinical events. Less than 5% of the studies performed an external validation. The authors also showed the poor transparency reporting and identified a data beautification phenomenon. These findings suggest that there is much wasted research effort in transplant biomarker medical research and highlight the need to produce more rigorous studies so that more biomarkers may be validated and successfully implemented in clinical practice. Despite the increasing number of biomarker studies published in the transplant literature over the past 20 years, demonstrations of their clinical benefit and their implementation in routine clinical practice are lacking. We hypothesized that suboptimal design, data, methodology, and reporting might contribute to this phenomenon. We formed a consortium of experts in systematic reviews, nephrologists, methodologists, and epidemiologists. A systematic literature search was performed in PubMed, Embase, Scopus, Web of Science, and Cochrane Library between January 1, 2005, and November 12, 2022 (PROSPERO ID: CRD42020154747). All English language, original studies investigating the association between a biomarker and kidney allograft outcome were included. The final set of publications was assessed by expert reviewers. After data collection, two independent reviewers randomly evaluated the inconsistencies for 30% of the references for each reviewer. If more than 5% of inconsistencies were observed for one given reviewer, a re-evaluation was conducted for all the references of the reviewer. The biomarkers were categorized according to their type and the biological milieu from which they were measured. The study characteristics related to the design, methods, results, and their interpretation were assessed, as well as reproducible research practices and transparency indicators. A total of 7372 publications were screened and 804 studies met the inclusion criteria. A total of 1143 biomarkers were assessed among the included studies from blood ( n =821, 71.8%), intragraft ( n =169, 14.8%), or urine ( n =81, 7.1%) compartments. The number of studies significantly increased, with a median, yearly number of 31.5 studies (interquartile range [IQR], 23.8-35.5) between 2005 and 2012 and 57.5 (IQR, 53.3-59.8) between 2013 and 2022 ( P < 0.001). A total of 655 studies (81.5%) were retrospective, while 595 (74.0%) used data from a single center. The median number of patients included was 232 (IQR, 96-629) with a median follow-up post-transplant of 4.8 years (IQR, 3.0-6.2). Only 4.7% of studies were externally validated. A total of 346 studies (43.0%) did not adjust their biomarker for key prognostic factors, while only 3.1% of studies adjusted the biomarker for standard-of-care patient monitoring factors. Data sharing, code sharing, and registration occurred in 8.8%, 1.1%, and 4.6% of studies, respectively. A total of 158 studies (20.0%) emphasized the clinical relevance of the biomarker, despite the reported nonsignificant association of the biomarker with the outcome measure. A total of 288 studies assessed rejection as an outcome. We showed that these rejection studies shared the same characteristics as other studies. Biomarker studies in kidney transplantation lack validation, rigorous design and methodology, accurate interpretation, and transparency. Higher standards are needed in biomarker research to prove the clinical utility and support clinical use.

Effectiveness of Transitional Care Program among High-Risk Discharged Patients: A Quasi-Experimental Study on Saving Costs, Post-Discharge Readmissions and Emergency Department Visits

Transitional care programs (TCPs), where hospital care team members repeatedly follow up with discharged patients, aim to reduce post-discharge hospital or emergency department (ED) utilization and healthcare costs. We examined the effectiveness of TCPs at reducing healthcare costs, hospital readmissions, and ED visits. Centers for Medicare and Medicaid Services Bundled Payments for Care Improvement (BPCI) program adjudicated claims files and electronic health records from Greenville Memorial Hospital, Greenville, SC, were accessed. Data on post-discharge 30- and 90-day ED visits and readmissions, total costs, and episodes with costs over BPCI target prices were extracted from November 2017 to July 2020 and compared between the “TCP-Graduates” (N = 85) and “Did Not Graduate” (DNG) (N = 1310) groups. As compared to the DNG group, the TCP-Graduates group had significantly fewer 30-day (7.1% vs. 14.9%, p = 0.046) and 90-day (15.5% vs. 26.3%, p = 0.025) readmissions, episodes with total costs over target prices (25.9% vs. 36.6%, p = 0.031), and lower total cost/episode (USD 22,439 vs. USD 28,633, p = 0.018), but differences in 30-day (9.4% vs. 11.2%, p = 0.607) and 90-day (20.0% vs. 21.9%, p = 0.680) ED visits were not significant. TCP was associated with reduced post-discharge hospital readmissions, total care costs, and episodes exceeding target prices. Further studies with rigorous designs and individual-level data should test these findings.

Lung Cancer Prediction Using Electronic Claims Records: A Transformer-Based Approach.

Electronic claims records (ECRs) are large scale and longitudinal collections of individual's medical service seeking actions. Compared to in-hospital medical records (EMRs), ECRs are more standardized and cross-sites. Recently, there has been studies showing promising results on modeling claims data for a wide range of medical applications. However, few of them address the exclusion criteria on cohort selection to extract new incidence without prior signs and also often lack of emphasis on predicting cancer in early stages. In this work, we aim to design a lung cancer prediction framework using ECRs with rigorous exclusion design using state-of-the-art sequence-based transformer. Furthermore, this work presents one of the first results by applying disease prediction model to the entire population in Taiwan. The result shows over 2.1 predictive power, 5 average positive predictive value (PPV), and 0.668 area under curve (AUC) in all-stage lung cancer and around 2.0 predictive power, 1 average PPV and 0.645 AUC in early-stage in our dataset. Sub-cohort analysis could funnel high precision selective group into prioritized clinical examination. Onset analysis validates the effect of our exclusion criteria. This work presents comprehensive analyses on lung cancer prediction, and the proposed approach can serve as a state-of-the-art disease risk prediction framework on claims data.

Heutagogical-based ICALL environment

The use of Intelligent Computer Assisted Language Learning (ICALL) in foreign language learning holds great promises, but the identification of rigorous design principles to develop students’ capability through practical learning design are still insufficient. As capability concerns how people use their competencies in the unknown rather than in familiar situations, ensuring students' capability development becomes crucial in today’s complex, dynamic, and rapidly changing system of modern society. One critical question to firstly answer regarding the numerous variety and available options of ICALL applications is what and how to choose appropriate and relevant ICALL applications which would effectively enhance students’ capability. This paper proposes a framework for the intervention design of the ICALL learning environment to develop EFL students’ capability based on the pedagogy-andragogy-heutagogy continuum and the authentic learning framework.