Systemic Efficiency Research Articles

Manual wheelchair training programs: a scoping review of educational approaches and intended learning outcomes

BackgroundTraining programs grounded in educational theory offer a systematic framework to facilitate learning and outcomes. This scoping review aims to map the educational approaches documented for manual wheelchair training and to record intended learning outcomes and any relationships between learning theories, instructional design and outcomes.MethodsEight databases; Cochrane’s Library, EMBASE, CINAHL, PubMed, Scopus, EmCare, Medline, ProQuest Nursing and Allied Health Database and grey literature were searched in September 2023, with citation chaining for relevant papers. Included papers related to manual wheelchair training programs/protocols describing intended wheelchair training outcomes for adults and/or caregivers. Data extracted included study characteristics, type of intervention, explicit learning theories, instructional design principles and intended learning outcomes. The International Classification of Functioning and Kirkpatrick’s evaluation framework were used to organise intended outcomes.ResultsOf the forty-four articles included in this review, only fourteen explicitly used a learning theory in the instructional design of training. Training outcomes most commonly related to changes in knowledge/skills of manual wheelchair users (Level 2b of Kirkpatrick’s evaluation (n = 43), with less emphasis on participatory outcomes. Training designs incorporating Social Cognitive Theory (n = 8) were more likely to explore long term training outcomes, compared with other training designs.ConclusionWheelchair training programs that are designed using learning theory are more likely to produce learning outcomes that are retained and meaningfully applied. Such longer terms outcomes could have systemic cost and efficiency implications, such as reduction in wheelchair falls and readmissions to hospital. Deliberate integration of learning theory into manual wheelchair training design is recommended to support broad outcomes and long-term learning. This design could synergise different learning theories.

Moving Beyond the Device: Key Lessons in Creating a Positive Patient Experience for a Remote Foot Health Program.

The burden of diabetic foot ulcers is largely underappreciated, even by the healthcare community. Living with advanced, complex chronic diseases can be challenging for the patient and often requires additional time and resource utilization by the provider. The use of novel technology within medicine should be focused on fostering excellent experiences, thereby promoting satisfaction and ultimately, quality care. Using a remote foot temperature monitoring program, we have learned that 3 strategies support positive experience including: design for ease of use, patient and provider support, and continuous process improvement. Further key points include: (1) foot ulcers and amputations are a significant source of morbidity, mortality, and decreased quality of life for people living with diabetes; (2) remote patient monitoring innovations in technology can help connect patients, healthcare providers, and data; (3) technology should serve as an extension of the patient-provider trust relationship and help improve systemic efficiency; and (4) future considerations for successful patient experiences must also address healthcare disparities and promote health equity.

The Decarbonizing Strategies of China’s Iron and Steelmaking Industry: A Comprehensive Perspective

Decarbonizing the iron and steelmaking industry is critical for China to pursue the net-zero emissions target and advance sustainable industrialization (SDG 9). This paper addresses the urgent need for decarbonization strategies in this sector, aiming to align with China’s carbon neutrality goals by 2060. By reviewing the current technological advancements and potential pathways for deep decarbonization, including process optimization, hydrogen-based direct reduction, and carbon capture, utilization, and storage (CCUS), these decarbonization technologies are categorized into six strategic approaches: systemic energy efficiency improvement, resource recycling, process optimization and innovation, breakthrough smelting, product iterative upgrading, and CCUS. These strategies also align with SDG 13 (climate action) by reducing greenhouse gas emissions and SDG 7 (affordable and clean energy) through the promotion of clean energy technologies. These strategies are evaluated for their emission reduction potential and technological maturity. The results indicate that, while efficiency improvements and resource recycling are currently the most mature and widely implemented strategy, significant breakthroughs in hydrogen metallurgy and CCUS are essential for achieving long-term carbon neutrality. Based on an analysis, a comprehensive roadmap is proposed, detailing the near-term to long-term actions required for the industry’s transition. The near-term focus (up to 2030) should be on enhancing energy efficiency and process optimization, whereas the mid-term (2030–2050) focus should emphasize the adoption of hydrogen-based technologies and CCUS. By the 2050–2060 period, the industry should achieve widespread commercialization of breakthrough smelting technologies and CCUS, ensuring the achievement of carbon neutrality. This study intends to provide a systematic framework and strategic recommendations for policymakers and industry stakeholders to guide the decarbonization of China’s iron and steelmaking sector, addressing both technological and economic challenges to achieve sustainable and low-carbon development.

Reflections on the Systemic Efficiency of Contemporary Democracy

This research article analyzes the complexity of democracy in the current context and the challenges it faces in maintaining its effectiveness and fundamental principles. Although democracy is seen as an effective system that protects human rights and promotes equality, it does not always guarantee these results. Democracy should be evaluated not only by the conduct of elections but also by its ability to respect and guarantee human rights and real equality, taking into account the variety of cultural, political, and economic influences. Additionally, it is necessary to have transitional justice mechanisms in place in contexts where democracy must address and repair human rights violations to ensure true social renewal.

Software Engineering in Health Care

Software engineering has emerged as a cornerstone in the evolution of healthcare delivery, serving as a key player in improving patient care and maximizing systemic efficiency. This paper delves into the integration of software engineering principles, methodologies, and technologies within the healthcare sector, highlighting key applications such as Electronic Health Records (EHR), telemedicine platforms, clinical decision support systems, and medical imaging software. Through an exploration of challenges, opportunities, future trends, and case studies illustrating successful implementations, this study underscores the critical importance of software engineering in shaping the future of providing healthcare and enhancing patient results. By tackling current issues, seizing opportunities, and embracing future trends, Software engineering's revolutionary potential can be used by the healthcare industry to improve patient care and operational efficiency.

Оценка эффективности системы управления крупномасштабными строительными проектами в течение их жизненного цикла

The relevance of the study is due to the increasing importance of large-scale construction management processes throughout the full life cycle, as well as the system-technical nature of the problems that arise in this case. To determine the effectiveness of the management system, the principles of a systematic approach can be applied, in which the subject of economic activity is considered as a single whole with an ordered structure and relationships. It has been established that currently there are many problem-oriented models (simulation, optimization, expert) containing various quantitative indicators and methods for determining effectiveness aimed at finding economically feasible management solutions and providing for their subsequent practical implementation. However, a unified methodological understanding on the issues of evaluating the effectiveness of large-scale construction management has not yet been achieved. The purpose of the study is a methodological justification of a holistic approach to evaluating the effectiveness of a large-scale construction management system. As a working hypothesis, the assumption of a direct inextricable link between the integrity of the management system and the effectiveness of its functioning is accepted. The conceptual framework of the theory of integrity, mathematical statistics, and set theory is used within the framework of a systematic approach. As a result of the conducted research, an understanding of the effectiveness of large-scale construction management has been developed as the integrity of the solutions embedded in it, expressed by a set of any assessments that adequately express the need and possibility of implementing these solutions. The economic aspect of the systemic efficiency of capital management of a construction enterprise is investigated and a variant of its cost (monetary) assessment is proposed. The result obtained in the course of the study can be used as the basis for the development of a wide class of tasks for multi-criteria optimization of the operation of any large-scale construction management system throughout the full life cycle.

Impact of Systemic Delays for Patient Access to Oncology Drugs on Clinical, Economic, and Quality of Life Outcomes in Canada: A Call to Action.

Canada has one of the most complex and rigorous drug approval and public reimbursement processes and is, unfortunately, one of the countries with the longest delays in drug access. To assess the overall impact of systemic delays in access to cancer therapy, a targeted literature review (TLR) was performed to identify studies associated with the clinical, economic, and quality of life impacts of delayed access to oncology drugs. Using MEDLINE/PubMed databases and snowballing, four unique records met the eligibility criteria. Results revealed that clinical outcomes were the most impacted by systemic delays in access to oncology drugs (e.g., life years lost, overall survival, and progression-free survival). The four articles retrieved by the TLR specifically illustrated that a substantial number of life years could potentially be saved by increasing systemic efficiency regarding the development, approval, and reimbursement processes of new drugs for advanced malignancies. It is imperative that initiatives are put in place to improve the performance and speed of Canadian drug regulatory and health technology assessment (HTA) processes, especially for new cancer therapeutics. The proposed solutions in this paper include better coordination between HTA and Canadian payers to harmonize coverage decisions, international collaborations, information sharing, and national standards for timeliness in oncology drug access.

Cholesterol-modified sphingomyelin chimeric lipid bilayer for improved therapeutic delivery

Cholesterol (Chol) fortifies packing and reduces fluidity and permeability of the lipid bilayer in vesicles (liposomes)-mediated drug delivery. However, under the physiological environment, Chol is rapidly extracted from the lipid bilayer by biomembranes, which jeopardizes membrane stability and results in premature leakage for delivered payloads, yielding suboptimal clinic efficacy. Herein, we report a Chol-modified sphingomyelin (SM) lipid bilayer via covalently conjugating Chol to SM (SM-Chol), which retains membrane condensing ability of Chol. Systemic structure activity relationship screening demonstrates that SM-Chol with a disulfide bond and longer linker outperforms other counterparts and conventional phospholipids/Chol mixture systems on blocking Chol transfer and payload leakage, increases maximum tolerated dose of vincristine while reducing systemic toxicities, improves pharmacokinetics and tumor delivery efficiency, and enhances antitumor efficacy in SU-DHL-4 diffuse large B-cell lymphoma xenograft model in female mice. Furthermore, SM-Chol improves therapeutic delivery of structurally diversified therapeutic agents (irinotecan, doxorubicin, dexamethasone) or siRNA targeting multi-drug resistant gene (p-glycoprotein) in late-stage metastatic orthotopic KPC-Luc pancreas cancer, 4T1-Luc2 triple negative breast cancer, lung inflammation, and CT26 colorectal cancer animal models in female mice compared to respective FDA-approved nanotherapeutics or lipid compositions. Thus, SM-Chol represents a promising platform for universal and improved drug delivery.

A systemic efficiency measurement of resource management and sustainable practices: A network bias-corrected DEA assessment of OECD countries

In the face of pressing challenges such as climate change and dwindling biodiversity, the global need for optimizing natural resource management is urgent. To address this, green innovations and digital government play a vital role in efficient resource utilization, aligning with Sustainable Development Goals (SDGs). Our study presents a comprehensive framework for evaluating natural resource management efficiency and its link to achieving SDGs. Using network bias-corrected Data Envelopment Analysis (DEA) and unsupervised machine learning techniques on 30 OECD countries, we found significant disparities in environmental and resource management efficiencies. Importantly, environmental efficiency strongly correlates with resource management efficiency, often surpassing the influence of green innovations. The results also reveal a pattern where major industrial economies like Germany, France, and the UK struggle with low natural resource efficiency. In contrast, smaller economies, particularly in the Nordic and Baltic regions, excel in resource management and employ green innovations and digital governance practices effectively to advance SDGs. This machine learning-driven dichotomy emphasizes the pivotal role of systemic resource management in achieving SDGs and highlights the leadership of smaller economies in sustainability. Our study significantly contributes to the understanding of green innovation systems and their role in enhancing natural resource management efficiency. Furthermore, it equips policymakers with the ability to pinpoint specific systemic shortcomings in natural resource management, facilitating the tailored development of policies to meet precise goals.

Evaluation of human mononuclear umbilical cord blood cells systemic administration efficiency in the acute period of experimental severe spinal cord injury

Aim. To evaluate the efficiency of systemic (intravenous) application of cryopreserved human umbilical cord blood mononuclear cells (HUCBCs) in animal models of acute contusion spinal cord injury for the restoration of hind limb motor function and formation of posttraumatic cysts using clinically significant examination methods.Materials and methods. Adult female Sprague–Dowley rats were used for the study. Severe acute contusion spinal cord injury model was performed using standard “weight‑drop” method. All samples of cryopreserved HUCBCs concentrate were prestored prior to infusion for 3 to 4 years at –196 °C. Hind limbs motor function was evaluated using open‑field technique and standard BBB testing system. Magnetic resonance scanning was performed using high‑field magnetic resonance CleanScan 7.0 T tomography (Bruker BioSpin, Germany).Results. Intravenous infusions of HUCBCs were performed on Day 1 following acute severe spinal cord injury. Motor function assessment demonstrated significant (p <0.05) improvement of hind limbs motor function (up to 40–50 %) comparing to self‑healing outcomes. Moreover, by the Days 4 and 5 after severe spinal cord injury, the volume of posttraumatic cystic cavity decreases significantly (up to 40 %) (p <0.05).Conclusion. The obtained results demonstrated that cryopreserved HUCBCs can be used as an effective source for cell therapy of acute contusion spinal cord injury.

The correlation between systemic inflammatory markers and efficiency for advanced gastric cancer patients treated with ICIs combined with chemotherapy.

Currently lacking research to explore the correlation between inflammatory markers and the efficacy of immune checkpoint inhibitors (ICIs) combined with chemotherapy in the treatment of advanced gastric cancer. This study is a retrospective study and included patients with advanced gastric cancer who receiving ICIs combined with chemotherapy from January 2020 to December 2022. We analysed the relationship between systemic inflammatory markers and the efficacy of ICIs combined chemotherapy and constructed a clinical prediction model. A nomogram was constructed based on the results of the bidirectional stepwise regression model. A total of 197 patients were enrolled in the training group, with a median follow-up period of time 26 months. Kaplan Meier analysis showed that the median OS of patients with low systemic immune-inflammatory index (SII) and low platelet to lymphocyte ratio (PLR) was superior to those with high SII and PLR. Univariate and multivariate Cox regression analysis showed that SII, NLR, PLR, and N stage as independent prognostic factors for OS. Adding SII to the conventional model improved the predictive ability of the 12-month OS. A total of 95 patients were included in the validation group, and external validation of the SII-based nomogram showed favourable predictive performance. Baseline SII, PLR, and N stage may serve as independent predictive factors for survival outcomes in advanced gastric cancer patients undergoing ICIs combined with chemotherapy. The SII-based nomogram can provide intuitive and accurate prognosis prediction of individual patients.

Aggregation-Induced Fluorescence Upconversion of Pyrene under Low Fluence: In Solutions and Polymeric Nanoparticles.

In this study, aggregation-induced photon upconversion (iPUC) is demonstrated in the small polyaromatic molecule, pyrene. In binary-solvent mixtures, water, which induces the aggregation of polyaromatic molecules, assisted in triplet-triplet annihilation-based upconversion. No upconverted emission was observed in a dry solvent. Although upconverted emission in the absence of a triplet sensitizer was assigned to pyrene-aggregate-induced sensitization, the presence of a triplet sensitizer enhanced the upconversion efficiency. This experimental finding was further simulated to explore the possibility of iPUC in the condensed-phase polymer matrix. We studied 2-aminoethyl methacrylate hydrochloride-polystyrene copolymer nanoparticles embedded with the molecular upconversion system. The nanoparticle iPUC agreed with the proposition that water domains were present in polymer nanoparticles and helped aggregate pyrene in the host polymer. Despite the low systemic upconversion efficiency, this study provides a method for achieving fluorescence upconversion in relatively simple systems.

All-analog photoelectronic chip for high-speed vision tasks

Photonic computing enables faster and more energy-efficient processing of vision data1–5. However, experimental superiority of deployable systems remains a challenge because of complicated optical nonlinearities, considerable power consumption of analog-to-digital converters (ADCs) for downstream digital processing and vulnerability to noises and system errors1,6–8. Here we propose an all-analog chip combining electronic and light computing (ACCEL). It has a systemic energy efficiency of 74.8 peta-operations per second per watt and a computing speed of 4.6 peta-operations per second (more than 99% implemented by optics), corresponding to more than three and one order of magnitude higher than state-of-the-art computing processors, respectively. After applying diffractive optical computing as an optical encoder for feature extraction, the light-induced photocurrents are directly used for further calculation in an integrated analog computing chip without the requirement of analog-to-digital converters, leading to a low computing latency of 72 ns for each frame. With joint optimizations of optoelectronic computing and adaptive training, ACCEL achieves competitive classification accuracies of 85.5%, 82.0% and 92.6%, respectively, for Fashion-MNIST, 3-class ImageNet classification and time-lapse video recognition task experimentally, while showing superior system robustness in low-light conditions (0.14 fJ μm−2 each frame). ACCEL can be used across a broad range of applications such as wearable devices, autonomous driving and industrial inspections.

Autologous exosome facilitates load and target delivery of bioactive peptides to repair spinal cord injury.

Spinal cord injury (SCI) causes motor, sensory and automatic impairment due to rarely axon regeneration. Developing effective treatment for SCI in the clinic is extremely challenging because of the restrictive axonal regenerative ability and disconnection of neural elements after injury, as well as the limited systemic drug delivery efficiency caused by blood spinal cord barrier. To develop an effective non-invasive treatment strategy for SCI in clinic, we generated an autologous plasma exosome (AP-EXO) based biological scaffold where AP-EXO was loaded with neuron targeting peptide (RVG) and growth-facilitating peptides (ILP and ISP). This scaffold can be targeted delivered to neurons in the injured area and elicit robust axon regrowth across the lesion core to the levels over 30-fold greater than naïve treatment, thus reestablish the intraspinal circuits and promote motor functional recovery after spinal cord injury in mice. More importantly, in ex vivo, human plasma exosomes (HP-EXO) loaded with combinatory peptides of RVG, ILP and ISP showed safety and no liver and kidney toxicity in the application to nude SCI mice. Combining the efficacy and safety, the AP-EXO-based personalized treatment confers functional recovery after SCI and showed immense promising in biomedical applications in treating SCI. It is helpful to expand the application of combinatory peptides and human plasma derived autologous exosomes in promoting regeneration and recovery upon SCI treatment.

Assessment of the systemic efficiency of an Npp base load supply based on combination with hydrogen technologies

The article presents a comparative analysis of effectiveness of the approaches developed by the authors to ensuring a further development of nuclear energy industry as a pollution-free energy source. To solve this problem, several options for using environmentally friendly hydrogen fuel were considered to ensure a high installed power factor of NPPs and/or maneuverability of existing and planned double-loop NPPs with a water coolant. It is proposed to accumulate off-peak electricity by means of water electrolysis to obtain hydrogen and oxygen, which ensures the basic operation mode of NPP and provides a possibility to use hydrogen/oxygen to produce peak electricity. The given approach is compared with the basic scheme of marketable hydrogen and oxygen production including their additional purification. The economic feasibility is estimated with account for the effect from replacement of environmentally harmful plants based on gas turbine units, including the effect of preventing forced unloading of NPPs and various options to the target prices for nuclear and hydrocarbon fuel. As a result, the main technical and economic indicators of the proposed approaches were determined, including the cost and accumulated net present value. Based on the assessments made, it is shown that the options for providing NPPs with a basic electrical load based on the proposed approaches are efficient and competitive. Production of hydrogen and oxygen with a subsequent production of peak electricity, i.e. the use of a hydrogen power complex as an off-peak energy storage allows achieving the maximum economic effect. The provided estimates show the relevance and prospects for solving the problem of providing NPPs with a baseline electrical load under conditions of increasing their share in the energy grid based on the combination with a hydrogen power complex.

Forecasting Commodity Market Synchronization with Commodity Currencies: A Network-Based Approach.

This paper shows that some commodity currencies (from Chile, Iceland, Norway, South Africa, Australia, Canada, and New Zealand) predict the synchronization of metals and energy commodities. This relationship links the present-value theory for exchange rates and its connection with commodity export economies' fundamentals, where prospective commodity price fluctuations affect exchange rates. Predicting commodity market return synchronization is critical for dealing with systemic risk, market efficiency, and financial stability since synchronization reduces the benefits of diversification and increases the probability of contagion in financial markets during economic and financial crises. Using network methods coupled with in-sample and out-of-sample econometrics models, we find evidence that a fall in the return of commodity-currencies (dollar appreciation) predicts an increase in commodity market synchronization and, consequently, in commodity market systemic risk. This discovery is consistent with a transitive capacity phenomenon, suggesting that commodity currencies have a predictive ability over commodities that extend beyond the commodity bundle that a country produces. The latter behavior would be exacerbated by the high financialization of commodities and strong co-movement of commodity markets. Our paper is part of a vigorously growing literature that has recently measured and predicted systemic risk caused by synchronization, combining a complex systems perspective and financial network analysis.

The coat protein of the ilarvirus prunus necrotic ringspot virus mediates long-distance movement.

The coat protein (CP) of plant viruses generally has multiple functions involving infection, replication, movement and pathogenicity. Functions of the CP of prunus necrotic ringspot virus (PNRSV), the causal agent of several threatening diseases of Prunus fruit trees, are poorly studied. Previously, we identified a novel virus in apple, apple necrotic mosaic virus (ApNMV), which is phylogenetically related to PNRSV and probably associated with apple mosaic disease in China. Full-length cDNA clones of PNRSV and ApNMV were constructed, and both are infectious in cucumber (Cucumis sativus L.), an experimental host. PNRSV exhibited higher systemic infection efficiency with more severe symptoms than ApNMV. Reassortment analysis of genomic RNA segments 1-3 found that RNA3 of PNRSV could enhance the long-distance movement of an ApNMV chimaera in cucumber, indicating the association of RNA3 of PNRSV with viral long-distance movement. Deletion mutagenesis of the PNRSV CP showed that the basic motif from amino acids 38 to 47 was crucial for the CP to maintain the systemic movement of PNRSV. Moreover, we found that arginine residues 41, 43 and 47 codetermine viral long-distance movement. The findings demonstrate that the CP of PNRSV is required for long-distance movement in cucumber, which expands the functions of ilarvirus CPs in systemic infection. For the first time, we identified involvement of Ilarvirus CP protein during long-distance movement.

The concept and essence of economic efficiency as one of the important tasks of economic analysis

Evaluation of economic efficiency is one of the main tasks of a comprehensive economic analysis. But existing views on the very conceptof “economic efficiency” or “production efficiency” do not let us to accurately determine its meaning, role and place in the system of economic analysis of nowadays. The author of the article was faced with the task of developing an up-to-date definition of economic efficiency, taking into account current trends, factors, risks affecting the financial management of enterprises, on the basis of which it would be possible to develop a detailed system for its assessment. As a conclusion we have proposed a system that divides economic efficiency into internal and external parts, which are also divided into the following elements: the external efficiency consists of operational, investment, market and technological efficiency; internal — of strategic, systemic, financial and personnel efficiency. It should be taken into account that the division into these elements is very conditional due to their close correlation and interdependence. However, the particular definition and system can be used as a basis of a set of quantitative and qualitative indicators for each selected element, based on its role and place in the system of complex economic analysis.

OPTIMIZING PROACTIVE COLLABORATIVE AND COOPERATIVE RELATIONSHIPS BETWEEN FOOD SUPPLIERS AND RESTAURANTS

Currently, agri-gastronomy and the ”tourist-catering” subsector have an increasingly well-defined role in the realization and commercialization of goods and services offered in terms of food quality and systemic efficiency. This study aims to identify that tourist destinations and many local communities offer a variety of gastronomic products and services and that the supply sector in semi-structured and still needs improvements in quality, safety and a wider commercial network. The paper highlights the need for suppliers to reinvent themselves and create new market opportunities to benefit from rapid growth in key sectors of the integrated food system. A number of relational solutions are analyzed with the potential to generate an authentic cuisine based on tradition and sustainability, with strong elements of originality. Consequently, it is highlighted that the consolidated and optimized relationships in the producer-processor network may be able to ensure diversified and quality local products, which gives restaurants a competitive advantage in the post-pandemic recovery.

On the viability and potential value of current and emerging neuroscience and technologies to the practice of forensic science.

As developments in neuroscience and neurotechnology (neuroS/T) advance, the criminal justice system’s consideration of, and interest in the applications of such technologies to forensics and legal proceedings are also increasing. In light of these advances, considerations and interest, it becomes essential to address the pragmatic validity, viability and potential value of neuroS/T to forensics and law. This essay describes ways that implementation of neuroS/T can directly benefit the forensic science community; identifies limitations of, and concerns about forensic use of neurioS/T; and proposes recommendations that may be useful when considering and/or implementing neuroS/T in forensic contexts. Toward such ends, we posit the value of an implementation science framework to identify and analyze extant gaps (in both neuroS/T and forensic sciences and law) and offer ways that such gaps can - and arguably should - be compensated, closed or prevented in order to promote ethical interdisciplinary and systemic utility, effectiveness, and efficiency.