Total Impact Score Research Articles

Validity of mobile application for monitoring behavioral and psychological symptoms in moderate to severe dementia in Thailand

Many patients with moderate - severe dementia with behavioral and psychological symptoms of dementia (BPSD) were living at home in Thailand. A mobile application which allows caregivers to evaluate patients’ BPSD at home is needed. To develop an application that caregivers can monitor BPSD in patients with moderate-severe dementia. A mobile application was developed to measure 9 common BPSD domains in Thai language. The application was a touchscreen-based questionnaire using Likert scale for frequency of each behavioral domain (frequency score) and visual analogue scale for its impact on caregivers’ emotion (impact score). Concurrent validity was compared to a paper-based version of Neuropsychiatric Inventory (NPI). From a total of 50 caregivers’ responses, both total frequency score and total impact score from the application were significantly correlated with NPI total frequency x severity score (ρ = 0.62, p <0.001) and NPI total burden score (ρ = 0.68, p <0.001). Frequency score in each domain from application was significantly correlated with corresponding NPI subscale scores (ρ = 0.31 – 0.73, all p <0.05). Regarding impact scores, every domain was significantly correlated with NPI burden score on corresponding subscales (ρ = 0.38 – 0.66, all p <0.01). The mobile application demonstrated strong to very strong correlations with NPI scores in patients with moderate – severe dementia. This application may be useful for caregivers in monitoring BPSD. Further testing for usability in community-dwelling is needed before implication into clinical practice.

The Annual Direct and Indirect Health Care Costs for Patients with Chronic Pruritus and their Determining Factors

The Annual Direct and Indirect Health Care Costs for Patients with Chronic Pruritus and their Determining Factors

The effect of Plantago major seed and Almond gum on refractory asthma: A proof-of-concept study

BackgroundAsthma is a chronic respiratory disease that affects more than 300 million people worldwide. Refractory asthma (RA) is characterized by poor control despite adequate treatment. Conditions like RA have led to a renewed interest in non-conventional approaches to managing asthma such as those used in Traditional Persian medicine (TPM). The aim of this trial was to test a TPM formulation including Plantago major seed and Almond gum powder for asthma. MethodsCurrent patients with RA received 5 g of herbal combination (2 g of Plantago major and 3 g of Almond gum powder) which was added to their conventional treatment 3 times a day for 4 weeks. Outcome measures were taken at baseline and 4 weeks including lung function testing and asthma questionnaires: the Asthma control test (ACT) and Asthma quality of life questionnaire (AQLQ). Results28 participants with average age of 54.7 ± 11.2 years were enrolled in the study. 4 participants withdrew from the trial due to reactions to the herbal formulation. There were increases in FEV1 and FVC post-intervention compared to baseline (p < 0.01). The number of participants with wheezing decreased compared to baseline (p < 0.01). There were also improvements in cough, dyspnea, sleep quality and ACT. AQLQ results showed improvements in total, physical, emotional and social impact scores (p < 0.01). ConclusionThe results demonstrate that a combination of Plantago major seed and Almond gum is well-tolerated and potentially beneficial for patients with RA. Further research is warranted to ascertain the mechanisms and therapeutic effects of these ingredients.

Quality of life in paediatric tracheostomy patients and their caregivers – A cross-sectional study

Objectives(1) To better outline quality of life outcomes in paediatric tracheostomy patients and their caregivers. (2) To establish whether quality of life outcomes for children are associated with those of their caregivers. (3) To establish whether quality of life outcomes were associated with the demographic and clinical variables of age, duration of time with a tracheostomy, number of comorbidities, and ventilator dependence. MethodsCross-sectional methodology was applied to gather quantitative data on quality of life outcomes, through PedsQL written questionnaires. These questionnaires covered social, emotional, physical and role/cognitive functioning. Caregivers also provided information on communication, worries, daily activities and family relationships. All children with a tracheostomy in situ, or recently decannulated, attending Sheffield Children's Hospital during the study period were eligible for inclusion. Results25 families wished to participate, with patients ranging from 0.5 to 16.5 years (median 6.25). Both patients and caregivers attained lower scores than many other chronic diseases studied. Mean patient HRQoL was 56.2, with a physical health score of 52.4, psychosocial health score of 61.7. Caregiver HRQoL was 63.8, family functioning score was 68.1 and total family impact score was 61.6. Relative deficits were seen in caregiver social functioning (54.9), communication (56.3), worries (49.1) and daily activities (48.9), whilst role/cognitive functioning (73.8) and family relationships (79.6) subsections produced higher scores. Child psychosocial health showed moderate positive correlation (r = 0.492, p = 0.015) with both caregiver HRQoL and total family impact score. No correlation was identified between quality of life outcomes and demographic or clinical variables. ConclusionsDisease burden appears to be particularly high for children and families with tracheostomies, especially when compared to other serious childhood disease. Lack of time and energy to complete daily activities, social isolation, worries, as well as difficulty communicating and perceived lack of understanding of their child's health were instrumental in reduced quality of life of caregivers. Anxiety about the future affected the majority of caregivers. This psychosocial impact may be lost in the busyness of delivery of medical care. We recommend provision of psychosocial support for these families as is now also recommended in other chronic childhood illness.

563-P: Autonomic Neuropathy in Type 1 Diabetes (T1D): Findings from the T1D Exchange

Diabetic autonomic neuropathy (DAN) may contribute to significant morbidity, including orthostatic hypotension, arrhythmia, hypoglycemia unawareness, gastroparesis, enteropathy, urinary incontinence and sexual dysfunction in T1D. Contemporary data on DAN impact are scarce. We evaluated the frequency of DAN in adult T1D patients enrolled in the T1D Exchange Clinic Network using the validated Survey of Autonomic Symptoms (SAS). Surveys were emailed to registry participants who consented to be emailed about future studies. DAN was defined as a score &amp;gt;3 on the Symptom Score (SS). Severity of symptoms was graded with the Total Impact Score (TIS) defined as mild (≤25th percentile), moderate (≤50th percentile) and severe (≤75th percentile). Multivariable linear regression and stepwise logistic regression were used to analyze SAS-defined DAN and the correlations between DAN and glycemic control, medical comorbidities and socioeconomic factors. Among 965 T1D participants, DAN frequency was 17%, of which 76% presented with moderate and 24% with severe symptoms. Participants with DAN were older (44±16 vs. 39±17 years), were more often female (73% vs. 62%), had longer T1D duration (28±14 years vs. 23±14 years), and had higher hemoglobin A1c (8.1±1.7% vs. 7.7±1.5%) than those without DAN (all p-values &amp;lt;0.05). Compared with those without DAN, those with DAN were more likely to have peripheral neuropathy (OR 8.10, 95% CI 4.57-14.18), gastroparesis (OR 5.35, 95% CI 2.55-11.23), cardiovascular disease (OR 2.60, 95% CI 1.34-4.91), depression (OR 2.20, 95% CI 1.46-3.32) and use opioids (OR 4.23, 95% CI 1.76-10.13), both p-values &amp;lt;0.01. As ascertained by the short SAS questionnaire, we found that DAN symptoms were common and should be screened for regularly. Traditional glycemic risk factors and the presence of peripheral neuropathy and CVD were associated with DAN. Opioid use also was greater in those with DAN, which might serve as a marker of more painful peripheral neuropathy. Disclosure K.R. Mizokami-Stout: None. R. Bailey: None. N.C. Foster: None. L. Ang: None. G. Aleppo: Advisory Panel; Self; Novo Nordisk Inc. Consultant; Self; Dexcom, Inc., Medtronic MiniMed, Inc. Research Support; Self; AstraZeneca, Dexcom, Inc., Lilly Diabetes, Novo Nordisk Inc. C.J. Levy: Advisory Panel; Self; Novo Nordisk A/S, Sanofi. Employee; Spouse/Partner; Allergan. M.R. Rickels: None. V.N. Shah: Advisory Panel; Self; Sanofi US. Consultant; Self; Dexcom, Inc. S. Polsky: Consultant; Self; Jaeb Center for Health Research. Research Support; Self; Barbara Davis Center for Diabetes, Children's Diabetes Foundation, Dexcom, Inc., Eli Lilly and Company, JDRF, Leona &amp; Harry Helmsley Charitable Trust, National Institute of Diabetes and Digestive and Kidney Diseases, Sanofi US. M. Katz: None. B.A. Nelson: None. A. Carlson: Consultant; Self; Sanofi US. Research Support; Self; Abbott, Dexcom, Inc., JDRF, Medtronic, National Institutes of Health, Novo Nordisk A/S. F. Vendrame: None. R. Pop-Busui: Consultant; Self; Novo Nordisk A/S. Research Support; Self; AstraZeneca. Other Relationship; Self; American Diabetes Association. Funding The Leona M. and Harry B. Helmsley Charitable Trust

Assessment of multi-air emissions: Case of particulate matter (dust), SO2, NOx and CO2 from iron and steel industry of China

Industrial activities are generally energy and air emissions intensive, requiring bulky inputs of raw materials and fossil fuels and emitting huge waste gases including particulate matter (PM, or dust), sulphur dioxide (SO2), nitrogen oxides (NOx), carbon dioxide (CO2), and other substances, which are severely damaging the environment. Many studies have been carried out on the quantification of the concentrations of these air emissions. Although there are studies published on the co-effect of multi-air emissions, a more fair and comprehensive method for assessing the environmental impact of multi-air emissions is still lacking, which can simultaneously consider the flow rate of waste gases, the availability of emitting sources and the concentrations of all emission substances. In this work, a Total Environmental Impact Score (TEIS) approach is proposed to assess the environmental impact of the main industrial processes of an integrated iron and steel site located in the northeast of China. Besides the concentration of each air emission substance, this TEIS approach also combines the flow rate of waste gases and the availability of emitting sources. It is shown that the processes in descending order by the values of TEIS are sintering, ironmaking, steelmaking, thermal power, steel rolling, and coking, with the values of 17.57, 16.68, 10.86, 10.43, 9.60 and 9.27, respectively. In addition, a sensitivity analysis was conducted, indicating that the TEIS order is almost the same with the variation of 10% in the permissible CO2 concentration limit and the weight of each air emission substance. The effects of emitting source availability and waste gas flow rate on the TEIS cannot be neglected in the environmental impact assessment.

Environmental impact assessment of wastewater discharge with multi-pollutants from iron and steel industry

The iron and steel industry discharges large quantities of wastewater. The environmental impact of the wastewater is traditionally assessed from the quantitative aspect. However, the water quality of discharged wastewater plays a more significant role in damaging the natural environment. Moreover, comprehensive assessment of multi-pollutants in wastewater from both quality and quantity is still a gap. In this work, a total environmental impact score (TEIS) is defined to assess the environmental impact of wastewater discharge, by considering the volume of wastewater and the quality of main processes. To implement the comprehensively qualitative and quantitative assessment, a field monitoring and measurement of wastewater discharge volume and the quality is conducted to acquire pH, suspend solids (SS), chemical oxygen demand (COD), total nitrogen (TN), total iron (TFe), and hexavalent chromium (Cr(VI)). The sequence of TEIS values is obtained as steelmaking > ironmaking > sintering > hot rolling > coking > cold rolling and TN > COD > SS > pH > Cr(VI) > TFe. The TEIS of the investigated steel plant is 26.27. The leading process lies in steelmaking with a TEIS of 19.98. The dominant pollutant is TN with a TEIS of 15.00. Finally, a sensitivity analysis is performed to validate the feasibility and generalisability of the TEIS.

The prevalence of behavioral disorders among children under parental care and out of parental care: A comparative study in India.

BackgroundChildren may suffer from a wide range of behavioral problems, but children living under conditions of perpetual stress and trauma and experiencing breakdown of family structures are tremendously affected. This study was adopted to identify the prevalence of behavioral disorders among children under parental care and out of parental care.MethodsA cross-sectional comparative descriptive study was conducted among 300 children of age 6-12 years from a pediatric outpatient department of a selected hospital and 300 children from selected orphanages in Kolkata to compare the prevalence of behavioral disorders in children under parental care and out of parental care using Strengths and Difficulties Questionnaire (SDQ).ResultsTotal difficulty was more prevalent in children out of parental care (220 children) than in children under parental care (128 children). Conduct problem was the most prevalent behavioral disorder among all the subscales of SDQ with 48.70% and 84.30% of children, respectively. This was followed by peer problem (44.60% and 48.30%), emotional problem (33.70% and 55.60%), and hyperactivity problem (26.70% and 32.30%), respectively. There was significant difference in total difficulty, all subscales, externalizing score, internalizing score, and impact score between the two groups. Regression analysis showed significant relationship of selected variables such as the child’s favorite hobbies and number of close friends the child has using total difficulty score in both the groups. Significant correlation was found among subscales in both the groups.ConclusionFamily-based care and improvised institutional care should be emphasized to reduce the burden of behavioral problem in children.

Measuring Patient Reported Outcomes in Multiple Myeloma: Are Legacy Instruments Fit for Purpose

Introduction:Measuring patient-reported outcomes (PROs) in oncology clinical trials is important to capture the patient perspective on quality of survival and the outcomes of health-related quality of life (HRQoL), symptoms, and functional status. In multiple myeloma (MM) randomized clinical trials (RCTs) the common PRO instruments include the EORTC QLQ-C30 and the EQ-5D as generic measures of a patient's health status. While these legacy PRO instruments have been widely used in the MM population, it is important to continue to assess the instruments psychometric properties for the specific context of use and target population.The purpose of this research was to investigate the strengths and limitations of the PRO instruments when analyzed free from developer construct and scoring recommendations to assess fit for purpose in various MM clinical trial populations.Methods:Data for the analysis included 3 MM RCTs (n=1,773) (Dimopoulos 2016, Palumbo 2016, Mateos 2018). The PRO analysis set consisted of 33 items from the EORTC QLQ-C30 and EQ-5D-5L collected at baseline and during the treatment phase of the RCTs. Item analysis and modern psychometric methods were applied to the PRO item pool as a 4-step process: (1) descriptive analysis of the items, (2) assessment of factor structure, (3) performance of factors across RCT populations (treatment naive, relapsed/refractory MM), and (4) assessment of meaningful change.Items were characterized using polychoric correlations to examine the inter-item association and relationships before determining appropriate factor structures. An exploratory factor analysis (EFA) followed by multidimensional item response theory (MIRT) and bifactor IRT models were conducted to determine how items fit into factors and to test a total symptom and total impact scoring option. Differential item functioning (DIF) was conducted to evaluation item and domain performance across study populations (treatment naïve vs. relapsed/refractory) and longitudinally (baseline vs. week 24). Meaningful change in these new domain constructs was evaluated using anchor-based techniques based on the EORTC-QLQ-C30 and EQ-5D-5L global items. A novel provisional latent class model approach creating responder groups was also developed and applied to assess meaningful change.Results:The 33 items from the EORTC QLQ-C30 and EQ-5D-5L demonstrated strong inter-item correlations supportive of pre-specified domain structures and consistent across RCT study populations. The EFA supported 3-domain structures for both symptoms and impacts separately. These domains were broadly consistent with the PRO instrument developer specifications but unique in several regards. These domains were statistically identical across RCTs. Model fit showed that a proposed bi-factor IRT (Symptom domain and Impact domain) fit better than the MIRT suggesting that subdomains are less useful than total domain scores. An extensive DIF analysis within this IRT framework found no evidence of substantial DIF effects. All evidence indicated that the items performed similarly across sample populations and time points.Anchor-based meaningful change calculations for the newly created total symptom score and the total impact score demonstrated separation between global health anchor groups but the meaningful change estimates were small. The latent class models demonstrated that treatment arms differed significant in responder rates within 1 RCT.Conclusions:The analyses confirmed psychometrically robust EORTC QLQ-C30 and EQ-5D-5L items in the MM population under newly specified factor structures. In addition, performance of the items allows for calculation of a total symptom score and total impacts score. The newly developed total domains performed identically across MM populations (treatment naïve versus relapsed/refractory). The results only focus on the on-treatment phase of the RCT so future research is needed to determine how psychometric methods can be adjusted to better accommodate survival status and censoring for progression in oncology RCTs. The psychometric properties and consistency of the findings across the newly created symptom and impact total domain structures support the results that daratumumab maintains HRQoL in patients with MM. DisclosuresGries:Janssen Research & Development, LLC: Employment. Fastenau:Janssen Research & Development, LLC: Employment. Iaconangelo:Janssen Research &Development, LLC: Consultancy. Serrano:Janssen Research & Development, LLC: Consultancy.

A phase 2b multicenter, randomized, double-blind, placebo-controlled clinical trial to evaluate the efficacy and safety of vaginal rings containing nomegestrol acetate or etonogestrel and 17β-estradiol in the treatment of women with primary dysmenorrhea

ObjectiveTo evaluate the effect of investigational vaginal rings containing nomegestrol acetate (NOMAC) plus 17β-estradiol (E2) or etonogestrel (ENG) plus E2 in women with moderate to severe primary dysmenorrhea. Study designThis was a Phase 2b randomized, placebo-controlled, multicenter, double-blind study. We randomized participants to one of five treatment groups: four hormonal rings and one placebo ring. The investigational vaginal rings released 300 μg of E2 daily along with 700 μg or 900 μg of NOMAC or 100 μg or 125 μg of ENG. Each participant received 2 identical rings and was to insert each for 21 days followed by a 7-day ring-free period. The primary endpoint, as assessed by a daily electronic diary (e-Diary), was the change in menstrual pain score from baseline to the second in-treatment withdrawal bleeding episode (Cycle 2). The pain score was the mean of the three highest scores for menstrual cramping pain (0–4 point scale) recorded from the day before menses to the third day of bleeding. The primary hypothesis was that at least one investigational vaginal ring would demonstrate a statistically significant larger reduction from baseline in pain score compared to placebo. Secondary endpoints included total mean impact score (which assessed the negative impact on work/school, physical activities, leisure/social activities) and the amount and days of rescue medication (ibuprofen) used. Clinical trial registration number: NCT01670656. ResultsWe randomized 439 participants. The mean pain score decreased from baseline to Cycle 2 in all groups; the decrease in all four treatment groups compared to placebo was statistically significant (p-values ≤0.002). All treatment groups had greater reductions than placebo in ibuprofen intake and greater improvement in impact scores; these differences were statistically significant for both endpoints for the ENG-E2 100/300 μg/day group, while the other groups were not statistically significant for one or both endpoints. ConclusionAll four investigational rings produced a statistically significantly larger reduction from baseline in mean menstrual pain score compared to placebo while pain medication use decreased. ImplicationsThis placebo-controlled study provides evidence that vaginal contraceptive rings containing NOMAC-E2 or ENG-E2 improve moderate to severe dysmenorrhea, across all of doses studied. This adds to the evidence that hormonal contraceptives are effective treatments for dysmenorrhea.

Persian Overall Assessment of the Speaker’s Experience of Stuttering for Adults: the Impact of Stuttering on the Persian-Speaking Adults Who Stutter

Objectives: This paper describes the validation process of the final form of the Persian version of the Overall Assessment of the Speaker’s Experience of Stuttering for Adults (OASES-A-P). The impact of stuttering on the Persian-speaking people who stutter was compared to other languages. / Methods: This study with a cross-sectional design involved 92 Persian-speaking adults who stutter (24 females and 68 males; mean age=20.05±4.85 years). Face and content validity, internal consistency, test-retest reliability, and item analysis for discriminant validity were examined. The impact scores and impact ratings were calculated in total and for the sections separately. / Results: Cronbach’s alpha and ICC proved to be high (0.98; 0.95, P<0.001 respectively). Corrected item-total correlation revealed no negative score. Mean of total impact score was 2.56(±0.67). Impact ratings for the total impact scores were as follows: mild=8.7%, mild-to-moderate=29.3%, moderate=43.5%, moderate-to-severe=15.2%, and severe=3.3%. The impact of separate sections in a high to low order were reactions to stuttering, quality of life, general information, and communication in daily situations. / Discussion: The results of the current study offer a reliable and valid form of the OASES, which is applicable for Persian-speaking Iranian adults who stutter. The predominant impact rating of stuttering was shown to be mild-to-moderate and moderate.

Can a home-based cardiac physical activity program improve and sustain quality of life and exercise capacity in children with Fontan circulation?

ObjectiveFontan survivors report reduced health-related quality of life (HRQOL) and have decreased exercise tolerance compared to healthy peers. We recently demonstrated that a 12-week home-based physical activity program was safe, feasible, and improved parent proxy-reported HRQOL and objective measures of exercise capacity in patients with Fontan circulation. We sought to determine if these improvements in HRQOL and exercise capacity are sustained at 6-month follow-up. DesignPatients, 8–12 years old, with Fontan circulation that completed a 12-week moderate-to-vigorous intensity home-based physical activity program were invited to attend a 6-month follow-up session to complete objective assessments of HRQOL and exercise capacity. HRQOL was measured with validated questionnaires. The 20-meter Shuttle Run (PACER Test) was used to measure exercise capacity. ResultsOf the 13 patients who completed the original 12-week physical activity program, 11 (85%) attended the 6-month follow-up. There were no adverse events during the follow-up period. Improvements in parent proxy-report for HRQOL at completion of the 12-week program were sustained at 6-month follow-up. Patients reported a significant decrease in HRQOL assessed by PedsQL at 6-month follow-up. However, there was a non-significant trend of improvement in patient PCQLI total and psychosocial impact scores at completion of the 12-week program, which was sustained at 6-month follow-up. The significant improvements in objective measures of exercise capacity seen from baseline to completion of the 12-week program were sustained at 6-month follow-up. ConclusionImprovements in parent-proxy report HRQOL and objective measures of exercise capacity after completion of a home-based 12-week physical activity program were sustained at 6-month follow-up. Despite improvements in exercise capacity, patients did not report improved HRQOL. A larger, controlled study of this home-based physical activity program is needed to assess the impact of physical activity and improved exercise capacity on HRQOL in children with Fontan circulation.

Effects of long-term home-based Liuzijue exercise combined with clinical guidance in elderly patients with chronic obstructive pulmonary disease

PurposeThis study was designed to investigate the effects of long-term home-based Liuzijue exercise combined with clinical guidance in elderly patients with chronic obstructive pulmonary disease (COPD).MethodsForty patients with COPD at stages II–III of the Global Initiative for Chronic Obstructive Lung Disease were enrolled. The subjects were randomly allocated to the Liuzijue exercise group (LG) or control group (CG) in a 1:1 ratio. Participants in the LG performed six Liuzijue training sessions, including 4 days at home and 2 days in the hospital with clinical guidance for 60 minutes/day for 6 months. Participants in the CG conducted no exercise intervention. In addition, lung function test, 6-minute walking test (6MWT), 30-second sit-to-stand test (30 s SST), and the St George’s Respiratory Questionnaire (SGRQ) were conducted at the baseline and at the end of the intervention.ResultsThirty-six patients completed the study. The patients’ lung function improved significantly (p < 0.05) in the LG as well as the 6MWT, 30 s SST, and SGRQ score (p < 0.01). While the SGRQ total score, activity, and impact scores increased significantly (p < 0.05) in the CG. In addition, there were significant differences between the groups (p < 0.01) in regard to the values of forced expiratory volume in 1 second as a percentage of the predicted volume, 6MWT, 30 s SST, and SGRQ.ConclusionsLong-term home-based Liuzijue exercise combined with clinical guidance can effectively improve the pulmonary function, exercise capacity, and quality of life of elderly patients with moderate to severe COPD.

Influence of spatial differentiation in impact assessment for LCA-based decision support: Implementation of biochar technology in Indonesia

Spatial differentiation in evaluation of environmental impacts in life cycle assessment (LCA) may give more accurate and realistic results, especially in cases where impacts occur at a local or regional scale and where sensitivity of receiving ecosystems differs from generic conditions. However, from a decision maker's perspective it is of interest to investigate whether the use of spatially differentiated impact assessment methods in addition leads to better decisions. Biochar production and agricultural utilization in Indonesia is an example of a micro-level decision-support case where spatial differentiation could be relevant.To study the influence of spatial differentiation on management recommendations for implementation of biochar as a waste management strategy and the choice of best performing biochar production techniques, agricultural utilization systems and geographic locations, comparisons were made between four communities living on different Indonesian islands, three biochar production techniques and two types of fertilizer.Results showed that the differences in impact scores between generic and spatially differentiated impact scores were an order of magnitude different for some of the considered impact categories. These differences influenced the identification of which system performed best when considering total damage to human health, which was mainly due to differences in accounting for impacts arising from water use. By contrast, trade-offs between impact categories combined with relatively small contribution of some spatially differentiated impacts rendered spatial differentiation less relevant with regard to total damage to ecosystems. Total impact scores were influenced to a greater extent by variations in inventories determining environmental burden and benefits, than by differences between generic and spatially differentiated characterization factors. Hence, irrespective of the scenario and type of damage considered, both generic and spatially differentiated assessments showed that implementing biochar technology in Indonesia is expected to bring environmental benefits.It was shown that spatial differentiation in impact assessment did not necessary lead to better decisions in this case study. This may suggest that depending on the goal of the LCA, practitioners should consider potential benefits of implementing spatially differentiated life cycle impact assessment methods as opposed to potential benefits from collecting site-specific inventories.

Towards Quantifying Behaviour in Social Crowdsourcing Communities

We analyze crowdsourcing communities by creating a detailed process for quantifying individual behaviour in online environments. The key feature of our communities is their social interactions so we call these social crowdsourcing communities (SCC). First, we derive factors based on actions captured about textual contributions. We interpret and name these factors. Then we demonstrate their utility in predicting the quality of team contributions. We capture the actions of members using measurable variables and perform factor analysis on these to produce factors of behaviour in SCCs (i.e. dimensions of behaviour). We derive factor scores for each member. An abstract notion of teams is used that is based on the social interactions. Team scores are then determined by the aggregation of the individual factor scores. The relationship between the team-level factor scores and the quality of contributions made by each team are then used as a proxy for team effectiveness. We found that member behaviour has three dimensions/factors: Impact, Activity, Policing/Rowdiness and there is a linear relationship between a team's contribution quality and their Impact scores. We also found a moderate negative linear relationship between the smallest Activity scores in each team with the quality of their individual contributions. This shows that teams that produce higher quality contributions tend to have higher total and maximum Impact score with lower levels of Activity. Thus, we demonstrate that properly aggregated behavioural factors can predict the quality of team-level contributions.

Data Access and Usage Practices Across a Cohort of Researchers at a Large Tertiary Pediatric Hospital: Qualitative Survey Study.

BackgroundHealth and health-related data collected as part of clinical care is a foundational component of quality improvement and research. While the importance of these data is widely recognized, there are many challenges faced by researchers attempting to use such data. It is crucial to acknowledge and identify barriers to improve data sharing and access practices and ultimately optimize research capacity.ObjectiveTo better understand the current state, explore opportunities, and identify barriers, an environmental scan of investigators at BC Children’s Hospital Research Institute (BCCHR) was conducted to elucidate current local practices around data access and usage.MethodsThe Clinical and Community Data, Analytics and Informatics group at BCCHR comprises over 40 investigators with diverse expertise and interest in data who share a common goal of facilitating data collection, usage, and access across the community. Semistructured interviews with 35 of these researchers were conducted, and data were summarized qualitatively. A total impact score, considering both frequency with which a problem occurs and the impact of the problem, was calculated for each item to prioritize and rank barriers.ResultsThree main themes for barriers emerged: the lengthy turnaround time before data access (18/35, 51%), inconsistent and opaque data access processes (16/35, 46%), and the inability to link data (15/35, 43%) effectively. Less frequent themes included quality and usability of data, ethics and privacy review barriers, lack of awareness of data sources, and efforts required duplicating data extraction and linkage. The two main opportunities for improvement were data access facilitation (14/32, 44%) and migration toward a single data platform (10/32, 31%).ConclusionsBy identifying the current state and needs of the data community onsite, this study enables us to focus our resources on combating the challenges having the greatest impact on researchers. The current state parallels that of the national landscape. By ensuring protection of privacy while achieving efficient data access, research institutions will be able to maximize their research capacity, a crucial step towards achieving the ultimate and shared goal between all stakeholders—to better health outcomes.

Can Modular Manufacturing Be the Next Game-Changer in Shale Gas Supply Chain Design and Operations for Economic and Environmental Sustainability?

Modular manufacturing is identified to have great potential in the exploitation of shale gas resource. In this work, we propose a novel mixed-integer nonlinear fractional programming model to investigate the economic and environmental implications of incorporating modular manufacturing into well-to-wire shale gas supply chains. Both design and operational decisions regarding modular manufacturing are considered, including modular plant allocation, capacity selection, installment planning, moving scheduling, and salvage operation, as well as other decisions for shale gas supply chain design and operations, such as drilling schedule, water management, and pipeline network construction. To systematically evaluate the full spectrum of environmental impacts, an endpoint-oriented life cycle optimization framework is applied that accounts for up to 18 midpoint impact categories and three endpoint impact categories. Total environmental impact scores are obtained to evaluate the comprehensive life cycle environmen...

Exercise Performance and 22q11.2 Deletion Status Affect Quality of Life in Tetralogy of Fallot

To identify mediators of health status and quality of life (QOL) in children and adolescents aged 8-18 years old following surgical repair for tetralogy of Fallot (TOF), including resource use, exercise performance, and 22q11.2 deletion status. We performed a corollary study to a cross-sectional analysis of subjects following repair for TOF that completed cardiac magnetic resonance imaging, cardiopulmonary exercise tests, and instruments assessing health status and QOL. General linear models were used to test for mediation. A total of 29 of 151 (19%) patients carried a 22q11.2 deletion. Parents of children with a deletion compared with those without a deletion reported worse physical and psychosocial functioning on the Child Health Questionnaire. The patients with a 22q11.2 deletion and their parents reported lower total and Disease Impact scores compared with the group without a deletion on the Pediatric Cardiac Quality of Life Inventory. Medical care use negatively correlated with measures of health status/QOL. Greater maximum work correlated with better patient health status and QOL, regardless of deletion status. Exercise performance mediated the association between deletion status and parent-reported outcomes (unstandardized effects ranging from 2.4 to 4.2) and patient-reported Disease Impact (0.99; 95% CI 0.02-2.70). Children and adolescents following repair for TOF seem to suffer significant challenges to their health status and QOL, which is amplified markedly in the context of the 22q11.2 deletion syndrome, and related to exercise performance.

Comparison of life cycle environmental impacts of different perovskite solar cell systems

Perovskite solar cells have attracted enormous attention due to their low cost and high power conversion efficiency. However, the use of toxic metals such as lead in the perovskite dye and the disposal methods of perovskite solar cells cause grave concerns about their environmental impacts. Inorganic and lead-free perovskite solar cells have been developed to overcome the disadvantages of lead-based organic perovskite solar cells, a development that involves different materials and manufacturing processes to fabricate different perovskite solar cells. In order to understand and develop an environmentally friendly perovskite solar cell technology, comprehensive environmental impact assessments have been conducted in this study on five typical perovskite solar cells, using an attributional life cycle assessment (LCA) approach. The results indicate that MAPbI3 and FAPbI3 perovskite solar cells have relatively larger environmental impacts than MASnI3−xBrx, CsPbBr3, and MAPbI2Cl perovskite solar cells based on a 1cm2 active area solar cell system, and this result can be explained by the different amounts of organic solvents used in the device fabrication. In addition, gold production makes the largest environmental impact contribution to perovskite solar cell systems, and the substitution of silver or aluminum for gold can significantly reduce the total environmental impact scores. For disposal methods, incineration with energy recovery is found better than landfill.

Mental Health in School-Aged Children Prenatally Exposed to Alcohol and Other Substances.

Prenatal exposure to substances can possibly influence a child’s neurodevelopment and may impact on subsequent mental health. We investigated the mental health status of school-aged children referred to a pediatric hospital with a history of prenatal exposure to alcohol or other substances. Mental health was assessed using the Strengths and Difficulties Questionnaire and compared with a reference group. A total of 105 of 128 (82%) eligible children prenatally exposed to substances participated in the study, with 48 children exposed to alcohol and 57 to other substances. Strengths and Difficulties Questionnaire subscale mean scores, total difficulties scores, and total impact scores were statistically significantly higher in the group of exposed children, compared with the reference group. In this hospital-based population of school-aged children prenatally exposed to alcohol or other substances, the exposed group had an increased risk of mental health problems, compared with the reference group.