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Background: Poorly regulated and insufficiently maintained medical devices (MDs) carry high risk on safety and performance parameters impacting the clinical effectiveness and efficiency of patient diagnosis and treatment. As infant incubators are used as a form of fundamental healthcare support for the most sensitive population, prematurely born infants, special care mus be taken to ensure their proper functioning. This is done through a standardized process of post-market surveillance., Objective: To address the issue of faulty infant incubators being undetected and used between yearly post-market surveillance, an automated system based on machine learning was developed for prediction of infant incubator performance status., Methods: In total, 1997 samples were collected during the inspection process of infant incubator inspections performed by an ISO 17020 accredited laboratory at various healthcare institutions in Bosnia and Herzegovina. Various machine learning algorithms were considered, including Decision Tree (DT), Random Forest (RF), Naïve Bayes (NB) and Logistic Regression (LR) for the development of the automated system., Results: The aforementioned algorithms were selected because of their ability to handle large datasets and their potential for achieving high prediction accuracy. The 0.93 AUC of Naïve Bayes indicates that it is overall stronger in predictive capabilities than decision tree and random forest which displayed superior accuracy in comparison to Naïve Bayes., Conclusion: The results of this study demonstrate that machine learning algorithms can be effectively used to predict infant incubator performance status on the basis of measurements taken during post-market surveillance. Adoption of these automated systems based on artificial intelligence will help in overcoming challenges of ensuring quality of infant incubators that are already being used in healthcare institutions., Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Virtual reality (VR) is increasingly used in healthcare education, offering immersive training experiences that are as effective as conventional methods, with benefits like cost-effectiveness, replicating complex scenarios, and reduced need for physical resources. However, the use of VR as an assessment tool is still emerging, particularly in nursing and medical education. The aim of this systematic review was to examine how immersive VR is used as an assessment tool for nursing and medical students., Methods: Embase, PubMed, PsycINFO, Cochrane, CINAHL, and ERIC were searched for articles that assessed nursing and/or medical students using immersive/HMD VR. The data was extracted, and content analysis was performed., Results: Twenty-six studies met the inclusion criteria, investigating VR assessments in various settings mostly emergencies. Assessments focused on core competencies Patient Care such as first triage, Interpersonal and Communication Skills (e.g., interprofessional communication), and Medical Knowledge (e.g., about coma), utilizing a range of assessment methods from knowledge to performance levels. VR was used either as an automated or supporting assessment tool. Practical considerations in VR implementation were also examined, such as hardware and software., Conclusion: The use of VR in medical education assessment shows promise, particularly for emergency scenarios and performance-based tasks related to core competencies such as Patient Care, Interpersonal and Communication Skills, and Medical Knowledge. While this technology offers opportunities to automate assessments and reduce examiner workload, challenges related to software, costs, and feasibility must be addressed. Additionally, aligning learning objectives, teaching methods, and VR assessments through constructive alignment is essential to ensure effective implementation as both a teaching and evaluation tool., Competing Interests: Declarations. This systematic review was registered in PROSPERO (CRD42023490861) and utilized the MERSQI Tool instead of the Cochrane Risk-of-Bias-Tool (as initially registered) for assessing data quality due to the inclusion of a wide range of study designs. Ethics approval and consent to participate: Not applicable. Consent for publication: Not applicable. Competing interests: TCS holds the endowed professorship of emergency telemedicine at the University of Bern sponsored by the Touring Club Switzerland. The sponsor has no influence on the research or decision to publish. All other authors have nothing to disclose., (© 2025. The Author(s).)

This paper aims to comprehensively review patient performance assessment (PPA) methods used in assist-as-needed (AAN) robotic therapy for upper extremity rehabilitation. AAN strategies adjust robotic assistance according to the patient's performance, aiming to enhance engagement and recovery in individuals with motor impairments. This review categorizes the implemented PPA methods in the literature for the first time in such a wide scope and suggests future research directions to improve adaptive and personalized therapy. At first, the studies are examined to evaluate PPA methods, which are subsequently categorized according to their underlying implementation strategies: position error-based methods, force-based methods, electromyography (EMG), electroencephalography (EEG)-based methods, performance indicator-based methods, and physiological signal-based methods. The advantages and limitations of each method are discussed. In addition to the classification of PPA methods, the current study also examines clinically tested AAN strategies applied in upper extremity rehabilitation and their clinical outcomes. Clinical findings from these trials demonstrate the potential of AAN strategies in improving motor function and patient engagement. Nevertheless, more extensive clinical testing is necessary to establish the long-term benefits of these strategies over conventional therapies. Ultimately, this review aims to guide future developments in the field of robotic rehabilitation, providing researchers with insights into optimizing AAN strategies for enhanced patient outcomes., Competing Interests: Declarations. Ethical approval and informed consent: Not applicable. Competing interest: The authors declare no competing interests., (© 2025. The Author(s).)

Background: After 25 years of implementing the Medical Devices Directive (MDD), in 2017, the new Medical Devices Regulation (MDR) came into force, establishing stricter requirements for post-market surveillance of the safety and performance of medical devices (MD). For electrocardiogram (ECG) devices, which are crucial for monitoring cardiac activities, these requirements are essential to ensure the reliability and accuracy of diagnosing cardiac conditions and timely treatment., Objective: This study aims to enhance post-market surveillance of ECG devices by leveraging Machine Learning (ML) algorithms to predict the operational status of these devices. Specifically, the research focuses on classifying the success or failure of ECG device operations based on performance and safety parameters. The ultimate goal is to improve the management strategies of ECG devices in healthcare institutions, ensuring optimal functionality and increasing the reliability of diagnostic procedures., Method: During the inspection process of ECG devices conducted by an accredited laboratory in accordance with ISO 17020 standard in numerous healthcare institutions in Bosnia and Herzegovina, a total of 5577 samples were collected. Various machine learning algorithms, including Decision Tree (DT), Logistic Regression (LR), Random Forest (RF), Gaussian Naive Bayes (NB), and Support Vector Machine (SVM), were employed for result comparison and selection of the most accurate algorithm., Results: All algorithms demonstrated good performance, but the Random Forest (RF) algorithm stood out, achieving 100% accuracy in predicting the success/unsuccess status of the device. While the results of this research are specific to the collected data from EKG devices, the developed algorithms can be applied to other similar datasets, offering opportunities for broader use in the medical environment., Conclusion: Implementing machine learning algorithms for automated systems in healthcare institutions can significantly enhance the quality of patient diagnosis and treatment. Additionally, these systems can optimize costs associated with managing medical devices. Improved post-market surveillance using ML can address challenges related to ensuring device reliability and safety., Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Polymer material (PM) is a novel vertical barrier material, demonstrated to be effective in impeding pollutants. However, the associated transport research is limited. This study aims to develop an analytical solution for two-dimensional transport of organic contaminant in the PM-enhanced composite cutoff wall (CCW) system, where the variable substitution and Fourier transform methods are used. This analytical solution, available in various simplifications, is effectively validated via several comparisons. Following this, the analyses show that an increase in the non-uniformity of pollution source concentration distribution shortens the PM-enhanced CCW's breakthrough time (t b ), while exhibits a marginal effect on the total flux at its exit. The increment of aquifer horizontal thickness prolongs the t b to some extent, whereas an increase in its hydraulic conductivity slightly reduces the t b . Additionally, the PM layer location is found to have a little effect on the PM-enhanced CCW's barrier performance. Furthermore, the equivalent performance assessment reveals that the improvement gained from increasing the PM layer thickness far surpasses that from increasing the single-layered cutoff wall thickness, and this difference may exceed 10. For a PM layer with low hydraulic conductivity, it is more suitable for engineering scenarios with the higher hydraulic head difference. Totally, the proposed analytical solution offers a valuable tool for designing the PM-enhanced CCW., Competing Interests: Declaration of competing interest The authors declare that there is no conflict of interest., (Copyright © 2025 Elsevier B.V. All rights reserved.)

The Serbian Country Factsheets on Physical Exercise and Performance for Esports Players provide a foundational assessment of nine physical exercise and performance indicators tailored to esports athletes. This study utilizes Serbia's Esports Physical Exercise/Performance Matrix 1.0 framework, integrating recent peer-reviewed studies and nationally representative secondary data to evaluate these indicators. However, insufficient data was identified, with all indicators scoring zero due to unreliable evidence. This fact highlights a critical need for targeted health initiatives within Serbia's esports community. Considering the strong correlation between physical fitness and cognitive skills essential for esports success, the findings suggest that prolonged physical inactivity may impair Serbian players' competitive potential. Serbia risks falling behind in this rapidly evolving field without a coordinated, cross-sectoral approach to health promotion tailored for esports. This factsheet is a pioneering resource for Serbian esports, aiming to stimulate further research, inform policy adjustments, and foster community engagement to build a healthier and more resilient esports population., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision., (Copyright © 2025 Zhou, Hu, Matic and Popovic.)

Background: In 2018, a nationwide survey carried out in 387 acute care hospitals from 16 out of 21 Italian regions, allowed defining an extended checklist for the participatory evaluation of person-centredness in hospital care. We aimed to validate a reduced set of core items for continuous use across the country., Methods: Factor analysis was used to validate the construct of the checklist. Varimax rotation with eigenvalues > 1 was used to optimize factor structure. Items with an item-total correlation > 0.30 and factor loadings > 0.4 were attributed to individual factors. Items with inter-item correlation coefficient > 0.70 were submitted to expert opinion for final decision. Overall internal consistency was assessed through Cronbach's alpha., Results: A total of 183 out of 243 items in the original checklist were submitted to factor analysis. A subgroup of 67 items was retained in 4 main areas, allocated as follows: 16 items in 4 sub-areas of "Person-oriented organizational and care processes", 16 items in 4 sub-areas of "Physical accessibility, liveability and comfort of the facilities", 15 items in 3 sub-areas of "Access to information, streamlining and transparency", and 20 items in 4 sub-areas of "Taking care of the relationship with patients and citizens". Overall values of Cronbach's alpha ranged between 0.77 and 0.90, showing high consistency., Conclusions: This study validated a "core" checklist that can be routinely used to monitor the implementation of person-centred care in Italian hospitals. The tool can be applied more widely by multiple stakeholders as a measurement instrument for the participatory evaluation of person-centredness., Competing Interests: Declarations. Ethics approval and consent to participate: Ethics approval was not needed, as the study only involved only aggregate data at the hospital level. The data were collected from panel members who gave their consent to participate to the evaluation. Personal data related to the data collectors were not available in any form or shape for each record. Consent for publication: All authors gave their consent to publish the results of the present study in the candidate journal. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Background: Interviewers' judgements play a critical role in competency-based assessments for selection such as the multiple-mini-interview (MMI). Much of the published research focuses on the psychometrics of selection and the impact of rater subjectivity. Within the context of selecting for entry into specialty postgraduate training, we used an interpretivist and socio-constructivist approach to explore how and why interviewers make judgments in high stakes selection settings whilst taking part in an MMI., Methods: We explored MMI interviewers' work processes through an institutional observational approach, based on the notion that interviewers' judgements are socially constructed and mediated by multiple factors. We gathered data through document analysis, and observations of interviewer training, candidate interactions with interviewers, and interviewer meetings. Interviews included informal encounters in a large selection centre. Data analysis balanced description and explicit interpretation of the meanings and functions of the interviewers' actions and behaviours., Results: Three themes were developed from the data showing how interviewers make professional judgements, specifically by; 'Balancing the interplay of rules and agency,' 'Participating in moderation and shared meaning making; and 'A culture of reflexivity and professional growth.' Interviewers balanced the following of institutional rules with making judgment choices based on personal expertise and knowledge. They engaged in dialogue, moderation, and shared meaning with fellow interviewers which enabled their consideration of multiple perspectives of the candidate's performance. Interviewers engaged in self-evaluation and reflection throughout, with professional learning and growth as primary care physicians and supervisors being an emergent outcome., Conclusion: This study offers insights into the judgment-making processes of interviewers in high-stakes MMI contexts, highlighting the balance between structured protocols and personal expertise within a socially constructed framework. By linking MMI practices to the broader work-based assessment literature, we contribute to advancing the design and implementation of more valid and fair selection tools for postgraduate training. Additionally, the study underscores the dual benefit of MMIs-not only as a selection tool but also as a platform for interviewers' professional growth. These insights offer practical implications for refining future MMI practices and improving the fairness of high-stakes selection processes., Competing Interests: Declarations. Ethics approval and consent to participate: All research method were conducted in accordance with relevant guidelines and regulations. The University of Sydney Human Research Ethics Committee approved the research. Protocol Number 13859. Informed written consent for participation was obtained from participants who were interviewed to enable us to include their data from this study. All participants were reassured that data were strictly de-identified to protect participant privacy. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

There is a limited awareness about the role of Sports and Exercise Medicine (SEM) among medical as well as nonmedical fraternity beyond just management of sports injuries. SEM professionals play a significant role in healthy general population and illness by designing and implementing specific primordial, primary and secondary preventive activities against the lifestyle disorders through exercise. In amateur and professional sports, they provide scientifically sound advice to enhance performance and prevent injuries through pre- and rehabilitative techniques. In the Armed Forces personnel, SEM has a special role beyond these to assess fitness for battle physical efficiency and also enhance the performance in various physical activities of military nature. Scientifically sound professionals in this field can help build a strong army and a healthier nation., Competing Interests: The authors have none to declare., (© 2024 Director General, Armed Forces Medical Services. Published by Elsevier, a division of RELX India Pvt. Ltd.)

This article presents a qualitative, quantitative, and experimental analysis of optical coherence tomography (OCT) volumes obtained using different families of non-raster trajectories. We propose a multicriteria analysis to be used in the assessment of scan trajectories used in obtaining OCT volumetric point cloud data. The novel criteria includes exploitation/exploration ratio of the OCT data obtained, smoothness of the scan trajectory and fast preview of the acquired OCT data in addition to conventional criteria; time and quality (expressed as volume similarity rather than slice-by-slice image quality). The set of criteria proposed will be useful in assessing OCT scan trajectories for optimisation in various applications including robot assisted in vivo optical biopsy. We show in this paper that the rate of data acquisition is improved without degrading the OCT volume quality by scanning using non-raster trajectories (they are fast, smooth, and make the galvanometer scanners have less wear and tear). In particular, the rosette scan trajectory, which was the preferred non-raster trajectory, provided a balanced performance in having better clarity at the centre and periphery of the scanned object., (© 2024 Royal Microscopical Society.)

Unless radiologist performance assessment is sufficiently deep, comprehensive, and balanced, it may tend to omit, obscure, or distort key aspects of the important contributions that radiologists make, with adverse consequences for employers, radiologists themselves, and above all, the patients they serve. Here we present a model of performance assessment that includes eight key dimensions, which can be tailored as appropriate to the needs of particular programs and radiologists., Competing Interests: Conflict of interest The authors declare that they have no disclosures relevant to the subject matter of this article., (Copyright © 2024. Published by Elsevier Inc.)

Objective: To develop and test an Objective Structured Assessment of Technical Skills (OSATS) score for the internal version and total breech extraction of the second twin if in a non-engaged cephalic position., Materials and Methods: This prospective interventional study took place in a tertiary obstetrics department in France. An objective scoring system was developed, and a standardized simulation scenario was set up. Score evaluation was blinded and analyzed according to group and number of past successful vaginal twin deliveries in real life. A satisfaction evaluation was performed, based on the "Student Design Scale" questionnaire., Results: Simulation was performed on 33 participants in three groups: novice group (15 first- and second-year residents), intermediate group (11 third- to sixth-year residents), and expert group (seven senior obstetricians). The total score obtained by experts was higher than that of the intermediate group (P = 0.001), which was higher than that of the novice group (P < 0.001). In the intermediate group, no correlation was found between OSATS score and number of past successful vaginal twin deliveries. Participants' satisfaction was excellent., Conclusion: The OSATS score developed was reliable and valid to evaluate an internal version and a total breech extraction of the second twin, and to differentiate novice, intermediate, and expert practitioners., (© 2024 The Author(s). International Journal of Gynecology & Obstetrics published by John Wiley & Sons Ltd on behalf of International Federation of Gynecology and Obstetrics.)

The Indian summer monsoon (ISM) is a complex and multiscale interacting climate system, which is responsible for major contribution in India's annual rainfall. Understanding the spatial and temporal variability of ISM rainfall is critical for managing water resources, which directly impact and regulate the functioning of India's socio-economic conditions and subsequently, sustenance of over a billion people. This study evaluates the suitability of various gridded precipitation data products with different spatiotemporal resolutions, essential requirement for hydrologic modeling, disaster mitigation, irrigation allocation and agricultural application. Hence, we evaluate the performance of seven gridded datasets in generating time-matched characteristic event occurrences and their respective magnitudes using gauge-based Indian Meteorological Department (IMD) gridded data as reference. We observe that reanalysis datasets underperform compared to satellite and hybrid products in identifying both normal and extreme precipitation events. We develop a performance measure, called 'rank score' that considers deviations from IMD data in magnitude, statistical moments, and rain event detectability for a robust assessment and identifying best-suited dataset. Results indicate that APHRODITE, MSWEP, and CHIRPS (in descending order) are the most suitable data products across India. Additionally, region-specific evaluations provide valuable insights into the applicability of these datasets in different climatic and homogeneous rainfall zones., Competing Interests: Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Ecosystem services (ESs), the benefits nature provides to people, are an important basis for fulfilling sustainable development goals (SDGs). Therefore, an ES-based approach will help deepen our understanding of the relationships between natural systems and human well-being and provide co-benefit pathways for sustainable development. However, monitoring progress towards achieving the SDGs based on the contributions of ESs to SDGs is lacking. Using the linkages between ESs and SDGs, this study quantified progress towards the SDGs in China from 2000 to 2020 and determined future development priorities at both the national and provincial levels. Our results indicated that (1) during the period 2000-2020, China showed decreasing trends in the 11 SDGs and SDG index scores; (2) there were significant differences in the scores for SDGs and the SDG index across 31 provinces; (3) SDG 3, SDG6, SDG11, SDG13, and SDG15 were recognized as the highest national priorities, concerning health and environment; and (4) 31 provinces faced diverse economic, social, and environmental development challenges. The ES-based approach may assist policy-makers in monitoring and comparing progress towards the SDGs in an integrated and composite way, prioritizing local action, and providing a scientific basis for formulating policies to achieve SDG implementation., Competing Interests: Declarations. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Background: Nepal implemented a pilot of the Supervision, Performance Assessment, and Recognition Strategy (SPARS) program aimed to increase health workers' ability to manage medicines through on- the-job training and support from a new cadre of Medicines Management Supervisors (MMS). This study aims to assess the implementation costs., Methods: Data from the SPARS central database and facilities was analysed to assess the total cost of the SPARS pilot including 293 public health facilities from 12 districts of 3 provinces, from May 2022 until July 2023. We estimated the number of health facilities to achieve a successful performance status, defined as a SPARS score ≥ 18.75 out of 25 (75%) and estimated the cost per facility to reach a successful score., Results: In total, 293 facilities received 838 visits, performed by 48 MMS for an estimated total cost of $226,531. 124 facilities (44.3%) reached a score of 18.75 points after two or more visits. On average, it costs $1827 USD per facility to reach a successful SPARS score., Conclusion: This study assesses the costs of implementing SPARS in 12 districts in Nepal. These findings can provide insights into further scaling up SPARS in Nepal or in other countries., Competing Interests: No potential conflict of interest was reported by the author(s)., (© 2024 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.)

This study explores the application of Universal Design (UD) principles to university environments, aiming to improve the experiences of students and staff by fostering inclusivity in educational and social spaces. The research began with a literature review and employed the 'Design for All A.U.D.I.T.' tool, developed by Politecnico di Milano. This tool was adapted to evaluate six buildings across two universities in Milan:Politecnico di Milano and Statale University. The buildings ranged from the most recent to medium-aged and the oldest on each campus. The assessment focused on three main categories-physical, social, and sensory-cognitive quality-across eight key areas, including outdoor environments, entrances, halls, horizontal and vertical circulation, restrooms, classrooms, and study/leisure spaces. A binary scoring system was used to calculate the satisfaction of requirements, previously weighted by experts. The evaluation revealed that newer buildings generally scored higher on average (77%) compared to those from the 1960s (62%) and historical ones (67%). Despite higher scores, newer constructions often prioritized educational spaces over social and leisure areas, resulting in a lack of student gathering spaces. Significant issues included poor entrance design, inadequate wayfinding strategies, and a lack of inclusive classroom features, although restroom facilities consistently demonstrated good accessibility. The most recent building atPolitecnico di Milano scored highest overall but struggled in leisure and study rooms, as did the new building at Statale University. This research highlights both the current state and potential for improvement in university architecture through the lens of UD. The study underscores that innovative design does not always equate to user satisfaction and provides an objective tool to aid decision-makers in enhancing the accessibility and inclusivity of university spaces, ultimately improving the well-being of all users.

Objectives: To evaluate the efficacy, safety and efficiency performances related to the introduction of innovative traceability platforms and integrated blood collection systems, for the improvement of a total testing process, thus also assessing the economic and organizational sustainability of these innovative technologies., Methods: A mixed-method approach was utilized. A key-performance indicators dashboard was created based on a narrative literature review and expert consensus and was assessed through a real-life data collection from the University Hospital of Padova, Italy, comparing three scenarios over time (2013, 2016, 2019) with varying levels of technological integration. The economic and organizational sustainability was determined considering all the activities performed from the tube check-in to the validation of the results, with the integration of the management of the prevalent errors occurred during the process., Results: The introduction of integrated venous blood collection and full sample traceability systems resulted in significant improvements in laboratory performance. Errors in samples collected in inappropriate tubes decreased by 42 %, mislabelled samples by 47 %, and samples with irregularities by 100 %. Economic analysis revealed a cost saving of 12.7 % per tube, equating to a total saving of 447,263.80 € over a 12-month period. Organizational efficiency improved with a reduction of 13,061.95 h in time spent on sample management, allowing for increased laboratory capacity and throughput., Conclusions: Results revealed the strategic relevance of introducing integrated venous blood collection and full sample traceability systems, within the Laboratory setting, with a real-life demonstration of TLA economic and organizational sustainability, generating an overall improvement of the process efficiency., (© 2024 the author(s), published by De Gruyter, Berlin/Boston.)

Background: Poorly regulated and insufficiently maintained medical devices (MDs) carry high risk on safety and performance parameters impacting the clinical effectiveness and efficiency of patient diagnosis and treatment. After the MD directive (MDD) had been in force for 25 years, in 2017 the new MD Regulation (MDR) was introduced. One of the more stringent requirement is a need for better control of MD safety and performance post-market surveillance mechanisms., Objective: To address this, we have developed an automated system for management of MDs, based on their safety and performance measurement parameters, that use machine learning algorithm as a core of its functioning., Methods: In total, 1997 samples were collected during the inspection process of defibrillator inspections performed by an ISO 17020 accredited laboratory at various healthcare institutions in Bosnia and Herzegovina. This paper presents solution developed for defibrillators, but proposed system is scalable to any other type of MDs, both diagnostic and therapeutic., Results: Various machine learning algorithms were considered, including Decision Tree (DT), Random Forest (RF), Naïve Bayes (NB) and Logistic Regression (LR). In addition, random forest regressor and XG Boost algorithms were tested for their predictive capabilities in the field of defibrillator output error prediction. These algorithms were selected because of their ability to handle large datasets and their potential for achieving high prediction accuracy. The highest accuracy achieved on this dataset was 94.8% using the Naive Bayes algorithm. The XGBoost Regressor with its r 2 of 0.99 emerged as a powerful tool, showcasing exceptional predictive accuracy and the ability to capture a substantial portion of the dataset's variability., Conclusion: The results of this study demonstrate that clinical engineering (CE) and health technology management (HTM) departments in healthcare institutions can benefit from proposed automatization of defibrillator maintenance scheduling in terms of increased safety and treatment of patients, on one side, and cost optimization in MD management departments, on the other side., Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

The countermovement vertical jump height, flight time, and jump duration are used to assess athletic performance. Force-plate and motion-capture cameras are used to estimate these parameters, yet, their application is limited to dedicated lab environments. Despite the potential of inertial measurement units (IMU) for estimating the jump height, their accuracy has not been validated. This study investigates the accuracy of our proposed method to estimate the jump height using a sacrum-mounted IMU, during countermovement jumping. Eleven individuals performed four jumps each. To obtain the jump height, we transformed the IMU readouts into anatomical planes, and double-integrated the vertical acceleration after correction for zero velocity and vertical displacement. The accuracy of jump height obtained by IMU was compared to force-plate and motion-capture cameras during jumps without arm swing (mean error (standard deviation) of 0.3(2.2) cm and 1.0(3.0) cm, and correlation coefficient of 0.83 and 0.82, respectively) and during jumps with arm swing (-1.1(2.1) cm and 0.5(1.9) cm, and 0.92 and 0.89). The correlation coefficients were high, and the errors were comparable to the difference between the jump height obtained by force-plate and cameras. Therefore, a sacrum-mounted IMU can be recommended for in-field assessment of countermovement jump with and without arm swing.

Background: We used a ten-item postoperative quality of recovery score (QoR-10) to assess the perioperative quality of care in an in-hospital ambulatory surgical unit., Methods: In Phase 1 of this secular trend study (n=300 patients, 3-months duration), we collected QoR-10 scores and potential confounders, including type of anesthesia and surgery; co-morbidities; and anesthesia components of the Amsterdam scale-measured anxiety scores. Phase 2 was the one-month performance feedback learning phase in which modifiable variables identified in Phase 1 were translated to actionable steps, reinforcing the already existing routine of our department's clinical practices, including pain, shivering and anxiety. The anesthesiology team was instructed and reminded of these steps using performance feedback methods. In Phase 3 (n=300 patients, 3-month duration) we evaluated the efficacy of this performance feedback instruction. QoR-10 scores were compared between Phase 1 and Phase 3., Results: Phase 1 identified three modifiable variables as targets for improvement: postoperative shivering; percentage of patients with numerical rating pain scale (NRS)<4; and preoperative anxiety from anesthesia scores. Compared to Phase 1, significantly fewer Phase 3 patients had severe shivering (2.3% vs. 7.3%, p = 0.023), and a greater percentage had NRS < 4 points (79% vs. 49.7%, p <0.001). The percentage of patients with a high anxiety score did not differ between phases. A direct association between anxiety score and QoR-10 score was not detected. The QoR-10 score (median (IQR)) was significantly higher in Phase 3 than Phase 1: 50 (49-50) vs. 49(49-50), p<0.001. In a multivariable logistic regression analysis, odds for a QoR-10 score of 49-50 were 1.92 higher in Phase 3 than Phase 1., Conclusion: Considering the study limitations, team feedback education contributed to improvement of the QoR-10 score, reduced the proportion of patients with severe shivering and increased the percentage of patients with low pain scores., Competing Interests: Conflict of interest None to declare., (© 2024 Alexander Dukhan et al., published by Sciendo.)

Although scholars have discussed in depth about the evaluation content and the construction of evaluation index system of emergency management and crisis management, a unified and standardized interpretation of system construction concepts and empirical research on the performance evaluation of urban emergency management is still lacking. In view of this, this paper is based on the theory of the  crisis life cycle, with the four phases of urban emergency management and the content of the task as a clue, constructed a performance evaluation index system containing 12 primary indicators and 44 secondary indicators, and centered on the emergency management work situation of S city. The study reveals that emergency management underperforms in S city, with a score of 5.948, qualifying as the "defined level". The "prevention and preparedness stage" receives poor evaluation, indicating a significant bias for crisis response instead of prevention. The report suggests the improvement of emergency material stockpile planning, the formation of grassroots emergency response teams, the emergency management publicity, and special emergency drill plans, etc., with a view to providing reference for city managers to comprehensively review and evaluate the emergency management system, and to promote the construction of a more systematic, complete and scientific urban emergency management system., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

This study was conducted to evaluate the overall performance of selected small-scale irrigation schemes using internal and external performance indicators. The performance of the irrigation schemes in relation to water balance was evaluated using three indicators. The results indicated that the relative water supply (RWS), relative irrigation supply (RIS), and field application ratio (FAR) of Midagdu irrigation scheme were 0.9, 1.3, and 0.75 respectively. This indicates that the water supply is not closely related to the water demand. However, for the Wadeti Irrigation scheme, the RWS, RIS, and FAR are 0.48, 0.35, and 2.83, respectively, indicating water stress. The Midagdu irrigation scheme shows 7496.75 birr/ha for both output per unit command area and output per unit cropped area. Output per unit irrigation water supply was 12.5 birr/m3, while output per unit water consumed was 4.4 birr/m3. For the Wadeti irrigation scheme, the values were 11,276.12 birr/ha, 11,276.12 birr/ha, 8.7 birr/m3, and 1.6 birr/m3, respectively. This study results showed that the Wadeti irrigation scheme is more land-efficient, while the Midagdu scheme is more water-efficient. The values of the hydraulic performance indicators Conveyance Efficiency (Ec), Water delivery capacity (WDC), and Delivery Performance Ratio (DPR), for the Midagdu irrigation scheme were 75 %, 0.45, and 0.8, respectively, while for the Wadeti irrigation scheme, the values were 42 %, 0.11, and 0.4, respectively. These results indicate that the water delivery performance of the two schemes was poor. Therefore, improving the hydraulic performance of the scheme requires minimizing water conveyance losses., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)

Background: Hospitals make up the main cost factor of health systems and also face increasing pressure to improve efficiency. Improving the performance of hospitals, which are vital for public health, is very important for developing countries such as Turkey. Aims : We conducted this study to assess the performance of 544 secondary-level public hospitals in Turkey by geographical region. Methods: In the study, we used the entropy weighting method to obtain the objective weights of indicators with the evaluation criteria, and then we utilized the TOPSIS (Technique for Order Preference by Similarity to Ideal Solution) method to rank the performance of hospitals by geographical region. Results: The comparison of hospital performances by geographical region indicated that the highest and the lowest mean scores belonged to the Mediterranean Region and the Eastern Anatolia Region, respectively. Conclusions: The socio-economic differences between geographical regions in Turkey were in parallel with the findings of the study. Although there is a need for professional management in resource allocation and use to improve the performance of public hospitals, it is necessary to focus on the origin of the problems first.

Image-guided radiotherapy (IGRT) systems using ionizing radiation may increase the risk of secondary cancer and normal tissue toxicity due to additional radiation exposure caused by large field sizes or repeated scans during X-ray imaging. As an alternative to these modalities, surface-guided radiotherapy (SGRT) systems which do not employ ionizing radiation have been developed. This study presents a comprehensive performance evaluation of the Varian Identify SGRT system by using an anthropomorphic Alderson Rando phantom in three different aspects: (a) the accuracy and reproducibility of the system in different regions of interest (ROI) for varying couch displacements, (b) the setup accuracy of the system for patient positioning based on different computed tomography (CT) slice thicknesses, and (c) the potential influence of obstructing SGRT cameras by the gantry on the system's overall accuracy and reproducibility. The accuracy and reproducibility of the SGRT system fell within 1 mm and 1°. Nevertheless, in certain situations, these values were observed to exceed prescribed limits. Consequently, concerning SGRT tolerance limits for treatment applications, careful consideration of ROIs and offset values of the system is crucial. We also recommend that patients should ideally be set up during 0° gantry rotation, and the on-board imaging (OBI) system should be retracted to prevent obstruction of the cameras. Additionally, reference CT images with a slice thickness of under 3 mm are recommended for this purpose., Competing Interests: Conflicts of interest The authors declare no conflicts of interest., (Copyright © 2024 American Association of Medical Dosimetrists. Published by Elsevier Inc. All rights reserved.)

The esbarrada and volta sobre patas manoeuvres are critical in Criollo horse equestrian activities, yet their kinematics remain largely unexplored. This observational study aimed to kinematically describe the manoeuvres in Criollo breed horses and explore the relationship between static goniometry and dynamics. A 2D kinematic analysis was conducted on 31 Criollo horses performing the manoeuvres using high-speed cameras. Joint angles were measured using static goniometry and analysed in relation to dynamic performance. The esbarrada covered a distance of 4.28 ± 0.99 m in 1.15 ± 0.11 s at a velocity of 3.77 ± 0.55 m/s. Joint angles showed a mean fetlock extension of 75.4° ± 5.3° and hock flexion of 43.2° ± 4.1°. In the volta sobre patas , significant differences were found in turn duration (first: 0.96 ± 0.07 s, second: 1.12 ± 0.09 s, p = 0.03) and thoracic limb suspension (first: 0.23 ± 0.02 s, second: 0.28 ± 0.03 s, p = 0.02). Static goniometry indicated that limb conformation did not significantly correlate with protraction angles during the esbarrada ( p = 0.27). The volta sobre patas demonstrated prolonged duration and increased thoracic limb suspension in the second turn. Also, the findings suggest that static conformation does not predict dynamic limb movement during the esbarrada .

Background: The administration of performance assessments during the coronavirus disease of 2019 (COVID-19) pandemic posed many challenges, especially for examinations employed as part of certification and licensure. The National Assessment Collaboration (NAC) Examination, an Objective Structured Clinical Examination (OSCE), was modified during the pandemic. The purpose of this study was to gather evidence to support the reliability and validity of the modified NAC Examination., Methods: The modified NAC Examination was delivered to 2,433 candidates in 2020 and 2021. Cronbach's alpha, decision consistency, and accuracy values were calculated. Validity evidence includes comparisons of scores and sub-scores for demographic groups: gender (male vs. female), type of International Medical Graduate (IMG) (Canadians Studying Abroad (CSA) vs. non-CSA), postgraduate training (PGT) (no PGT vs. PGT), and language of examination (English vs. French). Criterion relationships were summarized using correlations within and between the NAC Examination and the Medical Council of Canada Qualifying Examination (MCCQE) Part I scores., Results: Reliability estimates were consistent with other OSCEs similar in length and previous NAC Examination administrations. Both total score and sub-score differences for gender were statistically significant. Total score differences by type of IMG and PGT were not statistically significant, but sub-score differences were statistically significant. Administration language was not statistically significant for either the total scores or sub-scores. Correlations were all statistically significant with some relationships being small or moderate (0.20 to 0.40) or large (> 0.40)., Conclusions: The NAC Examination yields reliable total scores and pass/fail decisions. Expected differences in total scores and sub-scores for defined groups were consistent with previous literature, and internal relationships amongst NAC Examination sub-scores and their external relationships with the MCCQE Part I supported both discriminant and criterion-related validity arguments. Modifications to OSCEs to address health restrictions can be implemented without compromising the overall quality of the assessment. This study outlines some of the validity and reliability analyses for OSCEs that required modifications due to COVID., (© 2024. The Author(s).)

Background and Purpose: Industrial environments present unique challenges in ensuring worker safety and optimizing productivity. The emergence of smart wearable technologies such as smart insoles has provided new opportunities to address these challenges through accurate unobtrusive monitoring and analysis of workers' activities and physical parameters. This systematic review aims to analyze the utilization of smart wearable insoles in industrial environments, focusing on their applications, employed analysis methods, and potential future directions., Methods: A comprehensive review was conducted, involving the analysis of 27 papers that utilized smart wearable insoles in industrial settings. The reviewed articles were evaluated to determine the trends in application and methodology, explore the implementation of smart insoles across different industries, and identify the prevalent machine learning models and analyzed activities in the relevant literature., Results: The majority of the reviewed articles (67%) primarily focused on human activity recognition and gesture estimation using smart wearable insoles, aiming to enhance safety and productivity in industrial settings. Furthermore, 10% of the studies focused on fatigue identification, 10% on slip, trip, and fall hazard detection, and 13% on biomechanical analyses of workers' body joint loads. The construction industry accounted for approximately 60% of the studies conducted in industrial settings using smart insoles. The most prevalent machine learning models utilized in these studies were neural networks (48%), support vector machines (33%), k-nearest neighbors (30%), decision trees (26%), and random forests (15%). These models achieved median accuracies of 95%, 96%, 91%, 92%, and 95%, respectively. Among the analyzed activities, walking, bending with/without lifting/lowering a load, and carrying a load were the most frequently considered, with frequencies of 10, 10, and 7 out of the 27 studies, respectively., Conclusion: The findings of this systematic review demonstrate the growing interest in implementing smart wearable insoles in industrial environments to enhance safety and productivity. However, the effectiveness of these systems is dependent on factors such as accuracy, reliability, and generalizability of the models. The review highlights the need for further research to address these challenges and to explore the potential of these systems for use in other industrial applications such as manufacturing. Overall, this systematic review provides valuable insights for researchers, practitioners, and policymakers in the field of occupational health and safety., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Climate change exhibits a clear trend of escalating frequency and intensity of extreme weather events, posing heightened risks to drainage systems along the existing road networks. However, very few studies to date have investigated the consequences of projected future changes in rainfall on main road drainage and the resulting risk of road flooding. The work presented in this paper builds on the limited research by introducing a probabilistic model for assessing the impact of climate change on road drainage systems, incorporating climate uncertainty and drainage system variation. The probabilistic scenario-based model and associated framework offer a practical and innovative method for estimating the impact of short-duration storms under future climates for 2071-2100, in the absence of fine-resolution spatio-temporal data. The model also facilitates the assessment of the effectiveness of a climate adaptation strategy. An illustrative case-study of a road drainage system located in the south of Ireland is presented. It was found that the probability of road flooding during intense rainfall is projected to surpass the current acceptable limits set by Irish standards. Assessment of a proactive climate adaptation strategy implemented in 2015 indicated it may need to be adjusted to further reduce climate change impacts and optimise adaptation costs., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

This study investigates gender differences in core muscle morphology among elite alpine skiers using ultrasonography, highlighting significant disparities that could influence training and injury prevention strategies., Methods: A cross-sectional design was employed, examining ultrasound imaging (USI) in 22 elite skiers (11 male, 11 female) to assess the thickness of the external oblique (EO), internal oblique (IO), transversus abdominis (TrAb), and rectus abdominis (RA) muscles., Results: Significant differences were noted, with male skiers displaying greater muscle thickness, particularly in the right IO and RA and left IO, EO, TrAb, and RA., Conclusions: These findings suggest that male and female skiers may require different training approaches to optimize performance and reduce injury risks. This research contributes to a deeper understanding of the physical demands on elite skiers and underscores the need for gender-specific training regimens to enhance athletic outcomes and prevent injuries.

Purpose: Optimal ankle dorsiflexion range of motion plays a vital role in attaining the essential crouched posture necessary for excelling in speed skating. The purpose of this study was to determine how the ankle dorsiflexion angle evolves throughout a day of training and to identify the factors that influence this angle., Methods: Thirty short-track speed skaters, from 2 teams, participated in this study. The maximum ankle dorsiflexion angle was obtained in a lunge position facing a wall, using a digital inclinometer. All measures were obtained 3 times per side, 6 times per day, on 2 training days separated by at least a week. We conducted multiple tests to study the impact of repetition, day, side, team level, sex, and moment on the ankle dorsiflexion angle., Results: The 3 times repeated measures and the 2 days of training did not have a significant influence on the results. There was a statistically significant difference between the first time point of the day and the 5 other time points for both ankles. Moreover, the influence of sex and team level was not statistically significant., Conclusions: The results indicate that there are significant changes in ankle dorsiflexion range of motion but only after the first warm-up of the day. Such findings could enable team staff to enhance athletes' precompetition preparation and tailor ankle mobility training regimens more effectively.

Introduction: Since the World Health Report in 2000, Health System Performance Assessment (HSPA) has been established as a tool for the evaluation and evidence-informed governance of health systems. So far, the population perspective has not been integrated into HSPA in a systematic manner, although people's experiences and expectations are of great importance to improve health systems and especially to strengthen patient-centered care. Therefore, this study aims to conduct an HSPA of Germany's health system from the population's perspective covering all eight goals of WHO's Health Systems Framework, and to identify strengths and needs for improvement., Methods: In 2018, 32,000 people insured with the German sickness fund 'AOK Nordost' were invited by mail to participate in the survey. The questionnaire contained a total of 43 items covering the eight goals of WHO's Health Systems Framework (e.g., access, quality, safety) plus socioeconomics and other characteristics of the insured persons. The data on the health system goals were analyzed descriptively and by subgroups (age, sex, income, chronic conditions, health literacy)., Results: The sample (n=1,481; response rate 4.6%) was 54.8% female and had a mean age of 59.1 years (±18.5). Altogether, the participants saw several needs for improvement within the German health system. For instance, 60.0% found quality differences between hospitals to be big, and between 3.9% and 8.5% reported mistakes related to their treatment or prescription medication in the previous two years. A big need for reform was especially seen regarding out-of-pocket payments (51.5%) and the coordination of ambulatory care physicians among each other (44.2%) and with hospitals (41.9%). In addition, big subgroup differences were seen, especially for income and health literacy. Of the participants in the lower income group, 37.2% reported a (very) strong financial burden due to out-of-pocket payments (vs. 20.7%). People with limited health literacy (52.1%) assessed the access to care generally as not being good, and they perceived greater quality differences and needs for reform, compared to their counterparts. For instance, 36.6% had experienced discrimination in the previous year (vs. 19.9%)., Discussion: The survey results provide a comprehensive picture of Germany's health system from the population perspective. In some areas, previous findings were confirmed (e.g., a lack of coordination between providers). Other results expand existing knowledge (e.g., the role of health literacy in health care provision) or raise new questions (e.g., the difference between the subjectively assessed burden from out-of-pocket payments and the objective measures currently used). The great differences between subgroups are a call to action on the level of both politics and practice to better consider the individual's needs in order to make health better for everyone. Further research could provide deeper insights in this regard., Conclusion: Strengthening the population perspective in HSPA allows for a better understanding and evaluation of health systems and, in particular, helps to identify areas for improvement in patient-centered care., (Copyright © 2023. Published by Elsevier GmbH.)

Purpose: Despite the accuracy of heart rate (HR) as an indicator of the aerobic engagement has been evaluated in several intermittent on-court activities, its validity as an oxygen uptake ( V ˙ O 2 ) indicator during shuttle running over short paths remains uncertain. Moreover, it is unclear whether speed may affect such validity. This study evaluated the HR ability in estimating the V ˙ O 2 during 5-m shuttle running at different speeds. Methods: V ˙ O 2 and HR of 12 physically active young men were recorded during an incremental forward running (FW) protocol and a 5-m shuttle test at 50%, 60%, and 75% of maximal aerobic speed (MAS). Slope and intercept of the relationship between HR and V ˙ O 2 (HR/ V ˙ O 2 ) were individually determined, in both protocols. The HR measured during the shuttle test was used in the FW HR/ V ˙ O 2 to estimate V ˙ O 2 at each shuttle speed. A paired Student's t -test compared slopes and intercepts of the two HR/ V ˙ O 2 . A two-way RM-ANOVA and an equality test examined, respectively, the differences and the equality between measured and estimated V ˙ O 2 . Lastly, a Bland-Altman plot described the accuracy and precision of the estimated V ˙ O 2 at each shuttle intensity. Results: Slopes and intercepts of the HR/ V ˙ O 2 appeared not different between FW and shuttle running. At 50%MAS, HR underestimated the V ˙ O 2 (~7%), whereas returned accurate values at the two higher velocities, although with high variability (±18%). Conclusions: When using HR as V ˙ O 2 indicator during shuttle running over short paths, a separated analysis of the HR validity as V ˙ O 2 indicator is recommended especially when administering different exercise intensities.

The practice of sustainable buildings has become a general trend in urban development. Yet, with the rapid development of urban renewal, the performance of existing buildings often fails to meet the actual needs of sustainable urban development. To improve the performance of existing buildings, it is urgently needed to transform the existing structures and upgrade their functions and facilities. However, the pertinent guidelines have often been unclear for assessing the performance of existing structures, and a sounder and quantitative sustainable performance assessment approach has been lacking to guide decisions on the restoration, protection, or demolition of existing buildings. Based on a multi-expert consultation methodology, we proposed a revised flexible comprehensive assessment system and a comprehensive sustainability assessment approach. The system includes 4 categories, 7 quantitative and 47 qualitative indicators. Specifically, the assessment system involves a series of steps: 1) building a hierarchical model, 2) defining assessment indicators/items and constructing a judgment matrix, 3) determining the weight coefficients of the indicators, 4) collecting/calculating quantitative and qualitative data, 5) analyzing the data and results, and 6) drawing the assessment conclusions. A case study was presented to demonstrate the application of the approach. Compared to current practices, this comprehensive assessment system may serve as a scientifically sounder and quantitative approach to guide sustainable development of existing urban buildings., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors. Published by Elsevier Ltd.)

Nerve agents represent a serious threat to security worldwide. Chemical terrorism has become an alarming danger since the technological progresses have simplified the production of nerve agents. Therefore, there is an immediate demand for a fast and precise detection of these compounds on-site and real-time. In this perspective, Surface-Enhanced Raman Scattering (SERS) has emerged as a well-suited alternative for on-field detection. SERS performances of unfunctionalized SERS substrates were evaluated in realistic samples. Two nerve agents, Tabun and VX, were diluted in two matrix models: a contact lens solution, and a caffeine-based eye serum. The performance two research-grade instruments and two portable devices were compared. Despite the use of a small sampling volume of complex matrices without any sample pre-treatment, we achieved Tabun detection in both media, with a practical limit of detection (LOD) in the range of 7-9 ppm in contact lens liquid, and of 10.2 ppm in eye serum. VX detection turned out to be more challenging and was achieved only in contact lens solution, with a practical LOD in the range of 0.6-5 ppm. These results demonstrate the feasibility of on-field detection of nerve agents with SERS, that could be implemented when there is suspicion of chemical threat., Competing Interests: The authors declare the following financial interests/personal relationships which may be considered as potential competing interests:Giulia Zappalà reports equipment, drugs, or supplies was provided by Swedish Defence Research Agency. Giulia Zappalà reports equipment, drugs, or supplies was provided by Silmeco ApS. Anja Boisen has patent Surface enhanced Raman scattering substrates consumables for Raman spectroscopy licensed to Technical University of Denmark. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors. Published by Elsevier Ltd.)

Irrigation schemes across sub-Saharan Africa are constructed with the intention of increasing agricultural production to increase food security, reduce poverty and improve economic growth. However, most of these schemes are not performing as expected. This study therefore, diagnosed performance gaps in the pilot irrigation schemes of Mubuku and Doho in Uganda and analysed sustainable improvement options. Data was collected through systematic review of literature and scheme data, direct measurements at the schemes, field surveys, inspections, and key informant interviews. For each scheme, data for climate, irrigation, flow measurements, crop yields and farm gate prices were collected. Comparative indicators of agricultural output, water supply, financial and physical sustainability were used to assess scheme performance using standard approaches by International Water Management Institute (IWMI). The findings showed that the schemes were not performing optimally with crop yields being far below the attainable potential. The major contributing factors to the low performance were low water use efficiency and low agricultural output. Poor flow control, poor water distribution, and poor on-farm water application contributed to low water use efficiency. Low agricultural production was attributed to poor crop yields resulting from poor agronomic practices, poor irrigation scheduling and low produce prices. The financial self-sufficiency indicator pointed to farmers' inability to operate and maintain irrigation schemes effectively. Improving the irrigation schemes performance requires a multidisciplinary approach targeting the improvement water use efficiency and agricultural output., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)

This manuscript aims to study the reliability of different variables related to performance and acceleration during the golf putt in players with medium-to-high handicaps and to determine the number of attempts necessary to find reliable values for these variables. Eight males and two females [55.67 (13.64) years, 78.4 (11.4) kg, 1.75 (7.95) m] participated in two experimental sessions separated by one week. In these sessions, they performed three blocks of 10 putts trying to stop the golf ball at the center of a dartboard painted 2 m away. The performance was assessed depending on the area of the dartboard where the ball stopped, and the acceleration signals were acquired using the Xsens Dot. The results showed that to evaluate performance, 18 trials were necessary to reach reliable values using the 0-10 scoring system, and 28 trials were necessary for the 0-3 scoring system. Regarding the reliability of the accelerometer-related variables, 7 attempts were necessary to obtain good-to-excellent reliability values for most of the variables. It could be concluded that putting in medium-to-high handicap golf players can be reliably measured using the abovementioned protocol., (© 2024. The Author(s).)

Since isometric training is gaining popularity, some devices are being developed to test isometric force as an alternative to the more expensive force plates (FPs); thus, the aim of this study was to test the reliability and validity of "GSTRENGTH" for measuring PF in the isometric belt squat exercise. Five subjects performed 24 contractions at three different knee angles (90°, 105° and 120°) on two occasions (120 total cases). Peak force data were measured using FPs and a strain gauge (SG) and analyzed by Pearson's product-moment correlation coefficient, ICCs, Cronbach's alpha, a paired sample t -test and Bland-Altman plots. Perfect or almost perfect relationships (r: 0.999-1) were found with an almost perfect or perfect level of agreement (ICCs: 0.992-1; α: 0.998-1). The t -test showed significant differences for the raw data but not for the predictions by the equations obtained with the SG values. The Bland-Altman plots, when significant, showed trivial to moderate values for systematic bias in general. In conclusion, "GSTRENGTH" was shown to be a valid alternative to FPs for measuring PF.

We explore the dynamics of centralised and decentralised wastewater infrastructure across various scenarios and introduce novel insights into their performance regarding structural vulnerability, hydraulic capacity, and costs. This study determines circumstances under which infrastructure hybridisation outperforms traditional centralised infrastructure paradigms. We combined system analysis to map out the modelling problem with the model-based exploration of the transition space using the novel TURN-Sewers model. System diagramming was used to identify the parameters or combinations of parameters that significantly influence the performance indicators being assessed. This allowed the creation of relevant simulation scenarios to identify circumstances where a decentralised sewer system could outperform a centralised one. TURN-Sewers was applied to model the infrastructure maintenance and generation of new infrastructure over 20 years for a municipality on the Swiss Plateau, considering a population growth rate of 0.03 a -1 . Results show that decentralisation in expansion areas with higher densification can outperform the hydraulic performance and structural vulnerability of expanding centralised sanitary wastewater infrastructure. Decentralised systems can also offer economic advantages when capital expenditure costs for small-scale wastewater treatment plants are significantly reduced compared to current costs, particularly at higher discount rates, e.g. reaping effects of economies of scale. The findings of this study emphasise the potential of transition pathways towards decentralisation in urban water infrastructures and the value of models that allow the exploration of this transition space., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier Ltd.)

In today's health-monitoring applications, there is a growing demand for wireless and wearable acquisition platforms capable of simultaneously gathering multiple bio-signals from multiple body areas. These systems require well-structured software architectures, both to keep different wireless sensing nodes synchronized each other and to flush collected data towards an external gateway. This paper presents a quantitative analysis aimed at validating both the wireless synchronization task (implemented with a custom protocol) and the data transmission task (implemented with the BLE protocol) in a prototype wearable monitoring platform. We evaluated seven frequencies for exchanging synchronization packets (10 Hz, 20 Hz, 30 Hz, 40 Hz, 50 Hz, 60 Hz, 70 Hz) as well as two different BLE configurations (with and without the implementation of a dynamic adaptation of the BLE Connection Interval parameter). Additionally, we tested BLE data transmission performance in five different use case scenarios. As a result, we achieved the optimal performance in the synchronization task (1.18 ticks as median synchronization delay with a Min-Max range of 1.60 ticks and an Interquartile range (IQR) of 0.42 ticks) when exploiting a synchronization frequency of 40 Hz and the dynamic adaptation of the Connection Interval. Moreover, BLE data transmission proved to be significantly more efficient with shorter distances between the communicating nodes, growing worse by 30.5% beyond 8 m. In summary, this study suggests the best-performing network configurations to enhance the synchronization task of the prototype platform under analysis, as well as quantitative details on the best placement of data collectors.

India's healthcare system is, for a large part, organized around a vast network of Primary Healthcare Centres (PHCs) that form the pillar on which the public healthcare sector functions. The World Health Organization (WHO) has emphasized the important role that PHCs play in strengthening community health and the provision of healthcare. Although a few studies have assessed specific elements of services offered by PHCs, only a few have studied the patients' perspectives on the functioning and performance of PHCs in the Indian context. A qualitative research methodology was employed to explore the opinions of 188 patients attending one of three PHCs in Bengaluru (India), using in-depth interviews and thematic analysis. Results showed that patients assessed PHC based on the nine themes that broadly can be classified into components of the center, and that of the personnel. The patients valued the behavioural aspects of the personnel during service delivery and should be configured into the PHC performance., (© The Author(s) 2024.)

Objective: In this study, we develop a tool that can be used by tennis coaches to evaluate the groundstroke (forehand and backhand) technique of preadolescent tennis players., Methods: The participants of the study were 60 children (30 males and 30 females) aged 10-12 years, with at least two years of training in tennis. The Groundstroke Correction Checklist (GCC) was translated into Turkish by using a blind procedure. The Turkish translation was then evaluated by 15 coaches of the Turkish Tennis Federation who had at least a level-3 coaching license and more than five years of coaching experience. The technical components related to technique in the checklist were labeled as unimportant, important, and very important. Following this, the GCC was converted into a Groundstroke Technique Assessment Test Tool (GTATT) by a selection committee consisting of three experts, and its reliability and validity were assessed by using it in the field. Spearman's correlation was used to analyze the correlation (test- r test) between the technical evaluation scores assigned to the players by the tennis coaches based on the GTATT in the first and second weeks. Intra- and inter-rater reliability was used to analyze the overall scores of technical evaluations in the first and second weeks to assess the reliability of the scale used. We determined each player's number of years of playing experience (TPY), technical evaluation (TE), international tennis-level test score (ITN), I-cord classification order (ICCO), and the number of games won (GW) in a tournament organized among themselves and evaluated the correlations among these parameters by using Spearman's correlation analysis., Conclusion: A statistically high and significant correlation was observed between the technical evaluations of the players' forehand and backhand groundstrokes by the tennis coaches by using the GTATT in the first and second weeks ( r  > .90, p  < .01). The analysis of the intra- and inter-rater reliability of the GTATT yielded excellent agreement between the technical observations of the three coaches of the players' forehand and backhand strokes in the first and second weeks., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2024 Diler, Şahan and Erman.)

For reliable clinical decisions in transfusion medicine, assessing the performance of qualitative tests performed in medical laboratories is critical. When false results are reported, these can lead to an adverse reaction to blood components. Good performance assessment practices are essential for this kind of scenario, and they still remain as one of the many unmet high-priority challenges in this area. This paper aims to provide an overview of the current trends in this field. A review of the IFCC-IUPC. qualitative vocabulary was carried out, and a particular focus was given to the evaluation protocols CLSI EP12-A3 and Eurachem AQA, such as the European Union Regulation for class D in vitro diagnostic medical devices. There is a consistency between the current protocols and recognized performance assessment principles, which are mandatory in transfusion service labs. We believe that a revised imprecision interval approach and models based on emerging qualitative test types may prove beneficial in the long run. It is also important to emphasize the uncertainty of proportions to mitigate the risk of misclassification., Competing Interests: Declaration of Competing Interest Dr. Paulo Pereira, Ph.D., is a member of the CLSI's Consensus Council, a member of the Document Development Committee (DDC) for EP12-A3, EP24, EP21/EP46, a member of the Qualitative Analysis Working Group for AQA 2021, and an expert for Expert Panels on In Vitro Diagnostic Medical Devices of the European Medicines Agency (EMA). Dr. Jerard Seghatchian has no conflict of interest to declare., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background: Performance evaluation in the allied healthcare education sector is complex, making it essential for policymakers and managers to approach it comprehensively and thoughtfully to understand their performance. Hence, the development and monitoring of Key Performance Indicators (KPIs) in this domain must be considered one of the key priorities for the policymakers in AHIs., Aim: This study aims to develop a framework for the AHIs to extract and profile the indicators, measure, and report the results appropriately., Methods: The authors adopted a general review of the literature approach to study the primary goals of the institutional KPI framework, emphasizing the need for benchmarking while implementing KPIs and how to track performance using a KPI dashboard., Results: The study provides the scope, relevant KPI categories, and a list of KPIs for evaluating the effectiveness of allied healthcare programs. The study findings also emphasized the need for benchmarking the KPIs and establishing a KPI dashboard while measuring and monitoring performance., Conclusion: KPIs are considered an invaluable tool that contributes immensely to the performance monitoring process of AHIs, irrespective of the specialties. This helps to identify and guide AHIs for developing KPIs and the associated minimum data set to measure organizational performance and monitor the quality of teaching and learning. In addition, the KPI framework reported in this study is a tool to assist performance monitoring that can subsequently contribute to the overall quality of AHIs., Competing Interests: The authors report no conflicts of interest in this work., (© 2024 Sreedharan et al.)

Low-cost and field-viable methods that can simultaneously assess external kinetics and kinematics are necessary to enhance field-based biomechanical monitoring. The aim of this study was to determine the accuracy and usability of ground reaction force (GRF) profiles estimated from segmental kinematics, measured with OpenCap (a low-cost markerless motion-capture system), during common jumping movements. Full-body segmental kinematics were recorded for fifteen recreational athletes performing countermovement, squat, bilateral drop, and unilateral drop jumps, and used to estimate vertical GRFs with a mechanics-based method. Eleven distinct performance-, fatigue-, or injury-related GRF variables were then validated against a gold-standard force platform. Across jumping movements, a total of six and three GRF variables were estimated with a bias or limits of agreement <5 % respectively. Bias and limits of agreement were between 5 and 15 % for seventeen and nineteen variables respectively. Moreover, we show that estimated force variables with a bias <15 % can adequately assess the within-athlete changes in GRF variables between jumping conditions (arm swing or leg dominance). These findings indicate that using a low-cost and field-viable markerless motion capture system (OpenCap) to estimate and assess GRF profiles during common jumping movements is approaching acceptable limits of accuracy. The presented method can be used to monitor force variables of interest and examine underlying segmental kinematics. This application is a jump towards researchers and sports practitioners performing biomechanical monitoring of jumping efficiently, regularly, and extensively in field settings., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Objective: Patient-specific virtual reality (VR) simulation of cochlear implant (CI) surgery potentially enables preoperative rehearsal and planning. We aim to gather supporting validity evidence for patient-specific simulation through the analysis of virtual performance and comparison with postoperative imaging., Methods: Prospective, multi-institutional study. Pre- and postoperative cone-beam CT scans of CI surgical patients were obtained and processed for patient-specific VR simulation. The virtual performances of five trainees and four attendings were recorded and (1) compared with volumes removed during actual surgery as determined in postoperative imaging, and (2) assessed using the Copenhagen Cochlear Implant Surgery Assessment Tool (CISAT) by two blinded raters. The volumes compared were cortical mastoidectomy, facial recess, and round window (RW) cochleostomy as well as violation of the facial nerve and chorda., Results: Trainees drilled more volume in the cortical mastoidectomy and facial recess, whereas attendings drilled more volume for the RW cochleostomy and made more violations. Except for the cochleostomy, attendings removed volumes closer to that determined in postoperative imaging. Trainees achieved a higher CISAT performance score compared with attendings (22.0 vs. 18.4 points) most likely due to lack of certain visual cues., Conclusion: We found that there were differences in performance of trainees and attendings in patient-specific VR simulation of CI surgery as assessed by raters and in comparison with actual drilled volumes. The presented approach of volume comparison is novel and might be used for further validation of patient-specific VR simulation before clinical implementation for preoperative rehearsal in temporal bone surgery., Level of Evidence: n/a Laryngoscope, 134:1403-1409, 2024., (© 2023 The Authors. The Laryngoscope published by Wiley Periodicals LLC on behalf of The American Laryngological, Rhinological and Otological Society, Inc.)

Introduction: Slow patient accrual in cancer clinical trials is always a concern. In 2021, the University of Kansas Comprehensive Cancer Center (KUCC), an NCI-designated comprehensive cancer center, implemented the Curated Cancer Clinical Outcomes Database (C3OD) to perform trial feasibility analyses using real-time electronic medical record data. In this study, we proposed a Bayesian hierarchical model to evaluate annual cancer clinical trial accrual performance., Methods: The Bayesian hierarchical model uses Poisson models to describe the accrual performance of individual cancer clinical trials and a hierarchical component to describe the variation in performance across studies. Additionally, this model evaluates the impacts of the C3OD and the COVID-19 pandemic using posterior probabilities across evaluation years. The performance metric is the ratio of the observed accrual rate to the target accrual rate., Results: Posterior medians of the annual accrual performance at the KUCC from 2018 to 2023 are 0.233, 0.246, 0.197, 0.150, 0.254, and 0.340. The COVID-19 pandemic partly explains the drop in performance in 2020 and 2021. The posterior probability that annual accrual performance is better with C3OD in 2023 than pre-pandemic (2019) is 0.935., Conclusions: This study comprehensively evaluates the annual performance of clinical trial accrual at the KUCC, revealing a negative impact of COVID-19 and an ongoing positive impact of C3OD implementation. Two sensitivity analyses further validate the robustness of our model. Evaluating annual accrual performance across clinical trials is essential for a cancer center. The performance evaluation tools described in this paper are highly recommended for monitoring clinical trial accrual., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)

Objective: The purpose of this study was to explore factors that may influence a practice educator's assessment of an entry-to-practice pharmacy student during inpatient direct patient care practicums., Methods: This was a qualitative analysis of semi-structured interviews of existing practice educators from a variety of hospital practice environments. Participants were asked to assess a fictional case of a student's work, which provided a framework for a broader discussion of assessment practices. Interviews were transcribed and subjectively analyzed for themes and factors that each study participant considered for the case and in their past precepting experiences., Results: A total of 13 participants consented and were interviewed. Identified themes included the quality of student work, key aspects of the student's performance, professionalism, and the complexity of the patient assigned to the student. There was significant heterogeneity in both the assessment of the fictional student and the factors that influenced each participant's assessment. It was clear that not all guidance provided by the academic institution is read or followed. Participants described challenges in applying the assessment rubric, including lack of time, training, resources, knowledge of the degree requirements/structure, and psychological factors inherent in high-stakes courses., Conclusion: Complex, varied, and often contradictory factors are used by experiential practice educators in their assessment of pharmacy students on practicum. These findings lead to inconsistency and heterogeneity when assessing a mock case and actual students. Educators should consider mandatory training to ensure those who assess students have an understanding of practicum course expectations and assessments., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 American Association of Colleges of Pharmacy. All rights reserved.)

Background: Accurate clinical structural variant (SV) calling is essential for cancer target identification and diagnosis but has been historically challenging due to the lack of ground truth for clinical specimens. Meanwhile, reduced clinical-testing cost is the key to the widespread clinical utility., Methods: We analyzed massive data from tumor samples of 476 patients and developed a computational framework for accurate and cost-effective detection of clinically-relevant SVs. In addition, standard materials and classical experiments including immunohistochemistry and/or fluorescence in situ hybridization were used to validate the developed computational framework., Results: We systematically evaluated the common algorithms for SV detection and established an expert-reviewed SV call set of 1,303 tumor-specific SVs with high-evidence levels. Moreover, we developed a random-forest-based decision model to improve the true positive of SVs. To independently validate the tailored 'two-step' strategy, we utilized standard materials and classical experiments. The accuracy of the model was over 90% (92-99.78%) for all types of data., Conclusion: Our study provides a valuable resource and an actionable guide to improve cancer-specific SV detection accuracy and clinical applicability., (© 2024. The Author(s).)

Background and Aim: Performance assessment of the Stroke Pathway is a key element in healthcare quality. The aim of this study has been to carry out a retrospective assessment of the Stroke Pathway in a first level Stroke Unit in Italy, analyzing the temporal trend of the Stroke Pathway performance and the impact of the COVID-19 pandemic., Methods: A retrospective observational study was carried out analyzing data from 1/01/2010 to 31/12/2020. The following parameters were considered: volume and characteristics of patients with ischemic stroke undergoing intravenous thrombolysis, baseline modified Rankin Scale (mRS) and National Institutes of Health Stroke Scale (NIHSS) scores, Onset-to-Door (OTD), Door-To-Imaging (DTI) and Door-To-Needle (DTN) Times, mRS score 3 months after the ischemic event onset (3 m-mRS) and NIHSS score 24 h after the ischemic event onset (24 h-NIHSS). The study also compared the pre-COVID-19 pandemic period (March-December 2019) with the one immediately following it (March-December 2020)., Results: 418 patients were included. Over time, treatment was extended to older patients (mean age from 66.3 to 75.51 years; p = 0.006) and with a higher level of baseline disability (baseline mRS score from 0.22 to 1.22; p = 0.000). A statistically significant reduction over the years was found for DTN, going from 90 min to 61 min (p = 0.000) with also an increase in the number of thrombolysis performed within the "golden hour" - more than 50% in 2019 and more of 60% in 2020. Comparing pre- and during COVID-19 pandemic periods, the number of patients remained almost unchanged, but with a significantly higher baseline disability (mRS = 1.18 vs. 0.72, p = 0.048). The pre-hospital process indicator OTD increased from 88.13 to 118.48 min, although without a statistically significant difference (p = 0.197). Despite the difficulties for hospitals due to pandemic, the hospital process indicators DTI and DTN remained substantially unchanged, as well as the clinical outcome indicators 3 m-mRS, NHISS and 24 h-NHISS., Conclusions: The results of the retrospective assessment of the Stroke Pathway highlighted its positive impact both on hospital processes and patients' outcomes, even during the COVID-19 pandemic, so that the current performance is aligning itself with international goals. Moreover, the analysis showed the need of improvement actions for both hospital and pre-hospital phases. The Stroke Pathway should be improved with the thrombolysis starting in the diagnostic imaging department in order to further reduce the DTN score. Moreover, health education initiatives involving all the stakeholders should be promoted, also by using social media, to increase population awareness on timely recognition of stroke signs and symptoms and emergence medical services usage., (© 2023. The Author(s).)

Data on surgical robots are not openly accessible, limiting further study of the operation trajectory of surgeons' hands. Therefore, a trajectory monitoring system should be developed to examine objective indicators reflecting the characteristic parameters of operations. 20 robotic experts and 20 first-year residents without robotic experience were included in this study. A dry-lab suture task was used to acquire relevant hand performance data. Novices completed training on the simulator and then performed the task, while the expert team completed the task after warm-up. Stitching errors were measured using a visual recognition method. Videos of operations were obtained using the camera array mounted on the robot, and the hand trajectory of the surgeons was reconstructed. The stitching accuracy, robotic control parameters, balance and dexterity parameters, and operation efficiency parameters were compared. Experts had smaller center distance (p < 0.001) and larger proximal distance between the hands (p < 0.001) compared with novices. The path and volume ratios between the left and right hands of novices were larger than those of experts (both p < 0.001) and the total volume of the operation range of experts was smaller (p < 0.001). The surgeon trajectory optical monitoring system is an effective and non-subjective method to distinguish skill differences. This demonstrates the potential of pan-platform use to evaluate task completion and help surgeons improve their robotic learning curve., (© 2023. The Author(s), under exclusive licence to Springer-Verlag London Ltd., part of Springer Nature.)