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A nonparametric method proposed by DeLong et al in 1988 for comparing areas under correlated receiver operating characteristic curves is used widely in practice. However, the DeLong method as implemented in popular software quietly deletes individuals with any missing values, yielding potentially invalid and/or inefficient results. We simplify the DeLong algorithm using ranks and extend it to accommodate missing data by using a mixed model approach for multivariate data. Simulation results demonstrate the validity and efficiency of our procedure for data missing at random. We illustrate our proposed procedure in SAS, Stata, and R using the original DeLong data. [ABSTRACT FROM AUTHOR]

Study Design. Secondary analysis of a randomized controlled trial. Objective. We investigated the ability to distinguish patients with lumbar spinal stenosis (LSS) who improved from those who did not after receiving nonsurgical treatment. We used the disorder-specific Zurich Claudication Questionnaire (ZCQ) satisfaction subscale as an external anchor and estimated the minimal clinically important differences (MCiDs) for the ZCQ symptom severity and physical function subscales. Summary of Background Data. The ZCQ satisfaction subscale effectively distinguishes surgical patients who improved from those who did not for LSS. However, its responsiveness in non-surgical treatment has not been evaluated yet. Methods. Eighty-four patients with LSS who received supervised physical therapy or a home exercise program were included. Patients were classified as responders or nonresponders according to the cutoff of 2.5 for the ZCQ satisfaction subscales at six weeks and one year. The external responsiveness of the ZCQ satisfaction subscale was assessed using correlational and receiver-operating characteristic (ROC) curve analyses. MCIDs for the ZCQ symptom severity and physical function subscales were estimated using anchor and distribution approaches. Results. Pearson correlation coefficients between the changes in outcomes and the ZCQ satisfaction subscale at six weeks and one year were 0.37 to 0.58 (symptom severity) and 0.40 to 0.45 (physical function subscales) (> 0.30 is considered a good anchor). The area under the ROC curve values were 0.66 to 0.72 and 0.63 to 0.71 for the symptom severity and physical function subscales, respectively (> 0.7 is considered acceptable). The MCIDs at six weeks and one year estimated from anchor-based approaches were -0.64 to -0.13 (symptom severity) and -0.39 to 0.10 (physical function), and those from the distribution-based approaches were -0.31 to -0.30 and -0.29 to -0.27, respectively. Conclusions. The findings of this study suggest that the ZCQ satisfaction subscale has less ability to distinguish patients with LSS who improved in the ZCQ symptom severity and physical function subscales from those who did not after nonsurgical treatment, compared to those after surgical treatment. [ABSTRACT FROM AUTHOR]

Background: Health system responsiveness to public priorities and needs is a broad, multi-faceted and complex health system goal thought to be important in promoting inclusivity and reducing system inequity in participation. Power dynamics underlie the complexity of responsiveness but are rarely considered. This paper presents an analysis of various manifestations of power within the responsiveness practices of Health Facility Committees (HFCs) and Sub-county Health Management Teams (SCHMTs) operating at the subnational level in Kenya. Kenyan policy documents identify responsiveness as an important policy goal. Methods: Our analysis draws on qualitative data (35 interviews with health managers and local politicians, four focus group discussions with HFC members, observations of SCHMT meetings, and document review) from a study conducted at the Kenyan Coast. We applied a combination of two power frameworks to interpret our findings: Gaventa's power cube and Long's actor interface analysis. Results: We observed a weakly responsive health system in which system-wide and equity in responsiveness were frequently undermined by varied forms and practices of power. The public were commonly dominated in their interactions with other health system actors: invisible and hidden power interacted to limit their sharing of feedback; while the visible power of organisational hierarchy constrained HFCs' and SCHMTs' capacity both to support public feedback mechanisms and to respond to concerns raised. These power practices were underpinned by positional power relationships, personal characteristics, and world views. Nonetheless, HFCs, SCHMTs and the public creatively exercised some power to influence responsiveness, for example through collaborations with political actors. However, most resulting responses were unsustainable, and sometimes undermined equity as politicians sought unfair advantage for their constituents. Conclusion: Our findings illuminate the structures and mechanisms that contribute to weak health system responsiveness even in contexts where it is prioritised in policy documents. Supporting inclusion and participation of the public in feedback mechanisms can strengthen receipt of public feedback; however, measures to enhance public agency to participate are also needed. In addition, an organisational environment and culture that empowers health managers to respond to public inputs is required. [ABSTRACT FROM AUTHOR]

Purpose: Pediatric Cardiac Quality of Life Inventory (PCQLI) is a disease-specific pediatric cardiac health-related quality of life (HRQOL) instrument that is reliable, valid, and generalizable. We aim to demonstrate PCQLI responsiveness in children undergoing arrhythmia ablation, heart transplantation, and valve surgery before and after cardiac intervention. Methods: Pediatric cardiac patients 8–18 years of age from 11 centers undergoing arrhythmia ablation, heart transplantation, or valve surgery were enrolled. Patient and parent-proxy PCQLI Total, Disease Impact and Psychosocial Impact subscale scores were assessed pre- and 3–12 months follow-up. Patient clinical status was assessed by a clinician post-procedure and dichotomized into markedly improved/improved and no change/worse/much worse. Paired t-tests examined change over time. Results: We included 195 patient/parent-proxies: 12.6 ± 3.0 years of age; median follow-up time 6.7 (IQR = 5.3–8.2) months; procedural groups − 79 (41%) ablation, 28 (14%) heart transplantation, 88 (45%) valve surgery; clinical status − 164 (84%) markedly improved/improved, 31 (16%) no change/worse/much worse. PCQLI patient and parent-proxies Total scores increased (p ≤ 0.013) in each intervention group. All PCQLI scores were higher (p < 0.001) in the markedly improved/improved group and there were no clinically significant differences in the PCQLI scores in the no difference/worse/much worse group. Conclusion: The PCQLI is responsive in the pediatric cardiac population. Patients with improved clinical status and their parent-proxies reported increased HRQOL after the procedure. Patients with no improvement in clinical status and their parent-proxies reported no change in HRQOL. PCQLI may be used as a patient-reported outcome measure for longitudinal follow-up and interventional trials to assess HRQOL impact from patient and parent-proxy perspectives. [ABSTRACT FROM AUTHOR]

Premise of research. Species-level variation in interactions with root-associated microbial communities has its evolutionary origins within species, where dissection of the mechanistic basis of plant divergence is also tractable. We use montane annual and coastal perennial populations (ecotypes) of Mimulus guttatus (yellow monkeyflower) to ask whether and how plant-microbe-soil interactions have diverged between populations with distinct life histories. Methodology. We characterized fungal communities in representative montane annual (Iron Mountain) and dune perennial (Florence dunes) habitats in Oregon, where previous reciprocal transplants revealed local adaptation. We then investigated how plant ecotype, microbial source, and soil origin affected plant performance and root-associated fungal communities in a full-factorial greenhouse experiment using plants, soils, and nested inocula (sterilized, filtered to remove arbuscular mycorrhizal fungi, and whole) from the two sites. Pivotal results. In the field, coastal perennial and montane annual monkeyflowers harbored distinct fungal communities, and perennial roots were enriched for mutualistic taxa relative to local soils. In the greenhouse common garden, microbial effects were largely negative (particularly in the annual ecotype), and there was no evidence of plant local adaptation to belowground conditions. However, the coastal perennial ecotype was more colonized by arbuscular mycorrhizal fungi than the montane annual ecotype, and it preferentially recruited local arbuscular mycorrhizal fungi taxa even when inoculated from the montane source. Conclusions. Our results suggest that population divergence in life history and related traits shapes plant responsiveness to soil microbes and the specificity of their associations with root endophytic fungi, such as arbuscular mycorrhizal fungi. Complex belowground effects on plant performance do not fit a simple pattern of local adaptation but may be by-products of other drivers of plant divergence. This work advances the study of heritable variation in plant-soil-microbe interactions in a model species for understanding the genomics of plant adaptation. [ABSTRACT FROM AUTHOR]

Traditional polyurethane coating is prepared by combining isocyanate and polyol, but isocyanate is toxic, which is not conducive to the sustainable development of ecological environment. In this paper, dibutyltin dilaurate (DBTDL) was used as catalyst to synthesize dicyclic carbonate from four different acids and glycerol carbonates. Then, it was gradually polymerized with isophorone diamine (IPDA) and 4,4'-diaminodiphenyl disulfide ether to synthesize self-healing non-isocyanate polyurethane (NIPU). The effects of different acid types on coating forming and self-healing properties of NIPU were studied. Then, polypyrrole modified carbon nanotubes were prepared and physically blended with NIPU to obtain a responsive NIPU gel coating. The results show that NIPU has excellent scratch repair performance at 70°C by optical microscopy; Through the dissolution and re-formation of NIPU by N, N-dimethylformamide, it is proved that the material has repeatable processability and is conducive to the sustainable development of ecological environment; The high precision multimeter proved that NIPU has the responsiveness under different chemical environment of acid, alkali, oxidation and reduction. The coating has broad application prospects in biomimetic technology, biology, electronics and other fields. [ABSTRACT FROM AUTHOR]

This study examines the micro-level foundations of how policy responsiveness may come about. Our study builds on the assumption that elected officials' information source use shapes their policy actions. We analyze the variation in information sources elected officials rely on for agenda-setting and policy formulation, distinguishing between public opinion sources, advocacy sources, and expert sources. Additionally, we examine how elected officials' public opinion sources vary across individuals, parties, and political systems. Based on a 2015 survey with 345 Members of Parliament in Belgium and Canada, the results indicate that the actions of elected representatives are more affected by public opinion sources like citizens and the mass media when they initially prioritize issues for policy action, while interest groups are prominent in both stages, and parties and expert sources are more used in the policy formulation phase. Furthermore, politicians in majoritarian systems, those belonging to the opposition and members of populist parties, tend to rely more on public opinion sources than their peers in proportional systems, those in the majority and non-populist parties. [ABSTRACT FROM AUTHOR]

Previous research has highlighted that decentralization is key to understanding the marketization of the Swedish welfare state, while local political factors are important to explaining the subnational differences in actual degrees of welfare service privatization. Other research has highlighted the impact of pragmatism rather than ideology in local government's decisions to outsource welfare services, including policy diffusion through geographical proximity to highly privatized municipalities. However, little research has been done on the role or type of political representation and whether this matters to the diffusion of welfare service privatization. Thus, there is little knowledge about whether local governments are primarily responsive to public preferences, the ideological position of the local government, or influences from neighboring municipalities. Drawing on the literature on political representation and policy diffusion, I test three hypotheses: that the local governments are primarily responsive to public preferences (sanction representation), that local governments are primarily responsive to their own ideological position (gyroscopic representation), or that local governments are primarily influenced by outsourcing in neighboring municipalities (contagion). Using a time‐lagged correlational design with survey data covering both local politicians and ordinary municipal residents, as well as public accounts of municipal outsourcing, I find that public preferences play a negligible role to the privatization process. A minor part of the between‐municipal variation in welfare service privatization can be attributed to the preferences of local politicians (gyroscopic representation), while a more substantial part is due to pressures from outsourcing among municipal neighbors (contagion). [ABSTRACT FROM AUTHOR]

Purpose: To evaluate and compare responsiveness characteristics for the Foot Function Index revised short form (FFI-RS), RAND-12 Health Status Inventory (RAND-12), and Numeric Rating Scale (NRS), in patients with plantar fasciopathy receiving non-surgical treatment. Materials and methods: This study was conducted on a sub-group of patients from an ongoing randomised controlled trial. One-hundred fifteen patients were included. The patient-reported outcome measures (PROMs) were applied at baseline and after 6 months. Responsiveness was calculated using standardised response mean and area under the receiver operating characteristic (ROC) curve. ROC curves were used to compute the minimal important change (MIC) for the outcome measures. Results: The region specific FFI-RS had best responsiveness and the NRS at rest had lowest responsiveness. Conclusion: FFI-RS were marginally more responsive than the other PROMs. Responsiveness and MIC estimates should be regarded as indicative rather than fixed estimates. IMPLICATIONS FOR REHABILITATION: The region-specific Foot Function Index Revised Short Form could, based on responsiveness perspectives, be recommended as an outcome measurement for patients with plantar fasciopathy. Responsiveness and minimal important change estimates are indicative and should be interpreted with caution. [ABSTRACT FROM AUTHOR]

If European Union (EU) member states realise differentiations in EU Treaties, what effect do we see on public and political support for future integration? We argue on the basis of a two-tier integration theory and postfunctionalism that differentiations of member states do lead to a preference for slower future integration by its citizens and parties. Once citizens and parties are used to opting out, they demand more of the same in the future. We test our arguments with time-series cross-sectional data for 1994–2018 on all voluntary primary law opt-outs in the EU. Our panel matching estimates demonstrate that opt-outs decrease integration support. After a differentiation, parties become more Eurosceptic on average and publics express a lower preference for future integration. This suggests that differentiated integration is not a cure against Euroscepticism that leads to a unified EU in the future but rather reinforces two-tier integration. [ABSTRACT FROM AUTHOR]

The purpose of this study was to assess the content, construct, and discriminative validity and responsiveness of the Patient-Specific Functional Scale (PSFS) in patients with thumb carpometacarpal arthritis. Data were collected at Xpert Clinics, comprising 34 outpatient hand surgery and hand therapy clinics in the Netherlands. We included 267 patients for content validity and 323 patients for construct validity and responsiveness. The PSFS items were classified into the International Classification of Function Core Set for Hand Conditions to assess content validity. We used hypothesis testing to investigate the construct validity and responsiveness. The Michigan Hand Outcomes Questionnaire was used as a comparator instrument. The standardized response mean was calculated to evaluate the magnitude of change. For discriminative validity, we used independent t tests to discriminate between satisfied and dissatisfied patients. We classified 98% of the PSFS items in the International Classification of Function "activities" and "participation" domains, indicating good content validity. Two of six hypotheses for construct validity and three of six hypotheses for responsiveness were confirmed. The standardized response mean for the PSFS was 0.57 (0.46–0.68) and 0.47 (0.35–0.58) for the Michigan Hand Outcomes Questionnaire total score. The mean PSFS score showed good discriminative validity because it could distinguish between satisfied and dissatisfied patients at the 3-month follow-up. The PSFS scores showed good content and discriminative validity in patients with first carpometacarpal arthritis. Hypothesis testing for responsiveness and construct validity indicates that the PSFS measures a unique construct different from the Michigan Hand Outcomes Questionnaire. The PSFS may be a useful scale for measuring the patient-specific status of individuals with thumb carpometacarpal arthritis. [ABSTRACT FROM AUTHOR]

A close connection between public opinion and policy is considered a vital element of democracy. However, legislators cannot be responsive to all voters at all times with regard to the policies the latter favour. We argue that legislators use their speaking time in parliament to offer compensatory speech to their constituents who might oppose how they voted on a policy, in order to re‐establish themselves as responsive to the public's wishes. Leveraging the case of Brexit, we show that legislators pay more attention to constituents who might be dissatisfied with how they voted. Furthermore, their use of rhetorical responsiveness is contingent on the magnitude of the representational deficit they face vis‐à‐vis their constituency. Our findings attest to the central role of parliamentary speech in maintaining responsiveness. They also demonstrate that communicative responsiveness can substitute for policy responsiveness. [ABSTRACT FROM AUTHOR]

Chronic neck pain has a significant impact on the patient's quality of life. Specific outcome measures like Copenhagen Neck Functional Disability Index (CNFDI), Neck Bournemouth questionnaire (NBQ), and Spine Functional Index (SFI) are reliable and valid measures that have been used for comprehensively evaluating neck-related disabilities. However, responsiveness has not yet been investigated. The aim of this study was to examine the responsiveness and clinically meaningful changes of the CNFDI, NBQ, and SFI for Persian patients with chronic neck pain. Prospective recruitment of 145 patients with chronic neck pain was conducted. Participants completed the Persian versions of CNFDI, NBQ, and SFI at baseline and after 4 weeks of physical therapy. Also, the Global Rating of Change Scale (GRCS) was completed in the post-intervention assessment. The Receiver Operating Characteristics (ROC) curve and correlational analysis were used for evaluating the responsiveness. In addition, the Minimal Clinically Important Change (MCIC) was determined. All selected outcome measures revealed an area under the curve of 0.96. The MCICs of 10, 7, and 10 points were found for the CNFDI, NBQ, and SFI, respectively. The results showed an excellent Gamma correlation coefficient of the CNFDI (γ = 0.98), NBQ (γ = 0.99), and SFI (γ = 0.99) with the GRCS. The Persian versions of the CNFDI, NBQ, and SFI have acceptable responsiveness properties for evaluating the changes in health status in patients with chronic neck pain following physical therapy interventions. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate responsiveness and minimal important change (MIC) of Oswestry Disability Index (ODI), pain during activity on a numeric rating scale (NRSa) and health related quality of life (EQ-5D) based on data from the Norwegian neck and back registry (NNRR). Methods: A total of 1617 patients who responded to NNRR follow-up after both 6 and 12 months were included in this study. Responsiveness was calculated using standardized response mean and area under the receiver operating characteristic (ROC) curve. We calculated MIC with both an anchor-based and distribution-based method. Results: The condition specific ODI had best responsiveness, the more generic NRSa and EQ-5D had lower responsiveness. We found that the MIC for ODI varied from 3.0 to 9.5, from 0.4 to 2.5 for NRSa while the EQ5D varied from 0.05 to 0.12 depending on the method for calculation. Conclusion: In a register based back pain population, the condition specific ODI was more responsive to change than the more generic tools NRSa and EQ5D. The variations in responsiveness and MIC estimates also indicate that they should be regarded as indicative, rather than fixed estimates. [ABSTRACT FROM AUTHOR]

Background: The existing research on dialogue‐based learning and teaching predominantly highlights its capacity to yield productive educational outcomes, yet it often overlooks the pivotal factor of participation equity, which is fundamental to ensuring the efficacy of dialogic teaching and learning. Objectives: In this study, participation equity refers to a condition in which participation itself and opportunities to participate are fairly distributed among participants and all participants are equally listened to and respected. We designed a technology‐enhanced participatory visual learning analytical approach to promote equitable participation in dialogic collaborative problem solving from four dimensions: participation (i.e., ensuring equal contributions from all participants), opportunity (i.e., promoting equal engagement with others), responsiveness (i.e., encouraging equal attentiveness and responsiveness to others' input), and respect (i.e., cultivating a respectful communication style). Methods: The intervention class of fourth‐grade students (n = 59) interacted with a participatory visual learning analytical tool to reflect on their participation equity and learn productive peer talk moves to address equity issues concerning the four dimensions, while a comparison class (n = 59) only received simple feedback on participation and respect. Results: The results indicated that equal participation rates among group members were insufficient to secure participation equity. The intervention was effective in helping students realize and address equity‐related issues. Intervention students were more equitable regarding responsiveness and participation opportunity than the comparison students. Conclusions: The proposed multidimensional participation equity framework has the potential to deepen the understanding of equity and promote equitable learning interactions. Lay Description: What is currently known: Peer discussion has the potential to bring productive educational gains.Participation equity is essential in productive collaborative discussion.Participation equity currently mainly concerns the equality of participation. What we add: We use technology to help children analyse, visualize and reflect on participation equity.We use technology to teach students how to talk in an equitable approach.We define equity in four dimensions: participation, opportunity, responsiveness and respect. The implications for practitioners: Students should be guided to participate equally and respectfully in a group.Students should also be guided to equally listen to other group members' voices.Students should also be guided to equally address other group members. [ABSTRACT FROM AUTHOR]

In internally fertilizing species, an individual's mating history (whether they have previously participated in a successful mating interaction) can influence a range of mating behaviours. For example, mating often leads to a reduction in how responsive individuals are to future mating opportunities, especially for females. This fits the prediction of sexual selection theory that unmated individuals should be highly responsive to sexual stimuli to ensure a mating. This has led many researchers to prefer to use only unmated females in mating experiments, to maximize the likelihood that females will respond to sexual stimuli. However, other studies show contrasting results, and this effect has not yet been quantified formally. There is also some evidence that males of some species become less responsive after mating. This means it is unclear how general this behavioural change is, whether it occurs in both sexes, or whether it differs across taxonomic groups. I present a formal meta-analysis of 41 studies and 38 animal (mostly arthropod) species, which confirmed that female responsiveness to future mating opportunities is significantly reduced after mating. However, I found no consistent evidence for such an effect in males. This may be due to the greater mating potential of males compared to females, meaning that males typically benefit from further matings while females do not. I also collate evidence suggesting that most mating experiments probably exclusively use only unmated females. I use this evidence to consider how male and female mating history should influence how we design mating experiments. • Mating often leads to a reduction in how sexually responsive individuals are. • I performed a meta-analysis comparing the effect of mating on responsiveness. • Across 26 species, female responsiveness is significantly reduced after mating. • I found no consistent evidence for such an effect in males. • Researchers often prefer to use only unmated females in mating experiments. [ABSTRACT FROM AUTHOR]

Copyright of Environmental & Social Management Journal / Revista de Gestão Social e Ambiental is the property of Environmental & Social Management Journal and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Journalists are often the adult public’s central source of scientific information, which means that their reporting shapes the relationship the public has with science. Yet philosophers of science largely ignore journalistic communication in their inquiries about trust in science. This paper aims to help fill this gap in research by comparing journalistic norm conflicts that arose when reporting on COVID-19 and tobacco, among other policy-relevant scientific topics. I argue that the public’s image of scientists– as depositories of indisputable, value-free facts, trustworthy only when in consensus– makes it particularly difficult for journalists to ethically communicate policy-relevant science rife with disagreement. In doing so, I show how journalists, like scientists, face the problem of inductive risk in such cases. To overcome this problem, I sketch a model of trust in science that is grounded in an alternative image of scientists– what I call the responsiveness model of trust in science. By highlighting the process of science over its product, the responsiveness model requires scientists to respond to empirical evidence and the public’s values to warrant the public’s trust. I then show why this model requires journalists to be the public’s watchdogs by verifying and communicating whether scientists are being properly responsive both epistemically and non-epistemically. [ABSTRACT FROM AUTHOR]

AbstractPurposeMethodsResultsConclusions\nIMPLICATIONS FOR REHABILITATIONTo summarize and critically appraise the quality of studies investigating psychometric properties of pinch strength assessment.Medical literature up to February 2024 was searched for studies reporting on at least one measurement property of pinch strength assessment. The quality of the evidence and the risk of bias were rated using COSMIN 2018 guidelines.Thirty-three studies (1962 participants) were included. The majority (16/19) of reliability studies were of adequate to very good quality. Seven of 12 studies of validity were rated as adequate or very good. The quality of the eight responsiveness studies was adequate. Reliability was good to excellent (ICC > 0.75) for neurological conditions, and excellent (ICC > 0.90) for musculoskeletal disorders and healthy participants. Pinch strength showed strong to very strong correlations with grip strength (r = 0.72–0.92), moderate to strong correlations with assessments of dexterity (r = 0.78–0.80), and weak to moderate correlation with patient-reported outcome measures (r = 0.03–0.50). Varied results were found for pinch strength responsiveness in a small number of studies.Pinch strength assessment is reliable. Validity and responsiveness are less reported, but there is a strong correlation between pinch and grip strength, and a moderate correlation with dexterity.This review demonstrated that the reliability of pinch strength assessment is good to excellent.Clinicians can measure pinch strength and expect accurate results over repeated measurements and between raters.There is a strong correlation between pinch and grip strength, and a moderate correlation between pinch strength and hand dexterity.The low correlation between pinch strength and patient-reported outcome measures highlights the need to measure these outcomes independently of each other.This review demonstrated that the reliability of pinch strength assessment is good to excellent.Clinicians can measure pinch strength and expect accurate results over repeated measurements and between raters.There is a strong correlation between pinch and grip strength, and a moderate correlation between pinch strength and hand dexterity.The low correlation between pinch strength and patient-reported outcome measures highlights the need to measure these outcomes independently of each other. [ABSTRACT FROM AUTHOR]

Copyright of China Plastics / Zhongguo Suliao is the property of Journal Office of CHINA PLASTICS and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

This study investigated the impact of efficiency, reliability, responsiveness, safety, and security on customer satisfaction with sustainable e-banking. The study used a quantitative methodology, with data collected from customers of commercial banks in South Punjab, Pakistan. A Likert scale questionnaire was used to collect cross-sectional data. A sample of 350 was analyzed using the Statistical Package for the Social Sciences (SPSS) for testing descriptive statistics, correlation analysis, and regression results. The study's results revealed that efficiency, reliability, responsiveness, safety, and security significantly impacted customer satisfaction with e-banking services. Efficiency and reliability were the most crucial factors influencing customer satisfaction, followed by safety, security, and responsiveness. The research findings have important implications for commercial banks, as they highlight the critical role of these factors in the development of sustainable e-banking practices. Overall, the study provides valuable insights for commercial banks seeking to improve their e-banking services and ensure customer satisfaction. Commercial banks can enhance their competitiveness and achieve sustainable growth in the highly competitive e-banking sector by prioritizing efficiency, reliability, responsiveness, and safety and security. [ABSTRACT FROM AUTHOR]

AbstractBackgroundObjectiveMethodsResultsConclusionsResearch shows that power training offers more potential for improving muscle power and physical performance in older adults than strength training. However, the measurement properties of the tests used to assess the effects of power training are unclear.to review the reliability, validity, and responsiveness of tests used to measure the effects of power training in older adults.A comprehensive literature search was conducted on 24 previously identified tests in PubMed, Embase, CINAHL, PsycInfo, and SPORTDiscus until April 29, 2024. The methodological quality of the studies was assessed using the COSMIN Risk of Bias checklist. Tests were categorized according to the International Classification of Functioning, Disability, and Health (ICF) and evaluated using Terwee’s Modified Quality Criteria for Rating the Results of Measurement Properties.The search yielded a total of 74 articles, of which a majority had ‘doubtful’ or ‘inadequate’ methodological quality. Research on reliability was abundant and was considered high for a majority of tests, while validity and responsiveness were studied less. None of the included tests satisfied all criteria for Terwee’s Checklist.Aiming to cover each of the ICF domains, this review suggests the 1RM bench press, 1RM leg press, and CMJ for the function domain; and the 6-MWT, 10-MWT, timed stair climb, 5-STS, 30-seconds Sit to Stand, and TUG for the activities domain. No recommendations can be made for the participation domain at this time. [ABSTRACT FROM AUTHOR]

Sensitive caregiving behavior, which involves the ability to notice, interpret, and quickly respond to a child's signals of need and/or interest, is a central determinant of secure child–caregiver attachment. Yet, significant heterogeneity in effect sizes exists across the literature, and sources of heterogeneity have yet to be explained. For all child–caregiver dyads, there was a significant and positive pooled association between caregiver sensitivity and parent–child attachment (r =.25, 95% CI [.22,.28], k = 174, 230 effect sizes, N = 22,914). We also found a positive association between maternal sensitivity and child attachment security (r =.26, 95% CI [.22,.29], k = 159, 202 effect sizes, N = 21,483), which was equivalent in magnitude to paternal sensitivity and child attachment security (r =.21, 95% CI [.14, 27], k = 22, 23 effect sizes, N = 1,626). Maternal sensitivity was also negatively associated with all three classifications of insecure attachment (avoidant: k = 43, r = −.24 [−.34, −.13]; resistant: k = 43, r = −.12 [−.19, −.06]; disorganized: k = 24, r = −.19 [−.27, −.11]). For maternal sensitivity, associations were larger in studies that used the Attachment Q-Sort (vs. the Strange Situation), used the Maternal Behavior Q-Sort (vs. Ainsworth or Emotional Availability Scales), had strong (vs. poor) interrater measurement reliability, had a longer observation of sensitivity, and had less time elapse between assessments. For paternal sensitivity, associations were larger in older (vs. younger) fathers and children. These findings confirm the importance of both maternal and paternal sensitivity for the development of child attachment security and add understanding of the methodological and substantive factors that allow this effect to be observed. Public Significance Statement: The quality of care children receive from caregivers can shape the foundations of a thriving society. Sensitive caregiver behavior involves the ability to notice, interpret, and quickly respond to a child's signals of need and/or interest. Findings from our research suggests that caregivers' sensitive behavior toward their child plays a pivotal role in fostering children's secure attachment. We found that associations were similar for both mothers and fathers. These findings stress the urgency of allocating resources and supports to enhance sensitive caregiver behavior, to in turn promote healthier child–parent relationships. [ABSTRACT FROM AUTHOR]

The WOUND‐Q is a modular patient‐reported outcome measure (PROM) with 13 scales measuring constructs across 4 domains (i.e., wound characteristics, health related quality of life, experience of care and wound treatment). The psychometrics of the WOUND‐Q were previously assessed and the 13 scales evidenced good validity and reliability. However, the responsiveness (i.e., ability to detect clinical change) of the WOUND‐Q has yet to be assessed. The objective of this study was to evaluate responsiveness for 9 WOUND‐Q scales that assess outcomes, in a sample of people 18 years of age or older with chronic wounds that were present for at least 3 months. This study conducted a 4 month follow‐up of 421 participants who completed the WOUND‐Q as part of a previous psychometric study. Participants completed an online survey answering questions about their current wound state (e.g., number, type, size, smell, drainage), anchor questions about change, as well as the WOUND‐Q scales that they had completed in their initial assessment. Pre‐defined hypotheses were tested with a 75% acceptance threshold indicating sufficient evidence of responsiveness. Minimally important differences (MIDs) were also calculated using both anchor‐based and distribution‐based methods. Of 390 invited participants, 320 provided responses, ranging in age from 19 to 84 years. Acceptance of hypotheses ranged from 60% to 100%, with only the Symptom scale not meeting the 75% threshold. The findings of this study provide evidence that the WOUND‐Q can validly measure clinical change in patients with chronic wounds. [ABSTRACT FROM AUTHOR]

Background: There is a significant body of research investigating how institutions moderate the relationship between public opinion and policy in the American States, but far less attention has been given to understanding the variance of policy change. Some states have remained relatively stable in their ideological trajectory, while other states tend to see large unstable swings in policy. Objectives: I argue that the variance of policy, not just the mean, is an important component of understanding policy responsiveness. A state's institutional design can influence both the extent to which policymakers follow public opinion and the ease of moving the status quo. Methods: I use a heteroskedastic regression to model policy responsiveness and variance in the state using a measure of the strength of a state's checks and balance system and a measure of accountability pressure. Results: States with a robust checks and balances system see less policy variance, whereas there is mixed evidence that institutions designed to strengthen public opinion's role in policy are associated with more stable policy. I also find that institutions play a much stronger role in reducing social policy variance compared to economic policy. Conclusion: Variance should be incorporated into our understanding of policy responsiveness, and represents another dimension in which institutions may influence the relationship between public opinion and policy. [ABSTRACT FROM AUTHOR]

The identification of problem information is an important driver of political attention in parliament. This is widely acknowledged in the literature on party competition but there has been surprisingly little empirical research on the extent and when it matters. By relying on an extensive cross-country data set matching data on the policy content of parliamentary oral questions from ten European parliamentary democracies with well-established problem indicators (economy, immigration, and terrorism), this study sets out to answer these important questions. Our time series analysis reveals that not all problem indicators drive political attention in parliament to the same extent and that responsiveness varies based on differences in how government and opposition parties strategically take up problems as well as a partisan logic between left and right parties. While real world problem indicators can be a strong driver of parliamentary attention, that drive is still filtered through political and institutional processes. [ABSTRACT FROM AUTHOR]

Previous research has shown that elected officials are more responsive to the opinions of high-income citizens than to those of middle and working-class citizens in the United States. This is often explained by the fact that economic elites make campaign contributions to political elites, leading to decision-making that aligns with the preferences of the affluent. This paper examines the opinion-policy link in Swedish politics, where campaign contributions are relatively low. Despite this, the study finds that high-income citizens still receive the most policy responsiveness. Three alternative possible explanations are discussed. Do high-income citizens receive more responsiveness because (a) they are better able to put issues on the political agenda, (b) because they are easier to satisfy and prefer 'cheaper' symbolic policy reforms, while low-income citizens prefer more costly policies or (c) because the status quo bias works to the advantage of high-income citizens? [ABSTRACT FROM AUTHOR]

To compare the responsiveness of two unilateral lower-limb performance-based tests, the one-leg rise test and the maximal step-up test, with the bilateral 30-second chair-stand test and the self-reported measure of physical function (HOOS/KOOS). Specific aims were to evaluate responsiveness, floor/ceiling effect and association between the instruments. Data was included from 111 participants, mean age 61.3 years (8.3), with clinically verified hip or knee osteoarthritis, who reported less than 150 minutes/week of moderate or vigorous intensity physical activity. Responsiveness, how well the instruments captured improvements, was measured as Cohen's standardised mean difference for effect size, and was assessed from baseline to 12 months following a physical activity intervention. Other assessments were floor and ceiling effects, and correlations between tests. The maximal step-up test had an effect size of 0.57 (95% CI 0.37, 0.77), the 30-second chair-stand 0.48 (95% CI 0.29, 0.68) and the one-leg rise test 0.12 (95% CI 0.60, 0.31). The one-leg rise test had a floor effect as 72% of the participants scored zero at baseline and 63% at 12 months. The correlation between performance-based tests and questionnaires was considered to be minor (r = 0.188 to 0.226) (p = 0.018 to 0.048). The unilateral maximal step-up test seems more responsive to change in physical function compared to the bilateral 30-second chair-stand test, although the tests did not differ statistically in effect size. The maximal step-up test provides specific information about each leg for the individual and allows for comparison between the legs. [ABSTRACT FROM AUTHOR]

Bid Responsiveness in the public procurement process (PPP) is a crucial aspect of public construction projects. A responsive bid materially complies with the form or content requirements of the bidding documents; the responsiveness of a bid is determined during the bid evaluation period. Accepting low-responsive bids can lead to project failures and unexpected adverse consequences. The Public Procurement Systems (PPS) in developed countries frequently used systematic mechanisms to enhance the quality of the PPP which includes enhancing the responsiveness of bids. This study revealed six dominant factors impacting responsiveness and five systematic mechanisms more prominently discussed in the PPS in developed countries to enhance the quality of the PPP. The population of this study consists of procurement specialists in Sri Lankan public construction procurement at the pre-contract stage and among those who have more than 20 years of experience in PPP were considered as the sampling frame. The fuzzy-set theory was used to determine the ranking order of these systematic mechanisms based on their influence to enhance responsiveness by overcoming the impact of dominant factors. Suggestions were made for Sri Lankan PPS to implement these systematic mechanisms. [ABSTRACT FROM AUTHOR]

The results of the study show that decisions made by tourists (Y) about the Cikadongdong River Tubing attraction are significantly influenced by internet marketing (X1). Similarly, eWOM (X2), or electronic word of mouth, has a big influence on visitor choices. (Y). Additionally, travelers' decisions to visit are greatly influenced by eWOM (X2) and online marketing (X1); Cikadongdong River Tubing Tourism has a coefficient of determination of 0.680, or 68%. The purpose of this study is to examine how internet marketing and eWOM affect visitation decisions. The results show how important they are. A substantial positive correlation between chatbot usability (Y) and responsiveness (X) was found through hypothesis testing. This suggests that consumers view chatbots with higher levels of responsiveness as being more beneficial. Customers find chatbots useful and efficient for fulfilling their demands when they promptly respond with pertinent information. The study also discovered that usability (Y) has a major impact on consumer satisfaction (Z). In ecommerce, chatbots that are simple to use and efficient improve client happiness. A consumer may ask questions and get the assistance they need with ease when using a well-designed chatbot with an easy-to-use UI. Additionally, the chatbot's precise and pertinent replies help to efficiently satisfy client requests. In conclusion, the study emphasizes how responsive and user-friendly chatbots, which effectively and efficiently address consumer demands, greatly increase customer satisfaction in ecommerce. [ABSTRACT FROM AUTHOR]

We assess unequal responsiveness to citizen demands for municipal goods and services using a dataset of about 42 million 311 requests from 13 large cities between 2011 and 2019. We report three findings. First, we find no evidence that cities respond to requests from whiter and more affluent neighborhoods faster than they do the same type of request from less white and affluent neighborhoods, even after accounting for proxies of neighborhood need. On average, however, white, rich neighborhoods receive faster responses to their calls than non-white, poor neighborhoods. Additional analyses suggest that these disparities may not reflect deliberate bias on the part of cities in favor of the needs of whites and the rich, but rather that non-white and poor neighborhoods tend to ask for services that require more time and resources for the city to respond to. Our paper provides the most comprehensive and contemporary analysis to date of inequalities in U.S. city service delivery. [ABSTRACT FROM AUTHOR]

Abstract Background Health system responsiveness to public priorities and needs is a broad, multi-faceted and complex health system goal thought to be important in promoting inclusivity and reducing system inequity in participation. Power dynamics underlie the complexity of responsiveness but are rarely considered. This paper presents an analysis of various manifestations of power within the responsiveness practices of Health Facility Committees (HFCs) and Sub-county Health Management Teams (SCHMTs) operating at the subnational level in Kenya. Kenyan policy documents identify responsiveness as an important policy goal. Methods Our analysis draws on qualitative data (35 interviews with health managers and local politicians, four focus group discussions with HFC members, observations of SCHMT meetings, and document review) from a study conducted at the Kenyan Coast. We applied a combination of two power frameworks to interpret our findings: Gaventa’s power cube and Long’s actor interface analysis. Results We observed a weakly responsive health system in which system-wide and equity in responsiveness were frequently undermined by varied forms and practices of power. The public were commonly dominated in their interactions with other health system actors: invisible and hidden power interacted to limit their sharing of feedback; while the visible power of organisational hierarchy constrained HFCs’ and SCHMTs’ capacity both to support public feedback mechanisms and to respond to concerns raised. These power practices were underpinned by positional power relationships, personal characteristics, and world views. Nonetheless, HFCs, SCHMTs and the public creatively exercised some power to influence responsiveness, for example through collaborations with political actors. However, most resulting responses were unsustainable, and sometimes undermined equity as politicians sought unfair advantage for their constituents. Conclusion Our findings illuminate the structures and mechanisms that contribute to weak health system responsiveness even in contexts where it is prioritised in policy documents. Supporting inclusion and participation of the public in feedback mechanisms can strengthen receipt of public feedback; however, measures to enhance public agency to participate are also needed. In addition, an organisational environment and culture that empowers health managers to respond to public inputs is required.

Chi Zhou,1,&ast; Xu Li,1,&ast; Wenli Shen,2 Qunfang Huang,1 Xiaoling Lin,1 Gaofeng Zhang,3 Yin Dong3,4 1Department of Health Management, School of Public Health, Hangzhou Normal University, Hangzhou, Zhejiang, People’s Republic of China; 2Department of Health Development, Hangzhou Xixi Hospital, Hangzhou, Zhejiang, People’s Republic of China; 3The People’s Hospital of Yuhuan, Taizhou, Zhejiang, People’s Republic of China; 4Vanke School of Public Health, Tsinghua University, Beijing, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Yin Dong, The People’s Hospital of Yuhuan, No. 18 Changle Road, Yucheng Street, Yuhuan, Taizhou, 317600, People’s Republic of China, Tel +86-18957678008, Email 9597082@qq.comBackground: The responsiveness of community health centers can reflect the soft capacity of medical institutions and is related to the improvement of health outcome indicators. This study is aimed at assessing the level and distribution of community health centers’ responsiveness and its associated factors among outpatients under the health-oriented integrated healthcare system in China.Methods: A total of 634 outpatients were recruited from six community health centers in Zhejiang Province, China, in July 2022. SPSS software was used to conduct the analysis (version 23.0). Health system responsiveness was used as a measure of outpatient responsiveness to health care services through a self-administered questionnaire. Determinants of community health centers’ responsiveness were determined by using a multiple linear regression model at a p-value < 0.05.Results: The total score of community health centers responsiveness was 8.25± 1.01, and the Gini coefficient is 0.027. Within these domains, social support and dignity received the highest scores, while choice of providers and autonomy scored the lowest. Age group between 60– 74 years (β: 0.129; 95% CI: 0.042– 0.529), ≥ 75 years (β: 0.095; 95% CI: 0.006– 0.707), monthly income with 8000 RMB and above (β: 0.098; 95% CI: 0.035– 0.653), having a family doctor (β: 0.124; 95% CI: 0.096– 0.410), and satisficing with community health service (β: 0.298; 95% CI: 0.848– 1.428) were significant predictors of community health centers’ responsiveness.Conclusion: The Chinese community health centers show high responsiveness, indicating that the construction of a health-oriented integrated healthcare system has been effective. The family doctor contract service is important and should continually enhance both technical proficiency and health promotion capabilities. Encourage residents to actively participate in their treatment process is also essential.Keywords: responsiveness, community health center, outpatient

Multinational corporations (MNCs) must balance opportunity-seeking initiatives locally with global programs and imperatives. This balancing act between generating and responding to local insights and exploiting standardized marketing programs calls for some form of marketing agility. Under this lens, this study investigates the relationship between market orientation (MO) and marketing program standardization (MPS)—two critical marketing capabilities—and their dual effects on subsidiary performance. The authors compare the cases of Western MNCs' subsidiaries operating in Japan and Turkey and inquire about the moderating role of a country's economic development (advanced vs. emerging market) and an industry's global competitive interdependence. Analyzing MO at the subcomponent level, they find a positive relationship between responsiveness and MPS in both markets. MPS also functions as a partial mediator between responsiveness and profitability in an advanced market. In an advanced market, both responsiveness and MPS are positively related to profitability and market share. In an emerging market, MPS is negatively related to profitability in support of adapting the marketing program. The results and follow-up discussions with executives from established MNCs support the conceptualization of MO and MPS as reflections of international marketing agility in subsidiaries. [ABSTRACT FROM AUTHOR]

BACKGROUND: Differences in responding to sensory stimuli, including sensory hyperreactivity (HYPER), hyporeactivity (HYPO), and sensory seeking (SEEK) have been observed in autistic individuals across sensory modalities, but few studies have examined the structure of these supra-modal traits in the autistic population. METHODS: Leveraging a combined sample of 3868 autistic youth drawn from 12 distinct data sources (ages 3-18 years and representing the full range of cognitive ability), the current study used modern psychometric and meta-analytic techniques to interrogate the latent structure and correlates of caregiver-reported HYPER, HYPO, and SEEK within and across sensory modalities. Bifactor statistical indices were used to both evaluate the strength of a general response pattern factor for each supra-modal construct and determine the added value of modality-specific response pattern scores (e.g., Visual HYPER). Bayesian random-effects integrative data analysis models were used to examine the clinical and demographic correlates of all interpretable HYPER, HYPO, and SEEK (sub)constructs. RESULTS: All modality-specific HYPER subconstructs could be reliably and validly measured, whereas certain modality-specific HYPO and SEEK subconstructs were psychometrically inadequate when measured using existing items. Bifactor analyses supported the validity of a supra-modal HYPER construct (ωH = .800) but not a supra-modal HYPO construct (ωH = .653), and supra-modal SEEK models suggested a more limited version of the construct that excluded some sensory modalities (ωH = .800; 4/7 modalities). Modality-specific subscales demonstrated significant added value for all response patterns. Meta-analytic correlations varied by construct, although sensory features tended to correlate most with other domains of core autism features and co-occurring psychiatric symptoms (with general HYPER and speech HYPO demonstrating the largest numbers of practically significant correlations). LIMITATIONS: Conclusions may not be generalizable beyond the specific pool of items used in the current study, which was limited to caregiver report of observable behaviors and excluded multisensory items that reflect many real-world sensory experiences. CONCLUSION: Of the three sensory response patterns, only HYPER demonstrated sufficient evidence for valid interpretation at the supra-modal level, whereas supra-modal HYPO/SEEK constructs demonstrated substantial psychometric limitations. For clinicians and researchers seeking to characterize sensory reactivity in autism, modality-specific response pattern scores may represent viable alternatives that overcome many of these limitations.

Background Responsiveness is a key goal in evaluating the performance of the health system, and is also an essential basis for improving the capacity of primary health services. Currently, many studies confuse the concepts of responsiveness and satisfaction, and the evaluation of responsiveness is not comprehensive enough, focusing on the level of responsiveness but ignoring its distribution. Objective To understand the responsiveness evaluations of community health services among residents of different ages in Zhejiang province and to analyze its influencing factors. Methods Utilizing the method of purposive sampling and convenience sampling, six community health service centers in Hangzhou and Taizhou, Zhejiang province, were selected as the investigation sites from July to August 2022 to assess the responsiveness scale of outpatient residents. The weights of the eight components of responsiveness recommended by the WHO were used to calculate the overall level and distribution of responsiveness. Univariate analysis and multiple linear regression were used to explore the influencing factors on the responsiveness level among residents of different ages. Results The score of responsiveness for community health services in Zhejiang was (8.31±1.04) points, and the responsiveness distribution index was 0.13; residents of different age groups expressed their higher satisfaction with the dimensions of dignity and social support, with scores of (8.60±1.24) points and (8.63±1.20) points, respectively. In contrast, the dimensions of selectivity and autonomy received lower ratings, with scores of (7.96±1.56) points and (8.04±1.34) points, respectively. Household registration was an influencing factor for responsiveness evaluation of community health services among young people, while education level and monthly income were influencing factors for responsiveness evaluation among middle-aged individuals (P

Background The global prevalence of low back pain is gradually increasing, and it is the main cause of disability, sick leave, and unemployment, posing a heavy burden on individuals and society. Assessing the degree of disability in patients with chronic low back pain is crucial for evaluating the efficacy of clinical interventions and clinical epidemiology. The Roland-Morris Disability Questionnaire (RMDQ) is currently the main tool for evaluating disability in patients with low back pain, but the applicability of its measurement performance in the Chinese population remains unclear. Objective To evaluate the applicability of RMDQ in the Chinese population with low back pain and provide evidence for clinical practice and research application. Methods CNKI, Wanfang Data Knowledge Service Platform, SinoMed, PubMed, Embase and Web of Science were searched from inception to 2023-10-01, to establish a literature base for the performance of the low back pain scale, and then select research on the measurement performance of RMDQ from it. The measurement performance of the RMDQ scale was evaluated according to the COSMIN system evaluation guidelines, and the evidence evaluation level was used to grade the evidence. Results A total of six RMDQ documents were included, with insufficient methodological quality for RMDQ content validity and adequate measurement performance. The quality of internal consistency methodology was very good with uncertainty and measurement performance was adequate; the methodological quality of retesting was uncertain, and the measurement performance was sufficient; the methodological quality of measurement error was uncertain, and the measurement performance was sufficient; the methodological quality of criterion validity was uncertain, and the measurement performance was insufficient; hypothesis testing methodological quality was very good with uncertain, and the measurement performance was sufficient and uncertain; the quality of reactivity methodology was very good, with sufficient and insufficient, while the measurement performance was sufficient with insufficient. According to the GRADE evidence quality rating results, there is low quality evidence to prove uncertainty in content validity, and moderate quality evidence to prove sufficient retesting reliability and internal consistency; there is sufficient evidence of low quality to prove the measurement error and reactivity. There is very low quality evidence of insufficient calibration validity when using the Oswestry Dysfunction Index (ODI) and the Visual Analog Scale (VAS) as calibrators; hypothesis testing had moderate quality evidence of uncertainty. Conclusion The methodological quality of the RMDQ scale is not high, with acceptable measurement performanceand low quality of evidence, and needs to be used cautiously in clinical practice or trials of low back pain in China. Although there is sufficient evidence of moderate quality to prove the reliability and internal consistency of retesting, the research content and methods are not standardized. In future research, attention should be paid to standardization to more accurately assess its applicability in the Chinese population.

Abstract Background Responsiveness to the population’s non-clinical needs encompasses various dimensions, including responsive research and an educational outreach plan at the community level. This study aims to develop a community-responsive research model in the healthcare system to ensure the connection between community-identified health priorities and research funds, as well as capacity-building efforts. Methods A mixed-methods research study was conducted in three main phases, including a comprehensive literature review, a qualitative analysis of an expert panel’s points of view, and the developing of a model using the Equation Modeling (SEM) technique. R software version 3.2.4 was used to conduct statistical analysis, considering a significance level of 0.05. Results Based on the literature review, 41 responsiveness components were identified from sixteen relevant studies conducted between 2000 and 2022. Ten sub-themes in four major themes, including planning, implementation, monitoring and evaluation, and action, were identified through qualitative content analysis. Standardized coefficients revealed that components such as dissemination of results to all stakeholders, research prioritization aligned with community needs, commitment to implement research findings, and collaborative learning had statistically significant effects on the community-responsive research model. Conclusion It is essential to identify community health priorities by following a community-focused, priority-setting process based on the principles of community engagement to develop a community-responsive research model. Afterward, dissemination of research findings to all stakeholders, commitment to apply the obtained results in the real world, and promotion of shared learning among research partners have been proven to facilitate collaborative investigation and mutual understanding between the community and academic partners.

Chemotherapeutics can induce immunogenic cell death (ICD) in tumor cells, offering new possibilities for cancer therapy. However, the efficiency of the immune response generated is insufficient due to the inhibitory nature of the tumor microenvironment (TME). Here, we developed a pH/reactive oxygen species (ROS) dual-response system to enhance chemoimmunotherapy for melanoma. The system productively accumulated in tumors by specific binding of phenylboronic acid (PBA) to sialic acids (SA). The nanoparticles (NPs) rapidly swelled and released quercetin (QUE) and doxorubicin (DOX) upon the stimulation of tumor microenvironment (TME). The in vitro and in vivo results consistently demonstrated that the NPs improved anti-tumor efficacy and prolonged survival of mice, significantly enhancing the effects of the combination. Our study revealed DOX was an ICD inducer, stimulating immune responses and promoting maturation of dendritic cells (DCs). Additionally, QUE served as a TME regulator by inhibiting the cyclooxygenase-2 (COX2)-prostaglandin E2 (PGE2) axis, which influenced various immune cells, including increasing cytotoxic T cells (CLTs) infiltration, promoting M1 macrophage polarization, and reducing regulatory T cells (Tregs) infiltration. The combination synergistically facilitated chemoimmunotherapy efficacy by remodeling the immunosuppressive microenvironment. This work presents a promising strategy to increase anti-tumor efficiency of chemotherapeutic agents.

This study examines the effects of three interactive voice assistant (VA) features (responsiveness, ubiquitous connectivity, and personalization) on consumer happiness. An online survey was administered to 316 VA consumers, and the data were analyzed using structural equation modeling with SmartPLS 4 software. The results indicate that VA responsiveness, ubiquitous connectivity, and personalization have significant effects on consumer happiness. This study also provides evidence that consumer happiness is influenced by VA features through the mediating roles of autonomy and timeliness. Notably, perceived privacy risk has a dual effect, negatively affecting happiness but positively moderating the relationship between autonomy and happiness, suggesting a complex interplay between benefits and concerns in user interactions with VAs. This study highlights the need for VA businesses to consider both the enhancing and mitigating factors of technology for user experiences. Furthermore, our findings have significant implications for VA businesses and executives, suggesting that improved interactions through these VA features can better serve consumers and enhance their experiences.

Abstract Background The Michigan Hand Outcomes Questionnaire (MHQ) is a self-report tool widely recognized for measuring the health status of patients with hand and wrist problems from a multidimensional perspective. The aim of this study is to translate and culturally adapt the MHQ and validate its psychometric properties of validity, reliability, and responsiveness for different hand problems in Spain. Methods The MHQ was translated and culturally adapted following the recommendations of the American Association of Orthopaedic Surgeons. The validation process adhered to the current Consensus-Based Standards for the Selection of Health Status Measurement Instruments (COSMIN) group and was conducted on 262 hand patients. Reliability was assessed through internal consistency using Cronbach's alpha. The study evaluated the test–retest reliability of the measurements using the intraclass correlation coefficient (ICC). Additionally, the measurement error was calculated using the standard error of measurement (SEM) and smallest detectable change (SDC). To assess the structural validity, confirmatory factor analysis (CFA) was employed, while construct validity was evaluated using Pearson's correlation coefficient. Finally, responsiveness was assessed using effect size (ES), standardized response mean (SRM), and minimum clinically important difference (MCID). Results The reliability of the test was confirmed through internal consistency analysis, with a good Crombach's Alpha (0.82–0.85), and test–retest analysis, with good values of ICC (0.74–0.91). The measurement error was also assessed, with low values of SEM (1.70–4.67) and SDC (4.71–12.94)). The CFA confirmed the unidimensionality of each scale with goodness of fit indices, while the MHQ showed a high and negative correlation with DASH (r = − 0.75, P 0.005) and grip strength (r = 0.05, P > 0.005). At week 5, all 222 patients across the three diagnosed hand subgroups showed moderate to high values above 0.92 for ES and SRM, with one MCID above 6.85. Conclusions The MHQ-Sp was culturally adapted, and the results of this version showed good reliability and validity as well as high responsiveness for a wide range of hand conditions after surgical or conservative treatment in Spain.