A multifaceted approach to identifying and managing juvenile delinquency by integrating psycho-physiological indicators.

To understand and treat juvenile delinquency, the study explores the relevance of psycho-physiological indicators. It also emphasizes the necessity for thorough research to minimize the gap existing between psycho-physiological measurements and conventional psychosocial components. The study focuses on the relevance of personality features, habituation, and autonomic arousal required to monitor the proper management of delinquent conduct. Through the integration of biological, psychological, and social elements into a multidimensional approach, researchers can uncover novel insights and create cutting-edge therapies for youths who are at risk of delinquent behavior. The study proposes to develop a comprehensive framework that considers biological antecedents in addition to conventional metrics to reach the root cause of delinquency; thereby drawing special attention to current literature and research that emphasizes the psycho-physiological correlates of delinquency. By examining the complex interactions between stress, physiology, emotions, behavior, and social structures, the study highlights the intricacy of delinquent conduct and the necessity for adopting a multifaceted strategy to fully address the problematic areas. Future research paths are emphasized, with a focus on the significance of longitudinal studies, moderating and mediating variables, and creative treatment techniques. By utilizing psycho-physiological markers and psychosocial traits, researchers can tailor intervention strategies to meet individual needs effectively. Early identification of psycho-physiological deficits in children is crucial for implementing successful behavior modification techniques and promoting the well-being of future generations. This is expected to help the government agencies to save time and public money.

Tracking performance and its underlying characteristics in talented swimmers: a longitudinal study during the junior-to-senior transition.

The present study strived to gain a more profound understanding of the distinctions in development between swimmers who are considered to be on track to the senior elite level compared to those who are not. Longitudinal data of 29 talented sprint and middle-distance swimmers (12 males; 17 females) on season best performances (season best times) and underlying performance characteristics (anthropometrics, starts, turns, maximal swimming velocity, stroke index [SI, an indirect measure of swimming efficiency] and lower body power) were collected over four swimming seasons (median of n = 3 seasons per swimmer). Based on their season best performance at early senior age (males aged 18-19; females aged 17-18), some swimmers were considered to be on track to reach the elite level (referred to as high-performing seniors; 6 males and 10 females), whereas others were not (referred to as lower-performing seniors; 6 males and 7 females). Retrospectively studying these swimmers (males and females separately), we found that all high-performing seniors were already on track to the elite level at late junior age (males aged 17; females aged 16), evidenced with faster season best performances throughout their transition compared to their lower-performing peers (p < 0.05). Independent sample t-tests revealed that high-performing seniors significantly outscored their lower-performing peers on maximal swimming velocity (males and females), starts and turns (males), SI (females) and lower body power (females) at late junior age (p < 0.05). Additionally, multilevel models showed faster rates of development for high-performing seniors on turns and maximal swimming velocity (males), and SI (females) compared to lower-performing peers during the junior-to-senior transition (p < 0.05). Particularly, the higher initial levels of swim performance and underlying characteristics at late junior age as well as the ability to keep progressing on season best performances (males and females), turns and maximal swimming velocity (males), and SI (females) during the junior-to-senior transition, may be crucial factors in the attainment of swimming expertise.

An Integrated Multidimensional Resilience Index for urban areas prone to flash floods: Development and validation.

Resilience analysis is critical in developing flash flood risk reduction strategies in the context of global change and sustainable development. The most common method for assessing resilience is index-based. Nevertheless, the resulting indices typically fail to represent resilience's multidimensional character since they frequently disregard all involved dimensions (i.e., social, economic, environmental, physical, institutional, and cultural). Furthermore, regional resilience indices are rarely externally validated in urban areas prone to flash flooding because the required data are limited and flash flooding does not occur concurrently throughout the study region. This research developed and validated a regional Integrated Multidimensional Resilience Index (IMRI) in urban flash flood-prone areas to address the aforementioned knowledge gaps. The Monte Carlo method enabled internal validation of the IMRI following uncertainty and sensitivity analyses. Latent Class Cluster Analysis (LCCA) was used to characterize resilience, leveraging resulting regional spatial patterns. The findings obtained revealed that the most resilient urban areas have greater social and cultural resilience, while the least resilient urban areas should strengthen their social and institutional resilience. Validation results demonstrated a low bias between the IMRI scores and the control statistics derived from the Monte Carlo analysis as well as a higher than 80 % probability of not getting variations in the resilience categories, confirming the robustness of the IMRI. Through LCCA, five distinct regional spatial patterns of resilience were identified. The methodological approach deployed here enabled the identification of the underlying characteristics that determine the urban system's resilience to flash flooding, thereby supporting the formulation of resilience-building strategies for each dimension and urban area under consideration.

Embedding the Patient-Citizen Perspective into an Operational Framework for the Development and the Introduction of New Technologies in Rehabilitation Care: The Smart&Touch-ID Model.

To date, at least 2.41 billion people with Non-Communicable Diseases (NCDs) are in need of rehabilitation. Rehabilitation care through innovative technologies is the ideal candidate to reach all people with NCDs in need. To obtain these innovative solutions available in the public health system calls for a rigorous multidimensional evaluation that, with an articulated approach, is carried out through the Health Technology Assessment (HTA) methodology. In this context, the aim of the present paper is to illustrate how the Smart&TouchID (STID) model addresses the need to incorporate patients' evaluations into a multidimensional technology assessment framework by presenting a feasibility study of model application with regard to the rehabilitation experiences of people living with NCDs. After sketching out the STID model's vision and operational process, preliminary evidence on the experiences and attitudes of patients and citizens on rehabilitation care will be described and discussed, showing how they operate, enabling the co-design of technological solutions with a multi-stakeholder approach. Implications for public health are discussed including the view on the STID model as a tool to be integrated into public health governance strategies aimed at tuning the agenda-setting of innovation in rehabilitation care through a participatory methodology.

Diagnostic and therapeutic approaches for elderly asthma patients: the importance of multidisciplinary and multidimensional management.

INTRODUCTION: Asthma is commonly considered a disease of younger ages; however, it is not infrequent to pose a diagnosis of the disease in older individuals. Although current recommendations do not distinguish between young and old asthmatics in terms of diagnostic and therapeutic approaches, asthma in the elderly may present with peculiar features that contribute to complicate its management. AREAS COVERED: The current review focuses on the challenges that arise when approaching an older individual with suspected asthma. Age-associated changes of the lung may complicate the diagnostic approach. Measurement of the forced expiratory volume in the first 6 s (FEV6) in an easier and faster alternative to FVC estimation, and residual volume should always be assessed. Older individuals are often affected by concomitant diseases, both age- and drug-related, that need to be considered when approaching elderly asthmatics, since they can affect the efficacy of the treatment as well as the control of the disease. EXPERT OPINION: The potential drug to drug interaction should be routinely investigated, and documented in medical records. The effect of aging on the response to pharmacological therapy in older asthmatics should be explored. Therefore, the need of a multidisciplinary and multidimensional approach to the elderly asthmatics is strongly encouraged.

Identifying, exploring and integrating the spiritual dimension in proactive care planning: A mixed methods evaluation of a communication training intervention for multidisciplinary palliative care teams.

BACKGROUND: Patients receiving palliative care value attention given to their spiritual needs. However, these needs often remain unexplored as healthcare professionals lack the skills to identify and explore them and to integrate this information into care plans. AIM: To evaluate the effects of an interactive communication training intervention for palliative care teams in order to identify and explore the spiritual dimension and integrate it in patients' care plans. DESIGN: A mixed methods pre-post study, including self-assessment questionnaires, evaluation of videos with simulated consultations (applied competence) and medical record review (implementation). SETTING/PARTICIPANTS: Three palliative care teams including nurses (N = 21), physicians (N = 14) and spiritual caregivers (N = 3). RESULTS: The questionnaires showed an improvement on 'Patient and family-centred communication' of the End-of-life professional caregiver survey (+0.37, p < 0.01; the 8-item S-EOLC (+0.54, p < 0.01) and regarding the Spiritual Care Competence Scale, on the three subscales used (+0.27, p < 0.01, +0.29, p < 0.01 and +0.32, p < 0.01). Video evaluations showed increased attention being paid to patient's aims and needs. The medical record review showed an increase in anticipation on the non-somatic dimension (OR: 2.2, 95% CI: 1.2-4.3, p < 0.05) and, using the Mount Vernon Cancer Network assessment tool, addressing spiritual issues (OR: 10.9, 95% CI: 3.7-39.5, p < 0.001). CONCLUSIONS: Our training intervention resulted in increased palliative care professionals' competence in identifying and exploring patients' spiritual issues, and their integration in multidimensional proactive palliative care plans. The intervention directly addresses patients' spiritual concerns and adds value to their palliative care plans.

Comparison between real-world practice and application of the FRAX algorithm in the treatment of osteoporosis.

BACKGROUND AND AIMS: The most recent guidelines suggest treating patients whose FRAX 10-year fracture risk scores are ≥ 20%. However, this method of evaluation does not take into account parameters that are nonetheless relevant to the therapeutic choice. Our aim was to compare the therapeutic choices for treatment based on a wider assessment (real-world practice) with those based on FRAX scores, taking 20% as the cut-off score. METHODS: We obtained the medical history, bone mineral density (BMD) values, and the presence of major fragility fractures in a sample of 856 postmenopausal women. The 10-year FRAX risk of major osteoporotic fracture was calculated, and patients were grouped into risk classes ("FRAX < 20%" = low, "FRAX ≥ 20%" = high); we then compared the treated and untreated patients in each class. After an average interval of 2.5 years, changes in lumbar and femoral BMD and appearances of new fragility fractures were recorded. RESULTS: 83% of high-risk patients and 57% of low-risk patients were treated. The therapeutic decision was based mainly on densitometric values and the presence of vertebral fractures. At the 2.5 year follow-up, lumbar spine and femur BMD had decreased in the untreated group; 9.9% of the treated patients developed new vertebral fragility fractures, compared with 5.3% of the untreated patients. DISCUSSION AND CONCLUSIONS: Our wider assessment designated as at high fracture risk a group of patients who had not been identified by the FRAX assessment. FRAX could underestimate the risk of fracture in older people, for which the therapeutic choice should consider a broader approach, also based on individual patient's needs.

[Course of a child born with a transfusion-transfusion syndrome from prenatal to college]. / Parcours d'un enfant né au décours d'un syndrome transfuseur-transfusé du prénatal au collège.

The literature concerning the neurocognitive evolution of children with transfusion-transfusion syndrome (TTS) is poor beyond the first year of life. It is therefore of particular interest to trace the developmental and management pathway, from the age of 18 months to 11 years, of a boy who presented with TTS in utero. This example illustrates the benefit of early multidisciplinary support and the diagnostic issues raised with the development of the child.

Reducing waiting times of elective surgical procedures: effectiveness evaluation of a multi-interventions approach.

Background: Increasing waiting times for elective surgery is a major concern for policymakers and healthcare staff in many countries, due to its effect on health, patient satisfaction and the perceived quality of health-care. Many organizational models to reduce surgical waiting times have been studied, but the international literature indicates that multidimensional interventions on different aspects of the surgical pathway can be more effective in reducing waiting times than interventions focused on optimizing a single aspect. Aim: The aim of the study is to evaluate the effectiveness of a multidimensional intervention in reducing waiting times for elective surgery. Study design: We used a pre-post approach to evaluate the effect of a multidimensional project to reduce waiting times and lists. Methods: In a district general hospital (Italy) with three elective surgery operating rooms open 6 hours/day, 5 days/week (surgery specialties: general surgery, orthopaedics, gynaecology and urology), a project for reducing surgery waiting times was implemented in October 2018. The project focused on three aspects: i) separation of the flow of day surgery from that of ordinary surgery; ii) increasing available operating time by reorganizing the staff; iii) allocation of operating sessions flexibly in proportion to the waiting list. Waiting times for surgery in the periods 1/10/2019-31/12/2019 and 1/10/2018-31/12/2018 were compared by t test. Results: Waiting times for non-high-priority cases shortened significantly for all specialities (p<0.01), ex-cept for urology. For general surgery, orthopaedics and gynaecology, mean waiting times for day surgery decreased from 198 to 100 days (-50%) and for ordinary operations from 213 to 134 days (-37%). Waiting times for high-priority cases also shortened. Conclusions: Our multidimensional project based on reorganization of staff and facilities and on improved scheduling proved effective in reducing waiting times for elective surgery.

Cardiovascular Diseases in Pregnancy - A Brief Overview.

Even though, there have been many advances in maternal medical care and fertility treatments, the presence of cardiovascular disease has a significant impact on pregnancy. In pregnant women, several heart conditions, such as valvular heart disease, chronic hypertension, congenital heart defects and non-ischemic cardiomyopathies are linked to increased risk of fetal as well as maternal morbidity and mortality. To date, the management of the co-existing conditions of pregnancy and heart disease has been challenging. Therefore, in-depth information may be beneficial to tackle a difficult case scenario. Towards this end, this paper provides an overview of the recent updated knowledge of pregnancy-related cardiovascular diseases in women.

Family stress during the pandemic worsens the effect of adverse parenting on adolescent sleep quality.

BACKGROUND: Adverse parenting is consistently associated with increased sleep problems among adolescents. Shelter-in-Place restrictions and the uncertainty linked to the Covid-19 pandemic have introduced new stressors on parents and families, adding to the risk for youth's sleep problems. OBJECTIVE: Using multidimensional assessments of child maltreatment (CM; threat vs. deprivation), the present study examined whether parent-report and child-report of Covid-19 related stress potentiated the effect of CM on sleep problems among boys and girls. PARTICIPANTS AND SETTING: The study focused on a sample of 124 dyads of adolescents (Mage = 12.89, SD = 0.79; 52% female) and their primary caregivers (93% mothers) assessed before and during the pandemic (May to October 2020). METHOD: Data were obtained from both youth and their parents. Structural equation modeling (SEM) was used to test all study hypotheses. Simple slopes and Johnson-Neyman plots were generated to probe significant interaction effects. RESULTS: Deprivation, but not threat, directly predicted increased sleep problems among boys during the pandemic. Additionally, elevation in Covid-19 stress (both parent and child report) intensified the link between CM (threat and deprivation) and sleep problems among boys. CONCLUSION: Our findings inform prevention and intervention efforts that aim to reduce sleep problems among boys during stressful contexts, such as the Covid-19 pandemic.

A multidimensional model of healthy ageing: proposal and evaluation of determinants based on a population survey in Ecuador.

BACKGROUND: Healthy ageing is a complex construct which involves multiple dimensions. Previous studies of healthy ageing have focused only on measuring the intrinsic capacity of the older person. The objectives of this study were to design a multidimensional model of healthy ageing and to identify its determinants from national data in Ecuador. METHODS: A cross-sectional analytical study was carried out from the National Survey of Health and Well-being of the Older Adult, 2010. Sample was 1797 adults aged 65 years or more. A multidimensional model was designed based on the World Health Organization's concept of healthy ageing. For the analysis, two groups were created: a healthy ageing and a less healthy ageing group. Bivariate and multivariate logistic regressions were performed to analyze the probability of belonging to the healthy group according to sex, age, area of ​​residence, level of education, perceived health status, perceived life satisfaction, and poverty by income level. RESULTS: The 53.15% of the sample was classified in the healthy ageing group. Women and the poorest older adults were less likely to be in the healthy ageing group (OR 0.58; 95% CI 0.464-0.737; OR 0.44; 95% CI 0.343-0.564). Older adults with secondary education or higher, who considered their health as excellent and who were satisfied with their life, had a greater probability of being in healthy ageing group (OR 2.61; 95% CI 1.586-4.309; OR 28.49; 95% CI 3.623-224.02; OR 0.23; 95% CI 0.165-0.341). CONCLUSIONS: This study contributes with a multidimensional approach to healthy ageing. It proposes to evaluate the intrinsic capacity of the individual, the social and political environment and the interaction with it, through indicators that discriminate who are ageing in a healthy way and who are not. By using this model, it was identified that gender and economic situation seem to play an important role on heathy ageing of the Ecuadorian population. Public policies are necessary to promote healthy ageing, especially focused on improving socioeconomic conditions and gender equity.

Dataset for multidimensional assessment to incentivise decentralised energy investments in Sub-Saharan Africa.

In this data article, we present datasets from the construction of a composite indicator, the Photovoltaic Decentralised Energy Investment (PV-DEI) index, presented in detail in [1]. This article consists of a comprehensive energy-related data collected in practice from several sources, and from the outputs of the methodology described in [1]. The PV-DEI was designed and developed to measure the multidimensional factors that currently direct decentralised renewable energy investments. The PV-DEI index includes 52 indicators and was constructed because factors stimulating investment cannot be captured by a single indicator, e.g. competitiveness, affordability, or governance [1]. The PV-DEI index was built in alignment with a theoretical framework guided by an extensive review of the literature surrounding investment in decentralised Photovoltaic (PV), which led to the selection of its indicators. The structure of the PV-DEI was evaluated for its soundness using correlational assessments and principal component analyses (PCA). The raw data provided in this article can enable stakeholders to focus on specific country indicators, and how scores on these indicators contributed to a countries overall rank within the PV-DEI index. The data can be used to weight indicators depending on the specifications of several different stakeholders (such as NGOs, private sector or international institutions).

Glycated Albumin for Glycemic Control in T2DM Population: A Multi-Dimensional Evaluation.

PURPOSE: To investigate the glycated albumin (GA) introduction implications, as an add-on strategy to traditional glycemic control (Hb1Ac and fasting plasma glucose - FPG) instruments, considering insulin-naïve individuals with type 2 diabetes mellitus (T2DM), treated with oral therapies. METHODS: A Health Technology Assessment was conducted in Italy, as a multi-dimensional approach useful to validate any innovative technology. The HTA dimensions, derived from the EUnetHTA Core Model, were deployed by means of literature evidence, health economics tools and qualitative questionnaires, filled-in by 15 professionals. RESULTS: Literature stated that the GA introduction could lead to a higher number of individuals achieving therapeutic success after 3 months of therapy (97.0% vs 71.6% without GA). From an economic point of view, considering a projection of 1,955,447 T2DM insulin-naïve individuals, potentially treated with oral therapy, GA introduction would imply fewer individuals requiring a therapy switch (-89.44%), with a 1.06% in costs reduction, on annual basis, thus being also the preferable solution from a cost-effectiveness perspective (cost-effectiveness value: 237.74 vs 325.53). According to experts opinions, lower perceptions on GA emerged with regard to equity aspects (0.13 vs 0.72, p-value>0.05), whereas it would improve both individuals (2.17 vs 1.33, p-value=0.000) and caregivers quality of life (1.50 vs 0.83, p-value=0.000). Even if in the short term, GA required additional investments in training courses (-0.80 vs 0.10, p-value = 0.036), in the long run, GA could become the preferable technology (0.30 vs 0.01, p-value=0.018) from an organisational perspective. CONCLUSION: Adding GA to traditional glycaemic control instruments could improve the clinical pathway of individuals with T2DM, leading to economic and organisational advantages for both hospitals and National Healthcare Systems.

Relative Age-Related Biases in Objective and Subjective Assessments of Performance in Talented Youth Soccer Players.

Talent research has recommended that multidimensional assessments of performance are needed to improve the identification and development of talented young athletes. However, factors such as the relative age effect may cloud our ability to assess factors related to performance. The aim of this study was to determine the extent of any relationship between soccer players' chronological and relative age, and objective and subjective performance assessments. Data for highly talented male soccer players selected into the German Soccer Associations' talent promotion program (N = 16,138) for U12 to U15 age groups (M age = 12.62 ± 1.04 years) were examined. Besides anthropometric assessments, players completed a battery of five motor tests that objectively assessed speed abilities and technical skills (specifically sprint, agility, dribbling, ball control, and juggling). In addition, coaches subjectively rated players on their kicking, tactical, and psychosocial skills, as well as providing holistic evaluations of each player's current and future performance levels. Correlation analyses were used to investigate the extent of any relationships between the chronological and relative age of players and their results for each of the assessments. A strong linear decrease in the frequency of later-born players confirmed the overrepresentation of early-born players in all age groups (0.92 ≤ |r| ≤ 0.95, each p < 0.001). From U12 to U15, significant (each p < 0.001) correlations were found between the chronological age of players and their height (|r| = 0.70), weight (|r| = 0.69), speed abilities (|r| = 0.38), and technical skills (|r| = 0.43). When evaluating each age group separately, small effects were found when correlating relative age with the anthropometric assessments (0.18 ≤ |r| ≤ 0.26), and only trivial effects with speed abilities and technical skills (0.01 ≤ |r| ≤ 0.06). Similarly, low correlations were found for the subjective evaluations of kicking, tactical, and psychosocial skills with chronological age across age groups (0.03 ≤ |r| ≤ 0.07), and with relative age in each age group (0.01 ≤ |r| ≤ 0.11). The results show a skewed distribution toward early-born players and-in reference to their relative age-advanced performance in late-born athletes. However, trends toward a better holistic rating of early-born players for current and future performance levels were found. Coaches should be aware of these effects during talent selection, but also when interpreting results from subjective and objective assessments of performance.

Desarrollo de una estrategia holística para la valoración de la calidad de vida en pacientes con cáncer de mama en las distintas etapas de la enfermedad / Development of a holistic strategy for the assessment of the quality of life in patients with breast cancer in the different stages of the disease

Introducción: El cáncer de mama es considerado una enfermedad crónica que impacta de modo importante en la calidad de vida (QoL) de las pacientes. En la actualidad no se dispone de un sistema de evaluación totalmente satisfactorio que refleje la complejidad del cáncer de mama. Además, la mayoría de instrumentos están más orientados a la enfermedad en estadios iniciales que a la enfermedad avanzada. Objetivo: Describir la metodología utilizada para evaluar la calidad de vida y las estrategias de afrontamiento en un grupo representativo de cáncer de mama que incluye tanto pacientes metastásicas como no metastásicas. Método: Estudio prospectivo en pacientes con cáncer de mama del Servicio de Oncología Médica del Institut Català d’Oncologia (ICO) en diferentes estadios de la enfermedad, previo consentimiento informado. Se les aplica un protocolo de aproximadamente una hora de entrevista presencial donde se recoge su información sociodemográfica, y se contestan varios cuestionarios de calidad de vida como el cuestionario QLCA-AFex Font, QLQ-C30, QLQ-BR23 HADS, DME, BRCS, MINI-MAC, LOT-R y OE, que se completan con una entrevista semiestructurada. Resultados: De junio de 2017 a marzo de 2020, 257 pacientes han sido incluidas en el estudio. La media de edad es de 57,9 años (SD 10,1), la mayoría son mujeres (98,8%), con hijos (87,9%) y casadas (65,4%). Respecto al estadiaje clínico 75,5% son no-metastásicas y 24,5% metastásicas. El cumplimiento del protocolo se consiguió en más del 90% de los cuestionarios sin diferencias entre pacientes metastásicas y no metastásicas. Conclusión: Este protocolo multidimensional permite hacer una evaluación integral de la calidad de vida (AU)

Introduction: Breast cancer is considered a chronic disease that has considerable impact on the quality of life (QoL) of the patients. Yet, there is not a totally satisfactory evaluation system reflecting the complexity of the breast cancer condition. Furthermore, most instruments are more addressed towards early-stage disease than advanced disease. Objective: To describe the methodology used to measure the QoL of life and coping strategies in a representative group of breast cancer patients including metastatic and non-metastatic patients. Methodology: Prospective study including patients with breast cancer at different stages of the disease recruited at the Medical Oncology Department of the Catalan Oncology Institute (ICO)previous informed consent. A protocol of approximately one hour face-to-face interview is run to collect sociodemographic information and to answer the questions of several QoL scales such as the QLCA-AFex Font, QLQ-C30, QLQ-BR23,HADS, DME, BRCS, MINI-MAC, LOT-R and OE questionnaires, complemented by a semi-structured interview. Results: From June 2017 to March 2020, 257 patients were included in the study. Mean age 57.9 years (SD 10.1), mostly women (98.8%), with children (87.9%) and married (65.4%). According to clinical status 75.5% were non-metastatic and 24.5% metastatic. Protocol compliance was achieved in more than 90% in all questionnaires without differences between metastatic and no metastatic patients. Conclusions: This multidimensional protocol enables us to make an integral assessment of the QoL of the patients and their unmet needs, as well as to reflect the patients’ concerns, both in early and advanced stages of the disease, complementing currently available assessment methods. In the next future a complied questionnaire with the most challenging questions could be developed to be useful as a routine instrument in clinical practice (AU)

Assessing energy security in Africa based on multi-dimensional approach of principal composite analysis.

The concept of energy security has become an increasingly challenging issue in Africa, forcing energy-deficient countries to forge mutual partnerships with energy sufficient countries to access it for their domestic consumption. This study formulates a composite index of energy security in Africa as well as evaluates its impacts and trends using a sample of 28 countries on the continent, during the 2000-2018 period by using a principal composite factor analysis (PCA), with the series of 13 variables. Further interpretation was carried out using these tests: Kaiser-Meyer-Olkin measure of sampling adequacy and Bartlett's test of sphericity, Pearson correlation test, and Cronbach's alpha test. The key results show a trend of energy insecurity among the countries studied, as energy imports loads high in most countries as well as per capita emission, together with fossil fuel source consumption correlating high. These results validate the stark reality on the African continent. The inference from the results of the anaylsis conclude that the principal component analysis (PCA) results of the energy index were considered fit and reliable for the analysis, with the most important Cronbach's alpha test coefficient of 0.8797, far above the standard 0.6 model reliability level. Based on this study, the paper proffers there should be increased intra-regional trading of energy among the various power pools on the continent and increased regional renewable energy investments as well as investment in energy infrastructure, measures to reduce electricity system losses, environmental sustainability, and the adoption of energy in efficiency on the continent.

The Causes of Insulin Resistance in Type 1 Diabetes Mellitus: Is There a Place for Quaternary Prevention?

Diabetes mellitus was the first non-communicable disease that was recognized by the United Nations as a 21st-century pandemic problem. Recent scientific reports suggest that people with type 1 diabetes mellitus also develop insulin resistance, which is generally considered to be a distinctive feature of type 2 diabetes mellitus. The causes of insulin resistance in type 1 diabetes mellitus were explored, but there was a lack of publications that connected the risk factors of insulin resistance in type 1 diabetes mellitus with the proposition of repair mechanisms that are offered by quaternary prevention. Toward this end, the present review is an attempt to combine the previous reports on the causes of insulin resistance in type 1 diabetes mellitus and a brief review of quaternary prevention. The destructive effect of insulin resistance on many physiological processes that predisposes the individual to chronic diabetes complications creates an urgent need to introduce effective therapeutic methods for preventing the development and progression of this pathology.

Efficacy and safety of cerebrolysin in neurorecovery after moderate-severe traumatic brain injury: results from the CAPTAIN II trial.

INTRODUCTION: The objective of this trial was to evaluate the efficacy and safety of Cerebrolysin in treating patients after moderate to severe traumatic brain injury (TBI) as an adjunct to standard care protocols. The trial was designed to investigate the clinical effects of Cerebrolysin in the acute (neuroprotective) stage and during early and long-term recovery as part of a neurorestorative strategy. MATERIALS AND METHODS: The study was a phase IIIb/IV single-center, prospective, randomized, double-blind, placebo-controlled clinical trial. Eligible patients with a Glasgow Coma Score (GCS) between 7 and 12 received study medication (50 ml of Cerebrolysin or physiological saline solution per day for 10 days, followed by two additional treatment cycles with 10 ml per day for 10 days) in addition to standard care. We tested ensembles of efficacy criteria for 90, 30, and 10 days after TBI with a priori ordered hypotheses using a multivariate, directional test, to reflect the global status of patients after TBI. RESULTS: The study enrolled 142 patients, of which 139 underwent formal analysis (mean age = 47.4, mean admission GCS = 10.4, and mean Baseline Prognostic Risk Score = 2.6). The primary endpoint, a multidimensional ensemble of 13 outcome scales, indicated a "small-to-medium"-sized effect in favor of Cerebrolysin, statistically significant at day 90 (MWcombined = 0.59, 95% CI 0.52 to 0.66, P = 0.0119). Safety and tolerability observations were comparable between treatment groups. CONCLUSION: Our trial confirms previous beneficial effects of the multimodal, biological agent Cerebrolysin for overall outcome after moderate to severe TBI, as measured by a multidimensional approach. Study findings must be appraised and aggregated in conjunction with existing literature, as to improve the overall level of insight regarding therapeutic options for TBI patients. The widely used pharmacologic intervention may benefit from a large-scale observational study to map its use and to establish comparative effectiveness in real-world clinical settings.

Safety and efficacy of Cerebrolysin in acute brain injury and neurorecovery: CAPTAIN I-a randomized, placebo-controlled, double-blind, Asian-Pacific trial.

OBJECTIVE: To evaluate the safety and efficacy of Cerebrolysin as an add-on therapy to local standard treatment protocol in patients after moderate-to-severe traumatic brain injury. METHODS: The patients received the study medication in addition to standard care (50 mL of Cerebrolysin or physiological saline solution daily for 10 days, followed by two additional treatment cycles with 10 mL daily for 10 days) in a prospective, randomized, double-blind, placebo-controlled, parallel-group, multi-centre phase IIIb/IV trial. The primary endpoint was a multidimensional ensemble of 14 outcome scales pooled to be analyzed by means of the multivariate, correlation-sensitive Wei-Lachin procedure. RESULTS: In 46 enrolled TBI patients (Cerebrolysin 22, placebo 24), three single outcomes showed stand-alone statistically significant superiority of Cerebrolysin [Stroop Word/Dots Interference (p = 0.0415, Mann-Whitney(MW) = 0.6816, 95% CI 0.51-0.86); Color Trails Tests 1 and 2 (p = 0.0223/0.0170, MW = 0.72/0.73, 95% CI 0.53-0.90/0.54-0.91), both effect sizes lying above the benchmark for "large" superiority (MW > 0.71)]. While for the primary multivariate ensemble, statistical significance was just missed in the intention-to-treat population (pWei-Lachin < 0.1, MWcombined = 0.63, 95% CI 0.48-0.77, derived standardized mean difference (SMD) 0.45, 95% CI -0.07 to 1.04, derived OR 2.1, 95% CI 0.89-5.95), the per-protocol analysis showed a statistical significant superiority of Cerebrolysin (pWei-Lachin = 0.0240, MWcombined = 0.69, 95% CI 0.53 to 0.85, derived SMD 0.69, 95% CI 0.09 to 1.47, derived OR 3.2, 95% CI 1.16 to 12.8), with effect sizes of six single outcomes lying above the benchmark for "large" superiority. Safety aspects were comparable to placebo. CONCLUSION: Our trial suggests beneficial effects of Cerebrolysin on outcome after TBI. Results should be confirmed by a larger RCT with a comparable multidimensional approach.