Search results for: systematic analysis
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 28833

Search results for: systematic analysis

28503 Utilization of a Telepresence Evaluation Tool for the Implementation of a Distant Education Program

Authors: Theresa Bacon-Baguley, Martina Reinhold

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Introduction: Evaluation and analysis are the cornerstones of any successful program in higher education. When developing a program at a distant campus, it is essential that the process of evaluation and analysis be orchestrated in a timely manner with tools that can identify both the positive and negative components of distant education. We describe the utilization of a newly developed tool used to evaluate and analyze the successful expansion to a distant campus using Telepresence Technology. Like interactive television, Telepresence allows live interactive delivery but utilizes broadband cable. The tool developed is adaptable to any distant campus as the framework for the tool was derived from a systematic review of the literature. Methodology: Because Telepresence is a relatively new delivery system, the evaluation tool was developed based on a systematic review of literature in the area of distant education and ITV. The literature review identified four potential areas of concern: 1) technology, 2) confidence in the system, 3) faculty delivery of the content and, 4) resources at each site. Each of the four areas included multiple sub-components. Benchmark values were determined to be 80% or greater positive responses to each of the four areas and the individual sub-components. The tool was administered each semester during the didactic phase of the curriculum. Results: Data obtained identified site-specific issues (i.e., technology access, student engagement, laboratory access, and resources), as well as issues common at both sites (i.e., projection screen size). More specifically, students at the parent location did not have adequate access to printers or laboratory space, and students at the distant campus did not have adequate access to library resources. The evaluation tool identified that both sites requested larger screens for visualization of the faculty. The deficiencies were addressed by replacing printers, including additional orientation for students on library resources and increasing the screen size of the Telepresence system. When analyzed over time, the issues identified in the tool as deficiencies were resolved. Conclusions: Utilizing the tool allowed adjustments of the Telepresence delivery system in a timely manner resulting in successful implementation of an entire curriculum at a distant campus.

Keywords: physician assistant, telepresence technology, distant education, assessment

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28502 Executive Function in Youth With ADHD and ASD: A Systematic Review and Meta-analysis

Authors: Parker Townes, Prabdeep Panesar, Chunlin Liu, Soo Youn Lee, Dan Devoe, Paul D. Arnold, Jennifer Crosbie, Russell Schachar

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Attention-deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) are impairing childhood neurodevelopmental disorders with problems in executive functions. Executive functions are higher-level mental processes essential for daily functioning and goal attainment. There is genetic and neural overlap between ADHD and ASD. The aim of this meta-analysis was to evaluate if pediatric ASD and ADHD have distinct executive function profiles. This review was completed following Cochrane guidelines. Fifty-eight articles were identified through database searching, followed by a blinded screening in duplicate. A meta-analysis was performed for all task performance metrics evaluated by at least two articles. Forty-five metrics from 24 individual tasks underwent analysis. No differences were found between youth with ASD and ADHD in any domain under direct comparison. However, individuals with ASD and ADHD exhibited deficient attention, flexibility, visuospatial abilities, working memory, processing speed, and response inhibition compared to controls. No deficits in planning were noted in either disorder. Only 11 studies included a group with comorbid ASD+ADHD, making it difficult to determine whether common executive function deficits are a function of comorbidity. Further research is needed to determine if comorbidity accounts for the apparent commonality in executive function between ASD and ADHD.

Keywords: autism spectrum disorder, ADHD, neurocognition, executive function, youth

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28501 Case Study Analysis of 2017 European Railway Traffic Management Incident: The Application of System for Investigation of Railway Interfaces Methodology

Authors: Sanjeev Kumar Appicharla

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This paper presents the results of the modelling and analysis of the European Railway Traffic Management (ERTMS) safety-critical incident to raise awareness of biases in the systems engineering process on the Cambrian Railway in the UK using the RAIB 17/2019 as a primary input. The RAIB, the UK independent accident investigator, published the Report- RAIB 17/2019 giving the details of their investigation of the focal event in the form of immediate cause, causal factors, and underlying factors and recommendations to prevent a repeat of the safety-critical incident on the Cambrian Line. The Systems for Investigation of Railway Interfaces (SIRI) is the methodology used to model and analyze the safety-critical incident. The SIRI methodology uses the Swiss Cheese Model to model the incident and identify latent failure conditions (potentially less than adequate conditions) by means of the management oversight and risk tree technique. The benefits of the systems for investigation of railway interfaces methodology (SIRI) are threefold: first is that it incorporates the “Heuristics and Biases” approach advanced by 2002 Nobel laureate in Economic Sciences, Prof Daniel Kahneman, in the management oversight and risk tree technique to identify systematic errors. Civil engineering and programme management railway professionals are aware of the role “optimism bias” plays in programme cost overruns and are aware of bow tie (fault and event tree) model-based safety risk modelling techniques. However, the role of systematic errors due to “Heuristics and Biases” is not appreciated as yet. This overcomes the problems of omission of human and organizational factors from accident analysis. Second, the scope of the investigation includes all levels of the socio-technical system, including government, regulatory, railway safety bodies, duty holders, signaling firms and transport planners, and front-line staff such that lessons are learned at the decision making and implementation level as well. Third, the author’s past accident case studies are supplemented with research pieces of evidence drawn from the practitioner's and academic researchers’ publications as well. This is to discuss the role of system thinking to improve the decision-making and risk management processes and practices in the IEC 15288 systems engineering standard and in the industrial context such as the GB railways and artificial intelligence (AI) contexts as well.

Keywords: accident analysis, AI algorithm internal audit, bounded rationality, Byzantine failures, heuristics and biases approach

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28500 Risk Mapping of Road Traffic Incidents in Greater Kampala Metropolitan Area for Planning of Emergency Medical Services

Authors: Joseph Kimuli Balikuddembe

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Road traffic incidents (RTIs) continue to be a serious public health and development burden around the globe. Compared to high-income countries (HICs), the low and middle-income countries (LMICs) bear the heaviest brunt of RTIs. Like other LMICs, Uganda, a country located in Eastern Africa, has been experiencing a worryingly high burden of RTIs and their associated impacts. Over the years, the highest number of all the total registered RTIs in Uganda has taken place in the Greater Kampala Metropolitan Area (GKMA). This places a tremendous demand on the few existing emergency medical services (EMS) to adequately respond to those affected. In this regard, the overall objective of the study was to risk map RTIs in the GKMA so as to help in the better planning of EMS for the victims of RTIs. Other objectives included: (i) identifying the factors affecting the exposure, vulnerability and EMS capacity for the victims of RTIs; (ii) identifying the RTI prone-areas and estimating their associated risk factors; (iii) identifying the weaknesses and capacities which affect the EMS systems for RTIs; and (iv) determining the strategies and priority actions that can help to improve the EMS response for RTI victims in the GKMA. To achieve these objectives, a mixed methodological approach was used in four phrases for approximately 15 months. It employed a systematic review based on the preferred reporting items for systematic reviews and meta-data analysis guidelines; a Delphi panel technique; retrospective data analysis; and a cross-sectional method. With Uganda progressing forward as envisaged in its 'Vision 2040', the GKMA, which is the country’s political and socioeconomic epicenter, is experiencing significant changes in terms of population growth, urbanization, infrastructure development, rapid motorization and other factors. Unless appropriate actions are taken, these changes are likely to worsen the already alarming rate of RTIs in Uganda, and in turn also to put pressure on the few existing EMS and facilities to render care for those affected. Therefore, road safety vis-à-vis injury prevention measures, which are needed to reduce the burden of RTIs, should be multifaceted in nature so that they closely correlate with the ongoing dynamics that contribute to RTIs, particularly in the GKMA and Uganda as a whole.

Keywords: emergency medical services, Kampala, risk mapping, road traffic incidents

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28499 The Effectiveness of Blended Learning in Pre-Registration Nurse Education: A Mixed Methods Systematic Review and Met Analysis

Authors: Albert Amagyei, Julia Carroll, Amanda R. Amorim Adegboye, Laura Strumidlo, Rosie Kneafsey

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Introduction: Classroom-based learning has persisted as the mainstream model of pre-registration nurse education. This model is often rigid, teacher-centered, and unable to support active learning and the practical learning needs of nursing students. Health Education England (HEE), a public body of the Department of Health and Social Care, hypothesises that blended learning (BL) programmes may address health system and nursing profession challenges, such as nursing shortages and lack of digital expertise, by exploring opportunities for providing predominantly online, remote-access study which may increase nursing student recruitment, offering alternate pathways to nursing other than the traditional classroom route. This study will provide evidence for blended learning strategies adopted in nursing education as well as examine nursing student learning experiences concerning the challenges and opportunities related to using blended learning within nursing education. Objective: This review will explore the challenges and opportunities of BL within pre-registration nurse education from the student's perspective. Methods: The search was completed within five databases. Eligible studies were appraised independently by four reviewers. The JBI-convergent segregated approach for mixed methods review was used to assess and synthesize the data. The study’s protocol has been registered with the International Register of Systematic Reviews with registration number// PROSPERO (CRD42023423532). Results: Twenty-seven (27) studies (21 quantitative and 6 qualitative) were included in the review. The study confirmed that BL positively impacts nursing students' learning outcomes, as demonstrated by the findings of the meta-analysis and meta-synthesis. Conclusion: The review compared BL to traditional learning, simulation, laboratory, and online learning on nursing students’ learning and programme outcomes as well as learning behaviour and experience. The results show that BL could effectively improve nursing students’ knowledge, academic achievement, critical skills, and clinical performance as well as enhance learner satisfaction and programme retention. The review findings outline that students’ background characteristics, BL design, and format significantly impact the success of the BL nursing programme.

Keywords: nursing student, blended learning, pre-registration nurse education, online learning

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28498 Support for Reporting Guidelines in Surgical Journals Needs Improvement: A Systematic Review

Authors: Riaz A. Agha, Ishani Barai, Shivanchan Rajmohan, Seon Lee, Mohammed O. Anwar, Alex J. Fowler, Dennis P. Orgill, Douglas G. Altman

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Introduction: Medical knowledge is growing fast. Evidence-based medicine works best if the evidence is reported well. Past studies have shown reporting quality to be lacking in the field of surgery. Reporting guidelines are an important tool for authors to optimize the reporting of their research. The objective of this study was to analyse the frequency and strength of recommendation for such reporting guidelines within surgical journals. Methods: A systematic review of the 198 journals within the Journal Citation Report 2014 (surgery category) published by Thomson Reuters was undertaken. The online guide for authors for each journal was screened by two independent groups and results were compared. Data regarding the presence and strength of recommendation to use reporting guidelines was extracted. Results: 193 journals were included (as five appeared twice having changed their name). These had a median impact factor of 1.526 (range 0.047 to 8.327), with a median of 145 articles published per journal (range 29-659), with 34,036 articles published in total over the two-year window 2012-2013. The majority (62%) of surgical journals made no mention of reporting guidelines within their guidelines for authors. Of the journals (38%) that did mention them, only 14% (10/73) required the use of all relevant reporting guidelines. The most frequently mentioned reporting guideline was CONSORT (46 journals). Conclusion: The mention of reporting guidelines within the guide for authors of surgical journals needs improvement. Authors, reviewers and editors should work to ensure that research is reported in line with the relevant reporting guidelines. Journals should consider hard-wiring adherence to them. This will allow peer-reviewers to focus on what is present, not what is missing, raising the level of scholarly discourse between authors and the scientific community and reducing frustration amongst readers.

Keywords: CONSORT, guide for authors, PRISMA, reporting guidelines, journal impact factor, citation analysis

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28497 Relationships between Actors within Business Ecosystems That Adopt Circular Strategies: A Systematic Literature Review

Authors: Sophia Barquete, Adriana H. Trevisan, Janaina Mascarenhas

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The circular economy (CE) aims at the cycling of resources through restorative and regenerative strategies. To achieve circularity, coordination of several actors who have different responsibilities is necessary. The interaction among multiple actors allows the connection between the CE and business ecosystem research fields. Although fundamental, the relationships between actors within an ecosystem to foster circularity are not deeply explored in the literature. The objective of this study was to identify the possibilities of cooperation, competition, or even coopetition among the members of business ecosystems that adopt circular strategies. In particular, the motivations that make these actors interact to achieve a circular economy were investigated. A systematic literature review was adopted to select business ecosystem cases that adopt circular strategies. As a result, several motivations were identified for actors to engage in relationships within ecosystems, such as sharing knowledge and infrastructure, developing products with a circular design, promoting reverse logistics, among others. The results suggest that partnerships between actors are, in fact, important for the implementation of circular strategies. In order to achieve a complete and circular solution, actors must be able to clearly understand their roles and relationships within the network so that they can establish new partnerships or reframe those already established.

Keywords: business ecosystem, circular economy, cooperation, coopetition, competition

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28496 Systematic Review of Quantitative Risk Assessment Tools and Their Effect on Racial Disproportionality in Child Welfare Systems

Authors: Bronwen Wade

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Over the last half-century, child welfare systems have increasingly relied on quantitative risk assessment tools, such as actuarial or predictive risk tools. These tools are developed by performing statistical analysis of how attributes captured in administrative data are related to future child maltreatment. Some scholars argue that attributes in administrative data can serve as proxies for race and that quantitative risk assessment tools reify racial bias in decision-making. Others argue that these tools provide more “objective” and “scientific” guides for decision-making instead of subjective social worker judgment. This study performs a systematic review of the literature on the impact of quantitative risk assessment tools on racial disproportionality; it examines methodological biases in work on this topic, summarizes key findings, and provides suggestions for further work. A search of CINAHL, PsychInfo, Proquest Social Science Premium Collection, and the ProQuest Dissertations and Theses Collection was performed. Academic and grey literature were included. The review includes studies that use quasi-experimental methods and development, validation, or re-validation studies of quantitative risk assessment tools. PROBAST (Prediction model Risk of Bias Assessment Tool) and CHARMS (CHecklist for critical Appraisal and data extraction for systematic Reviews of prediction Modelling Studies) were used to assess the risk of bias and guide data extraction for risk development, validation, or re-validation studies. ROBINS-I (Risk of Bias in Non-Randomized Studies of Interventions) was used to assess for bias and guide data extraction for the quasi-experimental studies identified. Due to heterogeneity among papers, a meta-analysis was not feasible, and a narrative synthesis was conducted. 11 papers met the eligibility criteria, and each has an overall high risk of bias based on the PROBAST and ROBINS-I assessments. This is deeply concerning, as major policy decisions have been made based on a limited number of studies with a high risk of bias. The findings on racial disproportionality have been mixed and depend on the tool and approach used. Authors use various definitions for racial equity, fairness, or disproportionality. These concepts of statistical fairness are connected to theories about the reason for racial disproportionality in child welfare or social definitions of fairness that are usually not stated explicitly. Most findings from these studies are unreliable, given the high degree of bias. However, some of the less biased measures within studies suggest that quantitative risk assessment tools may worsen racial disproportionality, depending on how disproportionality is mathematically defined. Authors vary widely in their approach to defining and addressing racial disproportionality within studies, making it difficult to generalize findings or approaches across studies. This review demonstrates the power of authors to shape policy or discourse around racial justice based on their choice of statistical methods; it also demonstrates the need for improved rigor and transparency in studies of quantitative risk assessment tools. Finally, this review raises concerns about the impact that these tools have on child welfare systems and racial disproportionality.

Keywords: actuarial risk, child welfare, predictive risk, racial disproportionality

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28495 Strengths and Challenges to Embrace Attention Deficit/Hyperactivity Disorder (ADHD) in Employment: A Systematic Review

Authors: Adèle Hotte-Meunier, Lisa Sarraf, Alan Bougeard, Félicia Bernier, Chloé Voyer, Jiaxuan Deng, Stéphanie El Asmar, Alina Stamate, Marc Corbière, Patrizia Villotti, Geneviève Sauvé

Abstract:

Background: Attention-Deficit/Hyperactivity Disorder (ADHD) is characterized by a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with psychosocial, educational and occupational functioning. Although often conceptualized as a developmental disorder of childhood, 65% of children with ADHD continue to meet full or partial diagnostic criteria for ADHD in adulthood and an estimated 4% of the workforce has a diagnosis of ADHD. Methods: A systematic review was conducted to understand the experiences of people living with ADHD in the workplace. Articles reporting employment outcomes for people living with were identified by a search in eight databases on four separate occasions from June 27, 2022, to June 21, 2023. A risk of bias assessment for each study was performed using the Mixed Methods Appraisal Tool (MMAT). Results: A total of 79 studies were included in this systematic review (nADHD: 68, 216). Results were synthesized into three broad overarching categories: challenges, strengths and adaptations at work. Further, nine themes were included: ADHD symptoms at work, workplace performance, job satisfaction, interpersonal relationships at work, maladaptive work thoughts and behaviors, personal strengths, embracing ADHD, person-environment fit and accommodations and support. Sex differences were highlighted as a tenth subtheme. ADHD confers both strengths and limitations related to employment. Discussion: Workers with ADHD can not only adapt but thrive in employment with the right person-environment fit, accommodations and support. Many challenges related to ADHD can be managed or remodeled as assets in a workplace environment that fosters acceptance, flexible working practices and openness to neurodiversity.

Keywords: neurodivergence, occupation, workplace, person-environment fit

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28494 The Common Location and the Intensity of Surface Electrical Stimulation on the Thorax and Abdomen Areas: A Systematic Review

Authors: Vu Hoang Thu Huong

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Background: Surface electrical stimulation (SES) is a popular non-invasive approach that offers a wide range of treatments for many diseases of physical therapy. It involves applying electrical stimulation to the skin via surface electrodes to stimulate nerve fibers. SES was regularly used to treat the back and upper or lower extremities, but it was rarely used to treat the chest and abdomen. SES on the thorax and abdomen should be administered with more attention because crucial organs are under those areas (i.e., heart, lungs, liver, etc.). In these areas, safety precautions are suggested, and some SES applications might even be a contraindication. The fact that physical therapists have less experience with SES in these situations can also be attributed to these. Although a few earlier studies applied it to these settings and discovered hopeful results, none of them highlight the relationship between the intensity of SES and its depth of impact for safety considerations. Objective: To assure feasibility when using SES in these areas, the purpose of this study is to summarize the common location and intensity of those areas that have been conducted in previous studies. Method: A thorough systematic review was conducted to determine the common surface electrode position for the thorax and abdomen areas. The studies with the randomized controlled design were systematically searched using inclusion and exclusion criteria through nine electronic databases, including Pubmed, Scopus, etc., between 1975 and Dec 2021. Results: Thirty-three studies with over 1800 participants and 4 types of SES (TENS, IFC, NMES, and FES) with various categories of department hospitals were found. Following an anterior, lateral, and posterior observation, the particular SES positions found that it concentrated on 6 regions (the thoracic, abdomen, upper lateral, lower lateral, upper back, and lower back regions), and its intensity for each region was also summarized. Conclusion: This systematic review figured out the popular locations of SES in the thorax and abdominal areas as well as a summarized maximum of intensity that was found in previous studies with outstanding outcomes.

Keywords: surface electrical stimulation, electrical stimulation, thoracic, abdomen, abdominal.

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28493 Factor Associated with Smoking Cessation among Pregnant Woman: A Systematic Review

Authors: Galila Aisyah Latif Amini, Husnul Khatimah, Citra Amelia

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Smoking among women is of particular concern for the maternal and child health community due to the strong association between prenatal smoking and adverse birth outcomes. Pregnancy is perceived to be a unique reason for smoking cessation, as motivation to care for the unborn fetus. This study aimed to find out the determinants of smoking cessation among pregnant women. Method that we use in this study is systematic review. We identified relevant studies by searching on science database online through SAGE journals, Proquest, Scopus, Emerald, JSTOR, and Springerlink. Journals were screened by title and abstract according to the research topic then filtered using the criteria exclusion and inclusion. And then we did critical appraisal. The results of the four studies reviewed were found that the determinant of smoking cessation are parity, the level of education, socioeconomic status, household SHS exposure, smoking habits of both parents, partner smoking status, psychological factors, antenatal care, intervention for health care provider, age smoking duration. The factor most strongly associated with smoking cessation is parity (OR 2,55; Cl 2,34-2,77). The results of this study are expected to give advice for developing future smoking cessation and relapse prevention programs.

Keywords: pregnancy, smoking cessation, tobacco use cessation, smoking

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28492 Preparing and Scaling up Resiliency among Female Entrepreneurs in Mountain Environments

Authors: Shadreck Muchaku, Grey Magaiza, Jerit Dube

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The high insolvency rate of female-led emerging enterprises in the Southern African mountain region reflects the various vulnerabilities that exist. Although this is the case, there is a limited understanding of how these vulnerabilities influence entrepreneurship failure. This paper focuses on female entrepreneurs because of their role in economic development. Emerging female entrepreneurs in this region often operate in uncertain environments, which makes it difficult for them to thrive. The form and nature of entrepreneurial opportunities rural women of the Afro Montane region engage in are largely unsustainable as a lot of women struggle with confidence, and they need help with understanding their skills. However, there is still a gap in the existing literature on women entrepreneurship resilience and vulnerability reduction in the Afromontane. Furthermore, a major problem is the lack of empirical studies on this matter and limited studies indicating a general profile of emerging female entrepreneurs in this region. This systematic literature review attempts to fill in the gap of knowledge on entrepreneurship resilience and vulnerability reduction of emerging female entrepreneurs in the Afromontane regions and other similar precarious environments. In this review, we focus much on highlighting the nexus between entrepreneurship resilience and vulnerability reduction of emerging female entrepreneurs in academic literature through a chronological dispersal of publications in developing countries. This review adopts an ATLAS ti.22 software-based thematic analysis to analyze results obtained from reviewed academic journal articles. As research on entrepreneurship resilience and vulnerability reduction is still developing in the Sothern African mountain region, the results of this review will contribute to the body of literature and provide recommendations and a foundation for future research. This systematic review paper provides valuable insights and methodological approaches to scholarship in a nascent area of emerging female entrepreneurs in the Afromontane.

Keywords: entrepreneurship resiliency, vulnerability reduction, female entrepreneurs, mountain regions

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28491 First Systematic Review on Aerosol Bound Water: Exploring the Existing Knowledge Domain Using the CiteSpace Software

Authors: Kamila Widziewicz-Rzonca

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The presence of PM bound water as an integral chemical compound of suspended aerosol particles (PM) has become one of the hottest issues in recent years. The UN climate summits on climate change (COP24) indicate that PM of anthropogenic origin (released mostly from coal combustion) is directly responsible for climate change. Chemical changes at the particle-liquid (water) interface determine many phenomena occurring in the atmosphere such as visibility, cloud formation or precipitation intensity. Since water-soluble particles such as nitrates, sulfates, or sea salt easily become cloud condensation nuclei, they affect the climate for example by increasing cloud droplet concentration. Aerosol water is a master component of atmospheric aerosols and a medium that enables all aqueous-phase reactions occurring in the atmosphere. Thanks to a thorough bibliometric analysis conducted using CiteSpace Software, it was possible to identify past trends and possible future directions in measuring aerosol-bound water. This work, in fact, doesn’t aim at reviewing the existing literature in the related topic but is an in-depth bibliometric analysis exploring existing gaps and new frontiers in the topic of PM-bound water. To assess the major scientific areas related to PM-bound water and clearly define which among those are the most active topics we checked Web of Science databases from 1996 till 2018. We give an answer to the questions: which authors, countries, institutions and aerosol journals to the greatest degree influenced PM-bound water research? Obtained results indicate that the paper with the greatest citation burst was Tang In and Munklewitz H.R. 'water activities, densities, and refractive indices of aqueous sulfates and sodium nitrate droplets of atmospheric importance', 1994. The largest number of articles in this specific field was published in atmospheric chemistry and physics. An absolute leader in the quantity of publications among all research institutions is the National Aeronautics Space Administration (NASA). Meteorology and atmospheric sciences is a category with the most studies in this field. A very small number of studies on PM-bound water conduct a quantitative measurement of its presence in ambient particles or its origin. Most articles rather point PM-bound water as an artifact in organic carbon and ions measurements without any chemical analysis of its contents. This scientometric study presents the current and most actual literature regarding particulate bound water.

Keywords: systematic review, aerosol-bound water, PM-bound water, CiteSpace, knowledge domain

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28490 Assessing Solid Waste Management Practices and Health Impacts in Port Harcourt City, Nigeria

Authors: Perpetual Onyejelem, Kenichi Matsui

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Solid waste management has recently posed urgent challenges to environmental sustainability and public health in emerging Sub-Saharan urban centers. This paper examines solid waste management in Port Harcourt, the rapidly growing city in Nigeria, with a focus on current solid waste management practices and its health implications. To do so we analyzed past academic papers and official documents. The Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statement and its four-stage inclusion/exclusion criteria were utilized as part of a systematic literature review technique to identify papers related to solid waste management practices (Scopus and Google Scholar). In terms of policy documents, we focused on information about the implementation between 2014 and 2023. We found that the Rivers State Waste Management Policy and the National Policy on Solid Waste Management were the two most important documents to understand Port Harcourt’s practices. Past studies, however, highlighted that residents continued to dump waste in drainages as they were largely unaware of the policies that encourage them to sort waste. The studies tend to blame the city of its lack of political commitment to monitoring waste sites. Another study highlighted inefficient waste collection practices, the absence of community participation and poor resident awareness of 3R practices. Government documents and past studies tend to agree that an increase in disorderly waste management practices and the emergence of vector-borne diseases (e.g., malaria, lassa fever, cholera) co-incided in Port Harcourt. This led to increased spending for healthcare for locals, particularly low-income households. This study concludes by making some remedial recommendations.

Keywords: health effects, solid waste management practices, environmental pollution, Port Harcourt

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28489 Measuring Firms’ Patent Management: Conceptualization, Validation, and Interpretation

Authors: Mehari Teshome, Lara Agostini, Anna Nosella

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The current knowledge-based economy extends intellectual property rights (IPRs) legal research themes into a more strategic and organizational perspectives. From the diverse types of IPRs, patents are the strongest and well-known form of legal protection that influences commercial success and market value. Indeed, from our pilot survey, we understood that firms are less likely to manage their patents and actively used it as a tool for achieving competitive advantage rather they invest resource and efforts for patent application. To this regard, the literature also confirms that insights into how firms manage their patents from a holistic, strategic perspective, and how the portfolio value of patents can be optimized are scarce. Though patent management is an important business tool and there exist few scales to measure some dimensions of patent management, at the best of our knowledge, no systematic attempt has been made to develop a valid and comprehensive measure of it. Considering this theoretical and practical point of view, the aim of this article is twofold: to develop a framework for patent management encompassing all relevant dimensions with their respective constructs and measurement items, and to validate the measurement using survey data from practitioners. Methodology: We used six-step methodological approach (i.e., specify the domain of construct, item generation, scale purification, internal consistency assessment, scale validation, and replication). Accordingly, we carried out a systematic review of 182 articles on patent management, from ISI Web of Science. For each article, we mapped relevant constructs, their definition, and associated features, as well as items used to measure these constructs, when provided. This theoretical analysis was complemented by interviews with experts in patent management to get feedbacks that are more practical on how patent management is carried out in firms. Afterwards, we carried out a questionnaire survey to purify our scales and statistical validation. Findings: The analysis allowed us to design a framework for patent management, identifying its core dimensions (i.e., generation, portfolio-management, exploitation and enforcement, intelligence) and support dimensions (i.e., strategy and organization). Moreover, we identified the relevant activities for each dimension, as well as the most suitable items to measure them. For example, the core dimension generation includes constructs as: state-of-the-art analysis, freedom-to-operate analysis, patent watching, securing freedom-to-operate, patent potential and patent-geographical-scope. Originality and the Study Contribution: This study represents a first step towards the development of sound scales to measure patent management with an overarching approach, thus laying the basis for developing a recognized landmark within the research area of patent management. Practical Implications: The new scale can be used to assess the level of sophistication of the patent management of a company and compare it with other firms in the industry to evaluate their ability to manage the different activities involved in patent management. In addition, the framework resulting from this analysis can be used as a guide that supports managers to improve patent management in firms.

Keywords: patent, management, scale, development, intellectual property rights (IPRs)

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28488 Spatial-Temporal Clustering Characteristics of Dengue in the Northern Region of Sri Lanka, 2010-2013

Authors: Sumiko Anno, Keiji Imaoka, Takeo Tadono, Tamotsu Igarashi, Subramaniam Sivaganesh, Selvam Kannathasan, Vaithehi Kumaran, Sinnathamby Noble Surendran

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Dengue outbreaks are affected by biological, ecological, socio-economic and demographic factors that vary over time and space. These factors have been examined separately and still require systematic clarification. The present study aimed to investigate the spatial-temporal clustering relationships between these factors and dengue outbreaks in the northern region of Sri Lanka. Remote sensing (RS) data gathered from a plurality of satellites were used to develop an index comprising rainfall, humidity and temperature data. RS data gathered by ALOS/AVNIR-2 were used to detect urbanization, and a digital land cover map was used to extract land cover information. Other data on relevant factors and dengue outbreaks were collected through institutions and extant databases. The analyzed RS data and databases were integrated into geographic information systems, enabling temporal analysis, spatial statistical analysis and space-time clustering analysis. Our present results showed that increases in the number of the combination of ecological factor and socio-economic and demographic factors with above the average or the presence contribute to significantly high rates of space-time dengue clusters.

Keywords: ALOS/AVNIR-2, dengue, space-time clustering analysis, Sri Lanka

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28487 Desk Graffiti as Art, Archive or Collective Knowledge Sharing: A Case Study of Schools in Addis Ababa, Ethiopia

Authors: Behailu Bezabih Ayele

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Illustrative expressions in art education and in overall learning are being given increasing attention in the transmission of knowledge. The objective of this paper, therefore, is to present an analysis of graffiti on school desks-a way of smuggling knowledge on the edge of classroom education and learning. The methodological approach focuses on the systematic collection and selection of desk graffiti. Four schools are chosen to reflect socioeconomic status and gender composition. The analysis focused on the categorization of graffiti by genre. This was followed by an analysis of the style, intensity as well as content of the messages in terms of overall social impacts. The paper grounds the analysis by reviewing the literature on modern education and art education in the Ethiopian context, as well as the place of desk graffiti. The findings generally show that the school desks and the school environment, by and large, have managed to serve as vessels through which formal and informal knowledge is acquired, transmitted, engrained into the students and transformed into messages by the students. The desks have also apparently served as a springboard to maximize the interfaces between several ideas and disciplines and communications. However, the very fact that the desks serve as massive channels of expression and knowledge transmission also points to a lack of breadth availability of channels of expression, perhaps confounding the ability of classrooms as means of outlet of expression and documentation for the students. This points to the need for efforts in education policy and funding of artistic endeavors for young students.

Keywords: artistic expression, desk graffiti, education, school children, Ethiopia

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28486 Tandem Concentrated Photovoltaic-Thermoelectric Hybrid System: Feasibility Analysis and Performance Enhancement Through Material Assessment Methodology

Authors: Shuwen Hu, Yuancheng Lou, Dongxu Ji

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Photovoltaic (PV) power generation, as one of the most commercialized methods to utilize solar power, can only convert a limited range of solar spectrum into electricity, whereas the majority of the solar energy is dissipated as heat. To address this problem, thermoelectric (TE) module is often integrated with the concentrated PV module for waste heat recovery and regeneration. In this research, a feasibility analysis is conducted for the tandem concentrated photovoltaic-thermoelectric (CPV-TE) hybrid system considering various operational parameters as well as TE material properties. Furthermore, the power output density of the CPV-TE hybrid system is maximized by selecting the optimal TE material with application of a systematic assessment methodology. In the feasibility analysis, CPV-TE is found to be more advantageous than sole CPV system except under high optical concentration ratio with low cold side convective coefficient. It is also shown that the effects of the TE material properties, including Seebeck coefficient, thermal conductivity, and electrical resistivity, on the feasibility of CPV-TE are interacted with each other and might have opposite effect on the system performance under different operational conditions. In addition, the optimal TE material selected by the proposed assessment methodology can improve the system power output density by 227 W/m2 under highly concentrated solar irradiance hence broaden the feasible range of CPV-TE considering optical concentration ratio.

Keywords: feasibility analysis, material assessment methodology, photovoltaic waste heat recovery, tandem photovoltaic-thermoelectric

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28485 Systematic Review of Digital Interventions to Reduce the Carbon Footprint of Primary Care

Authors: Anastasia Constantinou, Panayiotis Laouris, Stephen Morris

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Background: Climate change has been reported as one of the worst threats to healthcare. The healthcare sector is a significant contributor to greenhouse gas emissions with primary care being responsible for 23% of the NHS’ total carbon footprint. Digital interventions, primarily focusing on telemedicine, offer a route to change. This systematic review aims to quantify and characterize the carbon footprint savings associated with the implementation of digital interventions in the setting of primary care. Methods: A systematic review of published literature was conducted according to PRISMA (Preferred Reporting Item for Systematic Reviews and Meta-Analyses) guidelines. MEDLINE, PubMed, and Scopus databases as well as Google scholar were searched using key terms relating to “carbon footprint,” “environmental impact,” “sustainability”, “green care”, “primary care,”, and “general practice,” using citation tracking to identify additional articles. Data was extracted and analyzed in Microsoft Excel. Results: Eight studies were identified conducted in four different countries between 2010 and 2023. Four studies used interventions to address primary care services, three studies focused on the interface between primary and specialist care, and one study addressed both. Digital interventions included the use of mobile applications, online portals, access to electronic medical records, electronic referrals, electronic prescribing, video-consultations and use of autonomous artificial intelligence. Only one study carried out a complete life cycle assessment to determine the carbon footprint of the intervention. It estimate that digital interventions reduced the carbon footprint at primary care level by 5.1 kgCO2/visit, and at the interface with specialist care by 13.4 kg CO₂/visit. When assessing the relationship between travel-distance saved and savings in emissions, we identified a strong correlation, suggesting that most of the carbon footprint reduction is attributed to reduced travel. However, two studies also commented on environmental savings associated with reduced use of paper. Patient savings in the form of reduced fuel cost and reduced travel time were also identified. Conclusion: All studies identified significant reductions in carbon footprint following implementation of digital interventions. In the future, controlled, prospective studies incorporating complete life cycle assessments and accounting for double-consulting effects, use of additional resources, technical failures, quality of care and cost-effectiveness are needed to fully appreciate the sustainable benefit of these interventions

Keywords: carbon footprint, environmental impact, primary care, sustainable healthcare

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28484 Occupational Health Programs for Artisanal and Small-Scale Gold Mining: A Systematic Review for the WHO Global Plan of Action for Workers' Health

Authors: Vivian W. L. Tsang, Karen Lockhart, Samuel Spiegel, Annalee Yassi

Abstract:

Background: Workers in the informal economy often incur exposure to well-documented occupational health hazards. Insufficient attention has been afforded to rigorously evaluating intervention programs to reduce the risks, especially in artisanal and small-scale gold mining (ASGM). Objectives: This systematic review, conducted as part of the World Health Organization’s Global Plan of Action for Workers’ Health, sought to assess the state of knowledge on occupational health programs and interventions for the informal artisanal and small-scale gold mining (ASGM) sector, an occupation which directly employs at least 50 million people. Methods: We used a comprehensive search strategy for four well-known databases relevant to health outcomes: PubMed, Engineering Village, OVID Medline, and Web of Science, and employed the PRISMA framework for our analysis. Findings: Ten studies met the inclusion criteria of a primary study focused on assessing the impact of interventions addressing occupational health concerns in ASGM. There were no studies evaluating or even identifying comprehensive occupational health and safety programs for this sector, although target interventions addressing specific hazards exist. Major areas of intervention –education and introduction of mercury-reducing/eliminating technology were identified, and the challenges and limitations of each intervention taken into the assessment. Even for these, however, there was a lack of standardization for measuring outcome or impact, let alone long-term health outcomes for miners and mining communities. Conclusion: There is an urgent need for research on comprehensive occupational health programs addressing the array of hazards faced by artisanal and small-scale miners.

Keywords: informal economy, artisanal and small-scale gold mining, occupational health, health and safety, workplace safety

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28483 On the Paradigm Shift of the Overall Urban Design in China

Authors: Gaoyuan Wang, Tian Chen, Junnan Liu

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Facing a period of major change that’s rarely seen in a century, China formulates the 14th Five-Year Plan and places emphasis on promoting high-quality development. In this context, the overall urban design has become a crucial and systematic tool for high-quality urban development. However, there are bottlenecks in the nature definition, content scope and transmission mechanisms of the current overall urban design in China. The paper interprets the emerging demands of the 14th Five-Year Plan on urban design in terms of new value-quality priority, new dynamic-space performance, new target-region coordination and new path-refined governance. Based on the new trend and appeal, the multi-dimensional thinking integrated with the major tasks of urban design are proposed accordingly, which is the biomass thinking in ecological, production and living element, the strategic thinking in spatial structure, the systematic thinking in the cityscape, the low-carbon thinking in urban form, the governance thinking in public space, the user thinking in design implementation. The paper explores the possibility of transforming the value thinking and technical system of urban design in China and provides a breakthrough path for the urban planning and design industry to better respond to the propositions of the country’s 14th Five-Year Plan.

Keywords: China’s 14th five-year plan, overall urban design, urban design thinking, transformation of urban design

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28482 Lead and Cadmium Spatial Pattern and Risk Assessment around Coal Mine in Hyrcanian Forest, North Iran

Authors: Mahsa Tavakoli, Seyed Mohammad Hojjati, Yahya Kooch

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In this study, the effect of coal mining activities on lead and cadmium concentrations and distribution in soil was investigated in Hyrcanian forest, North Iran. 16 plots (20×20 m2) were established by systematic-randomly (60×60 m2) in an area of 4 ha (200×200 m2-mine entrance placed at center). An area adjacent to the mine was not affected by the mining activity; considered as the controlled area. In order to investigate soil lead and cadmium concentration, one sample was taken from the 0-10 cm in each plot. To study the spatial pattern of soil properties and lead and cadmium concentrations in the mining area, an area of 80×80m2 (the mine as the center) was considered and 80 soil samples were systematic-randomly taken (10 m intervals). Geostatistical analysis was performed via Kriging method and GS+ software (version 5.1). In order to estimate the impact of coal mining activities on soil quality, pollution index was measured. Lead and cadmium concentrations were significantly higher in mine area (Pb: 10.97±0.30, Cd: 184.47±6.26 mg.kg-1) in comparison to control area (Pb: 9.42±0.17, Cd: 131.71±15.77 mg.kg-1). The mean values of the PI index indicate that Pb (1.16) and Cd (1.77) presented slightly polluted. Results of the NIPI index showed that Pb (1.44) and Cd (2.52) presented slight pollution and moderate pollution respectively. Results of variography and kriging method showed that it is possible to prepare interpolation maps of lead and cadmium around the mining areas in Hyrcanian forest. According to results of pollution and risk assessments, forest soil was contaminated by heavy metals (lead and cadmium); therefore, using reclamation and remediation techniques in these areas is necessary.

Keywords: traditional coal mining, heavy metals, pollution indicators, geostatistics, Caspian forest

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28481 The Ecosystem of Food Allergy Clinical Trials: A Systematic Review

Authors: Eimar Yadir Quintero Tapias

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Background: Science is not generally self-correcting; many clinical studies end with the same conclusion "more research is needed." This study hypothesizes that first, we need a better appraisal of the available (and unavailable) evidence instead of creating more of the same false inquiries. Methods: Systematic review of ClinicalTrials.gov study records using the following Boolean operators: (food OR nut OR milk OR egg OR shellfish OR wheat OR peanuts) AND (allergy OR allergies OR hypersensitivity OR hypersensitivities). Variables included the status of the study (e g., active and completed), availability of results, sponsor type, sample size, among others. To determine the rates of non-publication in journals indexed by PubMed, an advanced search query using the specific Number of Clinical Trials (e.g., NCT000001 OR NCT000002 OR...) was performed. As a prophylactic measure to prevent P-hacking, data analyses only included descriptive statistics and not inferential approaches. Results: A total of 2092 study records matched the search query described above (date: September 13, 2019). Most studies were interventional (n = 1770; 84.6%) and the remainder observational (n = 322; 15.4%). Universities, hospitals, and research centers sponsored over half of these investigations (n = 1208; 57.7%), 308 studies (14.7%) were industry-funded, and 147 received NIH grants; the remaining studies got mixed sponsorship. Regarding completed studies (n = 1156; 55.2%), 248 (21.5%) have results available at the registry site, and 417 (36.1%) matched NCT numbers of journal papers indexed by PubMed. Conclusions: The internal and external validity of human research is critical for the appraisal of medical evidence. It is imperative to analyze the entire dataset of clinical studies, preferably at a patient-level anonymized raw data, before rushing to conclusions with insufficient and inadequate information. Publication bias and non-registration of clinical trials limit the evaluation of the evidence concerning therapeutic interventions for food allergy, such as oral and sublingual immunotherapy, as well as any other medical condition. Over half of the food allergy human research remains unpublished.

Keywords: allergy, clinical trials, immunology, systematic reviews

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28480 Probiotics in Anxiety and Depression

Authors: Pilar Giffenig, Avanna Kotlarz, Taylor Dehring

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Anxiety and depression are common mental illnesses in the U.S today. While there are various treatments for these mental health disorders, many of the medications come with a large variety of side effects that decrease medication compliance. Recent studies have looked at the impact of probiotics on anxiety and depression. Our goal was to determine whether probiotics could help relieve symptoms of anxiety and or depression. We conducted a literature search of three databases focusing on systematic reviews and RTC and found 25 articles, 8 of which were used for our analysis. Seven out of the eight articles showed that probiotics have the potential to significantly reduce symptoms of anxiety and depression. However, larger study sample sizes, type of probiotic, and correct dosage are required in future research to determine the role of probiotics in the treatment of anxiety and depression.

Keywords: probiotics, anxiety, depression, treatment, psychology, nutrition

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28479 PH.WQT as a Web Quality Model for Websites of Government Domain

Authors: Rupinder Pal Kaur, Vishal Goyal

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In this research, a systematic and quantitative engineering-based approach is followed by applying well-known international standards and guidelines to develop a web quality model (PH.WQT- Punjabi and Hindi Website Quality Tester) to measure external quality for websites of government domain that are developed in Punjabi and Hindi. Correspondingly, the model can be used for websites developed in other languages also. The research is valuable to researchers and practitioners interested in designing, implementing and managing websites of government domain Also, by implementing PH.WQT analysis and comparisons among web sites of government domain can be performed in a consistent way.

Keywords: external quality, PH.WQT, indian languages, punjabi and hindi, quality model, websites of government

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28478 The Perception of Stallholders About the Early Childhood Education Male Teachers: A Systematic Review

Authors: Endale Fantahun Tadesse, Sabika Khalid

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The global call for increased male representation in early childhood education (ECE) has garnered significant attention. Emerging studies have indicated that involving men in ECE can yield positive outcomes for children's physical and psychological development. Challenging the prevailing misconception and stereotype that women dominate the ECE sector is crucial. In light of this, the present study undertakes a systematic review of nine studies on males working in ECE, revealing a dearth of male presence in the field in China as well. To address this issue, substantial structural changes must be implemented to enhance the inadequate pay and working conditions that dissuade both men and women from pursuing a sustainable career in ECE. It is recommended that school leadership raise awareness among female teachers and parents, encouraging them to support and uphold virtuous values for male teachers. Additionally, governing bodies should provide explicit guidelines during training programs to address concerns regarding potential abuse and gender biases. The findings of this review underscore the need for future studies to examine the self-identities of male teachers from various stakeholders' perspectives and explore the consequences of being in the profession through rigorous and robust methodologies that can inform policymakers.

Keywords: male teachers, Early Childhood Education (ECE), self-identity, perception of stakeholders

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28477 Local Boundary Analysis for Generative Theory of Tonal Music: From the Aspect of Classic Music Melody Analysis

Authors: Po-Chun Wang, Yan-Ru Lai, Sophia I. C. Lin, Alvin W. Y. Su

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The Generative Theory of Tonal Music (GTTM) provides systematic approaches to recognizing local boundaries of music. The rules have been implemented in some automated melody segmentation algorithms. Besides, there are also deep learning methods with GTTM features applied to boundary detection tasks. However, these studies might face constraints such as a lack of or inconsistent label data. The GTTM database is currently the most widely used GTTM database, which includes manually labeled GTTM rules and local boundaries. Even so, we found some problems with these labels. They are sometimes discrepancies with GTTM rules. In addition, since it is labeled at different times by multiple musicians, they are not within the same scope in some cases. Therefore, in this paper, we examine this database with musicians from the aspect of classical music and relabel the scores. The relabeled database - GTTM Database v2.0 - will be released for academic research usage. Despite the experimental and statistical results showing that the relabeled database is more consistent, the improvement in boundary detection is not substantial. It seems that we need more clues than GTTM rules for boundary detection in the future.

Keywords: dataset, GTTM, local boundary, neural network

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28476 Novel Framework for MIMO-Enhanced Robust Selection of Critical Control Factors in Auto Plastic Injection Moulding Quality Optimization

Authors: Seyed Esmail Seyedi Bariran, Khairul Salleh Mohamed Sahari

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Apparent quality defects such as warpage, shrinkage, weld line, etc. are such an irresistible phenomenon in mass production of auto plastic appearance parts. These frequently occurred manufacturing defects should be satisfied concurrently so as to achieve a final product with acceptable quality standards. Determining the significant control factors that simultaneously affect multiple quality characteristics can significantly improve the optimization results by eliminating the deviating effect of the so-called ineffective outliers. Hence, a robust quantitative approach needs to be developed upon which major control factors and their level can be effectively determined to help improve the reliability of the optimal processing parameter design. Hence, the primary objective of current study was to develop a systematic methodology for selection of significant control factors (SCF) relevant to multiple quality optimization of auto plastic appearance part. Auto bumper was used as a specimen with the most identical quality and production characteristics to APAP group. A preliminary failure modes and effect analysis (FMEA) was conducted to nominate a database of pseudo significant significant control factors prior to the optimization phase. Later, CAE simulation Moldflow analysis was implemented to manipulate four rampant plastic injection quality defects concerned with APAP group including warpage deflection, volumetric shrinkage, sink mark and weld line. Furthermore, a step-backward elimination searching method (SESME) has been developed for systematic pre-optimization selection of SCF based on hierarchical orthogonal array design and priority-based one-way analysis of variance (ANOVA). The development of robust parameter design in the second phase was based on DOE module powered by Minitab v.16 statistical software. Based on the F-test (F 0.05, 2, 14) one-way ANOVA results, it was concluded that for warpage deflection, material mixture percentage was the most significant control factor yielding a 58.34% of contribution while for the other three quality defects, melt temperature was the most significant control factor with a 25.32%, 84.25%, and 34.57% contribution for sin mark, shrinkage and weld line strength control. Also, the results on the he least significant control factors meaningfully revealed injection fill time as the least significant factor for both warpage and sink mark with respective 1.69% and 6.12% contribution. On the other hand, for shrinkage and weld line defects, the least significant control factors were holding pressure and mold temperature with a 0.23% and 4.05% overall contribution accordingly.

Keywords: plastic injection moulding, quality optimization, FMEA, ANOVA, SESME, APAP

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28475 A Research on a Historical Architectural Heritage of the Village: Zriba El Olia

Authors: Yosra Ben Salah, Wang Li Jun, Salem Bellil

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The village Hammem Zriba is a lost little paradise in the middle of a beautiful landscape that captures the eyes of every visitor. The village alone is a rich expression of different elements such as urban, architecture, technical and vernacular elements, as well as sociological, spiritual and religious behaviors. This heritage is in degrading conditions and is threatened by disappearing soon; thus, actions have to be taken as soon as possible to preserve this heritage, record, analyze and learn from its traditional ways of construction. The strategy of this study is to examine the architecture within the Berber society over a period of time and influenced by a certain location and its relationship to the social and cultural aspects; this research will focus on historical, environmental, social and cultural aspects influencing architecture. The contents of this paper should mainly be constructed by three successive layouts of historical view, a cultural view and an architectural view that will include the urban and domestic scale. This research relies on the integration of both theoretical and empirical investigations. On the theoretical level: A documentary analysis of secondary data is used. Documentary analysis means content analysis of the relevant documents that include books, journals, magazines, archival data, and field survey and observations. On the empirical level: analysis of these traditional ways of planning and house building will be carried out. Through the Analysis, three techniques will be employed to collect primary data. These techniques are; systematic analysis of the architectural drawings, quantitative analysis to the houses statistics, and a direct observation. Through this research, the technical, architectural and urban achievements of the Berber people who represent a part of the general history and architectural history will be emphasized. And on a second point the potential for the sustainability present in this traditional urban planning and housing to be used to formulate guidelines for modern urban and housing development.

Keywords: culture, history, traditional architecture, values

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28474 The Relationship between the Skill Mix Model and Patient Mortality: A Systematic Review

Authors: Yi-Fung Lin, Shiow-Ching Shun, Wen-Yu Hu

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Background: A skill mix model is regarded as one of the most effective methods of reducing nursing shortages, as well as easing nursing staff workloads and labor costs. Although this model shows several benefits for the health workforce, the relationship between the optimal model of skill mix and the patient mortality rate remains to be discovered. Objectives: This review aimed to explore the relationship between the skill mix model and patient mortality rate in acute care hospitals. Data Sources: A systematic search of the PubMed, Web of Science, Embase, and Cochrane Library databases and researchers retrieved studies published between January 1986 and March 2022. Review methods: Two independent reviewers screened the titles and abstracts based on selection criteria, extracted the data, and performed critical appraisals using the STROBE checklist of each included study. The studies focused on adult patients in acute care hospitals, and the skill mix model and patient mortality rate were included in the analysis. Results: Six included studies were conducted in the USA, Canada, Italy, Taiwan, and European countries (Belgium, England, Finland, Ireland, Spain, and Switzerland), including patients in medical, surgical, and intensive care units. There were both nurses and nursing assistants in their skill mix team. This main finding is that three studies (324,592 participants) show evidence of fewer mortality rates associated with hospitals with a higher percentage of registered nurse staff (range percentage of registered nurse staff 36.1%-100%), but three articles (1,122,270 participants) did not find the same result (range of percentage of registered nurse staff 46%-96%). However, based on appraisal findings, those showing a significant association all meet good quality standards, but only one-third of their counterparts. Conclusions: In light of the limited amount and quality of published research in this review, it is prudent to treat the findings with caution. Although the evidence is not insufficient certainty to draw conclusions about the relationship between nurse staffing level and patients' mortality, this review lights the direction of relevant studies in the future. The limitation of this article is the variation in skill mix models among countries and institutions, making it impossible to do a meta-analysis to compare them further.

Keywords: nurse staffing level, nursing assistants, mortality, skill mix

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