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This study compared syntactic complexity between undergraduate students' research papers and published research papers. A 2 (Groups: experts, students) × 4 (Sections: introduction, methods, results, discussions) mixed factorial analysis of variance (ANOVA) was conducted on each of the following variables: T-unit length, clause density, the frequencies of adverbial clauses, relative clauses, and nominal clauses. The analyses showed there were longer T-units and fewer adverbial clauses in the published papers than in the student papers. Section effects were robust. Qualitative analyses were further conducted to reveal how the student research paper is different from the published papers syntactically. Implications for education were discussed. [ABSTRACT FROM AUTHOR]

The apps for drawing are present in our children's life. Nevertheless, little is known about the impact of mobile technology on the freehand drawing educational activity. There are few works which are contextualised within short periods of time, with teachers who are not theirs and, in some cases, outside the children's classroom. In this paper, we are focussed on the use of technology on freehand drawing activity. Thus, we have compared the graphics produced by 4- and 5-year-old children with paper&crayon in comparison with those with tablet-finger. Children made the drawings during a planned free-drawing activity, in their ordinary classrooms, with their teachers and during five sessions. Assessment of drawings has evidenced tablet feasibility for making graphics. Nevertheless, with the passing of time, quality of graphics (tablet-finger vs paper&crayons), are nearly matched, demonstrating the low impact level technology has on this activity. In addition, if drawings are analysed specifically according to ages, results have shown that both groups have to develop adaptation strategies of visual perceptual skills and fine motor skills for the touch screen in order to obtain the same quality in the drawings made on both support types. [ABSTRACT FROM AUTHOR]

A novel approach for paper drying using airborne ultrasound technology is presented. A unique experimental setup is developed, and a systematic study is conducted using 23 factorial design of experiments and Analysis of Variance. Three controlling factors are considered in the experiments including the initial moisture content, basis weight and refining condition. The outcome of the experiments is compared to a previous work on direct-contact ultrasonic drying of paper. The results confirm that similar to direct-contact, for airborne ultrasonic drying, the basis weight/thickness of the sample is the most important factor in ultrasonic drying and it is followed by the effect of initial moisture content. Using linear regression model, a correlation for predicting the total time of ultrasonic drying is provided. Quality of the dried samples is evaluated, and the permeability measurements confirmed the effect of pore characteristics on ultrasonic drying. The analysis for energy consumption reveals that airborne ultrasonic drying is more efficient at higher moisture contents. [ABSTRACT FROM AUTHOR]

A systematic-study is conducted using an innovative technology for paper drying by applying ultrasound mechanism. The advantages include greater energy efficiency, lower drying time and temperature, improvement of the product quality, and it is considered a green technology. The effects of initial moisture content, thickness, and refining condition are studied for different types of pulps (hardwood and softwood) using 23 factorial design of experiments. Analysis of Variance show that in the range of the studied parameters, thickness has the maximum effect on ultrasonic drying time followed by the initial moisture content. In addition, using a linear regression model, a relationships for the total time of drying is provided. The results confirmed that ultrasonic drying is more efficient at higher moisture content and higher thickness of the sample. These results are related to the structural characteristic of the samples such as porosity, pore distribution, and surface roughness. [ABSTRACT FROM AUTHOR]

Background: The Integrated Palliative Care Outcome Scale (IPOS) validly and reliably measures symptoms and concerns of those receiving palliative care. Aim: To determine the equivalence of the paper version with an electronic version of the IPOS (eIPOS). Design: Multicentre randomised crossover trial (NCT03879668) with a within-subject comparison of the two modes (washout period 30 min). Setting/Participants: Convenience sample of specialist inpatient and palliative home care patients aged over 18 years with cancer and non-cancer conditions was recruited. Scores were compared using intraclass correlation coefficients (ICC), Bland-Altman plots and via a mixed-effects analysis of variance. Results: Fifty patients were randomised to complete paper-electronic (n = 24) and electronic-paper (n = 26) IPOS with median age 69 years (range 24–95), 56% male, 16% non-cancer. The ICCs showed very high concordance for the total score (ICC 0.99, 95% CI 0.98–1.00), lowest ICCs being observed for symptoms 'Appetite loss' and 'Drowsiness' (ICC 0.95, 95% CI 0.92–0.97). Nine of seventeen items had ICCs above 0.98, as did all subscales. No statistically significant mode, order, age, and interaction effects were observed for IPOS total score and subscales, except for 'Communication' (Fmode = 5.9, p = 0.019). Fifty-eight percent preferred the electronic version. In the group 75+ years, 53% preferred the paper version. Only three entries in the free-text main problems differed between the versions. Conclusion: The very high equivalence in scores and free text between the IPOS and the eIPOS demonstrates that eIPOS is feasible and reliable in an older palliative population. [ABSTRACT FROM AUTHOR]

The aim of this study is to employ a response surface methodology (RSM) to optimize experimental parameters in microfluidic paper-based analytical devices (µ-PADs). The independent parameters include concentrations and volumes of acetylcholinesterase, acetylthiocholine iodide, and 5,5-dithiobis-(2-nitrobenzoic acid). Their effect on mean color intensity was tested and optimized. From the analysis of variance, high regression and fitting values were obtained between the experimental and RSM predicted mean color intensity. Under optimum conditions, satisfactory linearity (R2 > 0.9990) in the range of 0.25–16 mg/L was obtained for the studied pesticides. The limit of detection (LOD) varies from 0.13 to 0.27 mg/L; high precision (RSD of 3.8–8.0%), reproducibility (RSD of 7.2–11.0%), and recovery (78–97%) were achieved. The RSM approach has been demonstrated to be more efficient than the traditional approach. It resulted in a µ-PAD system with less amount of reagent usage and better LOD compared with a univariate approach. [ABSTRACT FROM AUTHOR]

Appropriate paper-based technology (APT) is used to provide postural support for children with cerebral palsy (CP) in low-resourced settings. This pilot study aimed to evaluate the impact of APT on the children's and families' lives. A convenience sample of children with CP and their families participated. Inclusion was based on the Gross Motor Function Classification System levels IV and V. APT seating or standing frames were provided for six months. A mixed methods impact of APT devices on the children and families included the Family Impact Assistive Technology Scale for Adaptive Seating (FIATS-AS); the Child Engagement in Daily Life (CEDL) questionnaire; and a qualitative assessment from diary/log and semi-structured interviews. Ten children (median 3 years, range 9 months to 7 years). Baseline to follow-up median (IQR) FIATS-AS were: 22.7 (9.3) and 30.3 (10.2), respectively (p=.002). Similarly mean (SD) CEDL scores for "frequency" changed from 30.5 (13.2) to 42.08 (5.96) (p=.021) and children's enjoyment scores from 2.23 (0.93) to 2.91 (0.79) (p=.019). CEDL questionnaire for self-care was not discriminatory; seven families scored zero at both baseline and 6 months. Qualitative interviews revealed three key findings; that APT improved functional ability, involvement/interaction in daily-life situations, and a reduced family burden of care. APT devices used in Kenyan children with non-ambulant CP had a meaningful positive effect on both the children's and their families' lives. Assistive devices are often unobtainable for children with cerebral palsy (CP) in low-income countries. APT is a low cost and sustainable solution to make seating and standing devices for disabled children in Kenya. The regular use of a postural support device enhanced the children's motor skills, ability to function and participate in everyday activities, reduced the burden of care for the families and promoted the children's social interaction. The postural support devices were highly valued and utilised by the children and families in this study. [ABSTRACT FROM AUTHOR]

Objective: The medical record is critical for documentation and communication between healthcare professionals. This study compared the completeness of orthopaedic documentation between the electronic medical record (EMR) and paper medical record (PMR). Methods: A review was undertaken of 400 medical records (200 EMR, 200 PMR) of patients with operatively managed traumatic lower limb injury. The operative report, discharge summary and first and second out-patient reviews were evaluated using criteria designed by a senior orthopaedic surgeon and senior physiotherapist. The criteria included information deemed critical to the post-operative care of the patient in the first 6 weeks post-surgery. Results: In all cases, an operative report was completed by a senior surgeon. Notable findings included inferior documentation of patient weight-bearing status on the operative report in the EMR than PMR group (P = 0.018). There was a significant improvement in the completion of discharge summaries in the EMR compared with PMR cohort (100% vs 82.5% respectively; P < 0.001). In the PMR group, 70.0% of discharge summaries were completed and adequately documented, compared with 91.5% of those in the EMR group (P < 0.001). At out-patient review, there was an improvement in documentation of weight-bearing instructions in the EMR compared with PMR group (81.1% vs 76.2% respectively; P = 0.032). Conclusion: The EMR is associated with an improvement in the standard of orthopaedic medical record documentation, but deficiencies remain in key components of the medical record. What is known about the topic?: Medical records are an essential tool in modern medical practice and have significant implications for patient care and management, communication and medicolegal issues. Despite the importance of comprehensive documentation, numerous examples of poor documentation continue to be demonstrated. Recently, significant changes to the medical record in Australia have been implemented with the conversion of some hospitals to an EMR and the implementation of the My Health Record. What does this paper add?: Standards of patient care should be monitored continuously and deficiencies identified in order to implement measures for improvement and to close the quality loop. This study has highlighted that although there has been improvement in medical record keeping with the implementation of an EMR, the standard of orthopaedic medical record keeping continues to be below what is expected, and several key areas of documentation require improvement. What are the implications for practitioners?: The implications of these findings for practitioners are to highlight current deficiencies in documentation and promote change in current practice to improve the quality of medical record documentation among medical staff. Although the EMR has improved documentation, there remain areas for further improvement, and hospital administrators will find these observations useful in implementing ongoing change. [ABSTRACT FROM AUTHOR]

Research on soil microplastics is currently at an early stage, and there is no widely approved sampling protocol. Even so, any basic research should minimize errors to ensure that they are not amplified in future research. This paper examines some weaknesses of the original research paper 'Soil microplastic pollution under different land uses in tropics, southwestern China' recently published in this journal. The authors neglected to report the equipment used for soil sampling and did not use field blank samples. There is also a soil layer that was incorrectly named. The type and pore size of filter paper used for filtration during pre-analytical soil sample preparation is very important. In this paper the nature of the filter paper used, and its larger pore sizes are questionable by today's scientists. In addition, the authors in the original paper also overlooked reporting the statistical package used for statical analysis and ensuring if all data sets obey normality, homogeneity, and equality before running the one-way ANOVA test. This statistical step is widely considered mandatory, especially in the soil science community. So, this makes it difficult to trust the results documented. Furthermore, in the original paper, the needle and stereo microscope instruments used to sort microplastic-like materials prior to proper analysis are not reliable. [Display omitted] • A dissecting needle and stereo microscope shouldn't be used to sort out soil microplastics. • Gold-coated filter paper with smaller pore size is better than nitrocellulose filter paper. • The 0–10cm is the top soil layer and 10–20cm is the subsoil layer not a deep soil layer. • The statistical package used for analysis must be documented accordingly. • If the dataset is a normal distribution prior to ANOVA testing, it must be confirmed and reported. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To develop an automated algorithm to detect, quantify, and differentiate between tremor using pen-on-paper spirals. METHODS: Patients with essential tremor (n = 25), dystonic tremor (n = 25), Parkinson’s disease (n = 25), and healthy volunteers (HV, n = 25) drew free-hand spirals. The algorithm derived the mean deviation (MD) and tremor variability from scanned images. MD and tremor variability were compared with 1) the Bain and Findley scale, 2) the Fahn–Tolosa–Marin tremor rating scale (FTM–TRS), and 3) the peak power and total power of the accelerometer spectra. Inter and intra loop widths were computed to differentiate between the tremor. RESULTS: MD was higher in the tremor group (48.9±26.3) than in HV (26.4±5.3; p < 0.001). The cut-off value of 30.3 had 80.9% sensitivity and 76.0% specificity for the detection of the tremor [area under the curve: 0.83; 95% confidence index (CI): 0.75, 0.91, p < 0.001]. MD correlated with the Bain and Findley ratings (rho = 0.491, p = 0 < 0.001), FTM–TRS part B (rho = 0.260, p = 0.032) and accelerometric measures of postural tremor (total power, rho = 0.366, p < 0.001; peak power, rho = 0.402, p < 0.001). Minimum Detectable Change was 19.9%. Inter loop width distinguished Parkinson’s disease spirals from dystonic tremor (p < 0.001, 95% CI: 54.6, 211.1), essential tremor (p = 0.003, 95% CI: 28.5, 184.9), or HV (p = 0.036, 95% CI: -160.4, -3.9). CONCLUSION: The automated analysis of pen-on-paper spirals generated robust variables to quantify the tremor and putative variables to distinguish them from each other. SIGNIFICANCE: This technique maybe useful for epidemiological surveys and follow-up studies on tremor. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to evaluate the effects of uncoated paper on skin moisture, pressure injury risk and pressure injury incidence in neurological intensive care unit patients. Methods: A randomized controlled design was used. The experimental group (n = 68) received usual care (repositioning every 2 h and use of an air mattress) and application of uncoated paper on the sacral area for 5 days, whereas the control group (n = 67) received only usual care. A repeated measures analysis of variance was used to determine changes in the skin moisture and risk of pressure injury between the groups. A chi‐squared test was used to determine the change in the incidence of pressure injuries for sacral area. Data were collected from 20 October 2017 to 6 March 2018. Results: There were statistically significant differences in the skin moisture and risk of pressure injuries between the experimental and control groups. However, a significant difference was not observed in the incidence of pressure injuries between the groups. Conclusion: The use of uncoated paper may be a valid nursing intervention for the prevention of pressure injuries in neurological intensive care unit patients. SUMMARY STATEMENT: What is already known about this topic? The neurological intensive care unit patients with motor deficits, loss or deterioration of sensory function and decreased consciousness have high risk of pressure injuries.Although various guidelines consider excessive skin moisture as an important cause of pressure injuries, few targeted interventions exist to manage excessive skin moisture. What this paper adds? The uncoated paper application was effective in reducing skin moisture in neurologic intensive care unit patients.In addition, application of uncoated paper application has an effect on risk of pressure injury in neurologic intensive care unit patients. The implications of this paper: The use of uncoated paper may be a valid nursing intervention for the prevention of pressure injuries in neurological intensive care unit patients.Nurses should recognize that pressure injuries are potentially preventable adverse events and use various preventive interventions including skin moisture management. [ABSTRACT FROM AUTHOR]

Urine is the best specimen for the diagnosis of congenital cytomegalovirus, but collection and processing of liquid urine are impractical for screening. Urine dried on filter paper was processed by the same convenient, low-cost method used by newborn screening to test blood spots and showed high sensitivity and specificity. [ABSTRACT FROM AUTHOR]

Two quantitative, environment-friendly and easily monitored assays for Ni (II) and Co (III) ions analysis in different lipstick samples collected from 500-Iraqi dinars stores located in Baghdad were introduced. The study was based on the reaction of nickel (II) ions with dimethylglyoxime (DMG) reagent and the reaction of cobalt (III) ions with 1-nitroso-2-naphthol (NN) reagent to produce colored products. The color change was measured by spectrophotometric method at 565 nm and 430 nm for Ni and Co, respectively, with linear calibration graphs in the concentration range 0.25-100 mg L-1 (Ni) and 0.5-100 mg L -1 (Co) and LOD and LOQ of 0.11 mg L-1 and 0.36 mg L-1 (Ni), and 0.15 mg L-1 and 0.49 mg L-1 (Co). The UV/VIS data was compared to the results obtained by a novel microfluidic paper-based analytical device (µPAD) platform offering in-situ and cost-effect assay with a similar calibration graph with LOD and LOQ of 0.21 mg L-1 and 0.70 mg L-1 (Ni), and 0.22 mg L-1 and 0.75 mg L-1 (Co). The analysis of variance (ANOVA) indicated no significant difference between the UV/VIS, µPAD, and standard atomic absorption spectrometry (AAS) assay Ftab= 3.46 is much higher than FStat = 0.13 (Ni) and Ftab= 3.46 is much higher than FStat = 0.02 (Co). Also, a good correlation between results via the three methods was found. Thus, the µPAD platform offers a solid base for providing valuable information outside centralized laboratories. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to optimize the key parameters (mesh count, paper type and ink type) in screen printing, which are affecting the printed ink volume. The objective of the optimization was to maximize the color reliability by decreasing the color difference (ΔE value) of the prints while minimizing the ink consumption. Screen printing is still dominating the printing industry to make cost-effective production when high volumes are needed. Design/methodology/approach: The experiment was designed using the Taguchi method, and the samples were prepared with screen-printing by using the standard squeegee angle and pressure. The effect of mesh count, ink type and paper type on ink consumption was evaluated with using analysis of variances and main effects plots of S/N ratio and standard deviation. Findings: The factors ink type, paper type and mesh count were found significant for ink consumption due to their Probability (P) values which were lower than 0.05. It was determined that the mesh count was the most critical variable with the analysis of variance. The analysis showed that the selection of an optimum mesh count was the key to controlling the amount of the deposited ink. Although mesh counts were inversely proportional with the ink consumptions, they did not affect the color differences as expected. Originality/value: The optimization of process parameters, that are most effective on the print quality, is necessary to minimize the ink usage and lower the costs and environmental impact without exceeding the desired ΔE value limits. [ABSTRACT FROM AUTHOR]

This study explored the relationship between syntactic complexity and rhetorical functions and the relationship between syntactic complexity and level of move/step realization in learner-generated research paper introductions. We created a corpus of 79 introductions written by undergraduate L2 students at intermediate to high-intermediate levels. We annotated the introductions for moves and steps, measured their syntactic complexity at the global, clausal, and phrasal levels, and rated their level of move/step realization across four levels (no, low, intermediate, and high). We conducted one-way MANOVA, one-way ANOVA, Pearson correlation, and stepwise multiple linear regression analyses. We found sentences realizing Reviewing items of previous research function to be significantly longer than other steps in Move 1 and to contain significantly more clausal and phrasal complexity features. Sentences performing Claiming c entrality function also demonstrated significantly more phrasal complexity features as measured by complex nominals per clause. We also found a higher level of phrasal complexity in introductions with a higher level of move/step realization, which can be attributed to introductions including Step1 and Step3 , rather than containing all steps. Our findings imply that there is value in developing explicit instructions on how to use complex structures in performing rhetorical steps in research paper introductions. [ABSTRACT FROM AUTHOR]

While previous studies found that origami, when used for cognitive training and education, can improve spatial ability, the underlying mechanisms of this change, presumably associated with the origami folding process, remain unclear. In the present study, we focused on origami imagery in which participants imagined the process of folding paper to create a work of art; and we examined the cognitive factors involved in the imagery process and their association with mental transformations and the extent to which visual imagery was vivid. We identified four specific relevant cognitive factors in origami imagery: (a) controllability of origami transformations, (b) visual imagery of shapes, (c) hand sensations, and (d) visual imagery of colors. We associated the first two of these with non-rigid transformations: the controllability of origami transformations and the visual imagery of shapes. Moreover, vividness of visual imagery was related to all four cognitive factors. We propose this cognitive model of origami as one that considers the key relationships between origami imagery, mental transformations, and vividness of visual imagery. [ABSTRACT FROM AUTHOR]

Evidently, paper-based microfluidic devices, including fuel cells, have been proven to power low-power integrated miniaturized devices. However, the harvested energy depends on various design parameters, positioning and other ancillary factors. Herein, design of experiment is used to make a boisterous study of the data used in paper-based microfluidic fuel cell and to make various optimizations and studies of the raw data used in the microbial fuel cell paper. The paper-based microfluidic fuel cell was analysed for two different positioning, horizontal and vertical, and the maximum power outputs were noted. A statistical technique based on full factorial design was used to study the performance of paper-based microfluidic fuel cell. In the microbial fuel cell, a rigorous study was conducted pertaining to the electrode separation, channel variation and absorbent pad stability. In both these cases, the analysis of mean, analysis of variance, signal-to-noise ratio and desirability study were performed. For the paper-based microfluidic fuel cell, the best desirability values for the horizontal and vertical arrangements were measured to be 0.8842 and 0.92768, respectively. For the microbial fuel cell, in the case of 2 mm electrode separation, the present analysis of variance model came out to be significant. Inclusively, this work provides a pathway to realize optimum paper-based microfluidic fuel cell, and such study can be extrapolated to develop other microfluidic devices. [ABSTRACT FROM AUTHOR]

The purpose of this study was to investigate metacognitive self-regulated learning (SRL) differences in computer- and paper-based reading assignments across elementary students. Students in two after-school programs in a southeastern U.S. public school district were recruited. The final sample consisted of 48 students in Grades 2-5 who participated in two counterbalanced conditions involving a computer- and a paper-based reading assignment. The study employed a 2 x 4 (condition-by-grade) mixed-model analysis of variance (ANOVA) and followup tests to examine metacognitive SRL differences between conditions and grades. The results indicate that elementary students used various metacognitive SRL skills across both conditions. The mixed-model ANOVA results show a significant interaction in control processes in paper-based reading for students in fifth grade, a significant main effect of condition in evaluation practices in computer-based reading for all grades, and a significant main effect of condition in conditional knowledge in the paper reading assignment for all grades. The results suggest that students can benefit from focused instruction to apply metacognitive SRL skills between the two reading formats. [ABSTRACT FROM AUTHOR]

• International mathematical contest papers are an emerging type of research paper. • Metadiscourse analysis showed variances in use in winning papers across cultures. • Clear writing was more important than native-like writing in math contest papers. • Using IR and text analysis in an EAP course may increase contest competitiveness. Practitioners of English for Academic Purposes (EAP) are responsible for preparing students to fulfill the expectations of an ever-growing number of written genres. One emerging application of the research paper genre is found in a related pair of highly competitive international contests, the Mathematical Contest in Modeling (MCM) and Interdisciplinary Contest in Modeling (ICM). Through a lens of intercultural rhetoric (IR) and English as a lingua franca (ELF), this paper examines a metadiscourse analysis of 38 summary and 38 conclusion sections of MCM/ICM Outstanding Winner papers, half of which were written by Chinese teams and the other half by American teams. The study found that while both Chinese and American writing depended heavily on the use of metadiscourse in the two sections, there are distinct differences in the frequency and linguistic realization of metadiscourse across cultures. The paper concludes with proposed pedagogical applications of findings in designing an EAP course to prepare international student teams to be more competitive in their MCM/ICM writing. In line with recent research in IR and ELF, the current research demonstrates that the MCM/ICM contests do not require students to hold strictly to "native-speaker" levels of writing as long as the contest papers are mathematically and logically sound. [ABSTRACT FROM AUTHOR]

Cordia trichotoma (Vell.) Arrab. ex Steud. is a forest species native to Brazil, naturally propagated by seeds, whose quality assessment may be underestimated by the use of inappropriate methods for conducting the germination test. Given the potential use of this plant and the importance of conserving native species, the present work aimed to study parameters for conducting the germination test in louro-pardo seeds, during three consecutive years of evaluations. For this purpose, temperatures (20, 25 and 30 °C) and substrates (blotter paper, filter paper, sand and vermiculite) were tested in seeds collected in different crop seasons. The tests were carried out under a completely randomized experimental design, with four replications, in a factorial scheme for the germination test (temperatures x substrates), with the data obtained being subjected to analysis of variance and means compared by Tukey's test (p = 0.05). Germination percentage and speed index were determined, and seed health analysis was performed. It is concluded that the germination test for louro-pardo seeds should be carried out between vermiculite, at 30 °C, without light supply, with the first count carried out at 26 days and the last count at 48 days after setting up the test. [ABSTRACT FROM AUTHOR]

This paper outlines an initial analysis of 20 years of data held on an electronic bridge management database for approximately 3500 arch bridges across Northern Ireland (NI) by the Department for Infrastructure. Arch bridges represent the largest group of bridge types, making up nearly 56% of the total bridge stock in NI. This initial analysis aims to identify trends that might help inform maintenance decisions in the future. Consideration of the Bridge Condition Indicator (BCI) average value for the overall arch bridge stock indicates the potential for regional variations in the overall condition and the potential for human bias in inspections. The paper presents the most prevalent structural elements and associated defects recorded in the inspections of arch bridges. This indicated a link to scour and undermining for the worst-conditioned arch bridges. An Analysis of Variance (ANOVA) analysis identified function, number of spans, and deck width as significant factors during the various deterioration stages in a bridge's lifecycle. [ABSTRACT FROM AUTHOR]

Purpose: Kinesio-Taping (KT) is a new therapeutic approach for Shoulder Impingement Syndrome (SIS), which is common in swimmers. This study was performed to investigate the short- and long-term effects of KT on shoulder pain and functional stability in swimmers with SIS. Methods: In this quasi-experimental study (randomized control trial), 28 swimmers with SIS were randomly allocated to the taping and control group. We used the Davis test and Upper Quarter Y-Balance Test (UQYBT) to assess the functional stability of the shoulder girdle and also the Visual Analog Scale (VAS) to assess pain. The data were gathered in three time points: pre-test, 20 minutes, and 72 hours after the procedure. For statistical analysis, we used repeatedmeasures analyses of variance with a significance level of α<0.05. The analyses were done in SPSS. Results: The results showed that the taping group had a significantly improved in Davis test and UQYBT in the follow-up and the post-test and also significantly improved in VAS in the post-test compared to the control group. Also, the mean scores of pain, UQYBT, and Davis tests in the follow-up were significantly improved. The mean scores of the UQYBT and Davis test in the post-test were significantly better than those in the pre-test in the taping group (P=0.001). However, there was no significant difference between any of the time points in the control group (P<0.05). Conclusion: Given the results, KT can provide a basis for reducing pain and improving the functional stability of the shoulder girdle of swimmers with SIS. KT can be used as a complementary treatment technique in people with shoulder impingement syndrome and prevent possible injuries in the area. [ABSTRACT FROM AUTHOR]

Purpose: Various kinematics and kinetics methods have been proposed for the assessment of jumping ability as a critical skill in professional volleyball players, but little is known about the accuracy and differences between these methods. Therefore, the objective of the current study was to answer the question "Is there any difference between the results of various kinetic methods in the assessment of block jump height in volleyball players or not?" Methods: Twenty-one healthy male junior volleyball players of the Iran national team performed the block jump task on a force platform. Three common formulas mostly used in literature based on kinetics output of force platform were selected for the comparison of resultant jump height. Descriptive analysis, Shapiro-Wilk test, and ANOVA were used for statistical calculations (P<0.05). Results: The results showed no significant difference between the means of block jump heights measured based on different kinetic methods in volleyball players. Conclusion: Formula calculation methods are very valid for measuring the jump height of the block jump and lead to very similar results for estimating jump height and are also replaceable with each other. [ABSTRACT FROM AUTHOR]

The study was conducted in the period 2019 - 2021 in Experimental Field - Rila, at the Institute of Tobacco and Tobacco Products - Markovo. Three new lines of oriental tobacco and two varieties of high quality oriental tobacco Dupnitsa 160 and Katerini (Greece) and variety Rila 544 (standard) are included. Biometric measurements were performed on the following indicators: plant height (cm), number of leaves, length and width of the 14th leaf (cm). Yield (kg/da) and quality of dry tobacco were reported. Chemical analysis of basic chemical indicators was performed - nicotine, sugars (soluble carbohydrates), total nitrogen. Mathematical evaluation of morphological and economic features was made by analysis of variance. From the obtained data it can be concluded that lines 503 and 504 best meet the new requirements, forming a higher yield compared to the control and both varieties and quality similar to that of Dupnitsa 160 and Katerini. Valuable source material for the selection of oriental tobacco ecotype Dupnitsa has been created. [ABSTRACT FROM AUTHOR]

Background: In the digital environment, users' academic reading behaviour has changed, working with many articles simultaneously to search, filter, scan, link, annotate and analyse content fragments. The semantic enhancement environment has been widely set with semantic technologies to offer additional and handy support for users and thus facilitate the reading process. Despite many efforts devoted to developing a semantic enhancement environment, less attention has been paid to its actual effects. Objectives: This study aims to explore the effects of a semantic enhancement environment. Methods: Elaborating on cognitive load theory and focusing on academic reading, this study compared users' cognitive load and reading effect under the semantic enhancement environment and plain text environment and verified the three hypotheses. Results and conclusions: Through experiments and statistical analysis, this study found that, under a semantic enhancement environment, users had their cognitive load reduced and their reading effect improved. Consequently, a semantic enhancement environment promotes academic reading. Takeaways: This study adds to previous literature on semantic publishing by empirically corroborating the conducive effects of semantic enhancement environment in academic reading. Additionally, it justifies semantic publishing and provides a reference for the future design of semantically enhanced reading environments. Lay Description: What is already known about this topic?: The effects of a semantic enhancement environment are open to discuss.Academic reading is fundamental to researches and hence needs promotion.Limited studies investigated the effects of a semantic enhancement environment on academic reading.Publishers require effective reading environment designs. What this paper adds?: This study constructed a semantic enhancement reading environment to conduct a reading experiment.The experiment tested cognitive load, by using WP scale, and reading effects, by answer time and answer score.Semantic enhancement environment reduces users' cognitive load, promotes users' reading effects, and bolsters users' understanding of academic reading materials, especially in microstructure content.The design of semantic enhancement reading environments needs to fully consider the features of reading materials and give users a controllable way of interaction. The implications of study findings for practitioners: Compared to plain text environment, semantic enhancement environment is preferred in academic reading.Publishers are encouraged to add semantic enhancements to their publications.This study discussed how to design an effective learning and reading environment from the perspectives of reading resources, media forms of resources, and interaction modes. [ABSTRACT FROM AUTHOR]

Nowadays, the trend to benefit from environmentally friendly waste and recycle it instead of incineration processes that can cause pollution in the environment to have a clean and green environment that is free from pollution and can work for a long time without consumption and damage. This study is designed to manufacture prosthetics limbs from PMMA (polymethyl methacrylate) reinforced with different weight percentages of waste paper layers (0%, 3%, 6%, 9%, and 12%) by the "hand lay" method. The tensile, flexural, impact, compression, and hardness of these composites are tested before and after adding weight percentages waste paper layers to determine the mechanical properties behavior. The average values of all the samples are collected and analyzed by one-way analysis of variance (ANOVA) to interpret the results. When discussing the results of mechanical tests, it is found that the addition (12%-waste paper layers) to (PMMA) increased the average values (tensile, flexural, impact, compression, and hardness) by 142.1%, 532.3%, 146%, 99.2%, and 6.37%; respectively, compared to the mean values of other samples. It is clear from this work there is an improvement in the properties of PMMA after strengthening with waste paper layers. [ABSTRACT FROM AUTHOR]

With the rapid development of pure electric vehicles, how to improve the range has become the focus of research. Due to the large shell mass of the battery pack shell (BPE), it is necessary to optimize its structure in turn. In this paper, the BPE model was reconstructed by improving the upper shell material and adding reinforcements following the direction of the leaf vein fibers of the Magnolia Grandiflora. A quasi-Monte Carlo method based on Sobol sequences and a Latin hypercube design with variance sensitivity analysis was used to determine the seven design variables. The 122 data sets were trained and predicted using the basic gradient descent algorithm combined with the conjugate direction method, and the predictions were compared with static mechanical simulations for sharp cornering conditions on bumpy roads. The results showed that the BPE weight reduction ratio was 19.5%, and the maximum stress reduction ratio was 27.49%, and the displacement reduction ratio was 29.29% respectively, which satisfied the material requirements. It had a 20.88% increase in first-order mode frequency, which effectively prevented resonance. [ABSTRACT FROM AUTHOR]

The new generation of pavement technology with the goal of longevity is an important supporting technology that can promote the achievement of sustainable development of high-speed roadways. To further investigate the evolution trend of long-life pavement performance, this paper paved experimental sections to explore the correlations between pavement structure combinations and pavement performances. This paper presented four experimental sections with different pavement structures, asphalt concrete layer thicknesses, and pavement materials. Then, this paper analyzed the effects of the seasonal factors, pavement structure, and lanes on the deflection value and rut depth from three dimensions by the Pearson correlation coefficient (PCC). Finally, this paper used the analysis of variance (ANOVA) to analyze the relationships between the layer thickness of various materials in the pavement structure and the pavement performances, including the deflection value, international roughness index (IRI), texture depth (TD), British Pendulum Number (BPN), sideway force coefficient (SFC), rut depth, and disease area. The results showed that the seasonal factors significantly affected the deflection values of pavement structures with PCCs of 0.61, 0.72, 0.53, and 0.78. The high temperatures increased the average deflection values by 22.85%, 72.88%, 77.61%, and 88.13%, respectively. Under the influence of high temperature in summer and traffic loads, the increased ranges of average rut depth were -0.2%, 4.89%, 9.56%, and 7.31%, respectively. The results of ANOVA showed that the pavement structure type and thickness of each structural layer significantly affected the deflection value, and there also was a strong correlation between the pavement structure type, thickness, BPN, and SFC with p-values less than 0.05. Increasing the thickness of the asphalt surface was beneficial for reducing the area of defects, while laying the semi-rigid base layer was beneficial for maintaining the deflection value and rut depth at a lower level. [ABSTRACT FROM AUTHOR]

This study contributes to the diversity literature by probing whether diversity papers are cited as frequently as nondiversity papers in management and industrial/organizational (I/O) psychology journals. Based on the stigma‐by‐association theory, I argue that as a result of their association with minority groups, diversity papers may be devalued and thus "othered" by scholars. Using a citation analysis of 46,930 papers published in 29 peer‐reviewed management and I/O psychology journals, I present empirical evidence in Study 1 that diversity papers were cited significantly less frequently than nondiversity papers. The authors' gender and institutional prestige, journal tier and domain, and year of publication were not moderators. In Study 2, I used a scenario experiment to demonstrate the stigma‐by‐association effect. The authors' gender demonstrated a significant moderating effect in this experiment. [ABSTRACT FROM AUTHOR]

The current research paper aimed to investigate the current research practices in Higher Education Institutions (HEIs) in Khyber PakhtunKhwa (KP). The study was Mixed Methods Research (MMR) and thereby convergent Parallel design was used. A sample 254 participants were taken out of 695 individuals through (Yamane, 1967) formula. A selfdeveloped questionnaire, checklist and semi-structure interview were developed. Analysis of variance (ANOVA) was used as inferential statistics to analysis the quantitative data while thematic analysis was used to analyze the qualitative data. The result of study indicates that collaborative research environment in the HEIs. HEC approved supervisors available in the institutions. Thesis evaluation process found transparent but lengthy. The study found that paper publication is one of the difficult tasks for the teachers and students. [ABSTRACT FROM AUTHOR]

Background: The use of e‐exams in higher education is increasing. However, the role of student diversity in the acceptance of e‐exams is an under‐researched topic. In the current study, we considered student diversity in terms of three sociodemographic characteristics (age, gender, and second language) and three dispositional student characteristics (computer anxiety, test anxiety, and technology openness). Objectives: The main objective of this study was to investigate the relationship between student diversity and acceptance of e‐exams. Methods: Our research combined cross‐sectional analyses (N = 1639) with data from a natural experiment on the introduction of e‐exams versus the established paper‐pencil exams (N = 626) and used both self‐report and institutional data. Sociodemographic and dispositional characteristics were indirectly related to pre‐exam acceptance via expectancy variables from the Technology Acceptance Model framework. Results and Conclusions: Comparisons of post‐exam acceptance showed that practical experience with the e‐exam led to a significant increase in e‐exam acceptance, and that students with low openness toward technology particularly benefited from this effect. Students' exam performance (i.e., grades) was unrelated to the exam format or their pre‐exam acceptance of the e‐exam format, and this was true across students' sociodemographic and dispositional characteristics. Takeaway: Student diversity plays a role in e‐exam acceptance, but its influence is mitigated by first‐hand experience with e‐exams. The practical implications for higher education institutions aiming to implement e‐exams are discussed. Lay Description: What is already known about this topic: The use of e‐exams in higher education is increasingThe role of student diversity for e‐exam acceptance is unclearTechnology acceptance is predicted by expectancies towards new system What this paper adds: We investigated students' sociodemographic and dispositional diversityDiversity predicted e‐exam acceptance via the expectanciesIn a natural experiment, first‐hand experience increased e‐exam acceptanceNo difference between performance in e‐exams and paper‐pencil‐exams found Implications of the study findings for practitioners: Higher education institutions implementing e‐exams should consider diversitySupport for older students and students with low technology openness neededNo student groups systematically disadvantaged by e‐exam implementationPractice rooms can increase experience with new system before exam [ABSTRACT FROM AUTHOR]

Purpose: This paper aims to determine the demand category and level of government and investors in public–private partnership (PPP) projects. It emphasizes the importance of meeting the demands of stakeholders and controlling the unreasonable demands. This study aims to improve the demand management of stakeholders in the PPP project and lay a foundation for the research on behavior based on the motivation theory. Design/methodology/approach: This paper opted for a questionnaire survey to collect data based on indicators identified through literature. The participants come from the government and private sector (investors, contractors, operators, etc.) in China PPP Lecture Hall. The reliability, validity and variance analyses are used to test the reliability of data. Factor analysis and entropy method are used to determine demand categories and weights. Findings: The government's 14 demands are divided into four groups: satisfy public activities, self-interest, responsibility and relief financial pressure; 6 investor's demands are divided into development ability and satisfy social activities. The self-interest of government is higher than that of the publicity in PPP projects; investor's social reputation is most important, it is a foundation for obtaining external resources and achieving enterprise development. Research limitations/implications: Because of the chosen research approach, the demand indexes cannot be exhausted. Therefore, researchers are encouraged to enrich relevant contents further. Practical implications: This paper includes implications for a targeted demand control mechanism and for managing the unreasonable demand. Originality/value: This paper comprehensively identifies the demand hierarchy of the government and investors, and provides the theoretical basis for the target management of stakeholders. [ABSTRACT FROM AUTHOR]

With the progressive development of new energy technologies, high-power lithium batteries have been widely used in ship power systems due to their high-power density and low environmental pollution, and they have gradually become one of their main propulsion energy sources. However, the large-scale deployment of lithium batteries has also brought a series of safety problems to ship operations, especially the battery internal short circuit (ISC). Battery ISC faults are very hidden and unpredictable at the initial stage and often fail to be detected in time, ultimately leading to overheating, fire or even an explosion of the ship's power system. Based on this, this paper proposes a fast and accurate method for early-stage ISC fault location and detection of lithium batteries. Initially, voltage variations across the lithium battery packs are quantified using curvilinear Manhattan distances to pinpoint faulty battery units. Subsequently, the localized characteristics of voltage variance among adjacent batteries are leveraged to detect an early-stage ISC fault. Simulation results indicate that the proposed method can quickly and accurately locate the position of 5 Ω, 10 Ω and 15 Ω ISC faulty batteries within the battery pack, as well as detect the abnormal batteries in a timely manner with considerable sensitivity and reliability. [ABSTRACT FROM AUTHOR]

In the ever-evolving landscape of digital marketing, the role of social media in shaping effective communication strategies is paramount. This research paper delves into the world of data-driven insights to examine how social media channels contribute to the success of digital communication efforts. This paper focuses on exploring the multifaceted aspects of social media's impact on brand visibility, engagement, and customer interaction. The data was analyzed quantitatively using descriptive statistics while Analysis of Variance was used to establish associations between variables. The study revealed that major factors influencing the social media's effectiveness in digital communication are Content, Customer Interaction and Social Media metrics. As a result of comprehensive analysis, this research paper not only provides valuable insights into the current state of social media's effective-ness in digital communication but also offers practical recommendations for businesses looking to optimize their social media strategies. In an era where data reigns supreme, this research findings serve as a guide for harnessing the power of social media as a dynamic and influential tool in the digital communication arsenal. [ABSTRACT FROM AUTHOR]

Aim: This study examined the preliminary effects of a nurse‐led self‐management education and support programme on the self‐management behaviours and quality of life among people with type 2 diabetes in Western Ethiopia. Methods: A pilot randomized controlled trial was conducted between January and August 2021. Participants were recruited in the hospital and randomly assigned to the control arm to continue usual care (n = 38) or the intervention arm to receive usual care and the diabetes self‐management education and support programme (n = 38) in the community. Self‐management behaviours and quality of life were assessed using a 10‐item summary of diabetes self‐care activity (expanded) scale and a 34‐item diabetes quality of life measure, respectively, at baseline and 2 months after follow‐up. Generalized estimating equation models were used to examine the preliminary effects of the programme on the outcomes. Results: Preliminary results indicated that the programme outperformed usual care in self‐management practise, with large effect sizes immediately postintervention and at 2 months after the intervention, and quality of life at 2 months after the intervention. Conclusion: A nurse‐led diabetes self‐management education and support intervention, including the families of people with diabetes, may be an option to boost the self‐management practise and quality of life of patients with diabetes. Summary statement: What is already known about this topic? Family‐supported diabetes self‐management education intervention produced inconclusive effects on self‐management behaviour and quality of life. What this paper adds? A social‐cognitive theory‐guided, culture‐tailored, and community‐based diabetes self‐management education and support programme resulted in a preliminary effect on improving self‐management behaviour and quality of life.A nurse‐led diabetes self‐management education and support programme intervention, including the families of patients, may be an option to boost the self‐management practise and quality of life of people with diabetes. The implications of this paper: Culturally tailored diabetes self‐management education and support programme could be an option to improve self‐management behaviour and enhance quality of life.Community‐based nurse‐delivered diabetes self‐management education and support can improve self‐management behaviours and enhance quality of life in 2 months duration. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to conceptualise a research study to examine leadership as a relational concept between leaders and followers. The context is within surgical practice examining how motivated consultant surgeons are to lead junior doctors and which type of leadership style they use. From a follower perspective, the motivation of junior doctors will be explored, and their leadership preferences will be correlated with those of the actual style of consultant surgeons. Design/methodology/approach: In this paper, the authors provide a detailed description of the methods for an international quantitative research study, exploring sequentially how motivated consultant surgeons are to lead and how leadership styles impact on the motivation of junior doctors. The objectives, method and data collection of this study are explained, and the justification for each method is described. Findings: The findings for this outline study illustrate how critical it is to redefine leadership as a relational concept of leader and follower to ensure adequate support is provided to the next generation of consultant surgeons. Without consideration of the relational model of leadership, attrition will continue to be a critical issue in the medical workforce. Research limitations/implications: The research limitations are that this is a proposed quantitative study due to the need to collect a large sample of data from surgeons across the UK, Egypt and Germany. This research will have immense implications in developing new knowledge of leadership as a relational concept in medicine and healthcare. This study additionally will impact on how leadership is conceptualised in the curriculum for specialist surgical practice. Practical implications: The practical implications are that relational leadership is supportive of generating a supportive leadership culture in the workplace and generating more effective teamwork. Originality/value: To the best of the authors' knowledge, this is the first study of its kind to look at a relational model of leadership in surgical practice between consultant surgeons and surgical trainees. This study will also identify any specific country differences between the UK, Germany and Egypt. [ABSTRACT FROM AUTHOR]

This paper introduces a novel type of floating machine gun that can be simplified as a self-balancing two-degree-of-freedom mechanical system with distinct vibration characteristics. The model accounts for intricate motion patterns and encompasses numerous potential influencing factors. Multifactor combination optimization of the system represents a pressing engineering challenge. After establishing a simulation model for the machine gun and validating it experimentally, seven factors were chosen as optimization variables. The maximum recoil displacement of the inner receiver (MRD) and the firing rate were chosen to be indicators. Orthogonal combinations and variance analyses were used, and the effects of multiple factors were analyzed using SPSS software; these processes led to a determination of the optimal combination. The results indicated that the piston cylinder pressure, the bi-directional buffer spring energy storage, and the inner receiver mass significantly affected the MRD. Furthermore, the automaton mass and the reset spring energy storage were found to substantially affect the firing rate. Careful analysis of the variance results facilitated the determination of the optimal combination of parameter values. Remarkably, the optimal combination chosen resulted in an MRD reduction of approximately 20.2% and a firing rate increase of approximately 26.6%. [ABSTRACT FROM AUTHOR]

Tensor product smoothers are frequently used to include interaction effects in multiple nonparametric regression models. Current implementations of tensor product smoothers either require using approximate penalties, such as those typically used in generalized additive models, or costly parameterizations, such as those used in smoothing spline analysis of variance models. In this paper, I propose a computationally efficient and theoretically precise approach for tensor product smoothing. Specifically, I propose a spectral representation of a univariate smoothing spline basis, and I develop an efficient approach for building tensor product smooths from marginal spectral spline representations. The developed theory suggests that current tensor product smoothing methods could be improved by incorporating the proposed tensor product spectral smoothers. Simulation results demonstrate that the proposed approach can outperform popular tensor product smoothing implementations, which supports the theoretical results developed in the paper. [ABSTRACT FROM AUTHOR]

Soil moisture (SM) is a vital climate variable in the interaction process between the Earth's atmosphere and land. However, global soil moisture products from various satellite missions and land surface models are affected by inherently discontinuous observations and coarse spatial resolution, which limits their application at fine spatial scales. To address this problem, this paper integrates three diverse types of datasets from in situ, satellites, and models through Spherical cap harmonic analysis (SCHA) and Helmert variance component estimation (HVCE) to produce 1 km of spatio-temporally continuous SM products with high accuracy. First, this paper eliminates the bias between different datasets and in situ sites and resamples the datasets before data fusion. Then, multi-source SM data fusion is performed based on the SCHA and HVCE methods. Finally, this paper evaluates the fused products from three aspects, including the performance of representative sites under different climate types, the overall performance of validation sites, and the comparison with other products. The results show that the fused products have better performance than other SM products. In the representative sites, the minimal correlation coefficient (R) of the fused products is above 0.85, and the largest root mean square error (RMSE) is below 0.040 m3 m−3. For all validation sites, the R and RMSE of the fused products are 0.889 and 0.036 m3 m−3, respectively, while the R for other products is below 0.75 and the RMSE is above 0.06 m3 m−3. In comparison to other SM products, the fused products exhibit superior performance, generally align more closely with in situ measurements, and possess the ability to accurately and finely capture the spatial and temporal variability of surface SM. [ABSTRACT FROM AUTHOR]

The current paper studies data concerning consumer monetary expenditure in Bulgaria. They are structured and saved in several tables of a built data base. The considered objects are 10 different expenditures. A statistical analysis applied to these data on consumer monetary expenditure in Bulgaria is presented for the time period 2012-2021. The necessary information is searched and extracted from the indicated data base. As a result of the performed analysis of variance and Tukey's test four groups with statistically proven differences are obtained for the examined expenditures, average per household. A similar conclusion can be formed about the considered expenditures, average per person. As a whole, consumer monetary expenditure, average per household, increased in eight of the listed ten years. A quite small decline is found during 2016 as well as 2020. It is 1.36% for the first of the listed years and 1.32% for the second one. Approximately the same results are established for the consumer monetary expenditure average per person, where an insignificant decrease is calculated only for 2020. [ABSTRACT FROM AUTHOR]

Permutation tests are the standard technique for significance testing in Analysis of Variance Simultaneous Component Analysis. However, there is a vast number of alternative approaches for permutation testing, and the number of choices grows in relation to the complexity of the study design. In this paper, we focus on longitudinal intervention studies with multivariate outcomes, a relevant experimental design in clinical studies where the outcome is an omics profile (such as in genomics, metabolomics, and the like). We propose a new technique to derive power curves tailored to the size and (un)balanced nature of the data set in the study. This technique is useful to identify misleading permutation tests, with lack of power or overly optimistic outcomes. We found that choosing the best permutation approach is far from intuitive and that there is a significant risk of deriving incorrect conclusions in real‐life analyses. Our approach avoids this risk and can be extended to other complex designs of interest. The code is available for free use. Permutation tests are the standard technique for significance testing in ASCA. However, there is a vast number of alternative approaches. In this paper, we focus on clinical studies where the outcome is an omics profile (such as in metabolomics and the like). We propose a new technique to derive power curves tailored to the size and (un)balanced nature of the data set. This technique is useful to identify misleading permutation tests, with lack of power or overly optimistic outcomes. [ABSTRACT FROM AUTHOR]

Sheet metal forming is a critical process in the manufacturing industry, which involves shaping sheet metal into desired configurations and structures. The use of digital tools in the lifecycle management of sheet metal forming tools has become increasingly important to ensure the efficiency and effectiveness of the process. The digital model of tool lifecycle management (TLM) in sheet metal forming provides a complete approach to manage the entire lifecycle of tools used in sheet metal forming. It enables optimization of tool design, simulation of the tooling process, real-time monitoring of tool conditions, and retirement and replacement of tools. This approach improves efficiency, reduces costs, and ensures optimal performance in sheet metal forming. The paper presents an elaborate analysis of the development of TLM models concerning the progress in ICT modelling and its implementation in the field of sheet metal forming. Furthermore, the paper includes an exemplary TLM model for an industrial enterprise. [ABSTRACT FROM AUTHOR]

Background: This paper discusses the stages of health system resilience (HSR) and the factors underlying differences in HSR during the covid-19 pandemic, especially the vaccination challenge. We studied the relationship between vaccination strategies and macro-context backgrounds in 21 Latin American countries. Our objective was to capture the impact of those aspects in the SR and identify potential improvements for future crises and for vaccination programs in general. Methods: The study uses mixed-methods research to provide insights into how the countries' backgrounds and vaccination strategies impact the HSR. Particularly, we used explanatory sequential mixed methods, which entails a quantitative-qualitative two-phase sequence. The quantitative phase was conducted using cluster and variance analysis, in which the HSR was measured using as a proxy the covid-19 vaccination outcomes in three cut-offs of reaching 25%, 50%, and 75% of population coverage. This approach allows us to discriminate covid-19 vaccination progress by stages and contrast it to the qualitative stage, in which we performed a country-case analysis of the background conditions and the changes in vaccination strategies that occurred during the corresponding dates. Results: The paper provides a rich comparative case analysis of countries, classifying them by early, prompt, and delayed performers. The results show that differences in vaccination performance are due to flexibility in adapting strategies, cooperation, and the ability to design multilevel solutions that consider the needs of various actors in the health ecosystem. These differences vary depending on the vaccination stage, which suggests the importance of acknowledging learning, diffusion, and feedback processes at the regional level. Conclusions: We identified the importance of societal well-being as an ideal country antecedent for high and sustained levels of performance in covid-19 vaccination. Whereas in other countries where the set-up and beginning phases were rough, the value of the operational decisions and the learning on the move regarding their own and their peers' trajectories were crucial and were reflected in performance improvement. A contribution of this study is that the above-mentioned analysis was done using vaccination coverage cut-off points that allow a performance view that takes into consideration the stages of the vaccination progress and the learning process that goes with it. As well as framing this into the HSR shock cycles that allow to differentiate the stages of resilience on which countries must act. [ABSTRACT FROM AUTHOR]