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Abstract Mining in Brazil is one of the pillars that support its GDP (gross domestic product). Its execution requires technique and expertise. In a mining venture, the value chain drives the business to achieve its goals. Mine planning has a great influence on its performance, as it is through it that the organization is based to offer its products to the market and, consequently, the low compliance with the established premises will bring undesirable inconveniences. Within the planning, the short term is dedicated to operationalize the plans made possible by the long and medium term teams, in addition to attending to market variations. The indicators that control this process are of great importance, as an incorrect identification inserted in the various criteria that compose it can guide managers towards inefficient decision making. The objective of this study was, through lean methodology, to identify the main performance indicators that impact on the non-exception of the mining plan measured by the adherence and compliance indicators. In this method, the main causes of non-adherence and compliance with the mining plan were identified, enabling short and medium-term actions that leveraged the indicators. This study leveraged the average adherence and compliance by 17% and 54.9%, respectively, exceeding the target set for 6.5% and 49.2% respectively.

Yingyi Zhu,1,&ast; Kangyao Cheng,1,&ast; Hui Wang,1 Ziwei Xu,1 Ruiyu Zhang,1 Wenjie Cheng,1 Yan Wang,2 Weibo Lyu1 1School of Nursing, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China; 2Nursing Department, Tangzhen Community Healthcare Center, Shanghai, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Yan Wang, Tangzhen Community Healthcare Center, 75 Middle Chuangxin Road, Shanghai, 201203, People’s Republic of China, Tel +86 13816514677, Email guwangxin@aliyun.com Weibo Lyu, Shanghai University of Traditional Chinese Medicine, 1200 Cailun Road, Shanghai, 201210, People’s Republic of China, Tel +86 13661498053, Email Lyu_weibo@shutcm.edu.cnPurpose: To explore exercise adherence and compliance as well as its related factors among elderly patients with type 2 diabetes mellitus (T2DM) to provide a basis for clinical intervention strategies.Patients and Methods: The present study was a cross-sectional study of 205 elderly patients with T2DM who regularly visited a Shanghai community health center from August 2020 to July 2021. Exercise adherence and compliance was measured using an exercise adherence and compliance questionnaire, and potential correlates were explored using multiple linear regression analysis.Results: The mean total score of the exercise adherence and compliance questionnaire was 16.72± 5.08. The stepwise regression results revealed that exercise adherence and compliance was positively correlated with self-monitoring (F=3.510, P=0.005), exercise knowledge (r=0.784, P< 0.001), exercise willingness (r=0.556, P< 0.001), professional support (r=0.426, P< 0.001), and self-efficiency (r=0.5, P< 0.001). There was a negative correlation between hypoglycemia and exercise adherence and compliance (F=− 3.672, P< 0.001).Conclusion: Low exercise adherence and compliance was related to low glucose self-monitoring frequency, increased hypoglycemia, less exercise knowledge, less exercise willingness, less professional support, and less self-efficiency. When developing exercise instructions adapted to the cognitive and volitional needs of diabetic patients, it is essential to focus on their daily self-management habits and extrinsic motivation to improve exercise adherence and compliance.Keywords: aged, type 2 diabetes mellitus, T2DM, exercise, adherence and compliance

Mining in Brazil is one of the pillars that support its GDP (gross domestic product). Its execution requires technique and expertise. In a mining venture, the value chain drives the business to achieve its goals. Mine planning has a great influence on its performance, as it is through it that the organization is based to offer its products to the market and, consequently, the low compliance with the established premises will bring undesirable inconveniences. Within the planning, the short term is dedicated to operationalize the plans made possible by the long and medium term teams, in addition to attending to market variations. The indicators that control this process are of great importance, as an incorrect identification inserted in the various criteria that compose it can guide managers towards inefficient decision making. The objective of this study was, through lean methodology, to identify the main performance indicators that impact on the non-exception of the mining plan measured by the adherence and compliance indicators. In this method, the main causes of non-adherence and compliance with the mining plan were identified, enabling short and medium-term actions that leveraged the indicators. This study leveraged the average adherence and compliance by 17% and 54.9%, respectively, exceeding the target set for 6.5% and 49.2% respectively. [ABSTRACT FROM AUTHOR]

Abstract Background The standard to ensure utmost cancer treatment is a prerequisite in national cancer plans for comprehensive cancer centers (CCCs) and ensured through multidisciplinary tumor boards (MTBs). Despite these being compulsory for CCCs, various analyses on MTBs have been performed, since MTBs are resource-intensive. Outcome measures in these prior analyses had been survival (OS), MTB-adherence and -satisfaction, inclusion of patients into clinical trials and better cancer care. Main body A publication from Freytag et al. performed an analysis in multiple tumor entities and assessed the effect of number of MTBs. By matched-pair analysis, they compared response and OS of patients, whose cases were discussed in MTBs vs. those that were not. The analysis included 454 patients and 66 different tumor types. Only patients with > 3 MTBs showed a significantly better OS than patients with no MTB meeting. Response to treatment, relapse free survival and time to progression were not found to be better, nor was there any difference for a specific tumor entity with vs. without MTB discussions. An in-depth discussion of these results, with respect to the literature (PubMed search: “MTBs AND cancer”) and within the author group, including statisticians specialized in data analysis of cancer patients and questions addressed in MTBs, was performed to interpret these findings. We conclude that the results by Freytag et al. are deceiving due to an “immortal time bias” that requires more careful data interpretation. Conclusions The result of Freytag et al. of a seemingly positive impact of higher number of MTBs needs to be interpreted cautiously: their presumed better OS in patients with > 3 MTB discussions is misleading, due to an immortal time bias. Here patients need to survive long enough to be discussed more often. Therefore, these results should not lead to the conclusion that more MTBs will “automatically” increase cancer patients’ OS, rather than that the insightful discussion, at best in MTBs and with statisticians, will generate meaningful advice, that is important for cancer patients.

Abraham Aregay Desta, Kibriti Mehari Kidane, Ataklti Gebretsadik Woldegebriel, Kiros Fenta Ajemu, Asfawosen Aregay Berhe, Degnesh Negash Zgita, Letebrhan Weldemhret Teweldemedhn, Lemlem Legesse Woldegebriel, Nega Mamo Bezabih, Tewolde Wubayehu Woldearegay Tigray Health Research Institute, Mekelle, Tigray, EthiopiaCorrespondence: Abraham Aregay Desta Email abaregaydesta@gmail.comBackground: Poor adherence to ART increases viremia, which leads to disease progression and transmission of drug-resistant HIV strains. This study aimed to assess the level of ART adherence and associated factors among adolescents and adult patients enrolled in ART care in Northern Ethiopia.Methods: A retrospective analysis was conducted among 19,525 patients from April 2015 to March 2019. Data verification and filtration were done in Excel 2013 before exporting to STATA 14.0. Ordinal logistic regression was used to analyze the data.Results: About 94.84%, 95% CI (94.52%, 95.14%) of the study subjects were in good adherence. However, about 1.46%, 95% CI (1.30%, 1.64%) and 3.70%, 95% CI (3.44%, 3.97%) of them had poor and fair adherence respectively. In the adjusted analysis, being male (AOR =  0.75; 95% CI: 0.0.65, 0.87), patients from general hospitals (AOR =  0.52; 95% CI: 0.39, 0.69), WHO staging IV (AOR = 0.57; 95% CI: 0.41, 0.81) and non-suppressed viral load (VL) status (AOR = 0.54; 95% CI: 0.47, 0.63) were negatively associated with good adherence. Whereas, age of 50+ years old (AOR =  1.68; 95% CI: 1.13, 2.50), recent CD4 count of 200– 499 (AOR = 1.45; 95% CI: 1.21, 1.74) and recent CD4 count of 500 and above (AOR = 1.84; 95% CI: 1.47, 2.32) were positively associated with good ART drug adherence.Conclusion: There was a higher level of adherence compared to the previous studies conducted in Ethiopia. Being male, patients from general hospitals, WHO staging II, II and IV and non-suppressed VL status were negatively associated with good adherence. Whereas, older ages, recent CD4 count of 200– 499 and ≥ 500 CD4 count were positively associated with good ART drug adherence. The health system should recognize a higher need of younger age groups and males to design targeted counseling and support to encourage consistently high levels of adherence for a better ART treatment outcome.Keywords: adherence and compliance, antiretroviral therapy, retreatment

Background: The standard to ensure utmost cancer treatment is a prerequisite in national cancer plans for comprehensive cancer centers (CCCs) and ensured through multidisciplinary tumor boards (MTBs). Despite these being compulsory for CCCs, various analyses on MTBs have been performed, since MTBs are resource-intensive. Outcome measures in these prior analyses had been survival (OS), MTB-adherence and -satisfaction, inclusion of patients into clinical trials and better cancer care.Main Body: A publication from Freytag et al. performed an analysis in multiple tumor entities and assessed the effect of number of MTBs. By matched-pair analysis, they compared response and OS of patients, whose cases were discussed in MTBs vs. those that were not. The analysis included 454 patients and 66 different tumor types. Only patients with > 3 MTBs showed a significantly better OS than patients with no MTB meeting. Response to treatment, relapse free survival and time to progression were not found to be better, nor was there any difference for a specific tumor entity with vs. without MTB discussions. An in-depth discussion of these results, with respect to the literature (PubMed search: "MTBs AND cancer") and within the author group, including statisticians specialized in data analysis of cancer patients and questions addressed in MTBs, was performed to interpret these findings. We conclude that the results by Freytag et al. are deceiving due to an "immortal time bias" that requires more careful data interpretation.Conclusions: The result of Freytag et al. of a seemingly positive impact of higher number of MTBs needs to be interpreted cautiously: their presumed better OS in patients with > 3 MTB discussions is misleading, due to an immortal time bias. Here patients need to survive long enough to be discussed more often. Therefore, these results should not lead to the conclusion that more MTBs will "automatically" increase cancer patients' OS, rather than that the insightful discussion, at best in MTBs and with statisticians, will generate meaningful advice, that is important for cancer patients. [ABSTRACT FROM AUTHOR]

Objectives: This review paper attempts to identify various factors that affect adherence to oral contraceptives (OCs) Methods: We have searched related articles in the following data base through Google scholar advanced Google Scholar, the Cochrane Library, Pubmed, hinari, a Pop Line, Scopus, Science direct, the Cochrane register of Controlled Trials, and Medline. To identify factors affecting adherence to OCs and their association with contraceptive continuation. Results: Many factors influence adherence to OCs. Factors that affect contraceptive failure rates and probabilities reported in the literature can be divided into three categories: Patient-related factors, factors related to health care providers and factors related to health care system. Conclusion: More rigorous research is needed to understand factors affecting adherence to OCs continuation as well as, Counseling services should be expanded to address physical, social and emotional needs to improve continuation. Moreover, interventions to improve adherence and health system factors that prevent clients from using family planning consistently and effectively should also be addressed. [ABSTRACT FROM AUTHOR]

This article reports on our qualitative inquiry into the meanings biomedically trained doctors in Switzerland attach to treating vaccine hesitant (VH) and underimmunized patients. With support from social science literature on 'good' and 'bad' patients and doctors, we explore how both doctors and patients cross the boundaries of these conceptual categories in situations involving vaccine hesitancy and underimmunization. The doctors we interviewed (N = 20) and observed (N = 16 observations, subsample of 6 doctors from the interview sample) described how they screened, measured, and diagnosed patients' levels of vaccine hesitancy. Our results emphasize the meanings doctors associated with counseling hesitant patients, especially while managing their own professional responsibilities, legitimacy, and reputations among colleagues and patients. Doctors' discourses constructed the figure of 'problem patients,' characterized through their (potential) non-adherence to vaccination recommendations, desire for lengthy consultations and individualized counseling, and dogmatic ideologies running contra to biomedicine. Discussions around the dilemmas faced by doctors in vaccination consultations brings to the fore several key, yet underdiscussed, paradoxes concerning VH, patient-doctor relationships, and the constructs of 'good'/'bad' doctors and patients. These paradoxes revolve around expectations in Western societies for 'good' patients to be autonomous health-information seekers and active participants in clinical encounters, which research shows to be the case for many VH and underimmunizing individuals. However, in the eyes of many vaccination advocates and proponents of biomedical approaches, VH patients become 'bad' patients thru their risk of non-adherence, which has implications for the population at large. In these consultations, doctors find themselves conflicted around the expectations to promote vaccination while, at the same time, being active listeners and good communicators with those who question their biomedical training and legitimacy. Understanding these paradoxes highlights the need to better support HCPs in addressing VH in clinical practice. • Vaccine hesitancy stimulates discussion of paradoxes of good/bad doctors/patients. • Biomedical doctors sometimes perceive vaccine hesitant patients as problematic. • Biomedical doctors' vaccination approaches have implications for their reputations. • Qualitative interviews and ethnographic observations with biomedical doctors. [ABSTRACT FROM AUTHOR]