Expansion Of Programs Research Articles

Sharing in caring: Family caregiving task sharing patterns for older adults in Singapore

Abstract Objectives Research on family caregiving for older adults has largely focused on primary caregivers. We identify caregiving task sharing patterns among multiple caregivers, including family members and live-in hired workers. In addition, we investigate caregiver and care-recipient characteristics associated with these patterns. Methods We interviewed 278 primary family caregivers of home-dwelling older adults in Singapore about who provides what assistance across three domains: activities of daily living, health and social services use, and socio-emotional and other needs. Latent class analysis was used to identify caregiving task sharing patterns. Results Three patterns were identified: a) ‘Shared-Diverse' (39%) – multiple caregivers assisting in all three domains, b) ‘Shared-Domestic’ (32%) – multiple caregivers assisting with activities of daily living and socio-emotional and other needs, and c) ‘Solo-Diverse’ (29%) – a sole caregiver assisting in all three domains. ‘Solo-Diverse’ caregivers were less likely to be employed and had higher depressive symptoms relative to ‘Shared-Diverse' primary family caregivers. Discussion The predominance of caregiving task sharing patterns involving multiple caregivers calls for expansion of research, policies, and programs beyond primary caregivers. Greater attention should be given to how families and live-in hired workers share caregiving tasks for older adults, and how this varies across cultural settings, especially in familial Asian societies. The findings further highlight the vulnerabilities of solo caregivers, whose employment capacity and mental health may be adversely affected by their caregiving duties. Policymakers should ensure that solo caregivers have access to support programs that address their financial and mental health needs.

EPCO-28. UNVEILING INVASIVE MECHANISMS OF GLIOBLASTOMA CELLS THROUGH MULTIMODAL SINGLE-CELL SEQUENCING

Abstract Glioblastoma (GBM) is the most common malignancy of the central nervous system, characterized by a dismal prognosis and inevitable recurrence despite aggressive standard-of-care therapy. Extensive colonization of the surrounding brain parenchyma precludes complete surgical resection, posing a significant therapeutic challenge. While well-studied in model systems, the molecular features and epigenetic regulators of invasive GBM cells remain under-explored directly in clinical samples. To address this gap, we performed a multimodal single-cell sequencing characterization of GBM tumor samples from anatomically distinct regions collected using MRI guidance. Our results demonstrate an enrichment of progenitor-like (neural- and oligodendrocyte-like) malignant states and neurons at the tumor margins. In contrast, differentiated-like states and myeloid cells were more abundant in the tumor core. Peri-tumoral progenitor-like malignant states expressed a unique neuronal signature associated with synaptic signaling, neurogenesis, and Notch signaling. Further, the expression of this neuronal signature was correlated with increased invasiveness. Analysis of matched primary-recurrent GBM patient cohorts revealed an expansion of this neuronal activity program, which was associated with worse overall survival. Motifs of proneural transcription factors implicated in neuronal lineage differentiation were also found to be differentially accessible in progenitor-like malignant states marked by the neuronal invasive signature, potentially contributing to the remodeling of cell states at the invasive margin. Further, cell-cell interaction analysis predicted greater communication between neurons and peri-tumoral progenitor-like malignant states, mediated predominantly through neurexin-neuroligin trans-synaptic signaling, facilitating synaptogenesis and the integration of tumor cells into neural circuits. Altogether, these findings suggest a model in which GBM invasive cells communicate with normal brain neurons in peri-tumoral regions, exploiting neurodevelopmental pathways to facilitate invasion and potentially seed recurrence. Our characterization of invasive GBM cells provides insight into the mechanisms of brain invasion and highlights potential therapeutic vulnerabilities of malignant invasive cells. Understanding these mechanisms opens new avenues for targeted therapies aimed at curtailing the invasive and adaptive capabilities of GBM.

From subsidies to nutrition: Investigating effects among cohort children from the Subsidy Reinvestment programme in Nigeria

This study investigates the effect of a nationwide maternal health programme that targets both demand- and supply-side factors on the nutritional status of children under five years old whose mothers were potentially exposed to the programme. We employed a difference-in-differences approach by matching programme beneficiary facilities to the districts and communities where households reside. The data are drawn from the 2008, 2013, and 2018 rounds of Nigeria's Demographic and Health Surveys (DHS), comprising responses for approximately 120,000 children. Our findings reveal a significant increase in child dietary diversity, particularly in districts with two beneficiary facilities, suggesting stronger effects with expansive programme implementation. Additionally, we observed positive effects on children's consumption of various nutritious foods for those children in districts with two beneficiary facilities. This study investigates a potential mechanism by which expanding access to healthcare facilities, through funding two clinics per district, may contribute to improved child dietary diversity. Our findings suggest that, unlike districts with one beneficiary facility, those with two funded clinics have a higher likelihood of women engaging in work outside the home and earning cash for it. As shown in the analysis, this mechanism is likely due to easier access to health facilities and better contact with health officers, which facilitate quicker reintegration into the labour market for mothers after childbirth and, in turn, could lead to better maternal earnings and potentially enable a more diverse diet for children. The findings suggest that SURE-P's expansive implementation strengthens child nutrition outcomes and supports maternal economic empowerment. In areas with multiple SURE-P facilities, increased access to healthcare enables mothers to reintegrate into the labor market more quickly, facilitating cash income and fostering a reinforcing cycle of improved child dietary diversity and economic benefits for families. This highlights the potential of scaling such programs to maximize both health and economic outcomes in similar contexts.

Assessing Willingness to Accept a Compensation for Evicted Land in Peri-urban Areas: A Contingent Valuation Method

Urban expansion in developing countries like Ethiopia is causing political turmoil in peri-urban areas due to inadequate compensation for evicted farmers because of the absence of a land market, which is prohibited by Ethiopia's land policy. This paper applies the contingent valuation method to measure the compensation value considered acceptable to those who are evicted from their farm land. The west Gojjam and Awi zones of Amhara region, Ethiopia are chosen for the case study based on 393 completed questionnaires. It has been demonstrated that a willingness to accept compensation is essential for maintaining sustainable livelihoods. The study applied single-bounded contingent valuation and double-bounded contingent valuation methods to estimate the mean willingness to accept compensation value. Based on the finding, double-bounded contingent valuation could be more optimal for the welfare of the evictees in detecting and correcting respondent’s bias due to its narrow confidence interval. Pilot survey was employed to ensure reliability and validity of the methods employed. Therefore, the optimal bid vector for multiplying the average land output preceding three years of eviction is 29.27. Additionally, variables such as initial bid, age, education, and total annual income significantly affect the willingness to accept compensation. The study recommends that federal and local governments should provide adequate compensation offers that prioritize the well-being of peri-urban communities during urban expansion programs, as farmers are losing their most valuable asset. This is crucial for sustainable living and poverty reduction among those who have been evicted.

Expanding Horizons: Increasing Injectable Vaccine in the Expanded Program on Immunization

The World Health Organization started the Expanded Program on Immunization in 1974, including 6 antigens with up to 8 vaccine doses for childhood vaccination. The number of antigens has now increased to 11 antigens in 21 vaccines. The expansion of vaccination programs to include more antigens and doses has led to concerns about the burden of multiple injections on infants and children, as well as factors such as fear of adverse reactions, pain, and overall acceptability of vaccines. To address these challenges, there's a call for research to focus on developing combined vaccines that can be administered through more acceptable routes, such as oral, nasal, or needleless administration. This approach could potentially reduce the number of injections required and increase the willingness of individuals to receive vaccines. We highlight the importance of ongoing research and innovation in vaccine development and delivery methods to ensure that vaccination programs remain effective, efficient, and acceptable to the communities they serve, particularly in resource-limited settings.

Impact of Home Telehealth Expansion on High-Cost Utilization Among Veterans Health Administration Patients with Diabetes.

Home telehealth (HT) services have rapidly expanded in the Veterans Health Administration (VHA), but little is known about the real-world impact of the expansion of these services on utilization. To evaluate the impact of expanding HT diabetes services in VHA on high-cost utilization. This cohort study used cross-temporal propensity score matching to identify patients with diabetes who would receive HT services (treatment group) with program expansion (treatment group) with a comparison group of patients with diabetes who did not receive HT services (control group) between 2010 and 2018. A difference-in-differences design was used to compare pre-post changes in high-cost utilization between propensity-matched groups. Data used was from the VHA's Corporate Data Warehouse. VHA patients with diabetes, n=7214 in the treatment group who received HT services, and n=1,067,138 in the control group who did not receive HT services. Emergency department (ED) visits, all-cause hospitalization, and hospitalizations for ambulatory care sensitive conditions (ACSCs). In the baseline period, patients in our sample had a mean age of 67 years old (SD=11 years), were 97% male, and 78% had a hemoglobin A1c (HbA1c) < 8%. The increase in HT use was associated with a net increase of ED visits per patient (0.215 95% CI [0.152, 0.279]), all-cause hospitalization (0.053 95% CI [0.032, 0.074]), and ACSC hospitalization (0.032 95% CI [0.019, 0.045]). Expanding HT or remote monitoring services may lead to additional needs being identified for patients, including increased access to in-person care, such as ED or hospital services.

Menggali Potensi Kampung melalui Pemetaan Partisipatif: Pendekatan Komunitas dalam Pembangunan Berkelanjutan di Dupak Magersari Surabaya

Sustainable development is a timeless topic. Behind it are a myriad of aspirations for current and future generations, both from the economic, social and environmental aspects. The concept that is promoted is development that promotes the fulfillment of the needs of the present without involving the ability of the next generation to achieve 17 goals, which are often referred to as sustainable development goals (SDGs) or Sustainable Development Goals (SDGs). One of them is sustainable cities and communities. This should be realized in the village of Dupak Magersari RT 01 which is the study in this research. Researchers tried to explain the potential through participatory mapping by emphasizing the active involvement of many people such as communities and even stakeholders. The goal is to hold the community in maintaining and developing their village in a sustainable manner. The analysis is based on the Participatory Rural Appraisal (PRA) approach, which is a technique to stimulate community participation in various activities, starting from the social analysis stage, planning, implementation, evaluation to program expansion. The result is an alignment between the concept of sustainable development and the mapping practices studied. The community can make sustainable planning through the findings of five basic capitals, including natural, human, financial, physical and social capital.

Local Supports to Break the Cycle: A Description of Intersectional Interventions to Address Adverse Childhood Experiences and Drug Overdose.

Adverse childhood experiences (ACEs), substance use disorders (SUDs), and overdose are interconnected issues impacting individuals and communities at multiple levels of the social ecology and across generations. Few studies describe approaches that intentionally and simultaneously address these issues. This paper examines activities of 15 sites across the country that were designed to simultaneously prevent ACEs, SUD, and overdose. This paper describes the work at the intersection as well as gaps and opportunities. Describing ways to implement intersectional programming may assist other organizations in taking similar steps in their communities. From December 2020 through July 15, 2023, funded sites received technical assistance from the National Association of County and City Health Officials and the Centers for Disease Control and Prevention for 18months to support the implementation, adaptation, and/or expansion of evidence-based programs to address ACEs, SUD, and overdose. Activities were coded to identify intersectional interventions that addressed ACEs, SUD, and overdose. Most of the ACEs prevention strategies and overdose prevention priority areas/guiding principles from which communities could choose were represented. Most activities were implemented with caregivers and families and addressed ACEs through interventions to lessen harm or to promote social norms. Primary prevention and coordination of resources were the most used overdose prevention priority area/guiding principle. It is possible to address the intersection of ACEs, SUD, and overdose on a local level. Opportunities to further address the intersection include incorporating more secondary and tertiary prevention strategies, expanding economic supports, and increasing the work focused on equity.

Indigenous Peoples and Social Protection: The Case of the Peruvian Amazon

The persistence of indigenous poverty and exclusion is one of the main challenges for social policy in Latin America. Social protection programmes, in particular conditional cash transfers, have been among the main instruments used by governments over the past two decades to respond to the high incidence of poverty in indigenous contexts. The inclusion of indigenous peoples as social protection beneficiaries remains a largely unexplored topic, despite its relevance to understand social policy trajectories in the global South. This article discusses the expansion of poverty alleviation social programmes in the Peruvian Amazon. Although the expansion of these programmes increased the state’s capacity to deliver welfare services in historically excluded areas, it also revealed the limitations of existing social protection instruments to effectively respond to indigenous poverty and vulnerability. Addressing this challenge constitutes a key opportunity to promote transformative approaches in social protection systems in Latin America.

Navigating vaccine procurement and financing challenges in Cameroon: Insights and recommendations from a mixed-methods study (2015–2020)

ObjectivesVaccine stockouts at the national level has been recognized as a critical challenge in ensuring sustained and equitable immunization coverage. These stockouts often arise from inherent issues within countries, including delays in government funding, suboptimal forecasting and stock management practices, and inefficiencies in the procurement process amongst others. Understanding the complexities and barriers within vaccine procurement and financing systems is crucial for developing effective strategies to enhance vaccine availability and strengthen immunization programs. This is particularly relevant in the context of reaching zero dose children and transitioning from Gavi. This study aimed to comprehensively assess the vaccine procurement and financing landscape in Cameroon from 2015 to 2020. Study designThis was a descriptive cross-sectional study. MethodsEmploying a mixed-methods approach, we conducted a desk review of pertinent documents and engaged in in-depth interviews with key stakeholders involved in the procurement and funding mobilization processes. Through data collection and analysis using Microsoft Excel 365 and Dedoose software, we delineated the intricacies of the procurement process and pinpointed specific barriers that have contributed to vaccine stockouts. ResultsThe mapping of vaccine procurement processes revealed complexity, protracted timelines, and the involvement of multiple stakeholders. The Expanded Program on Immunization (EPI) faced a USD 4 million funding deficit for vaccine procurement between 2016 and 2019. Consequently, the program experienced delays in acquiring 20 million vaccine doses, leading to 41 months of stockout for at least one antigen. Major bottlenecks identified by key stakeholders in vaccine procurement and financing encompassed delayed fund mobilization, inefficient and lengthy processes for fund mobilization and disbursement, poor data utilization, and discrepancies between forecasted, allocated, and mobilized funds. ConclusionThe findings of this research hold significant implications for many EPIs. By elucidating procurement and financing challenges, we can formulate evidence-based recommendations aimed at optimizing resource allocation, streamlining procurement processes, and bolstering vaccine availability. These insights are essential for fostering collaboration between government agencies, technical partners, and financial partners to achieve sustainable vaccine access in Cameroon. Establishing a joint procurement working group could streamline processes, potentially reducing stockouts and improving vaccine coverage.

Rehabilitation delivery models to foster healthy ageing - a scoping review

Abstract Background Rehabilitation is crucial for healthy ageing among older adults, who face heightened risks of non-communicable diseases, infections, injuries, and mental health issues. Yet, understanding tailored rehabilitation for this demographic remains limited. To fill this gap, we conducted a scoping review to identify rehabilitation delivery models targeting older adults’ functioning and healthy ageing. Methods We systematically searched Medline and Embase (January 2015 to May 2022) for English-language studies on rehabilitation approaches for older adults. Three authors independently screened records for eligibility and synthesized findings through quantitative and qualitative analysis. Results Among 6,933 records, we assessed 585 articles, identifying 283 studies with 69,257 participants. Six main rehabilitation delivery models emerged, with outpatient (24%) and telerehabilitation (22%) being predominant. Multidisciplinary teams (31.5%) often followed integrated care principles (30.4%). However, most studies adopted a disease-centric approach (59.0%), neglecting prevalent issues like pain, sensory impairments, incontinence, and sexual dysfunctions. Therapeutic exercises (54.1%) and self-management education (40.1%) were common interventions. Conclusions Our scoping review outlines diverse rehabilitation delivery models for older adults, highlighting gaps in addressing prevalent issues and emphasizing evidence-based strategies to promote healthy ageing. It underscores the need for systematic functional assessment and expansion of rehabilitation programs to cover prevalent health concerns. While limitations include reliance on published research and not assessing model effectiveness, this review lays groundwork for future research and innovation in rehabilitation and healthy ageing. Key messages • The scoping review identifies six rehabilitation delivery models for older adults. • The scoping review advocates for evidence-based strategies for enhancing healthy ageing through rehabilitation.

A functional typology of exclusions: why and how women fail to access government schemes in India?

ABSTRACT Social exclusions in India are not solely a result of marginalised, personal identities. They are equally about the failure of the state to recognise those identities. With an expansion of welfare programs, the turf of exclusions is now actively shaped by the state. Drawing upon fieldwork in the drought-prone Marathwada region of Maharashtra (India), this paper outlines the pathways of how citizens fail to access government welfare schemes. The resulting typology of exclusions is a layered one, encompassing failures of state outreach, rejections of citizens’ claims, and inclusions in the schemes coinciding with exclusions from the benefits, fully or partially. Importantly, the exclusions are deeply gendered. During their lifetime, women end up going through multiple cycles of identity verification by the state; pre-marriage, post-marriage and once again, in widowhood or if the marriage were to fail. Ironically, even as the state extends its welfare resources to women through specific schemes, the underlying procedural requirements render women invisible.

Analysis of budget expenditures of the Republic of Kazakhstan

This article provides a comprehensive analysis of the structure of the budget system and expenditures of the Republic of Kazakhstan (ROK), which are characterized by complexity and multilevel and reflect the amount of financial resources and the size of budget constraints at the levels of the budget system. The main focus is on the republican budget, which generates the country's revenues and finances national expenditures directed to such areas as defense, national security, foreign policy, as well as projects and assistance programs. The functioning of the budget system is regulated by regulatory legal acts (NPAs), including the Constitution of the Republic of Kazakhstan, the Budget Code of the Republic of Kazakhstan and other NPAs, which ensures transparent and effective management of public finances. The Ministry of Finance of the Republic of Kazakhstan plays a key role in the implementation of the state financial policy, coordinating work with other ministries and departments.The article presents the results of the analysis conducted by the author of this article of the execution of republican budgets for the period 2018-2022. It is shown that all three categories of budgets (republican, regional and local) demonstrate steady growth in spending, which can lead to increased public investment and expansion of government programs. Special attention is paid to the increased level of education and health care, which ensures the priority and higher level of efficiency of these sectors in comparison with other sectors of the economy of the Republic of Kazakhstan. Based on the analysis, a SWOT analysis was conducted, which revealed the strengths and weaknesses of the budget system of the Republic of Kazakhstan, as well as identified threats and opportunities to improve its condition.The article concludes with recommendations on ensuring the sustainability of the budget system and improving the efficiency of budget funds, including measures to increase transparency and efficiency of budget processes, optimize budget allocation, improve the effectiveness of social programs, reduce public debt, develop interdepartmental experience and use the state experience achieved in a number of sectors and territories.

“We Need to Not Fear You”: Essential Factors Identified by Sworn Officers and Civilian Staff for Implementation and Expansion of a Co-Response Program

AbstractThe Fayetteville, AR, Police Department (FPD) initiated a co-response program in 2021, partnering with social workers to respond to individuals in crisis. Originally started with a University of Arkansas School of Social Work (UA) internship, the Crisis Intervention Response Team (CIRT) has grown over time. The program now includes two full-time co-response teams, two social work interns, and plans for further expansion. UA provides support for the program through continued internships, clinical supervision, and program evaluation. This article reports on one aspect of the UA program evaluation focusing on FPD employees’ perspectives on integrating social workers into their department and how those perspectives have changed over time as the program has expanded. Through semi-structured interviews and survey data collected in 2021 and 2023, this research highlights key factors contributing to the program’s successes and continued challenges. The results provide valuable insights, suggestions, and other factors to consider for similar police departments when making decisions whether to establish or expand co-response initiatives.

Does money buy innovation? The effect of the “Innovative City” pilot on firm innovation in China

This study investigates the “Innovative City” pilot in China and its impact on fostering firm innovation by alleviating financial constraints. Employing difference-in-differences-in-differences approach, we provide strong evidence that the policy significantly boosted firm innovation capabilities, measured by increased patenting. A key mechanism is the program's expansion of bank credit access for firms, particularly benefiting financially constrained firms. Furthermore, the positive impact is amplified in regions with more developed banking sectors and for firms with pre-existing bank relationships, highlighting the role of market frictions. These findings highlight the pivotal role of a competitive and transparent credit market.

The cost of COVID-19 vaccine delivery in Bangladesh

ABSTRACT COVID-19 vaccination has been instrumental in fighting the pandemic, but evidence on the actual costs associated with delivering these vaccines in resource-constrained settings has been limited. We estimated the cost of delivering COVID-19 vaccines in Bangladesh through five delivery strategies in 2021 and 2022, including Ministry of Health (MOH) hospitals, non-MOH government hospitals, outreach at Expanded Program on Immunization (EPI) centers, mass campaigns, and schools. This was a bottom-up costing study, estimating costs from a payer and beneficiary perspective. We also mapped the funding flows for COVID-19 vaccination activities and analyzed programmatic and financial challenges. The economic cost incurred by the health system to deliver COVID-19 vaccines was $1.05 per dose, excluding vaccine costs. This was made up of a financial cost of $0.29 per dose and an opportunity cost of $0.75 per dose. School-based delivery incurred the lowest financial cost of $0.27, while outreach at EPI centers incurred the highest at $0.44 per dose. The low financial cost per dose is attributed to the high daily volumes delivered at sampled sites, minimal additional resources provided to sites to implement the COVID-19 vaccination program, and a reliance on the existing workforce. Beneficiaries spent an average of $1.63 to receive a single dose of COVID-19 vaccination at fixed sites, with transport representing the largest cost driver ($0.75 per dose). The economic cost to receive one dose of the COVID-19 vaccine was $4.78. Findings can support the Government of Bangladesh to make efficient and equitable resource allocation decisions for vaccination programs.

Effect Program Educational Based on According to Raigloth Expansion Theory in Teaching Post-Modern Arts for Students of the Institute of Fine Arts

General Background: The evolving landscape of postmodern art necessitates innovative educational approaches to equip students with the skills and knowledge required to navigate this complex field. Specific Background: This research investigates the impact of an educational program grounded in Reigeluth's expansive theory on the teaching of postmodern art at the Institute of Fine Arts in Baghdad. Prior studies have highlighted the need for effective instructional designs that engage students and enhance their cognitive achievements. Knowledge Gap: Despite the proliferation of educational theories, there remains limited empirical evidence on the effectiveness of expansive instructional design in the context of postmodern arts education. Aims: This study aims to assess the effectiveness of an expansive educational program on students' cognitive achievement in postmodern art compared to traditional teaching methods. Results: Utilizing an experimental design with two equivalent groups, the findings reveal statistically significant differences (p &lt; 0.05) in post-test scores favoring the experimental group that engaged with the educational program based on Reigeluth's theory. Novelty: This research contributes to the literature by demonstrating that an expansive instructional approach can significantly enhance students' understanding and appreciation of postmodern art. Implications: The results underscore the necessity for art education curricula to incorporate innovative instructional designs that foster deeper cognitive engagement and mastery of complex artistic concepts. By bridging the gap between theory and practice, this study offers valuable insights for educators seeking to improve instructional effectiveness in the rapidly evolving domain of postmodern art. Highlights: Impact of expansive design on cognitive achievement in postmodern art. Controlled study shows significant differences in student performance outcomes. Innovative teaching methods enhance student engagement and understanding. Keywords: postmodern art, educational program, Reigeluth's theory, cognitive achievement, instructional design

Forging Paths of Compassion

In the United States, Florida leads the nation in prosecuting minors, from direct file to reinforcing systems like the school-to-prison pipeline. While the Department of Juvenile Justice has made an active effort to move away from the punitive avenues to address juvenile delinquency, the local implementation framework outlined in Florida Statute 985 results in variability in utilization across jurisdictions, influencing the treatment and consequences faced by justice-involved youth. The study unveils the influence of congregation-based community organizations, particularly within the Direct Action Research Training network (DART), in advocating for the expansion of civil citation programs. Through comparative analysis and qualitative interviews, it demonstrates the effectiveness of congregational advocacy in shaping juvenile justice policies. The findings underscore the necessity of statewide standards to ensure consistency and address local challenges in implementation. Additionally, the study highlights the importance of further research into the impact of socio-demographic and contextual factors on program effectiveness and youth outcomes, providing valuable insights for policy development.

Resident performance and program perception following merger of surgical residencies

PurposeThe primary objective of this study was to gauge resident and faculty sentiments surrounding a general surgery program merger between two programs, and to assess the effect on workplace morale and productivity. Secondarily, the authors sought to objectively examine the impact program expansion had on in-service training exam results and operative volumes.MethodsThis was a single-center, prospective, observational study that evaluated surgical resident and faculty feedback pertaining to the merger of two regional general surgery residency programs. The survey utilized the Likert scale at merger onset and post-merger to gather responses from residents and faculty from July 2020 to August 2021. Secondary outcomes evaluated case volume and ABSITE performance pre- and post-merger.ResultsA total of 27 residents and 31 faculty participated in the initial survey. The merger onset and post survey investigation found that there was increased workplace efficiency (78% onset, 96% post; p = 0.004), and increased comfort with effectively triaging patients (41% onset, 83% post; p = 0.001). Satisfaction levels regarding research infrastructure and mentorship also increased significantly (63% onset, 83% post; p = 0.03). ABSITE performance and operative volumes were not significantly changed post-merger.ConclusionThe merging of two academic programs led to feelings of increased mentorship, operative competency, and workplace efficiency among the residents. This was achieved without significant detriment to resident case volume or ABSITE performance. Our investigation also identified legitimate challenges that speak to the need for fluidity in a residency program and the constant need for continued growth and development.

Development, Evaluation, and Initial Findings of New York State Department of Health Community Drug Checking Pilot Programs.

The illicit drug landscape in the United States is dynamic, featuring a risky and erratic drug supply. Drug checking programs (DCP) have been successfully implemented and studied extensively in Canada and Europe but are scarce in the United States. Integrating DCP at harm reduction programs provides an opportunity to engage people at the point-of-care and deliver a combination of harm reduction services, access to healthcare services, and linkages to treatment. The New York State Department of Health (NYSDOH) developed and supports operation of 8 pilot community DCP sites throughout the state. The DCP were trained to utilize Fourier-transform infrared spectroscopy (FTIR) technology to deliver real-time results to participants. The NYSDOH community DCP pilot began development in 2022. Partnerships were formed across multiple domains including other DCP, universities, forensic laboratories, syringe service and harm reduction programs, and legal and regulatory offices within the NYSDOH. The first pilot sites began operating in mid-2023 and program expansion is on-going. Evaluation staff were extensively engaged in development and implementation phases. Qualitative evaluation focused on barriers, facilitators, and lessons learned from program staff and technicians. Quantitative evidence was gathered to assess the reach of the DCP and accuracy of results attained by drug checking technicians during their training periods. Drug checking results helped characterize the illicit drug supply. Development and implementation of DCP in NYS was facilitated by strong partnerships across sectors including public health and harm reduction. DCP may involve diverse partners who do not regularly collaborate, and health departments are positioned to build relationships and convene partners for program implementation. Evaluation findings highlight the importance of facilitating on-going training and technical assistance to DCP for quality assurance. The initial successes and lessons learned from the NYSDOH DCP demonstrate state public health departments' ability to successfully deploy this innovative harm reduction strategy.