Hypothetical Program Research Articles

Cost effectiveness of fortified bouillon in addressing Burkinabe children's vitamin A inadequacy: An economic optimization model.

Vitamin A dietary inadequacy remains a serious public health problem among young children 6-59 months of age in Burkina Faso. Planners face several interrelated challenges: Selecting concrete policy objectives regarding vitamin A inadequacy reductions, identifying cost-effective vitamin A intervention programs that can achieve those objectives, and being reasonably sure that proposed intervention programs are robust to uncertainty in program benefits and costs. A 10-year, subnational economic optimization model making use of secondary dietary intake data and program cost data was developed and implemented to address these issues and included the following vitamin A program options: existing or improved edible oils fortification, a pair of hypothetical vitamin A-fortified bouillon programs, and a set of subnational vitamin A supplementation (VAS) programs. The model consistently identified the improved edible oils and bouillon fortification programs as the core national programs upon which the more expensive subnational VAS programs could be layered, depending on policy objectives and available funding. These results were robust to uncertainty in program nutritional benefits and costs. However, even if the most impactful set of modeled programs was implemented, vitamin A inadequacy among children would remain a serious public health problem; hence, additional efforts to address it would be needed.

Potential public health impacts of gonorrhea vaccination programmes under declining incidences: A modeling study.

Gonorrhea is the second most common sexually transmitted disease notified in Singapore in 2023. Evidence suggests that the 4CMenB vaccine designed to protect against Neisseria meningitidis infection may offer partial cross-protection against gonorrhea. This generated interest in using 4CMenB for the purpose of staving gonorrhea transmission. We explored the efficacy of potential gonorrhea vaccination strategies in the context of historically declining gonorrhea incidence. We employed an integrated transmission-dynamic model, calibrated using Bayesian methods to local surveillance data to understand the potential public health impact of 4CMenB in reducing gonorrhea acquisition and transmission in men who have sex with men (MSM) in Singapore. We explored the efficacy of implementing six vaccination programmes: (1) offering vaccination to all male adolescents in schools (vaccination before entry [VbE]), (2) offering vaccination to individuals attending sexual health clinics for testing (vaccination on attendance [VoA]), (3) offering vaccination to individuals attending sexual health clinics and who were diagnosed with gonorrhea (vaccination on diagnosis [VoD]), or (4) vaccination according to risk (VaR), by offering vaccination to patients who were diagnosed with gonorrhea plus individuals who tested negative, but report having more than five sexual partners per year. We further examined how altering (5) VoA and (6) VoD strategies changed if the strategies only targeted high risk groups (VoA(H),VoD(H)). We assessed efficacy by examining vaccination impact relative to no vaccination and when behavioral parameters were held constant. We further ascertained the effects of varying vaccine uptake (10%, 33%, 100%), vaccine efficacy (22%, 31%, 47%), and duration of protection (1.5, 4, 7.5 years) on the effectiveness of each vaccination strategy. For a hypothetical 10-year vaccination programme, VbE had 14.18% of MSM gonorrhea cases averted over the time the programme was implemented. VoA had the highest protective impact on the MSM population with 40.26% averted cases (95% credible interval (CrI): 18.32%-52.57%), but required more vaccine doses than any other strategy. VoD had a smaller impact (12.04% averted cases (95% CrI: 7.12%-15.00%)), but was three times more efficient than VoA in terms of averted cases per dose. VoA(H) and VoD(H) improved the efficiency of VoA and VoD strategies by increasing averted cases per dose to 0.22 and 0.24 respectively, but conferred similar protective effects as VoA (VoA(H): 40.10% averted cases (95% CrI: 18.14%-52.55%)) and VoD (VoD(H): 12.04% averted cases (95% CrI: 7.12%-15.00%)), respectively. VaR (40.10% averted cases (95% CrI: 18.14%-52.55%)) had almost the same impact as VoA, but was more efficient by requiring administration of fewer doses than VoA, with 0.21 (95% CrI: 0.12-0.27) averted cases per dose. Sensitivity analyses indicated that VaR had the greatest public health impact with the highest number of averted cases per dose for vaccines of any efficacy or duration of protection (or both), although VoD and VoD(H) saved more vaccine resource and had the highest number averted MSM cases per dose for highly protective vaccines of long protection. Vaccination of MSM against gonorrhea, according to risk in sexual health clinics in Singapore, can be considered to reduce gonorrhea acquisition and transmission. Development of gonorrhea-specific vaccines which focuses on protective efficacy and the implementation of efficient vaccination programmes can maximize public health impact.

International interests: Student and industry perspectives on agicultural communications curriculum development in Ontario

This study explores the potential development of an agricultural communications program at the [Institution]. It aims to understand the current knowledge of and interest in the discipline among Ontarian agriculture students and industry professionals, and the perceived importance and employability of hypothetical program graduates, contributing to the Sustainable Development Goal of quality education. Using a qualitative descriptive case study approach, focus groups with 18 students and six industry professionals were conducted. Data were collected through open-ended questions, analyzed using open coding and thematic analysis, and triangulated with demographic surveys. The findings reveal a general lack of understanding of agricultural communications among Ontarian students, who nonetheless recognize the field's potential to bridge gaps between producers and consumers, particularly through social media and diverse job opportunities. Industry professionals emphasized the growing importance of storytelling, crisis communication, and the need for poly-skilled graduates capable of addressing varied communication needs within the agricultural sector. Both stakeholder groups expressed interest in an agricultural communications academic program. Recommendations include engaging broader industry support for the program, integrating agricultural communications training across existing agricultural disciplines at the [Institution], and continuing research to refine curriculum development.

Heterogeneity of provider preferences for HIV Care Coordination Program features: latent class analysis of a discrete choice experiment

The PROMISE study assessed revisions designed to facilitate implementation of an HIV care coordination program (CCP) addressing gaps in care and treatment engagement among people living with HIV in New York City (NYC). Through latent class analysis (LCA) of a discrete choice experiment (DCE), we explored heterogeneity of provider preferences regarding CCP features. From January-March 2020, 152 NYC CCP providers completed a DCE with 3–4 levels on each of 4 program attributes: 1) Help with Adherence to Antiretroviral Therapy (ART), 2) Help with Primary Care Appointments, 3) Help with Issues Other than Primary Care, and 4) Where Program Visits Happen. We used LCA to assess patterns of preference, and choice simulation to estimate providers’ endorsement of hypothetical CCPs. LCA identified three subgroups. The two larger subgroups (n = 133) endorsed more intensive individual program features, including directly observed therapy, home visits, and appointment reminders with accompaniment of clients to their appointments. The smallest subgroup (n = 19) endorsed medication reminders only, appointment reminders without accompaniment, and meeting at the program location rather than clients’ homes. Choice simulation analysis affirmed the highest degree of endorsement (62%) for hypothetical programs combining the intensive features described above. Results indicated providers’ preference for intensive program features and also reinforced the need for flexible service delivery options. Provider perspectives on service delivery approaches can inform program adjustments for successful long-term implementation, which in turn can improve patient outcomes.

Learning to Be Fair: A Consequentialist Approach to Equitable Decision Making

In an attempt to make algorithms fair, the machine learning literature has largely focused on equalizing decisions, outcomes, or error rates across race or gender groups. To illustrate, consider a hypothetical government rideshare program that provides transportation assistance to low-income people with upcoming court dates. Following this literature, one might allocate rides to those with the highest estimated treatment effect per dollar while constraining spending to be equal across race groups. That approach, however, ignores the downstream consequences of such constraints and, as a result, can induce unexpected harm. For instance, if one demographic group lives farther from court, enforcing equal spending would necessarily mean fewer total rides provided and potentially more people penalized for missing court. Here we present an alternative framework for designing equitable algorithms that foregrounds the consequences of decisions. In our approach, one first elicits stakeholder preferences over the space of possible decisions and the resulting outcomes—such as preferences for balancing spending parity against court appearance rates. We then optimize over the space of decision policies, making trade-offs in a way that maximizes the elicited utility. To do so, we develop an algorithm for efficiently learning these optimal policies from data for a large family of expressive utility functions. In particular, we use a contextual bandit algorithm to explore the space of policies while solving a convex optimization problem at each step to estimate the best policy based on the available information. This consequentialist paradigm facilitates a more holistic approach to equitable decision making. This paper has been This paper was accepted by Catherine Tucker, Special Issue on The Human-Algorithm Connection. Funding: This work was supported by Stanford Impact Labs [Start-Up Impact Labs/GEJBU], the Stanford Institute for Human-Centered Artificial Intelligence, and Harvard Data Science Initiative. Supplemental Material: The online appendix and data files are available at https://doi.org/10.1287/mnsc.2022.00345 .

Making Curriculum Development Fun for Nurse Educator Graduate Students Through the Use of Play Pedagogy.

Curriculum development is an important topic for nurse educator students to understand. The process of curriculum development requires knowledge of state laws, accrediting bodies, and various curriculum models. Students learn about curriculum development through assignments such as a scaffolded group project where they create a hypothetical undergraduate nursing program. Nurse educator students and nurse faculty view curriculum development as complicated and dull. This article describes the transformation of a curriculum development assignment using sociocultural learning theory and play. Nurse educator students appreciated the assignment and stated it helped them understand the curriculum development process.

Impact of Varying Pre-exposure Prophylaxis Programs on HIV and Neisseria gonorrhoeae Transmission Among MSM in the Netherlands: A Modeling Study.

In 2019, a 5-year pre-exposure prophylaxis (PrEP) program started in the Netherlands, in which up to 8500 men who have sex with men (MSM) can obtain PrEP and 3-monthly consultations with HIV/STI testing. We assessed the impact of the PrEP program on transmission of HIV and Neisseria gonorrhea (NG) among MSM in the Netherlands and examined prospective variations of the program after 2024. We used an agent-based model to estimate the effect of the PrEP program. For hypothetical prospective PrEP programs starting in 2024, we varied the capacity (8,500; 12,000; 16,000 participants) and consultation frequency (3-monthly; 6-monthly; 70% 3-monthly and 30% 6-monthly). At a capacity of 8,500 participants and 3-monthly consultations, the PrEP program could lead to 3,140 [95% credible interval (95% CrI): 1,780-4,780] and 27,930 (95% CrI: 14,560-46,280) averted HIV and NG infections, requiring 316,050 (95% CrI: 314,120-317,580) consultations. At a capacity of 16,000 participants, the programs with 3-monthly consultations and 6-monthly consultations could lead to comparable number of averted HIV [3,940 (95% CrI: 2,420-5,460), and 3,900 (2,320-5,630) respectively] and NG infections [29,970 (95% CrI: 15,490-50,350), and 29,960 (95% CrI: 13,610-50,620) respectively], while requiring substantially different number of consultations: 589,330 (95% CrI: 586,240-591,160) and 272,590 (95% CrI: 271,770-273,290), respectively. Continuation of a PrEP program could lead to a substantial reduction in HIV and NG transmission. More infections could be averted if the number of participants is increased. In turn, the consultation frequency could be reduced without reducing the number of averted infections if capacity is increased.

Discrete Choice Experiment on Financial Incentives for Engaging Young Adults in Vaping Cessation Programs

Introduction Contingency management involves rewarding individuals based on objective evidence of behavioral changes. This study explores preferences for financial incentives in vaping cessation programs. Methods A discrete choice experiment (DCE) was conducted among young adult current e-cigarette users aged 19-29. DCE attributes (and levels) included reward amount ($100, $300), reward schedule (consistent value, escalating value), reward procedure (gain-framed, loss-framed), vaping education modules (yes, no), text messaging support (yes, no), and cost ($30, $100). Participants were randomized into one of the four blocks, each containing four choice sets. Each choice set presented two hypothetical vaping cessation programs. Choice data (n × choice sets × alternative programs = 154 × 4 × 2 = 1,232 observations) were analyzed using generalized estimation equation models. Results Participants showed a preference for vaping cessation programs offering a higher reward amount (odds ratio [OR] = 11.5; 95% CI,7.0-19.2), gain-framed rewards for sustained abstinence (OR = 1.4; 95% CI,1.0-1.8), text messaging support (OR = 1.9; 95% CI,1.4-2.5), and a lower program cost (OR = 2.6; 95% CI,1.8-3.8). Interaction tests showed significant effects of the rewards procedure among daily e-cigarette users (adjusted OR [AOR] = 2.1; 95% CI,1.3-3.5), but not some-day users; and among those with no quit attempts in the past six months (AOR = 2.7; 95% CI,1.5-4.7), but not those with previous quit attempts. Female participants preferred text messaging support (AOR = 3.6; 95% CI,2.3-5.4), whereas male participants did not show this preference. Conclusion A multifaceted vaping cessation intervention augmented with financial incentives might improve participation and engagement among young adults. Future studies should investigate how these attributes can enhance program reach and vaping abstinence outcomes in real-world settings.

The costs and the potential allocation of costs of bouillon fortification: The cases of Nigeria, Senegal, and Burkina Faso.

Food and condiment fortification programs are needed to address micronutrient deficiencies and their health, developmental, and mortality consequences; but these programs are never free. Knowing program costs and their allocation across stakeholders is essential to design and manage effective, efficient, and sustainable programs. We developed 10-year hypothetical bouillon fortification program cost models for Nigeria, Senegal, and Burkina Faso that included start-up and operational costs for government and industry, as well as premix costs generated by an embedded premix cost calculator to allow for alternative premix formulas in cost calculations. The main drivers of total costs were total bouillon consumption and the types and amounts of fortificants in the micronutrient premix. For a premix that meets 30% of Codex Nutrient Reference Values in 2.5g of bouillon for vitamin A, folate, vitamin B12, zinc, and iron, the cost per metric ton of fortified bouillon was ∼$325 for all countries (∼$0.01 per 2.5g serving). Annual start-up costs ranged from ∼$324k (Burkina Faso) to ∼$455k (Nigeria); nonpremix annual operating costs ranged from ∼$108k (Burkina Faso) to ∼$3.9m (Nigeria); and annual premix costs varied from ∼$2.4m (Burkina Faso) to ∼$76m (Nigeria). In policy discussions, program costs should be set alongside nutritional benefits.

Using stated preference methods to design gender-affirming long-acting PrEP programs for transgender and nonbinary adults.

Integrating gender-affirming care with biomedical HIV prevention could help address the disproportionate HIV risk experienced by transgender and nonbinary (trans) adults. This discrete choice experiment assesses and identifies the most important programming factors influencing the decisions of trans adults to use injectable long-acting HIV pre-exposure prophylaxes (LA-PrEP). From March to April 2023 n = 366 trans adults in Washington state chose between four different choice profiles that presented hypothetical programs (each comprised of 5 attributes with 4 levels). We analyzed ranked choice responses using a mixed rank-ordered logit model for main effects. Respondents preferred to receive LA-PrEP from a gender-affirming care provider and a co-prescription for both oral and injectable hormones. Trans adults strongly favored 12-month protection and injection in the upper arm. No strong preferences emerged surrounding the type of health facility offering the gender-affirming LA-PrEP program. Our findings show that integrating and leveraging gender-affirming health systems, inclusive of medical services such as hormone therapy, with HIV biomedical products like LA-PrEP is strongly preferred and influential to trans adults' decision to use LA-PrEP. Leveraging choice-based design experiments provides informative results for optimizing gender-affirming LA-PrEP programming tailored to trans adults.

Perceived risks and benefits of telePrEP interventions: An interview study with rural sexual minority men in Texas.

Many rural areas lack brick-and-mortar HIV prevention resources despite the increasing rates of HIV. Although online HIV pre-exposure prophylaxis (PrEP) programs can potentially increase uptake among rural sexual minority men (SMM), their attitudes and preferences regarding telehealth-based PrEP (telePrEP) programming are uncertain. This qualitative study examined rural SMM's perceived risks and benefits of participating in a hypothetical telePrEP program. Twenty rural SMM living in Texas completed a semi-structured online videoconferencing interview between April 12 and June 14, 2023. Data were analyzed with reflexive thematic analysis. Four themes were constructed: (1) telePrEP interventions increase accessibility but completely online services might be inadequate; (2) telePrEP and mail-order interventions are convenient but face challenges; (3) telePrEP interventions need to address confidentiality and privacy within the context of the sociopolitical climate; and (4) telePrEP interventions need to address trustworthiness and transparency. Overall, our results indicate that rural SMM perceive telePrEP interventions that provide at-home and telehealth PrEP, HIV testing, and HIV care services as beneficial. However, overall utility and acceptability depend on perceptions of privacy, confidentiality, trustworthiness, and transparency. Given the HIV prevention and treatment service deserts in which many rural SMM live, telePrEP interventions must purposefully demonstrate how their operations and data will remain safe and secure. Further work should explore contextual or situational factors that influence the willingness and acceptability of rural SMM to participate in online HIV prevention intervention research studies.

Attitudes Toward Using and Willingness to Use a Hypothetical Online Sex Communication Intervention for Parents of Sexual and Gender Minority Adolescents.

Although parents of sexual and gender minority (SGM) adolescents play a critical role in communicating about sexual health to their children, most parents have reported that they are unknowledgeable and uncomfortable talking about sexual health to their SGM adolescent. Because of the limited availability of sex education programs for parents of SGM adolescents, the study aimed to (1) describe the attitudes toward using and willingness to use a hypothetical online sex communication intervention for parents of SGM adolescents and (2) examine factors associated with willingness to use such an intervention. Parents of SGM adolescents from across the United States (N = 385) completed an online survey from March 10-16, 2023. Most participants were open to participating in a hypothetical online sex communication program and had positive attitudes toward it. Logistic regression results showed that participants who overall agreed a hypothetical online parent-based sex education intervention would be helpful and of interest had higher odds of being overall willing to participate in such a hypothetical intervention. Additionally, participants with higher income levels were also more likely to be willing to participate in a hypothetical program. Results from this exploratory study suggest that most parents of SGM adolescents have positive attitudes toward a hypothetical online parent-based sex education program and are willing to participate in it, highlighting a need to develop sex education programs tailored to the needs and preferences of parents of SGM adolescents. Additionally, equitable access to such programs is necessary especially regarding income level.

Public Preferences for Genetic and Genomic Risk-Informed Chronic Disease Screening and Early Detection: A Systematic Review of Discrete Choice Experiments.

Genetic and genomic testing can provide valuable information on individuals' risk of chronic diseases, presenting an opportunity for risk-tailored disease screening to improve early detection and health outcomes. The acceptability, uptake and effectiveness of such programmes is dependent on public preferences for the programme features. This study aims to conduct a systematic review of discrete choice experiments assessing preferences for genetic/genomic risk-tailored chronic disease screening. PubMed, Embase, EconLit and Cochrane Library were searched in October 2023 for discrete choice experiment studies assessing preferences for genetic or genomic risk-tailored chronic disease screening. Eligible studies were double screened, extracted and synthesised through descriptive statistics and content analysis of themes. Bias was assessed using an existing quality checklist. Twelve studies were included. Most studies focused on cancer screening (n = 10) and explored preferences for testing of rare, high-risk variants (n = 10), largely within a targeted population (e.g. subgroups with family history of disease). Two studies explored preferences for the use of polygenic risk scores (PRS) at a population level. Twenty-six programme attributes were identified, with most significantly impacting preferences. Survival, test accuracy and screening impact were most frequently reported as most important. Depending on the clinical context and programme attributes and levels, estimated uptake of hypothetical programmes varied from no participation to almost full participation (97%). The uptake of potential programmes would strongly depend on specific programme features and the disease context. In particular, careful communication of potential survival benefits and likely genetic/genomic test accuracy might encourage uptake of genetic and genomic risk-tailored disease screening programmes. As the majority of the literature focused on high-risk variants and cancer screening, further research is required to understand preferences specific to PRS testing at a population level and targeted genomic testing for different disease contexts.

Risk-Adapted Breast Screening for Women at Low Predicted Risk of Breast Cancer: An Online Discrete Choice Experiment.

A risk-stratified breast screening program could offer low-risk women less screening than is currently offered by the National Health Service. The acceptability of this approach may be enhanced if it corresponds to UK women's screening preferences and values. To elicit and quantify preferences for low-risk screening options. Women aged 40 to 70 y with no history of breast cancer took part in an online discrete choice experiment. We generated 32 hypothetical low-risk screening programs defined by 5 attributes (start age, end age, screening interval, risk of dying from breast cancer, and risk of overdiagnosis), the levels of which were systematically varied between the programs. Respondents were presented with 8 choice sets and asked to choose between 2 screening alternatives or no screening. Preference data were analyzed using conditional logit regression models. The relative importance of attributes and the mean predicted probability of choosing each program were estimated. Participants (N = 502) preferred all screening programs over no screening. An older starting age of screening, younger end age of screening, longer intervals between screening, and increased risk of dying had a negative impact on support for screening programs (P < 0.01). Although the risk of overdiagnosis was of low relative importance, a decreased risk of this harm had a small positive impact on screening choices. The mean predicted probabilities that risk-adapted screening programs would be supported relative to current guidelines were low (range, 0.18 to 0.52). A deintensified screening pathway for women at low risk of breast cancer, especially one that recommends a later screening start age, would run counter to women's breast screening preferences. Further research is needed to enhance the acceptability of offering less screening to those at low risk of breast cancer. Risk-based breast screening may involve the deintensification of screening for women at low risk of breast cancer.Low-risk screening pathways run counter to women's screening preferences and values.Longer screening intervals may be preferable to a later start age.Work is needed to enhance the acceptability of a low-risk screening pathway.

The acceptability of hospital-at-home for persons living with cancer and their caregivers.

1548 Background: Hospital at Home (HaH) is part of a comprehensive patient-centered model that delivers multidisciplinary acute medical care in the home. While HaH has mainly been tested in general medical patients, uncertainties persist regarding the feasibility and acceptability of this model within oncology populations. This study assessed patient and caregiver characteristics associated with acceptability of a hypothetical HaH program in persons hospitalized with cancer and described patient medical needs. Methods: A cross-sectional survey assessing acceptability of a hypothetical HaH program, home characteristics, and demographics was completed by 250 patients and 33 caregivers. Eligible patients were English-speaking adults (18+ years) admitted to the medicine service at a cancer hospital. Acceptability was measured on a 5-point Likert scale and defined as responses of “strongly agree” or “agree” to the statement, “I would consent to the use of my home for my hospital care” if such a program were available. Surveys were conducted in person or via telephone during the index hospitalization. Unpaid adult caregivers were surveyed in person and acceptability of the hypothetical HaH program was similarly assessed. Characteristics of the hospitalization were assessed via the electronic health record. Continuous variables were compared between acceptability groups using Wilcoxon rank sum test; categorical variables were compared using Fisher’s exact test and Pearson’s chi-squared test. Results: Median patient age was 63, 134 (54%) were female, 38 (16%) identified as Black and 21 (8.8%) as Hispanic, and 171 (72%) completed some college education or more. 208 patients (83%) rated participation in HaH as acceptable, as did 28 (85%) caregivers. Patients living with metastatic disease were more likely to accept HaH (p&lt;0.05). Acceptability differed by race (p&lt;.05) and was lowest among Black patients (74%) and those who preferred not to provide their race (70%). Of those who rated HaH acceptable, 137 (66%) had advanced imaging or a surgical procedure after the first day of admission and 21 (10%) had an absolute contraindication to being hospitalized at home such as a home member using illicit drugs at home (15, 7%). Conclusions: Over 80% of persons hospitalized with cancer and their caregivers would agree to HaH. Those with advanced disease were more likely to agree to home hospitalization compared to curative-intent patients, but Black patients were less likely to agree to be hospitalized at home compared to white patients. Many patients had hospitalization characteristics (e.g., imaging) that may be challenging to coordinate from home, but few patients had safety-related contraindications to HaH. These findings will inform future efforts to evaluate and target HaH programs in oncology to patients most likely to agree to and benefit from them, and address barriers to uptake in certain racially minoritized populations.

Variation in partial direct costs of dry cow therapy on 37 large dairy herds

The objective of this observational study was to estimate partial direct costs of dry cow antibiotic therapy (DCT) protocols used on 37 large dairy herds in Wisconsin and to estimate the potential monetary savings and reduction in antimicrobial usage (AMU) if selective DCT was used. Partial direct costs of DCT were calculated using costs of intramammary (IMM) antimicrobials and teat sealants. Data were retrospectively collected on 37 large dairy farms for a period of 1 yr and included the total number of cows dried off, types of IMM antimicrobial used, and product prices (obtained from farm invoices). A single farm visit was performed to verify data. Clinical mastitis (CM) and SCC history across lactation were used as the criteria to identify cows eligible to receive only teat sealants (no antibiotic DCT) based on adoption of a hypothetical selective DCT program. Descriptive statistics were performed using PROC MEANS to summarize continuous herd and cow characteristics. Differences in costs among IMM antibiotic products and eligibility to not receive antibiotics at dry-off by parity were analyzed using ANOVA. Differences in milk yield at the last test-day and DIM at dry-off based on eligibility for selective DCT were analyzed using PROC MIXED. A total of 35,691 cows were dried off across all herds (n = 37) and most of the herds used IMM antibiotic DCT at dry-off in most of the cows. Teat sealant was used as part of the dry-off protocol in all but 3 herds. Of the enrolled farms, 30 used blanket antibiotic DCT in all quarters of all cows and 7 herds used selective DCT with no administration of antibiotics given to 0.8% to 58% of the dry cows within the herd. Across all farms, the average cost of products given per dried cow was $19.57 ± 0.64 (mean ± SE) and ranged from $8.72 to $24.04. As expected, the cost per dried cow was greater ($23.45 ± $0.38) in herds that used higher cost IMM antibiotics as compared with herds that used lower cost IMM antibiotics ($16.64 ± $0.40). When using an algorithm based on udder health records to hypothetically select cows that would be eligible to receive teat sealants only (no antibiotic DCT), eligibility ranged from 27.3% to 93.3% within-herds and varied by parity, milk yield at last test-day, and DIM at dry-off. If a selective DCT program based on udder health records was used, an overall reduction of $5.37 (27% of total costs) per dry cow would be expected. Likewise, adoption of selective DCT based on udder health records would reduce AMU at dry-off by approximately 51%. However, neither of these estimates included potential adverse health complications (such as increased CM) that can occur if selective DCT programs are not effectively performed. Variations in partial direct costs at dry-off were observed among herds based on treatment protocols. In herds that have good udder health management and contagious mastitis pathogens controlled, adoption of selective DCT based on SCC and history of CM can reduce AMU and partial direct costs of dry cow management.

Comparing preferences to evaluations of barrier self-efficacy for two strength training programs in US older adults.

Engagement in regular physical activity is one of the best strategies for older adults to remain healthy. Unfortunately, only 35% of older adults meet guidelines for muscle strengthening activities. Eliciting participant preferences is one possible way to improve physical activity engagement. However, other sources of participant input to improve uptake and maintenance remain uninvestigated. This study compared preferences to self-efficacy ratings for two strength training programs. We conducted a national cross-sectional survey of 611 US adults over age 65. We compared two participant evaluations (the preferred program and the program for which they had higher barrier self-efficacy) of two hypothetical strength training programs (45 minutes performed three times per week (traditional) and 5 minutes performed daily (brief)). Most participants (68%) preferred the brief strength training program. The difference in self-efficacy ratings was an average of 1.2 (SD = 0.92). One in five participants preferred a strength training program for which they had less self-efficacy; nearly all of these participants (92%) preferred the traditional strength training program but had more self-efficacy for the brief strength training program. Older adults reported preferring and having more self-efficacy for a brief compared to a traditional strength training program. Differences in self-efficacy ratings between the two strength training programs were large. Preferences were often not congruent with ratings of self-efficacy. Preferences for strength training programming may not always reflect the program most likely to be maintained. Future investigations should evaluate differences in behavioral uptake, maintenance, and outcomes from two comparative strength training interventions using preferences and self-efficacy.

Targeting the “poorest of the poor”: A multi-scale approach

Understanding that poverty presents multidimensional and multi-scale deployments, a methodology is proposed that allows to identify those poorest families among the poor in the State of São Paulo for cash transfer purposes. We propose a method to combine the vulnerability of the family with the other scales, resulting in a more refined classification of the situation of poverty, which is more difficult to be biased by the selfreported register. We added a georeferenced context-based component to differentiate among families with same vulnerability but living in different levels of intraurban and municipal conditions. At the municipal scale, we developed two sub-indexes through Principal Component Analysis (PCA): a) the Municipal Context Sub-Index, and b) the Municipal CadUnico Sub-Index. These sub-indexes were then integrated. On the scale of the Census enumeration area, we considered aspects that can aggravate the poverty condition, such as physical environmental risks and socioeconomic deprivation. On the family-scale, we consider the score defined by the São Paulo Multidimensional Poverty Index (MPI). The final multi-scale classification of families results from the sum of the scores obtained at the family level, the Census enumeration area and the municipality. The indexes were validated internally and externally. We simulated a scenario of hypothetical cash transfer programs using the current tool (MPI-S) and the proposed methodology to benefit up to 10,000 and 100,000 families in the State of São Paulo. We implemented the solution in Power BI tool to allow automatic updates of the indexes to be made in the developed “dashboard”. Results allow us to evaluate the impact of both approaches. The current approach, based only in the multidimensional poverty of the family is more distributed, with a wider geographic distribution, sometimes benefiting only one family in some municipalities or a great number of families in one municipality. The proposed approach tends to concentrate the assistance with greater percentages of families in the CadUnico by municipality. Besides aiding on cash transfer decision, the results obtained on the context and the intensity of municipal poverty can be used for programs aimed at leveraging economic development in the different administrative regions of the State of São Paulo.

Preferences for a community pharmacy-based pre-exposure prophylaxis (PrEP) delivery program: A discrete choice experiment

BackgroundCommunity pharmacies are ideal venues for pre-exposure prophylaxis (PrEP) delivery. Pharmacists and pharmacy-based PrEP delivery programs have the potential to improve access. ObjectivesThis study elicited preferences for attributes of a hypothetical community pharmacy-based PrEP delivery program among US men who have sex with men (MSM) and assessed predictors of their preferences. MethodsData were collected via a cross-sectional anonymous survey of US MSM, who were aged 18-65 years, not transgender, reported HIV status negative/unknown, and PrEP eligible. A discrete choice experiment was conducted with seven attributes of a pharmacy-based PrEP program: initial PrEP eligibility screening mode, location for human immunodeficiency virus (HIV) tests, timing for HIV test results, PrEP decision-making style, location of PrEP consultations, PrEP medication fill method, and mode for ongoing monitoring. Latent class analysis was performed to analyze preference heterogeneity. Multinomial logistic regression assessed predictors of latent class membership. ResultsThis study included 390 MSM. Time to receive HIV test results was the most important attribute; receiving results on the same day had the highest preference. The next most important attribute was PrEP screening mode; online questionnaires were the most preferred. Respondents’ preferences clustered into four classes: 1) “Same day results and online monitoring” (SDROM) group (63.1%), 2) “Consumerist decision-making” (CDM) group (16.2%), 3) “Self-screening (online questionnaire)” (SOQ) group (11.3%), and 4) “Same day results preferring” (SDRP) group (9.5%). Hispanic MSM (adjusted odds ratio [aOR] =0.31, 95% confidence interval [CI] [0.12-0.84], P = 0.020), MSM of other races (aOR=0.38, 95% CI [0.15-0.97], P = 0.044) vs. White MSM; and those having a sexually transmitted disease recently (aOR=0.37, 95% CI [0.16-0.85], P = 0.018), had lower odds of being in the CDM group vs. the SDROM group. ConclusionsMSM’s preferences for a pharmacy-based PrEP program are heterogeneous. Same day results for HIV tests and online PrEP screening are key components when designing a community pharmacy-based PrEP program.

Farmers’ Willingness to Participate in a Carbon Sequestration Program – A Discrete Choice Experiment

Farmers can counteract global warming by drawing carbon dioxide from the air into agricultural soils by building up humus. Humus programs were developed to motivate farmers for even more humus formation (= carbon sequestration) through an additional financial incentive. These programs are still at an early stage of development, which is why the number of participating farmers and research work is still low. This study is the first to analyze the willingness of German farmers to participate in hypothetical humus programs. The results of a discrete choice experiment show that a (higher) threshold for the payout of the premium, regional (rather than field-specific) reference values, and the risk of repayment clearly discourage farmers from participating. Program providers must more than double the premium (set at around 240 € per hectare and 0.1% humus increase) to maintain farmers’ willingness to participate despite a payout threshold. Regional reference values and an additional premium/repayment system would lead to an increase in the premium of around 20 € per hectare in order to keep the willingness to participate at the same level. The motivation to build up humus, the desire to maximize subsidies, and a higher livestock density have a positive influence on farmers’ decision to participate. Farm size and risk attitude have an impact on farmers’ preferences for program design. The study is relevant for policymakers and non-governmental organizations concerned with carbon management, as our findings highlight pathways for efficient, targeted designs of humus programs and carbon sequestration policies.