Local Staff Research Articles

Visible Materials, Invisible People: How Branding in International Development Reproduces Inequality

AbstractA democratization program in postwar Angola offers an example of contemporary development work and its branding: donors’ bureaucratized practice of claiming credit for any attempt at social improvement while simultaneously distancing themselves from failures. Development branding achieves its claims‐making and distancing effects by emphasizing, in institutional narratives of development work, the role of material resources over the larger social contributions of local staff and beneficiaries. Development agencies’ increased bureaucratization, including their focus on branding, is not incidental to the undertaking but an outgrowth of shared histories; bureaucracy as social form, including institutional narratives emphasizing the material, and development as industry are both rooted in racialized and classed systems of hierarchical relations. Branding practices work to conceal and deepen these relations. A complete accounting of development must include attention to how—in form, action, and representation—it perpetuates historical relationships of inequality in addition to documenting their effects.

Audit of amylase and lipase requests in suspected acute pancreatitis and cost implications, South Africa.

BackgroundThe internationally accepted criteria for the diagnosis of acute pancreatitis (AP) requires two of the three following features to be present: characteristic abdominal pain, elevated serum amylase and/or lipase enzymes, or consistent imaging results. However, sensitivity and specificity can vary depending on the population and cut-off values used.ObjectiveThis study evaluated the suitability of amylase and lipase as first-line diagnostic biomarkers of suspected AP for the local population served by Tygerberg Hospital, South Africa.MethodsThis retrospective analysis was conducted in June 2019 using all amylase and/or lipase request data from December 2018. Patient clinical data were included in sensitivity and specificity analyses of amylase, lipase or dual requests for diagnosis of AP. Cost per test data were obtained from the National Health Laboratory Service and used to calculate the total cost of the tests and potential savings.ResultsSensitivity for lipase was 90.0% compared to 50.0% for amylase. Specificity was similar for singular measurements of lipase and amylase. Dual measurement of amylase and lipase showed no improvement in sensitivity (83.3%) and only a minor increase in specificity (97.4%) compared with measurement of lipase alone. The estimated savings was R2522.85 ($174.98 USD), with a potential annual cost saving of R84 423.74 ($5855.69 USD).ConclusionLipase was shown to be a more sensitive biomarker compared to amylase for the screening of AP, providing evidence for laboratories to educate local staff and promote improved requesting practices by clinicians. Additionally, preventing unnecessary dual requests may reduce costs.

The Early Detection and Case Management of Skin Diseases With an mHealth App (eSkinHealth): Protocol for a Mixed Methods Pilot Study in Côte d'Ivoire.

BackgroundThere is a high prevalence of skin diseases sub-Saharan Africa, including skin neglected tropical diseases (NTDs) that could lead to lifelong disabilities and deformities if not diagnosed and treated early. To achieve early detection and early treatment of these skin diseases, we developed a mobile health app, eSkinHealth.ObjectiveThis paper outlines a protocol for evaluating the effect of our eSkinHealth app in the early detection and effective management of skin diseases in Côte d’Ivoire.MethodsA mixed methods pilot trial will be conducted in Côte d’Ivoire and will consist of 3 phases: (1) the development and improvement of the eSkinHealth app, (2) a pilot trial to evaluate the usability of the eSkinHealth app for local medical staff in Côte d’Ivoire, and (3) a pilot trial to evaluate the effectiveness of early detection and case management of targeted skin NTDs (Buruli ulcer, leprosy, yaws, and lymphatic filariasis) with the eSkinHealth app in Côte d’Ivoire. The pilot study will be implemented as a 2-arm trial with local health care providers and patients with skin NTDs over a 3-month follow-up period. The local health care providers will be assigned to an intervention group receiving the eSkinHealth app to be used in their daily practices or a control group. Training will be provided on the use and implementation of the app and the diagnostic pipeline to the intervention group only, while both groups will receive training on skin diseases. Our primary outcome is to evaluate the early detection and effective management of skin diseases using the eSkinHealth app in Côte d’Ivoire by the number of cases diagnosed and managed. Additionally, we will evaluate the eSkinHealth app with validated questionnaires and in-depth interviews. Procedures of our methods have been reviewed and approved by the Institutional Review Board of the Ministry of Health, Côte d’Ivoire and by Tulane University in 2021.ResultsThis study was funded in 2021. We started the enrollment of patients in February 2022, and data collection is currently underway. We expect the first results to be submitted for publication in 2023.ConclusionsOur eSkinHealth app is a field-adapted platform that could provide both direct diagnostic and management assistance to health workers in remote settings. The study will provide evidence for the usability and the effectiveness of the eSkinHealth app to improve the early detection and case management of skin NTDs in Côte d’Ivoire and, furthermore, is expected to contribute to knowledge on mobile health approaches in the control of skin NTDs.Trial RegistrationClinicalTrials.gov NCT05300399; https://clinicaltrials.gov/ct2/show/study/NCT05300399International Registered Report Identifier (IRRID)DERR1-10.2196/39867

Development of report-back materials of air pollution exposure results to participants in the HAPIN trial in Guatemala and Rwanda

Background: Interpretation of individual exposure information for reporting to research participants is an important aspect of the research process that can empower participants, increase community engagement with scientific research, and better tailor future community-engaged research. In the multi-country Household Air Pollution Randomized Intervention Network (HAPIN) trial, a randomized controlled trial among 3200 pregnant women that assessed the effect of a liquefied petroleum gas (LPG) stove and fuel intervention, we engaged a subset of study participants in Guatemala and Rwanda in the development of context-appropriate materials. The purpose of this study was to: 1) report and explain air pollution exposure levels to: 2) present strategies to increase awareness of the health effects of air pollution; and 3) discuss strategies to reduce personal exposure to air pollution. Methods: Local project staff in Guatemala and Rwanda were trained to conduct qualitative research. Individual interviews and participatory observations in participant homes (n=42 in Guatemala; n=20 in Rwanda) were followed by working groups to assess interpretability of different graphical displays of exposure data. Finally, focus groups assisted in iteration of contextually relevant visual aids illustrating exposure results, health impacts, and strategies to reduce exposures. Results: After iterations, visual materials depicting community and personal exposure to fine particulate matter (PM2.5) using a simple "thermometer-style” graphic were chosen, including a marker of community-level impacts of the liquefied petroleum gas (LPG) stove intervention. Educational material about the health impacts of air pollution and contextually feasible and available methods to reduce exposure were presented. Capacity was built among field teams to conduct qualitative research. Conclusions: Development of materials to report back scientific results to study participants in accurate and understandable ways is an ethical obligation to communities participating in complex research and may yield important benefits to researchers and participating community alike. Keywords: report-back; environmental health literacy; HAPIN trial

Providing On-Site Laboratory and Biosafety Just-In-Time Training Inside a Box-Based Laboratory during the West Africa Ebola Outbreak: Supporting Better Preparedness for Future Health Emergencies.

The Biological Light Fieldable Laboratory for Emergencies (B-LiFE) is a box-based modular laboratory with the capacity to quickly deploy on-site in cases of uncontrolled spread of infectious disease. During the 2014–2015 West Africa Ebola outbreak, this tent laboratory provided diagnostic support to the N’Zerekore Ebola Treatment Center (ETC), Guinea, for three months. One of the objectives of B-LiFE deployment was to contribute, as much as possible, to national capacity building by training local scientists. Two Guinean biologists were selected according to their basic biological knowledge and laboratory skills among 50 candidate trainees, and were integrated into the team through “just-in-time training” (JiTT), which helped the biologists acquire knowledge and laboratory skills beyond their expertise. The JiTT program was conducted according to standard laboratory procedures, in line with international biosafety guidelines adapted to field conditions. Supervised acquisition of field-laboratory practices mainly focused on biochemical testing and Ebola viral load quantification using routine PCR-based detection, including the Biofire FilmArray® system (BFA), a novel, as yet non-validated, automated assay for diagnostic testing of Ebola virus disease at the time of B-LiFE deployment. During the JiTT, the two biologists were closely involved in all laboratory activities, including BFA validation and biosafety procedures. Meanwhile, this successful JiTT enhanced the B-LiFE in-field operational capacity and contributed to national capacity building. A post-training evaluation and contacts were organised to assess the evolution and technical skills gained by the two researchers during the B-LiFE mission. At the end of the B-LiFE mission, both biologists were enrolled in follow-on programmes to curb the epidemic spreading in Africa. These results demonstrate that during infectious disease outbreaks or major crises, the JiTT approach can rapidly expand access to critical diagnostic testing and train local staff to do so.

Using the conservation excellence model to improve ecosystem restoration undertaken by organisations working in biodiversity hotspots

Ecosystem restoration is a relatively new discipline in conservation biology and good practice is needed to close the knowledge-action gap to implement evidence-based conservation and effective landscape recovery. The Conservation Excellence Model (CEM) has been used to evaluate over 100 conservation organisations including programmes involved in reforestation and ecosystem renewal. This study evaluates a reforestation initiative in Mauritius using the CEM methodology and compares the programme’s organisation with an equivalent Indian Ocean Island programme in Comoros. This study aims to identify whether improvements in reforestation can be identified by CEM evaluation, whether recommendations for these specific reforestation programmes generate learning about effective practices in the sector, and whether the CEM is a relevant tool for comparing effectiveness of reforestation initiatives. The Mauritius programme is shown to utilise sound approaches, whilst being a relatively new organisation (with a profile of more than 350 points), yet can still make improvements already implemented and observed in its Comorian equivalent, which will enable significant improvement in approach and results in the future. The findings identify the importance of addressing threats and factors influencing ecosystem degradation, ensuring links between agricultural and reforestation goals, involvement of local communities, resilient management teams, and having teams based on local staff. CEM assessment provides a rapid, low-intensity approach to investigate connections and facilitate improvements in organisational practice, enhance conservation and restoration work, and enable a more purposeful effort to ensure advances in achievement, outcomes and impact of reforestation initiatives.

Addressing local health service problems through integrated governance: a case study from Senegal

ABSTRACT Local governments, facility staff, and civil society actors are often best placed to identify and address local service delivery problems. We explore how an integrated governance approach – that empowers local actors and promotes cross-sectoral collaboration – affected health service problem-solving in Senegal. Using a quasi-experimental design, we draw on survey data to trace how local health governance bodies address problems. Findings suggest an integrated governance approach improves health service readiness through increased citizen involvement and greater access to resources. These exploratory findings illuminate a growing literature linking initiatives that empower local governments, citizen groups, and multi-stakeholder governance bodies to meaningful service improvements.

ОПТИМИЗАЦИЯ СТРУКТУРЫ И ШТАТНОЙ ЧИСЛЕННОСТИ ОРГАНОВ МЕСТНОГО САМОУПРАВЛЕНИЯ КАК ИНСТРУМЕНТ СОЦИАЛЬНО-ЭКОНОМИЧЕСКОГО РАЗВИТИЯ МУНИЦИПАЛЬНОГО ОБРАЗОВАНИЯ

The article provides the overview of approaches to members of the local governments staff number, analyzes practitioners in certain regions. As a result, a unified methodology was taken, similar to the structure and composition of local governments, based on a combined approach. The proposed methodology was tested on the territory of the urban district of the resort city of Sochi, Krasnodar Territory. The results of its testing are presented in the article.

Assessing the Impact of a PrEP Aware Week Campaign on PrEP Prescription Fills in NYS.

The New York State (NYS) Department of Health AIDS Institute engaged stakeholders across NYS to participate in the state's first "PrEP Aware Week" (PAW). PAW sought to increase the knowledge, interest, and number of PrEP (pre-exposure prophylaxis) prescriptions filled across NYS. PAW activities were designed to be easy to implement, with minimal cost. Stakeholders were provided activities to implement, along with a social media tool kit featuring videos, graphic ads, and sample social media posts in English and Spanish to use as is or modify. PAW included more than 750 distinct events and activities undertaken by more than 250 participating providers. To assess the impact of PAW on PrEP prescription filling patterns in NYS. An interrupted time-series analysis was conducted to estimate the impact of PAW on overall and new PrEP prescription filling patterns. Separate models were developed by sex (male, female), race and ethnicity (White non-Hispanic, Black non-Hispanic, Hispanic, other, unknown), and region (New York City, rest of NYS). PAW took place across NYS during the week beginning October 20, 2019. PAW was undertaken by more than 250 health care providers, nonmedical health & human services providers, local and state health department staff, and colleges and universities. The number of overall and new PrEP prescriptions. PAW was associated with modest increases (6%-9%) in the number of PrEP prescription fills in NYS. The PAW impact lasted for about 2 months, generated an estimated 2727 additional PrEP prescription fills statewide, and was realized across sex, region, and racial and ethnic subgroups. Increased prescription fills were driven by those previously prescribed PrEP. Increases in new prescriptions were noted among Latinx individuals (21% increase, 55 additional prescriptions) but not overall or across other groups. NYS's PAW was effective at increasing PrEP prescription refills in NYS.

Exploration and practice of building tele-critical care system

To look for the problems faced in the construction of the tele-critical care system, explore the framework of construction of the tele-critical care system, and verify the application effects of the established tele-critical care system. Through literature review and on-site investigation and demonstration, the causes affecting the construction of the tele-critical care system were explored. Through on-site investigation of the actual situation of the critical care department in relevant hospitals, arguing and choosing intended intensive care unit (ICU) and cooperative third-party communication and equipment companies, and through the Internet of Things and 5G communication technology, a tele-critical care system with the core hospital of the group as the center and the member institutes within the group as the nodes was built. Via the established tele-critical care system, activities such as tele-monitoring, visual remote ward rounds, remote consultation, remote teaching were carried out to verify the functions of the system. The insufficient cognition of relevant personnel, tele-medicine practice certification requirements, information security issues and the barriers of equipment information integration were the main causes affecting the construction of tele-critical care system. There were five parts in the tele-critical care system architecture foundations, including bed unit equipment and audio and video information collection system, lossless and secure transmission of collected information, real-time display of information in the remote center, real-time staff interaction between the centre and the nodal hospitals, and information cloud storage. It has been verified that patients' diagnostic and treatment information can be transmitted safely, losslessly and in real-time by a special line through private 5G network. Through this system, real-time and stable upload of audio and video information of patients and application information of monitors, ventilators and infusion work stations can be achieved; combined with tele-conference connections to conduct two-way communication with local medical staff, real-time tele-monitoring, visual remote ward rounds, remote consultation, remote teaching and other functions can be achieved. The tele-critical care system we established is feasible to construct within the medical group and can safely and effectively realize the functions of real-time tele-monitoring, visual remote ward rounds, remote consultation, and remote teaching.

Using the Consolidated Framework for Implementation Research to Foster the Adoption of a New Dementia Education Game During the COVID-19 Pandemic.

Background and ObjectivesThe pandemic of coronavirus disease 2019 (COVID-19) challenged educators to move staff education online and explore innovative ways to motivate learning to support dementia care for patients in geriatric settings. This article presents how the Consolidated Framework for Implementation Research (CFIR) was used to support the adoption of an online dementia education game in Canadian hospitals and long-term care homes (LTC). The dementia education was co-developed with local staff and patient partners to teach practical person-centered care communication techniques.Research Design and MethodsCFIR guided our strategy development for overcoming barriers to implementation. Research meetings were conducted with practice leaders, frontline healthcare workers, and a patient partner. Our analysis examined four interactive domains: intervention, inner context, outer settings, and individuals involved and implementation process.ResultsOur analysis identified five effective strategies: Easy access, Give extrinsic and intrinsic rewards, Apply implementation science theory, Multiple tools, and Engagement of champion. The CFIR provided a systematic process, a comprehensive understanding of barriers, and possible enabling strategies to implement gamified dementia education. Interdisciplinary staff (n=3,025) in ten hospitals and ten LTC played online games. The evaluation showed positive outcomes in knowledge improvement in person-centered dementia care.Discussion and ImplicationsGamified education in dementia care offers a social experience and a component of fun to promote adoption. In addition, CFIR is useful for engaging stakeholders to conduct project planning and team reflection for implementation. The real-time discussion and adjustment helped overcome challenges and timely meet the needs of multiple organizations.

Cultural Differences in International Tourists’ Perceived Safety in China

ABSTRACT To improve inbound tourism in China, differences in international tourists’ perceived safety must be analyzed. Thus, this study attempts to investigate and categorize international tourists’ perceived safety and then evaluate the resulting differences. Findings reveal distinctions in demographic attributes based on safety incidents, attitudes of local service staff and residents toward tourists, safety information, and media coverage of safety incidents. Safety satisfaction, specific safety concerns, and broad safety concerns were classified on the basis of Plog’s psychological theory and tourists’ perceived safety. Significant differences in tourist nationalities were also identified and assessed using Hofstede’s index of uncertainty avoidance.

Barriers and facilitators to scaling up Healthy Choices, a motivational interviewing intervention for youth living with HIV

BackgroundThis study included Community Health Workers and their supervisors from HIV clinical care teams who participated in the Healthy Choices intervention program. Healthy Choices is a Motivational Interviewing-based intervention aimed at improving medication adherence and reducing alcohol use for adolescents and emerging adults ages 16—24 living with HIV. In this study, the intervention was “scaled up” for delivery by local HIV care providers in real-world clinic settings.MethodsProviders (N = 21) completed semi-structured interviews (N = 29) about their experiences with intervention scale-up. Rigorous thematic analyses were conducted within discussions of barriers and facilitators of intervention implementation.ResultsThree dominant thematic areas emerged from the data: (1) perceptions of the Healthy Choices intervention, (2) engaging high risk YLH in in-person behavior interventions, and (3) perspectives on implementation of the intervention using local staff. Results offer insights into implementation of MI-based interventions for adolescents and emerging adults in clinic settings using local clinical staff instead of dedicated research staff.ConclusionsOverall, scaled-up intervention programs for youth are challenged to maintain scientific rigor, provide rigorous training and supports, and offer an attractive and engaging program.

Measuring forest ecosystem services in Aceh Province for inclusion to local forest resource management plans

The project trained forest managers from Kesatuan Pengelolaan Hutan (KPH) and Social Forestry units in Aceh Province in forest resource data collection and the use of three tools that report important forest ecosystem services. Data were collected in systematic forest plots by local KPH staff and social forestry community members for measuring forest carbon, tree biodiversity and forest ecosystem health. Teams represented nine different forest ecosystems in Aceh Province, Indonesia. Average forest carbon estimates range from a low of 27.14 Mg C ha<sup>-1</sup> in a coffee agroforestry system to a high of 446.93 Mg C ha<sup>-1</sup> in a tropical forest area managed under social forestry. Tree biodiversity ranged from a low of one species as expected in a coastal mangrove forest to a high of 35 species in the tropical forest area managed under social forestry. Forest health conditions on average for the nine areas were mostly healthy, with a few noted in fair condition and one considered to be in poor condition. Resources provided at the local level would enable mainstreaming of field data collection for measuring these forest ecosystem services, and continued and expanded training should be considered to meet national demand.

Local problem solving in the Portuguese health examination survey: a mixed method study

BackgroundParticipation rates in health surveys, recognized as an important quality dimension, have been declining over the years, which may affect representativeness and confidence in results. The Portuguese national health examination survey INSEF (2015) achieved a participation rate of 43.9%, which is in line with participation rates from other similar health examination surveys. The objective of this article is to describe how local teams of survey personnel conducted the survey, describing strategies used to solve practical survey problems and to try to increase the participation rate.MethodsAfter a literature search, informal interviews were conducted with 14 public health officials from local health examination teams, regional and central authorities. Forty-one of the local staff members (survey personnel) also filled in a short questionnaire anonymously. The interviews and self-administered questionnaires were analysed using mixed methods, informed by thematic analysis.ResultsThe local teams believed that the detailed manual, described as a “cookbook for making a health examination survey”, made it possible to maintain high scientific standards while allowing for improvising solutions to problems in the local context. The quality of the manual, supported by a series of training workshops with the central research and support team, gave the teams the confidence and knowledge to implement local solutions. Motivation and cohesion within the local teams were among the goals of the training process.Local teams felt empowered by being given large responsibilities and worked hard to incite people to attend the examination through a close and persuasive approach.Local teams praised their INSA contacts for being available for assistance throughout the survey, and said they were inspired to try harder to reach participants to please their contacts for interpersonal reasons.ConclusionsThe theory of organizational improvisation or bricolage, which means using limited resources to solve problems, was useful to discuss and understand what took place during INSEF.A detailed manual covering standard procedures, continuous monitoring of the data collection and face-to-face workshops, including role-play, were vital to assure high scientific standards and high participation rates in this health examination survey. Close contacts between the central team and local focal points in all regions and all survey sites were key to accommodating unexpected challenges and innovative solutions.

Patient satisfaction with computer-assisted structured initial assessment facilitating patient streaming to emergency departments and primary care practices: results from a cross-sectional observational study accompanying the DEMAND intervention in Germany

BackgroundPatient numbers in emergency departments are on the rise. The DEMAND intervention aims to improve the efficacy of emergency services by computer-assisted structured initial assessment assigning patients to emergency departments or primary care practices. The aims of our study were to evaluate patient satisfaction with this intervention and to analyse if reduced patient satisfaction is predicted by sociodemographic data, health status or health literacy.MethodsWe conducted a cross-sectional patient survey in emergency departments and co-located primary care practices. Each intervention site was planned to participate for two observation periods, each with a duration of one full week. Study participants were recruited by the local staff. The patients filled out a written questionnaire during their waiting time. Patient satisfaction was assessed by agreement to four statements on a four point Likert scale. Predictors of patient satisfaction were identified by multilevel, multivariable logistic regression models adjusted for random effects at the intervention site level.ResultsThe sample included 677 patients from 10 intervention sites. The patients had a mean age of 38.9 years and 59.0% were women. Between 67.5% and 55.0% were fully satisfied with aspects of the intervention. The most criticised aspect was that the staff showed too little interest in the patients’ personal situation. Full satisfaction (“clearly yes” to all items) was reported by 44.2%. Reduced patient satisfaction (at least one item rated as “rather yes”, “rather no”, “clearly no”) was predicted by lower age (odds ratio 0.79 for ten years difference, 95% confidence interval 0.67/0.95, p = 0.009), presenting with infections (3.08,1.18/8.05,p = 0.022) or injuries (3.46,1.01/11.82,p = 0.048), a higher natural logarithm of the symptom duration (1.23,1.07/1.30,p = 0.003) and a lower health literacy (0.71 for four points difference, 0.53/0.94,p = 0.019).ConclusionsThe patients were for the most part satisfied with the intervention. Assessment procedures should be evaluated a) regarding if all relevant patient-related aspects are included; and whether patient information can be improved b) for patients with strong opinions about cause, consequences and treatment options for their health problem; and c) for patients who have problems in the handling of information relevant to health and healthcare.Trial registrationGerman Clinical Trials Register (https://www.drks.de/drks_web/setLocale_EN.do) no. DRKS00017014.

P-005: COMPARISON OF SICKLE SCAN AND HEMOTYPE SC AS POINT-OF-CARE NEWBORN SCREENING DIAGNOSTICS FOR SICKLE CELL DISEASE IN LUANDA, ANGOLA

Purpose: Despite significant advances in the diagnosis and treatment of sickle cell disease (SCD), most of the >300,000 infants born with SCD will die before the age of 5 years, primarily due to the lack of timely and accurate diagnosis. In high-resource countries, early identification of SCD through newborn screening (NBS) is routine and subsequent delivery of preventive measures and comprehensive care is highly effective in reducing morbidity and early mortality. Despite the proven efficacy of NBS and successful pilot programs across Africa, large-scale implementation remains infeasible in many sub-Saharan countries due to inadequate financial, laboratory, and technical resources. The development and deployment of low-cost, rapid, user-friendly, and accurate diagnostic testing for SCD is imperative. Recently, several promising point-of-care (POC) diagnostics have been developed, but there have been few real-world studies that compare these tests head-to-head, particularly in the setting of NBS, where accurate diagnosis amidst high levels of fetal hemoglobin is critical. Materials and methods: We performed a prospective evaluation of two POC SCD diagnostics (Sickle SCAN and HemoTypeSC) at maternity centers and immunization centers in Luanda, Angola, with confirmation by isoelectric focusing (IEF). To evaluate the real-world feasibility and accuracy, with the guidance of the Angolan Ministry of Health, we planned to test 100 infants ≤6 months of age with each test at 10 different clinical sites (total of 2,000 infants tested). The study was designed to mimic a real-world setting with all POC testing performed and interpreted by local healthcare staff with basic instructions for the use of each test. Results: Of the 2,000 infants tested, 1958 results were included in the final analysis, with the exclusion of 42 tests that were not interpreted in the recommended time frame. Consistent with prior studies in Angola, the burden of sickle cell trait (HbAS, 21.9%) and sickle cell anemia (HbSS, 1.7%) was high. Tests were performed in maternity wards on the day of or following birth (63%) or at immunization centers through 6 months of life (37%). HemoTypeSC took an average of 15 minutes to obtain a result, was repeated 68 times (6.8%) due to invalid results, and was interpreted incorrectly only 4 times (0.4%). Sickle SCAN took an average of 7 minutes to obtain a result, was repeated 2 times (0.2%) due to invalid results, and interpreted incorrectly only 11 times (1.1%). The gold standard of IEF was imperfect with 5.5% of samples needing repeat testing at least once 12 samples with inconclusive results. Importantly, 92% of babies who were diagnosed and informed at the POC followed up in the SCD clinic, compared to the historical 56% who were successfully brought to care during the initial pilot NBS program in Luanda. Conclusion: This study demonstrates the feasibility and accuracy of both HemoTypeSC and Sickle SCAN for diagnosing SCD in newborns in a Luanda, Angola. Given the complexities of testing in the newborn period at busy maternity hospitals, this study suggests that testing at immunization centers using novel POC diagnostics may be a more practical solution to early infant diagnosis programs for SCD. The authors do not declare any conflict of interest

Application Software That Can Prepare for Disasters Based on Patient-Participatory Evidence: K-DiPS: A Verification Report.

This paper describes the design and function of an application that enables vulnerable people to provide medical information for use in disasters, and presents the results of an initial test of its usability in Nankoku, Japan. The application consists of two parts: K-DiPS Solo, a smartphone app, and K-DiPS Online, a web application for disaster management by local governments. We asked vulnerable people or their family caregivers to enter medical information into the app on their smartphones and connected this information to a local government application as a demonstration of a disaster response solution that manages information. We targeted a group of 14 healthy older people. The user information that they entered into the app was stored in the cloud via the communication system of the mobile phone. A ledger of vulnerable people for use in the event of a disaster was automatically created on the web application using the information supplied by the individuals. Local government staff corrected the location information, if necessary, by dragging points plotted on a map. This disaster response solution was shown to connect individuals to government offices, and to enable a consistent flow of information from patient details to stocking of supplies, and for simulation, training, and response during disasters.

Implementation of open-heart surgery in Dong Nai General Hospital: A preliminary result

Introduction: Implementation of open-heart surgery in local hospitals might be necessary to help economize the treatment, improve the quality of the local medical staff and unload central hospitals. Since 2018, Dong Nai General Hospital, such a program with the assistance from Cho Ray Hospital. After 4 years, a research was conducted to assess the efficacy of this program
 Methods: We retrospectively evaluated the efficacy of the cardiac surgery program in Dong Nai general hospital. Demographic characteristics, the preoperative cardiac lesions, comorbidities, early postoperative results, mid-term outcome were collected and analyzed.
 Results: From May 2018 to May 2022, a total of 62 patients underwent cardiac surgery at Dong Nai General Hospital. 33.9% were male, mean age was 45.6 ± 15.5. 47 cases were operated in the first phase and 15 underwent surgery in the second phase. The overall short-term mortality was 1.6% (1 patient), early complications rate was 9.7%. These complications did not lead to prolonged sequelae.
 Conclusion: Implementing cardiac surgery program in Dong Nai General Hospital under the assistance of Cho Ray hospital was proved safe and efficient in terms of short-term result. The success of this program should encourage other regional hospitals to start a new field and ameliorate the capacity of local healthcare system.

Participation in Software Development

Participatory planning holds important lessons for improving local government capabilities and responsiveness, but overall procedural regulations and statutory frameworks make its relevance for participatory IT development often just a matter of compliance. Developing analytical visualisations to support local government faces significant challenges because of the complexity and uncertainty about long-term benefits. We designed the process and local government staff understood their participation in an organised process. After each segment and the programming implementation, a new version of the software integrates improvements for participants.The participation process involved staff from ultimately 18 local governments. Participation became a verb describing the process that informed the directions to which we took up local government input.