Logistical Issues Research Articles

Interactive Geographic Visualization and Unsupervised Learning for Optimal Assignment of Preachers to Appropriate Congregations

Riau Province has a population of 6,642,874 and a diverse geography, which poses significant challenges in optimizing Islamic preaching activities. Traditional assignment methods often lead to inefficiencies due to misalignment between the preacher’s expertise and congregational needs, as well as logistical issues. This study integrates K-Means clustering and DBSCAN algorithms with interactive geographic visualization to optimize the assignment of preachers to mosques. We collected 435 data points, including 185 mosques and 250 preachers. K-Means was evaluated using the Elbow Method and Silhouette Score, identifying 10 clusters as optimal with a Silhouette Score of 0.435654. However, K-Means does not handle outliers effectively, as indicated by zero outliers in all configurations. DBSCAN was tested with various epsilon (eps) and minimum sample values. The optimal configuration with eps of 1.5 and 5 minimum samples resulted in 10 clusters with a Silhouette Score of 0.381108 and 60 outliers. DBSCAN effectively manages outliers and varying densities. Although K-Means is advantageous for its simplicity and higher Silhouette Scores, it is unable to handle outliers effectively. DBSCAN provides robust clustering for noisy data. Therefore, it can be concluded that hybridizing unsupervised learning algorithms with geographic visualization can potentially improve the effectiveness of preaching activities in Riau Province and enhance preacher assignment.

ANÁLISE DE ESTRATÉGIAS PARA DISPONIBILIDADE DE MATERIAIS EM MANUTENÇÃO DE MÁQUINAS DE VIA: UMA REVISÃO SISTEMÁTICA

This systematic research addresses the critical importance of material availability for the effective maintenance of track machines, a fundamental element to ensure safety and efficiency in railway operations. The central problem investigated focuses on the challenges faced in provisioning these materials, including logistical issues, stock errors, and delivery delays, which can compromise timely and efficient maintenance. The aim of this study is to analyze innovative and effective strategies that can optimize the provisioning of materials necessary for track machine maintenance. To achieve this goal, a bibliographic research methodology was adopted, focusing on the qualitative analysis of 19 literatures published between 2018 and 2023. The results reveal a convergence among authors on the need to integrate strategic planning, advanced technologies such as artificial intelligence, and efficient inventory management to overcome provisioning challenges. Prescriptive maintenance strategies and the use of advanced diagnostic technologies are highlighted as key elements for more proactive and less reactive maintenance. The final considerations demonstrate that the research problem has been thoroughly explored, with the proposed objectives being achieved. For future research, evaluating the real impact of emerging technologies on the life cycle of railway maintenance is suggested, aiming to provide effective strategies for the continuous optimization of maintenance operations.

Harnessing AI-Based Tools for Enhancing English Speaking Proficiency: Impacts, Challenges, and Long-Term Engagement

Technology like chatbots, speech recognition systems, and mobile apps that can give instant feedback on pronunciation and speaking skills has revolutionized learning a language in the traditional sense through artificial intelligence (AI). This study reviews the status of artificial intelligence in English language education and looks mainly at its influence on speaking fluency, pronunciation accuracy, and learner independence. The paper discusses implications from recent studies focusing on the immediate benefits of AI for novice and intermediate-level learners: decreased language anxiety and greater student engagement. Despite these advantages, major logistical issues – including the technology infrastructure, ethical challenges, and limited teacher training – prevent widespread adoption. It also identifies gaps in the literature, particularly concerning the long-term effects on learners' speaking proficiency and motivations surrounding higher-level learning. Filling the gaps can illuminate AI use to improve a sustainable language teaching or learning environment that may transform educational practices.

Telemedicine for Managing Type 1 Diabetes in Children and Adolescents Before and After the COVID-19 Pandemic.

The COVID-19 pandemic has catalyzed the rapid expansion of telemedicine for managing chronic conditions such as type 1 diabetes (T1D) in children and adolescents. This narrative review aims to explore the role of telemedicine in pediatric T1D management by comparing its use before and after the pandemic. We conducted a comprehensive literature review covering studies published between 2000 and 2024, focusing on telemedicine applications in pediatric T1D care. The review includes clinical trials, systematic reviews, and observational studies examining telemedicine's impact on glycemic control, patient satisfaction, and healthcare delivery. Results reveal that telemedicine has enhanced access to care, improved glycated hemoglobin (HbA1c) levels, and reduced diabetic ketoacidosis and hypoglycemic events. Patients and caregivers expressed high satisfaction, especially when using continuous glucose monitoring and insulin pump technologies integrated with telemedicine platforms. However, challenges such as digital literacy gaps, variability in healthcare provider training, and logistical issues like reimbursement policies persist. The pandemic highlighted the potential of telemedicine to supplement traditional in-person care, showing promise in enhancing patient outcomes and reducing healthcare burdens. Further research is needed to optimize telemedicine models for T1D, addressing barriers to implementation and exploring its long-term cost-effectiveness. This review underscores telemedicine's evolving role as a complementary approach in managing pediatric T1D, advocating for the development of standardized care protocols to fully integrate digital health solutions into routine clinical practice.

Improving Knowledge About Stroke Using Simulation Training.

Background Stroke is a medical emergency that is risk-stratified using a national scoring system called the National Institute of Health Stroke Scale (NIHSS). The management of an acute stroke necessitates prompt management and swift decision-making. Human factors were identified in the literature as the main rate-limiting step to improving door-to-needle (DTN) time. We felt it would be prudent to design a local stroke course implemented at Great Western Hospital Swindon that incorporates both traditional and simulation-based elements to improve theoretical knowledge and emulate real-life scenarios. The objective of this course was to improve practical application in the efficient assessment and management of stroke patients, as this is critical to delivering timely treatment with thrombolysis or thrombectomy. Methods Twenty-four medical professionals (medical students and resident doctors) participated in our course between November 2022 and July 2023. The domains assessed includedunderstanding thrombolysis, understanding thrombectomy, confidence in performing NIHSS, and confidence in the assessment of stroke patients. The effectiveness of the stroke simulation course was assessed both quantitatively and qualitatively with pre- and post-course questionnaires. Results There was a significant improvement (p<0.05) in all four assessed domains. There was a significant increase (p=0.0003) in the mean difference of score 3.75 (95% CI: 2.43-5.07) in understanding thrombolysis. Similarly,understanding of thrombectomy was significantly improved (p=0.0002) with a mean difference in score of 3.4 (95% CI: 2.28-4.46). There was also a significant increase (p<0.0001) in confidence in completing NIHSS scoring by a mean of 4.33 (95% CI: 3.55-5.12). Lastly, there was a significant increase (p=0.0012) in the mean by 2.75 (95% CI: 1.51-3.99) in confidence in the assessment of stroke. Overall, 95.8% of the participants found the course at least good, if not very good or excellent, and 91.7% would recommend this course to others. Conclusion We found traditional and simulation-based training to be effective in improving understanding of thrombolysis, understanding of thrombectomy,confidence in NIHSS scoring, andconfidence in the assessment of stroke patients. This study validates theeffectiveness of our course in improving assessment and management in acute stroke patients. We infer that improvements in these domains coupled with simulation training focused on human factors (e.g., fatigue affecting decision-making or logistical issues such as delays in neuroimaging due to scanner availability) would achieve better DTN time in the participants of our course.

Review of Current Normothermic Regional Perfusion Practice in Pediatric Cardiac Donation.

Cardiac allotransplantation is the optimal treatment for end-stage heart failure. However, organ supply remains the principal issue impacting patients. Pediatric patients present unique challenges resulting in long wait-list times and increased mortality. Donation after circulatory death with normothermic regional perfusion represents a method to increase the number of available organs in this population. Multi-institutional expert consultation was sought to outline extant technical, ethical, and logistical issues with regard to normothermic regional perfusion cardiac donation techniques. Specific advantages in the pediatric population are highlighted, as well as technical considerations resulting in successful organ procurement. Utilization of donation after circulatory death organs following normothermic regional perfusion in the United States is increasing and offers advantages to the pediatric heart failure population. Ethical reservations both nationally and abroad persist, namely pertaining to cerebral blood flow. This has led to variation in perception and utilization of normothermic regional perfusion, contributing to a discrepancy between donor and recipient locations. Procurement techniques and variations are described, with introduction into program planning and protocol development. Training in technical aspects of the procedure is paramount for both the surgeon and support staff to construct a successful program, along with transparent protocols to mitigate ethical concerns. Normothermic regional perfusion is relevant following donation after cardiac death in the pediatric population. Ethical and technical challenges remain in concert with substantial domestic and international variation. Standardization of technique may serve to increase future use and increase the number of available hearts for transplant, reducing pediatric mortality.

Consenso de expertos multidisciplinario para la calidad diagnóstica y uso de biomarcadores en cáncer de pulmón. Asociación Colombiana de Patología (ASOCOLPAT). 2023

Introduction: Lung cancer is the third cause of cancer worldwide of 2,200,000 and a mortality of approximately 35%. Diagnosis by a multidisciplinary team has become the most effective tool for early treatment. This is linked to the use of immunohistochemistry and immunomarkers that in the last decade have allowed us to strengthen the diagnosis and have involved target-directed therapies. Objective: To define by common agreement of experts, considerations for diagnostic quality and the use of biomarkers in lung cancer in Colombia. Methods: A formal consensus of experts, mixed type (Delphi/Nominal), was carried out with the participation of oncopathologists, pathologists, pulmonologists and chest surgeons by ASOCOLPAT. A group of questions and answers were graded, which were discussed in a nominal session. The information was consolidated in Excel and analyzed in STATA 14. Results: 12 questions and answers were structured and rated, addressing the following aspects: pathological diagnosis of lung cancer, description of the clinical centers, and some administrative and logistical issues in each region of Colombia. Conclusions: The consensus of experts defined 12 considerations by common agreement, for guidance in the pathological diagnosis of lung cancer, hoping to homogenize both medical and administrative aspects in order to generate an effective result and timely treatment.

Parental motivations and perceived barriers to participating in pediatric vaccine clinical trials: Findings from the OCV-S trial in Nepal

BackgroundPediatric vaccine clinical trials are crucial for evaluating and ensuring the safety and efficacy of new vaccines for children. However, in low-resource settings like Nepal, where clinical trials are relatively new, recruitment and retention of participants are challenging particularly due to diverse parental backgrounds, motivations and concerns. As such, parental motivations, perceived barriers, and experiences of participating in pediatric vaccine trial in Nepal, which hasn’t previously been explored, needs to be understood. Materials and MethodsWe performed face-to-face exit interviews from April 6, 2022 to June 7, 2022, with parents whose children participated in the phase III clinical trial of the Oral Cholera Vaccine − Simplified (OCV-S) using a structured questionnaire on motivations for enrolling and barriers faced during the trial. Data were initially cleaned and encoded in Microsoft Excel before being analyzed with R version 4.3.1. Descriptive statistics were used to summarize demographic and other participants’ characteristics. Bivariate and multivariate analyses, using odds ratios and their 95% confidence intervals, applying a significance level of 0.05 was used to analyze relationship between participant characteristics and trial experiences. Additionally, thematic analysis was performed on responses to open-ended questions. ResultsA total of 258 parents responded, out of which 252 (97.7 %) were first-time clinical trial participants with median age of 32 years. A majority, 196 (76.0 %), had a positive initial attitude towards the trial, and 204 (79.1 %) reported a positive overall experience. The primary motivations for participation included the potential health benefits for their children (56.2 %, n = 145). Despite 69 (26.7 %) participants receiving discouraging information from others, only 4 (5.8 %) were influenced by it. Most participants (n = 219, 84.9 %), felt that the trial had met their expectations. Challenges faced included loss of time (n = 30, 11.6 %) and missed school for children (n = 22, 8.5 %). Nonetheless, 179 participants (69.4 %) expressed a willingness to enroll their children in future trials. Participants who received specific details about the study before visiting the study site were significantly more likely to report positive experience, with an adjusted odds ratio of 1.97 (95 % CI: 1.03 – 3.72). ConclusionMajority of parents were supportive of their children’s participation in the OCV-S trial, motivated largely by anticipated health benefits for their child. Key barriers identified included logistical issues, costs (both financial and opportunity costs), misinformation, and concerns about trial procedures and potential side effects. Focus on reducing logistical and participation-related burdens, catering of trial-specific information, enhancing the clarity of the informed consent process, addressing safety concerns proactively and implementing continuous follow-up can help improve participation rates and retention in future trials. The high level of enthusiasm for clinical trials among parents, despite these barriers, highlights the promising potential for future research endeavors in Nepal.

ESTRATÉGIAS PARA A REGULARIZAÇÃO DOS CONCURSOS NA POLÍCIA MILITAR DO PARANÁ: ANÁLISE DOS IMPACTOS ORÇAMENTÁRIOS E ADMINISTRATIVOS

This study analyzes strategies for regularizing recruitment competitions for military police personnel in the Paraná State Military Police (PMPR) and the ensuing budgetary and administrative impacts due to the current irregularity of these competitions. The central aim is to identify the difficulties faced by the PMPR and the state government caused by the discontinuity of these recruitments, which result in budgetary and logistical planning issues. The research utilizes data from the Personnel Directorate, the Recruitment and Selection Center of the PMPR, and relevant legislation to quantify the financial and human impact resulting from the sporadic nature of the competitions, evidenced by a 32% deficit in the projected personnel. Four competitions between 2005 and 2020 were analyzed, exploring recruitment challenges, including the overload of Police Training Schools and sporadic selection processes. The results suggest that an annual competition policy could enhance the quality of candidate selection and facilitate better financial and logistical planning, ensuring a perennial and efficient replenishment of personnel. The conclusion emphasizes the importance of a regularization strategy to minimize the administrative and budgetary impacts and improve the operational capacity of the Military Police, thereby promoting greater public safety and efficiency in the services provided.

The use of a nursing implementation framework to enhance the uptake of an evidence-based intervention.

Evidence-based practices (EBPs) are instrumental in improving patient outcomes and ensuring high-quality nursing care, yet their implementation often encounters substantial barriers. The Iowa Implementation for Sustainability Framework and the Precision Implementation Approach© offer systematic strategies for overcoming barriers and enhancing EBP implementation and sustainability in health care settings. This project aimed to use the Iowa Implementation for Sustainability Framework and the Precision Implementation Approach© to support the use of an evidence-based maternal depression intervention within Iowa's Title V Maternal Health Program that serves mothers of young children living in poverty. This practice-based implementation was accomplished in three steps: (1) hold intervention-focused staff meetings, (2) identify barriers to using the intervention, and (3) identify and deliver implementation strategies. Collected data included barriers identified, selected implementation strategies, and evaluation of meeting attendance and impact on confidence. Four of the monthly virtual staff meetings focused on Listening Visits (LV) use. The 7 strategies comprising our approach to supporting LV use addressed three categories of identified barriers: lack of confidence, logistical issues, and not understanding intervention procedures. In the LV-focused meetings, representation of the 14 maternal health clinics was high, although attendance by individual staff was inconsistent. Post-meeting polls indicated that 40% to 65% of attendees felt more confident using intervention skills. This practical nursing-implementation framework facilitated EBP adoption, and our well-structured targeted strategies effectively increased staff confidence. Nursing managers and educators should consider using this framework to enhance their organizations' capacity to implement EBPs sustainably.

SentinelGuard Pro: Deploying Cutting‐Edge FusionNet for Unerring Detection and Enforcement of Wrong Parking Incidents

ABSTRACTWrong parking incidents pose a pervasive challenge in urban environments, disrupting the smooth flow of traffic, compromising safety and contributing to various logistical issues. Unauthorized parking occurs when vehicles are parked in locations not designated for such purposes, leading to a myriad of problems for both authorities and the general public. This research introduces a pioneering approach to confront the persistent challenge of unauthorized parking incidents in urban environments. The study focuses on harnessing the advanced capabilities of the FusionNet model to enhance the accuracy of license plate detection. This paper introduces the YOLO v8 Model, a deep learning architecture designed to enhance urban parking management by accurately detecting vehicles parked in unauthorized slots. The objective is to enhance parking management efficiency by accurately detecting vehicles and their occupancy status in designated parking areas. The methodology begins with data collection and preprocessing of images of parking spaces, followed by the training of YOLO v8 to identify vehicles and parking spaces in real time. Leveraging a diverse dataset encompassing various parking scenarios, including instances of unauthorized parking, the model achieves an accuracy of 98.50% in identifying vehicles outside designated areas. This model segments characters from detected license plates, enabling the accurate extraction of alphanumeric information associated with each vehicle. The integrated system provides timely identification of parking violations and facilitates effective enforcement actions through captured license plate data. Results demonstrate the model's effectiveness in real‐world scenarios, showcasing its potential for improving urban safety and efficiency. The implementation of FusionNet in the Python programming language, the proposed solution aims to streamline parking management, improve compliance with parking regulations and enhance overall urban mobility., with robust precision 96.17%, specificity 97.42% and sensitivity 96.19%, surpassing other MobileNet, CNN, ANN, DNN and EfficientNet models.

Deep geophysical investigations (DERT and Seismic Reflection) to unravel the Ferrara urban area geology

Exploring the ‘fragile crust of our planet’ is crucial for human survival holding an immense social and economic significance. Therefore, innovative approaches become of utmost importance for obtaining precise subsoil models in urban areas making the latter more resilient to natural disasters. Due to logistic issues and a high level of anthropogenic disturbance and related background noise, urban areas are usually intrinsically more problematic for applying geophysical prospecting methods. This work presents the results obtained by Deep Electrical Resistivity Tomography and P wave Seismic Reflection surveys performed along the Ferrara, north Italy, city walls documenting the adaptability of the geophysical surveys and how it is possible to obtain high-quality electrical resistivity and seismic data even in complex urban settings. The joint interpretation of geoelectrical and seismic data fully integrated with tectonic, geological and hydrogeological information allowed to reconstruct the stratigraphic evolution down to a depth of about 1.5 km. These results highlight the occurrence of a syndepositional Quaternary tectonic tilting associated with the growth of a fault-propagation fold.

AVALIAÇÃO DA EXECUÇÃO DE PRÉ-MOLDADOS EM RESIDÊNCIAS

The use of precast elements in residential construction has proven to be an effective and attractive option due to its speed, precision, and cost reduction. This research explores the particularities, benefits, and challenges associated with this construction method, covering various types of components, such as slabs and beams, as well as the stages of the process, including manufacturing, transportation, and assembly. Among the advantages are the uniformity of components, faster construction processes, waste reduction, and efficient material management, which promotes sustainability in the construction sector. However, challenges also arise, such as the need for rigorous planning, skilled labor, adherence to quality standards in production, and some limitations in project flexibility. Logistical issues and the resistance of structures to weather conditions are essential to ensure the durability of buildings. The study concludes that, despite certain constraints, the strategic use of precast elements can bring significant benefits to residential construction, especially with the advancement of new technologies and innovations.

Reasons for Declining Participation in Inpatient Research Among Historically Minoritized Racial and Ethnic Communities: A Scoping Review

BackgroundTo promote equitable recruitment for studies conducted in the inpatient hospital setting, we sought to characterize reasons why individuals, both from historically minoritized racial and ethnic groups and the broader patient population, refuse participation in clinical trials within inpatient settings. MethodsAn exhaustive search of the literature was conducted in Cochrane Library, Google Scholar, Embase, MEDLINE, PubMed, Scopus, and Web of Science databases to find relevant articles published from the inception of each database to April 30, 2023. Studies recruiting patients during their inpatient stay and reporting reasons for refusing participation in clinical trials met the inclusion criteria. ResultsThe search resulted in 2264 citations, of which 22 were included. 14 did not report data related to race, while 19 reported no ethnicity data. Reasons for refusal across trials included study burden and inconvenience (n=16), transportation and logistical issues (n=13), lack of interest in research (n=12), and refusal to be randomized (n=10). Prominent concepts included the importance of incorporating social support systems in consenting processes, lack of efforts to include data or recruitment efforts for individuals from minoritized groups, and physician involvement in recruitment. DiscussionTo enhance participation among historically minoritized communities in clinical trials, greater efforts must be made to collect demographic information and document refusal reasons to inform future recruitment methods. Strategies include proactively accounting for culture and language differences in study design and recruitment and intentionally engaging social support networks. Limiting study burden and logistics and optimizing collaborations between clinical and research teams would promote accessibility and foster patient trust.

Analysis of Efficacy of Soil Remidiation Done in Local Govrments within Zamfara State and Genral Enviromental Impact of the Lead Poisining

Between 2010 and 2013, a coordinated health and environmental response addressed an unprecedented lead poisoning epidemic in Zamfara State, northern Nigeria. The contamination, caused by gold mining, led to the deaths of over 400 children. Socioeconomic, logistical, and security issues necessitated the development of remediation and medical strategies tailored to local resources, labor practices, and cultural customs. The primary cause was unsafe mining and ore processing. The study evaluates the effectiveness of soil remediation in eight villages of Zamfara, comparing it to the USA's hazardous waste protocols. An environmental impact assessment was conducted to assess the outcomes of the remediation and to propose long-term solutions to prevent future occurrences.

Cardiac arrest in adult cardiology patients receiving anaesthetic care: analysis from the 7th National Audit Project (NAP7) of the Royal College of Anaesthetists.

The 7th National Audit Project of the Royal College of Anaesthetists studied peri-operative cardiac arrest because of existing knowledge gaps in this important topic. This applies in particular to cardiology patients receiving anaesthetic care, because numbers, types and complexity of minimally invasive interventional procedures requiring planned and unplanned anaesthesia in the cardiac intervention suite is increasing. We analysed collected data to determine the epidemiology, clinical features, management and outcomes of peri-operative cardiac arrest in adult patients receiving anaesthetic care for cardiology procedures. There were 54 reports of peri-operative cardiac arrest in adult patients receiving anaesthetic care for cardiology procedures, accounting for 54/881 (6.1%) of all reports to NAP7. The estimated incidence (95%CI) of cardiac arrests in this group was 1/450 or 0.22 (0.17-0.29)%. These patients were older than other adult patients in the NAP7 population, with a notably high proportion of patients of Asian ethnicity when compared with the remaining NAP7 cohort (9/54, 17% vs. 35/709, 5%). Rates of extracorporeal membrane oxygenation cardiopulmonary resuscitation were low (3/53, 6%). A common theme was that of logistical issues and teamworking, with reporters commenting on the difficulties of remote and/or unfamiliar locations and communication issues between specialties, on occasion resulting in poor teamworking and a lack of focus. The NAP7 panel review identified several other common themes which included: cardiogenic shock; late involvement of anaesthesia in the case; and transcatheter aortic valve implantation. Cardiology procedures requiring anaesthesia care account for < 1% of anaesthesia activity but generate 6% of all peri-operative cardiac arrests. The incidence of cardiac arrest was disproportionately high in cardiological procedures requiring anaesthetic care. The nature of the cardiac arrest reports to NAP7 indicate that logistical and human factors in multidisciplinary teams in the cardiac intervention suite merit addressing to improve care.

The Role of Animal Assisted Therapy in the Rehabilitation of Mental Health Disorders: A Systematic Literature Review

Mental health disorders like depression, anxiety, post-traumatic stress disorder (PTSD), and schizophrenia significantly reduce the daily functioning and quality of life of individuals. Traditional treatments often fall short, thus opening interest in complementary therapies like animal assisted therapy (AAT) which encourages the human-animal bond and gives emotional and psychological support. This review evaluated the efficacy of AAT in treating mental health disorders, and understanding its mechanisms and benefits. A comprehensive literature review was conducted (using databases such as PubMed, Google Scholar, and ResearchGate) focused on peer-reviewed articles, systematic reviews and meta-analyses published in the last 2 decades. Studies indicated that AAT improved mental health outcomes for people with depression, anxiety, PTSD, and schizophrenia. Interaction with therapy animals reduced cortisol levels, increased oxytocin, lowered blood pressure, and increased social engagement and emotional regulation. Benefits included reduced symptoms of depression, anxiety, PTSD, and improved social functioning and quality of life. AAT offered a complementary treatment for mental health disorders, providing emotional comfort, improving mood, and serving as a nonpharmacological option for individuals. However, challenges such as individual preferences, allergies, ethical concerns for therapy animals, and logistical issues must be addressed. Future research should focus on the long-term effects and mechanisms involved to optimize the application of AAT in the clinical setting, and alternatives like robotic companion pets could also be explored.

A Review of Innovative Approaches to Overcoming Agricultural Extension Challenges: A Case Study of the Knowledge Gap in Kigezi Sub-Region, Uganda

Agriculture remains the backbone of Uganda’s economy, but the Kigezi region continues to face significant challenges that limit its agricultural productivity. Farmers in this region, despite their reliance on agriculture, often struggle with low yields and limited access to modern farming techniques. These challenges are exacerbated by a knowledge gap in agricultural extension services, largely caused by logistical issues, poor infrastructure, and limited access to technology. This review examines the agricultural extension challenges in Kigezi and explores innovative approaches, with a particular focus on mobile-based teaching-learning frameworks (TLFs). The article evaluates the potential of mobile technology to address these challenges by providing scalable, accessible, and context-specific solutions. The findings suggest that while Kigezi faces digital and infrastructure barriers, mobile solutions tailored to local needs could empower farmers and enhance agricultural productivity. This review aims to contribute to ongoing discussions on agricultural extension in resource-constrained regions and provides practical recommendations for bridging the extension gap through innovative mobile platforms.

Development and Implementation of a Value-Based Care Telehealth Emergency Medicine Program: Triage and Care Alignment in an Integrated Health System

Background: Acute unscheduled episodic care is an area of potential cost savings, given the high frequency and cost of unnecessary emergency department (ED) utilization. Methods: We developed a provider-assisted patient navigation program using a telehealth platform designed to decrease ED utilization and reduce costs while providing exceptional patient satisfaction. Results: Urgent care (UC) visits were analyzed from July 1, 2022, to June 30, 2023. The “ED comparison” group (n = 68,320) consisted of patients discharged to home after receiving care in the ED. The “avoided ED visits” group included patients (n = 7,430) who received care in a lower-acuity setting and did not require emergency services within 48 hours. The calculated overall medical expense savings comparing the costs between the ED vs. lower-acuity settings revealed that 50% (n = 450) of consultations were managed as outpatients, avoiding ED visits. Evaluation of distribution by source revealed that 67% of ConnectCare consults resulted in admission, 48% for UC, while 36% of patients were service center consults. Conversely, 31% of consultations resulted in recommendations to go to the ED, and 16% of these were assisted transfers where the Telehealth Emergency Medicine (TeleEM) clinician communicated with the receiving ED. Among the 280 patients directed to the ED, 243 were sent because of immediate clinical acuity, 28 were because of logistical or scheduling issues, three for non-qualifying insurance for outpatient workup, and six were redirected to the ED following diagnostic results. Our analysis suggests an estimated average avoided medical expense of $1,701 per case to insurers and patients if an ED visit was avoided. Conclusion: Implementing a TeleEM program to assist with triage and resource alignment, as well as identification and outpatient management of patients while avoiding an ED visit, is feasible within an integrated health system. Our TeleEM program may be a model for other integrated health systems.

Certificate in Advanced Behavioral Interventions Among Multiple Populations

This manuscript describes the curricular and instructional approaches utilized in the composition and delivery of the Certificate in Advanced Behavioral Interventions Among Multiple Populations (CABISAM) created by the School of Social Work at Loyola University Chicago. CABISAM is a social work led interprofessional education (IPE) model where students from social work, nursing, and medicine engage in didactic and experiential activities to advance clinical and leadership knowledge of interprofessional approaches to screening, brief intervention, and referral for treatment (SBIRT) with diverse populations. An interprofessional team of faculty from each discipline was involved throughout the development and planning process to consider accreditation, cultural, and logistical issues unique to each profession. CABISAM engages students in an evidenced-based interprofessional education (IPE) experience with exposure to cutting-edge topics relevant to health professionals: training in interprofessional practice, substance use in unique settings with diverse populations, and clinical implementation skills. This manuscript presents an adaptable and generalizable interprofessional education approach to other undergraduate and graduate programs across disciplines.