Pilot Implementation Research Articles

Collaborative design of a care pathway for pharmacy-based PrEP delivery in Nigeria: insights from stakeholder consultation

BackgroundHIV remains a significant public health problem, particularly in Africa, where two-thirds of global cases occur. Nigeria is among the three countries with the highest burden. Despite free access to pre- and post-exposure prophylaxis (PrEP and PEP) in Nigerian hospitals, stigma, distance, and restrictive clinic hours hinder uptake, especially among vulnerable populations. Building on the successful pilot implementation of pharmacy-based PrEP delivery in Kenya, we engaged Nigerian stakeholders in adapting the model, addressing user and provider concerns to ensure effective implementation in Nigeria.MethodsThe stakeholder meeting took place in Abuja, Nigeria, which is selected for its central location and accessibility to various stakeholders, particularly those involved in HIV prevention efforts. The participants were purposefully selected to ensure diverse representations, including youth who are potential PrEP users, pharmacy providers, regulators, and representatives from civil society organizations. The meeting utilized the Nominal Group Technique (NGT)—a structured method for facilitating group decision-making and prioritizing ideas—to adapt the Kenyan pharmacy-delivered PrEP model for implementation in the Nigerian context. Mock role play was conducted to help participants understand the care pathway. The discussions culminated in identifying challenges and viable strategies for implementing the model in Nigeria.ResultsThe one-day stakeholder meeting on 9 October 2024 was attended by 20 participants from various sectors involved in HIV prevention services. Stakeholders expressed enthusiasm for pharmacy-based PrEP delivery while acknowledging challenges associated with clinic-based services, such as stigma, limited hours, and long wait times. The key recommendations included training pharmacy providers, increasing awareness, ensuring confidentiality, establishing referral linkages, and integrating program data into the Health Management Information System (HMIS) as well as ensuring commodity availability and access. To enhance the success of the pilot study, stakeholders proposed engaging a research assistant, forming a monitoring team, and submitting the results to the Pharmacy Council of Nigeria (PCN) for review.ConclusionsThe identified challenges and strategies for implementing the model in Nigeria will inform the development of a refined pharmacy-delivered PrEP framework that is ready for pilot testing and potential scaling across the country.

Pilot Implementation of a Primary Care Disease Management Concept for Venous Leg Ulceration: Results of a Mixed-Methods Process Evaluation

Background: Within the project “Ulcus Cruris Care”, a disease management intervention to improve general practice care for patients with venous leg ulcer was developed, comprising online teaching for practice teams, standardized patient education, and case management. Implementation of the intervention was piloted and evaluated via a process evaluation. This study aims to evaluate contentedness with the intervention, implementation effort, implementation determinants, intervention fidelity, and perceived intervention effects using a mixed-methods process evaluation. Methods: The mixed-methods process evaluation explored the views of general practitioners, medical assistants and patients regarding the intervention components. Data were collected through semi-structured telephone interviews and a survey questionnaire. Qualitative data were first analyzed inductively, followed by a deductive–inductive approach based on the Theoretical Domains Framework. Survey data were analyzed descriptively. Results: Participants (n = 21) reported a strong contentedness with the intervention, high intervention fidelity, low implementation effort, and a change in perception of compression therapy as the central treatment element. Healthcare professionals emphasized increased patient education and patient and family involvement. Patients reported feeling better informed and empowered to take an active role in their treatment, primarily due to increased knowledge and skills in compression therapy. As a result, they were more content with their care and reported positive experiences with wound healing since trial participation. Conclusions: The Ulcus Cruris Care intervention can lead to a noticeable change in knowledge and potentially influence practice teams’ approach to venous leg ulcer management, facilitating a significantly more frequent use of compression therapy in VLU care. A confirmatory evaluation of potential effects in a definitive RCT seems warranted.

Screening for undiagnosed atrial fibrillation using an electronic health record‒based clinical prediction model: clinical pilot implementation initiative

BackgroundAtrial fibrillation (AF) is a major risk factor for ischemic stroke, and early AF diagnosis may reduce associated morbidity and mortality. A 10-variable predictive model (UNAFIED) was previously developed to estimate patients’ 2-year AF risk. This study evaluated a clinical workflow incorporating UNAFIED for screening, education, and follow-up evaluation of patients visiting a cardiology clinic who may be at an elevated risk of developing AF within 2 years.MethodsPatients were included if they were aged ≥ 40 years with a scheduled in-person visit at the Eskenazi Health Cardiology Clinic between October 25, 2021, and August 10, 2022. Clinical decision support identified patients with an elevated AF risk. Initial screening with 1-lead electrocardiogram devices was offered, and routine clinical practice for diagnosis and management was followed. Physicians were surveyed on their use of the workflow, attitudes toward implementation, and perceived impact on patient care.ResultsA total of 2827 patients had a clinic visit during the study period, of whom 1395 were eligible to be screened because they were classified as “elevated risk” by the UNAFIED predictive model. AF or atrial flutter diagnosis was newly documented for 29 patients during the study period. Of the newly diagnosed patients, 13 began anticoagulant therapy to mitigate stroke risk. Physicians (n = 13) who used the workflow most clinic days were more likely to indicate that it was easy to use, was not time-consuming, and improved patient care compared with physicians who only used the workflow occasionally.ConclusionsTo our knowledge, this study is the first of its kind to demonstrate clinical application of an electronic health record-based AF predictive model. The newly documented diagnoses, however, did not solely result from implementation of UNAFIED. This non-invasive, inexpensive approach could be adopted by other sites wishing to proactively screen patients at elevated risk for AF. Other sites should verify the model’s performance in their own settings and ensure compliance with evolving regulatory requirements where applicable.

A heuristic evaluation of a pharmacy surveillance information system

IntroductionThe pharmacy surveillance information system (PSIS) is intended to manage the dispensing practice of under-controlled drugs and substances. We designed and developed a PSIS for the first time in a developing country. This study aimed to evaluate the usability of this system using a heuristic evaluation method before the pilot implementation in outpatient pharmacies.Materials and methodsThe study was conducted in 2022 during the development of a pharmacy surveillance information system. Five evaluators examined the system using Nielson’s heuristic evaluation method. The detected usability problems were categorized into 10 Nielson’s usability principles, and their severity was calculated.ResultsIn total, 91 unique usability problems were identified. The most detected usability problems were minor (60%). The “consistency and standard” (31%), “aesthetic and minimalist design” (28%), and “match between system and the real world” (12%) were the most frequent problems. Also, the “flexibility and efficiency of use” (mean = 2.9), “error prevention” (2.85), and “user control and freedom” (2.8) were the most severe problems.ConclusionThe study has identified the most common and severe usability issues of an information system. It is important for the system developers to address these issues as it can significantly improve users’ trust and satisfaction. Therefore, all the identified usability problems were resolved before the system was implemented.

Ambient artificial intelligence scribes: physician burnout and perspectives on usability and documentation burden.

This study evaluates the pilot implementation of ambient AI scribe technology to assess physician perspectives on usability and the impact on physician burden and burnout. This prospective quality improvement study was conducted at Stanford Health Care with 48 physicians over a 3-month period. Outcome measures included burden, burnout, usability, and perceived time savings. Paired survey analysis (n = 38) revealed large statistically significant reductions in task load (-24.42, p <.001) and burnout (-1.94, p <.001), and moderate statistically significant improvements in usability scores (+10.9, p <.001). Post-survey responses (n = 46) indicated favorable utility with improved perceptions of efficiency, documentation quality, and ease of use. In one of the first pilot implementations of ambient AI scribe technology, improvements in physician task load, burnout, and usability were demonstrated. Ambient AI scribes like DAX Copilot may enhance clinical workflows. Further research is needed to optimize widespread implementation and evaluate long-term impacts.

Labor Engine or Welfare Trap: New Evidence from the Impact of China's Long-Term Care Insurance Policies on Labor Market Performance

The long-term care insurance system is a crucial social service policy for disabled and elderly individuals with dementia in the context of the unfeasible traditional family old-age care model. Through the support of the social insurance model for old-age care security, it effectively addresses and meets the actual needs of long-term care recipients. This has become a significant way to alleviate the burden of disabled and demented elderly individuals, mitigate the impacts of ageing, and create employment opportunities for family caregivers. Using the long-term care insurance pilot policy implemented in Qingdao in 2012 as a quasi-natural experiment, this paper estimates the influence of long-term care insurance on the labor market performance of the pilot city using the synthetic control method of project policy evaluation. Several robustness tests of the labor market effects of long-term care insurance are conducted, utilizing two placebo methods based on time and space, and the ranked test method. The study's findings demonstrate that the implementation of the long-term care insurance policy pilot has a constructive influence on the employment choices of workers in the labor market. Specifically, it encourages participation in the workforce and expands the scale of labor force participation in the pilot cities. Furthermore, the policy's effect strengthens over time and has a marked positive effect on average employee wages, thereby spurring labor supply growth. Through further analysis, it can be determined that the pilot cities have contributed to an average annual growth of around 1 million people in total labor force participation between 2013-2017, surpassing the potential growth rate by approximately 10.5%. Additionally, during this period, the average employee wage displays a linear upward trend with a maximum increase of over 5,000 pounds per capita per year. This suggests a substantial effect on the overall performance of the labor market due to its growth-promoting influence. In addition, the analysis of the heterogeneity of its impact mechanism demonstrates that the long-term care insurance policy aims to enhance the willingness of tertiary industry workers to work and considerably increase the likelihood of their entry into the labor market. It also improves labor income expectations of urban private and self-employed workers, resulting in a virtuous circle of enhanced labor and employment driven by the increased value of labor and the strengthened willingness to participate.

A quality of life promoting model for the elders Apllying social laboratory concept in health region 5, ministry of public health

This research and development project aimed to promote and evaluate the effectiveness of a quality of life of the elders applying social laboratory concept. The study was conducted in three phases, Phase 1: Situational analysis to identify quality of life issues among 270 elders’ participants. Phase 2: Development of the model and piloting with a sample of 30 participants. Phase 3: A pilot implementation and evaluation of the model with 30 experimental and 30 control participants. The study was conducted from June to September 2024. The tools used included, A WHOQOL–BREF–THAI questionnaire for assessing the quality of life of elders, A questionnaire on lifestyle behaviors, and A quality-of-life enhancement model for elders applying social laboratory concept. Data were analyzed using t-tests. Findings, Phase 1: The quality of life of elders in Health Region 5 of the Ministry of Public Health was found to be at a moderate level. Phase 2: A prototype model was developed, emphasizing participatory planning based on social action concepts. The PRIME Model was introduced, comprising, P: Purpose, Plan, and Partnerships, R: Research, Response, and Reflection, I: Insight, Interest, and Influence, M: Materials, Monitoring, and Maintenance, E: Experience, Empowerment, and Environment. This model was aligned with six key lifestyle behaviors for elders. Phase 3: The prototype model was applied to the experimental and control groups, each consisting of 30 participants, over a six-week period. The results revealed, A significant improvement in the quality of life among the experimental group compared to pre-intervention levels (p-value &lt; .001). A significant enhancement in lifestyle behaviors in the experimental group compared to pre-intervention levels (p-value &lt; .001). A significant improvement in overall health status among the experimental group compared to pre-intervention levels (p-value &lt; .001). To sustain and improve the quality of life and health behaviors of elders, continuous application of the quality-of-life enhancement model based on the social laboratory concept is essential.

Impact of intellectual property protection on enterprise supply chain resilience: empirical evidence from China’s intellectual property pilot and demonstration city policy

This study leverages China’s staggered implementation of the intellectual property pilot and demonstration city (IPPDC) policy as a quasi-natural experiment to evaluate the impact of intellectual property protection (IPP) on enterprise supply chain resilience (SCR). The empirical analysis reveals that the establishment of the IPPDC significantly enhances SCR by promoting innovation, improving technology diffusion capabilities, and fostering a cooperative culture within enterprises. Additionally, when enterprise innovation and technology diffusion are treated as threshold variables, the positive effects of IPP on SCR intensify, exhibiting a nonlinear and progressively increasing spillover effect. In contrast, the influence of IPP on SCR through enterprise cooperation follows a U-shaped trajectory, with an initial decline followed by a subsequent rise. These findings emphasize the importance of interactions between policy-makers and enterprises in strengthening supply chain responsibility. Heterogeneity analysis indicates that IPPDC policies have a stronger effect on enterprises with robust SCR, with more significant improvements in the creation of SCR than in resistance and recovery abilities. This effect is consistently observed across primary, secondary, and tertiary industries, with particularly substantial impacts in western China. Moreover, private enterprises benefit more from IPP policies than do state-owned enterprises. These findings provide valuable insights for policy-makers by demonstrating the practical implications of IPP policies beyond their theoretical constructs. This study underscores the critical role of IPP in fortifying SCR, ultimately strengthening firms’ global competitiveness and resilience amid rising geopolitical risk and global uncertainty.

Result of Pilot Research and Implementation to Improve the Quality of Management Information Systems in Higher Educational Institutions (MSUE)

Nowadays, ICT have become commonplace entities in all sectors of society, especially in education. Across the past 2014 years MNUE develops LMS for Teacher Training Program. The purpose of the present paper is to examine the current situation of the LMS at MNUE, assess the needs of the users, determine the solution of the problem and seeks to explore how programs will be offered and delivered in the university of the future. In this framework, the paper introduces the outcomes of the survey where participated 1611 users and developed by the spss program: 100 lecturers, 1495 students and 16 staffs of curriculum office. When we faces difficulties we try to solve the problems: take action, adjust and improve. Despite the advantages of implementing LMS at the MNUE, the author observes that server dynamics, the number of users to access at one moment and customer awareness need to be concerned.

Measuring Patient Well-Being During Whole-Person Clinical Care: Lessons From the Veterans Health Administration Well-Beings Signs Implementation Pilot.

Measuring patient well-being during clinical care may enhance patient-centered communication and treatment planning. The Veterans Health Administration (VHA) piloted the use of the Well-Being Signs (WBS), a self-report measure of psychosocial well-being, in clinical care. To understand early WBS implementation and health care team member experiences with its use before developing detailed support materials and finalizing the measure. We conducted a mixed-methods evaluation of the WBS implementation pilot at 4 VHA facilities, including surveys of (n=4) Whole Health (WH) leaders/clinical leads, and semi-structured interviews with (n=11) clinical leads and team members. Survey data were characterized using descriptive statistics; interview data were analyzed using rapid qualitative analysis. Facilities supported WBS implementation by disseminating information to clinical team members, primarily during staff meetings (3/4 facilities), individual discussions (3/4), and email (3/4); only half provided training sessions. In interviews, some care team members expressed the need for more training on using the WBS in clinical care. Some interviewees also provided suggestions for changes to the draft measure, including response option format and question look-back period. Although there have been growing calls for attention to patient well-being in clinical care, our results suggest barriers to the implementation of well-being measures in this context. Findings were used to inform the development of enhanced training materials and make modifications to enhance the acceptability of the WBS to providers. Other identified barriers will need to be addressed in future implementation efforts, including bolstering leadership support and easing the added time and burden of administration.

Piloting Implementation Design and Preliminary Readiness for Universal Suicide Risk Screening Program in Emergency Department of a Tertiary Care Centre, Nepal: A Mixed Method Study

Introduction: Nearly three quarters of the suicides occur in developing world, however few evidenced-based health systems strategies exist to detect and prevent suicide in these contexts. This pilot study evaluates the feasibility of implementing a universal suicide risk screening program in a Nepalese emergency department. Methods: This study reports the preliminary training phases of a pilot implementation trial in the emergency department to evaluate the program. The approval was obtained from the Nepal Health Research Council (Approval no. 447/2021 P), and the Kathmandu University School of Medical Sciences Institutional Ethical Review Board (Approval no. 237/2021) and Yale University IRB (Protocol ID 2000029480). Implementation assessments included suicide screening acceptability, appropriateness, confidence, system priority, and myth knowledge of staff. Implementation strategies were selected, decolonized, and preliminarily trained followed by phased supportive coaching to initiate the screening package. We designed the implementation package through co-design staff focus groups and embedded ethnography. Results: Co-design focus groups (n=8) occurred with staff and leadership. We trained 26 (76.47%) the staff on the Nepali suicide screening tool followed by supported phased initial screening over two months. Implementation assessments demonstrated increased scores on appropriateness, confidence, system priority, and myth knowledge. The implementation package included key strategies to be deployed over six months. The embedded ethnographic observations revealed barriers to effective implementation, such as anticipated stigma, reluctance to engage families, and distrust in referral processes.Conclusions: The pilot study demonstrated that training improves staff appropriateness, confidence, system priority, and myth knowledge. Despite initial barriers, co-designed strategies and phased coaching facilitates screening uptake, highlighting the program's potential for sustainable implementation.

Compassion-Based Resilience Training (CBRT) to protect and nurture community care providers

Purpose This case study describes pilot implementation of Nalanda Institute’s Compassion-Based Resilience Training (CBRT) with community care providers in New York City (NYC) to protect them from stress and trauma impacts and nurture their capacity to deliver skillful, compassionate care. Design/methodology/approach The Academy for Community Behavioral Health in NYC offered CBRT at no cost to a diverse cohort of 28 nonprofit care providers. This virtual eight-week course met weekly for 2 hours over Zoom, with formal and informal meditation practice between sessions. A mixed methods pre/post survey assessed changes in meditation practice, work-related stress and mindfulness and compassion. A final survey invited participant feedback on course experiences and course outcomes. Findings This case study suggests that a virtual eight-week CBRT course can be both feasible and effective for community care providers, even in their demanding roles. Most participants who started the course completed it (77%). CBRT helped participants establish a regular meditation practice and led to improvements on indicators of work-related stress, mindfulness and compassion. Participants linked these changes to an increased sense of hopefulness, agency and resilience for navigating stress and trauma in their work. They also found valued peer support in the course. Originality/value This case study offers one model for sharing effective but underused contemplative healing tools with care providers who encounter significant stress and trauma. It can inform efforts by funders, organizational leaders, managers, direct care staff and researchers to better protect these critical helpers.

Physics-consistent input convex neural network-driven reinforcement learning control for multi-zone radiant ceiling heating and cooling systems: An experimental study

Radiant ceiling heating and cooling system is a technology used for space heating and cooling. Owing to the variable weather conditions, occupant behavior, and thermal lag of the system, it is challenging to design a control strategy to reduce air-conditioning energy consumption while maintaining the thermal environment. This study is the first pilot implementation of a physics-consistent input convex neural network (PCICNN)-driven reinforcement learning (RL) approach for real-world multi-zone radiant ceiling heating and cooling systems. A multi-zone PCICNN based on a graph neural network (GNN) was developed to simulate the zone temperature. The radiant panel load was simulated using the physics-based ε-NTU method. The PCICNN-driven RL agent was based on the soft actor-critic algorithm and trained in an environment model comprising the PCICNN and ε-NTU models. The proposed controller was deployed in real-time on one floor of an office building for one month. The real-world implementation showed that the proposed PCICNN-driven RL control can reduce the radiant panel cooling load by up to 33% compared with the inherited baseline control strategy under similar weather conditions. This study provides a comprehensive demonstration of real-world data-driven building controls and leverages future research on advanced building control.

Evaluating the Pilot Implementation of the DSWD Walang Gutom Program: A Case Study on Its Impact in Addressing Involuntary Hunger in Tondo

The Department of Social Welfare and Development (DSWD) launched the Walang Gutom (No Hunger) Program to address involuntary hunger among vulnerable populations in the Philippines. This study evaluates the pilot implementation of the program in Tondo, Manila, focusing on its impact on hunger and the lives of beneficiaries. The program com-bines direct financial assistance through an Electronic Benefit Transfer (EBT) system with social interventions like job training, nutritional workshops, and community engagement. While the program shows promise in addressing hunger and empowering beneficiaries, challenges such as eligibility criteria, limited funding, and digital literacy barriers need to be addressed. The study recommends strategies to enhance the program's effectiveness and sustainability, including strengthening out-reach efforts, improving digital literacy, and expanding the program's reach to more vulnerable communities. Evaluations of effectiveness have yielded favorable results, with notable improvements in food security observed among beneficiaries. The progress in food security for house-hold beneficiaries is encouraging, and focused interventions can further enhance these positive outcomes. Ongoing assessments allow the pro-gram to adjust to the evolving needs of participants, ensuring sustained effectiveness. Beneficiary feedback emphasizes the program’s respon-siveness and the high quality of services, indicating overall success in achieving its goals.

Examining the Implementation Experience of the Universal Health Coverage Pilot in Kenya

ABSTRACT The Kenyan government implemented a Universal Health Coverage (UHC) pilot project in four (out of 47) counties in 2019 to address supply-side gaps and remove user fees at county referral hospitals. The objective of this study was to examine the UHC pilot implementation experience using a mixed-methods cross-sectional study in the four UHC pilot counties (Isiolo, Kisumu, Machakos, and Nyeri). We conducted exit interviews (n = 316) with health facility clients, in-depth interviews (n = 134) with national and county-level health sector stakeholders, focus group discussions (n = 22) with community members, and document reviews. We used a thematic analysis approach to analyze the qualitative data and descriptive analysis for the quantitative data. The UHC pilot resulted in increased utilization of healthcare services due to removal of user fees at the point of care and increased availability of essential health commodities. Design and implementation challenges included: a lack of clarity about the relationship between the UHC pilot and existing health financing arrangements, a poorly defined benefit package, funding flow challenges, limited healthcare provider autonomy, and inadequate health facility infrastructure. There were also persistent challenges with the procurement and supply of healthcare commodities and with accountability mechanisms between the Ministry of Health and county health departments. The study underscores the need for whole-system approaches to healthcare reform in order to ensure that the capacity to implement reforms is strengthened, and to align new reforms with existing system features.

Pilot implementation and qualitative evaluation of a financial hardship screening among Native American patients with cancer.

Native American (NA) patients with cancer are at increased risk of financial hardship due to lack of private health insurance coverage, medical comorbidities, and higher poverty rates. We aimed to implement and evaluate a pilot financial hardship screening (FHS) program among NA patients with cancer. In 2022, we piloted the implementation of FHS among adult NA patients with cancer referred by NA-specific health facilities to an NCI-designated cancer center using the COmprehensive Score for financial Toxicity-Functional Assessment of Chronic Illness Therapy (COST-FACIT) tool. We dichotomized COST-FACIT scores as mild/no hardship (26-44) and moderate/severe hardship (≤ 25). To evaluate the implementation, we conducted interviews with patients and clinical staff who participated in the screening process. We thematically analyzed interview transcriptions using inductive and deductive coding to identify themes. Of 42 patients completing FHS, 76.2% reported moderate/severe hardship. Ten patients and four clinical staff (1 physician, 3 NA navigation staff) completed interviews. We identified three themes: (1) FHS perceptions and intervention experiences, (2) FHS efficacy and opportunities for expansion, and (3) nuances for NA patients and patient-related factors. Patients expressed positive experiences with FHS, including identifying financial challenges, but preferences regarding timing varied. Staff reported logistic and sustainability challenges in implementing FHS. However, clinic staff reported positive experiences with the tool, interactions with patients, and the resulting supportive care referrals. Implementation of FHS for NA patients with cancer was well received by patients and staff and was perceived by both groups as facilitating efforts to address financial hardship. Measures to improve staffing and sustainability are needed to enable broader implementation.

Study on the Development of Cross-border E-commerce by the Policy Trials of the Free Trade Zones (FTZ)

The Pilot Free Trade Zone is a milestone policy for opening up the foreign economy, and plays an important role under the policy orientation of ‘early and pilot implementation’ in China. 2023 will mark the 10th anniversary of the construction of the Pilot Free Trade Zone in Shanghai, and the new development pattern is based on the domestic macro-cycle as the main body, and the domestic and international double-cycle is mutually promoted, and cross-border e-commerce is just an important connection link relying on Internet technology and the emerging trade mode. Cross-border e-commerce, as an emerging trade mode relying on Internet technology, is an important link between the domestic and international double cycle. Exploring the path of enhancement of cross-border e-commerce development by the policy experiment of the Pilot Free Trade Zone can help to build a new development pattern in which the domestic and international double cycles promote each other, and provide a basis for deepening the policy in the future. Under the guidance of trade cost theory, government reengineering theory and cooperation theory, this paper draws the following conclusions, and the FTZ has reduced the trade cost of enterprises and further stimulated the vitality of cross-border e-commerce by continuously optimising the tax policy and simplifying the customs clearance procedures. In the future, it is necessary to aim for high-quality green development, identify strategic positioning, and give full play to regional characteristics, and at the same time, refine and improve the rules and standards for the development of digital trade and implement them fairly and equitably, so as to better promote cross-border e-commerce as well as the sustainable development of the economy as a whole.

Innovation and sustainability in technology parks: the transformation of Itec Park UFN through the PDCA cycle

This study examines the transformative role of the PDCA (Plan-Do-Check-Act) cycle as a strategic framework for managing science and technology parks, using Itec Park UFN as a case study. By implementing PDCA-based tools, this research seeks to streamline the operational processes of technology parks through structured planning, execution, monitoring, and continuous improvement. The approach aligns closely with the Sustainable Development Goals, notably SDG 9: Industry, Innovation, and Infrastructure. Employing an action research methodology that integrates literature review, tool development, and pilot implementation, the study emphasizes strategic management, innovation promotion, and knowledge transfer as core aspects. Findings reveal that the PDCA cycle enhances the park’s capacity to adapt to market shifts, supporting resilience and fostering a culture of sustainable innovation. The structured use of PDCA not only improves operational efficiency but also promotes stronger partnerships between academia, industry, and government. This systematic management approach establishes a replicable model that can be adapted by other science and technology parks, providing practical insights into the creation of innovation ecosystems that catalyze regional economic development and empower startup growth. Ultimately, the research contributes to the field by demonstrating how structured, goal-oriented methodologies can drive sustainable technological and economic advancement.

Developing Culturally Sensitive Suicide Prevention Programs for Medical Professionals in Indonesia

Introduction: Medical professionals in Indonesia experience high levels of stress, increasing their risk for mental health problems and suicidal behavior. Culturally appropriate suicide prevention programs are critical to address this issue. This study aimed to develop and evaluate the feasibility and acceptability of a culturally adapted suicide prevention program for Indonesian medical professionals. Methods: This mixed-methods study had two phases. Phase 1 involved program development, adapting an existing evidence-based suicide prevention program using a Delphi method with Indonesian mental health experts (n=10) and cultural consultants (n=5). Phase 2 comprised a pilot implementation of the program with 30 medical professionals. Quantitative data on program feasibility (attendance, completion rates) and acceptability (satisfaction surveys, qualitative feedback) were collected and analyzed. Results: The Delphi method resulted in a culturally adapted program incorporating Indonesian values related to collectivism, family support, religious beliefs, and stigma associated with mental health. Pilot implementation showed high attendance (87%) and program completion rates (93%). Participants expressed high satisfaction with the program's content, cultural relevance, and delivery format. Qualitative feedback emphasized the importance of peer support, spiritual integration, and addressing workplace stressors. Conclusion: This study provides preliminary evidence for the feasibility and acceptability of a culturally sensitive suicide prevention program for Indonesian medical professionals. Further research is needed to evaluate the program's effectiveness in reducing suicidal ideation and behavior.

Abstract 4135726: Prospective validation and implementation pilot study of an emergency department heart failure risk stratification tool: STRIDE-HF

Background: We previously found the STRIDE-HF emergency department (ED) risk tool accurately predicted risk of a 30-day serious adverse event (SAE), including 30-day mortality, cardiopulmonary resuscitation, intra-aortic balloon pump insertion, intubation, new dialysis, myocardial infarction, or coronary revascularization. Research question: We sought to prospectively validate STRIDE-HF and describe safety of the deployed model in a clinical pilot. We hypothesized that performance would decrease slightly with prospective evaluation and that real-time risk display would contribute to safe disposition decisions. Goals: 1) To prospectively validate KPCARES-HF across 21 community EDs among ED patients with acute heart failure (AHF) from January 1, 2023 – December 31 st , 2023; and 2) to describe outcomes among patients predicted to be very low risk and discharged home in the clinical pilot. Methods: For prospective validation, we report 30-day mortality rates by risk strata. We assess model performance using area under the receiver operator curve (AUROC) and sensitivity at a key clinical threshold. We describe rates of 30-day SAE among patients predicted to be very low risk and discharged after ED or observation unit care in the clinical pilot. Results: There were 13,274 ED patients in the prospective validation; median age was 76, 50.8% were female, and 44.5% were non-White. We found 11.4%, 24.8%, 31.9%, and 31.9% of patients were very low, low, moderate, and high risk, respectively, while 21.6%, 15.2% and 63.0% were discharged, observed, and admitted, respectively. Among discharged patients, 29.2% and 13.3% were moderate or high risk, respectively, and 30-day mortality rates among these patients were 2.2% and 8.4%, respectively. Among 8,363 admitted patients, 27.7% were very low or low risk. Conclusions: STRIDE-HF maintained high predictive accuracy with prospective validation in this diverse, multi-center cohort. Our findings suggest that use of STRIDE-HF might help better align risk with admission decision and can be safely used to assist providers in identifying patients who may be stable for outpatient care.