Pilot Program Research Articles

Leveraging Linked Ontario’s Health-administrative Data to Evaluate Internet-delivered Cognitive Behavioural Therapy (iCBT) in routine care

ObjectiveVirtual interventions show promise for meeting growing mental health (MH) service demands. In 2020, Ontario launched Internet-delivered Cognitive Behavioural Therapy (iCBT), an evidence-based, self-led, asynchronous intervention for anxiety and depression. While its efficacy has been demonstrated in randomized controlled trials, we examine its real-world reach and treatment completion in routine care. ApproachLinking iCBT records with health-administrative databases, we examined the characteristics (clinical, sociodemographic, health service use) of individuals receiving iCBT (via a pilot program), compared to fully-synchronous CBT (standard of care), ascertained who is more likely to receive either modality, and determined factors associated with treatment completion using Logistic regressions adjusted for sociodemographics, baseline depression (PHQ-9) and anxiety (GAD-7), and outpatient and acute MH-related service use one year prior to enrollment. ResultsAmong N=167 individuals receiving iCBT at the Centre for Addiction and Mental Health (Jan 2020-Aug 2021) and N=300 controls receiving fully-synchronous CBT via Ontario’s Structured Psychotherapy Program, we found that older individuals, those with lower baseline anxiety, and those with greater prior MH service use were more likely to receive iCBT. Intervention modality was the only significant predictor for treatment completion, with 51% lesser odds among iCBT clients (ORadjusted=0.49, 95%CI 0.31-0.76). ConclusionsWhile certain demographic characteristics differentiate iCBT recipients from those receiving standard CBT, treatment adherence is lower in self-led, asynchronous therapy. ImplicationsThis study examines iCBT in routine care and informs its wider implementation so it can reach the target population, ease access burdens, and improve MH service delivery. Future work will examine treatment effectiveness.

Assessment of a Pilot Program for Remote Support on Mental Health for Young Physicians in Rural Settings in Peru: Mixed Methods Study.

Telemedicine-based interventions show promise in addressing mental health issues among rural populations, yet evidence regarding their impact among the health care workforce in these contexts remains limited. This study aimed to evaluate the characteristics and the responses and perceptions of recently graduated physicians who work in rural areas of Peru as part of the Servicio Rural Urbano Marginal en Salud (Rural-Urban Marginal Health Service [SERUMS], in Spanish) toward a telehealth intervention to provide remote orientation and accompaniment in mental health. A mixed methods study was carried out involving physicians who graduated from the Universidad Nacional Mayor de San Marcos and participated in the Mental Health Accompaniment Program (MHAP) from August 2022 to February 2023. This program included the assessment of mental health conditions via online forms, the dissemination of informational materials through a website, and, for those with moderate or high levels of mental health issues, the provision of personalized follow-up by trained personnel. Quantitative analysis explored the mental health issues identified among physicians, while qualitative analysis, using semistructured interviews, examined their perceptions of the services provided. Of 75 physicians initially enrolled to the MHAP, 30 (41.6%) opted to undergo assessment and use the services. The average age of the participants was 26.8 (SD 1.9) years, with 17 (56.7%) being female. About 11 (36.7%) reported have current or previous mental health issues, 17 (56.7%) indicating some level of depression, 14 (46.7%) indicated some level of anxiety, 5 (16.6%) presenting a suicidal risk, and 2 (6.7%) attempted suicide during the program. Physicians who did not use the program services reported a lack of advertising and related information, reliance on personal mental health resources, or neglect of symptoms. Those who used the program expressed a positive perception regarding the services, including evaluation and follow-up, although some faced challenges accessing the website. The MHAP has been effective in identifying and managing mental health problems among SERUMS physicians in rural Peru, although it faced challenges related to access and participation. The importance of mental health interventions in this context is highlighted, with recommendations to improve accessibility and promote self-care among participants.

When English education isn't what it seems: Outcomes from a pilot study in Japan

Despite the desire of Japanese students to improve their English language skills, a lack of confidence has led to a fear of participating in activities designed to boost that very confidence. What if a program requiring communication in English were advertised as something other than an intercultural exchange program? Could this promotional strategy mitigate the fear of participation? Would it still accomplish the goal of motivating further English education? This paper discusses the results of offering a pilot program, which involved activities with native English speakers and was instead advertised as a non-paid internship focusing on tourism and artificial intelligence. The post-program survey shows that while Japanese students were most attracted to and satisfied with the aspect of working with companies, they found their experience in communicating in English to be the most rewarding and challenging.

Nitrogen-doped polydopamine manganese nanoparticles with excellent oxidase-like activity for ultrafast detection of glutathione at room temperature

Glutathione (GSH) is an essential natural antioxidant, and plays a crucial role in the prevention of various diseases. Herein, a nitrogen-doped polydopamine manganese nanoparticle (N-PDA@Mn) was prepared and used as nanozyme sensor for the rapid and colorimetric detection of GSH. N-PDA@Mn demonstrated excellent oxidase-like activity (Km = 0.0841 mM and Vmax = 3.6 × 10-7 MS-1), exhibiting a rapid balance period of < 100 s. N-PDA@Mn could activate dissolved oxygen to primarily generate singlet-oxygen (1O2), which oxidized colorless 3,3′, 5, 5′-tetramethylbenzidine (TMB) to blue oxidized (ox-TMB). Because GSH could rapidly deplete 1O2, an ultrafast and colorimetric strategy was developed for GSH detection based on N-PDA@Mn. The GSH detection range was 0.5–100 μM, and the detection limit was 0.28 µM. Importantly, at room temperature, the detection time was only 30 s, which was short than that of previously reported GSH detection methods. Furthermore, a point-of-care testing (POCT) platform was designed by combining the N-PDA@Mn colorimetric sensor with a smartphone. Use the POCT platform, a broad linear detection range of 0.5–100 μM and a detection limit of 0.40 μM were obtained. Subsequently, the N-PDA@Mn colorimetric sensor and POCT platform were successfully used in the real-time and on-site quantification of GSH in human serum, achieving a high accuracy and good recovery. Therefore, the N-PDA@Mn-based methods could realize the rapid, on-site visualization, and economical detection of GSH, demonstrating their substantial potential for application in practical testing in fields of food and medicine.

Community partnership approaches to safe sleep (CPASS) program evaluation

BackgroundSudden unexpected infant death (SUID) continues to be a leading cause of death in infants in the United States (US), with significant disparities by race and socio-economic status. Infant safe sleep behaviors are associated with decreasing SUID risk, but challenges remain for families to practice these routinely. The objective of this program was to implement and evaluate a novel approach for an infant safe sleep pilot program built upon partnerships between hospitals and community-based organizations (CBOs) serving pregnant and parenting families in at-risk communities.MethodsCommunity Partnership Approaches to Safe Sleep (CPASS) was a prospectively implemented infant safe sleep program. CPASS included children’s hospitals partnered with CBOs across five US cities: Portland, OR, Little Rock AR, Chicago, IL, Birmingham, AL, and Rochester, NY. The program consisted of (1) monthly learning community calls; (2) distribution of Safe Sleep Survival Kits; and (3) surveys of sites and families regarding program outcomes. Survey measures included (1) site participation in CPASS activities; (2) recipients’ use of Safe Sleep Kits; and (3) recipients’ safe sleep knowledge and behaviors.ResultsCPASS learning community activities were consistently attended by at least two representatives (1 hospital-based, 1 CBO-based) from each site. Across the five sites, 1002 safe kits were distributed over 9 months, the majority (> 85%) to families with infants ≤ 1 month old. Among participating families, 45% reported no safe sleep location before receipt of the kit. Family adherence to nighttime safe sleep recommendations included: (1) no bedsharing (M 6.0, SD 1.8, range 0–7); (2) sleep on back (M 6.3, SD 1.7, range 0–7); and (3) sleep in a crib with no blankets/toys (M 6.0, SD 2.0, range 0–7). Site interviews described how participation in CPASS influenced safe sleep conversations and incorporated local data into counseling. Hospital-CBO relationships were strengthened with program participation.ConclusionsThe CPASS pilot program provides a new, innovative model built on hospital-community partnerships for infant safe sleep promotion in SUID-impacted communities. CPASS reached families before their infant’s peak age risk for SUID and empowered families with knowledge and resources to practice infant safe sleep. Important lessons learned included improved ways to center and communicate with families.

The Impact of Internal Migration on HIV/AIDS Transmission in Tanzania

This study examines the complex and dynamic relationship acting between the internal migration and the spread of HIV/AIDS in Tanzania. The study uses the Tanzania HIV/AIDS and Malaria indicators Survey (2011-2012) data extracted from the National Bureau of Statistics database. The study applied multivariate and logistic regression to analyze the determinants of HIV/AIDS prevalence in Tanzania. The study found that there are marginal differentials in the HIV/AIDS prevalence between migrants and non-migrants, but considering gender-wise differences the trend is substantially significant. The infection rate is higher to migrants aged thirty and above (17.3% for male and 17.5% for female) and with no education. The study also found that the HIV/AIDS prevalence is higher for non-agricultural occupations dominated by females while males account high percentage for non-working group. This study is important to government and stakeholders for addressing the dynamic interactions, policies and programs established to reduce the migration to the spread of the HIV/AIDS. Also, this study show how the different forms of migration influence the spread of HIV/AIDS. As a suggestion, the pilot program could be crucial and cost-effective for addressing factors contributing to the spread of HIV/AIDS.

Costs and cost-effectiveness of the Kerala pilot screening programme for diabetic retinopathy in the public health system.

The Government of Kerala initiated a pilot screening programme for diabetic retinopathy in 16 Family Health Centres in Thiruvananthapuram district in 2019 in collaboration with the ORNATE India project. The evaluation of this pilot included a study of its costs and cost-effectiveness to inform decisions about extending the programme throughout Kerala. The participants comprise all 5307 people who were screened for diabetic retinopathy under the pilot programme for whom data could be collected. The costs of the pilot programme are estimated at INR 11.3 million (including INR 1.9 million costs to individuals) and the benefits at 514 QALYs, slightly over one QALY per person treated. The cost per QALY was INR22,000, which is well below India's Gross National Income per person. Kerala's 2019 pilot screening programme for diabetic retinopathy was highly cost-effective.

The effects of a risk-based approach to tax examinations: evidence from a tax pilot programme in Tanzania

AbstractTechnical assistance and increased use of ICT in tax administrations hold promise for greater revenue collection. Yet, the evidence on how these activities work in the real-world circumstances of developing countries is scant. The paper attempts to fill this gap by evaluating an intervention undertaken jointly by the Finnish and Tanzanian revenue administrations. The programme introduced a new risk-based case selection method for enhancing the effectiveness of firm tax examinations in Tanzania complemented by supplementary staff training and developing management practices. Our results, stemming from a difference-in-differences analysis and administrative data from the Tanzanian Revenue Authority, indicate that the intervention increased the corrected amount of taxable income by approximately 20% during the first year of the new approach.

Program Implementation Strategies Associated With Reduced Acute Care Utilization for Medicaid Beneficiaries in California's Whole Person Care Pilot Program.

Public health care policymakers and payers are increasingly investing in efforts to address patients' health-related social needs (HRSNs) as a strategy for improving health while controlling or reducing costs. However, evidence regarding the implementation and impact of HRSN interventions remains limited. California's Whole Person Care Pilot program (WPC) was a Medicaid Section 1115 waiver demonstration program focused on the provision of care coordination and other services to address eligible beneficiaries' HRSN. In this study, we examine pilot-level variation in impact on acute care utilization and identify factors associated with differential outcomes. The majority of pilots reduced emergency department (ED) visits for enrollees relative to matched controls; however, only four pilots reduced both ED visits and hospitalizations. Coincidence analysis results highlight the importance of cross-sector partnerships, field-based outreach and engagement, and adequate program investment in differentiating pilots that reduced acute care utilization from those that did not.

The Fletcher-Cox Pathway: A Unique View on Clinical Trial Education

PurposeThere currently are no established formal mentorship and training program for radiation oncology (RO) trainees to learn trial design, creation, writing, or implementation. There only exists informal training on analyzing clinical trials in RO residency programs. The integration of a longitudinal formal training and mentorship program for clinical trialists - consisting of clinical trial education, design, mentorship, and implementation during the RO residency education will give residents not only formal teaching in the subject, but strong tools and requisite mentorship in hopes to help them succeed as future academic physicians and leaders in the field of radiation oncology. Methods and MaterialsWe developed a clinical trial training pathway in 2018 at XXX, proposing it as a pilot program. The “Fletcher-Cox Pathway” was accepted with a highly positive response by trainees. and is is now offered as a standard option to RO trainees at our institution. ResultsWith the guidance of their principal investigator (PI), residents participating in this pathway design and submit a clinical trial for institutional review board (IRB) review. In 2019, after implementation of the pilot program, 4 of the incoming 7 residents joined the pathway. The program continues, and the current cohort of trainees have received training in clinical trials design andworked with dedicated mentor(s) regarding clinical trial ideas; their studies are currently accruing patients. ConclusionsThis pilot program has been viewed by trainees and mentors as successful; it highlights how a structured approach meets a clear need within RO training. We envision the creation of a national platform to increase access, whereby programs adopt this clinical trialist educational pathway, which ultimately leads to the development of a robust clinical trial community with communal resources. We hope that this not only improves and provides educational initiatives to all trainees but also initiates further collaboration.

Engaging Physicians in Improvement Priorities Through the American Board of Medical Specialties Portfolio Program

Physician involvement in quality improvement and patient safety (QIPS) work is critical for success. It is often difficult to engage physicians in this work given competing priorities and lack of individual benefits for participation. The American Board of Medical Specialties (ABMS) Portfolio Program was created to establish a systematic process for review and approval of health care organizations' implementation of QIPS work and that allows organizations to offer continuing certification credit to physicians who meaningfully engage in that same work. What started as a pilot program in 2010 between Mayo Clinic and the American Boards of Family Medicine, Internal Medicine, and Pediatrics has grown to include more than 100 organizations in 2024. The Portfolio Program has expanded from academic medical centers and medical schools to include government agencies, hospital groups, associations, and other types of health organizations. It has provided credit for more than 5,000 activities, and credit has been issued to physicians more than 60,000 times. To make QIPS submissions easier, standardized templates were created for certain types of quality improvement work; for example, the COVID-19 template facilitated the awarding of continuing certification credit to more than 10,000 physicians. The ABMS Portfolio Program helps organizations establish a framework around QIPS work so physicians can receive continuing certification credit for their engagement. It also provides structure to establish processes and procedures for awarding credit and is flexible enough to meet the needs of each organization.

The role of assistant psychologists working in crisis resolution and home treatment teams

A service evaluation was conducted to explore staff perception of the role of assistant psychologists (APs) working in a Crisis Resolution and Home Treatment Team (CRHTT). Four APs were employed on a pilot scheme and embedded in four CRHTTs across Hywel Dda University Health Board (HDUHB). Using a mixed-methods survey, data were collected from staff working with these CRHTTs (N = 26). Quantitative results reported that the participants perceived the contribution of the AP as ‘very valuable’ to both the team and its patients. Qualitative results identified two overarching themes (Additional Value and Additional Expectations) and five themes (with subthemes): (1) A Stepping Stone; (2) A Different Perspective; (3) More is Needed; (4) Clarifying the Remit; and (5) The Impact on Discharge. Integrative analysis indicated that there is a need to improve staff understanding of the role and its remit. Further evaluation and research is needed to ensure greater understanding and clarification of the role.

Using Existing Resources to Create a Successful End-of-Life Doula Program

The end-of-life doula role has emerged as an integral part of the interdisciplinary team caring for patients. The doulas provide an extra layer of support from a non-clinical lens to prevent crises, follow-up with families, and guide them through their journey. This manuscript describes how a hospice agency developed a performance improvement project to train volunteers to become end-of-life doulas through a rigorous training program, based on the Doula Model of Care. The implementation of the program was evaluated based on caregiver and staff satisfaction, and volunteer knowledge competency. The results from the pilot program showed mixed outcomes for patient and staff satisfaction, but created a rigorous training program for hospice volunteers. The COVID-19 pandemic disrupted data gathering and implementation of the program, so outcomes were varied. However, the program remains successful with ongoing training of the end-of-life doulas and an increase in new volunteers to support the program.

Do short-sale constraints inhibit information acquisition? Evidence from regulation SHO

We investigate how short-sale constraints influence investor information acquisition. Leveraging the U.S. Securities and Exchange Commission's (SEC's) Regulation SHO pilot program, we find that relaxed short-sale constraints lead to increased public information acquisition by investors. Investors acquire and process valuable information and utilize it to improve their short-selling decisions after the relaxation of short-sale constraints. We obtain similar findings using a quasi-natural experiment in China that lifted short-sale bans, supporting the external validity of our results. Collectively, our evidence demonstrates that reduced trading frictions promote information acquisition and contribute to price discovery.

A pilot program to improve TB care with primary and specialty care coordination in TB public health clinic

&lt;sec&gt;&lt;title&gt;BACKGROUND&lt;/title&gt;The Wetmore Tuberculosis (TB) Clinic in New Orleans serves patients who often lack primary care (PC) or specialty care (SC), which is complicated by comorbidities. An initiative to provide on-site PC and coordinate care aims to enhance TB patient management.&lt;/sec&gt;&lt;sec&gt;&lt;title&gt;METHODS&lt;/title&gt;Data collection involved categorizing patients based on their PC status: Group I (regular PC), Group II (intermittent PC), and Group III (no PC), with on-site Nurse Practitioner-based Bridge Care (NPBC) provided as needed.&lt;/sec&gt;&lt;sec&gt;&lt;title&gt;RESULTS&lt;/title&gt;Over 12 months, 209 out of 354 patients required NPBC and PC/SC coordination, with a 20% shift from Group III to Group I, reducing the need for NPBC.&lt;/sec&gt;&lt;sec&gt;&lt;title&gt;CONCLUSION&lt;/title&gt;The program improved TB care at Wetmore TB Clinic, offering a potential model for other TB clinics to enhance patient adherence and TB and post-TB treatment follow-up.&lt;/sec&gt;

Advancing global antibiotic research, development and access.

The pipeline of new antibiotics is insufficient to keep pace with the growing global burden of drug-resistant infections. Substantial economic challenges discourage private investment in antibiotic research and development (R&D), with a decline in the number of companies and researchers working in the field. Compounding these issues, many countries (from low income to high income) face a growing crisis of antibiotic shortages and inequitable access to existing and emerging treatments. This has led to an increasing role for public and philanthropic funding in supporting antibiotic R&D via the creation of nonprofit public-private partnerships, including Combating Antibiotic-Resistant Bacteria Biopharmaceutical Accelerator (CARB-X) and the Global Antibiotic Research and Development Partnership (GARDP), industry support for the AMR Action Fund, and pilot schemes to evaluate and reimburse antibiotics in innovative ways. Now is the time to raise the urgency, ambition and commitments of the world's leaders to fully support the antibiotic R&D ecosystem, incentivizing all sectors to conduct public health-driven antibiotic R&D and make effective antibiotics accessible to all who need them.

Does the Innovative City Pilot Policy Promote Urban Energy Use Efficiency? Evidence from China

The innovative city pilot policy (ICPP) is a key policy practice in China’s innovation-driven economic strategy, yet its influence on urban energy use efficiency (UEUE) has yet to be assessed. This study used balanced panel data from Chinese cities from the period of 2006 to 2022 to investigate the impact of innovative cities on urban energy consumption efficiency. The double-difference method, which treats creative cities as quasi-natural experiments, was applied to identify the impact mechanism of these cities. Additionally, this study looked at heterogeneity from several angles and assessed the effects of the policy on the environment. Following thorough testing to guarantee the reliability of the findings of this study—such as changing variables, ruling out further policy interferences, and running placebo tests—it can be concluded that the pilot program significantly improves urban energy consumption. The mechanism analysis performed in this study shows that, via talent concentration, utilizing technology, and optimizing the industrial structure, the creative city pilot policies increase energy consumption efficiency. Additionally, a heterogeneity analysis shows that eastern cities and cities with a high degree of digital finance benefit most from the legislation in terms of energy consumption efficiency. The application of creative city pilot programs has a more noticeable effect on increasing the energy consumption efficiency in eastern cities, as well as in cities with a high degree of digital infrastructure and digital finance, according to the heterogeneity analysis. Furthermore, an environmental consequence test shows that, by encouraging the growth of UEUE, the development of innovative cities can successfully help to reduce carbon emissions.

“We are the forerunners in Southern Europe”: Experimenting with Business Improvement Districts in Greater Barcelona

ABSTRACT This paper uses the experimentation with Business Improvement Districts in Greater Barcelona to examine its relational re-making in a rather over-looked Southern-Mediterranean urban, socio-spatial and political-institutional context. Drawing on semi-structured interviews and institutional archives, it offers three intellectual contributions to urban policy mobilities studies. First, the paper argues that the territorial adaptation, mediation and translation of urban entrepreneurial policies hinges upon the differential and inherited nature of welfare regimes, state-market constellations and existing political infrastructures. Second, the paper outlines that policymakers have followed open-ended and multilateral learning approaches through space and time, in which some policy features were (re-)learned, circulated and modified to fit more centralized regimes. Third, and finally, it sketches out the role of government-funded pilot programs as instances through which policies are showcased, experimented and ultimately constituted before and after their institutionalization in specific socio-legal and socio-spatial contexts.

China’s carbon trading pilot policy, economic stability, and high-quality economic development

The purpose of this study is to examine how economic development and stability are affected by carbon trading pilot programs. Using panel data from 31 Chinese provinces and autonomous regions between 2005 and 2021, two hypotheses were tested using the DID model. The findings indicate that (1) the carbon trading market pilot program has an immediate effect on economic stability. (2) High-quality economic development is positively and significantly impacted by the carbon trading market pilot program. Regional heterogeneity exists in the effects of carbon trading pilot programs on high-quality development and economic stability. The relationship between carbon trading pilot programs and economic development is not conclusive, despite the growing number of these policies. Given this, additional investigation into this connection is required. Understanding the results of carbon trading pilot programs can be used to gauge how successful these initiatives are. This research adds to the body of knowledge regarding the impact of the carbon trading pilot programs. It then makes policy recommendations that may serve as a guide for future “double carbon” research.

Empowering air quality prediction through "AI + big data technology" in the perspective of environmental lawA quasi-natural experiment analysis based on the "national big data comprehensive experimental zone" pilot program

The current environmental legal system primarily focuses on environmental pollution and ecological damage, yet it does not adequately address climate change as an environmental risk issue. Consequently, environmental law struggles to directly respond to air pollution and climate change. Due to the complexity of air pollution regulation, there is a need for legal frameworks that extend beyond conventional environmental pollution controls. The advent of "AI + Big Data" has provided new momentum and opportunities for predicting and improving air quality. This paper, viewed through the lens of environmental law and based on the policy of the National Big Data Comprehensive Experimental Zone, combined with the Difference-in-Differences (DID) model, outlines the impact mechanisms of Big Data and Artificial Intelligence in empowering air quality prediction and improvement. It also explores the path choices for achieving the objectives of accuracy and effectiveness in air quality prediction from the perspective of environmental law.