Pilot Sites Research Articles

Assessment of the Standardized Surveillance Case Definition for Neonatal Abstinence Syndrome by the Council of State and Territorial Epidemiologists, 4 Jurisdictions, 2020-2021

Objectives: In 2019, the Council of State and Territorial Epidemiologists ratified a multitiered standardized surveillance case definition (SSCD) for neonatal abstinence syndrome (NAS) to minimize variability in definitions across states. This evaluation of the tier 1 NAS SSCD aimed to identify common challenges and opportunities for enhancement to support consistent implementation of the definition. Methods: This mixed-methods analysis consisted of 3 virtual focus groups in March 2021 with site principal investigators, medical record abstractors, and data analysts (1 focus group each) from 4 jurisdictions piloting the tier 1 NAS SSCD. We analyzed focus group transcripts to create a codebook. We collected written reports in February 2022 from the 4 jurisdictions, conducted thematic analysis of focus group transcripts and written reports to identify themes, and collected surveillance data on infants identified with NAS born from January 2020 through December 2021 from the pilot sites. We analyzed surveillance data to further inform identified themes. We examined agreement among tier 1 classifications assigned independently by each pilot site and the Centers for Disease Control and Prevention to cases of NAS. Results: Three major themes emerged in the data: challenges abstracting data on withdrawal signs from the medical record, difficulty determining the time frame of prenatal substance exposure, and challenges assigning case classifications. In a comparison of tier 1 classifications assigned by the Centers for Disease Control and Prevention and the sites, 82.1% of cases in the dataset were concordant. Conclusions: We identified several opportunities to modify the SSCD to promote consistency and ease implementation across jurisdictions. Promoting consistent implementation supports comparability of NAS incidence estimates across jurisdictions, evaluation of prevention efforts, and allocation of resources to support families.

Enhancing Wetland Mapping: Integrating Sentinel-1/2, GEDI Data, and Google Earth Engine.

Wetlands are amongst Earth's most dynamic and complex ecological resources, serving productive and biodiverse ecosystems. Enhancing the quality of wetland mapping through Earth observation (EO) data is essential for improving effective management and conservation practices. However, the achievement of reliable and accurate wetland mapping faces challenges due to the heterogeneous and fragmented landscape of wetlands, along with spectral similarities among different wetland classes. The present study aims to produce advanced 10 m spatial resolution wetland classification maps for four pilot sites on the Island of Newfoundland in Canada. Employing a comprehensive and multidisciplinary approach, this research leverages the synergistic use of optical, synthetic aperture radar (SAR), and light detection and ranging (LiDAR) data. It focuses on ecological and hydrological interpretation using multi-source and multi-sensor EO data to evaluate their effectiveness in identifying wetland classes. The diverse data sources include Sentinel-1 and -2 satellite imagery, Global Ecosystem Dynamics Investigation (GEDI) LiDAR footprints, the Multi-Error-Removed Improved-Terrain (MERIT) Hydro dataset, and the European ReAnalysis (ERA5) dataset. Elevation data and topographical derivatives, such as slope and aspect, were also included in the analysis. The study evaluates the added value of incorporating these new data sources into wetland mapping. Using the Google Earth Engine (GEE) platform and the Random Forest (RF) model, two main objectives are pursued: (1) integrating the GEDI LiDAR footprint heights with multi-source datasets to generate a 10 m vegetation canopy height (VCH) map and (2) seeking to enhance wetland mapping by utilizing the VCH map as an input predictor. Results highlight the significant role of the VCH variable derived from GEDI samples in enhancing wetland classification accuracy, as it provides a vertical profile of vegetation. Accordingly, VCH reached the highest accuracy with a coefficient of determination (R2) of 0.69, a root-mean-square error (RMSE) of 1.51 m, and a mean absolute error (MAE) of 1.26 m. Leveraging VCH in the classification procedure improved the accuracy, with a maximum overall accuracy of 93.45%, a kappa coefficient of 0.92, and an F1 score of 0.88. This study underscores the importance of multi-source and multi-sensor approaches incorporating diverse EO data to address various factors for effective wetland mapping. The results are expected to benefit future wetland mapping studies.

Preventing and Treating Pain and Anxiety during Needle-Based Procedures in Children with Cancer in Low- and Middle-Income Countries.

Introduction: Children with cancer experience significant pain and anxiety during needle-based procedures. Undertreated pain in children has long-lasting consequences and reduces the efficacy of subsequent analgesic efforts. A validated quality improvement (QI) intervention, known as the "Children's Comfort Promise", includes (1) topical anesthetics, (2) sucrose or breastfeeding for infants, (3) comfort positioning, and (4) distraction techniques, and has been shown to be highly effective in decreasing procedural pain and anxiety in children. However, there is limited data about the adoption, adaptation, and implementation of these interventions in low- and middle-income countries (LMICs). Methods: A QI pilot project utilizing the Model for Improvement of the "Global Comfort Promise" was implemented in four global pediatric cancer hospitals (Lima, Peru; Barretos, Brazil; Pietermaritzburg, South Africa; and Manila, Philippines). Between August 2021 and January 2023, the pilot sites identified a specific aim, co-designed the measurement strategy with St. Jude Children's Research Hospital, and adopted, adapted, and implemented the project at their individual sites. Results: A total of 2,185 different procedures were recorded in the first year of implementation. Most patients were less than 10 years old (60.5%) and solid tumors (37.9%) were the most common diagnosis. Overall, healthcare professionals (98.3%) were satisfied with the procedures. Parents and patients reported that only 33.7% of patients experienced pain during the procedure. All (100%) parents and patients felt the healthcare teams adequately addressed their child's pain. Median self-reported adherence to ≥2 interventions was 98.0%. Challenges to the implementation of the QI initiative included lack of training, turnover of the medical staff, maintaining staff enthusiasm, and access to topical anesthetics. Each site had unique change ideas to implement the initiative. Conclusions: This multi-site, multi-country QI initiative was feasible and was successfully adopted, adapted, and implemented in the LMIC context to improve procedural pain in children (Global Comfort Promise). Additionally, this intervention resulted in high satisfaction of both healthcare professionals and patients/families. Further work is needed to overcome the challenges of topical anesthetic access and education of the workforce. Additional plans include modifying the Global Comfort Promise to include high-quality communication and expanding to additional sites with further refinement of the implementation strategy.

Artificial intelligence predictive analytics in heart failure: results of the pilot phase of a pragmatic randomized clinical trial.

We conducted an implementation planning process during the pilot phase of a pragmatic trial, which tests an intervention guided by artificial intelligence (AI) analytics sourced from noninvasive monitoring data in heart failure patients (LINK-HF2). A mixed-method analysis was conducted at 2 pilot sites. Interviews were conducted with 12 of 27 enrolled patients and with 13 participating clinicians. iPARIHS constructs were used for interview construction to identify workflow, communication patterns, and clinician's beliefs. Interviews were transcribed and analyzed using inductive coding protocols to identify key themes. Behavioral response data from the AI-generated notifications were collected. Clinicians responded to notifications within 24 hours in 95% of instances, with 26.7% resulting in clinical action. Four implementation themes emerged: (1) High anticipatory expectations for reliable patient communications, reduced patient burden, and less proactive provider monitoring. (2) The AI notifications required a differential and tailored balance of trust and action advice related to role. (3) Clinic experience with other home-based programs influenced utilization. (4) Responding to notifications involved significant effort, including electronic health record (EHR) review, patient contact, and consultation with other clinicians. Clinician's use of AI data is a function of beliefs regarding the trustworthiness and usefulness of the data, the degree of autonomy in professional roles, and the cognitive effort involved. The implementation planning analysis guided development of strategies that addressed communication technology, patient education, and EHR integration to reduce clinician and patient burden in the subsequent main randomized phase of the trial. Our results provide important insights into the unique implications of implementing AI analytics into clinical workflow.

Run, walk, cheer or volunteer: a patient and public involvement survey

BackgroundChildren with chronic diseases have been reported to participate in less regular physical activity (PA) than peers without chronic diseases; and less than recommended in guidelines. Sheffield Children’s Foundation Trust...

Assessing the policy benefits of constructing “Zero-waste Cities” in China: From the perspective of hazardous waste lifecycle management

Based on China's quasi-natural experiment of constructing “Zero-waste Cities”, this study assessed its policy benefits on hazardous waste lifecycle management. Utilizing the theory of difference-in-differences analysis, the study quantifies the net benefits of the policy in 10 pilot cities using an average treatment effect formula, and the results indicate a reduction of 162,900 tons/year in waste generation, an increase of 2.3 % in utilization and disposal rate, and a decrease of 28,200 tons/year in end-of-pipe storage. By constructing a regression model and employing robustness tests such as changing control variables, substituting the explained variable, re-matching control groups, and random assignment of pilot sites, the study confirms that the significant policy benefits primarily lie in source reduction, with a reduction intensity of approximately 1.73 tons/100 million yuan of industrial GDP. Additionally, by applying the mixed-effects model and mediation-analysis model, the study finds that the policy benefit of source reduction exhibits a lag effect, and during the pilot period, the main approach to achieving the benefit was through enhancing cleaner production in companies rather than adjusting industrial structures in cites.

P15 UK Antimicrobial Registry Study: progress to date

Abstract Background Effective antimicrobial stewardship is key in the fight against antimicrobial resistance, a key element of which is the surveillance of antimicrobial use and antimicrobial resistance. In addition to quantitative analysis of antibiotic use trends it is also important to understand qualitative aspects of how antimicrobials are used in routine clinical settings. Objectives The UK Antimicrobial Registry (UKAR) Study, a 5 year collaboration between BSAC and the University of Aberdeen, aims to determine how recently licensed antimicrobial agents are being used, their effectiveness and safety. The study is included in the NIHR portfolio in England with similar arrangements in Scotland and Wales. Here, we present brief information on the first few months of participant recruitment. Methods The study commenced recruiting patients prescribed selected antibiotics in May 2023. The intention was to commence with a small number of pilot hospital sites then to expand to a larger number of hospitals. Adult patients are potentially eligible if they have been prescribed any drug on the eligible drug list within their current stay in hospital unless the drug is actively withdrawn after less than 24 h. Data are collected from the medical records of participants who have given informed consent. Clinical data, including infection, microbiology susceptibility testing, eligible drug and dosing regimens are collected as well as prior and concurrent antibiotic therapy. Results As of November 2023, the study is open to recruitment in nine sites across the UK. There are a further 22 sites across the UK in study set-up and a further 15 sites who have submitted an expression of interest to join the registry. Fifty-two patients have been recruited as of November 2023. Five of the 11 study drugs were prescribed; the majority of the participants (N=29) were prescribed dalbavancin, the remainder received various Gram-negative agents (Table 1). Study drugs were used to treat bone and joint infections (33%) and lower respiratory tract infections (33%), with other disease areas including skin and subcutaneous tissue infections and urinary tract infections. Conclusions A key objective for UKAR pilot sites was to verify that the data collection process was feasible and address any issues around clarity of responses. Very few issues were identified, and all were resolved quickly. Early data show that participants are most likely to be female with a median age above 60 years. There is also, currently, a preponderance of patients commencing dalbavancin, although the study is still in its infancy. As more sites recruit participants to the UKAR Study, more detailed analyses can be performed on the clinical usage and outcomes being achieved. Also, follow-up data including clinical outcomes and adverse events will be collected 56 days after commencing therapy, and 28 days after last administration of an eligible study drug. In addition, clinical outcomes and relapse of the initial infection will be recorded at 6 and 12 months.

Assessment of nutrient load on the Cheboksary Reservoir using the results of modeling runoff and removal of biogenic elements from the pilot catchments

The paper presents the results of an approximate assessment of the nutrient load on the Cheboksary reservoir of the Volga Cascade from the right-bank and left-bank parts of the catchment basin. The main solution tools are the recognition of the underlying surfaces in the catchment and mathematical modeling. The catchment basins of the Kudma (right-bank tributary) and Linda (left-bank tributary) rivers have been identified as pilot sites. The catchment basins of the Kudma (right-bank tributary) and Linda (left-bank tributary) rivers have been identified as pilot sites. The representativeness of the selected pilot sites for the catchment basins of the Cheboksary reservoir is demonstrated. The mathematical basis of the research was the “precipitation-runoff-removal” model describing the formation of runoff and removal of biogenic elements from the catchment basin. To calibrate the mathematical model, the materials of observations of water discharges and the content of chemical agents in the gauging sections of the pilot catchment basins were used. The modeling data provides an approximate estimate of the total nutrient load on the Cheboksary reservoir, as well as the contribution of natural nitrogen and phosphorus removal to the load from the catchment basin.

ВЛИЯНИЕ ВОДНОГО РЕЖИМА ДЕРНОВО-ПОДЗОЛИСТЫХ ПОЧВ НА УРОЖАЙНОСТЬ БЕЛОКОЧАННОЙ КАПУСТЫ ПРИ КАПЕЛЬНОМ ПОЛИВЕ

The purpose of the research is to determine the moisture boundaries of sod–podzolic soils during drip irrigation of cabbage. The research was carried out at the pilot site in 2022-2023. The research methodology was developed by the teaching staff of the Department of Agricultural Land Reclamation of the Russian State Agrarian University - Ministry of Agriculture named after K.A. Timiryazev. Scientific research was carried out on experimental plots and in the laboratory. The results of scientific research were used to solve the problem. Using the obtained data and the formula of V.V. Shabanova, a graph of the regularity of changes in the relative yield (Yi/Ymax) of white cabbage from the relative humidity of sod-podzolic soil (in a layer of 0.5 m) during drip irrigation is constructed. In the expression of V.V. Shabanov, for irrigated sod-podzolic soils in the Non-Chernozem zone of the Russian Federation, the value of the indicator i was determined, amounting to γ = 7,275. It has been established that the moisture content of sod-podzolic soils in the Moscow region should be maintained within the most favorable limits based on the needs of white cabbage during its growth and development. According to the conducted studies, the best humidity range of sod-podzolic soils was for white cabbage (0.66-0.78) of the total moisture capacity (PV). The ratio coefficient of this dependence is 0.942±0.089, which indicates a strong relationship between the studied values.

Enhancing Patient Transport Systems in the U.S. Department of Defense’s National Disaster Medical System (NDMS) Pilot Program

Abstract Objective Congress directed the Secretary of Defense (DoD) to conduct a Pilot program to increase the National Disaster Medical System’s (NDMS) surge capacity, capabilities, and interoperability to support patient movement during a large-scale overseas contingency operation. Methods The Pilot conducted a mixed methods exploratory study, the Military-Civilian NDMS Interoperability Study (MCNIS), identifying 55 areas of solutions for NDMS innovation that align with interagency stakeholder interests. Priorities were determined via facilitated discussions, refined and validated by all five Pilot sites. Results As the DoD provides essential support for the patient movement component within NDMS, the results highlighted areas for improvement between receiving patients at an airfield and moving them to NDMS definitive care partners during a large medical surge event. This includes patient tracking capabilities, transportation processes and patient placement. Conclusions In collaboration with the Departments of Health & Human Services, Homeland Security, Transportation, and Veterans Health Administration, the Pilot is addressing these areas for improvement, by executing site-specific projects that will be validated and identified for export across the system. Leaders across the Pilot site healthcare networks are working to enhance patient movement and tracking. Ultimately, the Pilot will deliver dozens of proven solutions to enhance the NDMS’s patient movement capabilities.

Contextualizing Inequities in COVID Vaccination Trends Among Project REFOCUS Pilot Sites: Racism-Related Determinants of Health.

Coronavirus disease (COVID) dashboards rarely provide insights about the racialized contexts in which vaccination inequities occur. The purpose of this study was to use the emerging Project REFOCUS dashboard to contextualize COVID vaccination patterns among 6 diverse communities. We queried the dashboard to generate descriptive statistics on vaccination trends and racism-related contextual factors among the 6 Project REFOCUS pilot sites (Albany, Georgia, Bronx, New York, Detroit, Michigan, Helena-West Helena, Arkansas, San Antonio, Texas, and Wake County, North Carolina). Vaccination rates, demographic indicators, and contextual factors differed across sites. As of October 17, 2022, the proportion of people who had received at least 1 COVID vaccine dose ranged from 58.4% (Wayne County, Michigan) to 95.0% (Wake County, North Carolina). The pilot sites with the greatest percentage of Black residents (Dougherty County, Georgia, Wayne County, Michigan, and Phillips County, Arkansas) had lower proportions of fully vaccinated people. Wayne County, Michigan, had the highest level of residential segregation between Black and White residents (78.5%) and non-White and White residents (68.8%), whereas Phillips County, Arkansas, had the highest overall mortgage denial rates (38.9%). Both counties represent settings where over 75.0% of residents report Black race and over 30.0% of the population live in poverty. The dashboard integrates racism-related factors with COVID vaccination visualizations and provides a fuller picture of the context in which COVID trends are occurring. Community organizers, researchers, policymakers, and practitioners can track racism-related factors and other social determinants of health as part of the contexts in which COVID-related inequities occur.

Управление электротяговыми нагрузками на основе взаимодействия с системой электроснабжения железных дорог

Currently, the principles of electric rolling stock management do not involve consideration of the instantaneous load of traction substations and the operating mode parameters of other electric traction loads in the inter-substation zone of an electrified section of railways. The inter-train travel intervals on the section are set based on the preliminary software-based calculation of the traction power supply system for trains with a given range of train weight. The article provides the reasonable approach to managing electric traction loads based on their interaction both with each other and the railway power supply system in real time with instantaneous limitations of the energy infrastructure. The results of experimental synchronized measurements with two trains in the substation area of an electrified AC section are presented. Using a mathematical model of the pilot site and measurement data, the coefficients of the influence of electric traction loads on the voltage in arbitrary nodes and on the loading of the feeders of the contact network are calculated.

Reform and Effectiveness Assessment of Accounting Teaching in Colleges and Universities Based on Multi-source Data Mining

Abstract The growing discrepancy between the supply and demand of new accounting professionals underscores an urgent need for reform in the educational paradigms within higher education accounting programs. This paper introduces a comprehensive proposal for educational reform in accounting at the collegiate level, using ‘A school’ as a pilot site for our experimental teaching reform. Central to our methodology is the design of a multi-source data mining process, utilizing characteristics of educational information data. Employing the K-means clustering algorithm as a foundation, we further develop a Fuzzy C-Means (FCM) clustering algorithm to evaluate the impact of these pedagogical reforms. Subsequent to the reform, we collected and analyzed teaching data, establishing specific assessment metrics. The analysis, conducted via clustering, revealed significant improvements. Prior to the reform, the experimental class scored an average of 62.89, compared to the control class’s 63.05. Post-reform, the experimental class’s performance elevated to 74.57, while the control class saw a more modest increase to 65.14. This marked enhancement in the experimental class’s performance underscores the efficacy of the reform, aligning with our educational objectives, which anticipate an 80% qualification rate and a 42% excellence rate among accounting majors. This study not only advances the theoretical framework but also refines the practical approaches to cultivating accounting talent in collegiate settings. It offers valuable insights and serves as a reference for future reforms in accounting education at universities.

Комплексная оценка состава и свойств чернозема южного мицеллярно-карбонатного, орошаемого ограниченно пригодными водами

Purpose: to take a comprehensive assessment of southern micellar-carbonate chernozem content and properties, irrigated with limitedly available water. Materials and methods. The research was carried out on the territory of a pilot site located in the Saki region of the Republic of Crimea near the village Chervonoye. During the work, the state of water resources used for irrigation and the soil were analyzed. The assessment of water suitability for irrigation was carried out on the basis of soil reclamation classification. The analysis of soil conditions included the determination of: bulk density and solid phase density, granulometric content, particle size distribution, pH, expanded salt content of the. When determining the agro-physical properties of the soil water extract, the following methods were used: pycnometric, drying to constant weight, cutting ring, sieve with water washing, pipette. Results. The topsoil layer was identified as compacted with satisfactory porosity. The nutrient supply was mainly characterized as medium and high, only low content was recorded in 2022 for nitrate nitrogen (0.3–0.7 mg/100 g of soil). Despite the use of limitedly suitable water for irrigation, no water-soluble salt accumulation was recorded in a meter layer of soil. At the end of the irrigation period in 2023, the soils were classified as non-saline, and according to their granulometric texture depending on the depth – as medium loamy, heavy loamy and light clayey. Conclusions. Despite the fact that in the period from 2022 to 2023, irrigation with water with a mineralization of about 1.5 g/l did not lead to the accumulation of water-soluble salts in the soil of the pilot site, it is recommended to organize regular observations of its salt regime. This is justified by the fact that in drier years the precipitation may not be enough to wash out the salts arriving during the growing season with irrigation water into the underlying horizons.

Attributes: Selective Learning and Influence

An agent selectively samples attributes of a complex project so as to influence the decision of a principal. The players disagree about the weighting, or relevance, of attributes. The correlation across attributes is modeled through a Gaussian process, the covariance function of which captures pairwise attribute similarity. The key trade‐off in sampling is between the alignment of the players' posterior values for the project and the variability of the principal's decision. Under a natural property of the attribute correlation—the nearest‐attribute property (NAP)—each optimal attribute is relevant for some player and at most two optimal attributes are relevant for only one player. We derive comparative statics in the strength of attribute correlation and examine the robustness of our findings to violations of NAP for a tractable class of distance‐based covariances. The findings carry testable implications for attribute‐based product evaluation and strategic selection of pilot sites.

The VALUECARE Model for value-based, integrated health and social care services delivery supported by ICT for older adults: participatory research in 6 European countries

Introduction: In 2006, Michael Porter and Elizabeth Teisberg introduced the concept of value-based health care delivery by presenting a new framework for health system design. They proposed a fundamental unifying goal for health care: maximizing value for patients. Value is defined as the health outcomes achieved in response to the needs of a patient relative to the costs of delivering these outcomes. Consequently, understanding patient goals and values is integral to delivering high value. Participatory approaches are a key element in defining the care delivery model according to the patients’ needs and contribute to the sustainability of the care delivery. This study presents the VALUECARE model co-designed with older adults, care team members, health and social service managers and ICT experts to adapt the ValueCare concept supported by technology to the community context and end-users needs.
 Target group: Older people 65 years and older with comorbidity from 6 European countries (Croatia, Ireland, Portugal, Italy, Spain & The Netherlands) facing different health challenges (cardiovascular disease, cognitive decline, frailty, and stroke).
 Participants engaged in the co-design of the value based integrated care: A total of 369 participants were involved in participatory activities with the purpose of co-designing the VALUECARE care model and supportive digital solution (n= 127 older adults, n=86 caregivers, n=109 health and social care practitioners, n=7 ICT experts, n=34 service managers, n=3 policy makers, n=3 municipality providers).
 Co-design activities implemented: Qualitative data was collected using focus groups and interviews, combining face-to-face and online means with the participants trying to adapt the methodology foreseen in the project to the pandemic situation. The eHealth Enhanced Chronic Care Model was used as a heuristic tool to integrate the discourses of the different stakeholders including older adults and those involved in the delivery of health and social care for them and featuring the guiding principles and the core elements for value-based, integrated health and social care for this group supported by ICT solutions. 
 Results: VALUECARE model highlights best practice value-based, integrated care delivery through the application of a set of 6 guiding principles for the model (i.e. quality and safety, technology as supportive tool) across 7 different key core elements (i.e. health and care decision support, comprehensive support and monitoring). Applying these principles and elements, better health outcomes and care experience for older adults are expected and an improvement in the care team wellbeing. 
 Next steps: Based on the co-design sessions, the co-designed VALUECARE model is being implemented and tested in 6 pilot sites. Continuous and periodic feedback is being collected from participants (older people and care team members) to refine the model and ensure quality care delivery, at the end of the project, a validated model of value-based and integrated care supported by technology.

Actioning usability study findings in the development of the ADLIFE integrated care digital tools.

Introduction: The ADLIFE project aims to improve the quality of life of older people with advanced chronic diseases by providing integrated intelligent personalised care via a digitally enabled holistic and integrated supportive care ICT Toolbox. The two interlinked user-facing tools are firstly, a Personalised Care Plan Management Platform (PCPMP) used by healthcare professionals; and secondly, a Patient Empowerment Platform (PEP) that patients and their informal caregivers use to promote patient self-management. 
 The impact of the ADLIFE digital tools will be explored in a 12-month pilot study conducted across 7 clinical sites in 6 countries to evaluate their impact on a range of health-related, implementation and socio-economic outcomes.
 The development of digital tools needs to be done in continuous collaboration with target end-users. Feedback from prototype testing with typical user scenarios is crucial to identify any remaining issues to resolve ahead of the deployment of such tools. We present the findings from a pre-deployment usability study conducted on the ADLIFE Toolbox.
 Methods: Pilot sites recruited 3-5 participants for their feedback on the PCPMP and PEP tools. Usability data was collected using a standardised Questionnaire for User Interface Satisfaction (QUIS), administered online, following a training workshop and testing by the participants. One site collected feedback via a Patient and Public Involvement (PPI) approach for the PEP tool as an option for the activity timeline. The questionnaire responses were analysed to identify the key areas of improvement. The analysis includes a standard scoring system giving an indication of users’ satisfaction with each facet of interest. These scores identify specific features of the ADLIFE tools that have lower usability scores, allowing useful improvements to be made before deployment in the main ADLIFE pilot study. Additional free text comments are used to complement the QUIS scores and provide greater depth of understanding around specific usability issues. PPI responses were analysed separately as the group did not test the tool directly.
 Results: 13 responses were received for PCPMP and 18 for PEP. Overall, the study participants (excluding 10 PPI participants) scored both tools above average, with scores over 66% on average in all questionnaire categories (scores of over 6 out of 9, average score on this scale is 4.5). Some areas of usability scored lower, such as task progression and highlighting where input is required. Together with comments elaborating on scores given, those areas are being assessed further for prioritising updates to the tools and also to be considered in the study planning, such as training materials and communication channels. The PPI feedback provided insight into how ADLIFE tools can fit within the wider context of healthcare and technology. 
 Conclusions: The usability studies have provided an opportunity to get feedback from participants similar to the ADLIFE study participants and make improvements to the ADLIFE tools, training and communication ahead of the pilot study start.
 Acknowledgements: ADLIFE has received funding from the EU Horizon 2020 research and innovation programme under grant agreement no. 875209. The authors thank all partners within ADLIFE for their cooperation and valuable contribution.

A new perspective in radon risk assessment: Mapping the geological hazard as a first step to define the collective radon risk exposure

Radon is a radioactive gas and a major source of ionizing radiation exposure for humans. Consequently, it can pose serious health threats when it accumulates in confined environments. In Europe, recent legislation has been adopted to address radon exposure in dwellings; this law establishes national reference levels and guidelines for defining Radon Priority Areas (RPAs). This study focuses on mapping the Geogenic Radon Potential (GRP) as a foundation for identifying RPAs and, consequently, assessing radon risk in indoor environments. Here, GRP is proposed as a hazard indicator, indicating the potential for radon to enter buildings from geological sources. Various approaches, including multivariate geospatial analysis and the application of artificial intelligence algorithms, have been utilised to generate continuous spatial maps of GRP based on point measurements. In this study, we employed a robust multivariate machine learning algorithm (Random Forest) to create the GRP map of the central sector of the Pusteria Valley, incorporating other variables from census tracts such as land use as a vulnerability factor, and population as an exposure factor to create the risk map. The Pusteria Valley in northern Italy was chosen as the pilot site due to its well-known geological, structural, and geochemical features. The results indicate that high Rn risk areas are associated with high GRP values, as well as residential areas and high population density. Starting with the GRP map (e.g., Rn hazard), a new geological-based definition of the RPAs is proposed as fundamental tool for mapping Collective Radon Risk Areas in line with the main objective of European regulations, which is to differentiate them from Individual Risk Areas.

THE BENEFITS OF LONG-TERM CARE INSURANCE FOR FAMILY CAREGIVERS: EVIDENCE FROM CHINA

Abstract This paper aims to evaluate the impacts of the long-term care insurance (LTCI) program on family caregivers of older adults with functional limitations in mainland China. The study used data collected from 1,658 LTCI beneficiaries or those in the LTCI application process in 16 pilot Chinese cities in 2021. Descriptive statistics, chi-square tests, and multiple regression analyses were used to analyze the data. The results indicate that LTCI beneficiaries are more likely to receive institutional care than non-beneficiaries (27.8% vs. 16.8%), reducing the responsibilities and potential burden of family caregivers. LTCI beneficiaries are also more likely to receive social care services than non-beneficiaries (35.9% vs. 26.7%). Family caregivers of LTCI beneficiaries spend less time per day on care than non-beneficiaries (15.45 vs.16.59 hours), and they are less likely to delay their work due to caregiving (41.4% vs. 60.7%). Additionally, LTCI has a positive impact on various aspects for family caregivers, with over 40% reducing their caregiving time, 55.0% reducing care service costs, 68.5% feeling that LTCI has reduced their physical burden, and 77.9% indicating that their psychological burden has been lessened. The study concludes that the establishment of long-term care insurance nationwide should be promoted as the pilot sites have seen significant positive effects on family caregivers. LTCI should also consider more direct support to family caregivers.

Equity and local health systems: a qualitative evaluation of the experiences of local health service leads during the first two years of the NHS Low Calorie Diet programme pilot

Background: Obesity and type 2 diabetes (T2DM) can both profoundly impact health and wellbeing. Their prevalence largely follows a social gradient. The National Health Service Low Calorie Diet programme in England aims to support people to achieve T2DM remission while also reducing health inequalities. We aimed to explore the experiences of local health service leads and identify barriers and facilitators in relation to the equitable mobilisation of the Low Calorie Diet programme. Methods: Twenty semi-structured interviews were completed with 24 locality leads across the first two years of the Low Calorie Diet programme. Interviewees were purposively sampled from the 10 localities who undertook the Low Calorie Diet programme pilot. Each interview explored a number of topics of interest, including referrals, training, communication, incentivisation, governance and engagement, before being subjected to a thematic analysis. Results: From the data, seven core themes were identified: COVID-19 and primary care capacity and engagement; methods of communication; approaches to training; approaches to incentivisation; approaches to referrals; barriers to referrals; and the importance of collaboration. COVID-19 presented a specific challenge to the mobilisation and delivery of the Low Calorie Diet programme; however, our findings demonstrate the large variation and differences in the approaches taken when delivering the programme across 10 geographically and demographically distinct pilot sites. We also identified a lack of a recognised approach or strategy to mobilisation and delivery support for the Low Calorie Diet programme, such as proportionate universalism, which is a social policy response to tackling health inequalities by ensuring that service delivery is equitable. Conclusions: Health inequalities remain a significant challenge, and health service leads have the potential to adopt an equity perspective from the start of programme mobilisation. In doing so, resources at their disposal can be managed equitably and can therefore contribute to efforts to reduce the potential occurrence of intervention-generated inequalities.