Primary Decision Research Articles

Climate Mitigation in the Swedish Single-Family Homes Industry and Potentials for LCA as Decision Support

Decision support tools for incentivizing environmentally sound decisions in building design, such as LCA (life cycle assessment), have been highlighted as an essential feature for enhancing the realization of more sustainable buildings. Nevertheless, the use of LCA to support decisions in building design is still limited in practice. A better understanding of the social dynamics and detailed contexts of the decisions leading up to a final building design is therefore critical for better integration of LCA-based information in the decision-making processes. This paper reports a qualitative, semi-structured interview study of single-family home producers in Sweden and their decision-making in relation to climate mitigation, with a particular focus on embodied carbon mitigation. By studying a specific branch of the building and construction sector, a more in-depth record can be obtained of the particularities of implementation contexts and decision-making situations in which LCA may, or may not, have a role in driving climate mitigation. Four primary decision contexts in which LCA may have an influential role to drive embodied carbon reduction include: (1) the development of building systems, (2) development and offering of house models, (3) the selection of construction products for the building system as well as for the offer of add-on products to customers, and (4) the dialogues in the individual house-buyer projects. Decision-making that affects sustainable outcomes in this part of the sector is very much dependent on a supporting regulatory context. Over the years, using building LCA in early design stages, for optimization towards low-impact final buildings, has been a repeatedly promoted recommendation both in academia and practice. This study, however, reveals that such a conclusion is too simplistic. The different overarching decision contexts identified for this particular branch display the variety of needs for life cycle-based information.

Technoeconomic analysis of high-value, crystalline silicon photovoltaic module recycling processes

Recycling is an important circular economy strategy, and for photovoltaics (PV), the one that has received the greatest research attention. Recycling of PV modules is required in Europe; everywhere else it competes in the market of end-of-life options, where cost is a primary decision factor. The vast majority of PV modules sold globally are crystalline-silicon (c-Si); most of the rest of the market are cadmium telluride thin film modules whose primary manufacturer runs its own commercial-scale recycling program. While many different c-Si recycling approaches and technologies have been proposed, they generally lack accompanying cost estimates or enough process information to model costs. Herein we develop detailed estimates of seven categories of capital and operating costs along with estimates of revenue from recovered materials for each step in two proposed recycling processes for c-Si PV modules. Using these results, we develop a hypothetical third recycling process merging process steps from the original two, estimate surcharges required to achieve minimum sustainable prices for each recycling process, as well as consider how economies of scale could reduce costs. Increasing the purity of and identifying higher-value markets for recovered materials are approaches to reducing costs and increasing recycling rates in voluntary markets.

P137 Supporting patients to get the best from their osteoporosis treatment; what works for whom, why and in what circumstance: a rapid realist review

Abstract Background/Aims For two decades, clinicians and academics have been writing about the problem of poor adherence in osteoporosis, while people with osteoporosis have identified a need for more follow up and information about medicines. We aimed to understand what works in supporting people with osteoporosis to get the best from their medicines, and specifically, to understand what mechanisms enable components of interventions to support osteoporosis medication optimisation and the underlying contextual conditions that enabled these mechanisms. Methods We conducted a Rapid Realist Review. The scope was informed by a workshop of the Effectiveness Working Group of the Royal Osteoporosis Society Osteoporosis and Bone Research Academy and the approach informed by background syntheses of qualitative literature and the Perceptions and Practicalities Approach as an underpinning conceptual framework. A primary search identified observational or interventional studies which aimed to improve medicines adherence or optimisation. Included studies were assessed for quality and data extracted relating to context, mechanism and outcomes. A supplementary second search was conducted to gain additional insight on included key papers and emerging mechanisms. Extracted data were interrogated by authors independently for patterns of context-mechanism-outcome configurations and further discussed in weekly team meetings. Recommendations for research and clinical practice were co-developed with clinical and lay stakeholders. Results 41 papers were included. We identified five contextual timepoints for the person with osteoporosis (identifying a problem; starting medicine; continuing medicine) and the practitioner and healthcare system (making a diagnosis and giving a treatment recommendation; reviewing medicine) and mechanisms relating to patient informed decision making, treatment burden, supporting routinisation and memory, supporting clinical decision making, targeting support, and approaches which were integrated and sustainable. Interventions which support patient informed decision making, improve patient knowledge and understanding, have potential to influence long-term commitment to treatment, although few studies explicitly addressed patients’ perceptions of illness and treatment as recommended in NICE guidelines. During treatment, targeting additional consultations to those most in need may be a cost and clinically effective approach to enable this. Supporting primary care clinician decision making and integration of primary and secondary care services also appears to be important, in improving rates of treatment initiation and adherence. Supporting patients’ ability to adhere (eg by lowering treatment burden and issuing reminders) may be helpful to address practical difficulties but there is little evidence to support the use of reminders alone. Conclusion For medicines optimisation for people with osteoporosis, we suggest a need for more patient-centred interventions to address patients’ perceptions of illness and treatment, and reduce treatment burden. Specialist services should consider the extent to which they integrate with, and support primary care clinical decision-making, in order to impact long-term clinical outcomes. Specific research recommendations have been co-developed, to address these knowledge gaps. Disclosure Z. Paskins: Grants/research support; NIHR, Versus Arthritis, Royal Osteoporosis Society. O. Babatunde: None. A. Sturrock: None. L. Toh: None. R. Horne: None. I. Maidment: None.

Decision Support for Oropharyngeal Cancer Patients Based on Data-Driven Similarity Metrics for Medical Case Comparison.

Making complex medical decisions is becoming an increasingly challenging task due to the growing amount of available evidence to consider and the higher demand for personalized treatment and patient care. IT systems for the provision of clinical decision support (CDS) can provide sustainable relief if decisions are automatically evaluated and processed. In this paper, we propose an approach for quantifying similarity between new and previously recorded medical cases to enable significant knowledge transfer for reasoning tasks on a patient-level. Methodologically, 102 medical cases with oropharyngeal carcinoma were analyzed retrospectively. Based on independent disease characteristics, patient-specific data vectors including relevant information entities for primary and adjuvant treatment decisions were created. Utilizing the ϕK correlation coefficient as the methodological foundation of our approach, we were able to determine the predictive impact of each characteristic, thus enabling significant reduction of the feature space to allow for further analysis of the intra-variable distances between the respective feature states. The results revealed a significant feature-space reduction from initially 19 down to only 6 diagnostic variables (ϕK correlation coefficient ≥ 0.3, ϕK significance test ≥ 2.5) for the primary and 7 variables (from initially 14) for the adjuvant treatment setting. Further investigation on the resulting characteristics showed a non-linear behavior in relation to the corresponding distances on intra-variable level. Through the implementation of a 10-fold cross-validation procedure, we were further able to identify 8 (primary treatment) matching cases with an evaluation score of 1.0 and 9 (adjuvant treatment) matching cases with an evaluation score of 0.957 based on their shared treatment procedure as the endpoint for similarity definition. Based on those promising results, we conclude that our proposed method for using data-driven similarity measures for application in medical decision-making is able to offer valuable assistance for physicians. Furthermore, we consider our approach as universal in regard to other clinical use-cases, which would allow for an easy-to-implement adaptation for a range of further medical decision-making scenarios.

Perspectives of Rural Primary Care Clinicians on Pediatric Attention-Deficit/Hyperactivity Disorder Care.

Despite efficacious treatments, evidence-based guidelines, and increased availability of integrated behavioral health care, youth coping with attention-deficit/hyperactivity disorder (ADHD) receive suboptimal care. More research is needed to understand and address care gaps, particularly within rural health systems that face unique challenges. We conducted a qualitative study within a predominantly rural health system with a pediatric-integrated behavioral health care program to address research gaps and prepare for quality improvement initiatives, including primary care clinician (PCC) trainings and clinical decision support tools in the electronic health record (EHR). Semistructured interviews were conducted with 26 PCCs representing clinics within the health system. Interview guides were based on the Practical Robust Implementation and Sustainability Model to elicit PCC views regarding determinants of current practices and suggestions to guide quality improvement efforts. We used thematic analysis to identify patterns of responding that were common across participants. PCCs identified several internal and external contextual factors as determinants of current practices. Of note, PCCs recommended increased access to continuing education trainings held in clinic over lunch and delivered in less than 30 minutes. Suggested improvements to the EHR included incorporating parent and teacher versions of the Vanderbilt Rating Scale into the EHR, documentation templates aligned with evidence-based guidelines, and alerts and suggestions to aid medication management during appointments. Future research to identify implementation strategies to help rural PCCs adopt innovations are needed given the increased responsibility for managing ADHD care and intractable gaps in access to behavioral health care in rural regions.

Feasibility of a primary care patient decision aid for smoking cessation with information about e-cigarettes

Decision aids can promote shared decision making and behavior change and may be effective in helping patients quit smoking. Patients are increasingly using e-cigarettes for smoking cessation; however, little is known about the impact of including e-cigarette information in smoking cessation decision aids. Our objective was to assess the feasibility and acceptability of a smoking cessation decision aid including e-cigarette information. This study was conducted at one family medicine clinic in the United States. We used a pre-post design. In Phase I, the decision aid presented information about approved cessation methods. In Phase II, current e-cigarette users and patients with no intention of quitting received additional information on switching to e-cigarettes. We assessed the impact of the decision aids on quit attempts and abstinence, confidence and readiness to quit, confidence and readiness to switch to e-cigarettes, and patient satisfaction. We enrolled 60 patients in each phase (N = 120). Patients reported higher confidence and readiness to quit after viewing the decision aids and consulting with their physician (p < 0.01). Patients reported the decision aid helped prepare them to make a decision about quitting smoking and expressed satisfaction with the decision aid and clinician consultation. We did not observe an impact of including e-cigarette information. Smoking cessation decision aids are acceptable to patients and may promote behavior change. Future studies should explore the impact of providing patients e-cigarette information using larger sample sizes and rigorous designs. Further research is needed to identify strategies to promote shared decision-making regarding e-cigarettes.

To Study the Role of Parents in Developing Computer Awareness among Schools Going Children in Pune City

The National Policy on Education 1986, as modified in 1992, stressed the need to employ educational technology to improve the quality of education. The policy statement led to two major centrally sponsored schemes, namely, Educational Technology (ET) and Computer Literacy and Studies in Schools (CLASS) paving the way for a more comprehensive centrally sponsored scheme – Information and Communication Technology @ Schools in 2004.The comprehensive choice of ICT for holistic development of education can be built only on a sound policy. The initiative of ICT Policy in School Education is inspired by the tremendous potential of ICT for enhancing outreach and improving quality of education. A parent is primary helper, monitor coordinator, observes, record keeper and decision maker for the child. The most important duty of parents is to look after their children and to take interest in their welfare and progress. ” Successful parenting entails both effective components in terms of commitment, empathy and positive regard for children.”

Pandemics, policy, and the power of paradigm: will COVID-19 lead to a new scientific revolution?

Critical historical analysis of the 19th-century cholera and 21st-century coronavirus-19 (COVID-19) pandemics suggests that in conflicts over pandemic-mitigation policies, the professional backgrounds of principal opponents reveal dominant and minority scientific paradigms, presaging possible epistemological shifts. Epistemic conflict over cholera helped spur biomedical expertise as the dominant paradigm for U.S. public health science and policy beginning in the 20th century. This paradigm was reflected in federal government reliance on infectious disease physicians as the primary scientific decision makers in the COVID-19 pandemic. Similarly, epistemic conflict over challenges to behavioral and social well-being in 2020 may highlight discordance between the dominant biomedical paradigm used in making federal policy and the inherently holistic impact of that policy on population health, suggesting need for a new paradigm of multidisciplinary scientific engagement. Because population-wide public health initiatives affect many aspects of health—physiological, psychological, behavioral, and social—that are best measured and interpreted by experts in these respective fields, multidisciplinary scientific engagement would facilitate optimal, holistic evaluation of policy benefits and harms. This multidisciplinary approach, analogous to that currently recommended in medical management of chronic disease, would advance epidemiological research to inform evidence-based policy for public health crises in which U.S. population-wide interventions are contemplated.

Independent Association of Lipoprotein(a) and Coronary Artery Calcification With Atherosclerotic Cardiovascular Risk

BackgroundElevated lipoprotein(a) [Lp(a)] and coronary artery calcium (CAC) score are individually associated with increased atherosclerotic cardiovascular disease (ASCVD) risk but have not been studied in combination. ObjectivesThis study sought to investigate the independent and joint association of Lp(a) and CAC with ASCVD risk. MethodsPlasma Lp(a) and CAC were measured at enrollment among asymptomatic participants of the MESA (Multi-Ethnic Study of Atherosclerosis) (n = 4,512) and DHS (Dallas Heart Study) (n = 2,078) cohorts. Elevated Lp(a) was defined as the highest race-specific quintile, and 3 CAC score categories were studied (0, 1-99, and ≥100). Associations of Lp(a) and CAC with ASCVD risk were evaluated using risk factor–adjusted Cox regression models. ResultsAmong MESA participants (61.9 years of age, 52.5% women, 36.8% White, 29.3% Black, 22.2% Hispanic, and 11.7% Chinese), 476 incident ASCVD events were observed during 13.2 years of follow-up. Elevated Lp(a) and CAC score (1-99 and ≥100) were independently associated with ASCVD risk (HR: 1.29; 95% CI: 1.04-1.61; HR: 1.68; 95% CI: 1.30-2.16; and HR: 2.66; 95% CI: 2.07-3.43, respectively), and Lp(a)-by-CAC interaction was not noted. Compared with participants with nonelevated Lp(a) and CAC = 0, those with elevated Lp(a) and CAC ≥100 were at the highest risk (HR: 4.71; 95% CI: 3.01-7.40), and those with elevated Lp(a) and CAC = 0 were at a similar risk (HR: 1.31; 95% CI: 0.73-2.35). Similar findings were observed when guideline-recommended Lp(a) and CAC thresholds were considered, and findings were replicated in the DHS. ConclusionsLp(a) and CAC are independently associated with ASCVD risk and may be useful concurrently for guiding primary prevention therapy decisions.

Study of the Impact of sanitary decisions over water quality using Bayesian Belief Networks in Upper Pantanal Wetland Basin – Brazil

Bayesian Belief Networks (BBN) modeling the water quality has become popular due to advances in computational techniques. For this instance, BBN is a useful tool to modeling the relationship between water quality data and population or urbanization parameters on a watershed scale. This method can combine primary water quality data and decision parameters and help scientists and decision-makers analyze several scenarios on a watershed, including the effect of scale. This paper aims to analyze and discuss the application of Bayesian Belief Network (BBN) on the relationship between watershed water quality and sanitary management indicators, studying a case on the Pantanal Wetland tributary watershed. Two scales BBN were constructed using ten years of water quality and sewage management datasets. Both BBNs were responsive and sensitive to water quality parameters. The Total Nitrogen and E. coli were de most essential parameters to simulate changes in water quality scenarios. The simulated scenarios showed structural limitations about the Pantanal Wetland Cities' sanitary system in the present study. We strongly recommend a review of the goals of sanitary structure and services and alert to the risk of a sanitary crisis in Pantanal Wetland.

Power, authority and expertise: policy making about relationships and sex education in English primary schools

ABSTRACT This paper analyses the experiences of English primary school leaders who perform critical roles in interpreting government policy and navigating the landscape to design relationship and sex education (RSE) for their pupils. It considers schools as sites of political contestation and educators as policy actors, the voices of whom are often absent in the literature about RSE. Drawing on Peter Morriss’ theory of power, the paper considers how primary school decision makers utilise their epistemic abilities to advance their policy preferences and how structures of authority and legitimacy energize and constrain them in their policy-making work. The findings suggest a paradox in power: while the national government has delegated decision-making about RSE to individual schools, it has simultaneously failed to uniformly equip schools to make appropriate policies about RSE and enabled parents to deny schools’ credibility and authority as leaders in RSE.

Patient Decision-Making Factors in Aggressive Treatment of Low-Risk Prostate Cancer.

BackgroundActive surveillance (AS) is underutilized for low-risk prostate cancer. This study examines decision-making factors associated with AS vs aggressive treatment in a population-based cohort of low-risk patients.MethodsNewly diagnosed patients (n = 599) were enrolled through the North Carolina Central Cancer Registry from 2011 to 2013 and surveyed regarding 5 factors that may impact treatment decision making: perceived cancer aggressiveness, aggressiveness of treatment intent, most important goal (eg, cure, quality of life), primary information source, and primary decision maker. We examined the association between treatment decision-making factors with patient choice for AS vs aggressive treatment using multivariable logistic regression analysis.ResultsThis is a sociodemographically diverse cohort reflective of the population-based design, with 37.6% overall (47.6% among very low-risk patients) choosing AS. Aggressive treatment intent (odds ratio [OR] = 7.09, 95% confidence interval [CI] = 4.57 to 11.01), perceived cancer aggressiveness (OR = 4.93, 95% CI = 2.71 to 8.97), most important goal (cure vs other, OR = 1.72, 95% CI = 1.12 to 2.63), and primary information source (personal and family vs physician, OR = 1.76, 95% CI = 1.10 to 2.82) were associated with aggressive treatment. Overall, 88.4% of patients (92.2% among very low-risk) who indicated an intent to treat the cancer “not very aggressively” chose AS.ConclusionsThese data from the patient’s perspective shed new light on potentially modifiable factors that can help further increase AS uptake among low-risk patients. Helping more low-risk patients feel comfortable with a “not very aggressive” treatment approach may be especially important, which can be facilitated through patient education interventions to improve the understanding of the cancer diagnosis and AS having a curative intent.

Shared decision-making for youth psychotherapy: A preliminary randomized clinical trial on facilitating personalized treatment.

Engaging youth and caregivers as active collaborators in the treatment planning process is a patient-centered approach with the potential to facilitate the personalization of established evidence-based treatments. This study is the first randomized clinical trial to evaluate shared decision-making (SDM) to plan youth psychotherapy. Forty youth (7-15 years; 33% ethnic minority) were randomly assigned to psychosocial treatment planned using SDM (n = 20) or planned primarily by the clinician (n = 20). In the SDM condition, clinicians guided youth and caregivers through a collaborative treatment planning process that relies on research findings to inform three primary decisions: (a) treatment target problem(s), (b) treatment participants, and (c) treatment techniques. Assessments occurred at baseline, following treatment planning, midtreatment, and post-treatment. Youth and caregivers in the SDM condition reported significantly greater involvement in the treatment planning process compared to their counterparts in the clinician-guided condition (U = 123.00, p = .037; U = 84.50, p = .014, respectively) and SDM caregivers reported significantly lower decisional conflict (U = 72.00, p = .004) and decisional regret (U = 73.50, p = .020). Supporting the feasibility of successful SDM implementation, there were no significant differences between conditions on treatment length, satisfaction with decisions, or engagement. There were no significant diagnostic or symptom differences between conditions. Planning psychosocial treatments in collaboration with youth and caregivers is a promising way to support youth and caregiver autonomy and plan evidence-based treatments that are responsive to patient preferences, culture, and values. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Unintended pregnancy and associated factors during COVID-19 pandemic in Ethiopia: Community-based cross-sectional study.

Introduction:The term ‘unintended pregnancy’ refers to a pregnancy that occurred when no children were desired or occurred earlier than desired. Unintended births account for one out of every three births in Ethiopia, and they are the leading cause of maternal morbidity and mortality. During the coronavirus disease (COVID-19) pandemic, this could be useful. COVID-19 has a significant impact on maternal health care utilization, including family planning services. As a result, this study aimed to assess unintended pregnancy and associated factors in Ethiopia during the COVID-19 pandemic.Method:A community-based cross-sectional study was conducted in Gedeo zone, Ethiopia, from April 1 to May 30, 2021. A simple random sampling technique was utilized to get 383 pregnant women from their respective kebeles. A structured questionnaire was used to collect data during a face-to-face interview. The data were coded, cleaned, and entered into Epidemiological Data Version 3.1 before being exported to the Statistical Package for Social Science Version 23.0 for analysis. A bivariate and multivariable logistic regression model was used to identify statistically significant associations between dependent and independent variables. The odds ratio, with a 95% confidence interval and a P value of 0.05%, was considered statistically significant.Result:A total of 383 pregnant women participated in the study, giving a response rate of 90.8%. During the COVID-19 pandemic, 140 (36.6%) participants stated that their current pregnancy was unintended. Unintended pregnancy was significantly associated with respondents’ age (adjusted odds ratio (AOR) = 5.214 (1.449–18.762)), primary decision maker for family planning services (AOR = 9.510 (5.057–17.887)), and fear of COVID-19 to visit a health care facility (AOR = 7.061 (2.665–18.710)).Conclusion:During the COVID-19 era, more than one-third of women had unintended pregnancies. Unintended pregnancy was significantly associated with respondents’ age, autonomy to use contraceptive methods, and fear of COVID-19, which required them to attend a health care institution.

Bi-level programming for modelling inventory sharing in decentralized supply chains

This paper deals with inventory sharing in the context of a decentralized supply chain. The supply chain consists of a manufacturer who distributes a set of products through a network of independents Points of Sale (POS). The primary decision each player has to make is to optimize its service level while maintaining a minimum total cost. The POS share their inventory allowing transshipment to enhance their ability to face demand and to avoid shortages. The problem is modelled as a 1-leader, n-followers Stackelberg game. A mixed integer bi-level program is developed considering that the manufacturer decides first on inventory levels and routes to be constructed knowing each follower\’s (POS) response function arising from its own minimization of its total cost. In this game, a manufacturer incurs the vehicle routing cost for regular shipments. In addition to their own holding costs, it is assumed that the manufacturer and the POS each are willing to incur both a part of the cost of lost sales associated with the products shortage and a part of the cost of transshipment. To address the combinatorial complexity of the problem and to provide efficient solutions for large size instances, a hybrid Genetic Algorithm coupled with deep reinforcement learning is developed. Results show that Stackelberg mechanism for inventory sharing under certain conditions allows the network as a whole to achieve savings and improve its service level.

Fractional-order coronavirus models with vaccination strategies impacted on Saudi Arabia's infections

&lt;abstract&gt;&lt;p&gt;Several newly nonlinear models for describing dynamics of COVID-19 pandemic have been proposed and investigated in literature recently. In light of these models, we attempt to reveal the role of fractional calculus in describing the growth of COVID-19 dynamics implemented on Saudi Arabia's society over 107 days; from 17 Dec 2020 to 31 March 2021. Above is achieved by operating two fractional-order differential operators, Caputo and the Caputo-Fabrizio operators, instead of the classical one. One of expanded SEIR models is utilized for achieving our purpose. With the help of using the Generalized Euler Method (GEM) and Adams-Bashforth Method (ABM), the numerical simulations are performed respectively in view of the Caputo and Caputo-Fabrizio operators. Accordance with said, the stability analysis of the two proposed fractional-order models is discussed and explored in view of obtaining the equilibrium points, determining the reproductive number ($ R_0 $) and computing the elasticity indices of $ R_0 $. Several numerical comparisons reveal that the fractional-order COVID-19 models proposed in this work are better than that of classical one when such comparisons are performed between them and some real data collected from Saudi Arabia's society. This inference together with the cases predictions that could easily deduced from the proposed fractional-order models can allow primary decision makers and influencers to set the right plans and logic strategies that should be followed to face this pandemic.&lt;/p&gt;&lt;/abstract&gt;

Exergo-economic comparison of waste heat recovery cycles for a cement industry case study

This work evaluates the performance regarding exergo-economic and emissions requirements of Waste Heat Recovery configurations (Organic Rankine cycle, Trilateral flash cycle, and Kalina cycle) under different operating conditions and working fluids. It was found that the best economic performance is presented by the Organic Rankine cycle that operates with Cyclo-Pentane and has two intermediate heat exchangers since it pushes the expansion temperature up while allowing a higher heat input to the cycle. As a result, it delivers 6.2 MW with a net present value, the net present value of 0.74 million dollars, saving up to 11480 tonnes of carbon dioxide per year. This performance far exceeds that obtained in the previous work, around 50% higher net-work with 80% higher net present value, and constitutes the best alternative in terms of performance to recover waste heat from the source evaluated. Regarding the Trilateral flash cycle, it can be stated that the net work and the exergetic performance are independent of the working fluid as long as there is not a very large volume change in the expander. The Kalina cycle presents slight exergy destruction, but the power delivered does not compensate for the high total capital cost due to the high pressures that must be handled, 55–120 bar, compared to the Organic Rankine cycle, 4–40 bar. An approach was made to more realistic cases where the methodology used facilitates selecting the best alternative when there is a budget restriction using the total capital cost and net work alternatively like a fixed requirement and net present value as the primary decision criterion.

Politics, preparedness, or resources Examining state responsiveness to the COVID-19 pandemic.

U.S. states are often the primary decision makers during a public health crisis. The COVID-19 pandemic led to several different reopening processes across states based on their unique characteristics. We analyze whether states' reopening policy decisions were driven by their public health preparedness, resources, COVID-19 impact, or state politics and political culture. To do so, we summarized state characteristics and compared them across three categories of reopening scores in a bivariate analysis using the chi-square or Fisher exact test for the categorical variables and a one-way analysis of variance (ANOVA) for the continuous variables. A cumulative logit model was used to assess the primary research question. A significant factor in a state's reopening decision was the party of the governor, regardless of the party in control of the legislature, state political culture, public health preparedness, cumulative number of deaths per 100,000, and Opportunity Index score.

Legislative Perspectives on Human Trafficking Training for Physicians

ABSTRACT Human trafficking is a public health crisis in the United States, affecting all 50 states, the District of Columbia, and the territories Puerto Rico and Guam. The damaging effects of human trafficking are also felt globally as countries all over the world grapple with how to best identify victims, prosecute traffickers, and prevent future victimization. Physicians are in a unique position as primary decision makers in medical care to identify and support trafficking survivors in receiving appropriate care and connection to resources for medical and social safety. In the United States, there are currently ten states with legislation requiring licensed physicians to receive training on human trafficking with notable lack of standardization among mandates. The aim of this multidisciplinary article is to discuss legislative considerations for the implementation of a human trafficking training program for physicians and medical trainees. Building upon existing literature, this paper supports the responsive sharing and implementation of physician training in light of increasing national awareness of the damaging effects of human trafficking and the shift toward mandated training for physicians.

Knowledge of mothers regarding children\u2019s vaccinations in Greece: an online cross-sectional study

BackgroundOne of the main reasons that influence parental choice to postpone or avoid children’s vaccination is insufficient knowledge. Mothers’ knowledge can be considered as an important factor when determining childcare, as they are often the primary decision maker for their children’s healthcare issues. This study aimed to assess the level of mothers’ knowledge and practice on certain aspects of vaccination for their child/children in Greece.MethodsThis was an online cross-sectional survey, which collected information about mother’s socio-demographic characteristics, vaccination-related information, and vaccine knowledge using a self-administered questionnaire. The survey was conducted between April 2020 and June 2020 and the study population included mothers over 18 years old with at least one child (< 18 years old), living in four broad geographical areas of Greece (Attica, Central Greece, North Greece, and Crete/Aegean Islands).ResultsA total of 1885 Greek mothers participated in the study. The majority stated that they vaccined their child/children (98%), and the most popular source of information about vaccination was their child’s pediatrician (89%). About half of participants (52%) have delayed their child/children vaccination with their pediatrician’s suggestion being the main driver. The median knowledge score was 11 which indicates a high knowledge level for childhood vaccination among Greek mothers. Multiple linear regression analysis identified an inverse association between education and knowledge score, characterized by higher knowledge scores among individuals with secondary and even higher among those with higher education. Multiple logistic regression analysis showed that the strict adherence to the prescribed dosage as indicated by the local recommendations for each vaccine, was associated with most of the knowledge items included in the study.ConclusionsOur findings show that the vast majority of mothers in Greece did vaccinate their child/children, while pediatricians appear to have a very influential role in mothers’ decision making. High knowledge around vaccination was associated with mothers’ educational attainment, being particularly high among those who completed higher education. Considerable attention is required from public health authorities to promote vaccination through educational programs and campaigns, particularly aimed at people with lower educational attainment. Additionally, improving communication between pediatricians and mothers to reach those women who have not decided to vaccinate or delayed vaccination for their children, may prove to be very beneficial.