Program Decisions Research Articles

Leveraging patient-centric sampling for clinical drug development and decentralized clinical trials: Promise to reality.

Advances in the technologies to enable patient-centric sampling (PCS) have the potential to improve blood sample collection by enabling clinical trial participants to collect samples via self-collection or with the help of a caregiver in their home. Typically, blood samples to assess pharmacokinetics and pharmacodynamics of a drug during clinical development are collected at a clinical site via venous blood draw. In this position paper by the International Consortium for Innovation and Quality in Pharmaceutical Development (IQ), the potential value PCS can bring to patients, to the clinical datasets generated, and to clinical trial sponsors is discussed, along with considerations for program decision making, bioanalytical feasibility, operations, and regulatory implications. With an understanding of the value of PCS and considerations when implementing during clinical drug development, we can bring the promise of PCS closer to reality and enable decentralized clinical trials.

Incentives and disincentives to private sector reporting on family planning in Kenya: why these matter, and how they may change over time

Background: This study sought to understand private sector reporting on family planning in Kenya’s health information system (KHIS). We approached this through three lenses: governance, procedural and technical. Our study looked at these areas of interest in Kenya, complemented by deeper exploration in Nairobi County. Methods: The study used mixed methods drawing on analysis from the KHIS and surveys, complemented by desk review. The qualitative research entailed group discussions with public sector personnel while more in-depth qualitative interviews were done with public and private sector respondents. A framework matrix was developed for the qualitative analysis. The study was approved by the Ministry of Health in March 2022 and conducted over the period March - May 2022. Results: From a governance lens, private sector respondents recognised the importance of registry and reporting as a government policy requirement. From a procedural lens, private sector respondents saw reporting procedures as duplicative and parallel processes as reports are not generated through digitised information systems. From a technical lens, private sector reporting rates have improved over time however other data quality issues remain, which include over- and under-reporting of family planning services into KHIS. Secondary analysis for Nairobi County shows that the private facility contribution to family planning has declined over time while family planning access through pharmacies have grown over the same period; there is no visibility on this shift within the KHIS. Changes in private sector family service provision have implications for assumptions underpinning modern contraceptive modelled estimates and programmatic decision-making. Conclusions: There is limited monitoring of the incentives and disincentives for reporting by private health facilities into the KHIS. These have changed over time and place. Sustained private sector engagement is important to align incentives for reporting as is greater visibility on the role of pharmacies in family planning.

Optimization and self-dispatching of hydro-power companies in the electricity market

The deepening reform of the power system has resulted in increased competition between electricity market participants. The ADP method is applied to solve the optimal self-dispatch problem of hydro-power companies under uncertain conditions. Firstly, according to the characteristics of hydropower generation technology and self-dispatching, the operation model of hydropower is given. Then, according to the organization and trading behavior of the forward contract market and day-ahead market, a medium and long-term contract quantity decision framework based on stochastic programming is given. Based on the stochastic programming decision framework, the ADP method is used to solve the generation and water decisions in each stage, and the distribution strategy of the electricity quantity of forward transactions and day-trading electricity quantity is obtained. Finally, an example is given to demonstrate the effectiveness of the proposed model and ADP method.

Health sector readiness for the prevention and control of non-communicable diseases: A multi-method qualitative assessment in Nepal.

In Nepal, deaths attributable to NCDs have increased in recent years. Although NCDs constitute a major public health problem, how best to address this has not received much attention. The objective of this study was to assess the readiness of the Nepalese health sector for the prevention and control of NCDs and their risk factors. The study followed a multi-method qualitative approach, using a review of policy documents, focus group discussions (FGDs), and in-depth interviews (IDIs) conducted between August and December 2020. The policy review was performed across four policy categories. FGDs were undertaken with different cadres of health workers and IDIs with policy makers, program managers and service providers. We performed content analysis using the WHO health system building blocks framework as the main categories. Policy documents were concerned with the growing NCD burden, but neglect the control of risk factors. FGDs and IDIs reveal significant perceived weaknesses in each of the six building blocks. According to study participants, existing services were focused on curative rather than preventive interventions. Poor retention of all health workers in rural locations, and of skilled health workers in urban locations led to the health workers across all levels being overburdened. Inadequate quantity and quality of health commodities for NCDs emerged as an important logistics issue. Monitoring and reporting for NCDs and their risk factors was found to be largely absent. Program decisions regarding NCDs did not use the available evidence. The limited budget dedicated to NCDs is being allocated to curative services. The engagement of non-health sectors with the prevention and control of NCDs remained largely neglected. There is a need to redirect health sector priorities towards NCD risk factors, notably to promote healthy diets and physical activity and to limit tobacco and alcohol consumption, at policy as well as community levels.

MATERNAL MORTALITY IN GROBOGAN DURING COVID-19 PANDEMIC 2020-2021

Background: Maternal mortality is one of the health statuses that is considered global. Central Java Province has the highest maternal mortality rate in Indonesia, and one of the regencies with a high MMR (Maternal Mortality Rate) is Grobogan. Purpose: This research wants to describe maternal mortality in Grobogan in 2020-2021. In further research, we can determine the relationship between risk factors that cause maternal death and use them to develop program decisions to reduce maternal mortality in Grobogan. Methods: This study used a descriptive-quantitative study using Maternal and Infant Mortality data from the Health Office of Grobogan in 2020-2021 and analyzed averages and proportions.Results: This study showed that 103 mothers died, 69% mothers at the age of 20-35 years, 46.60% mothers had Junior High School, 8% were in the Purwodadi 2 area, 73% with gestational age >28 weeks, 52% had 2-3 parity, 87.38% of mothers never abortion, 57% of mothers died during the puerperium, and 39% caused by being infected of COVID-19. Conclusion: Maternal mortality in Grobogan Regency during the 2020-2021 COVID-19 pandemic, most of the causes of death were due to COVID-19 infection, which mainly occurred in mothers aged 20-35 years, last educated at junior high school, at gestational age >28 weeks, parity 2-3, more common in mothers who have never had a history of abortion, and is currently experiencing the puerperium. This maternal death occurred in 28 of the 30 Puskesmas in Grobogan.

Hematological and blood chemistry parameters of a Podocnemis vogli and P. unifilis captive population in Colombia.

The Podocnemididae family is seriously affected by anthropogenic factors, which is why almost all of their family members are threatened, according to the IUCN red list. The biology and ecology of these species, as well as the hematological and serum chemistry reference intervals that allow clinical action and decision-making conservation programs, are poorly known. Based on this, the objective of this study was to establish the hematological and blood chemistry parameters of the Savannah side-necked turtle (Podocnemis vogli) and Yellow-spotted river turtle (Podocnemis unifilis) maintained in captivity at the Estación de Biología Tropical Roberto Franco (Villavicencio-Colombia). Forty-nine captive turtles of the species P. vogli (n = 28) and P. unifilis (n = 21) were sampled to determine hematological and serum chemistry parameters. Blood samples were taken from the jugular veins of both male and female turtles across both species. Student's t-test and Mann–Whitney–Wilcoxon tests were used to compare values between the parameters evaluated against genders and sizes. Reference intervals were calculated for the hematological and biochemical values of each species. Some assessed parameters demonstrated significant differences between the males and females of both species. Most of the analyzed parameters exhibited similar reference intervals in both species. In this study, we report values and propose the hematological and serum chemistry reference intervals for P. vogli and P. unifilis, which can be used in the clinical diagnosis of these reptiles and in future research.

Can the ShangRing bring us closer to endorsing early infant male circumcision in sub-Saharan Africa?

Can the ShangRing bring us closer to endorsing early infant male circumcision in sub-Saharan Africa?

Policy space and pro-health equity national policymaking: a case study of Myanmar during political transition (2006-16).

Health equity is central to achieving Sustainable Development Goals and COVID-19 has emphasised its importance. Ensuring health equity is prominent in policy discussions and decision-making, is a critical challenge in all countries. Understanding the policy space for actors to promote health equity in the policy process may help to strengthen prioritisation of equity in policy and programme discussions and decisions. Authors developed a conceptual framework for policy space based on a narrative literature review. This comprised five key elements and their associated factors: i.e. context, policy circumstances, policy characteristics, actor engagement, and policy spaces. Authors then applied it in Myanmar during a period of political transition, using a qualitative case study design. Findings showed that political transition provided an important ‘policy window’ to develop more equitable health policy in Myanmar. Changing policy circumstances offered opportunities for advancing pro-equity policy. However, lack of visibility of health equity and long-standing inequalities were important challenges to policy space. Within a changing context, actors at individual and organisational levels used a range of policy spaces to advance pro-equity health policy. Learning from using the framework in Myanmar was incorporated into a revised framework. Application of this revised framework could provide valuable insights into the opportunities to promote a pro-health equity approach across policy and programme discussions and decision-making for actors trying to promote equity in other transition and non-transition contexts.

Knowledge and Incidence of Gender-Based Violence among Young Adults in the South-South Region of Nigeria: A Comparative Study

Background: Gender-Based Violence (GBV) entails fundamental violation of human rights and a violence that occurs due to normative role expectations attributable to one’s gender. It also includes all activities that facilitate an unbalanced power distribution between genders. These acts are likely to result in physical, sexual or emotional suffering which is usually meted out directly or indirectly through deceit, seduction, threat, coercion or any other means on the victim with the aim of intimidating, punishing or humiliating them. Methodology: The study was carried out in Cross River and Akwa Ibom States, South-South Region of Nigeria. A communitybased cross sectional and descriptive approach was used, incorporating qualitative and quantitative techniques. A total number of 426 copies of the questionnaire were administered to respondents by the research team. Analysis was performed on the received data from the questionnaires, using Statistical Package for Social Sciences software (SPSS). Results and Discussion: Majority of the respondents 343(83.1%) have heard about gender-based violence, with Radio/TV 214(51.8%) being the highest source of information. A greater population, 325(78.7%) accepted that maltreatment to a person on the basis of gender which can cause harm to him or her describes gender-based violence. The study further showed that 72.9% young adults could identify the various forms of gender-based violence. Analysis of responses revealed that 198(47.9%) young adults in the study area have experienced at least, one form of gender-based violence in their lifetime. Further analysis showed that physical violence 140(33.9%) and sexual violence 108(26.2%) were the most reported forms of gender-based violence experienced by respondents. Conclusion: The study showed a significant knowledge of gender-based violence among young adults, since 72.9% could clearly describe the subject matter. Despite this good knowledge, there was a high 47.9% occurrence of gender-based violence in the study area. Our findings and recommendations could impact GBV programming and policy decisions at the individual, community and national levels. Communities should be encouraged to work towards changing various narratives including the domineering attitude of men and encouraging female empowerment as these were linked to reducing incidences of genderbased violence. Campaigns to increase female education should be incorporated into the policies at the national level, as lower levels of education were associated with occurrence of GBV

Applying the Tailored Implementation in Chronic Diseases framework to inform implementation of the Preferences Elicited and Respected for Seriously Ill Veterans through enhanced decision-making program in the United States Veterans Health Administration.

In 2017, the National Center for Ethics in Health Care for the United States Department of Veterans Affairs (VA) commenced national roll-out of the Life-Sustaining Treatment Decisions Initiative. This national VA initiative aimed to promote personalized, proactive, patient-driven care for seriously ill Veterans by documenting Veterans' goals and preferences for life-sustaining treatments in a durable electronic health record note template known as the life-sustaining treatment template. The Preferences Elicited and Respected for Seriously Ill Veterans through Enhanced Decision-Making (PERSIVED) quality improvement program was created to address the high variation in life-sustaining treatment template completion in VA Home Based Primary Care (HBPC) and Community Nursing Home programs. This manuscript describes the program that focuses on improving life sustaining treatment template completion rates amongst HBPC programs. To increase life-sustaining treatment template completion for Veterans receiving care from HBPC programs, the PERSIVED team applies two implementation strategies: audit with feedback and implementation facilitation. The PERSIVED team conducts semi-structured interviews, needs assessments, and process mapping with HBPC programs in order to identify barriers and facilitators to life-sustaining treatment template completion to inform tailored facilitation. Our interview data is analyzed using the Tailored Implementation in Chronic Diseases (TICD) framework, which identifies 57 determinants that might influence practice or implementation of interventions. To quickly synthesize and use baseline data to inform the tailored implementation plan, we adapted a rapid analysis process for our purposes. This paper describes a six-step process for conducting and analyzing baseline interviews through applying the TICD that can be applied and adapted by implementation scientists to rapidly inform tailoring of implementation facilitation.

Building a school data portal using open data: A description of the user research & development process

The lack of relevant and disaggregated data about schools is a challenge for organizations implementing and funders looking to invest in kindergarten through 12th-grade education programs in New York City (NYC), often forcing organizations to make critical programmatic and financial decisions with only partial or anecdotal information about schools and its existing efforts. Over the last two years, an institution of higher education and a private foundation worked together to address this problem by indexing text in thousands of annual school reports and combining multiple open data sets about schools, including geography, demographics, and academic performance, into a single database. The initial use case focused on understanding the existing computing education efforts in NYC. However, seeing the potential to inform a broader set of questions, the collaborators began exploring the utility of such data with program officers at the foundation. Interviews of program officers around their programmatic needs and challenges illuminated their struggles with analyzing scattered data, difficulty accessing non-academic data and the need for disaggregated and geographical data. These findings are being used to inform the development of a data portal that interfaces with the aggregated dataset for foundations and others interested in data about schools.

Financial System Design for High-Tech Enterprise Based on Cloud Service and Task Scheduling Algorithm

So far, with the development of the network, a new era of cloud computing is gradually advancing. Cloud services based on cloud computing technology have long become a new business model with broad application prospects. This paper studies the design of a high-tech enterprise financial system based on cloud service and task scheduling algorithm. The project can fully meet the following requirements: the establishment of a financial management system can improve the degree of automation and computerization of financial management and reduce the labor intensity of financial personnel. It is an analysis and decision-making program for the financial management of high-tech enterprises that can be shared using financial management software. Using a financial management system in actual work can achieve rapid financial data entry and improve the accuracy of data accounting. The high-tech enterprise financial management system is a very suitable and convenient management system, which substantially meets the daily business needs of high-tech financial management of enterprises.

PKM PELATIHAN KEPEMIMPINAN DAN MANAJEMEN BAGI PENGURUS ORGANISASI SANTRI ISMAH

The management of the Santri organization consisting of senior students at the Al-Mashduqiah Islamic Boarding School Kraksaan Probolinggo is a fairly important and potential human resource in leading the daily activities of all students at the Badridduja Islamic Boarding School in the Al-Mashduqiah Region. Its effectiveness and efficiency is highly dependent on the leadership of the ISMAH organization so that leadership and management training is very important for the administrators for self-development, training to become quality leaders and managers. This community service is carried out by implementing the PAR (Participatory Action Research) approach strengthened by field survey methods, analysis of problems developing in the field, FGD (Focus Group Discussion), SWOT analysis, direct action in the field consisting of mentoring programs in the preparation of organizational work programs. , assistance in the dynamics and sharing of organizational affairs, assistance in work evaluation activities, assistance in increasing the effectiveness of student discipline, and the implementation of a mini workshop program on leadership and management for organizational management. The results of this service contribute to controlling work program decisions that are not in accordance with the organization's SWOT analysis, Strengthening organizational HR work and increasing work understanding within the organization, Controlling irrelevant work programs and compiling feedback for further planning, Realizing a quality work culture that has implications for effectiveness and performance efficiency, and Improving the quality of understanding and understanding of organizational human resources theoretically and practically. This training is carried out by an organized team, by providing some materials and practices of leadership and management that have been planned for approximately 9 months. In addition, the team also accompanied the activities carried out in a planned manner by the management in order to monitor and evaluate the practices that needed to be improved so as to provide best practices for ISMAH administrators in carrying out their leadership and management tasks.

A Method to Increase and Document the Impact of Astrobiology Education and Public Outreach.

Astrobiology education and public outreach (E/PO) efforts vary widely in terms of audience, content focus, duration, intensity, and numerous other characteristics. To identify best practices and gauge impact, an evaluation model is needed that functions across a variety of activities. In 2013, the NASA Astrobiology Institute (NAI) convened 19 astrobiology E/PO specialists for 2 days in Phoenix, AZ, with a professional evaluator to develop an evaluation model. The resulting model, termed the impact analysis method (IAM), is a series of evaluation-based practices that are tied to each phase in the "life cycle" of an E/PO project: beginning with needs assessment, which leads to the articulation of clear measurable objectives, from which design criteria for the project are developed, followed by examining the fidelity of the implementation and measuring the impacts. Data from those measurements were then used by astrobiology E/PO specialists to refine future implementation, collect evidence of impact, and support subsequent program decisions. A rubric was developed to show increasing levels of rigor of the evaluation practices in each phase of the project. Eleven astrobiology E/PO specialists who used the IAM reported increases in their understanding of evaluation and improvements in their programs.

Implementation of a shared decision-making training program for clinicians based on the major depressive disorder guidelines in Japan: A multi-center cluster randomized trial.

BackgroundAlthough shared treatment decision-making with patients requires attention, it is not widely implemented, particularly in the field of psychiatry. The aim of this study was to assess whether a shared decision-making (SDM) training program for clinicians based on the major depressive disorder (MDD) guidelines improved the perceived involvement of the decision process for patients with MDD.MethodsA multi-center cluster-randomized controlled intervention of a clinician training program based on the Japanese MDD guidelines using related decision aids compared to usual care was conducted among 56 clinicians from 23 institutions. A total of 124 patients with MDD were enrolled in this study. The primary outcomes were the scores of the Shared Decision Making-Questionnaire-9 (SDM-Q-9) and Decision Conflict Scale (DCS) after the first visit to the outpatient clinics. The secondary outcomes were patients’ satisfaction, quality of life, trust in clinicians, and depressive symptoms. Additionally, we evaluated all the observed outcomes at the first and third months of follow-up.ResultsThe scores of the SDM-Q-9 in the SDM training program group were significantly higher than those in the control group at the first visit. However, no significant difference in the DCS scores was found between the two groups. There was no intervention effect for secondary outcomes and the outcomes at the first- and third-month follow-up visits.ConclusionThe clinician training program based on the Japanese MDD guidelines can be useful for implementation of SDM. Additional research is needed to confirm the efficacy of this SDM training program.Clinical trial registration[https://www.umin.ac.jp/], identifier [UMIN000034397].

Kemitraan Program Dakwah Ekstrakurikuler Yayasan Al-Khoiriyah Puger-Jember-Jawa Timur

Abstract:
 This research is motivated by the development of the quality of the foundation through the cooperation and partnership of a foundation da'wah program. Foundations that oversee formal educational institutions have different strategies and decision-making with targeted goals and special considerations in determining the program decisions to be realized. This study focuses on the concept, pattern and implementation of the agreed da'wah program. The approach used in this research is a descriptive qualitative approach. Several methods were used to collect data, including observation, documentation, and interviews. Data analysis includes data reduction, data presentation, and data validation. The results show that: first, the concept of the da'wah program, namely the leadership of the foundation, designs a program idea that will be discussed with the parties within the foundation. Second, the pattern of the da'wah program, namely the program design, will be followed up by seeing how much impact will be obtained later in the form of an initial design. Third, implementation, namely joint partnerships with resource persons whose implementation was carried out significantly as well as partnering with extracurricular programs in the form of local taklim majlis in the area around the school environment. Then do a partnership with the scholars who are resource persons in the Mauidzatul Hasanah program in the form of religious lectures.
 Keywords: Foundation, Partnership, Da'wah Program, Extracurricular

The importance of coupling aerodynamic and cost analysis in aircraft design

Companies are increasingly required to improve their quality, flexibility and innovation while maintaining or reducing their costs. However, engineering and finance are often handled by different staff groups at different times in the manufacturing process, and by uncoupling engineering and finance, a company runs the risk of overlooking important interactions between the two. A design system that performs engineering and financial analysis simultaneously may, therefore, improve upon the efficiency and effectiveness of the traditional methods, as the existing practice of designing aircraft from a technical perspective without simultaneously considering the impact on overall program value is not optimal in a business sense. A coupled performance/financial framework enables an integrated approach to technical design and programmatic decisions. This work thus seeks to couple aero performance and financial design. Specifically, a multi-objective trade study is conducted to see the impact on the direct operating cost (DOC) and manufacturing cost of parametrically varying aircraft wing thickness to chord ratio along the wing span. While the present process is only partially automated, the purpose is to establish a useful foundation for further developments and to gain insight into the interactions between technical and program design.

Industry: Bang on a Can and New Music in the Marketplace, by William Robin

<i>Industry: Bang on a Can and New Music in the Marketplace</i>, by William Robin

Polynomial Time Reachability Analysis in Discrete State Chemical Reaction Networks Obeying Conservation Laws

In this paper the reachability problem of discrete state Chemical Reaction Networks (d-CRNs) is studied. We consider sub-classes of sub-and superconservative d-CRN network structures and prove that the reachability relation can be decided in polynomial time. We make use of the result that in the studied d-CRN sub-classes, the reachability relation is equivalent to the existence of a non-negative integer solution of the d-CRN state equation. The equivalence implies the reformulation of the reachability problem as integer linear programming decision problem. We show that in the studied classes of d-CRN structures, the state equation has a totally unimodular coefficient matrix. As the reachability relation is equivalent to the non-negative integer solution of the state equation, the resulting integer programming decision program can be relaxed to a simple linear program having polynomial time complexity. Hence, in the studied sub-classes of sub and superconservative reaction network structures, the reachability relation can be decided in polynomial time and the number of continuous decision variables is equal to the number of reactions of the d-CRN.

Preferences Elicited and Respected for Seriously Ill Veterans through Enhanced Decision-Making (PERSIVED): a protocol for an implementation study in the Veterans Health Administration

BackgroundEmpirical evidence supports the use of structured goals of care conversations and documentation of life-sustaining treatment (LST) preferences in durable, accessible, and actionable orders to improve the care for people living with serious illness. As the largest integrated healthcare system in the USA, the Veterans Health Administration (VA) provides an excellent environment to test implementation strategies that promote this evidence-based practice. The Preferences Elicited and Respected for Seriously Ill Veterans through Enhanced Decision-Making (PERSIVED) program seeks to improve care outcomes for seriously ill Veterans by supporting efforts to conduct goals of care conversations, systematically document LST preferences, and ensure timely and accurate communication about preferences across VA and non-VA settings.MethodsPERSIVED encompasses two separate but related implementation projects that support the same evidence-based practice. Project 1 will enroll 12 VA Home Based Primary Care (HBPC) programs and Project 2 will enroll six VA Community Nursing Home (CNH) programs. Both projects begin with a pre-implementation phase during which data from diverse stakeholders are gathered to identify barriers and facilitators to adoption of the LST evidence-based practice. This baseline assessment is used to tailor quality improvement activities using audit with feedback and implementation facilitation during the implementation phase. Site champions serve as the lynchpin between the PERSIVED project team and site personnel. PERSIVED teams support site champions through monthly coaching sessions. At the end of implementation, baseline site process maps are updated to reflect new steps and procedures to ensure timely conversations and documentation of treatment preferences. During the sustainability phase, intense engagement with champions ends, at which point champions work independently to maintain and improve processes and outcomes. Ongoing process evaluation, guided by the RE-AIM framework, is used to monitor Reach, Adoption, Implementation, and Maintenance outcomes. Effectiveness will be assessed using several endorsed clinical metrics for seriously ill populations.DiscussionThe PERSIVED program aims to prevent potentially burdensome LSTs by consistently eliciting and documenting values, goals, and treatment preferences of seriously ill Veterans. Working with clinical operational partners, we will apply our findings to HBPC and CNH programs throughout the national VA healthcare system during a future scale-out period.