Program Decisions Research Articles

Partitioning the Expected Value of Countermeasures with an Application to Terrorism

Benefit–cost analyses are critical to support U.S. agencies’ programmatic decision making. These analyses are particularly challenging when one of the benefits is adversary deterrence. This paper presents a framework for calculating the value of deterrence related to countermeasures implemented to mitigate an attack by an adaptive adversary. We offer an approach for partitioning the benefit of countermeasures into three components: (1) threat reduction (deterrence), (2) vulnerability reduction, and (3) consequence mitigation. The benefit of a countermeasure is measured by the expected value of countermeasure implementation (EVCI) attributable to a specific countermeasure. It is based on the concept of expected value of imperfect control, defined as the difference in the expected values of alternatives with and without countermeasures. The EVCI represents all the benefits of implementing the countermeasure and is derived from three sources: (1) changes in attack probability (threat reduction from deterrence), (2) changes in detection probability (vulnerability reduction), and (3) changes in the distribution of attack outcomes (consequence mitigation). We partition the EVCI and estimate the portion attributable to each of these three sources to quantify the unique benefit of each. We provide two applications of the partitioning methodology using examples from the published literature that examine countermeasures designed to protect commercial aircraft against man-portable air defense systems. The proposed framework provides an approach for explicitly accounting separately for deterrence, vulnerability reduction, and consequence mitigation in benefit–cost analyses. It provides quantifiable insights into how countermeasures reduce terrorism risk. Funding: This material is based upon work supported by the U.S. Department of Homeland Security under [Grant Award 22STESE00001-02-00]. The views and conclusions contained in this document are those of the authors and should not be interpreted as necessarily representing the official policies, either expressed or implied, of the U.S. Department of Homeland Security. This award was made to Northeastern University and the University of Southern California is a sub-awardee. This work was also supported by the National Science Foundation [Grant 2027296] awarded to Decision Research.

Deltamethrin and transfluthrin select for distinct transcriptomic responses in the malaria vector Anopheles gambiae

BackgroundThe widespread use of pyrethroid insecticides in Africa has led to the development of strong resistance in Anopheles mosquitoes. Introducing new active ingredients can contribute to overcome this phenomenon and ensure the effectiveness of vector control strategies. Transfluthrin is a polyfluorinated pyrethroid whose structural conformation was thought to prevent its metabolism by cytochrome P450 monooxygenases in malaria vectors, thus representing a potential alternative for managing P450-mediated resistance occurring in the field. In this study, a controlled selection was used to compare the dynamics of resistance between transfluthrin and the widely used pyrethroid deltamethrin in the mosquito Anopheles gambiae. Then, the associated molecular mechanisms were investigated using target-site mutation genotyping and RNA-seq.MethodsA field-derived line of An. gambiae carrying resistance alleles at low frequencies was used as starting material for a controlled selection experiment. Adult females were selected across 33 generations with deltamethrin or transfluthrin, resulting in three distinct lines: the Delta-R line (selected with deltamethrin), the Transflu-R line (selected with transfluthrin) and the Tiassale-S line (maintained without selection). Deltamethrin and transfluthrin resistance levels were monitored in each selected line throughout the selection process, as well as the frequency of the L1014F kdr mutation. At generation 17, cross-resistance to other public health insecticides was investigated and transcriptomes were sequenced to compare gene transcription variations and polymorphisms associated with adaptation to each insecticide.ResultsA rapid increase in resistance to deltamethrin and transfluthrin was observed throughout the selection process in each selected line in association with an increased frequency of the L1014F kdr mutation. Transcriptomic data support a broader response to transfluthrin selection as compared to deltamethrin selection. For instance, multiple detoxification enzymes and cuticle proteins were specifically over-transcribed in the Transflu-R line including the known pyrethroid metabolizers CYP6M2, CYP9K1 and CYP6AA1 together with other genes previously associated with resistance in An. gambiae.ConclusionThis study confirms that recurrent exposure of adult mosquitoes to pyrethroids in a public health context can rapidly select for various resistance mechanisms. In particular, it indicates that in addition to target site mutations, the polyfluorinated pyrethroid transfluthrin can select for a broad metabolic response, which includes some P450s previously associated to resistance to classical pyrethroids. This unexpected finding highlights the need for an in-depth study on the adaptive response of mosquitoes to newly introduced active ingredients in order to effectively guide and support decision-making programmes in malaria control.

The Effect of an Online Decision-Making Skills Psychoeducation Programme on University Students’ Decision-Making Styles: A Mixed Method Study

This study examines the effect on university students’ decision-making styles of an online decision-making skills psychoeducation programme focused on cognitive behavioural therapy. A nested design, which is one of the mixed method designs, was used in the study. In the quantitative part of the study, a quasi-experimental design was used to test the effect of the programme, while in the qualitative part, a phenomenological design was used. The quantitative data of the study were obtained through the “Melbourne Decision Making Questionnaire”, while the qualitative data were obtained through a “Semi-Structured Interview Form”, “Session Evaluation Form” and “Psychoeducation Programme Evaluation Form”. The quantitative data of the study were collected from 22 participants, of whom 11 were in the experimental group and 11 were in the control group, and the qualitative data were collected from the 11 participants included in the experimental group. Descriptive statistics, exploratory and confirmatory factor analysis, reliability analysis, the Friedman rank test, the Wilcoxon signed-rank test and the Mann-Whitney U test for independent samples were used for the analysis of the quantitative data. Content analysis was performed on the qualitative data. As a result of the study, it was determined that the psychoeducation programme caused a partially significant increase in the decision-making self-esteem and vigilant decision-making style, a partially significant decrease in the avoidant decision-making style, and a significant decrease in the procrastinating decision-making style of the participants in the experimental group. However, it was observed that the psychoeducation programme did not have a significant effect on the hypervigilant decision-making style of the students in the experimental group. When the views of the participants in the experimental group about the psychoeducation programme were examined, the main views were that the content of the programme was considered satisfactory, that the programme was evaluated as an awareness-raising process, that it aroused positive and motivating emotions, and that it was a beneficial study that provided practical and tangible gains.

Error orientation in a decision-making simulation program: differences between promotion vs. prevention focus.

Changing situations develop work environments where workers must generate strategies to learn and persist from continuous errors and setbacks. Previous research has shown that errors enhance motivation, break the routine, lead to creative solutions, and reduce frustration; however, this positive aspect seems to have a stronger presence if personal factors and contextual background support such a focus. The main aim of this paper was to analyse, with an experimental design, how different frames about errors and negative feedback (error promotion versus error prevention) affected performance and decision-making processes in a complex simulation task, taking into account individual attitude towards errors. The sample included 40 employees of a Spanish transportation company (37.5% were women and 62.5% were men). Firstly, participants answered a questionnaire about their individual Error Orientation. Then, they were randomly assigned to an experimental condition to carry out a complex decision-making task through a multimedia simulator, which aimed to expose the participant to factors that influence the dynamics of innovation and change, elements that are present in all modern organizations. None of the participants had previous experience in the task. Performance was measured through different aspects: (1) final performance values: adopters, points, time to make decisions and time after receiving negative feedback; (2) the decision-making process. Results showed that error orientation is related to final performance, especially error risk taking and error communication. The effect of the experimental condition was higher for the time to make decisions after receiving negative feedback and for the time to complete the simulation program. Those who worked under the error prevention condition took significantly longer to perform the task. Although our results show non-consistent effects, which frame than the other (promotion versus prevention) is better to make decisions is discussed. A promotion frame prioritizes flexibility, openness, and rapid progress, but does so by sacrificing certainty, and careful analysis. The most crucial factor may be which one best fits the demands of the task at hand.

Enhancing the Introduction and Scale Up of Self-Administered Injectable Contraception (DMPA-SC) in Health Systems (the EASIER Project): Protocol for Embedded Implementation Research.

The introduction of self-administered injectable contraception presents an opportunity to address the unmet need for family planning. As ministries of health scale up self-administered injectable contraception, there is a scarcity of knowledge on the implementation practices and contextual conditions that help and hinder these efforts. The World Health Organization has launched the "enhancing self-administered family planning through embedded research project" (EASIER) to address this challenge. EASIER's objectives are to: (1) assess the coverage of self-injectable contraception, and the readiness of health systems to integrate it into the contraceptive method mix; (2) document strategies used to introduce and scale up self-injectable contraception and understand practices that have led to success and challenges; (3) identify the contextual factors that affect the adoption and implementation of self-injectable contraception throughout health systems; (4) understand whether implementation addresses users' preferences and needs; (5) strengthen collaboration between decision makers, researchers, and implementers; support and build capacity to use evidence. EASIER developed a global protocol that implementation research (IR) teams in Burkina Faso, Ghana, and Kenya adapted into country-level embedded IR projects. In all countries (1) at the national level, IR teams evaluate the policy environment for scaling up by conducting a desk review and in-depth interviews; (2) at the local level, IR teams implement quantitative questionnaires on structural and organizational readiness to integrate self-injection into the method mix; (3) in "case study" localities, IR teams conduct in-depth interviews and focus group discussions with implementers, method users, and community members; and (4) IR teams use participatory action research to elicit stakeholder participation and translate findings into programmatic decisions. EASIER has been launched in all 3 countries. Preliminary findings are available from Burkina Faso and Kenya. In Burkina Faso, IR teams identified the need to strengthen health worker training approaches to ensure that family planning providers at primary health care facilities are adequately oriented to depo-medroxyprogesterone acetate subcutaneous (DMPA-SC) and self-injection and capacitated to initiate women to the method. In addition, they report the need for service communication strategies that reach potential users of the method with knowledge about self-injection and how to initiate the practice. In Kenya, the findings illuminate the need for practice guidelines that county health teams can use to coordinate the rollout of self-administered DMPA-SC. In addition, Kenya's findings underscore the importance of addressing logistical bottlenecks to help avoid stock-outs. EASIER presents a strategy to embed IR in contraceptive method introduction and scale-up, address local knowledge needs, devise ways to maximize the impact of new technologies in health systems, and build capacity for using evidence in programmatic decisions. Adaptation and implementation of country-level IR studies will advance the use of IR to strengthen family planning programs. Australia New Zealand Clinical Trials Registry ACTRN12622001228774; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=384534&isReview=true. DERR1-10.2196/44222.

Clinicians' Perspectives and Proposed Solutions to Improve Contraceptive Counseling in the United States: Qualitative Semistructured Interview Study With Clinicians From the Society of Family Planning.

Contraceptive care is a key element of reproductive health, yet only 12%-30% of women report being able to access and receive the information they need to make these complex, personal health care decisions. Current guidelines recommend implementing shared decision-making approaches; and tools such as patient decision aid (PtDA) applications have been proposed to improve patients' access to information, contraceptive knowledge, decisional conflict, and engagement in decision-making and contraception use. To inform the design of meaningful, effective, elegant, and feasible PtDA applications, studies are needed of all users' current experiences, needs, and barriers. While multiple studies have explored patients' experiences, needs, and barriers, little is known about clinicians' experiences, perspectives, and barriers to delivering contraceptive counseling. This study focused on assessing clinicians' experiences, including their perspectives of patients' needs and barriers. It also explored clinicians' suggestions for improving contraceptive counseling and the feasibility of a contraceptive PtDA. Following the decisional needs assessment approach, we conducted semistructured interviews with clinicians recruited from the Society of Family Planning. The Ottawa Decision Support Framework informed the interview guide and initial codebook, with a specific focus on decision support and decisional needs as key elements that should be assessed from the clinicians' perspective. An inductive content approach was used to analyze data and identify primary themes and suggestions for improvement. Fifteen clinicians (12 medical doctors and 3 nurse practitioners) participated, with an average of 19 years of experience in multiple regions of the United States. Analyses identified 3 primary barriers to the provision of quality contraceptive counseling: gaps in patients' underlying sexual health knowledge, biases that impede decision-making, and time constraints. All clinicians supported the development of contraceptive PtDAs as a feasible solution to these main barriers. Multiple suggestions for improvement were provided, including clinician- and system-level training, tools, and changes that could support successful implementation. Clinicians and developers interested in improving contraceptive counseling and decision-making may wish to incorporate approaches that assess and address upstream factors, such as sexual health knowledge and existing heuristics and biases. Clinical leaders and administrators may also wish to prioritize solutions that improve equity and accessibility, including PtDAs designed to provide education and support in advance of the time-constrained consultations, and strategic training opportunities that support cultural awareness and shared decision-making skills. Future studies can then explore whether well-designed, user-centered shared decision-making programs lead to successful and sustainable uptake and improve patients' reproductive health contraceptive decision-making.

Tactical and operational planning of express intra-city package services

In this paper, we focus on routing and load planning associated with the tactical and operational planning of an express intra-city courier service provider that receives a large number of shipments on a daily basis and is committed to delivering them to their destinations given a short service guarantee. Tactical planning relies on high-level aggregated demand rates over long time periods and takes the form of a multi-commodity service network design where the goal is to identify one path per commodity while maximizing consolidation opportunities in the network. Commodities are transported on their paths by means of a series of continuously operating vehicle cycles, where the structure and number of such cycles are determined concurrently with commodity path assignment decisions in a mixed integer programming. A second model is designed to refine the time allocation along different segments of a commodity path allowing a potential reduction in the number of vehicles required to meet the service guarantee. In operational planning, the focus is narrowed down to a shorter time period, and the baseline plan obtained from the tactical planning phase is adjusted to better fit potential deviations in observed demand patterns compared to the aggregate patterns. Through an extensive computational study designed on the topology of a major US city, we observe that the plans designed at the tactical level guarantee high service levels, which are improved at the operational level by customizing the plan to the special characteristic of a day of operation.

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.

Organization clinical decision-making programs in the local practice of the region: problematic issues that determine the choice of therapy in the progression of endometrial cancer

Introduction. For the treatment of uterine body cancer (UBC), modern oncologists have at their disposal clinical recommendations of scientific communities, the set of drug options in which is represented by a limited range of drugs that have not been studied enough (phase II studies, no more than 52 patients in each). There is an obvious lack of information about clinical routine data systematization algorithms that describe the molecular biological features of the tumor, its prevalence, patient characteristics, existing treatment models, and form a decision-making program when planning the treatment of UBC patients.Aim. Тo develop an algorithm for routing patients with UBC on the territory of the Krasnodar Region in the existing conditions for organizing medical care and human resources.Materials and methods. Local observational retrospective study. Sources – medical records. The data were collected by the co-authors of the article in the course of daily clinical activities. Information from the medical records of 72 patients with endometrial cancer who were referred for microsatellite instability (MSI) testing at the Oncological Dispensary of Krasnodar from 01/01/2021 to 11/16/2022 was analyzed to determine the possibility of receiving immuno/immuno-targeted therapy in the second and subsequent lines medicinal treatment.Results. In the Krasnodar Oncological Dispensary all the therapy options specified in the clinical guidelines were used. One line of systemic therapy for a common disease was received by 61 patients out of 72, only 41 patients received the second line, and only 19 patients received the third line. Five patients received the immunotargeted combination in the second line and 3 in the third. One patient received immunotherapy with pembrolizumab in the third line. One patient received immunotherapy with pembrolizumab in the third line. An analysis of the factors influencing the possibility of receiving this therapy showed the importance of timely genetic testing of MSI, as well as related organizational issues, such as the ability to quickly receive treatment and ensure appropriate follow-up of patients.Conclusions. Based on the study, low awareness of clinicians about the possibility and necessity of early testing for the presence of MSI in an endometrial tumor was revealed. The organization of delivery of material from clinics that have a territorial remoteness, insufficient access to patient consultations by related specialists, and low patient compliance limit the introduction of modern methods of therapy for UBC patients. Establishing a system of close professional interaction between physicians will contribute to a wider introduction of new methods of diagnosis and treatment of UBC patients.

Teaching Spatial Data Analysis: A Case Study with Recommendations

Abstract Learning from data is a valuable skill for nonprofit professionals and researchers. Often, data have a spatial component, and data relevant to the nonprofit sector are no exception. Understanding spatial aspects of the nonprofit sector may provide immense value to social entrepreneurs, funders, and policy makers, by guiding programmatic decisions, facilitating resource allocation, and development policy. As a result, spatial thinking has become an essential component of critical thinking and decision making among nonprofit professionals. The goal of this case study is to support and encourage instruction of spatial data analysis and spatial thinking in nonprofit studies. The case study presents a local nonprofit data set, along with open data and code, to assist the instructors teaching spatial aspects of the nonprofit sector. Pedagogical approaches are discussed.

A novel adaptation of spatial interpolation methods to map health attitudes related to COVID-19

BackgroundThe COVID-19 pandemic presented substantial challenges to public health stakeholders working to vaccinate populations against the disease, particularly among vaccine hesitant individuals in low- and middle-income countries. Data on the determinants of vaccine hesitancy are scarce, and often available only at the national level. In this paper, our goal is to inform programmatic decision making in support of local vaccine uptake. Our analytical objectives to support this goal are to (1) reliably estimate attitudinal data at the hyperlocal level, and (2) estimate the loss of data heterogeneity among these attitudinal indicators at higher levels of aggregation. With hyperlocal attitudinal data on the determinants of vaccine hesitancy, public health stakeholders can better tailor interventions aimed at increasing uptake sub-nationally, and even down to the individual vaccination site or neighborhood.MethodsWe estimated attitudinal data on the determinants of vaccine hesitancy as framed by the WHO’s Confidence, Complacency, and Convenience (“3Cs”) Model of Vaccine Hesitancy using a nationally and regionally representative household survey of 4,922 adults aged 18 and above, collected in February 2022. This custom survey was designed to collect information on attitudes towards COVID-19 and concerns about the COVID-19 vaccine. A machine learning (ML) framework was used to spatially interpolate metrics representative of the 3Cs at a one square kilometer (1km2) resolution using approximately 130 spatial covariates from high-resolution satellite imagery, and 24 covariates from the 2018 Nigeria Demographic and Health Survey (DHS).ResultsSpatial interpolated hyperlocal estimates of the 3Cs captured significant information on attitudes towards COVID-19 and COVID-19 vaccines. The interpolated estimates held increased heterogeneity within each subsequent level of disaggregation, with most variation at the 1km2 level.ConclusionsOur findings demonstrate that a) attitudinal data can be successfully estimated at the hyperlocal level, and b) the determinants of COVID-19 vaccine hesitancy have large spatial variance that cannot be captured through national surveys alone. Access to community level attitudes toward vaccine safety and efficacy; vaccination access, time, and financial burden; and COVID-19 beliefs and infection concerns presents novel implications for public health practitioners and policymakers seeking to increase COVID-19 vaccine uptake through more customized community-level interventions.

The impact of COVID‐19 on school psychologists and evaluation

AbstractWith the challenges, the pandemic created for school districts, schools, educators, and families, school psychologists faced unique challenges. To understand the lived experiences of school psychologists related specifically to conducting their jobs during the pandemic and the impact the pandemic had on them professionally and personally, we conducted a phenomenological study. Within this work, 12 school psychologists engaged in one‐on‐one semistructured interviews specifically designed to understand the unique perspectives and experiences of school psychologists derived by the pandemic. Participants expressed concerns that little guidance or support was provided specific to testing protocols, which, many expressed, led to ethical dilemmas regarding testing and data validity, and ultimately resulted in concerns about under‐ and overidentification of students with disabilities. We conclude, evaluation decisions made during the height of the pandemic may need to be reassessed as additional data dictates. Additionally, we recognize the unique and unforeseen complexities the pandemic continues to present, particularly for minority and low socioeconomic students, and recommend school psychologists receive administrative support, guidance, and training. Additionally, we encourage individualized education program teams to work collaboratively and rely on their collective expertise when making eligibility and programming decisions.

Transforming Gifted Education in Schools: Practical Applications of a Comprehensive Framework for Developing Academic Talent

The foundation for talent development as a framework for gifted education can be found in a synthesis of the psychological literature on creativity, eminence, giftedness, and high performance. The talent development framework acknowledges the contributions of both general cognitive ability and domain-specific abilities to achievement, as well as the malleability of these ability constructs. Talent development is also consistent with research on the contributions of non-cognitive or psychosocial factors to school achievement, as well as studies on factors that influence the attainment of scholarly productivity and artistry within specific domains of non-academic talent. Although there are several theoretical frameworks and models of giftedness, talent development, ability, and intelligence, each with varied areas of emphasis and desired outcomes, the research base and practical applications for the talent development megamodel (TDMM) can serve as a guide to leaders and school administrators in making fiscal and programmatic decisions that maximize short- and long-term impacts for individuals and society. In this article, we discuss some of the practical implications of the model for assessment, curriculum and instruction, and psychosocial development within a school context.

Baseline characterization of entomological drivers of malaria transmission in Namibia: a targeted operational entomological surveillance strategy

BackgroundNamibia’s focus on the elimination of malaria requires an evidence-based strategy directed at understanding and targeting the entomological drivers of malaria transmission. In 2018 and 2019, the Namibia National Vector-borne Diseases Control Program (NVDCP) implemented baseline entomological surveillance based on a question-based approach outlined in the Entomological Surveillance Planning Tool (ESPT). In the present study, we report on the findings of the ESPT-based NVDCP on baseline vector species composition and bionomic traits in malaria endemic regions in northern Namibia, which has the aim of generating an evidence base for programmatic decision-making.MethodsNine representative sentinel sites were included in the 2018 entomological surveillance program (Kunene, Omusati, Oshana, Ohangwena, Oshikoto, Otjozondjupa, Kavango West, Kavango East and Zambezi); the number was reduced to four sites in 2019 due to limited funding (Ohangwena, Kavango West, Kavango East, and Zambezi). In the 2018 baseline collections, multiple sampling methods (human landing catches, pyrethroid spray catches, U.S. Centers for Disease Control and Prevention light traps [CDC-LTs], resting boxes [RBs] and larval sampling) were utilized to evaluate indoor/outdoor human biting rates, resting behaviors and insecticide resistance (IR). CDC-LTs and RBs were not used in 2019 due to low and non-representative sampling efficacies.ResultsOverall, molecular evidence demonstrated the presence of three primary mosquito vectors, namely Anopheles arabiensis, rediscovered Anopheles gambiae sensu stricto and Anopheles funestus sensu stricto, alongside Anopheles squamosus and members of the Anopheles coustani complex. Vectors were found to bite throughout the night (1800 hours 0600 hours) both indoors and outdoors, with An. arabiensis having the highest biting rates outdoors. Low numbers of indoor resting Anopheles point to possible low indoor residual spraying (IRS) efficacy—with An. arabiensis found to be the major vector species resting indoors. The IR tests demonstrated varying country-wide resistance levels to the insecticide deltamethrin, with the resistance levels confirmed to have increased in 2019, evidence that impacts national programmatic decision-making. Vectors demonstrated susceptibility to the insecticides dichlorodiphenyltrichloroethane, bendiocarb and Actellic 300CS in 2018, with mosquitoes from only one site (Kavango West) demonstrating possible resistance to DDT. Targeted and question-based entomological surveillance enabled a rapid and focused evidence base to be built, showing where and when humans were being bitten and providing entomological data on long-lasting insecticidal nets, IRS efficacy and insecticide resistance, which the Ministry of Health and Social Services-Namibia can use to further build a monitoring and evaluation framework for understanding the drivers of transmission.ConclusionIdentification and characterization of species-specific bionomic traits allows for an understanding of where and when vector human contact may occur as well as the potential impact of interventions. Low indoor resting rates as well as the presence of insecticide resistance (and the increase in its frequency) point to the need for mosquito-behavior-directed and appropriate interventions as well as the requirement for a resistance mitigation strategy. The ESPT-based question- and minimal essential indicator-based operational research strategy provides programs with directed and focused data for facilitating decision-making while requiring limited funding and capacity.Graphical

Routine Health Information System Utilization and Its Associated Factors among Healthcare Professionals in Debre Berhan Town, Ethiopia

Background. A routine health information system (RHIS) is a system that records, stores, and processes health data in order to enhance healthcare decision-making. However, systematic use of health information is still not used for program decisions in developing nations, particularly in Ethiopia. Objective. Identifying regular utilization of health information systems and related factors among healthcare workers in Debre Berhan Town health facilities, North Shoa, Amhara, Ethiopia, 2022. Methods. A facility-based cross-sectional study was conducted from February 22 to September 22, 2022 in Debre Berhan Town, Ethiopia. Data from participants were gathered using a self-administered, pretested structured questionnaire by employing a systematic random sample technique among healthcare workers at public health facilities. Data were entered into EpiData version 3.1 and analyzed using SPSS. We employed multivariable logistic regression and descriptive statistics. Variables with a p-value < 0.05 were considered statistically significant factors. Hosmer–Lemeshow goodness of fit was used to check the adequacy of the model. Result. A total of 383 workers were study participants with 100% response rate. The mean age was 32 (±5.23). Utilization of routine health information among health professionals was 42.6%. Type of institution (AOR = 0.56), complexity of RHIS) (AOR = 2.19), training on HMIS (AOR = 9.35), and feeling guilty of not accomplishing their performance (AOR = 2.96) were found significantly associated with routine health information utilization (RHIU). Conclusion. Utilization of RHIS among the health professionals was low. Type of institution, complexity of RHIS, data management skills, training on HMIS, and feeling guilty of not accomplishing their target performance were factors related to RHIS utilization. Comprehensive training and improve data management skills are highly recommended for improving RHIU.

Development of Symbolic Expressions Ensemble for Breast Cancer Type Classification Using Genetic Programming Symbolic Classifier and Decision Tree Classifier

Breast cancer is a type of cancer with several sub-types. It occurs when cells in breast tissue grow out of control. The accurate sub-type classification of a patient diagnosed with breast cancer is mandatory for the application of proper treatment. Breast cancer classification based on gene expression is challenging even for artificial intelligence (AI) due to the large number of gene expressions. The idea in this paper is to utilize the genetic programming symbolic classifier (GPSC) on the publicly available dataset to obtain a set of symbolic expressions (SEs) that can classify the breast cancer sub-type using gene expressions with high classification accuracy. The initial problem with the used dataset is a large number of input variables (54,676 gene expressions), a small number of dataset samples (151 samples), and six classes of breast cancer sub-types that are highly imbalanced. The large number of input variables is solved with principal component analysis (PCA), while the small number of samples and the large imbalance between class samples are solved with the application of different oversampling methods generating different dataset variations. On each oversampled dataset, the GPSC with random hyperparameter values search (RHVS) method is trained using 5-fold cross validation (5CV) to obtain a set of SEs. The best set of SEs is chosen based on mean values of accuracy (ACC), the area under the receiving operating characteristic curve (AUC), precision, recall, and F1-score values. In this case, the highest classification accuracy is equal to 0.992 across all evaluation metric methods. The best set of SEs is additionally combined with a decision tree classifier, which slightly improves ACC to 0.994.

Laryngeal cancer treatment decision making: A conjoint analysis of general public attitudes and priorities.

Patients with advanced laryngeal cancer are typically presented with divergent treatment options, namely chemoradiation versus total laryngectomy. This study aims to understand general perspectives of the factors involved in this decision-making process. Surveys were constructed using specialized conjoint analysis software. Seven attributes integral to the decision-making process for advanced laryngeal cancer treatment were included. Three hundred one healthy adult volunteers completed the decision-making program. The relative impact of each treatment attribute on decision making across all participants was scored with an average importance score (standard deviation) as follows: Lifespan 22.2% (±8.5), Voicing 21.4% (±5.9), Swallowing 19.1% (±7.3), Cancer Cure 14.9% (±6.2), Mode of Breathing 11.0% (±3.7), Self-Image 6.7% (±2.9), and Treatment Type 4.8% (±3.0). General public opinion ranked lifespan, voicing, and swallowing aspects as similarly important, and all were ranked more important than probability of cure. These data demonstrate a variety of priorities among participants and the need for tailored discussions when determining treatment choice for advanced laryngeal cancer. Level 4.

Use of Framework Matrix and Thematic Coding Methods in Qualitative Analysis for mHealth: NIRUDAK Study Data.

Framework Matrix Analysis (FMA) and Applied Thematic Analysis (ATA) are qualitative methods that have not been as widely used/cited compared to content analysis or grounded theory. This paper compares methods of FMA with ATA for mobile health (mHealth) research. The same qualitative data were analyzed separately, using each methodology. The methods, utility, and results of each are compared, and recommendations made for their effective use. Formative qualitative data were collected in eight focus group discussions with physicians and nurses from three hospitals in Bangladesh. Focus groups were conducted via video conference in the local language, Bangla, and audio recorded. Audio recordings were used to complete a FMA of participants' opinions about key features of a novel mHealth application (app) designed to support clinical management in patients with acute diarrhea. The resulting framework matrix was shared with the app design team and used to guide iterative development of the product for a validation study of the app. Subsequently, focus group audio recordings were transcribed in Bangla then translated into English for ATA; transcripts and codes were entered into NVivo qualitative analysis software. Code summaries and thematic memos explored the clinical utility of the mHealth app including clinicians' attitudes about using this decision support tool. Each of the two methods contributes differently to the research goal and have different implications for an mHealth research timeline. Recommendations for the effective use of each method in app development include: using FMA for data reduction where specific outcomes are needed to make programming and design decisions and using ATA to capture the more nuanced issues that guide use, product implementation, training, and workflow. By describing how both analytical methods were used in this context, this paper provides guidance and an illustration for use of these two methods, specifically in mHealth design.

Depression and Quality of Life among Ukrainian Adults Relocated to Russia

At an early stage of Russia–Ukraine War, the psychological conditions of Ukraine people relocated to Russia were reported by the International Journal of Loss and Trauma. In this paper, updated findings evidence the war impact on quality of life, depression, loneliness, substance use, and eating behavior among refugees relocated from the Ukraine to the Russian Federation. Indicators of quality of life, mental health, depression, substance use, and unhealthy food intake tend to be attributed to the war regardless of refugee gender, age, religiosity, and marital status. These findings are consistent with those previously reported about the impact of war and location status among Ukrainian “help” professional women showing relocation associated with poor psycho-emotional well-being, increased burnout, loneliness, and substance use. Responses from the refugees continue to evidence key issues that need to be addressed by policy and program decision makers as well as service providers for prevention and treatment intervention purposes.

Community Participation and Performance of One Cup Milk Per Child Programme in Rwanda; A Case of Selected School Based Early Childhood Development’s in Gicumbi District

The study lookd at the role of community participation on the performance of one cup milk per child programme in Rwanda especially in Gicumbi District (2019-2021). Specific Objectives were to examine the influence of program planning, decision making and monitoring and evaluation on the performance of one cup milk per child programme in Gicumbi District. The study was guided by stakeholder theory and resource based view theory. The research adopted a combination of descriptive and analytic research designs to assess the community's involvement in the program and evaluate its effectiveness. The target population consisted of committee members, student committees, parent committees, and program teams at the district and sector levels, with a total population size of 244 individuals. The research used purposive sampling to select participants with relevant information, and data was collected through questionnaires, interviews, observations, and documentary reviews. The collected data was analyzed using descriptive statistics, correlation analysis and multiple linear regressions. Findings on the first objective confirmed that the community's suggestions and input were considered, together with the resources that were available, while designing the One Cup Milk Per Child Programme in the Gicumbi district stated by 85.3% respondents strongly agreed and agreed. Findings on the second objective confirmed that healthier judgments about the One Cup Milk Per Child Programme in the Gicumbi District are made as a result of gathering pertinent community involvement information, stated by 89.7% respondents strongly agreed and agreed. Findings on the third objective showed the community is aware of the program's goals and objectives, which helped with the creation and execution of One Cup Milk Per Child Programme in the Gicumbi District, stated by 94.1% respondents strongly agreed and agreed. The correlation matrix results indicated there is a very strong correlation between program planning and performance of One Cup Milk Per Child Programme as Pearson correlation is 0.917** with the p-value of 0.000, which is less than standard significance levels of 0.01. This indicates that, out of the considered other factors influencing performance of One Cup Milk Per Child Programme in Rwanda, only program planning has significant and high positive effect on the performance of One Cup Milk Per Child Programme in Gicumbi district. This eventually signifies that planning for the program is very vital and assists in the management of the stakeholders.  The research recommended that management of school programme for One Cup Milk Per Child should choose among best decision alternative that improve performance in the programmes in the district.  Management of the program should ensure that community members have a control over the choosing and electing One Cup Milk Per Child Programme committee members in the district. Management should ensure that community is understanding the goals and objectives of the program to aid the design and implementation of One Cup Milk Per Child Programme in Gicumbi district. Keywords: Program planning, decision making, monitoring & evaluation, performance, Gicumbi district, Rwanda