Programming Effort Research Articles

Justice, Equity, Diversity, Inclusion, and Belonging (JEDI-B) in Transition to Practice Programs.

Justice, equity, diversity, inclusion, and belonging (JEDI-B) are essential for creating safe and productive professional environments. Clear definitions of JEDI-B terms are essential for collective understanding and organizational buy-in. Institutional and transition to practice program efforts should focus on the development of inclusive cultures, diverse curriculum, and data-driven evaluation of JEDI-B policies, processes, and practices. Engagement in bias recognition and the unlearning of those biases is also vital. Despite current legislative challenges, the integration of JEDI-B principles remains a vital component in enhancing health care experiences for patients and fostering inclusive workplaces. [J Contin Educ Nurs. 2024;55(6):273-275.].

Using the Socio-Ecological Model to Understand Increased Risk of Gun Violence in the African American Community.

Gun violence is a major public health issue of growing concern in the United States (U.S.) with 48,830 lives lost to gun related violence in 2021, documenting the highest number of gun related homicides and suicides ever recorded. The African American community is disproportionately impacted by gun violence and members of this community are almost 14x more likely to die by gun homicide than their white counterparts. The Centers for Disease Control and Prevention (CDC) has identified a socio-ecological framework as a lens through which to better understand violence and inform potential prevention strategies to address it. This model identifies four levels (individual, relationship, community, societal) which help to enhance our understanding of the complex interplay between individuals and their environments. Here, we use this model to understand why the African American community experiences elevated risk of gun violence in the U.S. and propose strategies for prevention. Understanding the issue of gun violence beyond individual level risk, this analysis highlights the interplay between multiple levels including the ways in which societal level factors influence violence. While this paper provides a lens through which to understand the multi-leveled factors that contribute to gun violence in the African American community, it also serves as a call to action for policymakers, scholars, and agencies to develop culturally informed policy and programming efforts specific to those who are most impacted.

The Launch of Massachusetts Community Health Worker Certification: Findings From the Massachusetts Community Health Worker Workforce Surveys.

The launch of state certification for community health workers (CHWs) in Massachusetts in 2018 aimed to promote and champion this critical workforce. However, concerns exist about unintentional adverse effects of certification. Given this, we conducted 2 cross-sectional surveys to evaluate this certification policy. We conducted surveys of CHW employers and CHWs in 3 sample frames: community health centers and federally qualified health centers, acute-care hospitals, and community-based organizations. We administered the surveys in 2016 (before certification launch) and 2021 (after certification launch) to answer the following questions: Was certification associated with positive outcomes among CHWs after its launch? Did harmful shifts occur among the CHW workforce and employers after certification launch? Was certification associated with disparities among CHWs after its launch? Certification was associated with higher pay among certified (vs noncertified) CHWs, better perceptions of CHWs among certified (vs noncertified) CHWs, and better integration of certified (vs noncertified) CHWs into care teams. We found no adverse shifts in CHW workforce by sociodemographic variables or in CHW employer characteristics (most notably CHW employer hiring requirements) after certification launch. After certification launch, certified and uncertified CHWs had similar demographic and educational characteristics. However, certified CHWs more often worked in large, clinical organizations while uncertified CHWs most often worked in medium-sized community-based organizations. Our evaluation of Massachusetts CHW certification suggests that CHW certification was not associated with workforce disparities and was associated with positive outcomes. Our study fills a notable gap in the research literature and can guide CHW research agendas, certification efforts in Massachusetts and other states, and program efforts to champion this critical, grassroots workforce.

SOLID WASTE MANAGEMENT RELATIVE TO IMPLEMENTATION OF POLICIES AND PROGRAMS TOWARDS SAFE AND HEALTHY ENVIRONMENT

This study aims to investigate solid waste management programs and policies implemented to promote a safe and healthy school environment in Anao-Kiling Elementary School, Roxas, Isabela. Fifty internal and 30 external stakeholders served as respondents of the study. This research uses a descriptive-normative approach to assess stakeholders' awareness, implementation levels, and challenges. The data were collected through structured questionnaires and interviews, and analyzed through statistical tools such as percentages, weighted means, ANOVA, Chi-Square C-Test, and Pearson's correlation coefficient. The results showed that there is a high level of awareness among respondents regarding the policies of segregation, reduction, reuse, and recycling. However, challenges remain regarding waste disposal, showing the need for improvements in the overall implementation of the program and advocacy efforts. In addition, the level of stakeholder participation varied, with composting of biodegradable waste showing the highest level of implementation. Internal stakeholders experienced excessive waste, whereas external stakeholders experienced problems such as a lack of time. There was a significant relationship between existing programs, dissemination, and implementation levels. However, the respondents' perceptions and their profile variables did not show a significant correlation. Conclusions emphasize stakeholder representation, adequate dissemination of program information, and the need for targeted solutions to address implementation challenges. As a result of this study, holistic waste management strategies are crucial to creating a sustainable and healthy educational environment.

Systems management strategies for increasing alfalfa use in warm‐humid regions

AbstractAlfalfa use (Medicago sativa L.; “lucerne”) in warm, humid regions of the world represents a potential area of expansion for the alfalfa industry. The objective of this review paper is to demonstrate how alfalfa forage breeding and systems research efforts have identified opportunities for increasing alfalfa contributions in these regions, along with potential pathways for seed industry and farming operations to increase adoption. Our review draws primarily on reports from the Southeast United States and Argentina. Significant technological advancements in plant screening and selection have identified alfalfa plant populations that are more adapted to the growing conditions experienced in these regions, which are often characterized by mild temperature, long growing seasons, and multiple other abiotic and biotic stressors. Management systems research conducted in the United States and Argentina has demonstrated the use of alfalfa for conserved forage, grazing, or dual‐purpose use in monoculture or mixtures with warm‐season grasses such as bermudagrass (Cynodon spp.). These trials report increased forage production, nutritive value, and ecosystem services of alfalfa–grass mixtures when compared with traditionally N‐fertilized warm‐season grass‐based systems. Grazing‐based alfalfa systems in Argentina have demonstrated methods for utilizing alfalfa as part of beef, dairy, and finishing systems. Some approaches for expanding alfalfa production in the region include targeted marketing efforts for adapted varieties and demonstrating alfalfa applications within existing farming frameworks. This includes educational programming efforts and on‐farm demonstrations to promote alfalfa use as a component of the livestock diets, integration into grass‐based systems, crop rotations, and wildlife use. Continued emphasis on a systems approach to alfalfa inclusion represents an opportunity for improved forage and livestock production in warm, humid regions of the world.

The release of ‘LCP 85‐384’ and its contribution to the Louisiana sugar industry

AbstractBasic breeding efforts initiated at the USDA‐ARS in Houma, LA, in the late 1950s allowed Louisiana sugarcane breeders, once again, to cross with the wild germplasm of cultivated sugarcane, Sacharum spontaneum. ‘LCP 85‐384’ was the first success story from this effort and was quickly adopted by growers. It became clear that the cultivar would prove to be substantially impactful to the Louisiana sugar industry. Performing at unprecedented yields in ratoon crops, LCP 85‐384 changed how Louisiana growers would manage their crops. The variety proved to possess traits that fared well in the subtropical production zones of the state. Substantial stalk populations seemed to play a vital role in the necessary ratoon ability and consequent cold tolerance necessary for production in Louisiana. After significant disease pressure, the variety quickly declined in production acreage, but not in impact. It continued to provide sustained progress as a parent for years, contributing to most modern commercial cultivars in Louisiana. Today, LCP 85‐384 and its progeny are used in breeding and genetic research to usher in the next era of progress in the Louisiana sugar industry. Meanwhile, through cooperative efforts of breeding programs around the world, it is making its mark on the sugarcane industries of Argentina in much the same way as it did in Louisiana. In the future, it is expected that the progress made in the breeding program will continue by building upon the gains achieved from LCP 85‐384 and its progeny for the sustained success of the Louisiana sugarcane industry.

Can I see myself there? How Black potential applicants use diversity cues to learn about graduate program climate.

In academia, showcasing diversity, equity, and inclusion (DEI) values has become increasingly prominent in efforts to recruit students and faculty with marginalized identities, yet little work has examined the empirical effects that such DEI practices and identity safety cues have on the perceptions of these institutions. In the present study, we examine the contextual factors that shape how Black science, technology, engineering, and mathematics (STEM) students learn and draw inferences about diversity and cultural climate in the graduate programs to which they consider applying. A sample of 217 Black participants with background in a STEM discipline viewed a mock academic department website which presented varied combinations of expressed diversity cues (diversity vs. neutral mission statement) and/or evidence-based diversity cues (racially diverse vs. all-White faculty). Participants reported perceptions of the department's DEI culture, their own perceived fit within the program, and belief of future personal success within that institution. Results indicated a significant main effect of evidence-based cue, in the form of faculty diversity, on all examined outcomes, with Black participants more positively assessing a program exhibiting this cue. An expressed cue, in the form of diversity statement, did not have significant effects. These results indicate that in higher education, as in other settings, evidence-based cues may be more effective means to cue identity safety. This study provides a foundation for future research to help guide efforts of academic programs seeking to create a welcoming and supportive climate for all potential applicants. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Women in leadership matters: Achieving diversity in radiology residency recruitment

Rationale and objectivesTo assess whether academic radiology departments and residency programs with efforts toward supporting and augmenting Diversity, Equity, and Inclusion (DEI) are associated with a higher proportion of residents from diverse backgrounds. Materials and methodsProgram Directors within the Radiology Residency Education Research Alliance were surveyed to gather information about program characteristics, incorporation of diversity in resident recruitment, the sponsoring department's commitment to efforts at expanding diversity, and a summary of their current and past residents, staff and faculty members (academic years 2020 and 2023) with respect to a list of diversity characteristics. ResultsSurvey response rate was 51 %. Sixty-three percent (15/24) of participating programs have departmental committees dedicated to DEI work; 46 % (11/24) of programs' departments have a Vice Chair for DEI. Sixty percent (15/24) of programs use their social media accounts to advertise their DEI programming efforts. Ninety-six percent (23/24) of programs participating in the survey use diversity factors to select candidates for their program. Women Leadership was associated with above-median diversity of residents and faculty. ConclusionThis study of radiology residency programs encourages a more prominent role for women in leadership positions within academic radiology departments to drive diversity and inclusion efforts.

Health Outcomes and Health Services Utilization Evaluation Protocol: Assessing the Impact of the Nova Scotia Rapid Access and Stabilization Program

IntroductionEmergency psychiatric care, unplanned hospital admissions, and inpatient health care are the costliest forms of mental health care. According to Statistics Canada (2018), almost 18% (5.3 million) of Canadians reported needing mental health support. However, just above half of this figure (56.2%) have reported their needs were fully met. To further expand capacity and access to mental health care in the province, Nova Scotia Health has launched a novel mental health initiative, the Rapid Access, and Stabilization Program (RASP).ObjectivesThis study evaluates the effectiveness and impact of the RASP on high-cost health services utilization (e.g. ED visits, mobile crisis visits, and inpatient treatments) and related costs. It also assesses healthcare partners’ (e.g. healthcare providers, policymakers, community leaders) perceptions and patient experiences and satisfaction with the program and identifies sociodemographic characteristics, psychological conditions, recovery, well-being, and risk measures in the assisted population.MethodsThis is a hypothesis-driven program evaluation study that employs a mixed methods approach. A within-subject comparison will examine health services utilization data from patients attending RASP, one year before and one year after their psychiatry assessment at the program. A controlled between-subject comparison will use historical data from a control population will examine whether possible changes in high-cost health services utilization are associated with the intervention (RASP). The primary analysis involves extracting secondary data from provincial information systems, electronic medical records, and regular self-reported clinical assessments. Additionally, a qualitative sub-study will examine patient experience and satisfaction, and examine health care partners’ impressions.ResultsThe results for the primary, secondary, and qualitative outcome measures to be available within 6 months of study completion. We expect that RASP evaluation findings will demonstrate a minimum 10% reduction in high-cost health services utilization and corresponding 10% cost savings, and also a reduction in the wait times for patient consultations with psychiatrists to less than 30 calendar days. In addition, we anticipate that patients, healthcare providers, and healthcare partners would express high levels of satisfaction with the new service.ConclusionsThis study will demonstrate the results of the Mental Health and Addictions Program (MHAP) efforts to provide stepped-care, particularly community-based support, to individuals with mental illnesses. Results will provide new insights into a novel community-based approach to mental health service delivery and contribute to knowledge on how to implement mental health programs across varying contexts.Disclosure of InterestNone Declared

A feasible balance? The Italian teachers’ standpoint on assessment literacy, assessment practice, and teacher professional development

ABSTRACT The unprecedent times of the COVID-19 pandemic have had a relevant impact on schooling. In this context, identifying the features of effective and responsive teachers’ professional development paths in the assessment domain has never been as critical as it is today. However, despite the widespread interest in teacher assessment literacy and despite the efforts of educational policies and teacher education programs, research continues to show that teachers are generally underprepared to face assessment challenges. The present article reports on an explorative study aimed at examining teachers’ conceptions of assessment literacy, assessment practice, and professional development. Qualitative data are drawn from semi-structured interviews with 30 Italian primary school teachers. The descriptions of what they consider as assessment literacy and the qualities necessary for an effective assessment practice constitute the starting point for a wider discussion on the professional development drivers for being and becoming an assessment literate teacher.

Newly established, multifunctional woody polycultures preserve agroforestry soil health benefits of a widespread U.S. land retirement program

Soil health degradation within intensively managed annual crop systems threatens the long-term economic sustainability of maize- and soybean-dominated production regions like the U.S. Corn Belt. While Conservation Reserve Program (CRP) efforts to perennialize portions of farmland to improve soil health have been largely successful, many landowners intend to return CRP land to high revenue maize and soybean cultivation. The CRP could be a pathway for a regionally tailored and profitable form of agroforestry focused on fruit and nut production potential, known as multifunctional woody polycultures (MWPs). In theory, MWPs should provide similar soil health benefits as CRP agroforestry, as soil health benefits are generally robust across agroforestry practices. We conducted a study in the heart of the U.S. Corn Belt to compare soil health responses between newly established (<10 years) CRP and MWP agroforestry systems and adjacent annual crop production fields. Because organic inputs from plant litter and roots are more consistent under untilled perennial vegetation systems compared to intensively managed annual crop systems, we hypothesized that CRP and MWP would entail similar enhancements to physical, soil organic matter (SOM), and biological soil health. Our results indicate establishing untilled, perennial CRP and MWP systems can quickly improve physical and biological soil health relative to annual crop production, based on decreased soil bulk density, greater soil water infiltration, and increased soil enzyme activity. Unexpectedly, CRP and MWP elicited divergent SOM responses. Notably, only MWP increased surface soil organic carbon stocks relative to annual crop fields, likely reflecting species-variant plant biomass growth rates. Our study demonstrates MWPs can manifest similar improvements to physical and biological soil health as CRP agroforestry on a relatively short timescale. The sensitivity of transition-state SOM responses between CRP and MWP demonstrates the importance of woody perennial selection to maximize specific soil health outcomes.

A new thread-level speculative automatic parallelization model and library based on duplicate code execution

Loop-efficient automatic parallelization has become increasingly relevant due to the growing number of cores in current processors and the programming effort needed to parallelize codes in these systems efficiently. However, automatic tools fail to extract all the available parallelism in irregular loops with indirections, race conditions or potential data dependency violations, among many other possible causes. One of the successful ways to automatically parallelize these loops is the use of speculative parallelization techniques. This paper presents a new model and the corresponding C++ library that supports the speculative automatic parallelization of loops in shared memory systems, seeking competitive performance and scalability while keeping user effort to a minimum. The primary speculative strategy consists of redundantly executing chunks of loop iterations in a duplicate fashion. Namely, each chunk is executed speculatively in parallel to obtain results as soon as possible and sequentially in a different thread to validate the speculative results. The implementation uses C++11 threads and it makes intensive use of templates and advanced multithreading techniques. An evaluation based on various benchmarks confirms that our proposal provides a competitive level of performance and scalability.

First Fit Algorithm: A Graph Coloring Approach to Conflict-Free University Course Timetabling

Aims: Tackling scheduling issues with the most optimal graph coloring algorithm has consistently posed significant difficulties. The university scheduling problem can be expressed as a graph coloring problem, where courses are depicted as vertices and the connections between courses that have common students or teachers are represented as edges. Subsequently, the task at hand is to assign the vertices with the minimum number of colors. In order to accomplish this task, this paper present a graph coloring technique to conflict free university course timetabling using first fit algorithms.&#x0D; Methodology: The conflict graph is partitioned into a set of independent color classes to be assigned time slots and transformed into a conflict-free timetable. The Ladoke Akintola University of Technology (LAUTECH) University Course Timetabling Data was adopted. The allocation of venue based on the allotted time slots is done using first fit packing algorithm. The proposed model is implemented using Python programming language. The developed model had courses being represented as vertices and edges. The course conflict graph was created based on the acquired dataset using vertices-edges relationship diagram. The implemented model is evaluated in terms of Halstead complexity metrics: Program Volume (PV), Program Length (PL), Program Effort (PE), Program Difficulty (PD) and Execution Time (ET). The PV, PL, PE, PD and ET values obtained for the implemented model are 18.45kbits, 0.51, 1037684, 1.97 and 20.45 secs, respectively.&#x0D; Conclusion: The proposed model shows a significant improvement over the existing models by producing conflict-free course timetabling problem with better evaluation results. This work will be highly useful in solving various scheduling, optimization and NP-hard related computational problems.

EdgeOptimizer: A programmable containerized scheduler of time-critical tasks in Kubernetes-based edge-cloud clusters

Edge computing has garnered significant attention in recent years, leading to the evolution of more delay-sensitive applications towards a three-tier architecture with edge-cloud collaboration. Concurrently, technologies associated with containerization have been maturing. Notably, K8s(Kubernetes) emerges as a prominent solution for the management of extensive, dynamically evolving, and intricate container clusters. However, optimizing performance in a K8s-based architecture requires careful consideration, as intelligent algorithms cannot be easily rehearsed or retracted, and a poorly functioning algorithm can result in significant damage. To enhance the success rate of time-critical task execution in real production environments, it is crucial to provide an algorithm optimizer for service orchestration and request dispatching, especially when dealing with different services. Traditionally, building a K8s-based experimental system during the early stages of experiments has been time-consuming and involved significant programming efforts. In this paper, we introduce EdgeOptimizer, a decoupled and modularized optimizer for scheduling in multiple clusters. EdgeOptimizer also serves as an online testbed for algorithm verification in K8s-based systems, offering detailed configuration options to facilitate cluster management. By collecting system information and employing an interface-oriented system architecture, EdgeOptimizer enables users to quickly develop, deploy, and switch between various algorithms, significantly reducing the upfront costs associated with setting up an experimental environment. We evaluated the performance of EdgeOptimizer based on overall overload and demonstrated its scalability and effectiveness in verifying the efficacy of service orchestration and request dispatching algorithms for time-critical tasks. Our findings illustrate the value of EdgeOptimizer in improving the overall success rate of executing time-critical tasks, thus highlighting its potential in real-world scenarios.

Expanding the Massachusetts Birth Defects Monitoring Program to include additional pregnancy outcomes: Programmatic efforts and impacts on case ascertainment, 2012-2020.

Birth defects affect 1 in 33 infants in the United States and are a leading cause of infant mortality. Birth defects surveillance is crucial for informing public health action. The Massachusetts Birth Defects Monitoring Program (MBDMP) began collecting other pregnancy losses (OPLs) in 2011, including miscarriages (<20 weeks gestation) or elective terminations (any gestational age), in addition to live births and stillbirths (≥20 weeks gestation). We describe programmatic changes for adding OPLs and their impact on prevalence estimates. Using population-based, statewide, data from the MBDMP (2012-2020), we assessed prevalence per 10,000 live births and 95% confidence intervals (CIs) with and without OPLs overall and for specific birth defects by time period, maternal age, and race/ethnicity. Including OPLs required amending a state statute and promulgating regulations, new data sources, and additional data processing, cleaning, and verification. Overall prevalence with OPLs increased from 257.4 (95% CI: 253.5-261.4) to 333.9 (95% CI: 329.4-338.4) per 10,000; increases were observed in all time periods, age, and race/ethnicity groups. After including OPLs, the prevalence increased for neural tube defects [3.2 (2.7-3.6) to 8.3 (7.6-9.0)], and trisomies 13 [0.5 (0.3-0.7) to 4.1 (3.6-4.6)], 18 [1.5 (1.2-1.9) to 8.2 (7.5-8.9)], and 21 [12.3 (11.4-13.2) to 28.9 (27.6-30.2)]. Cardiovascular defects increased slightly, while prevalence of eye/ear, respiratory, and gastrointestinal defects remained similar. Adding OPLs required substantial programmatic efforts and resulted in more complete case ascertainment, particularly for certain birth defects. More complete case ascertainment will allow for improved research, screening, and resource allocation.

Prevalence and determinants of minimum dietary diversity for women of reproductive age in Uganda

BackgroundGlobally, over a billion women of reproductive age (WRA) suffer from some kind of undernutrition micronutrient deficiencies, and/or anemia as a result of inadequate dietary diversity. This leads to poor maternal and child health outcomes, however, there is limited research on population level research on minimum dietary diversity for women (MDD-W). This study assessed the prevalence and predictors of MDD-W among WRA in Uganda.MethodsThis study was a secondary analysis of data from the lot quality assurance sampling (LQAS) survey conducted across 55 Ugandan districts between May and September 2022. Women of various ages were interviewed across 5 study subgroups that this study used to construct its study population (WRA). Descriptive analyses, tests for outcome differences, and multilevel mixed-effects logistic regression were conducted at a 5% statistical significance level using STATA version 17. The results were reported using Adjusted Odds Ratios (aOR) as the measure of the outcome.ResultsThe study analyzed responses from 29,802 WRA with a mean age of 27.8 (± 6.8) years. Only 8.8% (95% CI 8.5–9.3) achieved the MDD-W, the least proportion was observed in the South-Central region (3.13%). In the adjusted analysis, WRA who were older than 25 years (aOR 1.1, 95% CI 1.1–1.3, p < 0.001), had secondary education (aOR = 1.4, 95% CI 1.1–1.7, p = 0.003) or above (aOR = 1.7, 95% CI 1.3–2.2, p < 0.001), and used modern contraceptives (aOR = 1.1, 95% CI 1.0-1.3, p = 0.01) were more likely to achieve the MDD-W. Conversely, WRA who travelled longer distances to the nearest household water source (aOR = 0.8, 95% CI 0.7–0.9, p = 0.002) and those residing in larger households (aOR = 0.9, 95% CI 0.8-1.0, p = 0.019) were less likely to achieve the MDD-W.ConclusionA low proportion of WRA met the MDD-W. Age, education level, household sizes and use of modern contraception were predictors of MDD-W among WRA in Uganda. MDD-W-related program efforts in Uganda should strengthen multisectoral collaboration with prioritization of younger women, education, household sizes and access to safe water sources.

Insights and Challenges for the Development of Mosquito Control Action Thresholds Using Historical Mosquito Surveillance and Climate Datasets.

Strategies to advance action threshold development can benefit both civilian and military vector control operations. The Anastasia Mosquito Control District (AMCD) has curated an extensive record database of surveillance programs and operational control activities in St. Johns County, Florida, since 2004. A thorough exploratory data analysis was performed on historical mosquito surveillance and county-wide climate data to identify climate predictors that could be used in constructing proactive threshold models for initiating control of Aedes, Culex, and Anopheles vector mosquitoes. Species counts pulled from Centers for Disease Control and Prevention (CDC) light trap (2004-2019) and BG trap (2014-2019) collection records and climate parameters of temperature (minimum, maximum, average), rainfall, and relative humidity were used in two iterations of generalized linear models. Climate readings were incorporated into models 1) in the form of continuous measurements, or 2) for categorization into number of "hot," "wet," or "humid" days by exceedance of selected biological index threshold values. Models were validated with tests of residual error, comparison of model effects, and predictive capability on testing data from the two recent surveillance seasons 2020 and 2021. Two iterations of negative binomial regression models were constructed for 6 species groups: container Aedes (Ae. aegypti, Ae. albopictus), standing water Culex (Cx. nigripalpus, Cx. quinquefasciatus), floodwater Aedes (Ae. atlanticus, Ae. infirmatus), salt-marsh Aedes (Ae. taeniorhyncus, Ae. sollicitans), swamp water Anopheles (An. crucians), and a combined Total Mosquitoes group. Final significant climate predictors varied substantially between species groups. Validation of models with testing data displayed limited predictive abilities of both model iterations. The most significant climate predictors for floodwater Aedes, the dominant and operationally influential species group in the county, were either total precipitation or frequency of precipitation events (number of "wet" days) at two to four weeks before trap collection week. Challenges hindering the construction of threshold models were discussed. Insights gained from these models provide initial feedback for streamlining the AMCD mosquito control program and analytical recommendations for future modelling efforts of interested mosquito control programs, in addition to generalized guidance for deployed armed forces personnel with needs of mosquito control but lacking active surveillance programs.

Reducing wait times and avoiding unnecessary use of high-cost mental health services through a Rapid Access and Stabilization Program: protocol for a program evaluation study.

Emergency psychiatric care, unplanned hospital admissions, and inpatient health care are the costliest forms of mental health care. According to Statistics Canada (2018), almost 18% (5.3 million) of Canadians reported needing mental health support. However, just above half of this figure (56.2%) have reported their needs were fully met. In light of this evidence there is a pressing need to provide accessible mental health services in flexible yet cost-effective ways. To further expand capacity and access to mental health care in the province, Nova Scotia Health has launched a novel mental health initiative for people in need of mental health care without requiring emergency department visits or hospitalization. This new service is referred to as the Rapid Access and Stabilization Program (RASP). This study evaluates the effectiveness and impact of the RASP on high-cost health services utilization (e.g. ED visits, mobile crisis visits, and inpatient treatments) and related costs. It also assesses healthcare partners' (e.g. healthcare providers, policymakers, community leaders) perceptions and patient experiences and satisfaction with the program and identifies sociodemographic characteristics, psychological conditions, recovery, well-being, and risk measures in the assisted population. This is a hypothesis-driven program evaluation study that employs a mixed methods approach. A within-subject comparison (pre- and post-evaluation study) will examine health services utilization data from patients attending RASP, one year before and one year after their psychiatry assessment at the program. A controlled between-subject comparison (cohort study) will use historical data from a control population will examine whether possible changes in high-cost health services utilization are associated with the intervention (RASP). The primary analysis involves extracting secondary data from provincial information systems, electronic medical records, and regular self-reported clinical assessments. Additionally, a qualitative sub-study will examine patient experience and satisfaction, and health care partners' impressions. We expect that RASP evaluation findings will demonstrate a minimum 10% reduction in high-cost health services utilization and corresponding 10% cost savings, and also a reduction in the wait times for patient consultations with psychiatrists to less than 30 calendar days, in both within-subject and between-subject comparisons. In addition, we anticipate that patients, healthcare providers and healthcare partners would express high levels of satisfaction with the new service. This study will demonstrate the results of the Mental Health and Addictions Program (MHAP) efforts to provide stepped-care, particularly community-based support, to individuals with mental illnesses. Results will provide new insights into a novel community-based approach to mental health service delivery and contribute to knowledge on how to implement mental health programs across varying contexts.

Satisfaction Level of Multi-Drug Resistant Tuberculosis Patient: A Hospital Based Study in Bangladesh

Background: Realizing the patients’ need and improving the quality of services, a satisfaction survey can effectively help management and the patient. The aim of this study was to investigate satisfaction level of multi-drug resistant tuberculosis (MDRTB) patients at tertiary level hospital in Bangladesh. Methods: A cross-sectional study conducted at Chest Disease Hospital (CDH), Rajshahi among 199 MDR-TB patients using random sampling technique. A semi-structured questionnaire was used to collect basic, socio-demographic, behavioral and satisfaction specific data with ensuring no any risk for providing right information. Five point “Likert Scale” was used to measure patients’ satisfaction level. The relevant data were carefully coded and recoded for statistical analysis, and independent samples t-test and multinomial logistic regression analysis were used to see the difference and association of influencing factors on satisfaction. Results: In this study, we observed that the mean age of MDR-TB patient admitted at CDH was 39.8 years with range from 16 to 62 years. About 90% patients were satisfied with behavior of care providers, and 50% and 29% patients were satisfied in hospital environment and supplied food respectively. We also found that old age group, male, less educated, smoker, diabetic, married, high income and less expenditure group, business or service holder and Muslim were more satisfied than their counterparts. The multinomial logistic regression analysis showed that young age group (≤40 years) was five times more dissatisfied than old age group (≥40 years) (OR=5.345; 95% CI: 1.123-25.448; p&lt;0.05). Receiving monthly money from the program positively impacted on satisfaction. Similarly, drug toxicity, length of stay and loneliness was negatively impacted on satisfaction. Conclusion: Considering the mentioned influencing factors can strengthen the national control program effort at CDH in Rajshahi division, Bangladesh. Similar study in other chest disease hospitals located mostly in different divisions in the country can also help comparing the factors for nationwide improvement.

On-line pornography and minors. Diagnosis, challenges and proposals

The consumption of pornography over the Internet by minors has been increasing exponentially in recent years. The use of digital technologies and the ease of access to these contents are causes that explain this event. Simultaneously, there is concern about the increase in sexual violence, associated with discriminatory behavior, despite the efforts of laws and programs that promote sexual reproductive health (SRH) and the principle of equality. From a bioethical point of view, it is urgent to address this issue, which affects the physical and psychological health of minors and their affective-sexual education. The study addresses whether it is possible to relate the consumption of online pornography by minors and sexual violence. To do this, legal sources, reports from associations, audiovisual councils and scientific studies are consulted. In all of them, the relationship between the consumption of online pornography by adolescents and risky behavior in emotional-sexual matters and gender inequality is evident. In the legal and fiscal sphere, it is alerted to the damage that is occurring and points out the need to propose lines of action that reverse this situation. We propose measures to technically regulate access to content. These measures are based on the precautionary principle, a tool that has been applied in fields such as health and the environment. More studies and political actions are needed to make the Internet a safe place for minors.