搜索结果：Evaluation and program planning

Southern Africa faces intensifying climate risks shaped by rising temperatures, prolonged droughts, extreme weather events, and deep structural inequalities. As investment in climate resilience programming grows, so does the need for rigorous, context-sensitive frameworks for planning and evaluating such programmes. Yet current approaches to vulnerability assessment, predominantly built on the IPCC dimensions of exposure, sensitivity, and adaptive capacity, often fail to capture the social, institutional, and relational drivers that shape how communities experience and respond to climate change. This paper employs a qualitative, comparative case study methodology to examine three climate resilience programmes implemented across Southern Africa between 2018 and 2023. Drawing on both primary data, including household surveys, participatory rural appraisals, ethnographic interviews, and micro-narrative studies, and secondary sources, the authors conduct a structured cross-case analysis of how vulnerability was conceptualised, how programme responses were designed, and how outcomes were evaluated. The authors propose an expanded vulnerability framework that builds on the IPCC model by incorporating three additional dimensions: mitigation and preparedness, response capacity, and recovery capacity. These additions are argued to better reflect the social dimensions of vulnerability, particularly in contexts of institutional fragility and structural inequality. Findings demonstrate that vulnerability in Southern Africa is shaped not only by climatic exposure but by governance failures, land tenure insecurity, limitations of social protection, and the marginalisation of indigenous knowledge. Programmes that adopted participatory, iterative approaches were more effective at revealing these intersectional and structural dimensions of vulnerability. The paper argues for a more holistic approach to resilience programming that integrates material, relational, and subjective dimensions of wellbeing, and calls for evaluation frameworks that go beyond economic and agricultural indicators. These findings have practical implications for national and international development agencies involved in climate adaptation programming across the sub-region.

Papua New Guinea (PNG) has implemented a three-tiered Field Epidemiology Training Program (FETP) to strengthen their public health workforce. The first advanced (extended) level FETP (aFETPNG) commenced in 2019. This study evaluates the outputs, outcomes and impacts of aFETPNG. Guided by an FETP impact evaluation framework, a mixed-methods evaluation was conducted to assess program effectiveness and identify opportunities for improvement. Data were collected through an online survey of graduates and interviews with graduates and senior-level government managers and executives. Quantitative data were analysed descriptively. Qualitative data were analysed thematically; findings were triangulated and assessed using contribution analysis. Despite disruption from COVID-19, 17 of 30 (57%) trainees graduated in 2022. Graduates reported high confidence in and frequent application of core field epidemiology competencies. All reported applying field epidemiology skills in their workplace. Graduates strengthened surveillance systems, investigated outbreaks, and implemented a range of public health interventions that contributed to stronger health systems and improved public health programs. Most graduates (82%, n = 14) used surveillance data to guide program planning and delivery. Fifty-five outbreaks were investigated (average of 1.8 per graduate per year). Many assumed leadership roles during the pandemic, and 47% received a promotion following graduation. Barriers to applying skills included unsupportive workplaces, heavy workloads, limited resources, security challenges and professional jealousy; enablers included active professional networks, supportive workplaces and communities, and recognition of the field epidemiology skillset. Senior managers confirmed that aFETPNG strengthened health system performance and recommended institutionalising and expanding the program. Graduates recommended more structured mentoring during and after training. Senior managers recommended formal qualification recognition and a pathway toward a master's degree to support career progression. aFETPNG made a substantive and credible contribution to PNG's public health system demonstrating progress along the theory of change impact pathway. The program enhanced outbreak response, improved surveillance practice, strengthened public health programs and delivered tangible benefits at community and system levels. These achievements reflect the intentional design of the program and the sustained application of skills by graduates. Key recommendations include strengthening mentoring during and after training, expanding post-graduation professional development, and securing funding for graduate-led projects.

To explore stakeholders' experiences and perspectives regarding the development, implementation, and evaluation of physical activity (PA) programmes in universities which are critical to be understood to address the implementation challenges. This qualitative study gathered experiences and perspectives from 34 participants recruited using purposive and snowball sampling. Participants represented five stakeholder levels, four types of United Kingdom institutions and three types of Indonesian institutions. Data were analysed using the six-stage framework method analysis by three coders, informed by critical realism and drawing on the Consolidated Framework for Implementation Research and the United Kingdom Medical Research Council framework for developing and evaluating complex interventions. Seven themes influenced PA programme implementation in university across both countries. Three themes cut across development, implementation and evaluation: institutional mobilisation and alignment, leadership and champions, external PA communities. Practical guidance and stakeholder capability shaped programme development. Delivery capacity and staffing, as well as physical and digital infrastructures shaped implementation. Institutional recognition facilitated evaluation. Our findings may help identify and address challenges faced by stakeholders in developing, implementing, and evaluating PA programmes in universities. They also suggest a need for context-sensitive support to help stakeholders address these challenges within their institutional settings.

This surgical rehabilitation program in a community setting provides a case study for the implementation of an effective monitoring and evaluation (M&E) plan. The partnership between St. Catherine University evaluators and staff at Kafika House Tanzania offers insights into how to strengthen evaluation and planning for a rehabilitation program and provides a case study for working in intercultural partnerships. This paper assesses the responsiveness, quality and fidelity of M&E implementation, and elucidates lessons learned from evaluation implementation and key adaptations from piloting data collection in a resource-limited setting. Feedback interviews with Kafika House staff demonstrated responsiveness to the M&E tools. Pilot data collected from tools developed for program and impact evaluation were used to measure implementation quality and fidelity. Data collector buy-in and responsive and communicative partnership supports motivation for consistent data collection. Kafika House learned that program evaluation was imperative to data quality and fidelity while the academic team learned how to best support the evaluation plan. Utilizing an ecological model strengthened our consideration of the individual, community, and innovative factors of implementation that promoted the sustainability of the M&E program. Evaluation and planning adaptations in a resource-limited setting considered training, funding, sustainable integration, and administration of measurement tools.

Family planning (FP) is a critical component of reproductive health, enabling individuals to plan the number and timing of children through various contraceptive methods.We outline the conceptual framework and country case study methodology used by the Exemplars in Family Planning (EFP) project. This was based on the wider Exemplars in Global Health programme, which uses mixed-methods to examine determinants of FP progress in countries that exceed expectations for health outcomes. The EFP project integrates findings from case studies on six such countries, including quantitative analyses of trends and drivers of modern contraceptive prevalence, systematic reviews, policy, programme and financing assessments, and qualitative data collection with policymakers, providers and community actors. Data triangulation across these methods, complemented by consortium input and country workshops, enabled robust validation of findings and identification of cross-cutting themes. This approach produced a nuanced understanding of FP progress by capturing interactions between government programmes (demand and supply), service delivery mechanisms, subnational contexts and individual determinants. Quantitative decomposition and trend analyses quantified the contributions of population characteristics, behavioural factors and interventions, while qualitative and stakeholder data contextualised these findings within local sociocultural, health system and policy environments.This multicountry, mixed-methods analysis led by local researchers and supported by a global consortium enhanced methodological rigour, contextualised findings and enabled cross-country learning on FP progress. It identified key cross-cutting drivers and offers evidence-informed guidance to improve contraceptive uptake and demand satisified, while highlighting the need for context-specific interventions and further longitudinal, multicountry research.

Program evaluation is critical in ensuring the effectiveness of both sport programs and organizations. Despite its importance, many sport organizations lack sufficient knowledge and resources (e.g., funding) to carry out evaluation, reflecting a broader trend referred to as low capacity for evaluation. To address evaluation capacity gaps, organizations can connect with and learn from "evaluation champions" within their respective sectors. Evaluation champions are individuals or organizations that actively promote and exemplify best evaluation practices, provide training and support, and mentor peers in program evaluation. However, little research profiles evaluation champions in sport, limiting sport knowledge users' accessibility to potential knowledge exchange and collaboration opportunities to enhance evaluation capacity. Therefore, this reflective case narrative describes an evaluation champion in the sport sector with a specific emphasis on the impact of its evaluation practices, priorities, and approaches. Recommendations and lessons learned from the organization are shared to provide insight to other sport organizations that engage in evaluation. Findings add to the ongoing work in Canada to support sport organizations in increasing their capacities for effective program evaluation.

Ethnic disparities in reproductive, maternal, neonatal and child health (RMNCH) persist in Latin America, rooted in structural racism and colonial legacies. Evidence on the temporal evolution of these disparities and the impact of policies targeting Indigenous populations remains limited. Following the 2000 economic crisis, Ecuador showed the region's largest ethnic gaps in intervention coverage and social determinants. Since 2008, inclusion policies have advanced. This study analysed trends in RMNCH coverage, social determinants and their potential association with policies and strategies over 14 years. Using a mixed-methods design, we analysed three nationally representative surveys (2004, 2012 and 2018) to assess changes in social determinants and the coverage of six RMNCH services; defined as the proportion of women and children receiving essential health services across the continuum of care, including family planning, antenatal care, skilled birth attendance and child immunisation, stratified by ethnicity (Indigenous women and children, Afro-Ecuadorian populations and Mestizo and White populations). We estimated absolute inequality measures and adjusted coverage ratios using Poisson regression models. Through a literature review and temporal graphs, we analysed plans, policies and strategies in health, education and ethnic inclusion during the same period to estimate potential impact. By 2018, Indigenous populations doubled their representation in the highest wealth quintiles (10% to 20%) and increased secondary education attainment (25% to 45%), with slower progress in rural areas. RMNCH coverage, including prenatal care, institutional deliveries and professional-assisted births, rose significantly (27% to 75%) among Indigenous populations. Afro-Ecuadorians also experienced improvements in RMNCH coverage and social determinants, though progress was less pronounced compared with Indigenous groups. Although ethnic gaps persisted, inequalities declined over the study period. These reductions coincided with increased social investment in rural health and education, constitutional recognition of plurinationality, and policies promoting intercultural health practices. However, gaps in monitoring and impact evaluation were evident. Ecuador demonstrates that inclusive and integrated policies, leadership, social participation and sustained social investment can reduce ethnic inequalities, promote the integral development of society and strategies that should be maintained. Temporal studies based on routine surveys are crucial for monitoring the impact of such policies. These findings provide a pre-pandemic benchmark and serve as a reference for countries aiming to improve health outcomes among Indigenous and Afro-descendant populations and advance the Sustainable Development Goals.

Generative artificial intelligence (GenAI) tools are being increasingly applied to teaching and learning in medical education creating both instructional opportunities and pedagogical challenges. While GenAI offers potential to enhance teaching, assessment, and curriculum design, many medical faculty lack structured guidance on how to integrate these tools ethically and pedagogically within discipline-specific, high-stakes educational contexts. This study aimed to design, implement, and evaluate a faculty development workshop series for ethical and pedagogical integration of GenAI in medical education teaching. A mixed methods pilot study was conducted to design, implement, and evaluate a faculty development workshop series "Professional Development in Generative Artificial Intelligence for Pedagogy" at Weill Cornell Medicine-Qatar, a US medical school in Qatar. The program consisted of five 1-hour synchronous online workshops grounded in Experiential Learning Theory and the Technological Pedagogical Content Knowledge framework. Ten medical faculty from multiple disciplines participated. Quantitative data were collected through an online preintervention survey, an online postintervention survey with open-ended questions, and an online 2-week follow-up survey. Surveys consisted of 5-point Likert scale items capturing perceptions of workshop quality, confidence, and intended application. Qualitative data included full workshop transcripts, facilitator theoretical notes, and facilitator memos. Descriptive statistics summarized quantitative findings, while qualitative data were analyzed using a combination of deductive and inductive coding, alongside narrative analysis. Findings were integrated to generate convergent interpretations. Qualitative analysis of workshop transcripts suggested evolving engagement with GenAI, with participants describing movement from exploratory use toward more intentional pedagogical application. Postintervention survey results indicated high satisfaction with program content, organization, relevance, and overall quality. Two-week follow-up survey responses (n=5) suggested increased self-reported confidence in applying GenAI tools, and perceived shifts in how participants conceptualized teaching with GenAI. Faculty described intended strategies for integrating GenAI into lesson planning, assessment design, visualization of learning materials, and case-based instruction, while emphasizing the importance of human oversight, critical appraisal, and ethical judgment. Findings highlighted the perceived value of hands-on experimentation, reflective discussion, and adaptive facilitation in supporting early faculty engagement. This pilot study provides early evidence that an experiential, theory-informed, and adaptively facilitated faculty development workshop series may support medical faculty in developing self-reported confidence, awareness, and initial strategies for responsible GenAI integration. Findings are exploratory and limited by a small sample size, a single institution, and reliance on self-reported data. Nevertheless, the Professional Development in Generative Artificial Intelligence for Pedagogy workshop series presents a flexible and theory-informed faculty development approach that may inform future faculty development initiatives in medical education as GenAI technologies continue to evolve.

Self-management is important for effective care for people living with epilepsy. The Chronic Disease Self-Management Program (CDSMP) is an evidence-based program that improves health outcomes and lifestyle behaviors in chronic diseases such as diabetes, hypertension, heart disease, stroke, and arthritis. We describe initial results from a program evaluation of the CDSMP in adults with epilepsy. The Epilepsy Foundation of America (EFA) recruited adults with epilepsy to participate in the CDSMP through its nationwide community network. The program included 6 workshops held weekly online or by phone and led by trained facilitators. At program outset and at 1 and 6 months after completion, participants reported on measures of epilepsy self-management (Epilepsy Self-Management Scale, ESMS), self-efficacy (Self-Efficacy for Managing Chronic Disease, SEMCD), depression (Patient Health Questionnaire-8, PHQ-8), and self-rated health. Participants and EFA sites delivering the program in their communities provided qualitative feedback. Across 8 EFA sites, 99 adults with epilepsy completed the CDMSP. Evaluation measure scores at 1 and 6 months after program completion showed improvement in epilepsy self-management, self-efficacy, and depression, but no change in self-rated health. Feedback from staff, facilitators, and participants suggested the program was well-received and recommended strategies to strengthen planning, recruitment, and delivery. The CDSMP can be implemented in a community-based network for adults living with epilepsy. Initial participant outcomes suggest that program completion is associated with improvements in epilepsy self-management, self-efficacy, and depression. The CDSMP is a beneficial addition to community-based resources that promote disease self-management in adults with epilepsy.

Structured physical education (PE) programs are essential for fostering students' physical development, cognitive performance, and emotional well-being in academic settings. This study introduces a novel intelligent decision-making algorithm (IDA) for the dynamic optimization and real-time assessment of college PE programs. The proposed framework synergistically integrates a hybrid genetic algorithm (GA) that is viable global optimizer with pattern search (PS) that is an adaptive local search technique. The exploration in the search domain is performed with GA while PS exploitation in a minimal computational budget is performed by the PS. The system encodes program performance data into chromosome-like representations, enabling nuanced evaluation across academic progress, health indices, and affective-psychomotor domains. A tailored vector of weight factors refines the fitness function to reflect individual learning trajectories and institutional goals. Experimental results demonstrate that the model achieves a high prediction accuracy of 98%, with quantifiable improvements of 151.13% in holistic performance, 19.63% in educational metrics, and 26.7% in psychomotor development as compared with reported results. Comparative models, including Random Forest (RF), Adaptive Neuro-Fuzzy Inference System (ANFIS), and RF regression, that achieved accuracies of 88.21%, 94.49%, and 82%, respectively. The hybrid framework maintained a mean global fitness value of 5.3451 × 10⁻¹² with an average computational time of 1357.04 s over 100 runs that is used to validate the reliability of the proposed framework. By enhancing efficiency and reducing computational complexity, this AI-driven evaluation model offers a scalable and intelligent approach for real-time optimization and policy refinement in higher education PE curriculum planning.

A program evaluation will be conducted to assess the achievement of African American males at predominantly white institutions (PWIs) by examining how effectively, efficiently, and equitably the Education Opportunity Fund program supports job placement, graduation, and semester-to-semester progress. Since no comprehensive evaluation of the Education Opportunity Fund has been conducted, this plan will provide valuable insights to help practitioners fund, improve, and set meaningful goals for programs serving economically disadvantaged college students in New Jersey. An Education Opportunity Fund Program Planning & Development logic model serves as the main evaluation approach, with a survey as the qualitative and quantitative data collection method to gather information on mentorship, academic counseling, leadership, and/or extracurricular opportunities from Education Opportunity Fund program staff, students, and others. The primary goal of the Education Opportunity Fund is to structure a sustainable cohort model for first-generation students over time within the United States of America. The need for equity and access is important for African American male students who come from educationally and economically disadvantaged backgrounds. This program evaluation plan assesses the support services Education Opportunity Fund offers, including academic tutoring, professional development opportunities, and a 5-week first-year orientation, and whether these resources translate into intergenerational success for the target population.

The indigenous people of Peninsular Malaysia, locally known as the Orang Asli, are vulnerable to outbreaks and novel threats such as Disease X. This is due to socioeconomic challenges, limited healthcare access, and exposure to zoonotic spillover. Outbreaks in this community often result in fatalities, yet their interest in preparedness is low and no tailored intervention exists. This study describes the development of X-SIAGA, an intervention to improve household-level preparedness for Disease X and outbreaks among the Orang Asli in Selangor using the Intervention Mapping (IM) approach, a systematic framework for developing theory&#x2011; and evidence&#x2011;based health interventions. The six-step IM framework was applied: needs assessment, setting program goals, selecting intervention methods, developing components, implementation planning, and program evaluation. Evaluation involved validation of X-SIAGA and its measurement tool, Household Outbreak Preparedness Evaluation (HOPE) questionnaire, with experts (n&#x2009;=&#x2009;5) and community members (n&#x2009;=&#x2009;14), and a pilot test (n&#x2009;=&#x2009;18) to assess its acceptability and preliminary effectiveness. Needs assessment confirmed the necessity of a tailored intervention for outbreak and Disease X household preparedness. Findings guided the development of logic models, outcomes, and objectives. Both X-SIAGA and HOPE showed high content and face validity (validity indexes 0.97 to 1.0). The pilot test showed high acceptability (83.3%), and HOPE measured a significant improvement in household preparedness following X-SIAGA (mean difference&#x2009;=&#x2009;0.22, 95% CI&#x2009;=&#x2009;0.17-0.27, p&#x2009;<&#x2009;0.001, Cohen's d&#x2009;=&#x2009;1.99). X-SIAGA is a comprehensive, evidence- and theory-based intervention designed to improve household preparedness for Disease X and outbreaks among the Orang Asli in Selangor. It is valid, feasible, and acceptable in the community. X-SIAGA shows promise and is ready for full-scale trial evaluation and long-term assessment, with potential for adaptation in other communities.

To evaluate the feasibility and potential effectiveness of a structured psychoeducational group program aimed at enhancing resilience and reducing burnout among primary healthcare workers. A single-arm pre-post implementation study conducted between September 2022 and February 2024. Trial registration at ClinicalTrials.gov: NCT05720429. SITE: 81 primary care centers of the Catalan Health Institute. Primary care professionals from all occupational profiles were eligible. A 11-session program, delivered by community psychologists, combined psychoeducational content, interactive activities, and relaxation techniques. Outcomes were measured before and immediately after the intervention using the Connor-Davidson Resilience Scale and the burnout subscale of the Professional Quality of Life Scale. Analyses included effect sizes and multivariate models to identify predictors of change. Of 1419 baseline participants, 387 (87.1% women; median age 47 years) completed both assessments. Resilience increased significantly post-intervention (p=0.001; effect size=0.21), with larger gains in men and younger participants. Burnout decreased significantly (p=0.001; effect size=0.21), particularly among physicians. Higher baseline secondary traumatic stress predicted greater burnout reduction. Program overall assessment, feasibility and satisfaction were high. This psychoeducational group intervention was feasible, well-received, and associated with modest but significant improvements in resilience and burnout. Targeted benefits were observed for specific subgroups, suggesting value in tailoring content to professional role and baseline emotional burden. Evaluar la viabilidad y la efectividad de un programa grupal psicoeducativo para fortalecer la resiliencia y reducir el burnout entre los profesionales de atenci&#xf3;n primaria. Estudio de implementaci&#xf3;n con un solo grupo y mediciones pre y post-intervenci&#xf3;n. Registro en ClinicalTrials.gov: NCT05720429. 81 centros de atenci&#xf3;n primaria del Institut Catal&#xe0; de la Salut. Profesionales de atenci&#xf3;n primaria de diversos perfiles laborales. Programa de 11 sesiones impartido por psic&#xf3;logos comunitarios, combinando contenidos psicoeducativos, din&#xe1;micas participativas y t&#xe9;cnicas de relajaci&#xf3;n. Las variables de resultado se evaluaron antes y despu&#xe9;s de la intervenci&#xf3;n mediante la Connor&#x2013;Davidson Resilience Scale y la subescala de burnout de la Professional Quality of Life Scale. Se calcularon tama&#xf1;os del efecto y se aplicaron modelos multivariantes para identificar predictores del cambio. De los 1.419 participantes iniciales, 387 (87,1% mujeres; edad mediana 47 a&#xf1;os) completaron ambas evaluaciones. La resiliencia aument&#xf3; significativamente tras la intervenci&#xf3;n (p&#xa0;=&#xa0;0,001; tama&#xf1;o del efecto&#xa0;=&#xa0;0,21), especialmente en hombres y participantes m&#xe1;s j&#xf3;venes. El burnout se redujo significativamente (p&#xa0;=&#xa0;0,001; tama&#xf1;o del efecto&#xa0;=&#xa0;0,21), especialmente en m&#xe9;dicos. El nivel basal de estr&#xe9;s traum&#xe1;tico secundario se asoci&#xf3; con una mayor reducci&#xf3;n del burnout. La viabilidad, la aceptaci&#xf3;n y la valoraci&#xf3;n global del programa fueron elevadas. El programa grupal psicoeducativo demostr&#xf3; ser viable, bien valorado y asociado con mejoras modestas en la resiliencia y el burnout. Los resultados sugieren beneficios diferenciales seg&#xfa;n perfil profesional y carga emocional inicial, lo que refuerza la conveniencia de adaptar el contenido a las caracter&#xed;sticas de los participantes.

Disasters are increasing globally, necessitating enhanced disaster response competencies among frontline nurses. Tabletop exercise (TTX), as a low-resource, immersive scenario-based training tool, offers significant potential for improving nurses' disaster preparedness. However, systematic evaluations of nurse-centered TTX programs remain scarce in China. This study aimed to comprehensively evaluate the effectiveness of a nurse-tailored competitive TTX program using the Kirkpatrick model. A sequential explanatory mixed-methods design was adopted. A 270-min TTX competition program covering three disaster themes was implemented for 90 nurses from 30 healthcare institutions in Anhui Province. In accordance with the Kirkpatrick model, quantitative data from 85 participants were collected using the Student Satisfaction and Self-Confidence in Learning Scale (SCLS), Simulation Design Scale (SDS), Nursing Disaster Emergency Knowledge Scale (NDEKS), and Educational Practices Questionnaire (EPQ). Additionally, a survey on disaster-related activities in participants' institutions in 2025 was conducted. For the qualitative phase, maximum variation sampling was employed to purposely select 10 nurses for semi-structured interviews, and the qualitative data were analyzed using Colaizzi's methodological framework. The TTX program achieved positive outcomes across all four Kirkpatrick levels. At the Reaction Level, SCLS scores (4.42&#x202f;&#xb1;&#x202f;0.54) and SDS scores (4.38&#x202f;&#xb1;&#x202f;0.52) reflected nurses' high satisfaction and recognition of program design. At the Learning Level, all six core domain scores of the NDEKS improved significantly post-TTX (all p&#x202f;<&#x202f;0.001). At the Behavior Level, the EPQ total score reached 4.40&#x202f;&#xb1;&#x202f;0.55, indicating effective cultivation of positive behavioral tendencies. At the Results Level, the program drove remarkable regional disaster nursing development in Anhui Province in 2025, evidenced by over 220 science popularization activities, the establishment of new municipal committees, and diversified continuing education programs. Qualitative analysis identified four key themes, further supplementing and validating the quantitative findings of the TTX program's multi-dimensional effectiveness. The nurse-tailored competitive TTX program, evaluated through the Kirkpatrick model, effectively enhances disaster knowledge, core competencies, and interdisciplinary collaboration while demonstrating tangible regional impact. This integrated evaluation framework provides robust evidence for optimizing disaster nursing training and strengthening healthcare system resilience.

Sustainment of evidence-based programs within dynamic health care environments requires ongoing adaptation to internal and external changes. Yet, strategies to support the sustainment of large-scale programs in heterogeneous settings are understudied. We developed and implemented a 3-phase participatory approach to support the sustainment of GRECC Connect, a 19-site Veterans Health Administration program that uses a hub-and-spoke model to expand rural access to geriatric specialty care. Our goal is to describe a novel participatory approach for identifying sustainment strategies for large-scale health care programs in complex environments, using our experience with GRECC Connect as an example to illustrate the application of this approach. We implemented the following 3-phase participatory approach with GRECC Connect team members from 19 hub sites. Phase 1: hub site clinicians and staff completed the Program Sustainment Assessment Tool, a publicly available online self-assessment of sustainability capacity. Phase 2: all sites then participated in a virtual retreat to exchange information, knowledge, and experiences related to sustainment strategies. Phase 3: each site submitted a locally-developed sustainment plan created with input from hub site team members. The sustainment plan worksheet included 3 questions asking respondents to reflect on the value of the participatory approach to sustainment. The process and experience of implementing this approach were also documented in structured meeting notes. Responses to Likert scale questions were analyzed with descriptive statistics, and qualitative data were analyzed using conventional content analysis. Overall, there was a high level of participation across all 19 hub sites. In phase 1, a total of 25 individuals from 14 sites responded to the Program Sustainment Assessment Tool survey; in phase 2, a total of 58 individuals from 19 sites attended the retreat; and in phase 3, a total of 17 site sustainment plans were completed. Three primary sustainment paths were proposed and discussed during the retreat. Sites varied in their confidence to sustain program activities, but were able to articulate several barriers and facilitators specific to their site. The level of specificity in the sustainment plans varied considerably across sites. Most sites reported that this participatory approach was "very useful" (ie, &#x2265;7 on a 10-point Likert scale) for planning their program sustainment. This approach offered a framework for sites to learn from one another, anticipate local barriers and facilitators, and move from reflection to identifying next steps for maintaining core program activities. Here, we describe the process used to guide 19 site teams through sustainment activities. We found the process is well-received, with sites reporting that their participation was useful for planning their sustainment journey. In elucidating our process, we provide a blueprint for other programs seeking to support sustainment across heterogeneous health care networks.

This systematic review aims to summarize the effectiveness, acceptability, and potential mechanisms of chatbot-based interventions in improving diet, physical activity, and tobacco use behaviors. This protocol follows the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P). We will include individual- or cluster-randomized, parallel-group controlled trials that compare chatbot-based interventions with active-control, waiting-list, or usual-control comparators among children, adults, and the elderly irrespective of their behavioral patterns at baseline. We will also include the non-randomized or single-group trials to expand the evidence base. The primary outcomes will be the change in diet, physical activity, and tobacco use behaviors assessed by validated questionnaires or objective measures. The secondary outcomes will include the change in obesity-related outcomes, stage of behavioral change, change of motivation, emotion, knowledge, or other constructs that might mediate the intervention effect, chatbot use behaviors during the process of intervention implementation, the facilitators and barriers to chatbot use, and safety issues. We will search both the studies published in PubMed, EMBASE, ACM Digital Library, Web of Science, PsycINFO, CINAHL, and IEEE and the unpublished studies in the WHO's International Clinical Trials Registry Platform, ClinicalTrials.gov, conference proceedings, GitHub, and arXiv. We will group the included studies based on their consistency in the Population, Intervention, Comparator, Outcome and Study design (PICOS) elements for data synthesis. The random-effects meta-analysis will be used to quantitatively synthesize the results across studies if data permits; otherwise, we will synthesize the study results based on the guideline of Synthesis Without Meta-analysis (SWiM). We will use the correlation-based meta-analytical structural equation modeling approach to examine the presence of mediators of chatbot-based interventions. We will assess the risk of bias for each included study using the revised version of the Cochrane risk-of-bias tool for randomized trials (RoB 2) or the Risk of Bias In Non-randomized Studies of Interventions (ROBINS-I), and appraise the certainty of the evidence for each synthesized result using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. This systematic review will not only answer whether the state-of-the-art chatbot-based interventions are acceptable and effective in changing a person's diet, physical activity, and tobacco use behaviors but also explore the potential mechanisms underlying the effects of the chatbot-based interventions. The findings of this study will pave the way for optimizing future chatbot-based interventions in the field of health-related behaviors. PROSPERO CRD42023492013.

Radiation dose to circulating blood, a surrogate for circulating lymphocyte damage by radiotherapy (RT), has emerged as a factor predicting treatment outcomes, including overall survival, tumor recurrence, and lymphopenia occurrence. This study aimed to investigate strategies for reducing circulating blood dose in head and neck cancer (HNC) patients by comparing treatment plans, the implementation of which varied by modality and blood vessel-sparing (BVS) approach. Using a publicly available dataset, 20 HNC patients were randomly selected and a total of 120 treatment plans were generated using RayStation. For each of the two modalities, including intensity-modulated radiation therapy (IMRT) and intensity-modulated proton therapy (IMPT), three planning strategies were evaluated: a conventional plan (Conv) and two blood vessel-sparing plans with mean dose constraints targeting 90% and 80% of the conventional vessel dose (BVS-90% and BVS-80%, respectively). Blood dose was estimated using the HEDOS simulation framework. IMPT reduced circulating blood dose compared to IMRT, lowering the mean blood dose by 21.5% and D90% by 31.8%. The BVS-80% constraint further decreased the mean blood dose by 12.5% for IMPT and 12.6% for IMRT, while the intermediate BVS-90% constraint yielded reductions of 8%. These reductions were achieved without clinically meaningful compromise in target coverage or increase in dose to other organs-at-risk (OARs). Monitor unit analysis revealed no significant increase in delivery complexity with BVS planning. In this preliminary planning study, incorporating blood-rich structures as OARs and adopting IMPT effectively reduced blood dose. Integrating blood dose considerations into RT planning is readily implementable within existing clinical workflows to minimize lymphocyte damage.

Information on childhood cancer burden is crucial for effective cancer policy planning. Unfortunately, observed paediatric cancer data are not available in every country, and previous global burden estimates have not discretely reported several common cancers of childhood. We aimed to inform efforts to address childhood cancer burden globally by analysing results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023, which now include nine additional cancer causes compared with previous GBD analyses. GBD 2023 data sources for cancer estimation included population-based cancer registries, vital registration systems, and verbal autopsies. For childhood cancers (defined as those occurring at ages 0-19 years), mortality was estimated using cancer-specific ensemble models and incidence was estimated using mortality estimates and modelled mortality-to-incidence ratios (MIRs). Years of life lost (YLLs) were estimated by multiplying age-specific cancer deaths by the standard life expectancy at the age of death. Prevalence was estimated using survival estimates modelled from MIRs and multiplied by sequelae-specific disability weights to estimate years lived with disability (YLDs). Disability-adjusted life-years (DALYs) were estimated as the sum of YLLs and YLDs. Estimates are presented globally and by geographical and resource groupings, and all estimates are presented with 95% uncertainty intervals (UIs). Globally, in 2023, there were an estimated 377&#x2008;000 incident childhood cancer cases (95% UI 288&#x2008;000-489&#x2008;000), 144&#x2008;000 deaths (131&#x2008;000-162&#x2008;000), and 11&#xb7;7 million (10&#xb7;7-13&#xb7;2) DALYs due to childhood cancer. Deaths due to childhood cancer decreased by 27&#xb7;0% (15&#xb7;5-36&#xb7;1) globally, from 197&#x2008;000 (173&#x2008;000-218&#x2008;000) in 1990, but increased in the WHO African region by 55&#xb7;6% (25&#xb7;5-92&#xb7;4), from 31&#x2008;500 (24&#x2008;900-38&#x2008;500) to 49&#x2008;000 (42&#x2008;600-58&#x2008;200) between 1990 and 2023. In 2023, age-standardised YLLs due to childhood cancer were inversely correlated with country-level Socio-demographic Index. Childhood cancer was the eighth-leading cause of childhood deaths and the ninth-leading cause of DALYs among all cancers in 2023. The percentage of DALYs due to uncategorised childhood cancers was reduced from 26&#xb7;5% (26&#xb7;5-26&#xb7;5) in GBD 2017 to 10&#xb7;5% (8&#xb7;1-13&#xb7;1) with the addition of the nine new cancer causes. Target cancers for the WHO Global Initiative for Childhood Cancer (GICC) comprised 47&#xb7;3% (42&#xb7;2-52&#xb7;0) of global childhood cancer deaths in 2023. Global childhood cancer burden remains a substantial contributor to global childhood disease and cancer burden and is disproportionately weighted towards resource-limited settings. The estimation of additional cancer types relevant in childhood provides a step towards alignment with WHO GICC targets. Efforts to decrease global childhood cancer burden should focus on addressing the inequities in burden worldwide and support comprehensive improvements along the childhood cancer diagnosis and care continuum. St Jude Children's Research Hospital, Gates Foundation, and St Baldrick's Foundation.

Previous research suggests that many hospitalized adults have unmet oral health needs and could benefit from discharge planning that includes linkage to dental care. This study protocol describes the planned implementation and evaluation of a study to develop and implement a system for referral to community dental providers with the goal of improving dental care utilization after hospitalization. A preexperimental research design will be utilized to evaluate the feasibility of recruiting hospital inpatients for a program to improve their basic oral health knowledge and assist them in selecting a&#xa0;community dental provider within a newly established network and making an appointment to receive dental&#xa0;care. This study will be implemented within the general medicine service in a metropolitan medical center for adult inpatients (&#x2265;&#x2009;18 years) who have dental insurance coverage but report having not seen a dental provider in the past year. The study aims to recruit at least 60 hospitalized patients and identify at least 10 local dental providers to create a referral network. Local dental providers will be identified via online internet searches, referrals from hospital community partners, and word of mouth, and invited for participation. Improvements in oral health knowledge will be measured by a simple pre-/posttest. Patients will be recruited while hospitalized through a large, preexisting, and ongoing hospital-based longitudinal study. The expected outcomes for this study are (1) improved knowledge about oral health care and (2)&#xa0;attendance of dental appointments by study enrollees. This study will provide evidence regarding the feasibility of implementing a hospital-based referral program to increase patient oral health knowledge and engagement with routine dental care after hospitalization.