To evaluate the effectiveness of Health-E You/Salud iTu, a mobile health application (app), on increasing knowledge, self-efficacy and contraception use among Latina adolescents, its impact on visit ...quality, and app satisfaction.
This study used cluster-randomized controlled trial (CRCT) of 18 school-based health centers (SBHCs). Prior to the visit, intervention participants received the patient-centered contraceptive decision-making support app and controls answered sexual health questions on iPads. Participants completed a previsit questionnaire and 3 follow-up surveys (48 hours, 3-, and 6-months) after the recruitment visit (where intervention participants completed the app). Differences in adolescents’ contraceptive knowledge, self-efficacy, and use over the 6-month follow-up were assessed by generalized mixed effects regression models.
A total of 1,360 Latina adolescents participated; 57.2% responded to the 48-hour survey, 50.1% to the 3-month, 49.7% to the 6-month, and 42.3% to both the 3- and 6-month surveys. Health-E You users’ demonstrated significant increases in pre-post knowledge (p < 0.001). Intervention participants who completed the follow-up survey reported greater increases in mean self-efficacy from baseline (23.2 intervention vs. 22.5 controls) to 6 months (26.1 vs. 23.4; b = 1.58, 95% CI 0.38–2.77, p = 0.01), and greater increases in non-barrier contraceptive use from baseline (29% intervention vs. 30% controls) to 3 months (63% vs. 45%; OR = 3.29, 95% CI 1.04–10.36, p = 0.04) and 6 months (63% vs. 44%; OR = 5.54, 95% CI 1.70–18.06, p = 0.005). Providers and adolescents reported high app satisfaction and stated it improved visit quality.
While data suggest that Health-E You improved outcomes, findings must be interpreted cautiously. Intervention participants had higher baseline sexual activity rates, more recruitment visits for pregnancy testing, emergency contraception or birth control, and lower completion rates of follow-up surveys than controls.
Despite declines in adolescent pregnancy in the United States, Latinas continue to have disproportionately high rates compared to white females. The Health-E You app may be an effective support tool for both adolescents and providers in SBHCs, and possibly other clinical settings, across the country to increase contraceptive use and thereby decrease unintended pregnancies. It could potentially reduce disparities in adolescent pregnancies and create more efficient visit time spent between clients and their providers.
Current investment in conservation is insufficient to adequately protect and recover all ecosystems and species. The challenge of allocating limited funds is acute for Pacific salmon Oncorhynchus ...spp. in Canada, which lack a strategic approach to ensure that resources are spent on actions most likely to cost‐effectively recover diminished populations.
We applied the Priority Threat Management framework to prioritize strategies most likely to maximize the number of thriving Pacific salmon populations on the Central Coast of British Columbia, Canada. These included 79 genetically, ecologically and spatially distinct population groups called conservation units (CUs) for five salmon species. This region has high salmon biodiversity and spans the territories of four First Nations: the Heiltsuk, Nuxalk, Kitasoo/Xai'xais and Wuikinuxv.
Using structured expert elicitation of Indigenous and other experts, we quantified the estimated benefits, costs and feasibility of implementing 10 strategies. Under a business‐as‐usual scenario (i.e. no additional investments in salmon conservation or management), experts predicted that only one in four CUs would have >50% chance of achieving a thriving status within 20 years. Limiting future industrial development in salmon habitats, which was predicted to safeguard CUs from future declines, was identified as the most cost‐effective strategy. Investment in three strategies: (a) removal of artificial barriers to fish migration, (b) watershed protection and (c) stream restoration—at 11.3M CAD per year—was predicted to result in nearly half (34 of 79) of the CUs having a >60% chance of meeting the conservation objective.
If all conservation strategies were implemented, experts estimated a >50% probability of achieving a thriving status for 78 of 79 CUs, at an annual cost of 17.3M CAD. However, even with the implementation of all strategies, most sockeye salmon CUs were unlikely to achieve higher probability targets of reaching the objective.
Policy implications. We illustrate how Priority Threat Management can incorporate the perspectives and expertise of Indigenous peoples and other experts to prioritize conservation strategies based on their cost, benefit and feasibility. Implementation of this framework can help safeguard and recover Pacific salmon in Canada, and could also be used to prioritize actions for other conservation issues globally.
We illustrate how Priority Threat Management can incorporate the perspectives and expertise of Indigenous peoples and other experts to prioritize conservation strategies based on their cost, benefit and feasibility. Implementation of this framework can help safeguard and recover Pacific salmon in Canada, and could also be used to prioritize actions for other conservation issues globally.
Increasing population and life standards causes fossil fuel consumption to increase. Due to this increasing consumption, fossil fuels are being depleted rapidly. In addition to rapid exhaustion, ...another important problem associated with fossil fuels is that their consumption has major negative impacts on the environment. Therefore, many countries around the world have included renewable energy systems (RES) in their future energy plans so that they can produce reliable and environmentally friendly energy. Parallel to this trend, various RES have been identified and recently integrated into the current energy network of Turkey as well. However, it should be recognized that renewable energy resources are not fully environmentally safe. Different RES are associated with different environmental impacts. In planning the future energy development of a country, evaluation of renewable energy resources potentials together with their associated environmental impacts is critical. The aim of this study is to create a decision support system for site selection of wind turbines using Geographic Information System (GIS) tools. Wind energy potential and environmental fitness/acceptability are used as decision criteria for the site selection process. Potential environmental impacts of wind generation are identified in accordance with Turkish legislations and previous studies; and represented as fuzzy objectives of the decision problem. Wind potential map of Turkey generated by General Directorate of Electrical Power Resources Survey and Development is used to identify economically feasible locations in terms of wind energy generation. A study area composed of Usak, Aydin, Denizli, Mugla, and Burdur provinces in Turkey is selected and divided into 250
m
×
250
m grids. Each grid represents an alternative location for a wind turbine or group of wind turbines. Fuzzy environmental objectives such as “Acceptable in terms of noise level”, “Acceptable in terms of bird habitat”, “Acceptable in terms of safety and aesthetics” and “Safe in terms of natural reserves” associated with wind turbines are identified based on previous research and each of these objectives are represented by a fuzzy set. Individual satisfaction degree of each of these environmental objectives for each grid is calculated. Then these individual satisfactions are aggregated into an overall satisfaction degree using various aggregator operators such as “and”, “or”, and “order weighted averaging.” Thus, an overall satisfaction degree of all the environmental objectives is obtained for each grid in the study area. A map of environmental fitness is developed in GIS environment by using these overall satisfaction degrees. Then this map is utilized together with the wind potential map of Turkey to identify both potentially and environmentally feasible wind turbine locations within the study area.
To evaluate and improve MATCH-IT – a digital, interactive decision support tool displaying structured evidence summaries for multiple comparisons – to help physicians interpret and apply evidence ...from network meta-analysis (NMA) for their clinical decision-making.
We conducted a qualitative user-testing study, applying principles from user centred design in an iterative development process. We recruited a convenience sample of practicing physicians in Norway, Belgium and Canada, and asked them to interpret structured evidence summaries for multiple comparisons – linked to clinical guideline recommendations – displayed in MATCH-IT. User-testing included (a) introduction of a clinical scenario, (b) a think aloud session with participant-tool-interaction and (c) a semi-structured interview. We video recorded, transcribed, and analysed user-tests using directed content analysis. The results informed new updates in MATCH-IT.
Distributed across five development cycles we tested MATCH-IT with 26 physicians. Of these, 24 (94%) reported either no or sparse prior experience with interpretation of NMA. Physicians perceived MATCH-IT as easy to interpret, navigate and appreciated its ability to provide an overview of the evidence. Visualization of effects in pictograms and inclusion of information on burden of treatment (“practical issues”) were highlighted as potentially useful features in interacting with patients. We also identified problems, including undiscovered functionalities (drag and drop), suboptimal tutorial, and cumbersome navigation of the tool. In addition, physicians wanted definition/explanation of key terms (e.g., outcomes and “certainty”) and there were concerns that overwhelming evidence from a large NMA would complicate applicability to clinical practice. This led to several updates with development of a new start page, tutorial, updated user-interface for more efficient manoeuvring, solutions to display definition of key terms and a FAQ section. To facilitate interpretation of large networks, we improved categorization of results using colour coding and added filtering functionality. These modifications allowed physicians to focus on interventions of interest and reduce information overload.
This study provides proof of concept that physicians can use MATCH-IT to understand NMA evidence. Key features of MATCH-IT in a clinical context include providing an overview of the evidence, visualization of effects and the display of information on burden of treatments. However, unfamiliarity with GRADE concepts, time constraints and accessibility at the point of care may be challenges for use. To what extent our results are transferable to real-world clinical contexts remains to be explored.
What is new?
Key findings•Practicing physicians found an interactive tool (MATCH-IT) that dynamically displays structured evidence summaries for multiple comparisons understandable and useful.
What this adds to what is known?•Interactive Summary of Findings tables for multiple comparisons may enhance physicians understanding of complex bodies of evidence.•In a clinical setting evidence from network meta-analyses should be categorized and prefiltered to reduce information overload.
What is the implication, what should change now?•Researchers are encouraged to include MATCH-IT in network meta-analyses and clinical practice guidelines informed by multiple comparisons.•Further research is needed to explore the functioning of MATCH-IT at the point of care.
•Development of a decision-support tool for innovative electrical microgrid design.•Microgrid design with technological and management parameters.•Physical modelling of conversion and storage ...technologies and sequential simulation.•Multi-objective non-weighted optimization with NSGA-II genetic algorithm.•Variety of compromises between economic, technical and environmental indicators.
Centralized electrical networks induce a dependency of local territories for their power supply. However, thanks to microgrids, territories can increase their decision-making autonomy to design a network that matches their values. Technological and management choices are critical to minimize microgrids negative impacts on their environment. Influence of the latter on the design space is rarely discussed whereas extending the design space would help to find innovative microgrids. The purpose of this paper is to find several microgrids with various performances and parameters that are compromises between economic, technical and environmental objectives. The solutions’ variety therefore extends the decision-makers’ design space. A tool has been developed to answer this goal. Design parameters are both technological and management parameters. A physical modelling is implemented in a sequential simulation of the microgrid operation. The performance of the simulation allows to use genetic algorithms to perform multi-objective non-weighted optimizations. Two two-objective optimizations are performed. Results show how the solutions’ diversity in terms of performances and parameters helps the user choosing innovative microgrids. Especially, it underlines the potential of this approach to find microgrids with close performances but different parameters.
•A simulation-based decision support tool for in-house logistics is developed.•Both distribution and a production facilities are considered towards logistics 4.0.•The resulted models are verified and ...validated based on two real-world operations.•The models can be applied in different in-house logistics settings.
In-house logistics activities are an essential part of any organisation as they improve operations productivity and efficiency. In this context, agile decision-making raises the need for planning the overall shop-floor operations and effectively control them. This work tackles this need and proposes a simulation-based decision support tool for in-house logistics that analyses the activities that can occur in both a distribution facility and a production facility towards logistics 4.0. This is done by developing two simulation models using Simio – simulationmodelling framework based on intelligent objects. The resulted models are verified and validated based on two real-world operations. As a conclusion, the developed models are representative of the reality and can be applied in different in-house logistics settings, functioning as digital-twinning tools to operations improvement without real sets disruption.
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•Current environmental risk assessment approaches hamper offshore energy expansion.•Strategically planned DST development can enable substantial savings, improving resource efficiency ...and high quality EIA.•The main midrange scenario results in potential cost savings of 1,580 M€ until 2050.•The DST development is beneficial for economy of future energy development and marine environmental protection.
In the transition to a sustainable energy system, there is an urgent need for expansion of offshore renewable energy installations. To ensure sustainable development also with respect to the marine environment, a variety of decision support tools (DSTs) are currently under development, aiming at potentially increased quality and efficiency for environmental risk assessment (EIA) of planned offshore energy installations. However, the savings potential of a DSTs is to a large extent governed by the timing of the DST development, which in turn is directly dependent on the investment rate over time. A set of development scenarios were evaluated, simulating different degrees of strategic implementation and successful utilization of the DST for offshore energy. Using the situation in Sweden as a case study, we demonstrate that a planned investment can lead to considerably lower total costs for the EIA at a national level, at the same time allowing for improved quality of the EIA in line with the ambitions in both marine spatial planning and existing goals within marine environmental management.
Increasing fertilizer access and use is an essential component for improving crop production and food security in sub-Saharan Africa (SSA). However, given the heterogeneous nature of smallholder ...farms, fertilizer application needs to be tailored to specific farming conditions to increase yield, profitability, and nutrient use efficiency. The site-specific nutrient management (SSNM) approach initially developed in the 1990 s for generating field-specific fertilizer recommendations for rice in Asia, has also been introduced to rice, maize and cassava cropping systems in SSA. The SSNM approach has been shown to increase yield, profitability, and nutrient use efficiency. Yield gains of rice and maize with SSNM in SSA were on average 24% and 69% when compared to the farmer practice, respectively, or 11% and 4% when compared to local blanket fertilizer recommendations. However, there is need for more extensive field evaluation to quantify the broader benefits of the SSNM approach in diverse farming systems and environments. Especially for rice, the SSNM approach should be expanded to rainfed systems, which are dominant in SSA and further developed to take into account soil texture and soil water availability. Digital decision support tools such as RiceAdvice and Nutrient Expert can enable wider dissemination of locally relevant SSNM recommendations to reach large numbers of farmers at scale. One of the major limitations of the currently available SSNM decision support tools is the requirement of acquiring a significant amount of farm-specific information needed to formulate SSNM recommendations. The scaling potential of SSNM will be greatly enhanced by integration with other agronomic advisory platforms and seamless integration of digital soil, climate and crop information to improve predictions of SSNM recommendations with reduced need for on-farm data collection. Uncertainty should also be included in future solutions, primarily to also better account for varying prices and economic outcomes.
•The SSNM approach was adapted for rice, maize and cassava production systems in SSA.•The SSNM approach increased yield, profitability, and nutrient use efficiency.•SSNM had 24% and 69% higher yield than the farmer practice for rice and maize.•Rice and maize yields were 11% and 4% higher in SSNM than local recommendations.•Integration with other digital platforms and databases can improve SSNM tools.
Digestate is a byproduct of anaerobic digestion, which can be considered waste or a product of potential use for the chemical industry or agriculture. In either case, the digestate must usually be ...treated prior to being disposed of or valorized. This review describes digestate processing technologies and their specific characteristics. Nutrient recovery and removal from digestate can be achieved through mechanical, physicochemical or biological processes. Available and potential digestate treatment techniques are presented. The complexities of the technologies available, legislation, the agronomical value of the digestate and the economic value of the process mean a decision support tool is required to help managers choose the best digestate processing technology. To ensure adequate analysis, the whole biomethanization project should be integrated in the use of these decision support tools. The objectives and limits of some of the currently available tools are analyzed at the end of this review.
Over 10% of children with Wilms tumor (WT) have an underlying cancer predisposition syndrome (CPS). Cognizant of increasing demand for genetic evaluation and limited resources across health care ...settings, there is an urgent need to rationalize genetic referrals for this population. The McGill Interactive Pediatric OncoGenetic Guidelines study, a Canadian multi‐institutional initiative, aims to develop an eHealth tool to assist physicians in identifying children at elevated risk of having a CPS. As part of this project, a decisional algorithm specific to WT consisting of five tumor‐specific criteria (age <2 years, bilaterality/multifocality, stromal‐predominant histology, nephrogenic rests, and overgrowth features) and universal criteria including features of family history suspicious for CPS and congenital anomalies, was developed. Application of the algorithm generates a binary recommendation—for or against genetic referral for CPS evaluation. To evaluate the algorithm's sensitivity for CPS identification, we retrospectively applied the tool in consecutive pediatric patients (n = 180) with WT, diagnosed and/or treated at The Hospital for Sick Children (1997–2016). Odds ratios were calculated to evaluate the strengths of associations between each criterion and specific CPS subtypes. Application of the algorithm identified 100% of children with WT and a confirmed CPS (n = 27). Age <2 years, bilaterality/multifocality, and congenital anomalies were strongly associated with pathogenic variants in WT1. Presence of >1 overgrowth feature was strongly associated with Beckwith‐Wiedemann syndrome. Stromal‐predominant histology did not contribute to CPS identification. We recommend the incorporation of the WT algorithm in the routine assessment of children with WT to facilitate prioritization of genetic referrals in a sustainable manner.
What's new?
Over 10% of children with Wilms tumor (WT) have an underlying cancer predisposition syndrome (CPS). CPS recognition can lead to immediate changes in first line cancer therapy, implementation of surveillance strategies, and genetic counselling of family members. Here, as part of the MIPOGG (McGill Interactive Pediatric OncoGenetic Guidelines) study, the authors report the effectiveness of a novel, easy‐to‐use eHealth decision‐support tool in identifying those patients diagnosed with WT who are at highest likelihood of having an underlying CPS. These findings provide a systematic approach for pediatric oncologists worldwide to rationalize genetic referral practices and genetic testing for children with Wilms tumor.
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