Integrating Sexual and Reproductive Health Equity Into Public Health Goals and Metrics: Comparative Analysis of Healthy People 2030's Approach and a Person-Centered Approach to Contraceptive Access Using Population-Based Data.

BACKGROUND: The Healthy People initiative is a national effort to lay out public health goals in the United States every decade. In its latest iteration, Healthy People 2030, key goals related to contraception focus on increasing the use of effective birth control (contraceptive methods classified as most or moderately effective for pregnancy prevention) among women at risk of unintended pregnancy. This narrow focus is misaligned with sexual and reproductive health equity, which recognizes that individuals' self-defined contraceptive needs are critical for monitoring contraceptive access and designing policy and programmatic strategies to increase access. OBJECTIVE: We aimed to compare 2 population-level metrics of contraceptive access: a conventional metric, use of contraceptive methods considered most or moderately effective for pregnancy prevention among those considered at risk of unintended pregnancy (approximating the Healthy People 2030 approach), and a person-centered metric, use of preferred contraceptive method among current and prospective contraceptive users. METHODS: We used nationally representative data collected in 2022 to construct the 2 metrics of contraceptive access; the overall sample included individuals assigned female at birth not using female sterilization or otherwise infecund and who were not pregnant or trying to become pregnant (unweighted N=2760; population estimate: 43.9 million). We conducted a comparative analysis to examine the convergence and divergence of the metrics by examining whether individuals met the inclusion criteria for the denominators of both metrics, neither metric, only the conventional metric, or only the person-centered metric. RESULTS: Comparing the 2 approaches to measuring contraceptive access, we found that 79% of respondents were either included in or excluded from both metrics (reflecting that the metrics converged when individuals were treated the same by both). The remaining 21% represented divergence in the metrics, with an estimated 5.7 million individuals who did not want to use contraception included only in the conventional metric denominator and an estimated 3.5 million individuals who were using or wanted to use contraception but had never had penile-vaginal sex included only in the person-centered metric denominator. Among those included only in the conventional metric, 100% were content nonusers-individuals who were not using contraception, nor did they want to. Among those included only in the person-centered metric, 68% were currently using contraception. Despite their current or desired contraceptive use, these individuals were excluded from the conventional metric because they had never had penile-vaginal sex. CONCLUSIONS: Our analysis highlights that a frequently used metric of contraceptive access misses the needs of millions of people by simultaneously including content nonusers and excluding those who are using or want to use contraception who have never had sex. Documenting and quantifying the gap between current approaches to assessing contraceptive access and more person-centered ones helps clearly identify where programmatic and policy efforts should focus going forward.

Mesophotic zone as buffer for biodiversity protection: A promising opportunity to enhance MPA effectiveness.

Coastal areas conservation strategies often left deeper habitats, such as mesophotic ones, unprotected and exposed to anthropogenic activities. In this context, an approach for including the mesophotic zone inside protection plans is proposed, considering 27 Italian Marine Protected Areas (MPAs) as a model. MPAs were classified considering their bathymetries, exposure to marine heat waves (MHWs), mass mortality events (MMEs) and, using a local ecological knowledge (LEK) approach, the estimated resilience of certain sessile species after MMEs. Only 8 MPAs contained considerable mesophotic areas, with stronger MHWs mainly occurring in shallower MPAs, and MMEs mostly affecting coralligenous assemblages. Even with only a 10% response rate, the LEK approach provided useful information on the resilience of certain species, allowing us to suggest that the presence of nearby mesophotic areas can help shallower habitats facing climate change, thus making the "deep refugia" hypothesis, usually related to tropical habitats, applicable also for the Mediterranean Sea.

Dysphagia and chest pain in a 7-year-old girl.

Dysphagia is a common gastrointestinal complaint in the pediatric population and should raise concern for oropharyngeal as well as esophageal disorders. We describe a 7-year old patient who was admitted to the hospital for sudden onset dysphagia, abdominal pain, and decreased oral intake. Extensive evaluations including endoscopy eventually revealed herpes simplex esophagitis as well as eosinophilic esophagitis. Herpes simplex esophagitis is a rare condition in the immunocompetent population and is typically self-resolving. Eosinophilic esophagitis is a chronic, inflammatory condition characterized by esophageal eosinophilia and signs of esophageal dysfunction. The concurrent presentation of both conditions in the pediatric population has rarely been described.

Assessment during clinical education among nursing students using two different assessment instruments.

BACKGROUND: Assessment of undergraduate students using assessment instruments in the clinical setting is known to be complex. The aim of this study was therefore to examine whether two different assessment instruments, containing learning objectives (LO`s) with similar content, results in similar assessments by the clinical supervisors and to explore clinical supervisors' experiences of assessment regarding the two different assessment instruments. METHOD: A mixed-methods approach was used. Four simulated care encounter scenarios were evaluated by 50 supervisors using two different assessment instruments. 28 follow-up interviews were conducted. Descriptive statistics and logistic binary regression were used for quantitative data analysis, along with qualitative thematic analysis of interview data. RESULT: While significant differences were observed within the assessment instruments, the differences were consistent between the two instruments, indicating that the quality of the assessment instruments were considered equivalent. Supervisors noted that the relationship between the students and supervisors could introduce subjectivity in the assessments and that working in groups of supervisors could be advantageous. In terms of formative assessments, the Likert scale was considered a useful tool for evaluating learning objectives. However, supervisors had different views on grading scales and the need for clear definitions. The supervisors concluded that a complicated assessment instrument led to limited very-day usage and did not facilitate formative feedback. Furthermore, supervisors discussed how their experiences influenced the use of the assessment instruments, which resulted in different descriptions of the experience. These differences led to a discussion of the need of supervisor teams to enhance the validity of assessments. CONCLUSION: The findings showed that there were no significant differences in pass/fail gradings using the two different assessment instruments. The quantitative data suggests that supervisors struggled with subjectivity, phrasing, and definitions of the LO´s and the scales used in both instruments. This resulted in arbitrary assessments that were time-consuming and resulted in limited usage in the day-to-day assessment. To mitigate the subjectivity, supervisors suggested working in teams and conducting multiple assessments over time to increase assessment validity.

On exploiting nonparametric kernel-based probabilistic machine learning over the large compositional space of high entropy alloys for optimal nanoscale ballistics.

The large compositional space of high entropy alloys (HEA) often presents significant challenges in comprehensively deducing the critical influence of atomic composition on their mechanical responses. We propose an efficient nonparametric kernel-based probabilistic computational mapping to obtain the optimal composition of HEAs under ballistic conditions by exploiting the emerging capabilities of machine learning (ML) coupled with molecular-level simulations. Compared to conventional ML models, the present Gaussian approach is a Bayesian paradigm that can have several advantages, including small training datasets concerning computationally intensive simulations and the ability to provide uncertainty measurements of molecular dynamics simulations therein. The data-driven analysis reveals that a lower concentration of Ni with a higher concentration of Al leads to higher dissipation of kinetic energy and lower residual velocity, but with higher penetration depth of the projectile. To deal with such conflicting computationally intensive functional objectives, the ML-based simulation framework is further extended in conjunction with multi-objective genetic algorithm for identifying the critical elemental compositions to enhance kinetic energy dissipation with minimal penetration depth and residual velocity of the projectile simultaneously. The computational framework proposed here is generic in nature, and it can be extended to other HEAs with a range of non-aligned multi-physical property demands.

Using construction procurement strategy to achieve socioeconomic development objectives.

The procurement strategy for a construction project should provide the framework to achieve secondary procurement and socio-economic development objectives [2]. However, little attention has been focused on this in theory and practice. This paper addresses that gap by presenting a case study of the innovative targeting strategy developed and successfully implemented on a New Universities Project in South Africa to promote specified socioeconomic development objectives. Document analysis was used to examine how four socioeconomic development targets or key performance indicators, namely: local employment, skills development, local expenditure, and B-BBEE, were contractually integrated into the main works contracts. Four out of five framework contractors achieved the development targets, with low-performance damages applied in one case where the contractor failed to achieve all the development targets. The findings demonstrate how an appropriate construction procurement strategy that effectively integrates the packaging, targeting, and contracting strategies with effective systems for monitoring performance-based specifications, can play an essential role in promoting and realising socio-economic development objectives and social value through infrastructure projects.

Shuffling-type gradient method with bandwidth-based step sizes for finite-sum optimization.

Shuffling-type gradient method is a popular machine learning algorithm that solves finite-sum optimization problems by randomly shuffling samples during iterations. In this paper, we explore the convergence properties of shuffling-type gradient method under mild assumptions. Specifically, we employ the bandwidth-based step size strategy that covers both monotonic and non-monotonic step sizes, thereby providing a unified convergence guarantee in terms of step size. Additionally, we replace the lower bound assumption of the objective function with that of the loss function, thereby eliminating the restrictions on the variance and the second-order moment of stochastic gradient that are difficult to verify in practice. For non-convex objectives, we recover the last iteration convergence of shuffling-type gradient algorithm with a less cumbersome proof. Meanwhile, we also establish the convergence rate for the minimum iteration of gradient norms. Under the Polyak-Lojasiewicz (PL) condition, we prove that the function value of last iteration converges to the lower bound of the objective function. By selecting appropriate boundary functions, we further improve the previous sublinear convergence rate results. Overall, this paper contributes to the understanding of shuffling-type gradient method and its convergence properties, providing insights for optimizing finite-sum problems in machine learning. Finally, numerical experiments demonstrate the efficiency of shuffling-type gradient method with bandwidth-based step size and validate our theoretical results.

The international league against epilepsy primary healthcare educational curriculum: Assessment of educational needs.

OBJECTIVE: To assess the need for an epilepsy educational curriculum for primary healthcare providers formulated by the International League Against Epilepsy (ILAE) and the importance attributed to its competencies by epilepsy specialists and primary care providers and across country-income settings. METHODS: The ILAE primary care epilepsy curriculum was translated to five languages. A structured questionnaire assessing the importance of its 26 curricular competencies was posted online and publicized widely to an international community. Respondents included epilepsy specialists, primary care providers, and others from three World Bank country-income categories. Responses from different groups were compared with univariate and ordinal logistic regression analyses. RESULTS: Of 785 respondents, 60% noted that a primary care epilepsy curriculum did not exist or they were unaware of one in their country. Median ranks of importance for all competencies were high (very important to extremely important) in the entire sample and across different groups. Fewer primary care providers than specialists rated the following competencies as extremely important: definition of epilepsy (p = .03), recognition of seizure mimics (p = .02), interpretation of test results for epilepsy care (p = .001), identification of drug-resistant epilepsy (0.005) and management of psychiatric comorbidities (0.05). Likewise, fewer respondents from LMICs in comparison to UMICs rated 15 competencies as extremely important. SIGNIFICANCE: The survey underscores the unmet need for an epilepsy curriculum in primary care and the relevance of its competencies across different vocational and socioeconomic settings. Differences across vocational and country income groups indicate that educational packages should be developed and adapted to needs in different settings.

Impact of planning horizon length on traits in an economic breeding goal and ranking of selection candidates in beef cattle.

In beef production herds, unique situations such as breeding system, economic parameters, and current phenotypic performance can affect the emphasis of traits in the breeding goal and consequently the weighting of traits within a selection index. An often overlooked component of breeding goals is the planning horizon, or the time span to consider the economic impact of a selection decision, that varies between enterprises. A platform for constructing economic selection indexes (iGENDEC) was used to determine the impact of planning horizon length, breeding system, and sale endpoint on the relative emphasis of traits in the breeding goal and the re-ranking of selection candidates. As part of this investigation, the adjustment of phenotypic means for hot carcass weight and planning horizons were used to determine the impact of the relative emphasis on hot carcass weight as its mean approached a predetermined discount threshold. General-purpose indexes were created for animals sold at weaning and slaughter for three breeding systems with six different planning horizons (2, 5, 10, 20, 30, and 50 yr). As planning horizon increased, the relative emphasis on weaning weight or hot carcass weight, which affected revenue, decreased while the relative emphasis on stayability and mature weight increased. As the phenotypic mean for hot carcass weight approached and surpassed a predetermined discount threshold, the relative emphasis decreased before increasing again, once the mean weight surpassed the threshold. Rank correlations between indexes with different sale endpoints was 0.71 ±â€…0.1. Within a slaughter endpoint, re-ranking occurred between short and long planning horizons (r = 0.78 ±â€…0.09) while that of a weaning endpoint was less substantial (r = 0.85 ±â€…0.10). Jacard index scores between indexes with different planning horizons ranged from 39.7% to 87.9% and from 47.9% to 78.7% for weaning and carcass endpoints, respectively, for the top 5% of selection candidates. These results illustrate that the determination of a planning horizon can impact the rank of selection candidates and increases in net profit.

A Student-Driven Approach to Course Revitalization.

A first-year foundational science course grew beyond its scope. Revitalization of the course was driven by second and third-year medical students, who created new learning objectives and edited cases that were well-received by course facilitators and students. The students' role in the course revitalization is a novel approach.

On Persons, Populations, and Causal Mechanisms Some Critical Reflections on Lundh (2023).

While agreeing with Lundh (2023) on many of his major points, this article also questions the notion of a 'population psychology.' It is argued that the knowledge produced in population-level studies, whether correlational, experimental, or mixed, is inherently demographic in nature. Concerning individual-level studies, agreement with Lundh (2023) is expressed concerning the need to distinguish between a conception of individuals as mere depositories of neurophysiological mechanisms on the one hand, and as active, purposeful agents on the other. It is suggested that the conceptual framework called 'critical personalism' would well serve a scientific psychology committed to the latter view.

The achievement of pre-operative expectations in patients undergoing knee arthroplasty: a cohort study evaluating unique patient goals.

BACKGROUND: Total knee arthroplasty (TKA) is a common procedure employed to treat end-stage osteoarthritis. While TKA is generally believed to have acceptable outcomes, many patients report pain or functional deficits not in line with their expectation following the procedure. It has been postulated that patient's pre-operative expectations regarding post-operative treatment outcomes play a significant role in satisfaction. It is therefore important to assess if the outcomes of surgery truly align with patient's individual expectations. Thus, the purpose of this study was to determine the degree to which patient expectations of TKA are achieved and the contribution of TKA to achieving patient goals one year after surgery. METHODS: A consecutive sample of 110 patients booked for total knee arthroplasty were asked to identify their most important goals to inform the Direct Questioning of Objectives Index (DQO Index, range 0 to 1) and identify their surgical goals and grade their expectation that a knee arthroplasty would achieve each goal on an 11-point scale. One year after surgery, the DQO Index was repeated to assess their current ability to achieve each pre-operative goal, and asked to estimate the contribution of their knee arthroplasty in achieving each goal. Mean differences between baseline and one year follow-up were calculated regarding the DQO Index and expected achievement of pre-operative goals. RESULTS: According to the DQO Index at one year, patients improved from a poor quality of life pre-operatively (mean ± standard deviation: 0.20 ± 0.18) to moderately high quality of life (mean ± standard deviation: 0.71 ± 0.21) reflecting a large improvement in ability to achieve each goal. Although achievement improved, for each goal, the patient estimates of the extent to which the knee arthroplasty had contributed to achieving the goal was lower than their initial expectation provided pre-operatively (mean difference range: 0.6 to 1.9 on an 11-point scale). CONCLUSION: Patients undergoing TKA have high expectations that their surgery will address their primary goals. Despite surgery largely achieving these goals (improved pain and function), the extent to which the goals were achieved was lower than patients had expected pre-operatively.

Alignment analysis between teacher-made tests with the learning objectives in a selected school of central regional state of Ethiopia.

Alignment studies can offer valuable insights to educators about the effectiveness of the course objectives, assessments, and teaching. In this particular study, the aim was to determine the extent to which teacher-made tests aligned with the learning objectives of natural science subjects. The study included a total of 180 learning objectives (46 from Biology, 71 from Chemistry, and 63 from Physics) and 88 test items (30 from Biology, 30 from Chemistry, and 28 from Physics). Bloom's revised taxonomy was used to identify, organize, and code the objectives and test items. Porter's alignment index was used to analyze the data, allowing for determining the degree of alignment between tests and learning objectives. The results showed that the overall alignment between teacher-made tests with course objectives was 45 % for Biology, 46 % for Chemistry, and 62 % for Physics. The study also found that a dependable degree of alignment was not yet established between learning objectives and tests. Therefore, it was suggested that teachers should use assessment procedures and blueprints that consider higher-order cognitive levels and expected learning objectives. Further investigations are also required to determine whether students are meeting the expected learning objectives and moving to the next grade level.

A Mixed-Methods Evaluation to Inform the Hawai'i Suicide Prevention Strategic Plan.

The Prevent Suicide Hawai'i Taskforce is a state, public, and private partnership of individuals, organizations, and community groups that leads statewide suicide prevention efforts in Hawai'i. The purpose of this evaluation was to identify the progress and barriers of the Taskforce to inform the upcoming 2025 Hawai'i Suicide Prevention Strategic Plan in the following areas: Hope, Help, Heal, Research and Evaluation, and Policy and Advocacy. Utilizing a sequential exploratory mixed-methods approach, 18 key informants were interviewed, followed by a 13-question survey sent to the Taskforce member listserv. Results were analyzed using qualitative coding techniques and descriptive statistics. Interview findings contained six themes: importance of community relationships, interconnection of suicide prevention efforts, progress in diversifying training, organizational challenges, adaptations to the COVID-19 pandemic, and funding challenges. Of the 34 survey respondents, most were involved in the area of Hope (91%). The respondents reported the area with most progress was Hope (87%), and the most important area to address was Help (41%). The majority (82%) of the respondents characterized the level of Taskforce communication as Excellent or Good. Interview and survey data corroborated each other and revealed new insights about the successes and barriers of the Taskforce and their progress in implementing the Strategic Plan. Recommendations included advocating for long-term funding for suicide prevention and building community relationships.

Students' and junior doctors' perspectives on radiology education in medical school: a qualitative study in the Netherlands.

BACKGROUND: Modern medicine becomes more dependent on radiologic imaging techniques. Over the past decade, radiology has also gained more attention in the medical curricula. However, little is known with regard to students' perspectives on this subject. Therefore, this study aims to gain insight into the thoughts and ideas of medical students and junior doctors on radiology education in medical curricula. METHODS: A qualitative, descriptive study was carried out at one medical university in the Netherlands. Participants were recruited on social media and were interviewed following a predefined topic list. The constant comparative method was applied in order to include new questions when unexpected topics arose during the interviews. All interviews were transcribed verbatim and coded. Codes were organized into categories and themes by discussion between researchers. RESULTS: Fifteen participants (nine junior doctors and six students) agreed to join. From the coded interviews, four themes derived from fifteen categories arose: (1) The added value of radiology education in medical curricula, (2) Indispensable knowledge on radiology, (3) Organization of radiology education and (4) Promising educational innovations for the radiology curriculum. CONCLUSION: This study suggests that medical students and junior doctors value radiology education. It provides insights in educational topics and forms for educational improvement for radiology educators.

Cost-effectiveness of erosion mitigation to meet water clarity targets in the Manawatu-Whanganui Region of New Zealand.

Soil erosion is a significant environmental issue worldwide. It affects water quality, biodiversity, and land productivity. New Zealand government agencies and regional councils work to mitigate soil erosion through policies, management programmes, and funding for soil conservation projects. Information about cost-effectiveness is crucial for planning, targeting, and implementing erosion mitigation to achieve improvements in sediment-related water quality. While there is a good understanding of the costs of erosion mitigation measures, there is a dearth of literature on their cost-effectiveness in reducing sediment loads and improving water quality at the catchment level. In this study, we estimate the cost-effectiveness of erosion mitigation measures in meeting visual water clarity targets. The analysis utilizes the spatially explicit SedNetNZ erosion process and sediment budget modelling in the Manawatu-Whanganui Region and region-specific mitigation costs. The erosion mitigation measures considered in the analysis include afforestation, bush retirement, riparian retirement, space-planted trees, and gully tree planting. We modelled two scenarios with on-farm erosion mitigation implemented across the region from 2021 to 2100, resulting in a 48% and 60% reduction of total sediment load. We estimate the marginal costs to achieve the visual national bottom line for water clarity, as assessed by the length of waterways that meet the clarity targets. We also estimate the marginal costs of improving average water clarity, which can be linked with non-market valuation studies when conducting a cost-benefit analysis. We find that gully tree planting and space-planted trees are the most cost-effective mitigation measures and that riparian retirement is the least cost-effective. Moreover, cost-effectiveness is highly dependent on current land use and the biophysical features of the landscape. Our estimates can be used in cost-benefit analysis to plan and prioritize soil erosion mitigation at the catchment and regional levels.

Capturing artificial intelligence applications' value proposition in healthcare - a qualitative research study.

Artificial intelligence (AI) applications pave the way for innovations in the healthcare (HC) industry. However, their adoption in HC organizations is still nascent as organizations often face a fragmented and incomplete picture of how they can capture the value of AI applications on a managerial level. To overcome adoption hurdles, HC organizations would benefit from understanding how they can capture AI applications' potential.We conduct a comprehensive systematic literature review and 11 semi-structured expert interviews to identify, systematize, and describe 15 business objectives that translate into six value propositions of AI applications in HC.Our results demonstrate that AI applications can have several business objectives converging into risk-reduced patient care, advanced patient care, self-management, process acceleration, resource optimization, and knowledge discovery.We contribute to the literature by extending research on value creation mechanisms of AI to the HC context and guiding HC organizations in evaluating their AI applications or those of the competition on a managerial level, to assess AI investment decisions, and to align their AI application portfolio towards an overarching strategy.

Transforming health science libraries around the globe: The impact of technology.

This article presents an analysis of seven articles published within the International Perspectives and Initiatives regular feature series on the impact of technology on the provision of health information. The articles provide a road map of how technology is facilitating new and enhanced services for library users in seven countries: Australia, Bangladesh, China, England, Germany, Sweden and the United States. Although there are differences in how countries are implementing technological solutions, only one describes problems in leveraging technology to improve library services. Authors from the remaining six countries describe how they ensure that the 21st century library consults with its user groups and find way of using the latest applications.

Implementing Lifestyle Medicine in Undergraduate Medical Education at Riphah International University, Pakistan.

The Need of the LM content in Medical undergraduate curriculum was imperative based on the mortality and morbidity statistics in Pakistan along with lack of LM training and unhealthy lifestyle of physicians themselves. Aims and Objectives for integrating LM content were designed including cognitive, affective and psychomotor domains of learning. while embedding LM content in an integrated modular system, every step was technically monitored and matched with the academic year, teaching methodology and importance of the topic. LM content was integrated in every educational activity from first to final year by adding or modifying LM learning objectives. The alignment of learning domains was in accordance with the teaching and assessment strategies. Teaching methods chosen were according to the designed learning objectives and phase of curriculum. LM content was assessed in formative and summative assessment through, single best and case cluster MCQs, reflections, OSPE. LM curriculum was communicated to teaching faculty and medical students through academic calendar, module guides and timetables. It was shared on Moodle and Teams. Educational environment incorporated both physical and virtual learning and has been supportive of lifestyle practices among medical students. The entire process of embedding LM content in medical education has been multifaceted. Different committees were formed including Steering, Core, implementation, and Evaluation Committees. Students were part of each committee. This write-up describes the evidence-based approach used to embed LM content in Undergraduate Medical Education and offers guidance to other undergraduate medical colleges that may wish to implement lifestyle medicine content.