Enhancing affordability and profit in a non-cooperative, coordinated, hypothetical pediatric vaccine market via sequential optimization.

This study considers a hypothetical global pediatric vaccine market where multiple coordinating entities make optimal procurement decisions on behalf of countries with different purchasing power. Each entity aims to improve affordability for its countries while maintaining a profitable market for vaccine producers. This study analyzes the effect of several factors on affordability and profitability, including the number of non-cooperative coordinating entities making procuring decisions, the number of market segments in which countries are grouped for tiered pricing purposes, how producers recover fixed production costs, and the procuring order of the coordinating entities. The study relies on a framework where entities negotiate sequentially with vaccine producers using a three-stage optimization process that solves a MIP and two LP problems to determine the optimal procurement plans and prices per dose that maximize savings for the entities' countries and profit for the vaccine producers. The study's results challenge current vaccine market dynamics and contribute novel alternative strategies to orchestrate the interaction of buyers, producers, and coordinating entities for enhancing affordability in a non-cooperative market. Key results show that the order in which the coordinating entities negotiate with vaccine producers and how the latter recuperate their fixed cost investments can significantly affect profitability and affordability. Furthermore, low-income countries can meet their demands more affordably by procuring vaccines through tiered pricing via entities coordinating many market segments. In contrast, upper-middle and high-income countries increase their affordability by procuring through entities with fewer and more extensive market segments. A procurement order that prioritizes entities based on the descending income level of their countries offers higher opportunities to increase affordability and profit when producers offer volume discounts.

Lateness of Acetaminophen and Non-steroidal Anti-inflammatory Drug Administrations in a Retrospective Cohort of Medication Administration Records Among Patients After Cesarean Delivery.

INTRODUCTION: In an earlier study of patients after cesarean delivery, the concurrent versus alternating administration of acetaminophen and non-steroidal anti-inflammatory drugs was associated with a substantial reduction in total postoperative opioid use. This likely pharmacodynamic effect may differ if the times when nurses administer acetaminophen and non-steroidal anti-inflammatory drugs often differ substantively from when they are due. We examined the "lateness" of analgesic dose administration times, the positive difference if administered late, and the negative value if early. METHODS: The retrospective cohort study used all 67,900 medication administration records for scheduled (i.e., not "as needed") acetaminophen, ibuprofen, and ketorolac among all 3,163 cesarean delivery cases at the University of Iowa between January 2021 and December 2023. Barcode scanning at the patient's bedside was used right before each medication administration. RESULTS: There were 95% of doses administered over a 4.8-hour window, from 108 minutes early (97.5% one-sided upper confidence limit 105 minutes early) to 181 minutes late (97.5% one-sided lower limit 179 minutes late). Fewer than half of doses (46%, P <0.0001) were administered ±30 minutes of the due time. The intraclass correlation coefficient was approximately 0.11, showing that there were small systematic differences among patients. There likewise were small to no systematic differences in lateness based on concurrent administrations of acetaminophen and ibuprofen or ketorolac, time of the day that medications were due, weekday, year, or number of medications to be administered among all such patients within 15 minutes. DISCUSSION: Other hospitals should check the lateness of medication administration when that would change their ability to perform or apply the results of analgesic clinical trials (e.g., simultaneous versus alternating administration).

The Use of a Behavior Chain Interruption Strategy to Teach Mands for Help with an Adult with Intellectual Disability and Deaf-Blindness.

Individuals with deaf-blindness and co-occurring diagnoses, such as intellectual and developmental disabilities, may experience difficulty with independence, specifically with communication. One behavior-analytic procedure that may be useful for increasing independence and teaching communication to this population is the behavior-chain interruption strategy (BCIS). The current study examined the use of the BCIS to teach a 65-year-old deaf-blind participant with severe intellectual disability to use a SadoTech Elderly Monitoring Pager to notify others in the environment when help was needed. The researcher alternated between establishing operation (EO; help needed, items missing, or inoperable) and abolishing operation (AO; help not needed, items present, and operable) trials for three previously mastered daily living routines. The results demonstrated that following intervention, the participant used the device independently during EO trials and never used it during AO trials across behavior chains, and similar results were obtained during a treatment-extension phase. Limitations and implications for applied practice are discussed. Supplementary Information: The online version contains supplementary material available at 10.1007/s40616-024-00204-8.

The concept of cognitive readiness: potential solution and opportunity for the Malaysian army.

This paper focuses on exploring the potential solution and opportunity in the development of the Malaysian Army Transformation Plan by using the concept of Cognitive Readiness (CR). Here, the concept of CR equipped the military personnel to be cognitively ready to perform their role in military operations. The main aim of the paper is to highlight the fundamental discourse of 'what is cognitive readiness' in discovering the potential solution and opportunity in the development of the Malaysian Army Transformation Plan. The paper suggests that the strategy for transformation may start at the tactical level by focusing on enhancing the military personnel's CR. The study proposed that the Malaysian Army Organization prepare the military personnel with Knowledge, Skills and Abilities (KSA). KSA are important to boost the military personnel to have a distinctive character such as thinking critically, problem-solving and decision-making to perform effectively during military operations. In this preliminary study, the paper proposed a Framework for Tactical Cognitive Readiness (TCR) as a potential solution and opportunity for the Malaysian Army.

Recent developments on sustainable biobutanol production: a novel integrative review.

Renewable and sustainable biofuel production, such as biobutanol, is becoming increasingly popular as a substitute for non-renewable and depleted petrol fuel. Many researchers have studied how to produce butanol cheaply by considering appropriate feedstock materials and bioprocess technologies. The production of biobutanol through acetone-butanol-ethanol (ABE) is highly sought after around the world because of its sustainable supply and lack of competition with food. The purpose of this study is to present the current biobutanol production research and to analyse the biobutanol research conducted during 2006 to 2023. The keyword used in this study is "Biobutanol," and the relevant data was extracted from the Web of Science database (WoS). According to the results, institutions and scholars from the People's Republic of China, the USA, and India have the highest number of cited papers across a broad spectrum of topics including acetone-butanol-ethanol (ABE) fermentation, biobutanol, various pretreatment techniques, and pervaporation. The success of biobutanol fermentation from biomass depends on the ability of the fermentation operation to match the microbial behaviour along with the appropriate bioprocessing strategies to improve the entire process to be suitable for industrial scale. Based on the review data, we will look at the biobutanol technologies and appropriate strategies that have been developed to improve biobutanol production from renewable biomass.

A retrospective chart review to assess the impact of alpha-guided transcranial magnetic stimulation on symptoms of PTSD and depression in active-duty special operations service members.

Introduction: Special Operations Forces service members (SOF) are regularly exposed to traumatic and concussive events, increasing the prevalence of symptoms of post-traumatic stress disorder (PTSD) and depression, shortening potential years of service. Methods: This retrospective chart review presents preliminary data on a Human Performance Optimization (HPO) program that provided an average of 30 sessions of individualized alpha frequency repetitive transcranial magnetic stimulation (α-rTMS) to active-duty SOF as to reduce symptoms of PTSD and depression following traumatic brain injury. Scores from the PTSD Checklist for DSM-5, PROMIS Depression short form and Perceived Deficits Questionnaire (PDQ) were reviewed. Results: Significant reductions were noted after the HPO program in all clinical scales with an average 37% decrease in PCL-5 (p<.01), 11.3% reduction in PROMIS depression T-scores (p<.01), and 45.5% reduction in PDQ scales by session 30 (p<.01), with side effects matching those commonly reported in rTMS. Importantly, the average PCL-5 score decreased from 42.9 to 27 by end of the treatment program, which is below the clinical threshold of 33 for presence of PTSD. For those with depression symptoms scores greater than cut off clinical thresholds at baseline, 46% resolved following treatment. Conclusion: This data provides preliminary support for safe application of α-rTMS for symptom reduction in active-duty special operations military personnel.

Ad libitum caffeine consumption, cognitive performance, and sleep in special forces soldiers during a 96-h combat exercise.

Introduction: This observational study investigated the effects of sleep deprivation and ad libitum caffeine consumption on cognitive performance, risk behavior, and mood among 28 Israeli Special Forces (SF) soldiers (mean age: 20.57 ± 0.92 years) during a 96-hour combat exercise. Methods: Actigraphy was used to monitor sleep and activity; cognitive function, risk-taking propensity, mood states, and self-reported sleepiness were assessed using the Psychomotor Vigilance Task (PVT), Evaluation of Risks Scale (EVAR), Profile of Mood States (POMS), Karolinska Sleepiness Scale (KSS); and caffeine consumption by questionnaire at 0, 50, and 96 hours. For analyses, participants were divided into Low (<400 mg) and High (≥400 mg) caffeine consumption groups. Results: The soldiers hiked 108.5 ± 0.52 km and slept for 12.7 ± 0.5 h, with a notable transition from multiple short sleep epochs in the initial 50 hours to a consolidated 5-hour sleep period subsequently. In the High caffeine group, PVT reaction time was faster (p = 0.024) compared to the Low caffeine group, with fewer premature response errors (p = 0.026). However, this group showed increased risk-taking (p = 0.037), particularly reduced Self-Control (p = 0.010). No significant impact of ad libitum caffeine intake on mood was observed. However, degradation over the course of the exercise in both groups in mood states, including anger, fatigue, tension, and vigor, was noted (p < 0.05). KSS scores increased significantly at 50 and 96 h (p < 0.001). Discussion: These results suggest that while caffeine enhances cognitive function, its ad libitum consumption did not consistently improve these measures in this cohort of SF soldiers. The study highlights the complex relationship between sleep deprivation and caffeine intake and their combined effects on soldiers' cognitive and behavioral functions, indicating a need for evidence-based caffeine use guidelines for using caffeine in military settings.

Integrating experiments with modeling to understand key bacterial taxa dynamics after episodic mixing of a stratified water column.

Hydraulic mixing of stratified reservoirs homogenizes physicochemical gradients and microbial communities. This has potential repercussions for microbial metabolism and water quality, not least in dams and hydraulically controlled waters. A better understanding of how key taxa respond to mixing of such stratified water bodies is needed to understand and predict the impact of hydraulic operations on microbial communities and nutrient dynamics in reservoirs. We studied taxa transitions between cyanobacteria and sulfur-transforming bacteria following mixing of stratified water columns in bioreactors and complemented the experimental approach with a biogeochemical model. Model predictions were consistent with experimental observations, suggesting that stable stratification of DO is restored within 24 h after episodic and complete mixing, at least in the absence of other more continuous disturbances. Subsequently, the concentration of S2- gradually return to pre-mixing states, with higher concentration at the surface and lower in the bottom waters, while the opposite pattern was seen for SO42-. The total abundance of sulfate-reducing bacteria and phototrophic sulfur bacteria increased markedly after 24h of mixing. The model further predicted that the rapid re-oxygenation of the entire water column by aeration will effectively suppress the water stratification and the growth of sulfur-transforming bacteria. Based on these results, we suggest that a reduction of thermocline depth by optimal flow regulation in reservoirs may also depress sulfur transforming bacteria and thereby constrain sulfur transformation processes and pollutant accumulation. The simulation of microbial nutrient transformation processes in vertically stratified waters can provide new insights about effective environmental management measures for reservoirs.

Testosterone and neurobehavioral outcomes in special operations forces military with multiple mild traumatic brain injury.

BACKGROUND: U.S. Special Operations Forces (SOF) are at increased risk of multiple mild traumatic brain injury (mmTBI). Testosterone was prescribed for several participants in a VA program designed to address sequelae of mmTBI for SOF. OBJECTIVE: To determine testosterone prevalence in the Palo Alto VA Intensive Evaluation and Treatment Program (IETP) and observe for association between testosterone and neurobehavioral outcomes. METHODS: A retrospective cohort study included patients in the Palo Alto VA IETP. Sociodemographic data, testosterone blood levels, and neurobehavioral outcomes were collected from medical records. RESULTS: 55 IETP participants were included: six were testosterone users; the rest were classified as non-users. Testosterone use in this population is 11%, higher than reported national averages in the U.S. Of the 6 testosterone users, 2 (33%) had a formal diagnosis of hypogonadism prior to initiation of testosterone. Neurobehavioral outcome scores between testosterone users and non-users failed to show statistically significant differences, except for the PROMIS pain score, which was higher in the testosterone user population. CONCLUSION: The current study did not find an association between mmTBI, testosterone use, or testosterone level and neurobehavioral outcomes. This study highlights a need to further examine the relationship between hypogonadism, mmTBI, SOF culture around testosterone, and the effects of testosterone use in this population.

Impact of power outages: Unveiling their influence on micro, small, and medium-sized enterprises and poverty in Sub-Saharan Africa - An in-depth literature review.

The paper explores the review on the impact of electricity outages on MSMEs in Sub-Saharan Africa, analyzing their effects on productivity and poverty levels based on a review of 102 studies spanning from 2010 to 2023. The review organizes the studies by subject, theme, and major research findings to analyze the impact of power outages in Sub-Saharan Africa on poverty reduction. Power outages in the region hinder income generation and employment, perpetuating the cycle of poverty. The key findings emphasize the importance of proactive action to minimize the negative consequences of power outages on small businesses and poverty. MSMEs face disruptions that lead to reduced productivity, operational inefficiencies, higher production costs, and supply chain disruptions. Strategies to lessen power outage effects on MSMEs, the review proposed promoting energy source diversification, such as renewables. The research review concludes that power outages are a major challenge for MSMEs and energy diversification is a key solution to reduce poverty in the region.

Effects of applying blended learning based on the ADDIE model in nursing staff training on improving theoretical and practical operational aspects.

Objective: To assess the impact of blended learning, based on the ADDIE model, on theoretical and practical aspects of nursing staff training. Methods: Retrospective analysis of data from 87 nursing staff members in Xi'an Qinhuang Hospital divided into control (n = 43) and observation (n = 44) groups. The control group received conventional training, while the observation group underwent blended learning. Comparative analysis included theoretical knowledge, practical skills, self-directed learning, critical thinking, and teaching satisfaction. Results: The observation group showed significantly higher theoretical knowledge, practical skills, self-directed learning, critical thinking, and teaching satisfaction compared to the control group (p < 0.05). Conclusion: Blended learning based on the ADDIE model enhances nursing staff training outcomes, improving theoretical knowledge, practical skills, self-directed learning, critical thinking, and teaching satisfaction. This approach presents a promising method for enhancing nursing education and warrants further implementation in clinical settings.

LONEStar: The Lunar Flashlight Optical Navigation Experiment.

This paper documents the results from the highly successful Lunar flashlight Optical Navigation Experiment with a Star tracker (LONEStar). Launched in December 2022, Lunar Flashlight (LF) was a NASA-funded technology demonstration mission. After a propulsion system anomaly prevented capture in lunar orbit, LF was ejected from the Earth-Moon system and into heliocentric space. NASA subsequently transferred ownership of LF to Georgia Tech to conduct an unfunded extended mission to demonstrate further advanced technology objectives, including LONEStar. From August to December 2023, the LONEStar team performed on-orbit calibration of the optical instrument and a number of different OPNAV experiments. This campaign included the processing of nearly 400 images of star fields, Earth and Moon, and four other planets (Mercury, Mars, Jupiter, and Saturn). LONEStar provided the first on-orbit demonstrations of heliocentric navigation using only optical observations of planets. Of special note is the successful in-flight demonstration of (1) instantaneous triangulation with simultaneous sightings of two planets with the LOST algorithm and (2) dynamic triangulation with sequential sightings of multiple planets.

Bayesian reinforcement learning for navigation planning in unknown environments.

This study focuses on a rescue mission problem, particularly enabling agents/robots to navigate efficiently in unknown environments. Technological advances, including manufacturing, sensing, and communication systems, have raised interest in using robots or drones for rescue operations. Effective rescue operations require quick identification of changes in the environment and/or locating the victims/injuries as soon as possible. Several techniques have been developed in recent years for autonomy in rescue missions, including motion planning, adaptive control, and more recently, reinforcement learning techniques. These techniques rely on full knowledge of the environment or the availability of simulators that can represent real environments during rescue operations. However, in practice, agents might have little or no information about the environment or the number or locations of injuries, preventing/limiting the application of most existing techniques. This study provides a probabilistic/Bayesian representation of the unknown environment, which jointly models the stochasticity in the agent's navigation and the environment uncertainty into a vector called the belief state. This belief state allows offline learning of the optimal Bayesian policy in an unknown environment without the need for any real data/interactions, which guarantees taking actions that are optimal given all available information. To address the large size of belief space, deep reinforcement learning is developed for computing an approximate Bayesian planning policy. The numerical experiments using different maze problems demonstrate the high performance of the proposed policy.

Specific Features of Diagnostic and Treatment Tactics in Patients with Crushed Abdominal Hernias Without Resection of a Hollow Organ.

The purpose of the work is to analyze the results of the use of optimized diagnostic and therapeutic tactics in patients with strangulated abdominal hernias without resection of the hollow organ. Materials and methods: The work is based on the analysis of the results of surgical treatment of 665 patients with strangulated abdominal hernias without resection of the hollow organ, who were divided into 2 groups depending on the features of the diagnostic and treatment tactics. Unlike the patients of group 1, the following diagnostic tactics were used in group 2: substantiated laparoscopic diagnosis of abdominal organs; mandatory biochemical assessment of hernia water; mandatory intraoperative instrumental assessment of the state of the strangulated organ; expansion of indications for the use of laparoscopic interventions and components of the comprehensive Fast track program; substantiated complex prevention of malignancy. The clinical diagnostic algorithm included laboratory, instrumental and biochemical research methods. Results: The use of priority diagnostic and therapeutic tactics in the patients of group 2 allowed to increase the number of laparoscopic hernioplasty by 49.34%, the number of allohernioplasty by 18.62%, among which the "Sublay" technique was preferred for strangulated ventral hernias. This was accompanied by a decrease in the pain syndrome on the VAS scale during the four days of observation, both during coughing and at rest, and amounted to only 2.21 ± 0.29 points on the fourth day when at rest. In addition, and after 12 months, the patients of group 2 observed a better recovery according to the SF-36 questionnaire, which amounted to 76.77±6.63 points for the assessment of the general state of health, 70.81±5.86 points for the assessment of physical functioning, 68.88±5.37 points for the assessment of role functioning due to physical condition, 68.03±5.92 points for the assessment of role functioning due to emotional state, and social activity was characterized by 72.82±5.52 points. Conclusions: 1. The proposed diagnostic and treatment tactics in the patients of group 2 with strangulated abdominal hernias without resection of a hollow organ, in contrast to patients in group 1, made it possible to increase the number of laparoscopic operations to 227 (66.37%) in contrast to 55 (17.03%) in the first group, which was accompanied by a decrease in pain syndrome on the VAS scale on the fourth day when coughing from 4.35 ± 0.38 points to 2.97 ± 0.43 points. 2. The expansion of indications for the use of laparoscopic operations in patients of group 2, in contrast to patients of group 1, led to a decrease in the postoperative complications by 10.48% and the postoperative mortality by 2.29% and was characterized by better postoperative rehabilitation according to the assessment of the patients' condition after 12 months according to the SF-36 questionnaire..

Quality improvement in the era of boarding and burnout: A postpandemic blueprint.

The COVID-19 pandemic led to unprecedented challenges to healthcare quality in the emergency department, including directly impacting quality metrics and worsening barriers to the quality improvement process such as burnout, staff turnover, and boarding. We aimed to develop a blueprint for postpandemic quality improvement to address these specific barriers, focused on prioritizing frontline staff engagement from idea generation to implementation and assessment. Drawing from teamwork literature, we constructed a process that emphasized egalitarian conversations, psychological safety, and creating an environment where staff could feel heard at every step of the process. We applied this blueprint to improving rates of patients who leave without being seen and achieved a four percentage point reduction (9% vs. 5%, p < 0.001), with high rates of staff satisfaction with the process. We conclude that while postpandemic quality improvement presents significant challenges, we can rise to meet those challenges by adapting existing quality improvement processes to increase frontline staff engagement.

Gynecological Laparoscopic Surgeries under Spinal Anesthesia: Benefits and Challenges.

OBJECTIVE: This prospective study investigated the feasibility of performing laparoscopic pelvic surgery under spinal anesthesia and analyzed the intraoperative side effects, like pain, nausea, and vomitus, of 915 patients. METHODS: The implementation and performance of laparoscopic surgery under local anesthesia on 915 patients (out of a total of 3212 who underwent laparoscopic pelvic surgery under spinal anesthesia) were analyzed in relation to BMI (body mass index), obesity, pain during surgery, amount of intraperitoneal mmHg CO2 gas pressure, and surgical complications. RESULTS: BMI > 30, intra-abdominal adhesions, increased duration of the operation, bleeding, and increased intraperitoneal CO2 pressure were statistically significant as the main causes of pain during laparoscopic surgery under spinal anesthesia. Underweight patients, on the other hand, had less pain when intra-abdominal pressure increased compared to those of normal weight. The appearance of pain, nausea, and vomitus occurred in 10.3% of patients, and these events were easy to manage and treat. They did not affect the surgeon's work or the course of the operation. CONCLUSIONS: In light of these observations, we are proposing spinal anesthesia for laparoscopic surgery as the first choice in patients who have no contraindications. To the best of our knowledge, this clinical study constitutes the largest clinical observation and dataset concerning spinal anesthesia in laparoscopic pelvic surgery. TRIAL REGISTRATION: ISRCTN38987, 10 December 2019.

Novel complex fuzzy distance measures with hesitance values and their applications in complex decision-making problems.

A complex fuzzy distance measure (CFDMs) plays a significant role in applications involving complex or high-dimensional data where traditional distance measures may not adequately capture the nuances of the data relationships. The significance of CFDMs lies in their ability to handle uncertainty, imprecision, and complexity in various domains. Numerous researchers introduced different concepts of CFDMs, yet these CFDMs fails to convey any information regarding the hesitancy degree associated with an element. The main objective of this paper is to introduce some new distance measures based on complex fuzzy sets, called complex fuzzy hesitance distance measure and complex fuzzy Euclidean Hesitance distance measure, which is the generalization of complex fuzzy normalized Hamming distance measure and complex fuzzy Euclidean distance measure. Some new operations and primay results are discussed in the environment of proposed CFDMs and complex fuzzy operations. Moreover, we discussed the applications of the proposed CFDMs in addressing decision-making problems. We introduced a new decision-making algorithm that integrates CFDMs into decision-making processes, providing a robust methodology for handling real-world complexities. Further, the comparative study of the proposed CFDMs is discussed with some existing CFDMs.

DistilIQA: Distilling Vision Transformers for no-reference perceptual CT image quality assessment.

No-reference image quality assessment (IQA) is a critical step in medical image analysis, with the objective of predicting perceptual image quality without the need for a pristine reference image. The application of no-reference IQA to CT scans is valuable in providing an automated and objective approach to assessing scan quality, optimizing radiation dose, and improving overall healthcare efficiency. In this paper, we introduce DistilIQA, a novel distilled Vision Transformer network designed for no-reference CT image quality assessment. DistilIQA integrates convolutional operations and multi-head self-attention mechanisms by incorporating a powerful convolutional stem at the beginning of the traditional ViT network. Additionally, we present a two-step distillation methodology aimed at improving network performance and efficiency. In the initial step, a "teacher ensemble network" is constructed by training five vision Transformer networks using a five-fold division schema. In the second step, a "student network", comprising of a single Vision Transformer, is trained using the original labeled dataset and the predictions generated by the teacher network as new labels. DistilIQA is evaluated in the task of quality score prediction from low-dose chest CT scans obtained from the LDCT and Projection data of the Cancer Imaging Archive, along with low-dose abdominal CT images from the LDCTIQAC2023 Grand Challenge. Our results demonstrate DistilIQA's remarkable performance in both benchmarks, surpassing the capabilities of various CNNs and Transformer architectures. Moreover, our comprehensive experimental analysis demonstrates the effectiveness of incorporating convolutional operations within the ViT architecture and highlights the advantages of our distillation methodology.

Protocol for the Support Application for Food PAntrieS trial: design, implementation, and evaluation plan for a digital application to promote healthy food access and support food pantry operations.

Introduction: Food-insecure households commonly rely on food pantries to supplement their nutritional needs, a challenge that was underscored during the COVID-19 pandemic. Food pantries, and the food banks that supply them, face common challenges in meeting variable client volume and dietary needs under normal and emergency (e.g., pandemic, natural disaster) conditions. A scalable digital strategy that has the capacity to streamline the emergency food distribution system, while promoting healthy food options, managing volunteer recruitment and training, and connecting to emergency management systems in times of need, is urgently required. To address this gap, we are developing a working mobile application (app) called the Support Application for Food PAntrieS (SAFPAS) and will evaluate its feasibility and impact on food pantry staff preparedness, stocking, and client uptake of healthful foods and beverages in two urban United States settings. Methods: This paper describes the protocol for a randomized controlled trial of the SAFPAS mobile application. We will conduct formative research in Baltimore, Maryland and Detroit, Michigan to develop and refine the SAFPAS app and increase scalability potential to other urban settings. Then we will test the app in 20 food pantries in Baltimore randomized to intervention or comparison. The impact of the app will be evaluated at several levels of the emergency food system, including food pantry clients (n = 360), food pantry staff and volunteers (n = 100), food pantry stock, and city agencies such as the local food bank and Office of Emergency Management. The primary outcome of the SAFPAS trial is to improve the healthfulness of the foods received by food pantry clients, measured using the Food Assessment Scoring Tool (FAST). Post-trial, we will conduct additional formative research in Detroit to prepare the app for scale-up. Discussion: We anticipate that SAFPAS will improve alignment in the supply and demand for healthy foods among food pantry clients, food pantries, and city agencies which supply food in Baltimore. Real-time, bidirectional communication between entities across the system allows for increased situational awareness at all levels during normal and emergency operations. By conducting formative research in Detroit, we hope to increase the scalability of the SAFPAS app to additional settings nationwide. Clinical trial registration: NCT87654321. https://classic.clinicaltrials.gov/ct2/show/NCT05880004.