Manatt, Phelps & Phillips (United States)

Penelitian ini mengatasi permasalahan metode pembelajaran yang kurang efektif dengan menggunakan gambar statis dalam mengenalkan profesi kepada anak-anak di TK Timothy Kids Wolaang, yang membatasi keterlibatan dan aksesibilitas. Tujuannya adalah mengembangkan aplikasi pembelajaran interaktif berbasis Augmented Reality (AR) pada platform Android untuk meningkatkan motivasi dan pemahaman anak-anak tentang berbagai profesi. Proses pengembangan menggunakan metodologi Multimedia Development Life Cycle (MDLC) untuk memastikan pembuatan aplikasi yang sistematis dan optimal. Temuan menunjukkan bahwa teknologi AR, dengan kemampuannya menyajikan konten 3D virtual, real-time, dan interaktif, secara signifikan meningkatkan minat dan pemahaman belajar pada anak usia dini. Selain itu, pemilihan Android sebagai platform memanfaatkan penggunaan yang luas di Indonesia sehingga memudahkan akses pengguna. Penelitian menyimpulkan bahwa penerapan aplikasi berbasis AR di Android secara efektif mengatasi keterbatasan media tradisional, memberikan alat edukasi yang lebih menarik, efisien, dan mudah diakses bagi anak-anak untuk mengenal profesi, mendukung pembelajaran awal dan cita-cita masa depan mereka.

BackgroundPsychiatric collaborative care management (CoCM) has potential to mitigate the challenges rural communities face accessing behavioral health (BH) services. However, implementation of CoCM in rural clinics has proved difficult and may benefit from a tailored approach. This study examines implementation of a telehealth-enabled CoCM program in four rural South Carolina clinics guided by the Dynamic Adaptation Process (DAP), with particular focus on identifying barriers, facilitators, and strategies to support implementation.MethodsThis study used a mixed-methods, embedded, chronological case study approach, integrating several data sources collected longitudinally during implementation. Data included surveys, focus groups, key informant interviews, and administrative data. Data were integrated using a weaving approach to develop summaries of each of the DAP phases of program implementation (Exploration, Preparation, Implementation, Sustainment).ResultsInitial Exploration implementation activities included workflow development, telehealth platform configuration, building the CoCM provider team, and conducting an assessment among implementation clinics. Scarcity of BH resources was the primary barrier to rural BH treatment, leading to strong anticipated fit of the CoCM pilot among providers. These data informed activities and adaptations in subsequent phases. During the Preparation phase, the CoCM team was trained and site visits were conducted by the remote care manager to build rapport with clinic staff. In Implementation, the pilot launched, receiving 296 referrals and 99 patient enrollments in the first eight months. Post-implementation feedback showed strong provider satisfaction. Patient need, patient interest, and provider engagement with the care manager were identified as the primary facilitators for referral. During the Sustainment phase, workflow, technology, and auditing process improvements took place alongside planning for future program expansion.ConclusionlThe DAP shows great utility for tailoring implementation of CoCM to specific rural settings by providing a roadmap for identifying contextual barriers and facilitators that can be addressed through adaptation and other implementation strategies.

ObjectivesCervical cancer disproportionately impacts patients insured through Medicaid. Of the recurrent or metastatic cervical cancer (r/mCC) population in the US, ~30% are enrolled in Medicaid. Understanding the geographic distribution of new r/mCC patients may identify areas needing intervention, and further inform r/mCC geography-specific risk factors. This study assesses the geographic variation of r/mCC among Medicaid enrollees.MethodsRetrospective analyses of nationwide Medicaid claims data were used to identify adult r/mCC patients from 2016–2019. Rates of r/mCC were estimated by dividing the number of patients with cervical cancer diagnosis who initiated a systemic treatment beyond surgery or radiation associated with chemotherapy, by the total number of enrollees with cervical cancer diagnosis in each metropolitan statistical area (MSA).ResultsThe analytic cohort included 3,375 r/mCC patients from 2016–2019. Overall r/mCC burden among Medicaid enrollees in metropolitan MSAs ranged from lows of 0% in many MSAs to highs of 27.3% in The Villages, Florida and 50% in Cheyenne, Wyoming (figure 1). Meanwhile, state-level r/mCC burden ranged from a low of 1% in Vermont to a high of 7.7% in Arizona. Annual rates for the five states with the highest overall rates are shown in table 1. EP071/#406 Figure 1Overall rates of r/mCC burden among medical enrollees at the metropolitan statistical area (MSA) level, 2016 – 2019 EP071/#406 Table 1States with highest overall rates of r/mCC burden among medical enrollees, 2016 – 2019ConclusionsThis study found substantial variability in r/mCC burden at the state and MSA level. Results highlight areas in the US with disproportionately high r/mCC burden and indicate a potential gap in preventative care for women, and unmet need for education and healthcare resource allocation. Future research should evaluate associations between community-level factors and rates of r/mCC burden.

e17525 Background: Cervical cancer remains a disease with high unmet need, and a large proportion of patients are insured through Medicaid (̃30%). Previous real-world studies demonstrated significant variability in treatments for recurrent or metastatic cervical cancer (r/mCC) patients following doublet chemotherapy ± bevacizumab, despite the 2018 approval of pembrolizumab in PD-L1+ r/mCC. As r/mCC treatment landscape continues to evolve, there is a need to understand current real-world unmet need among Medicaid r/mCC patients. This study aims to evaluate treatment patterns and healthcare resource utilization (HCRU) among Medicaid-insured r/mCC patients. Methods: This is a retrospective analysis of nationwide Medicaid claims to assess patient characteristics, treatment patterns, and HCRU among r/mCC patients between 2016-2019 (most recent Medicaid data available). First line treatment (1L) for r/mCC was identified as the first administration of systemic therapy without concomitant radiation or surgery. Patient characteristics, treatment patterns, and HCRU were characterized by line of therapy. Results: A total of 2,741 adult females initiated systemic treatment for r/mCC between 2016–2019, mean age was 52.8 (SD = 12.8), and most patients were enrolled in comprehensive managed care plans (58%). Over 41% (N = 1,145) had evidence of second line treatment (2L), with over one third (N = 385) of those also having evidence of third line treatment (3L). Consistent with treatment guidelines, the majority (61%) of 1L regimens were doublet chemotherapy ± bevacizumab. In contrast, no clear standard of care was observed among patients receiving 2L or 3L therapy. Notably, immunotherapy accounted for 22% of treatment regimens in 2L/3L overall, with its use increasing significantly over time (< 6% in 2016 to 41% in 2019; p-value < 0.001); however, despite availability of immunotherapy, most patients did not remain on treatment for a prolonged duration (immunotherapy median duration 2.2 months vs. 2.5 months for non-immunotherapy, p-value = 0.9). Across all HCRU measures (inpatient admissions, outpatient visits, emergency visits, and pharmacy claims), 2L/3L patients had less utilization per patient, compared with 1L patients. Conclusions: There was no clear standard of care for 2L+ r/mCC patients enrolled in Medicaid treated between 2016-2019. Although immunotherapy use is increasing, there is still high medical unmet need based on short durations of treatment and poor historical outcomes. New therapies should provide meaningful clinical benefit without significant increase in HCRU.

O estudo sobre o clima é de extrema importância para conhecimento dos fenômenos que atuam numa determinada região e subsidia o planejamento e a prevenção de riscos climáticos deflagrados no espaço urbano, como alagamentos e inundações. Dessa maneira, o objetivo deste trabalho foi analisar os anos padrão da precipitação pluvial e o ritmo climático em Manaus-AM. A análise desse trabalho partiu do referencial teórico e metodológico da climatologia geográfica, sendo que os dados de precipitação pluvial, foram coletados do INMET no período de 30 anos, tratados estatisticamente por técnicas descritivas e análise dos anos e meses-padrão das chuvas. Os resultados da análise rítmica dos meses mais chuvosos e secos, demonstraram quais foram os principais sistemas atmosféricos que atuaram e contribuíram para os acumulados diários e mensal das chuvas em Manaus.

The current literature’s focus on unidirectional effects of psychological and organizational climates at work on work outcomes fails to capture the full relationship between these factors. This article examines whether a psychological climate for caring contributes to specific work outcomes and investigates whether work outcomes support the climate for caring, creating a feedback loop. Results confirm a bi-directional, temporal association between perceived climate for caring and two of the four explored work outcomes: self-reported productivity and self-reported work quality. The effect of a perceived caring climate on these work outcomes was stronger than the effect in the opposite direction. The perception that the work climate was caring was also found to affect work engagement, but the reverse relationship was not identified. We did not find any evidence for a link between job satisfaction and a climate for caring at work in either direction.

With pragmatic clinical trials, an opportunity exists to answer important questions about the relative risks, burdens, and benefits of therapeutic interventions. However, concerns about protecting the privacy of this information are significant and must be balanced with the imperative to learn from the data gathered in routine clinical practice. Traditional privacy protections for research uses of identifiable information rely disproportionately on informed consent or authorizations, based on a presumption that this is necessary to fulfill ethical principles of respect for persons. But frequently, the ideal of informed consent is not realized in its implementation. Moreover, the principle of respect for persons—which encompasses their interests in health information privacy—can be honored through other mechanisms. Data anonymization also plays a role in protecting privacy but is not suitable for all research, particularly pragmatic clinical trials. In this article, we explore both the ethical foundation and regulatory framework intended to protect privacy in pragmatic clinical trials. We then review examples of novel approaches to respecting persons in research that may have the added benefit of honoring patient privacy considerations.

Guiding Medicaid requires an understanding of American federalism and an unwavering focus on the needs of the program’s enrollees.