Identifying barriers to ART initiation and adherence: An exploratory qualitative study on PMTCT in Zambia

Background Though antiretroviral therapy (ART) is widely available, HIV positive pregnant women in Zambia are less likely to start and remain on therapy throughout pregnancy and after delivery. This study sought to understand readiness to start ART among HIV pregnant women from the perspectives of both women and men in order to suggest more holistic programs to support women to continue life-long ART after delivery. Methods We conducted a qualitative study with HIV positive pregnant women before and after ART initiation, and men with female partners, to understand readiness to start lifelong ART. We conducted 28 in-depth interviews among women and 2 focus group discussions among male partners. Data were transcribed verbatim and analyzed in NVivo 12 using thematic analysis. Emerging themes from the data were organized using the social ecological framework. Results Men thought of their female partners as young and needing their supervision to initiate and stay on ART. Women agreed that disclosure and partner support were necessary preconditions to ART initiation and adherence and, expressed fear of divorce as a prominent barrier to disclosure. Maternal love and desire to look after one’s children instilled a sense of responsibility among women which motivated them to overcome individual, interpersonal and health system level barriers to initiation and adherence. Women preferred adherence strategies that were discrete, the effectiveness of which, depended on women’s intrinsic motivation. Conclusion The results support current policies in Zambia to encourage male engagement in ART care. To appeal to male partners, messaging on ART should be centered on emphasizing the importance of male involvement to ensure women remain engaged in ART care. Programs aimed at supporting postpartum ART adherence should design messages that appeal to both men’s role in couples’ joint decision-making and women’s maternal love as motivators for adherence.

Design, adaptation, and diffusion of an innovative tool to promote shared contraceptive decision-making: Balanced Counseling Strategy Plus

Contraceptive decision-making is highly complex, and family planning (FP) clients choose methods according to a host of personal, interpersonal, and context-specific considerations. These include concerns about side effects, confidence in their ability to adhere to daily or monthly use, efficacy of methods, partner support, and HIV vulnerability. FP decision support tools can support FP clients and providers to engage in a joint decision-making process to ensure clients make informed choices about contraception. For more than two decades, the Balanced Counseling Strategy (BCS) and Balanced Counseling Strategy Plus (BCS+) decision support tools have been used in lower- and middle-income countries, informed by implementation science research and iterative updates and refinements to reflect new developments in contraceptive technology and HIV prevention strategies. To inform the development and scale-up of future FP decision support tools, as well as share lessons from translating implementation science results to practice, this article describes the development, evaluation, and proliferation of BCS and BCS+.

Nudging and boosting children’s restaurant menus for healthier food choice: a blinded quasi-randomized controlled trial in a real life setting

Background Restaurants are ideal settings for implementing food interventions targeted at children. Studies with adults suggest that changes to the physical menu can lead to healthier food choices; online studies with parents indicate that specific menu designs facilitate healthier choices. However, it is unknown whether applying well-established nudging and boosting methods to children’s menus also increases their choice of healthier meals in a real-world restaurant setting. Methods The effects of two versions of a restaurant menu on the frequency of choosing a healthy meal (newly created, healthy target dish) were tested in a blinded quasi-randomized controlled trial. The menu in the control condition contained all dishes (including the healthy target dish) in a standardized format. The intervention menu included nudging (e.g. comic character, fun attractive name for the dish) and boosting elements (e.g. information on low calorie density) next to the healthy target dish. Over five months, the control and intervention menus were switched every two weeks and records were made of how often the healthy target dish was ordered. Results In total, 607 orders were made from the children’s restaurant menu (57% from the intervention menu). During the intervention phase, 4.2% of all ordered dishes from the children’s menu were the healthy target dish, during the control phase, 4.4% of orders were for the target dish (p=.896). Conclusions Contrary to our hypothesis, a modified children’s menu did not lead to a significant increase in the number of orders for a healthy dish compared with a neutral control menu. Importantly, given that parents and children often choose the child’s dish together, particularly boosting methods that focus on social processes and joint decision making could be promising to increase children’s frequency of healthy food choices in restaurants. Trial registration DRKS00027039, registered on 11/22/2021, (Retrospectively registered).

Coastal aquaculture management of research and development coastal aquaculture center region 3, Takhianthong Subdistrict, Kanchanadit District, Surat Thani Province, Thailand

The objectives of this research were: 1) to study the management of coastal aquaculture at the Coastal Aquaculture Research and Development Center, Region 3, Surat Thani Province; 2) study problems and obstacles in aquaculture management. 3) Guidelines for the development of aquaculture management. This research used both qualitative and quantitative methods simultaneously. The sample consisted of 60 people, and a categorical randomisation method was used. The qualitative method used a focus group and selected five key informants specifically. The research instruments used include questionnaires and semi-structured interviews. The Quantitative data analysis used statistics such as; mean, percentage and standard deviation. The results showed that the overall opinion on the management of coastal aquaculture Research and Development Center, Region 3 (Surat Thani) was at a high level with a mean of 4.03. The qualitative research method used in-depth interviews with the sample groups; it was found that coastal aquaculture management can be of two types: 1) The government sector co-ordinates with some agencies and organizations to seek the people’s opinions in unity, which shows a direct collaboration with the government, hence opening room for mutual understanding. Both in terms of giving information, problem-solving, expression of opinion, and joint decision.

The impact of supply chain practice on green hotel performance through internal, upstream, and downstream integration

The company builds communication and collaboration with suppliers and customers to increase competitiveness in the supply chain flow. The organization's ability to involve suppliers and customers in business activities to achieve efficiency and effectiveness is one of the objectives of supply chain practice. The distribution of questionnaires directly to hotel practitioners was 25 respondents, and 65 respondents obtained the distribution of google form links. The results showed that supply chain practices with supplier relationship management and quality information sharing activities could increase internal and upstream integration and not directly impact downstream integration. Internal integration with data integration activities accurately and coordination between functions on an ongoing basis can affect upstream and downstream integration and green hotel performance. Upstream integration and downstream integration with joint decision activities and planning synchronization with external parties can directly impact green hotel performance. They were increasing the market share and image of the hotel with the implementation of caring for the environment. This research contributes to hotel practitioners adopting practical supply chains in building internal and external integration to increase competitiveness and theoretical contribution to developing supply chain theory and green performance.

Low carbon joint strategy and coordination for a dyadic supply chain with Nash bargaining fairness

<p style='text-indent:20px;'>In the paper, fairness concern criterion is utilized to explore the coordination of a dyadic supply chain with a fairness-concerned retailer (acting as a newsvendor), who is committed to low carbon efforts. Two models are developed for stochastic demand disturbances in the forms of multiplicative case and additive case, respectively. Firstly, the optimal joint decision of the retailer and the supply chain are proposed in two scenarios, i.e., decentralized decision and the centralized decision. Secondly, in order to realize channel coordination, the contract of revenue sharing combined with the mechanism of low-carbon cost sharing is designed. Moreover, the influences of the retailer's fairness concern and bargaining power on the joint decision and the contract parameters are also investigated. Finally, numerical examples are given to illustrate the theoretical results and some suggestions to supply chain management are also provided. The results show that the revenue sharing contract can make the supply chain achieved coordination with the cost sharing mechanism of low-carbon efforts. Furthermore, the optimal low-carbon effort level and ordering quantity decrease in terms of fairness-concerned parameter and Nash bargaining power parameter, which increases in unit cost. However, the optimal pricing makes the opposite change.</p>

The Influence of Father and Mother's Joint Decision Making on Children's Basic Immunization:Empirical Research on Indonesia's Demographic and Health Survey 2017

The 2017 diphtheria outbreaks in Indonesia shows the downside of inadequate immunization for certain group that could endanger public health. Despite years of government intervention on this vaccine-preventable disease, insofar mandating basic vaccination for children from an early age, ultimately, it is parents that will decide on having their children being immunized. Utilizing the 2017 Indonesia Demographic and Health Survey, this study aims to uncover the association between parents' decision-making processes and their demographic variables to their children's immunization completion status. Logistic regression suggests discussion between parents in household's major purchases, more likely to result in complete basic immunization for their children. Additionally, mothers' traits, which are education, frequency of access to mass media, and exposure to medical professionals, are positively associated with compliance with basic vaccines administration. Differences in compliance can also be observed in children's gender and order of birth.

Joint Decision-Making Model Based on Consensus Modeling Technology for the Prediction of Drug-Induced Liver Injury

Drug-induced liver injury (DILI) is the major cause of clinical trial failure and postmarketing withdrawals of approved drugs. It is very expensive and time-consuming to evaluate hepatotoxicity using animal or cell-based experiments in the early stage of drug development. In this study, an in silico model based on the joint decision-making strategy was developed for DILI assessment using a relatively large dataset of 2608 compounds. Five consensus models were developed with PaDEL descriptors and PubChem, Substructure, Estate, and Klekota–Roth fingerprints, respectively. Submodels for each consensus model were obtained through joint optimization. The parameters and features of each submodel were optimized jointly based on the hybrid quantum particle swarm optimization (HQPSO) algorithm. The application domain (AD) based on the frequency-weighted and distance (FWD)-based method and Tanimoto similarity index showed the wide AD of the qualified consensus models. A joint decision-making model was integrated by the qualified consensus models, and the overwhelming majority principle was used to improve the performance of consensus models. The application scope narrowing caused by the overwhelming majority principle was successfully solved by joint decision-making. The proposed model successfully predicted 99.2% of the compounds in the test set, with an accuracy of 80.0%, a sensitivity of 83.9, and a specificity of 73.3%. For an external validation set containing 390 compounds collected from DILIrank, 98.2% of the compounds were successfully predicted with an accuracy of 79.9%, a sensitivity of 97.1%, and a specificity of 66.0%. Furthermore, 25 privileged substructures responsible for DILI were identified from Substructure, PubChem, and Klekota–Roth fingerprints. These privileged substructures can be regarded as structural alerts in hepatotoxicity evaluation. Compared with the main published studies, our method exhibits certain advantage in data size, transparency, and standardization of the modeling process and accuracy and credibility of prediction results. It is a promising tool for virtual screening in the early stage of drug development.

Disrupting Family Group Conference practice in Aotearoa New Zealand: A learning project

Participation in, or facilitation of, Family Group Conferences (FGCs) and hui-ā-whānau (family meetings) are key social work practice activities in Aotearoa New Zealand. Social work students are expected to graduate with the cultural competence necessary to work ethically with whānau Māori according to the bicultural practice principles of Te Tiriti ō Waitangi. This competence includes skills in the facilitation of joint decision making, shared responsibility and the use of Māori engagement principles, all of which are fundamental to the traditional and professional practice of hui (meetings).We argue that, for social work students to enter the profession with the ability to work effectively in a statutory setting, and with whānau Māori, learning must go beyond the processes of the FGC as set out in the Oranga Tamariki Act (1989)—originally the Children, Young Personsand Their Families Act, 1989—and embrace the historical and cultural intent of this practice. It must encourage students to be mindful of their cultural selves in the process and to reflect on the tensions arising from how the FGC sits within a statutory, managerial, and neoliberal policy framework. This article applies concepts of Māori and Western pedagogy to a learning strategy developed by the authors over a period of four years. The Reality FGC Project began as a way of assisting students to develop skills and apply theory to practice, and unexpectedly became an opportunity to reflexively and iteratively consider the role of social work education in re-thinking FGC practice in Aotearoa New Zealand.