The burden of Cardio-Metabolic Syndrome (CMS) is surging globally and in LMICs like India. Despite several efforts to address this burden, significant challenges for managing CMS remain, especially in the management of such cases in primary care. ECHO India plans to address this gap by training 1700 primary care physicians (PCPs) across six states through a tele-mentoring process. The goal of the program is to improve the skills of PCPs in managing patients with CMS. To evaluate the effectiveness of the training of PCPs for management of CMS in primary care, to evaluate the benefit of the training program vis-à-vis the system costs incurred (cost-benefit analysis), to examine intended and unintended benefits at the system level as a result of the mentoring program. A Type II hybrid quasi-experimental design will be used, adapting the RE-AIM-QuEST framework with a mixed-methods approach. Effectiveness will be evaluated through a controlled before–after study with patients conducted in two states, Tamil Nadu and West Bengal. A difference-in-difference design will be used to assess patient satisfaction and cost–benefit outcomes across the two states. Program performance data from ECHO India will be analyzed quantitatively, alongside qualitative key informant interviews to explore system-level changes in CMS management. Quantitative analysis will be conducted using R, and qualitative analysis using NVivo. Quantitative and qualitative findings will be integrated and reported using an adapted RE-AIM QuEST framework. This study will provide a comprehensive evaluation of the ECHO tele-mentoring model for PCPs’ training on the management of CMS in India.
This paper explores methods for topological optimization of structures and the particularities of their implementation. It describes lattice and other complex geometric structures with regularly repeating unit cells that provide non-solid internal filling of components, taking into account the feasibility of their fabrication using additive manufacturing technologies. A case study of topological optimization using an implicit geometric model representation was conducted for a component intended for production via selective laser melting of metal powder alloys. The optimization resulted in a 27% reduction in the component’s mass without compromising its mechanical strength, achieved through modification of the internal geometry. The study emphasizes the importance of verifying the results of topological optimization under operational loads while accounting for the specific characteristics of additive manufacturing technologies.
The study assessed participant feedback on a capacity-building program for breast and oral cancer care among health workers in India using the Extension for Community Healthcare Outcomes (ECHO) model. The training aimed to enhance knowledge and competence in early detection, diagnosis, treatment, and patient-centred care. The objective of the study was to assess participants’ perceptions of changes in their knowledge level before and after the session, as well as self-competency and satisfaction ratings for the sessions. A mixed-methods approach was used across 12 hubs in 11 states, conducting 72 online sessions from April to October 2024. Training included didactic presentations, case discussions, and interactive activities. Data from post-session surveys (iECHO platform) assessed participation, satisfaction, knowledge change, and intent to apply learning. Quantitative analysis involved descriptive statistics and the Wilcoxon Signed Rank test, while qualitative data underwent thematic analysis. For breast cancer, 960 responses were collected across 36 sessions; for oral cancer, 536 responses were gathered. Self-reported knowledge significantly increased (p < 0.001) from 30.3
Abstract Introduction India has the largest cohort of community health workers with one million Accredited Social Health Activists (ASHAs). ASHAs play vital role in providing health education and promoting accessible health care services in the community. Despite their potential to improve the health status of people, they remain largely underutilized because of their limited knowledge and skills. Considering this gap, Extension for Community Healthcare Outcomes (ECHO)® India, in collaboration with the National Health System Resource Centre (NHSRC), implemented a 15-h (over 6 months) refresher training for ASHAs using a telementoring interface. The present study intends to assess the impact of the training program for improving the knowledge and skills of ASHA workers. Methods We conducted a pre–post quasi-experimental study using a convergent parallel mixed-method approach. The quantitative survey (n = 490) assessed learning competence, performance, and satisfaction of the ASHAs. In addition to the above, in-depth interviews with ASHAs (n = 12) and key informant interviews with other stakeholders (n = 9) examined the experience and practical applications of the training. Inferences from the quantitative and qualitative approaches were integrated during the reporting stage and presented using an adapted Moore’s Expanded Outcomes Framework. Results There was a statistically significant improvement in learning (p = 0.038) and competence (p = 0.01) after attending the training. Participants were satisfied with the opportunity provided by the teleECHO™ sessions to upgrade their knowledge. However, internet connectivity, duration and number of participants in the sessions were identified as areas that needed improvement for future training programs. An improvement in confidence to communicate more effectively with the community was reported. Positive changes in the attitudes of ASHAs towards patient and community members were also reported after attending the training. The peer-to-peer learning through case-based discussion approach helped ensure that the training was relevant to the needs and work of the ASHAs. Conclusions The ECHO Model ™ was found effective in improving and updating the knowledge and skills of ASHAs across different geographies in India. Efforts directed towards knowledge upgradation of ASHAs are crucial for strengthening the health system at the community level. The findings of this study can be used to guide future training programs. Trial registration The study has been registered at the Clinical Trials Registry, India (CTRI/2021/10/037189) dated 08/10/2021.
The number of women and underrepresented individuals working in science, technology, engineering and mathematics (STEM) fields does not reflect the diversity of our societies. Even if children have an interest in STEM, they may not consider choosing a study or career in that direction if their perception is that they would not belong in science. This study examines the effects of a STEM lesson series aimed at inclusivity and diversity on children's perception and sense of belonging in space science. Before and after the lesson series, children filled out a questionnaire aimed at eliciting their perception of space science and space scientists. After the lessons, a subsample of children was interviewed about the effects of the lesson series on the children's perception and sense of belonging regarding space science. Six months after the last lesson took place, children from two classes filled out a short survey with open questions to measure retention. The results of this study showed that the lesson series had a significant impact on children's perception of space scientists, and that the implementation of the lessons facilitated thinking about (a future in) space science. This lesson series has succeeded in changing children's perception of space scientists as a diverse and international group of people.
