Bandung, the fourth largest city in Indonesia and capital of West Java province, has been considered a major endemic area of dengue, and studies show that the incidence in this city could increase and spread rapidly. At the same time, estimation of incidence could be inaccurate due to a lack of reliable surveillance systems. To provide strategic information for the dengue control program in the face of limited capacity, this study used spatial pattern analysis of a possible outbreak of dengue cases, through the Geographic Information System (GIS). To further enhance the information needed for effective policymaking, we also analyzed the demographic pattern of dengue cases.Monthly reports of dengue cases from January 2014 to December 2016 from 16 hospitals in Bandung were collected as the database, which consisted of address, sex, age, and code to anonymize the patients. The address was then transformed into geocoding and used to estimate the relative risk of a particular area’s developing a cluster of dengue cases. We used the kernel density estimation method to analyze the dynamics of change of dengue cases.The model showed that the spatial cluster of the relative risk of dengue incidence was relatively unchanged for 3 years. Dengue high-risk areas predominated in the southern and southeastern parts of Bandung, while low-risk areas were found mostly in its western and northeastern regions. The kernel density estimation showed strong cluster groups of dengue cases in the city.This study demonstrated a strong pattern of reported cases related to specific demographic groups . Furthermore, spatial analysis using GIS also visualized the dynamic development of the aggregation of disease incidence (hotspots) for dengue cases in Bandung. These data may provide strategic information for the planning and design of dengue control programs. Dengue infection has been considered a significant global health problem in many tropical and subtropical countries, with 3.97 billion people worldwide are at risk , 2. IndoHowever, these incidence figures may actually be an underestimate due to dependence on passive surveillance systems. Passive surveillance systems depend largely on a country’s capacity or resources  to identify all cases of a disease. When a country does not possess the required capacity or resources, passive surveillance is less likely to detect all cases, which could lead to periodic outbreaks –9. ConsiIn recent years, GIS has been utilized to assess, identify, and visualize the potential risk factors involved in disease transmission , 11–14. 2 while Bucaramanga covers only 27 km2). This larger space may lead to broader movement of disease carriers among areas in Bandung.Taking into account the lack of reliable surveillance networks in a developing country, spatial epidemiological investigations can be approached by mapping the relative risk, a process which essentially compares the probability of disease in the exposed group to the probability in the unexposed group , using tFurthermore, dengue incidences have a temporal signature, as outbreaks at a particular space-time location can surge and resurface in a cyclic pattern. It is therefore critical to analyze the data through space-time clustering—as the disease tends to exhibit in a non-random pattern—and geosurveillance—as the disease tends to occur in similar regions which could translate into geographical position , 28. HowThe high uncertainty which leads to conclusion biases can be overcome by applying higher and optimal kernel bandwidth  which isThrough this study, we aimed to develop spatial-temporal patterns of dengue case incidence by the application of the kernel density estimation to assess the spatial distribution of relative dengue risk in Bandung over a specific range of years. The study also enabled us to produce a map visualizing the relative risk of dengue in Bandung by indicating the hotspots of dengue transmission. This research improves on previous studies about the pattern of dengue spread which simply showed the total dengue incidence for a specific time without comparison to the number of cases in other areas, or without showing spatial and temporal fluctuations . Furthero36′ east longitude and 6o55′ south latitude. It has a total area of 16,729.65 hectares and lies at 791 m above sea level (asl). Its highest point is in the northern area at 1050 m asl, while the lowest point is located in the southern area at 675 m asl. The southern part of the city consists mostly of sloping contours, while the northern part is far more mountainous. The city comprises 30 sub-districts with 151 villages and can be divided as north, south, east, and west boundaries [Bandung is the largest city on the southern island of Java, located at 107undaries .Monthly reports of diagnosed dengue cases from 16 hospitals in Bandung were collected from the Dengue Disease Surveillance database of the city health office. These reports were obtained for the period January 2014 to December 2016. Dengue cases were distinguished into five different categories based on symptoms and laboratory results , namely undifferentiated fever, dengue fever, dengue hemorrhagic fever, dengue shock syndrome, and expanded dengue syndrome . UndiffeThe demographic profile of each reported case included the patient’s age, gender, residential address, date of confirmed diagnosis, and reporting hospital. The data were analyzed anonymously and it was assumed that each infection occurred at the residential address of the patients. Population size data of 151 villages of Bandung for 2014–2016 were also obtained from the Bandung Central Bureau of Statistics for the year 2017. Data were further categorized by age group  as the spatial density function, and distribution of infected population at specific regions (g) as the temporal density function, then the dengue relative risk at spatial coordinate W is Bandung) can be defined asThe probability was estimated from the spatial distributions of dengue cases (the residence address of the patients with confirmed dengue) and the temporal distribution of dengue cases at each area within Bandung (the time when the positive cases were reported). By defining the spatial distribution of dengue cases . Also, more male (n = 5533) than female (n = 5040) dengue patients were reported during the observation period . Annually, there were increasing trends of positive cases for young patients  with reported dengue cases were children under 10 years old for all observation years, with the total number of patients consistently declining with age , it is important to ensure that the identification of hotspots is as accurate and effective as possible [The local Moran’s possible .Underreported data in disease study is difficult to avoid. However, by assuming the underreporting occurs in all areas and times randomly, we believe that the underestimation problem is not an issue due to random error assumption.Dengue incidences in Bandung showed an increasing number from 2014 to 2016. In general, the pattern of hospitalized cases was remained relatively stable despite the change in hotspot areas. The pattern showed large numbers of cases early in the year followed by a peak period about May to June. The pattern is strongly related to meteorological factors such as rainfall and humidity which can been observed at different scope levels: village-wide , region-wide (West Java province and its nearby areas) , and natThis study also found that most of the patients were male, similar to previous studies from Cambodia, Malaysia, Sri Lanka, Singapore, the Philippines, and India –57. One The study also highlighted a strong demographic pattern of cases in children, with a significant increase in 2016. This result is similar to other data from a different city in West Java  which suOur results confirmed that dengue cases in Bandung have a clustered distribution pattern among the local villages. High-risk areas of dengue incidences were mostly located in Bandung’s downtown, in the intersection of the area between Cibeunying, Karees, Tegalega, and Bojanegara. This area is one of the most economically productive in Bandung, where most of the best public services , industries, commercial enterprises, and recreation are concentrated and the rate of population growth is considered higher than in other regions due to a higher birth rate and urbanization . This reThe kernel density estimation allowed the generated map to show the development of new hotspots in the northern part of the city since 2015. This was possible because the estimation process adds the pattern of point event changes in an equation and compares it to other point events. Thus, although the number of cases may be much lower than in other regions, a positive change will be registered as a positive result of forecasting—in this case, showing an increase in the risk of dengue incidences. A possible explanation of the phenomenon may be related to the rapid development of the northern part of the city during the last 10 years. The development activities created a region that provides better education, job opportunities, recreation, and standard of living that have encouraged temporary rural-urban immigration from established hot spots . This reAnother notable point in the generated spatial map Fig.  is the aThe main limitation of this study is a broader inability to assess the underreporting of hospitalized patients’ data. The data we gathered from Bandung City Health Office covered only 60% of the hospitals that were registered in Bandung. The extent to which such partial data might have influenced the analysis result is unknown. However, the omissions are considered minor and the findings still applicable, as we gathered most of the data from type B hospitals, which generally act as the primary reference for health services in their respective areas.A study by Tapia-Coyer is relevant to our findings. It showed that community empowerment is a key aspect of disease-eradicating strategy, as it allows a local population to drive the eradication of diseases in its environment. Hence, a sustainable process is necessary to encourage individuals to maintain efforts in keeping their environment free of dengue . KnowledThis study demonstrates a strong pattern of reported cases related to specific demographic groups . Furthermore, spatial analysis using GIS also visualized the dynamic development of aggregation of the disease incidence (hotspots) for dengue cases in Bandung. In the future, observation of clustered hotspots in Bandung could provide strategic information for the planning and design of a dengue control program and may encourage communities to initiate their own dengue prevention programs. Existing surveillance methods should be evaluated and modified as needed based on the spatial analysis presented in this report so that local resources can be optimally utilized in a specific area. Moreover, the clustering distance information, which is around 900 m in radius, and demographic data can be used for detailed technical planning in dengue case countermeasures.


Combat sports and martial arts are often associated with aggressiveness among the general public, although data on judo and/or martial arts and aggressiveness seem to be unclear. This research aims to compare athletes who have trained judo for a prolonged time (minimum 5 years) and athletes from various team sports, primarily regarding the manifestation of aggression, but also regarding personality traits, emotional intelligence, and self-efficacy. Also, the potential predictive value of personality traits, emotional intelligence, and self-efficacy for aggression within subsamples of judokas and team athletes was tested. The research findings showed that professional judo athletes are characterized by a low degree of aggression, especially low indirect and physical manifestations of aggression. In addition, the personality traits Honesty-Humility and Openness to experience are well expressed, contrary to Emotionality and Extraversion, which are less pronounced. They are also characterized by moderate general self-efficacy. On the other hand, members of team sports produced the opposite results, as they are characterized by increased aggression, pronounced traits of Emotionality and Extraversion, somewhat less pronounced traits of Honesty-Humility, Openness to new experience, and less pronounced general self-efficacy. The percentage of explained variability of aggression is slightly higher in the subsample of team sports and constitutes 49.9% of the variability, while in the subsample of judokas it constitutes 47.8% of the variability of the criteria. Practical implications, limitations, and future research directions were discussed. Judo is a Japanese martial art that is now widely recognized as an Olympic sport and it is the first martial art to be included in the Olympics in 1964. It is composed of the technical part, but also the moral and ethical part of the art . In 2012At the youngest age (8 years), it seems that judo attracts children that scored higher on the anger scale compared to children who train karate or children who are not involved in any sports activity , and thoSomewhat indifferent results show that the aggressiveness of judokas does not differ from the group of non-athletes in boys  and girlThe most recent studies gathered evidence about a positive influence of martial arts and combat sports on aggression . EvidencAccording to However, the present study prioritizes the relationship between emotional intelligence and aggression. Lower scores for the trait emotional intelligence are connected with both physical and verbal aggression in adolescents of both genders . ResultsSelf-efficacy can be defined as an individual’s assessment of his or her capacities to organize and execute specific actions necessary to achieve the desired goals , and it The HEXACO model of basic personality structure  was creaThere is some evidence that team sports athletes are more aggressive than athletes from individual sports (including MA and CS), but these findings came from the research that differs considerably in the methodology, sample characteristics, sports included, and outcomes . The preThe research sample consisted of 140 male respondents from Serbia (mean age 19.26), of whom 60 (42.9%) were judokas, while 80 (57.1%) were athletes who are active in team sports . At the time this research was conducted, all athletes included in the sample had been engaged in their chosen sport for at least 5 years, had at least 5 training sessions per week, and competed at least at the national level. Respondents completed (paper/pen) questionnaires at the scheduled time, 1 h before the start of the training session.The instrument used to assess aggressiveness was Questionnaire A-87 , which cThe instrument used to determine personality traits was HEXACO-PI-R , which cThe emotional competence questionnaire  consistsThe instrument used to assess self-efficacy was the General Self-Efficacy Scale GSE, , which cThe Perceived Social Self-Efficacy (PSSE) Scale measures people’s beliefs in their capabilities to voice their own opinions with others, to work cooperatively and share personal experiences with others, and to manage interpersonal conflicts. PSSE is positively related to self-esteem, life satisfaction, and optimism . The relDescriptive measures, mean differences, hierarchical linear regression analysis, and discriminant analysis were used in the data analysis.The research findings showed that professional judo athletes have statistically significant less pronounced indirect and physical manifest aggression compared to athletes from team sports . Also, iTo check whether it is possible to distinguish judokas from athletes engaged in team sports, the method of canonical discriminant analysis was applied based on a set of variables that comprise aggression and its modalities, aspects of emotional competence, general and social self-efficacy, subjective assessment of general well-being, and personality traits according to the HEXACO model.p < 0.01.The values of the group centroids (average discriminant scores for each of the groups) range from −1.167 for judokas to 0.876 for athletes engaged in team sports . The disBased on the data shown in Given that a significant number of predictor variables are present in the study, it was also examined to what extent it is possible to predict the severity of aggression and its models based on a set of predictor variables consisting of personality traits according to the HEXACO model, aspects of emotional competence—expression, recognition, and control of emotion, and general and social self-efficacy.Prediction models were shown to be statistically significant, both on the judo sample and on the team sports sample . The pert = −3.868, p < 0.01), Extraversion , and Emotionality . Beta coefficients are negative, which indicates that the expression of these personality traits is inversely proportional to the expression of aggression in team athletes.In the subsample of team athletes, a significant partial contribution to the explanation of the variability of the criterion variable aggression is made by the variables Agreeableness  and Conscientiousness , which means that in this subsample a higher degree of Agreeableness leads to a lower expression of aggression (negative beta coefficient) while a higher expression of Conscientiousness leads to higher aggressiveness (positive beta coefficient).In the subsample of judokas, a statistically significant partial contribution to the explanation of the variability of the criterion variable aggression is made by the variables Agreeableness  of the criterion aggression. What both models have in common is that the personality trait Agreeableness has a significant partial contribution to explaining the aggressiveness with which it is inversely proportional. This is in line with earlier findings . PersonsWhat is surprising is the fact that emotional intelligence and generalized and social self-efficacy are not significant predictors, although this was expected based on previous research reporting an association between emotional intelligence and lower aggressiveness  and signThe proposed suggestions for further research are directly related to the limitations of this study. These limitations primarily appertain to the sample, which is not large enough to perform analyses such as moderator effects. In addition, the sample included only male participants so it would be beneficial that future research includes females. Also, it must be stated that the sport success of athletes involved in this research was not controlled, and the objectives of the research cannot be achieved on subsamples defined on the basis of success, which would certainly be significant. Furthermore, the questionnaires used in this research are not sports-specific. The reason is that the basic thread for such research was the importance and expediency of including martial arts  in school curricula and that the possible general psychosocial effects, rather than sports success, were the primary value.Despite these limitations, it is safe to consider the objectives of the research as achieved. Less pronounced aggression with all its subdomains in judokas compared to athletes who play team sports certainly breaks the prejudices related to martial arts that many people have due to the similarity of numerous techniques with manifestations of aggression outside sports facilities. The obtained results not only equate judo with team sports in terms of inclusion in the school curriculum but also favor it in a certain way. The obtained predictors of aggression in athletes who engage in different types of sports can help coaches and sports psychologists to better understand the aggressive behavior of athletes, but also to prevent it more effectively.The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.The studies involving human participants were reviewed and approved by Ethics Committee of Faculty of Sport and Physical Education, University of Nis. The patients/participants provided their written informed consent to participate in this study.NemS, DT, NM, MM, and NenS designed the experiments, analyzed and interpreted the data, edited the manuscript, and approved the final version to be published and are accountable for all aspects of the work. NemS and DT performed the experiments and wrote the initial draft of the manuscript. All authors contributed to the article and approved the submitted version.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


Recent developments in the field of microwave planar sensors have led to a renewed interest in industrial, chemical, biological and medical applications that are capable of performing real-time and non-invasive measurement of material properties. Among the plausible advantages of microwave planar sensors is that they have a compact size, a low cost and the ease of fabrication and integration compared to prevailing sensors. However, some of their main drawbacks can be considered that restrict their usage and limit the range of applications such as their sensitivity and selectivity. The development of high-sensitivity microwave planar sensors is required for highly accurate complex permittivity measurements to monitor the small variations among different material samples. Therefore, the purpose of this paper is to review recent research on the development of microwave planar sensors and further challenges of their sensitivity and selectivity. Furthermore, the techniques of the complex permittivity extraction  are discussed based on the different approaches of mathematical models. The outcomes of this review may facilitate improvements of and an alternative solution for the enhancement of microwave planar sensors’ normalized sensitivity for material characterization, especially in biochemical and beverage industry applications. By definition, microwave sensors utilize electromagnetic fields and are devices internally operating at frequencies starting from 300 MHz up to the terahertz range. Various types of microwave planar sensors have been developed over the past decade. Certain types are known, while some are new and surprising . ResonatAlthough resonators are considered for their key performance in a range of RF/microwave communications and electronics applications such as oscillators and filters, significant efforts have been devoted to microwave resonator sensors for material characterization applications. The importance of studying material characterization is that this can be used for many applications such as agriculture, which is involved in grain drying, seed treatment in order to improve seed germination and insect control in stored grain using high-frequency and microwave electric fields. In addition, this is used for food processing purposes to check the quality and safety of food. This is also used for dairy products to roughly determine the content of milk in terms of ionic compounds, fats, carbohydrates and proteins. On the other hand, this is used for fruits and vegetables because there is a need for rapid non-destructive quality measurements to know the freshness of fruits and vegetables. This is also used for geoscience because when studying the dielectric properties of the soil, this would be helpful for planting. Furthermore, this is used for biosensing in order to know the properties of tissues and cells and to increase the knowledge of biological processes at the molecular level, and this is also involved in continuing developments in radio frequency and microwave hyperthermia treatments for cancer. Finally, this is used in the pharmaceutical industry in order to check and validate the quality and safety of medicines ,5,6,7,8.The analysed literature was found through scientific service tools using “microwave sensor” and “microwave planar resonators” as queries. Filtered articles published from 2012 to 2020 were adopted in this research, and they were used to review the main streams of research focusing on microwave resonator sensors and their general use in material characterization. This review shows the recent development of various studies and examples of applications of microwave planar sensors in material characterization. It includes the mathematical models for complex permittivity extraction ,22,23,24Various numerical methods have been used for extracting the complex permittivity or dielectric properties of materials such as the Nicholson–Ross–Weir (NRW), NIST iterative, new non-iterative, the Rational Function Model (RFM), and the frequency and quality factors methods. In most cases, it is important to know the appropriate measurement technique and conversion methods for a material in order to measure its dielectric properties. The resonance frequency is dependent on the relative permittivity of tested materials . A numerThe polynomial curve fitting can be used to extract the permittivity of the tested material. A common polynomial model is generally used based on the second order polynomial, as indicated in the expression below:To develop a mathematical sensing model for the sensor, the measurements of the resonance frequency and the peak attenuation, which are related to complex permittivity , are required based on a binary mixture of aqueous solutions ,11,12,13In order to determine the unknown coefficients of the model in Equation , the datThe unknown coefficients can be calculated from:As reported in ,16,17, tSimilar to the previous section, the unknown coefficients of the model in Equation  can be oPolar liquids will be penetrated by the electric field of the microwave sensor, which leads to the rotation of the molecule and causes the loss of energy. The response of the designed sensor will be changed in terms of the resonance frequency and quality factor. These behaviours provide information in terms of the real and imaginary parts of the complex permittivity of the tested polar liquids. The complex permittivity of the polar liquids can be formed as terature ,18,19: were employed for complex permittivity extraction, and this is due to their strong learning ability and high accuracy ,22,23,24Another study was done by , where tMicrowave sensors based on microwave resonator sensors have been extensively reported by researchers for detecting and characterizing various solid materials operating at different frequencies. Some are based on Microstrip Ring Resonators (MRRs) ,32,178, Recent developments in the field of microwave resonator sensors have led to a renewed interest in material characterization especially for liquid detection and their mixtures. Early examples of microwave resonator sensors for liquid detection include oil permittivity determination ,51,52,53One of the most significant current discussions in liquid detection using microwave resonator sensors is the binary mixture of two liquid materials. Some researchers tested various combinations of water-ethanol ,54,55, wConsiderable studies based on microwave sensors have been done for glucose monitoring. This is due to the capability of microwave sensors to non-destructively measure the parameters inside the volume since the daily monitoring techniques of glucose are invasive, requiring a blood sample to measure the parameters ,66,67,68There is an increasing interest in developing planar resonator sensors that lead to high sensitivity and accuracy. These advantages are used to sense the properties of materials such as solid, powder and aqueous solutions and impurities including the glucose concentration in water solutions based on the complex permittivity extraction. Recently, a high sensitivity microstrip line with an Electric-LC(ELC) resonator sensor was proposed by Kapoor, Varshney and Akhtar . The autOne possibility for designing the ELC is by using the Coplanar Waveguide technology (CPW) as proposed by Varshney, Sharma and Akhtar . The devSince the interdigital capacitor enhanced the electric field distribution as discussed by Kapoor, Varshney and Akhtar , the SRRTo demonstrate a high accuracy, Kiani, Rezaei and Navaei  designedSimilarly, the CSRR-based differential microwave sensor can be used for dual-sensing, which was implemented in microstrip technology, as presented by Gan et al. . Figure In the same vein, Khanna and Awasthi  presenteConversely, the CSRR can be integrated with the design of the metamaterial transmission lines for single-sensing. Haq et al.  proposedA new type of resonator was produced by Hamzah, Abduljabar and Porch , which iOne possible design for a split ring resonator is to use a CPW. A new technique was proposed by Hosseini, Olokede and Daneshmand  based onAnother type of coplanar waveguide was proposed by Moolat et al. , which wRocco et al.  conducteMoreover, the SIW sensors have various structure designs such as rectangular and circular. A comparison between these structures was discussed by Varshney and Akhtar . The autE. coli) of 50 L over the sensing resonator while the other resonator was used as the reference. E. coli on the LB agar associated with the experiment, which was captured at different times. The sensor exhibited a good performance with the capability of monitoring the growth of bacteria in solid medium with a low concentration of 1.8 × 107 cells/cm2.While many resonator sensors focus on the detection of solid and liquid materials, resonator sensors also have applications in monitoring bacterial growth on solid agar media. A non-invasive and real-time microwave biosensor based on a pair of planar split ring resonators was proposed by Mohammadi et al. , which cCompared to current reported microfluidic planar resonator sensor technologies based on PCB or polymer substrate materials integrated with PDMS or Teflon as a fluidic channel, Low Temperature Co-fired Ceramic (LTCC) technology can be used for lab-on-a-chip and biosensing due to the easy integration with microfluidic devices and electronic circuits in a ceramic substrate. LTCC technology is based on multiple layers, and it can be fabricated using laser micromachining, mechanical milling or hot embossing ,180. LiaQ is the quality factor, f is the resonance frequency, and The Quality factor (Q-factor) is an essential parameter for estimating the quality of microwave sensing resonators. The unloaded Q-value Q=foThe Q-factor increases as the shift in resonance frequency decreases. Thus, a narrower band and a sharper dip of the cut-off frequency of the bandwidth lead to higher Q-factor value. S of the sensor can be found from [To quantify the sensitivity of the resonator sensor, the resonance frequency for the empty case and for the case of being filled or loaded with the MUT are considered. The empty sensor is usually used as the reference model since the relative permittivity and the loss tangent of air are well known. When the sensor is loaded with the MUT in the strongest generated area of the electric field, the resonance frequency is changed, which is fully dependent on the permittivity of the tested materials. This relation is linear where any changes in relative permittivity  or Transverse Magnetic (TM) modes . The absMicrowave planar resonators have been extensively reported in recent years due to their advantages such as the ease of fabrication, low cost, and small physical size, which are compatible with many applications. However, these kinds of approaches carry with them various well-known limitations such as low quality factors (Q-factor), sensitivity, performance, and electric fields, which restrict their application in materials’ characterization. One of the serious limitations with this explanation is that the normalized sensitivity is quite low in detecting the properties of the materials using the planar resonators. A variety of microwave planar resonator techniques are used to detect and characterize the properties of materials in terms of complex permittivity. Each has its advantages and drawbacks. A major advantage of these techniques is that they have a simple design and fabrication along with minimizing the circuit size. However, there are certain drawbacks associated with the use of these techniques such as low electric field confinement, Q-factor, and sensitivity, which restrict their use in many applications and limit the range of permittivity detection. To enhance the sensitivity, the electric field must be highly confined on and around the sensor so that most of the energy will be concentrated on desired area . Table 7Furthermore, a summary of the physical and electrical size for the recently reported sensors in previous works aligned with sensing and measurement types is presented in The topic of sensing the presence of a substance in an environment, whether the substance is solid, liquid or a binary mixture, is one of the most active areas in materials science research today. This is due to the increasing demand of important industrial applications such as quality control in material science, in the food industry and biomedical sensing ,64,152. Another closely related obstacle to food industry application is the moisture content, which affects the products’ quality in various ways. Some are prone to fungal, bacterial and pest contamination, while others result in improper processing in an undesirable high moisture content environment. This leads to reducing the quality, efficacy and storage life of foodstuffs, drugs and chemicals and even poses a significant risk through food poisoning. Furthermore, the originality of food composition is widely considered as a main factor ,161. TheAnother important aspect is quality control, such as water content . For insA variety of microwave planar sensors are used for material characterization and their constituents in order to be used for monitoring in the food industry and for biomedical and quality control purposes ,165,166.To enhance the sensitivity, the authors in  did so bAnother important key restrict factor is the limited measurement applications based on microwave planar resonators. Most of the researchers focused on the liquid materials’ detection along with their binary mixtures or concentrations ,135,136,The aim of this paper is to review recent research into RF planar resonator sensors, mainly focused on passive resonators. The study critically addresses the low normalized sensitivity as the main challenge related to planar resonator sensors for material characterization and identifies research directions to motivate and facilitate researchers to contribute to this topic. The techniques of extracting complex permittivity  are discussed based on the different approaches of the mathematical models. The observations from this study suggest that the complex permittivity extraction based on ANNs provides high accuracy and reliable performance in a short time compared to empirical models. Further research might explore how to achieve high normalized sensitivity since the reported normalized sensitivity is within the range of 0.026% and 0.43% for planar resonator sensors. This study clarifies the recent development of material characterization techniques based on planar resonator sensors and provides current limitations for researchers who are interested in microwave resonators for material characterization.


The postoperative period is crucial for the initiation of healing and prevention of complications after any surgical procedure. Due to factors such as poor compliance, comprehension, and retention of instructions, and other unaccounted factors, the objectives of postoperative care are not always achieved. Therefore, an Android-based mobile health app (ExoDont) was developed to ensure a smooth postoperative period for patients after a dental extraction. The ExoDont app delivers reminders for postoperative instructions and drug intake at defined intervals, thus fostering self-reliance among patients in taking their prescribed dose of medication.The aim of this study is to design, develop, and validate ExoDont, an innovative app for improved adherence to postoperative instructions after tooth extraction.A postoperative treatment protocol was developed by a team of oral and maxillofacial surgeons and general dentists, following which the clinical and technological requirements of the app were determined along with the software engineers, graphic designers, and applications architect in the team. ExoDont was developed to provide timely reminders for medication and postoperative care. The app was field tested and validated using the User Version of the Mobile Application Rating Scale.The ExoDont software design was divided into a 3-level architecture comprising a user interface application, logical layer, and database layer. The software architecture consists of an Android-based ExoDont app for patients and a web version of the admin panel. The testing and validation of the ExoDont app revealed that Perceived Impact received the highest mean score of all rated components , while Engagement received the lowest mean score .The testing and validation of the app support its usability and functionality, as well as its impact on users. The ExoDont app has been designed, keeping the welfare of patients in view, in a user-friendly manner that will help patients adhere to the prescribed drug regimen and ensure easy and efficient dissemination of postoperative instructions. It could play an instrumental role in fostering compliance among patients and significantly decrease the complication rate following dental extractions. One of the most important factors that influences the recovery process after any surgical procedure is adherence to postoperative care instructions. Patient compliance describes the degree to which a patient follows medication regimens and instructions given by the doctor . A succeTooth extraction is the most common surgical procedure in oral surgery. Compliance with postoperative instructions after a tooth extraction is influenced by language difficulty, low health literacy, inadequate surgeon-patient communication, and patient inability to concentrate on instructions due to postoperative stress and their emotional and psychological state -5.The World Health Organization classifies the lack of adherence to posttreatment instructions as a major global problem . StudiesWith this in mind, our team developed an innovative software application for timely delivery of postoperative instructions named ExoDont. ExoDont is an Android-based hybrid application aimed at fostering treatment adherence in patients undergoing tooth extractions. It is an attempt toward encouraging the public to take ownership over their medication use—including taking the prescribed dose at the right frequency and for the correct duration—with a personalized, easy-to-use innovative app-based system that displays reminders to take medication at appropriate times and illustrates postoperative instructions. We hypothesize that the use of this internet-based application will improve patient compliance and reduce complications after tooth extraction over the conventional mode of transmission of postoperative instructions; a detailed analysis will be presented as the second part of the project.The first step in developing the ExoDont app was to establish the postoperative treatment protocol, which included antibiotics and analgesics along with postextraction instructions to be prescribed to the patient after tooth extraction. A team of oral and maxillofacial surgeons along with 2 general dentists developed a list of postprocedural medications  along with their dosages based on international recommendations . A list The technology team, consisting of software engineers, a graphic designer, and an applications architect, was then briefed about the app requirements. The following list of requirements was provided to the technology team: (1) the app should provide the abovementioned list of medications for the doctor to choose from, (2) patients should get timely instructions and reminders based on the time of tooth extraction and frequency and duration of prescribed medication, (3) the user interface should display the prescription and all instructions for the patient to view once logged into the app, and (4) patient data privacy should not be compromised.The technological team laid out the app design considering the following points. First, the app should ensure the confidentiality of patient information. Second, the system needs to be user-friendly for both the admin/doctor and the patient. Third, there needs to be a back-end server that stores and manages notifications sent to the patient. Fourth, it should be usable and adaptable for common operating systems. The patient will be required to download the app on his/her Android-operated device and enter the user ID and password provided by the authorized individual who will enter the patient credentials as well as the prescribed medication via a secured web page.Field testing was done in a group of 5 volunteers to check for the accuracy of the app in delivering the right instructions and reminders for medication. The app was tested in a group of 10 patients who underwent tooth extraction. The modified User Version of the Mobile Application Rating Scale (uMARS) was used to critically appraise the app.The ExoDont software system design was divided into a three-level architecture: (1) user interface application, (2) logical layer, and (3) database layer.Both the user interface layer and logical layer are separate from the database layer. This design protects patient/user privacy and permits only authorized hospital staff to access the data from the admin interface. The design of the software relies on client-server architecture, with the user application interfaces operating as clients (resource and service requesters) and the back-end system operating as the server (resource and service provider).In the development of ExoDont, the Ionic framework was used, which is an open-source mobile user interface toolkit for building high-quality, cross-platform native and web app experiences; it is fast, has a single code base, and runs everywhere with JavaScript. The framework works with Angular, with TypeScript as the programming language.When designing the server-side software, data security and cross-platform connectivity were taken into consideration. Node.js with an Express backend was used in its development, which includes a support library that interacts with popular database management systems and protects against malicious attacks. The admin panel was designed to allow an authorized person to enter patient details and choose suitable medications and instructions to be given to the patient.This Android-based app has to be downloaded onto the patient’s mobile phone. The patient will be able to access it using the login credentials provided by an authorized person. The entire process at reception takes less than 10 minutes, after which the patient will be able to view the home screen displaying all current and past notifications . A feed Only an authorized admin/doctor was allowed access to this panel using login credentials made available exclusively to him/her. Once logged in, the admin was able to view all patient records and current prescriptions. He/she will be able to add a new patient, select required medications, and set up notifications according to the time of extraction . NonpropTo improve cross-platform connectivity, a popular and robust open-source database management system called MongoDB was used to capture, query, and administer the data collected by the ExoDont app. The database comprises the following 4 tables that store raw and processed data:The patient table, which contains the personal information  and login credentials of all patients.The medicine course table, which includes details about the medicine course of all patients and gets updated with every new patient entered.The medicine store table, which includes the list of all available medications the doctor can choose from.The notification table, which contains information about all notifications sent to the patient and gets updated depending on the prescription of various patients.Field testing results showed that privacy of patient data was maintained in the app as no test participant could access details of other patients. The 10 patients who used the app were asked to complete the uMARS questionnaire . AccordiThe past few years have seen a greater reach of mobile devices in developing countries such as India, much more than that of the necessities of electricity, roads, and clean water. Extensive and rapid development of mobile technology, a fall in market prices of products, and a large increase in rates of use are the driving factors of the increase in eHealth delivery systems . The vasThere are also certain mobile healthcare apps available that support patients in adhering to their prescribed medication regimen through reminder functionalities. Medication adherence–based mHealth apps aim at delivering a behavioral intervention through reminder systems in the form of push notifications, text messages, text messages requiring a response, and other methods . RxmindMThe emergence of technology-associated healthcare has paved the way for teledentistry, which includes a plethora of dental health apps that are being used for teleconsultation for oral health–related issues, booking appointments, and for electronic recordkeeping. The earliest evidence reported for online dental services was for teleassistance for minor orthodontic emergencies using mobile phones with a video function . Since tCommon complications after tooth extraction include alveolar osteitis , infection, bleeding, and paresthesia ,28. To eAntibiotic dose optimization is crucial for any antimicrobial treatment or prophylactic regimen to be successful. For a drug to be effective against a microbe, it is essential that the drug remains at the site of infection at the optimal concentration and for an adequate amount of time. A drug should be able to produce concentration-dependent inhibition (by attaining a peak concentration with respect to the minimum inhibitory concentration) or time-dependent inhibition (by remaining at a concentration above the minimum inhibitory concentration for an adequate length of time). Any variation in the temporal spacing of the dose or noncompliance can cause a disturbance in the aforementioned factors and disturb the microbial flora, which may encourage the development of antimicrobial resistance . The WorThe critical appraisal of the ExoDont app using the uMARS scale suggested that the participants found the app to be lagging behind in engagement, which can be justified as per the aims and objectives of the app. The app was designed solely for the purpose of sending reminders and postoperative care instructions to patients, without any scope for customization or feedback on their part, which explains why this aspect of the app received the lowest score. The highest scores were awarded to the app’s Functionality and Perceived Impact. The app aims at improving postoperative care through its functionality, as there is currently a lack of conclusive evidence regarding the best method of dissemination of postoperative instructions. The perceived impact rating of the app suggests that the app will be successful in achieving its objectives. Esthetics and Subjective Quality are aspects of the app that will be improved in future modified versions.ExoDont can be thought of as a first step toward an even broader and holistic idea that includes all specialties of the dental field. This prototype presents an innovative scope to teledentistry and can be expanded to allow a host of other multidisciplinary functions too. From booking appointments to providing teleconsultation, ExoDont can be broadened in scope to include all specialty-specific functions. As with any technological advancement, ExoDont too has certain limitations. The app is useful only in the subset of the population that uses smartphones. An internet connection must be maintained at all times during the postoperative period for timely notifications and prompts through the app. The field testing of the app involved a smaller group of patients to check for any major functional flaws of the app. Therefore, the limited responses may not be a very accurate representation of a broader group’s rating of the app. As a second part of this study, the app will be tested on specific parameters clinically with a greater sample size; it will be compared with the existing modalities of postoperative instruction dissemination. Notably, ExoDont is an Android app and it is not currently available to iOS users. Furthermore, the app does not take into account educational barriers and health literacy, which may negatively impact the usability of the app.ExoDont is a promising mHealth app specifically addressing postoperative treatment and medication adherence after tooth extraction. The app is expected to show improved patient compliance and increased medication adherence. Initial studies have demonstrated acceptability and ease of use by both the dentist and patient. Future studies are required to establish the advantages of this app over the conventional mode of postoperative care. Therefore, as a second part to this study, the ExoDont app will be tested against the conventional modes of postoperative care on parameters such as adherence to medication, functionality of the ExoDont app in a larger sample size, and reduction in postoperative complication rate.


An online group of career counseling for unemployed young adults during the COVID-19 pandemic was developed. Twelve participants were involved in online group career counseling intervention, based on the Life Design for an inclusive and sustainable future. Results indicated at post-test on increased scores on career adaptability, resilience, future orientation, and propensity to identify inclusive and sustainable actions for the future than pre-test. Overall, the online group career counseling intervention effectively promoted particular aspects of young adults' life design for an inclusive e-sustainable future. The COVID-19 pandemic is a health emergency and implies a significant crisis in the economy and the labor market that has an enormous impact on people and particularly young adults, globally. Even before the onset of the crisis, being a young adult placed in the labor market was an ongoing challenge due to a work environment already pervaded by crises and global challenges, such as increasing social injustice, ecological threats, and the flexibility of work contracts. This situation has led to a substantial increase in the level of discomfort toward future career planning in an increasing number of young adults who are grappling with hurdles and obstacles in the realization of their plans , social skills trial, self-efficacy, and intrinsic motivation enhancement since sharing one’s own experience with the group may facilitate the construction of meaning in life , allowing the subject to provide new meaning to the experience and enhance a reflexive meaning construction of this experience.To foster specific and personalized activities, Zainudin et al.  suggest The increasing use of technology in the field of counseling has led to the development of counselor competency standards and ethical guidelines for the use of technology. For example, in light of the COVID-19 global pandemic, the American Counseling Association  organizeCounselors who use online media should also sort rapidly, compose expressively, and be proficient at online communication and Web-browser administration. Wang et al.  found thA few studies regarding online Life Design interventions with different samples have been published. Santilli et al. (2015) developed and validate the effectiveness of an online Life Design career intervention comprised of three 2-h sessions, each introduced with a video and specific activity for students  held by computer. Specifically, the intervention aimed at helping students in their career construction, fostering career and life goal setting. Another example is provided by Pordelan et al. , which dReferring to the above literature, we would develop and preliminarily assess the effectiveness of an online group career counseling intervention, divided into five sessions to incorporate the principles of the Life Design for an inclusive and sustainable future with personal and collective reflections. The activity was developed for young adults to engage in this time of crisis as an opportunity to help shape a world where decent, supportive, and dignified work is possible for all who want it.A new and growing research area is starting to recognize that COVID, conceived as a macro event, may also influence young adults’ inclusion in the job market  residing in Northeast Italy. Eight participants had a University degree, and four participants had a high school diploma. All of them were looking for a job: eight were looking for their first job, and four were looking for a job because of COVID-19 lockdown: they were not working and not receiving a salary.In total, 12 young Italian adults interested in designing the future and looking for employment were involved, ten women and two men between the ages of 20 and 30  to 5 (very strong). The 24 items combine into a total score indicating career adaptability. It consists of four subscales that measure the adaptability resources of Concern , Control , Curiosity , and Confidence . A previous study conducted by Ginevra et al. (2017) showed that the total score and four subscales have reasonable internal consistency estimates (range 0.80 to 0.86) and a coherent multidimensional hierarchical structure in Italian adults, and the structure was similar to CAAS-International Form 2.0  to 5 (It describes me very well). It assesses Future orientation ; and Resilience . Previous analyses  to 5 (It describes me very well). It assesses the propensity to provide help and support and to spread inclusive feelings , and the propensity to act sustainably and spread ideas of sustainability . Previous analyses carried out by Ginevra et al.  to 5 (extremely satisfied).et al.’s  study: “All participants were involved in the online group career counseling intervention through an employment agency of the community. The employment agency asked people who had approached during the pandemic period if they were interested in the activity that was also publicized through video ads on its social channels. To the people who showed interest in a career design, the intervention was advertised in detail, and after asking them if they wished to participate, and obtained their consent.The online group career counseling consists of five work sessions, two of which are individual (beginning and closing section) and have one hour each, while the remaining three are group sessions of 2 h each, bringing the total amount of work time to 8 h. Two online group career counseling interventions were conducted. Each online group counseling counted six randomly distributed participants.The online intervention began with about 1 h conducted individually through face-to-face online meetings in which a brief introduction of the member and the counselor was designed to build a connection among each participant. The counselor led participants first to describe what they hoped to get from experience. Subsequently, during the first meeting, the counselor tried to highlight the state experienced by the person looking for a job during the pandemic period. People narrated their training, work, and job search experiences in the past, their vision of the future, and their hopes, also initiating forms of reflection on what they have experienced. This individual meeting allowed to build a personalized action with each participant to pay attention to their narratability related to career adaptability, resilience, future orientation and contextual aspects associated with the situation experienced and the experienced barriers to starting to promote the development of new meanings to their difficulties.The following 6 h were spent participating in an online group career counseling split into three sessions of two hours each on the topic of work. The online career counseling workshop was used to intentionally guide participants to deeply and personally engage with the topic of unemployment in this specific pandemic situation. Facilitators initiated the dialog by inviting participants to discuss the economic reasons behind unemployment, supplemented by the use of news and YouTube videos .According to Cohen's ES 1988), the effect size was calculated for changes over time, applying the Wilcoxon Signed-Rank test (r) using the formula z/√N, where z is the test statistic, and N equals twice the number of individuals included in the respective analyses. According to Cohen's  procedure was used to estimate the semantic differences in the reflections made by participants between the three different group sessions and in the thoughts about the future at pre- and post-test. For the goals of this study, we followed the holistic method applied by others , Control , Curiosity , and Confidence . Furthermore, results highlighted changes in Resilience , Future Orientation , and Propensity to identify inclusive and sustainable actions for the future . Participants involved in the online group career counseling presented at post-test higher level career adaptability, resilience, future orientation, and propensity to identify inclusive and sustainable actions for the future  of participants indicated that they were extremely satisfied with the overall program, and 25% (N = 3) were satisfied, none were neutral about it, none reported being a little satisfied, and none indicated that they were not at all satisfied with the program.Overall, participants evaluated the online group career counseling as important for reflecting on specific dimensions of their careers and helping them cope with career future projects and transitions. A total of 75%  may be due to the emphasis given to young adults to find their voices and identify their role in building a quality future for themselves and others. Specifically, participants may have experienced the possibility of positively project their professional future, of 'looking beyond the present, having a more active role in detecting challenges and threats that could be dealt with in their future to improve everyone's life (career control). Moreover, the online group career counseling intervention let young adults answer questions and face challenges about the future of humanity that required them to explore something that they recognized as being new to focus their attention on (career curiosity). By analyzing these challenges that they would have liked to face, the intervention allowed young adults to identify their ‘mission possible’, they are striving to achieve. This may have generated a sensation of self-efficacy that helps to successfully carry out the necessary actions to pursue said ‘mission possible’ .During the online group career counseling intervention, particular emphasis was given to the reflection on multiple potential scenarios and the analysis of the already experienced negative situations such as unemployment, work precariousness, inequality, and undignified work also in order to identify a new way to read them, to manage them, and to resist to the difficulties associated with them. This may explain participants' increased future orientation and resilience .These findings have both theoretical and practical value. In terms of theoretical implications, findings advanced the literature on career interventions during the COVID-19 pandemic. Firstly, as Blustein et al.  suggesteIn terms of practical implications, the study provided the first evidence that online group career counseling intervention, which involves the stimulation of individual reflections through personalized activities and collective reflections through the use of collective activities, could be an effective strategy to involve young adults that experience difficulties during this pandemic period (Zainudin et al., Although our findings are encouraging, some limitations must be considered. Firstly, the sample size is relatively small; the gender composition is biased, with more women involved in the study and all participants live in Northeast Italy. Therefore, the generalizability of the results could be limited. Hopefully, future research should involve more men and participants from other Italian regions to verify the generalizability of the analyses reported in this study. Secondly, a control group has not been involved, and, in this sense, future research may verify the impact of the intervention on the participants compared to those who did not participate in it. Thirdly, it should also be specified that the effectiveness of the career intervention should not be limited to the examination of changes that occur only at the end of the career intervention. This implies that future research should also include 6- or 12-month follow-ups to verify whether young adults did pursue their goals or not.


The community health worker (CHW) asthma home-visiting model developed by Public Health-Seattle & King County (PHSKC) is an evidence-based approach proven to improve health outcomes and quality of life. In addition, it has been shown to be an effective and culturally appropriate approach to helping people with asthma understand the environmental and behavioral causes of uncontrolled asthma, while acquiring the skills they need to control their asthma. This paper describes the development and implementation of training curricula for CHWs and supervisors in the asthma home visiting program. To facilitate dissemination, this program took advantage of the current healthcare landscape in Washington State resulting from Centers for Medicare & Medicaid Services (CMS) approval of the 1115 Medicaid Waiver project. Key aspects of the training program development included: (1) Engagement: forming a Community Advisory Board with multiple stakeholders to help prioritize training content; (2) Curriculum Development: building the training on evidence-based home-visit protocols previously developed at PHSKC; (3) Implementation of the training program; (4) Evaluation of the training; and (5) Adaptation of the training based on lessons learned. We describe key factors in the training program's improvement including the use of a community-based participatory approach to engage stakeholders at multiple phases of the project and ensure regional adaption; combining in-person and online modules for delivery; and holding learning collaboratives for post-training and technical support. We also outline our training program evaluation plan and the planned evaluation of the home visit program which the trainees will deliver, both of which follow the RE-AIM framework. However, because the COVID-19 pandemic has curtailed training activities and prohibited the trainees from implementation of these CHW home visit practices, our evaluation is currently incomplete. Therefore, this case study provides insight into the adaptation of the training program, but not the delivery of the home visit program, the outcomes of which remain to be seen. Asthma is a chronic condition that impacts the lives of ~1 in 12 Americans and over 24 million people in the United States . In WashMany of the drivers of asthma morbidity are factors related to low socioeconomic status, such as transportation, language, and financial barriers; poor access to primary health care services; and environmental exposures to allergens and irritants including second-hand smoke , 8–13. MThese multicomponent home visit interventions for asthma led by CHWs have been shown to reduce morbidity from asthma and result in cost savings to the overall health care system –16. MultPublic Health-Seattle & King County (PHSKC), the health department of the most populous county in Washington State, has prioritized reduction of asthma health disparities using a CHW-led intervention model. The CHW program at PHSKC has many years of experience in development and implementation of CHW-led public health programs for asthma, including five research studies spanning from 2004 to 2015 , 18–21. This success motivated us to scale up the CHW asthma home visit model used by PHSKC to other communities throughout Washington State. Historically, there has been no sustainable funding source for such a project. However, the recent initiation of the $1.5 billion 1115 Medicaid Waiver project in Washington created an opportunity . The WaiThe project described here is hosted by PHSKC with four primary implementation partners within western Washington: three ACHs  and one Federally Qualified Health Center , a safety-net provider with clinics in nine counties in Western Washington . These pWe sought to train the CHWs connected to these regional hubs on the delivery of the evidence-based asthma home visiting program. However, we realized that our CHW program had 25 years of development and infrastructure that may contribute to positive results not easily replicable by other programs. In order to boost regional program effectiveness and sustainability, we decided to develop a program manager/supervisor training as well. This training would be built on the principles of best practices in creating supportive and sustainable CHW programs –26.The development and implementation of our training program followed five phases: (1) Engagement: we establish our community advisory board, partnership, and infrastructure for decision-making to support throughout the project. (2) Curriculum Development: we develop our training curriculum. (3) Implementation: we host our first trainings. (4) Evaluation: we measure and assess how the trainings were received. (5) Adaptation: we iterate phases 2, 3, and 4 applying improvements based on learnings from the implementation and evaluation stages. This manuscript is intended to present the proposal, design, and development of a training program, following many years of research and development of the program. At the time of submitting this manuscript, we are between phases 4 and 5. Therefore, we present some initial  outcomes and our plan for the Adaptation phase. This work was funded by the Patient-Centered Outcomes Research Institute (PCORI).Our work approaches community, program development, and research based on the principals of community based participatory research (CBPR) . Using tOur initial step was to convene a Community Advisory Board (CAB) consisting of key stakeholders who would provide guidance and increase local engagement. The CAB included representatives from our priority patient populations, CHW and supervisor teams, Washington State's Department of Health CHW program, local managed care organizations and Medicaid, a Federally Qualified Health Center, PHSKC, and three additional regional ACHs. Three CHWs from PHSKC served as lead educational consultants, and a University of Washington research group specializing in producing online, interactive medical training resources provided expertise. The CAB was representative of both new stakeholders as well as partners who were involved in our recent PCORI-funded randomized trial. This was intentional so that the diversity of experiences and expertise from our partners would enable adaptation within local contexts and provide a feedback loop regarding implementation challenges and opportunities. Authentic engagement, clear communication, and shared leadership with patients and other stakeholders in all project phases was considered critical to the project's success.We held regular monthly CAB meetings during which we created working groups for different tasks, and encouraged active participation toward four primary goals: (1) improve the scope and design of the training program to meet the needs of the various project partners; (2) develop, tailor, and deliver the support structures needed by the CHWs, program supervisors and organizations implementing the model; (3) provide input on the design of the evaluation of the training program, and (4) engage stakeholder end-users and funders to determine opportunities for continued spread. Participation in CAB meetings ranged from 20 to 30 in attendance, beginning in March 2020 and continuing to the present.Participation in the CAB was compensated with an annual stipend offered to our four project partner agencies through funds from our PCORI grant. The amount was calculated based on the anticipated staff time and resources, and use of the stipend was not restricted. In addition, we developed several additional entry points for engagement that were fully compensated. Each site was encouraged to identify at least one CHW, one program manager, and one person with asthma from their region to sit on the CAB. We also budgeted for interviewing program recipients in each region to provide feedback on the program aspects they experienced, compensating them for their time.After assembling the CAB, we conducted an in-depth examination of the existing evidence-based CHW asthma educational and environmental protocols at PHSKC and resources on CHW supervision to create a comprehensive foundation on which to build the new curriculum. We strategized with the CAB to narrow down the protocols to those most relevant and useful, and to identify gaps in information. The resulting protocols were then modified into a format appropriate for an in-person 2-day training for CHWs. Selected content was converted into a multi-media interactive online tutorial for asthma-focused CHWs by our partners at the University of Washington.In order to assist the integration of CHWs into their teams and to increase the sustainability of the project, we also designed a training specifically for CHW supervisors. We used the same strategy described above to develop a curriculum for a 2-day training for CHW supervisors.During the monthly meetings of the CAB, we worked together on the above curriculum development tasks and solicited feedback on the materials developed. The CAB provided invaluable feedback regarding potential implementation challenges and opportunities for continued dissemination of this model. For example, one of our primary partners noted that their CHWs primarily work with asthma patients who also are experiencing homelessness. Based on that feedback we incorporated information in our trainings on how CHWs can be innovative when it comes to delivering the asthma intervention protocols in situations where traditional housing or indoor shelter is not an option.chw.uwimtr.org), to be followed by an in-person training, covering the topics listed in The application of a community-based collaborative approach paired with an adult learner-centered curriculum development process resulted in a training tailored to support CHWs focused on asthma and their supervisors. This process yielded a collection of online tutorials intended for independent, self-paced study , but no data regarding the home visit intervention. The evaluation will continue when in-person asthma CHW activities are allowed to resume.In January and February of 2020, we delivered two in-person CHW trainings and two in-person CHW supervisor trainings, rather than the planned four trainings for each group (one for each ACH region). Our initial plan to hold separate trainings in each ACH region was modified once we discovered established venues that were convenient to multiple regions, allowing us to consolidate to two locations. A total of 60 individuals attended a training. This initial cohort of trainees were representative of over 12 different organizations including health departments, local neighborhood groups, community-based organizations, and managed care organizations. The training was provided in Spanish and English as planned.77% of CHWs (24 out of 31) were extremely clear about the takeaway points.91% of supervisors (32 out of 35) were extremely clear about the takeaway points.74% of CHWs (23 out of 31) thought the presentation of information was extremely clear.89% of supervisors (32 out of 36) thought the presentation of information was extremely clear.71% of CHWs (22 out of 31) were rated their confidence 8 or higher for their ability to apply what they learned at work .91% of supervisors (31 our 34) rated their confidence 8 or higher for their ability to apply what they learned at work Initial results from surveys of training participants showed the following:Interviews revealed that overall, there was a positive experience with major elements of the training such as food, environment, location, built confidence, facilitation, activities, interactivity and engagement, and room set-up and rotation. When speaking about the facilitation, one participant stated, “I think any time you have a training that's gonna be 16 hours over two days and there's a lot of material to cover, the facilitation makes or breaks the training. And they were just so personable and open, and asked pertinent questions and waited for the replies that needed to come out. I didn't feel pressured in any way to perform or not perform. I think the facilitators make or break any training, and they were exceptional.”CHWs especially felt that the motivational interviewing, visual aids/diagrams, role playing practice and the background was helpful. One CHW stated, “What will help me are the handouts that they gave us on ‘What is asthma?' and ‘How do we breathe?' [and] on why it's important to have controlled asthma and the importance of what the inhalers do. The actual visual diagrams I think will help clients understand ‘Oh yes, this is important', since they'll be able to see how it affects them when they are having an asthma attack, what actually is happening inside their lungs.”Several areas for improvement of the training program were identified. For example, feedback from the CHW training showed the desire for a refresher course online, funding for supplies, instruction on topics beyond asthma, and avoiding repetition of the online module content. Supervisors suggested slowing the pace of the training, providing tools that can also be applied to other chronic conditions, and spending more time on best practices for supportive supervision. One supervisor also suggested including a half-day overlap with CHWs to share learnings.This report has outlined the development of a training program to teach CHWs and CHW supervisors how to deliver an asthma home visit intervention built on an evidence-based, cost-effective model in Washington State. The scale-up of this approach took advantage of the state Medicaid Waiver program, which is likely to accelerate its integration into the health care system and improve its sustainability over time. Our use of a Community Advisory Board from the very early stages of the project enabled us to identify opportunities for adaptation of the proposed training to the settings in which it would be delivered, and offered invaluable feedback on what was and was not working. Following the trainings, the monthly Learning Collaboratives allowed ongoing engagement and review of skills, which is also expected to improve effectiveness and sustainability. The iterative nature of the curriculum design allows for continual improvement of the program over time. While not all states are participants in a Medicaid Waiver project, the other community-based participatory methods described here may still be applicable for other organizations seeking to scale up CHW home visit models across different settings in their state.Throughout the implementation of this project, we learned several lessons which will help to improve future iterations of the program. Firstly, changing conditions during the pandemic reinforced the importance of flexibility and willingness to adapt program implementation to the setting. Since the COVID-19 pandemic started in our region very shortly after our in-person trainings, many trainees were unable to go back to their communities in person and immediately apply their new asthma education skills. As the pandemic continues and some attention shifts back toward non-COVID-19 health concerns, we are encouraging our trainees to begin conducting virtual asthma visits as a way to resume providing this service. We are also developing ways for trainees to refresh these asthma skills remotely. Another invaluable lesson was the tremendous utility of soliciting feedback from both the community and CHW participants early on and frequently. This provided the insight we needed into the needs of each individual community, such as a focus on managing asthma during housing instability, or the importance of obtaining funding for program supplies. Recognizing the challenging and complex environments the trainees were working in was essential to adapting the training appropriately.Our program has a number of limitations which are important to consider. Firstly, the training capitalized on the Washington Medicaid Waiver project. While any state can apply for permission to pursue similar projects through the Centers for Medicare and Medicaid Services, they do not currently exist in every state, which limits the generalizability of our program design. Additionally, our program is funded by an outside source (PCORI). In accordance with PCORI values, we have done our best to avoid direct compensation for program aspects that would require coverage by an employer or the health system to be sustainable. However, we have offered compensation for the CAB and the training program staff, and the training and materials are offered free of charge, which raises concerns for sustainability. The Learning Collaboratives are also dependent on this funding as it provides for program staff. Because of this, our team has been exploring avenues of more sustainable funding, including the potential for Medicaid reimbursement of material costs and CHW time, but this issue has not yet been resolved.Despite these limitations, our case study has shown that a community-based approach to curriculum development and improvement can produce a training program that is adaptable, engaging, and valuable to participants and has the potential to produce CHWs competent to deliver high-quality, effective home visit interventions for asthma. The coronavirus pandemic has limited the ability of our trainees to implement their training, but our program is adapting with the creation of protocols for virtual visits. The next steps include evaluation of the effectiveness of our trainees' services, and further refinement of the training program design. Through this community-based, adaptive approach, we hope to harness the proven effectiveness of CHW-led home visits to address asthma in a way that is culturally acceptable and cost-effective, and addresses some of the root causes of asthma-related disparities.The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.The studies involving human participants were reviewed and approved by University of Washington Institutional Review Board. Written informed consent for participation was not required for this study in accordance with the national legislation and the institutional requirements.JS, BW, and CK contributed to the conception and design of the program and evaluation plan. NE, JS, KB, and CK implemented the program. NE wrote the first draft of the manuscript. NE, MC, KB, and CK wrote sections of the manuscript. All authors contributed to the article and approved the submitted version.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.