Internet-based cognitive behavioral therapy (iCBT) increases treatment access for adolescents with anxiety; however, completion rates of iCBT programs are typically low. Understanding adolescents’ experiences with iCBT, what program features and changes in anxiety  are important to them, may help explain and improve iCBT program use and impact.Being Real, Easing Anxiety: Tools Helping Electronically (Breathe), with anxiety-based resource webpages, we aimed to (1) describe intervention use among adolescents allocated to Breathe or webpages and those who completed postintervention assessments (Breathe or webpage respondents); (2) describe and compare user experiences between groups; and (3) calculate an MCID for anxiety and explore relationships between iCBT use, experiences, and treatment response among Breathe respondents.Within a randomized controlled trial comparing a six-session iCBT program for adolescent anxiety, Breathe or webpages. Self-reported demographics and anxiety symptoms  were collected preintervention. Automatically-captured Breathe or webpage use and self-reported symptoms and experiences (User Experience Questionnaire for Internet-based Interventions) were collected postintervention. Breathe respondents also reported their perceived change in anxiety  following program use. Descriptive statistics summarized usage and experience outcomes, and independent samples t tests and correlations examined relationships between them. The MCID was calculated using the mean MASC-2 change score among Breathe respondents reporting somewhat better anxiety on the GRCS.Enrolled adolescents with self-reported anxiety, aged 13 to 19 years, were randomly allocated to Breathe  or webpages , but was higher for Breathe  and webpage respondents . Total user experience was significantly more positive for Breathe than webpage respondents (P<.001). Breathe respondents reported program design and delivery factors that may have challenged  or facilitated  program use. The MCID was a mean MASC-2 change score of 13.8 (SD 18.1). Using the MCID, a positive treatment response was generated for 43% (35/81) of Breathe respondents. Treatment response was not correlated with respondents’ experiences or use of Breathe (P=.32 to P=.88).Adolescents were mostly female , aged 16.6 years (SD 1.7), with very elevated anxiety . Intervention use was low for adolescents allocated to Breathe; however, their reports were not correlated with program use. Breathe respondents identified program design and delivery factors that help explain their experiences and use of iCBT and inform program improvements. Future studies can apply our measures to compare user experiences between internet-based interventions, interpret treatment outcomes and improve treatment decision making for adolescents with anxiety.Respondents reported positive experiences and changes in their anxiety with ClinicalTrials.gov NCT02970734; https://clinicaltrials.gov/ct2/show/NCT02970734 Anxiety disorders are the most prevalent mental health concern in children and adolescents, affecting about 8% to 11% of youth . ChildreInternet-based CBT (iCBT), with its self-help format, can increase the access and availability of CBT for adolescents with mild-to-moderate anxiety ,11. Recegood program usability  [Evaluations of adolescent experiences with various iCBT program delivery and content formats have revealed  to use) -24, mode to use) ,25-30, a to use) ,28,31. Y to use) ,17,32-34Other aspects of the user experience, such as psychosocial barriers and facilitators to program usage, adolescents’ perceived program impacts , and adolescents’ identification of the minimum change in anxiety symptoms that they would accept to make it worth completing an iCBT program , have nBeing Real, Easing Anxiety: Tools Helping Electronically (Breathe), in reducing anxiety symptoms among adolescents aged 13 to 19 years compared with webpages detailing anxiety resources . Within this trial, we had four distinct objectives for the user experience study: (1) to determine the adolescents’ usage of the Breathe program and resource-based webpages, (2) to define the adolescents’ user experiences with the Breathe program and the resource-based webpages and examine whether experiences differ between program and webpage use, and (3) to have adolescent users of the Breathe program define an MCID for anxiety symptoms after program use, and (4) to explore relationships among the user experiences, program usage, and the MCID among those adolescents who used the Breathe program. The overall intent of these objectives was to examine self-reported user experience data and automatically captured program usage data together for a better understanding of the relationship between behavioral (objective usage) and experiential  data [We conducted a prospective study of iCBT users’ experiences in the context of a large-scale, parallel design randomized controlled trial (RCT). The large-scale trial was designed to evaluate the effectiveness of an iCBT program developed by our research team, ID) data -40 to exThe RCT was conducted across Canada. We embedded user experience outcome measures (user experience and MCID) and automatically captured intervention data (usage) into pre- and postintervention time points of the trial. The Research Ethics Boards at the University of Alberta approved the trial . The trial commenced on November 21, 2016, and the final date of data collection was November 22, 2018.Adolescents were recruited for trial participation between November 21, 2016, and July 1, 2018. Recruitment was conducted through the trial’s social media platforms  with posts and paid advertisements across Canada and through health care professionals who provided study pamphlets to prospective participants seeking mental health care in specialty care clinics, primary care clinics, and schools in Edmonton, Alberta; Hamilton, Ontario; and Halifax, Nova Scotia. Advertisements and pamphlets directed adolescents to view the trial website , which pyes answer to thoughts about killing oneself in the past week or a prior attempt), (2) indicated the possible presence of a psychosis-related disorder via the 5-item Schizophrenia Test and Early Psychosis Indicator [Adolescents interested in participation were screened for eligibility using a secure Web-based application, Research Electronic Data Capture (REDCap). Inclusion criteria were as follows: (1) a minimum score of 25 on the Screen for Child Anxiety Related Disorders , indicatndicator  , there was a trigger in IRIS to notify the research assistant to contact the adolescent  depending on the concern) by phone within 36 hours to assess whether the adolescent required more immediate care and to provide emergent or nonemergency resources. A safety video that included recommendations for immediate safety planning was also provided to adolescents. The Discover component of the program introduced the session’s key topics. Check-out involved adolescents reflecting on their responses to session content. Try Out outlined activities for practicing the session’s key concepts and skills before the next session. An overview of session content is provided in Breathe program.The lsewhere . In brieBreathe coach, a trained paraprofessional, who initiated an optional telephone coaching session after session 1. The telephone call was not designed as a therapy session but was offered to answer any program-specific questions and to help participants prepare to complete program activities . Participants were not required to complete the call to proceed with the program. Users were also provided with the option for a summary of each session to be emailed to an identified parent or guardian after each completed session.Animations, embedded video, audio playback, graphic novel style vignettes, image maps, timed prompts, and on-screen pop-ups were embedded in the program to provide an interactive and multimodal experience. Features based on persuasive systems design  were empBreathe program was used. No coaching, safety, or anxiety monitoring was provided during the webpage use.The resource-based webpages included suggestions of anxiety-based books and educational websites, contact information for local and national crisis lines, and information on the emergency department and other crisis mental health resources. We collected user experience data at the preintervention (baseline) and postintervention (6 weeks following enrollment) assessment time points of the trial ; assessmAdolescent demography included self-reported birth date , gender, and province of residence.never true about me) to 4 (often true about me). The questionnaire yields several scores, including a total raw score and standardized t scores based on 18,000 North American children and adolescents aged 8 to 19 years. The scale has acceptable internal consistency , test-retest reliability  [Anxiety symptoms were reported using the Multidimensional Anxiety Scale for Children—2nd Edition (MASC-2) . The MAS P<.001) , and str P<.001) .Breathe program or the resource-based webpages during the 6-week intervention period. Intervention usage was automatically recorded in IRIS using the number of Breathe sessions completed per allocated adolescent (a maximum of six sessions) and webpages visited per allocated adolescent (no maximum).We defined intervention usage as adolescent’s use of the We developed the User Experience Questionnaire for Internet-based Interventions (UEQII) to evaluate and compare adolescents’ self-reported user experience across internet-based interventions . UEQII iBreathe program or resource-based webpage responded to 21 items (Core items) on their user experience using a 4-point Likert scale, ranging from 0  to 4 . An additional 15 items specific to the Breathe program experience  were completed by adolescents who used the Breathe program. If an adolescent responded not at all or slightly to items 30, 32, or 34, an open text box appeared  for the adolescent to elaborate on their experience. Items 35 and 36 were also open text boxes where adolescents could describe what they considered to be the most challenging and enjoyable aspects of the Breathe program, respectively. There was not an option for adolescents to skip certain questions.Adolescents allocated to either the Breathe program users to indicate the degree to which their anxiety had changed for the better, for the worse, or whether they experienced no change at all as a result of participating in the Breathe program. GRCS are widely used in clinical and research settings and are reproducible, clinically relevant, and sensitive to change [Breathe users. On the GRCS, the smallest change in anxiety symptoms that adolescents identified as important after completing the program [We used a Global Rating of Change Scale (GRCS) that contained a single question with an 11-point Likert scale (ranging from +5 to 0 to −5) to allow o change . To vali program ,56 was uBreathe program completed at least one session and those allocated to the resource-based webpages visited at least one webpage). This criterion ensured that adolescents commented directly on their experience with the intervention they received. For adolescents who had some missing data among the measures, we used pairwise deletion to maximize the use of all available data on an analysis-by-analysis basis. Normality testing was conducted for all variables. We used means (SDs), median (range), or number (proportion) to describe findings, as appropriate. To compare differences and explore relationships between variables, we conducted independent t tests and Pearson correlations (r) for parametric data, and Spearman rank-order correlation coefficients (Spearman rho) and point-biserial correlations for nonparametric data . Data analysis was conducted with IBM SPSS Statistics 25. The significance level was set at P less than or equal to .05.All enrolled participants were included in the analysis of demographic, MASC-2, and intervention usage data; no data imputation strategies were used. For analysis of UEQII and GRCS data, including the MCID calculation, we included adolescents who accessed their assigned intervention at least once during the trial intervention period  were summarized using means (with SDs) and numbers (proportions).t scores. We calculated pre- and postintervention symptom scores for each adolescent.The MASC-2 responses were entered in the Multi-Health Systems Online Assessment Center to generate total raw scores and validated Breathe sessions and webpages visited was calculated at the postintervention time point. Interquartile ranges were used to establish data cutoffs  to assist with data interpretation. We explored the relationship between intervention usage (the number of completed Breathe sessions or webpages visited) and user experience  using Pearson or Spearman correlation.The mean number (with SD) of completed Breathe program and resource-based webpage users, we calculated total scores for all core user experience items and total subscale scores for each of the three core constructs. Among Breathe program users, we calculated total scores for all treatment user experience items, total subscale scores for each of the three treatment constructs, and a total score of all UEQII items by summing the core and treatment items. IQRs were used to establish cutoffs for the scores  to assist with data interpretation; values were rounded up to the nearest whole number for categorization. We tested differences between the user groups for the core all items total score and the three subscale construct total scores using independent samples t tests. Open-ended responses from Breathe users on the UEQII were extracted verbatim. A basic thematic analysis was conducted by a single author (AR) and reviewed by a second author (AN) [User experience data were summarized using means and standard deviations. Multiple construct and total scores were calculated  with highor (AN) . Similarhor (AN) . A minimThe total and subgroup responses to the GRCS were summarized using means with standard deviations and numbers and proportions. We created 11 subgroups based on adolescents’ responses to the GRCS . We also applied the following interpretation to the GRCS scores:Adolescents who reported 0 on the GRCS were considered to have experienced no change in their anxiety.Adolescents who reported +1  were considered to have experienced a very small change, but one that may not be clinically relevant.Adolescents who reported +2 (somewhat better) on the GRCS were considered to have experienced a small change in their anxiety.Adolescents who reported +3 (much better) were considered to have experienced a moderate change in their anxiety.Adolescents who reported +4  or +5  were considered to have experienced a large change in their anxiety.The scores of adolescents who reported a worsening of anxiety symptoms (−1 to −5) were grouped and classified in a similar manner.anchor [no change, very small change, small change, moderate change, and large change). Third, we identified the mean change in MASC-2 scores for adolescents who reported experiencing a small change in their anxiety  to provide the final MCID estimate [Breathe program treatment responders. We used point-biserial correlations  to determine the relationship between treatment response (dichotomous variable: treatment responder or nonresponder) and several user experience and usage variables .The anchor-based method, the most commonly used method, was used to calculate the MCID. This method involved comparing the change score on the MASC-2 with the GRCS score, which served as the anchor . MCID caestimate ,60,61. Testimate . In addiBreathe program and 278 allocated to the resource-based webpages). t score of 74.9 , indicating a very elevated level of anxiety.The total number of adolescents enrolled in the trial was 536 . Of 258 adolescents, 50 (19.4%) completed the entire six-session program. Using IQRs and the 75th percentile as a cut point, 27.9% (72/258) adolescents completed four or more sessions of the Breathe program and were considered to be active Breathe participants. Breathe respondents was 6.0 (range 1-6). Moreover, of 81 Breathe respondents 61 (75%) were active participants in the program, with 43 (53.1%) completing the entire program. Among 278 adolescents allocated to the resource webpages, 148 (53.6%) provided postintervention user experience data and visited at least one webpage (herein referred to as webpage respondents). The median number of webpages visited by webpage respondents was 2.0 (range 1-9).The median number of sessions completed by Breathe and webpage respondents . Across both interventions, adolescents reported that the information was easy to understand , adolescents trusted the information from the intervention , the internet was a good method for delivering the information , and the intervention was easy to use . Breathe and webpage respondents did not consider computer access or availability and internet or technical problems as major barriers to using the interventions. Breathe respondents reported that personal  and school  commitments limited their intervention use more so than adolescents who used the webpage .Breathe and webpage respondents. Breathe users had significantly higher total satisfaction and acceptability (construct 1), credibility and impact (construct 2), and core items total scores than webpage users. We found that the adherence and usage (construct 3) total score was higher among webpage users compared with Breathe respondents, but this difference was not statistically significant.Breathe respondents’ user experiences with the program (treatment items). The most positive user experiences (higher scores) involved how the Breathe program looked, the relevance of the information to the user’s situation, and the likelihood of the program being recommended to others. The lowest rated user experience items were the time required to complete the program, exposure activities (facing your fears), and whether the program helped users meet their treatment goals.Breathe respondents provided open-ended responses for UEQII items 30a, 32a, 34a, 35, and 36. Themes associated with these responses are identified in Breathe and webpage respondents. The number of Breathe sessions completed was significantly correlated with the adherence and usage construct scores for both the core and treatment items, the total score for all treatment items, and the total score for all user experience items.Breathe respondents, 80  reported their change in anxiety using the GRCS . Among these adolescents, 75% (60/80) reported that their anxiety level improved after they had used the program with an average improvement of 2.3 . For the 5% (4/80) of adolescents who reported that their anxiety was worse after the program, the average worsening rating was 1.3 . In addition, 20% (16/80) of adolescents reported no change in their anxiety after the program. The mean GRCS response among respondents was 1.7 (SD 1.3). Breathe respondents.Among the 258 Breathe respondents’ reported changes in anxiety on the GRCS . We found that the GRCS was related to the average user experience, including core total score , treatment total score , and the all items total score .We did not find a statistically significant relationship between the number of sessions completed (program use) and Breathe respondents , providing face validity for the GRCS to indicate changes in adolescents’ anxiety symptoms [Breathe respondents  who reported a somewhat better change in their anxiety  on the GRCS. This mean MASC-2 change score was 13.8 (SD 18.1). Therefore, the MCID for the improvement of adolescents’ anxiety following the Breathe program was 13.8 points on the MASC-2. Using this estimate, the number of Breathe respondents who reached (or surpassed) the MCID threshold and were considered treatment responders was 35 of 81 (43%).We found a significant positive correlation between the GRCS scores and the MASC-2 change scores among symptoms . To calcrpb) between the treatment response (treatment responder or nonresponder) of Breathe respondents and (1) the number of sessions completed , (2) UEQII core total score , (3) UEQII treatment total score , (4) UEQII satisfaction and adherence total score , (5) UEQII credibility and impact total score , (6) UEQII adherence and usage total score , and (7) UEQII all items total score .We found no significant point-biserial correlations , 75% of whom were considered active program participants. This more engaged user group of Breathe respondents can be used to explore ways that we might increase program use among other adolescent iCBT users. Although other studies have looked to user demographics to provide explanations in low program use, explanations have been mixed [Similar to previously published studies , programprograms . Programen mixed ,15,18, wBreathe respondents described difficulty remembering to work on the program [Breathe program, adolescents received one telephone-based coaching call after completing their first session to prepare adolescents for the skills-based program activities to follow, including exposure activities, that would begin in session 2. Almost half of the adolescents allocated to the Breathe program did not go on to complete the next program session and the personalized exposure activities they had set up in session 1 . Although some adolescents described the call as a positive experience, others considered it stressful because they did not know the coach, and some adolescents described avoiding and delaying the call. This mixed response to coach involvement suggests that how support is provided is a key aspect of program delivery and the user experience. Some studies of Web-based interventions have described including rapport building activities  between adolescents and the adjunct support person before treatment material is discussed  [Breathe program or ameliorate some of the discomfort or nervousness they experienced leading up to or during the coaching call, thereby retaining active participants in the program.Consistent with the literature,  program ,52, conc program ,71,72, t program ,73-75, a program ,77 as th program  so that  program ,29,78-82 program ,81,83-85 program ; however program ,28,86,87 program ,15,17,88ercises) . IncludiIt is important to note that the stage of the program at which user experiences are measured may provide more or less information on the relationship between adolescents’ use of, experiences with, or perceived impact of a program. In this study, we administered our user experience measures after program use. However, moving forward in the field, there is value in formative evaluation during program use. Such evaluations may reveal how the user experience changes over time, how it can be optimized , and howBreathe respondents than for resource-based webpage respondents. The only user experience questionnaire construct for which we found no difference between the two intervention groups was the adherence and usage construct—both the Breathe program and webpage respondents reported few concerns with technology or internet accessibility or functionality during the study. Similar to other iCBT studies, Breathe respondents reported that the program was easy to understand [Breathe respondents’ satisfaction and acceptability with the program were not correlated with their use of it, suggesting that other program factors need to be explored for their association with iCBT use. A distinguishing feature of Breathe compared with the resource webpages was that Breathe incorporated instruction and interaction (providing opportunities for doing) in addition to information (providing opportunities for knowing) as part of the intervention, helping adolescents develop their capacity and competency for self-management rather than redirecting them to alternative resources. Breathe respondents liked activities that improved their ability to self-manage their anxiety by informing them, empowering them, or normalizing their experiences. Respondents reported the greatest interest in developing skills that were relatively easier to learn and had a timelier impact . When designing an iCBT program, it may be helpful to consider balancing the variety and sequence of program content and activities included according to their expected level of effort from the user and the immediacy of benefit. Breathe respondents reported positive experiences with more immediate  and short-term relief tasks , suggesting that when long-term relief tasks  are presented in sessions, some immediate and short-term relief tasks should also be included  to maintain adolescents’ interest and sense of self-mastery or achievement with the program. Combining immediate and short-term relief tasks with long-term ones could potentially offset the discomfort and effort required to persist through more demanding tasks , making it easier for adolescents to continue with the program.Overall, in this study, user experiences were significantly more positive for derstand , met thederstand , and thaderstand ,93,94. NBreathe program was developed using persuasive systems design components , streamline the recruitment and eligibility screening process , uphold research or clinical practice ethics , and stimulate or kick start adolescents use of the program (adolescents become intrigued and interested in commencing the program). Another strategy to promote initial program engagement is to incorporate an assessment of beliefs and attitudes before program use. Persuasive technology aims to reinforce, change, or shape users’ attitudes or behaviors toward their health goal [persuasion to occur (an attitude or behavior change) with the use of the iCBT program; and (2) if a positive potential exists, what persuasive system design components may be most appropriate to match the beliefs and goals of the adolescent. Being able to assess and appropriately tailor a program’s persuasive features based on adolescents’ beliefs, attitudes, and goals could improve adolescents’ experience and use of iCBT.In addition to program content and activities, technological features are also inherent aspects of iCBT. The ehaviors ) to incr setting -97), and setting ). On thelth goal ,98, suggConsidering that multiple iCBT components work together to form a complex intervention , we recoeffective or useful by adolescents [Previous iCBT studies have measured whether program participation was perceived as lescents ,92 but hlescents ,101.better after using the Breathe program. On the basis of the MCID estimate generated from adolescents’ ratings, 43% (35/81) of Breathe respondents were positive treatment responders. Previous iCBT studies have used clinical severity ratings (ratings have ranged from 0=none to 8=extremely severe) as a proximal indicator of treatment response [In this study, most adolescents reported that their anxiety was response ,29,79,81Breathe respondents, we did not find a statistically significant relationship between treatment response and the number of program sessions completed. There is mixed evidence as to whether a causal relationship between iCBT use and change in anxiety (a dose-response relationship) exists—some studies have found evidence for this relationship [For tionship ,103, whetionship ,105; howtionship -108. In tionship ,102,109,core items to other internet-based interventions and adapting the treatment items for their intervention under study to narrow in on what specific intervention components meet the needs and preferences of their target users. As a first step before broader use, we recommend that the UEQII undergo further psychometric testing to assess its feasibility and transferability in other contexts, ages, and patient groups and iCBT programs.This study has several strengths related to the assessment of user experiences of an iCBT program for adolescents with anxiety. Currently, there is considerable heterogeneity in how the user experience is defined and evaluated, with most research being conducted with adult populations ,110,111.gold standard screen of adolescent-reported anxiety symptoms, providing support for the validity of the MCID estimate. Disadvantages of the anchor-based method, however, include the selection of the anchor itself  and the potentially arbitrary nature of the MCID cut point for a small change in anxiety , although the GRCS change is consistent from other studies [This study also has several limitations. First, we used adolescent ratings on a global rating scale  to calculate the MCID. There is no standard for how to calculate the MCID; therefore, a variety of methods exist and can be used depending on the study sample and data collected  at preintervention, which reflects a greater severity of anxiety symptoms in those seeking help than those in most minimally supported iCBT studies. This study was inclusive of youth at any stage in their treatment journey, and it is possible that some youth were exploring multiple options to access help and that an iCBT program was not the option of best fit at that time. It is also possible that the limits in timing of the evaluation at baseline and 6 weeks from enrollment may also have impacted the number of respondents as some adolescents may have been excluded who would have engaged further with a longer time course. Thus, our user experience findings may be based on adolescents who are different from those who dropped out of the study. Breathe respondents who used the program and completed the postintervention assessments may have had a preference for self-help programs, greater motivation, or commitment to treatment or viewed the program to be highly relevant or beneficial to them [Finally, in this study, there was a large rate of attrition, which resulted in only about one-third of enrolled adolescents included in the user experience analysis. Attrition is said to be a fundamental characteristic and methodological limitation of longitudinal iCBT studies -123; how to them ,121,124.Breathe respondents reported compared with webpage respondents may be attributed to the interactive technological features and program activities  with specific focus on anxiety-coping skills that were incorporated into the iCBT program. Although most adolescent respondents experienced benefit from an iCBT program, the relationship between adolescents’ use, their experiences, and perceived impact on anxiety is still unclear, indicating that further understanding of what adolescents find challenging and enjoyable about iCBT as well as the characteristics of those who would most benefit from this delivery mode is necessary to optimize its delivery. Future studies can validate the UEQII, test and integrate our program suggestions, and apply our user experience measures toward creating robust treatment planning guidelines, including mechanisms to engage more youth in treatment completion.Given the high prevalence of anxiety disorders, the challenges in accessing CBT, and the interest of young people in internet interventions, iCBT is an important area of clinical research. In this study, we used user-reported measures, including a new measure, the UEQII, to examine the multiple components that influence anxious adolescents’ experiences with an iCBT program compared with that of resource-based webpages. How iCBT is delivered may influence and help explain the relatively low number of session use, perception of time constraints, and other commonly reported challenges to completing a program. The more positive experience that


N = 13). The program involved a synthesis of English as a Second Language instruction, social justice as a content area, and service learning, in a two-week credit-bearing summer session course. A post-participation survey revealed highly positive reactions, particularly in terms of working with local community members, and broad agreement that the program had been life-altering. The implications for international student program development at regional institutions are discussed.Universities across the U.S. have increasingly emphasized internationalization, leading to rising numbers of international students attending U.S. institutions of higher education. However, these students tend to gravitate toward larger research-intensive universities with many other institutions seeing no increase in international student enrollments. Little is known concerning how to attract international students to regional institutions lacking name recognition. To address the above and promote internationalization through increasing the presence of students from abroad, an academic department at a regional public U.S. college used needs analysis to develop a pilot program for Japanese university students ( Institutions of higher educationHowever, for institutions without distinguished national or international name recognition, internationalization may be challenging . Ehrlich  defines Language development Heuser, ;Linguistic self-confidence and general academic performance Hummel, ; andSocial awareness  align with the needs assessment of targeted international students while taking advantage of what the institution had to offer Hudzik, ; (b) infTop Public Schools category of U.S. News and World Report’s Best Colleges  is a regional public institution of higher education in the American Northeast, with a Carnegie Classification of Master’s Colleges and Universities. It is not ranked in major ranking systems nationally or internationally, although it consistently ranks among the top 10 in the regional Located about an hour on public transportation from the center of a large city, one of the college’s core missions is to serve the local community. Although it is primarily a commuter institution, there is an on-campus dormitory. International undergraduate students pay approximately US$19,000 in tuition and fees annually (approximately US$890/credit in summer), which is markedly lower than the cost of local private institutions where, at a similar-sized neighboring private institution, the annual tuition is around US$45,000.The development of the pilot program was led by an academic department that almost exclusively specializes in certification-bearing teacher preparation. Probably due to the heavy focus on teacher certification, international students do not routinely enroll in this department. The pilot project was undertaken to stimulate international enrollment within this department as well as to contribute to college-level internationalization initiatives, by creating a program that is designed to cater to the interests and needs of the university students in Japan.needs assessment was conducted through conversations with undergraduate students from universities across Japan who were attending these gatherings. These conversations, which were made possible by assistance from the organizers of these events, were structured as both individual interviews and small group discussions of fewer than 10 students. During these conversations, Japanese university students were asked open-ended questions about their views on: (a) study abroad opportunities in general; (b) destination preferences; (c) program duration; (d) the destination institution’s ranking or name recognition; (e) learning goals; (f) program structure; and (g) cost. Additionally, the department chair was able to call on the assistance of colleagues from Japan’s Honda University (pseudonym), who were instrumental in facilitating additional conversations with students at this university. In total, approximately 40 students provided feedback.Because the department chair spearheading the project was scheduled to visit Japan on two separate occasions for conferences, seminars, and research meetings in 2018, Japanese students were selected as the target population for this pilot program. Subsequently, In summary, it was revealed that: (i) Japanese university students were more eager to attend short-term English language courses overseas than long-term degree programs, presumably because diverting from their prescribed course of study at home institutions could complicate their future career prospects; (ii) Prince College, with its strong regional presence and without global name recognition, appeared suitable for short-term programs among this population; (iii) students looked to connect with the local community; (iv) they valued a content area-based ESL program that was ideally credit-bearing; and (v) cost was an important factor. Remarkably, these needs, aside from cost, had not been emphasized in the literature reviewed, which further corroborates the importance of regional institutions undertaking thorough due diligence when considering the needs of the potential “target audience” in designing international programs Hudzik, .In early fall of 2018, the department chair met with various Prince College stakeholders, such as the department faculty, the Study Abroad Office, and the college’s upper administrators, in order to assess how well these identified needs could be matched with the college’s resources. The right column of Table The host department at Prince College was confident that it could respond effectively to all of the needs identified during Phase 1, as seen on the right column of Table JAFSA: Japan Network for International Education. Honda University, however, requested that the program enrollment be limited to its students. Since the host department was agreeable to the idea of keeping the inaugural cohort small, other participants were not recruited in the end.The two-week course, delivered over 10 calendar days, included 3 hours of class time each morning of which 3 days were to be dedicated to on-site activities at a local homeless shelter. Because the fieldwork site, a homeless family shelter, had an existing relationship with the host academic department, no particular arrangements were required apart from notifying the shelter that the student visitors comprised English learners from Japan. The shelter did not raise any concerns; on the contrary, the staff welcomed the opportunity for residents to interact with people from backgrounds they would not ordinarily encounter. During this phase, the host department began announcing the preview of the program on its website and through colleagues at Japanese universities, with additional plans to publicize it through such not-for-profit advocates as In terms of cost to participants, the out-of-state summer tuition and fees for this two-credit course were approximately US$1,900, including books, materials, and fieldwork supervision. In addition, students paid US$65/night for campus housing and were responsible for other expenses, such as transportation, meals, and incidentals. From the departmental budgetary standpoint, the instructor and a half-time teaching assistant were paid according to the regular summer session salary rate, with no additional administrative costs incurred.Thirteen  Honda University students participated in this undergraduate-credit-bearing program in summer session 2019. Honda University coordinated the trip from Japan to Prince College as well as the rest of the pre-arrival details, such as student visa clearance and insurance. While not a requirement, Honda University opted to send and pay for a chaperone, who was the director of Honda’s School of Education and Human Development’s International Office.The department chair communicated with the chaperone to address questions and concerns throughout the program. Here, two issues are noteworthy. First, the instructor did not consistently start the class precisely on the dot, frustrating the students from a highly punctual culture Okazaki, . While dThe hosting department called an emergency meeting to discuss this issue at length, consulting with various faculty experts; subsequently, it concluded that it would not be pedagogically sound to divert from the seminar format in an integrated SL course with an explicit emphasis on helping students improve English. Consistent with Grabois’s  view, thProgram participants were asked to complete an anonymous online post-participation survey in Japanese, conducted by the hosting department. Of the 13 students who participated in the program, 11  completed the survey. The Institutional Review Board granted an exemption for this study on the basis that it consists of an analysis of existing data from an anonymous student survey, which had been administered as part of program evaluation. The survey included questions regarding program satisfaction, feedback on structure and content, and program impact. The survey included Likert-type questions, some of which were followed up with open-ended questions asking the participants to elaborate on their answers. Given the small sample size, no inferential statistics were performed. While the results are discussed in detail below, Table n=1, or 9% each). Incidentally, with the exception of campus aesthetics, all the answers were directly relevant to the dimensions identified during the needs assessment process, signaling that the needs analysis was effective.On a scale from 1 (completely satisfied) to 5 , the participants expressed substantial satisfaction with the program. Among the nine responses obtained on the follow-up open-ended questions probing the program’s overall strengths,When asked about areas of improvement overall, four (36%) expressed disappointment that they did not have much interaction with Prince College students. The remainder of the answers included one (9%) each concerning the following: (a) a desire for more organized activities, such as parties and fieldtrips; (b) feeling uneasy about speaking up in class; (c) neighborhood safety concerns; and (d) the total cost being higher than anticipated. Since this program took place during the summer session, there were much fewer people, events, and activities on campus than there ordinarily are during the academic year, which may have also contributed to safety-related concerns. In light of these responses, forums whereby international and domestic students interact are to be organized when running future programs.“Children are so curious and nonjudgmental that they are happy to talk to you, even if you cannot communicate smoothly in English.” Second, three answers (27%) alluded to being able to take an inside look at the local community as a strength. One remaining answer (9%) noted that, through SL, the participant had overcome a fear of the unknown.The survey participants indicated overwhelming satisfaction with the SL component. When asked to comment on the program’s strengths open-endedly in terms of SL, two major themes around community involvement emerged. First, four responses (36%) noted interaction with children had been a strength, with two participants specifically explaining that children made ideal conversational partners because of their open-mindedness. As one participant commented, The notion of children being ideal conversational partners is particularly noteworthy. On a related note, besides evidence of its pedagogical effectiveness, research has demonstrated that pairing ESL students with elderly volunteers can be personally gratifying to both students and volunteers  noted occasional challenges in interacting with children, with two suggesting that the pre-fieldwork seminar could have included more concrete tips on managing children’s behavior . These responses provide guidance for future planning, for example, that more attention needs to be paid to supporting students in terms of “behavioral management” in fieldwork.The survey participants expressed strong satisfaction with the class, which had sought to seamlessly synthesize ESL and social justice through an application of SL. When asked to elaborate their reasons, two themes emerged. Three participants (27%) commented on how useful it was to be obliged to speak English throughout the day. Two additional answers (18%) indicated that learning English as a tool, rather than studying English as an end in itself, made the experience more positive. These responses directly corroborate studies by Grabois  and BunnIn terms of responses to the Likert-type questions, moderately positive ratings were obtained on two questions: improved fluency in English and increased interest in pursuing a longer-term study abroad in the future. These responses were not unexpected, given the short-term nature of the pilot program, with a likely limited effect on one’s linguistic skills or on attitudes toward a long-term study abroad.This program was positively life-altering. The clear agreement among the participants that the program had had an exceptionally positive impact on their lives, as indicated by the small standard deviation of .33, was especially gratifying for the program organizers. Open-endedly, all seven responses obtained (63%) concerned self-discovery and personal growth. Of these, three responses specifically alluded to the realization of their privileged upbringing. One participant stated, “[Participating in the program and interacting directly with financially-distressed families experiencing housing instability]…made me realize how lucky I have been. All the hardships I thought I had faced in my life, in the bigger scheme of things, weren’t hardships at all.” These responses provide strong evidence that the participants left the program with personal accomplishments far greater than language acquisition or academic learning. Specifically, these students seem to have gained life-altering experiences through personally tackling a specific social issue involving children and their families.The participants gave more positive ratings for the other questions, in terms of an increased interest in studying English further, having had positive interactions with locals, and becoming more comfortable interacting with people from other cultures. The most notable result was obtained concerning the item: The pilot program comprised three notable characteristics. First, informed by previous research, this project was developed using a needs analysis of the target population. The post-participation survey revealed that the features identified in the needs analysis were overwhelmingly noted as positive features of the program, suggesting that the needs analysis was effective. This step was vital to the success of the program, given the dearth of literature on “best practices” for institutions without major name recognition to attract international students. As highlighted earlier, a number of specific needs, not explicitly identified in previous research, were discovered through this process. Prince College’s modest international name recognition was used as an opportunity to design a short-term SL program with a social justice focus, which is unusual for an ESL program, that capitalized on the institution’s existing relationship with the local community. This led to the development of a program that is pedagogically and socially responsible, resource-conserving, and, perhaps most importantly, satisfying to the participating students.Second, this credit-bearing program was spearheaded by an academic department, in coordination with various stakeholders. Compared to more formalized programs offered by universities, this approach gave the program greater control and flexibility. For example, when a concern was raised about seminar discussions, the department was able to make changes to address the issue swiftly and amicably. From a budgetary standpoint, since the academic department conducted the summer program at no administrative cost to the institution, the program provided an example of a promising non-resource-intensive method for internationalization. Although the number of participating students was just average for a summer class, they paid out-of-state tuition—set at roughly three times higher than in-state degree-candidate summer tuition, and they all fully utilized auxiliary campus services  that often remain grossly underutilized over the summer. While the program thus generated notably higher earnings for the college than a typical summer class, students did not pay beyond the cost of taking a regular summer session course; naturally, the academic credits gained may be transferred to other universities to the extent that those institutions allow.social justice education and SL with an underlying focus on ESL, designed to create a synergistic effect to enhance student learning in an authentic manner while emphasizing the college’s mission to serve the local community. Findings from the post-participation survey revealed overwhelming student satisfaction with this pedagogical approach and showcased a program providing a life-altering experience, in addition to language learning.Third, following Dewey’s  educatioThere are some limitations to be considered. First, the department chair received occasional assistance from his colleagues in Japan, which is an advantage others may not necessarily enjoy. Furthermore, since the pilot participants were restricted to Honda University students, student recruitment efforts were minimal. Still, based on the volume of inquiries the host department received in response to the initial announcement released on its website, as well as through colleagues at Japanese universities as described earlier, it speculates that a greater number of students could have participated, had it opted to recruit others. Expanding the program, nevertheless, needs to be approached with caution, as forming a small and cohesive cohort may have contributed to participant satisfaction. Finally, the outcomes were measured through survey-based self-reports without other sources of assessment, and the sample size was small at 11 survey participants. Future program assessment data should include other measures, such as academic and linguistic achievement benchmarks, to afford a more comprehensive program evaluation.Circumstances related to the COVID-19 pandemic have made international travel impractical, and the future of internationalization in higher education remains uncertain. Nevertheless, when conversations resume concerning future cohorts for the program, close attention will be paid to the pilot student feedback to ensure that the positive features identified are enhanced while areas for improvement are addressed as appropriate. Overall, this pilot program offers a helpful approach in designing and hosting international student programs more effectively, where institutional features, priorities, and resources are used to their full advantage. It would be of critical importance for other institutions seeking to apply a similar program to closely scrutinize the needs of the potential target population in the context of their institution’s strengths, weaknesses, institutional priorities, and available resources. When this process is applied effectively in developing a cohesive and coherent strategy, the resulting international student program is more likely to be successful.Not applicable.


A common concern of federal funders and grant recipients is how to sustain program activities once their federal funding period ends. Federal funding can be intended to develop or seed a program but not necessarily to continue its activities indefinitely. Understanding the importance of programmatic sustainability, the Office of Population Affairs (OPA) conducted research in 2015 on the elements that contribute to sustainability. As part of the Sustainability Study, OPA collected information from former Pregnancy Assistance Fund (PAF) program grantees.Grantees that were awarded cohort 1 PAF program funding (2010–2014) but not awarded cohort 2 funding (2014–2017) were eligible for study inclusion because their OPA funding ended more than 1 year prior to the Sustainability Study, allowing for an assessment of sustainability after federal funding. Seven former PAF grantees were identified as eligible. Interviews were conducted with six of these grantees; grant applications and interim final reports from all seven were reviewed.Five lessons emerged from interviews and review of grant documentation. Programs successfully continuing beyond the federal grant period tended to (1) diversify funding sources, (2) communicate regularly with key stakeholders, (3) form partnerships with like-minded programs, (4) consider implementing evidence-based interventions, and (5) begin planning for sustainability early.By considering these lessons learned from the research, grantees can be well positioned to continue beyond a federal grant period. The lessons garnered from the Sustainability Study have informed, expanded, and affirmed OPA’s sustainability toolkit, sustainability framework, and technical assistance. Existing research suggests that acknowledging the importance of supportive stakeholders, remaining flexible, and beginning sustainability planning early are key elements that contribute to program sustainability. This article supports this existing research and adds information specifically for programs that serve expectant and parenting youth, a population with unique needs.OAH Framework for Program Sustainability  but not awarded cohort 2 PAF program funding 2014–2017) were eligible for study inclusion because their OPA funding had ended more than 1 year prior to the Sustainability Study, allowing for an assessment of sustainability after federal funding. Seven of the 15 former cohort 1 PAF grantees were identified as eligible. An email was sent to gather information from eligible former grantees about whether the program had continued beyond PAF grant funding and to invite them to participate in the study. Semi-structured telephone interviews were conducted with six former PAF grantees, lasting roughly 90 minutes each.010–2014  were eliOPA also initiated an update to the Sustainability Resources and formed a multidisciplinary team to review and update the current materials. The team consisted of currently funded grantees, experts, and researchers, including those on the Sustainability Study. By involving one of the researchers on the team, lessons learned from the study could be incorporated directly into the update of the resources. While the materials were being updated, the team could cross-reference findings from the study to ensure resources were evidence based.Interviews and reviews of interim and final reports revealed the types of programs and services offered and themes across grantees that were eligible for study inclusion. During their grant period, the seven former grantees delivered services including, but not limited to, case management, referrals, educational workshops, medical assessments, counseling services, and incentives. Former grantees served expectant and parenting teens and/or young adults. All grantees relied on subrecipients to deliver some or all programming and were awarded annual funding ranging from $500,000 to $2,000,000. Five of the seven cohort 1 PAF grantees were able to sustain the program in some form after their PAF grant concluded  diversify funding sources, (2) communicate regularly with key stakeholders, (3) form partnerships with like-minded programs, (4) consider implementing evidence-based interventions, and (5) begin planning for sustainability early.The OPA Sustainability Resources defined eight specific factors associated with action steps leading toward program sustainability. The five overarching lessons emerging from this Sustainability Study largely aligned with some of the key factors identified by the Identifying and securing continued funding is critical for program sustainability. Former grantees who succeeded in sustaining their programs relied on a combination of federal, state, private, and in-kind support both before and after the grant period concluded. Some federal funding sources that former grantees secured included the Maternal, Infant, and Early Childhood Home Visiting (MIECH-V) program; Healthy Start Home Visiting; Medicaid reimbursement for qualifying services like home visits; Temporary Assistance for Needy Families dollars; and small grants from the Department of Justice (DOJ) and the Substance Abuse and Mental Health Services Administration (SAMHSA). Securing this funding allowed grantees to offer some or even all their services after their PAF grant period ended. In one case, the school district in which the grantee implemented the program absorbed some of the program costs into the district’s budget. In another case, a foundation interested in supporting programs for families with young children in tribal communities approached the grantee with funding to continue operating the program. One state earmarked the fee collected for marriage licenses for the grantee to use toward program costs. No single funding stream was able to support the entire original program, but former OPA grantees combined new grant awards to support different program components.Former grantees also relied on in-kind support both during the PAF grant program and after funding had concluded. Examples included in-kind staff such as community nurse practitioners, a community health director, and a school district employee. Meeting space for trainings and community events along with parenting supplies offered to program participants were often also in-kind donations. Former grantees emphasized that with multiple funding streams supporting and complementing one another, their programs were more successful than if they relied on one funding stream alone.Communicating regularly with key stakeholders through focus groups and community meetings helped grantees identify new funding sources, keep programming relevant, and build support for their programs. Strategies included gathering input from participants both to make improvements to the program and to highlight the benefits expressed by participants when presenting to community leaders and potential funders. One former PAF grantee brought program participants to a city council meeting to speak about the positive impact the program had on their lives. Another assembled a team of service providers, youth, and school principals who strongly supported the program to develop a plan for sustainability. Once funding ended, the grantee leveraged those relationships to secure school district funding to continue the program on a slightly smaller scale.Sustainability was more challenging for two grantees who lacked community and stakeholder support. A shift in state leadership, where buy-in had not been secured, and lack of school district recognition of the program as an academic intervention challenged the sustainability of these programs.Establishing formal partnerships with outside organizations increased the likelihood of sustainability. Two of the five grantees that were able to sustain their programs joined coalitions of local organizations doing similar work. Joining these partnerships helped secure other federal funding. One grantee was able to secure an MIECH-V grant awarded to the coalition as a whole. Grantees expressed that coalitions have more success securing grant awards because they have the potential to make a bigger impact than one organization alone and because coalitions allow funders to contribute to multiple entities. Coalitions also allow organizations to work together to strengthen funding applications, as opposed to competing with one another.Former grantees also established formal partnerships and shared program implementation responsibilities with those partners. Direct involvement in implementation contributed to partner organizations recognizing the importance of the program and becoming champions of the program in the community. Their support improved the grantees’ ability to secure local funding after the PAF grant period had ended.The PAF program does not require use of an evidence-based intervention (EBI), and a public evidence review clearinghouse for interventions specifically designed to serve expectant and parenting youth does not exist. Former grantees explained that implementing EBIs benefits organizations for two reasons—to increase the likelihood of securing federal funding and to gain buy-in from local stakeholders. Two former grantees described the benefits associated with implementing programs that had shown positive impacts in an evaluation. One former grantee chose to implement an EBI partway through PAF grant funding in response to an award from the MIECH-V grant program, which required use of an EBI  align well with discoveries from the Sustainability Study. The research also indicated areas of opportunity, improvement, and expansion. Accordingly, OPA used the research from the Sustainability Study along with a peer review process to update the OAH sustainability framework  and study participants had previously been awarded grant funding from the same federal program, which means the types of entities receiving funding (states and tribes are eligible for funding through the PAF program), populations served, and types of programs implemented were similar. Additionally, the reported lessons learned are lessons that appeared to be effective based on themes gathered through interviews and grantee reports; however, the effectiveness of these lessons has not been tested. These limitations raise questions about the generalizability of the findings presented. A larger study of the sustainability of programs serving expectant and parenting youth and a systematic review of existing literature are needed. By considering and applying these lessons learned, projects supporting expectant and parenting youth and projects providing support to other populations may be positioned to continue services beyond a federal grant period.


This study proposesd a novel, entropy-based structural health monitoring (SHM) system for measuring microvibration signals generated by actual buildings. A structural health diagnosis interface was established for demonstration purposes. To enhance the reliability and accuracy of entropy evaluation at various scales, composite multiscale cross-sample entropy (CMSCE) was adopted to increase the number of coarse-grained time series. The degree of similarity and asynchrony between ambient vibration signals measured on adjacent floors was used as an in-dicator for structural health assessment. A residential building that has been monitored since 1994 was selected for long-term monitoring. The accumulated database, including both the earthquake and ambient vibrations in each seismic event, provided the possibility to evaluate the practicability of the CMSCE-based method. Entropy curves obtained for each of the years, as well as the stable trend of the corresponding damage index (DI) graphs, demonstrated the relia-bility of the proposed SHM system. Moreover, two large earthquake events that occurred near the monitoring site were analyzed. The results revealed that the entropy values may have been slightly increased after the earthquakes. Positive DI values were obtained for higher floors, which could provide an early warning of structural instability. The proposed SHM system is highly stable and practical. Infrastructures, including bridges, dams, and buildings have been widely set up to protect and facilitate our daily life. As the structural performance of a building which is frequently subjected to natural hazards or human use is likely to lose its original strength over time, how to evaluate whether the building is safe or not has become an important issue. As a result, structural health monitoring (SHM) has been extensively developed over the last few decades.In 1993, Kim analyzed a ten-bay hexagonal truss and applied a new method to match the undamaged analytical model and the damaged test modes . In 2002Rudolph Clausius first proposed entropy to represent the variation of an object. Entropy is an amount of energy in thermodynamics that cannot work in terms of kinetics . In 1948In 1996, Pincus proposed cross approximate entropy (Cross-ApEn) . RichmanThe aim of this study was to develop an entropy-based SHM system to effectively monitor long-term structural safety. Based on previous research and experimental results, composite multiscale cross-sample entropy (CMSCE), which had good performance in accuracy and reliability, was adopted as the core SHM algorithm. A structural health monitoring demonstration program combining CMSCE and the damage index was also developed with the support of LabVIEW software. The flowchart of the study is shown in τ ranging from 1 to N. The length of each coarse-grained time series is N/τ, and a new time series In the concept of multiscale entropy (MSE) proposed by Costa , an origτ can be defined as follows:Wu et al.  proposedm for: Cross-sample entropy (cross-SampEn) primarily entails evaluating the degree of asynchrony and dissimilarity between two time series from the same system. Cross-SampEn and SampEn involve similar procedures, which can be summarized as follows: First, consider two individual time series i and j. If the maximum distance is within r, which is a predetermined threshold, The number of similarities between The probability of similarity between the templates can be calculated as follows:m + 1 by using the following equation:Subsequently, the average probability of similarity between the templates of length τ SampEn values represents the CMSE value, as expressed in the following equation:SampEn values can be calculated for all coarse-grained time series. The mean of On the basis of the concept of CMSE, Yin et al.  proposedThe CMSCE values can be derived for the two time series. The derived values can then be plotted as a function of the scale factor H and D represent healthy and damaged structural conditions, respectively. Furthermore, the numerical subscripts for H and D represent the floors of the structures under analysis.Studies in the field of bioinformatics have reported that the area of the MSE curve can be used as an index to quantify complexity ,21,22. Aτ under healthy structure conditions. Accordingly, the cross-SampEn of each damaged floor can be expressed as follows: τ under damaged structure conditions.Therefore, The DI can be derived using the following equation:The DI of each floor can be calculated by subtracting the entropy value of the damaged structure from the reference entropy value of the healthy structure on the same floor and then adding the values up. Previous research has demonstrated that the damage level and condition of a three-dimensional multibay structure can be detected by CMSCE analysis correctly. A positive DI value indicates that the floor is damaged, whereas a negative DI value indicates that the floor is undamaged .2, and the yield strength 2. Moreover, the girder section measures 50 cm × 70 cm, the beam section measures 40 cm × 65 cm, and the ground beam section measures 100 cm × 250 cm. This structure was one of the sites of the Taiwan Strong Motion Instrumentation Program implemented by the Central Weather Bureau. During this program, 24 sensors were deployed on the structure to record its response to earthquakes. Acceleration data for each floor were measured using strong-motion seismometers (FBA-11)   with sevA human–machine interface to facilitate on-site processing and provide a real-time visualization of the monitoring result was developed by LabVIEW. The interface integrated the complex operation and visualized the building information, time history, CMSCE curves, and DI graphs, thereby facilitating the task of monitoring the long-term health condition of the building. The operating procedures of LabVIEW for CMSCE analysis are outlined as follows. First, the event data and vibration orientation to be analyzed were selected. Subsequently, the parameters required for CMSCE analysis were entered into the program, including the sample dimension (m), threshold value (r), and sample length. Because CMSCE analysis entails comparing the similarity of two time template spaces, a healthy time template (denoted as a reference) must be determined. The interface displayed a CMSCE diagram that comprised the curves (displayed in distinct colors) of the cross-SampEn between time series generated from two adjacent floors. The curves were plotted as a function of the scale factor , thus enabling users to clearly observe the entropy trends for various earthquake events. Bar graphs were also plotted for the DI and visualized on the interface, enabling users to clearly identify the damaged floors. 2), indicating an earthquake event, a trigger mechanism would activate the monitoring system to collect data. Data regarding ambient vibration periods after the earthquake excitation were recorded for CMSCE analysis. Since 1994, data on earthquake-induced accelerations of the Dexin building have been recorded in a database. Earthquakes can be classified into two categories, according to their intensity: minor and major earthquakes. Data regarding minor earthquakes were recorded for long-term structural health monitoring (SHM) from 1994 to 2020 using the proposed system, and the last 12.5 s (2500 points) ambient vibration after an earthquake for each data set was used for CMSCE analysis. An earthquake that occurred on 6 June 1994 was the first event during the 27 year monitoring period. This data set was considered as the reference to represent the healthy condition, and the corresponding structural characteristics were analyzed.When the measured peak ground acceleration (PGA) exceeded 4 gal  was used to transform time series data from the time domain to the frequency domain. As the fundamental frequency is proportional to As mentioned, the monitoring database comprised data collected from 1994 to 2020. The health and performance of the structure may have been affected by earthquakes or long-term use. To demonstrate the long-term performance of the CMSCE-based SHM method, this study applied a method to analyze the effect of a minor earthquake event that occurred during this period. Thus, the effects of a total of 18 minor earthquake events were analyzed. The ambient vibration time history measured after earthquake-induced excitation was 12.5 s (2500 points). This structural response was used for CMSCE analysis to evaluate the long-term health condition of the building. Curves of entropy values measured along the X- and Y-axes for the various years are presented in The DI values were calculated for various sections of the building to quantify any possible structural damage. Except for a few marginally positive DI values (<1), the remaining values were negative throughout the 27 year monitoring period. This finding reveals that the building was not damaged. For the cases involving positive DI values, the damage was located on higher floors, such as 3F–7F or 7F–14F. According to the analysis results, data sampled from higher floors were amplified, possibly leading to incorrect diagnoses. Such false alarms can be avoided by adjusting the DI threshold. According to the long-term trends of the CMSCE analysis results, the building was not damaged. Earthquakes have caused severe loss of life and economic losses in the past three decades. Therefore, to diagnose the health condition of the building, this study conducted CMSCE analysis on the acceleration of the structure caused by two major earthquakes that occurred near the monitoring site.The 430 Earthquake occurred on 30 April 2011. Its epicenter was located at 24.65° N (latitude) and 121.81° E (longitude) in New Taipei City, and its depth of focus was approximately 76 km. The earthquake intensity was recorded to be 5.8 on the Richter scale. As shown in The 613 Earthquake occurred on June 13, 2012 in Jianshi Township, Hsinchu County. The earthquake intensity was recorded to be 4.9 on the Richter scale. The epicenter of the earthquake was at 24.75° N (latitude) and 121.27° E (longitude), with a depth of focus of approximately 6.7 km. This was the first earthquake with a magnitude of more than 4.5 in the area in 58 years. The shallow depth of the earthquake rendered it favorable for SHM evaluation. The time history of the structural vibration is displayed in Entropy analysis has been extensively used in various fields. In this study, a CMSCE system was applied to analyze the long-term structural health of a residential building over a period of 27 years. CMSCE, which improves the reliability of CMSE, was adopted as the core algorithm for SHM diagnosis software, implemented using LabVIEW. The effectiveness of the system for long-term monitoring and earthquake analysis was verified. A data set collected in 1994 was selected as the reference for the executed CMSCE analysis. Entropy curves were plotted for 18 collected minor earthquake events, and the corresponding DI values were plotted in graphs to demonstrate the long-term health condition of the building. The DI graphs exhibited a stable trend, indicating the health condition of the building. Moreover, two large earthquake events that occurred near the monitoring site were analyzed. The results revealed that the entropy values increased slightly after the major earthquakes. Positive DI values were derived for higher floors. These values could provide an early and efficient warning of structural instability. The CMSCE-based SHM system demonstrated high stability and practicability over a long monitoring period.


In school year (SY) 2014‐2015, 128 schools in 24 districts and 14 states were randomly assigned to receive either onsite or online support to implement a school‐based wellness program. The objective of this study was to assess the cost‐effectiveness (CE) of the 2 models of implementation support: onsite and online.We adapted the “ingredients method” for the CE analysis. Using expenditure data, we tabulated the costs of relevant expense categories and allocated the appropriate proportion to determine the total costs of providing each type of support for 4 years (SY 2014‐2015 through SY 2017‐2018). We divided the average cost per school by the average change in school wellness policies and practices, using assessment data provided by the program provider, to calculate a CE ratio for schools in each group.Findings indicate that when the program is implemented as intended, online support is, on average, approximately 1.3 times more cost‐effective than onsite support at the end of 4 years.By demonstrating the relative CE of 2 approaches to supporting the implementation of a school health program, this study provides further insight on more efficient interventions for improving overall school wellness. Obesity is a persistent public health concern. Childhood and adolescent obesity rates remain relatively high despite efforts to reduce them.Recognizing the potential for schools to provide more healthful nutrition and physical activity environments for students, a wellness‐focused organization created a school‐based health program to support schools with students of low socioeconomic status (SES) to create environments in which physical activity and healthy eating are encouraged and accessible before, during, and after school. The program supports schools' implementation of health‐focused policies and practices via a model that provides either onsite support in the form of training and technical assistance (TA) provided by a program manager and team of content advisors, or online support in the form of self‐guided online program participation and access to resources. Program managers and call center staff guide onsite and online schools as they implement the program. The program's goals are to support and recognize schools that establish a healthy school environment as an education priority; provide healthier food options for students during the regular and extended school day; increase opportunities for students to exercise and play before, during, and after school; and develop programs to help teachers and staff become healthy role models. The program provides schools in participating districts with resources and TA to build their capacity to implement a 6‐step process and best practice framework designed to integrate school wellness efforts. The 6‐step process is repeated annually to expand and institutionalize wellness policies and practices, with implementation support provided online or onsite.Schools receiving onsite TA from program managers were encouraged to attend district training sessions and statewide summits and to apply for the National Recognition Program—an award indicating that the school meets standard health best practices. Also, for onsite schools, program managers arranged in‐person visits by national content experts, as requested. Online schools had access to similar support by email and telephone. Any school implementing the program had access to online resources, including toolkits, step‐by‐step instructions, and access to funding opportunities. The program logic model Figure  includesTo identify which type of support (onsite vs online) helps schools improve their overall wellness levels, as measured by changes in assessment data, for the lowest relative cost, we applied the “ingredients method”Over the study period, 128 elementary schools serving students in low‐SES neighborhoods in 24 districts and 14 states were randomly assigned to receive onsite or online implementation support and began implementing the program. The cost data are based on the original sample of 128 schools  and was used to generate an average cost per school for each type of support. Outcome data, consisting of baseline and Year 4 assessment scores, was available for 68  schools; these 68 schools are included in this analysis.To estimate the total costs of providing each type of support over 4 years, we obtained expenditure data for each program ingredient: personnel, facilities, equipment and materials, and other costs. Personnel included salaries of program managers, content experts, field operations specialists, marketing and communications staff, information technology staff, and call center support staff. We determined the costs of personnel for each type of support by prorating staff salaries based on conversations with the program provider about the number of schools served by staff, and then we adjusted the staff's full‐time equivalent (FTE) rates accordingly. For example, based on the typical number of schools served, 0.55 FTE of the average program manager's salary was ascribed to onsite support. Facility, equipment and materials, and other costs were ascribed in a similar manner. We used actual facility costs and equipment and materials costs associated with providing each type of support and prorated the costs based on the FTEs applied to their salary rates. “Other costs” refers to all other ingredients that do not fit readily into the categories above, including, for example, indirect costs, professional fees, travel, and meeting expenses.For onsite support, we used the following FTEs: 0.55 FTE for program managers, 0.08 FTE for content experts, and 0.01‐0.02 for field operations specialists, marketing and communications staff, information technology staff, and call center staff. For online support, we used similar FTEs except for program managers, because, contrary to the intervention design, these staff also provided support to schools in the online group; for this reason, we attributed program manager FTEs of 0.00 (none) for year 1, 0.45 for year 2, and 0.52 for years 3 and 4 for online support.School health policies and environment (14 items);Health education (6 items);Physical education and other physical activity programs (12 items);Nutrition services (8 items);Health promotion for staff (6 items); andFamily and community involvement (3 items).To measure program effectiveness, we used differences in each school's assessment scores across the 4 years. Schools monitored their progress in implementing the program using a subset of items from the US Centers for Disease Control and Prevention's School Health Index (SHI).Responses are provided using a 4‐point scale, where 4 = fully in place, 3 = partially in place, 2 = under development, and 1 = not in place. Assessment scores range from 0% to 100% of items fully implemented. In the first year, referred to as the baseline year, the average overall wellness score for schools in both groups was 61% of items fully implemented, 59% for onsite schools, and 63% for online schools. Baseline equivalence results are presented in Table Obtained data related to actual costs of personnel, facilities, materials and equipment, and other inputs, such as travel and overhead from program developers, to calculate the costs of providing online and onsite implementation support to the original 128 study schools  during the 4 years of program implementation (SY 2014‐2015 through SY 2017‐2018).Tabulated the costs of relevant expense categories and allocated the appropriate proportion, to determine the total costs of providing each type of support for years 1, 2, 3, and 4 (SY 2014‐2015 through SY 2017‐2018).Divided the total cost of each type of support by the number of schools originally in each group , to calculate the average cost of supporting a school using each type of support for all 4 years.Determined the CE metric using the average change in school wellness policies and practices (as measured by the assessment) from years 1 to 4, to measure the effectiveness of each type of support for the fourth year of program implementation, and created a matched sample based on fidelity, baseline and year 4 assessment scores, and school characteristics .Divided the average cost per school by the average change in school wellness policies and practices to calculate a CE ratio.To conduct the CE analysis, we combined cost and effectiveness measures. For each type of support, we divided the average cost per school by the average change in wellness policies and practices from years 1 to 4. This calculation provides a CE ratio, interpreted as the cost per unit of effectiveness; that is, a 1 percentage point increase on the assessment, for each type of support. We followed these steps to conduct the CE analysis:The resulting CE ratio provides information about how much it costs over 4 years to increase school wellness policies and practices by 1 percentage point on the assessment. The type of implementation support with the lower CE ratio is the less expensive approach for achieving a 1 percentage point increase in school wellness policies and practices.Table Between onsite and online schools, there were no statistically significant differences in wellness gains after 4 years of program implementation. Across all wellness areas, onsite schools fully implemented more policies and practices in year 4 compared to baseline levels, rising 16 percentage points from 59% to 75%. Similarly, online schools fully implemented more policies and practices in year 4 compared to baseline levels, rising 15 percentage points from 63% to 78% Figure .Table Although onsite support is slightly more effective (average percentage point increase in assessment score of 16 vs 15), it cost $1481 more per school to support an onsite school than an online school. The type of support that yields a given level of effectiveness for the lowest cost  is more cost‐effective.Based on projections using the CE ratios, it would cost an average of $4007 per online school, versus the $5253 average cost per onsite school, to achieve a 16 percentage point increase in wellness outcomes after 4 years. We arrived at this estimate by multiplying the online school CE ratio of $256 by 16, which is the percentage point increase in wellness as measured by the assessment for onsite support. This estimate assumes that online schools with the current CE ratio of $256 would be able to achieve the same increase in wellness outcomes as the onsite schools did.Our results suggest that providing schools with online support to implement school health programs may be a more cost‐effective approach than providing onsite implementation support. It is worth noting that the costs of providing online support are mostly fixed and do not vary, regardless of the number of schools supported. Therefore, all else being equal, increasing the number of schools supported online would make online support even more cost‐effective than onsite support, because onsite support relies more on the variable and substantial costs associated with program managers' salaries.Whereas studies have examined the overall CE of school health and activity programs,This study is subject to several limitations noted in similar CE research efforts. First, the CE ratios are highly dependent on the costs of one key ingredient: program manager salaries. Program managers were initially supposed to support onsite schools only. Based on the results of a related implementation study, which included annual interviews with program managers in addition to the time they logged supporting onsite and online schools, we adjusted the actual costs associated with those salaries to reflect a more realistic estimate of the time that program managers spent providing support to online schools. Over the course of the 4 years, we adjusted the costs of program manager salaries for online support by adding 0.45 FTE to the cumulative costs of ingredients in year 2 and by adding 0.52 FTE in years 3 and 4. If we had not adjusted the program managers' FTE across the 4 years for the schools receiving online support, the CE ratios would indicate that online support is closer to 3.4 times more cost‐effective, rather than 1.3 times more cost‐effective. This finding underscores the importance of using multiple sources of data to ascertain and ascribe the costs of the ingredients to a program.A second limitation is that the effectiveness measure may not capture all the impacts resulting from onsite support. It is possible that onsite support affects other key outcomes not measured here. For example, schools receiving online support had higher attrition rates than schools receiving onsite support, suggesting that there may be other program benefits that accrue to onsite schools that keep them engaged in the program longer. If researchers can confirm that schools with missing data dropped out of the school health program (vs just not providing outcome data), then they might consider either (1) adjusting the overall costs by including the costs of schools that dropped out, or (2) obtaining outcome data from schools that did not complete the assessment annually. Either approach would likely make the program less cost‐effective, either by increasing the cost for a given level of effectiveness or by lowering the effectiveness for a given cost.Based on our experience, we recommend that future researchers consider the implications of using self‐reported data. In this study, both baseline and outcome data were self‐reported by schools. To explore whether school‐reported outcome data was sufficiently reliable and to mitigate response bias, we interviewed a subset of participating schools that reported changes on a subset of assessment items. Although average levels of agreement between school data and independent interview data were found to be above 85%, schools often reported slightly higher scores than were justified, to reflect gains that would otherwise have gone undetected had they adhered strictly to the definitions of the 4‐point response scale. Future researchers might consider (1) triangulating self‐reported data with other data sources to examine reliability or (2) developing more sensitive measures of school health outcomes to account for schools' tendency to slightly inflate their self‐reported outcome data.By demonstrating the relative CE of 2 approaches for supporting implementation of a school health program, this study contributes to recent research showing that school wellness programs can play an important role in improving overall student wellness.The CE analysis of online versus onsite implementation support for a school health program suggests that online support is a promising way to promote healthy eating and physical activity in elementary schools that serve students from low‐SES households who are at high risk of obesity. Investments in online implementation support for school health programs may cost less than onsite support and produce similar improvements in students' health and reductions in childhood and adolescence obesity rates. However, online schools had higher attrition from the study than onsite schools over the 4 years. Because online implementation support may be more cost‐effective than onsite support but may not provide enough support to keep developing school health programs engaged, school staff should assess their level of capacity to implement a school health program when determining whether to participate in online or onsite support. In addition, school staff should consider participating in a school health program with a group of schools. Spreading onsite support across schools within a district or within close proximity may mitigate some of the costs of school attrition and provide opportunities for program providers to distribute resource‐intensive, in‐person supports to more schools without reducing the outcomes achieved.Westat's institutional review board (IRB) is a specially constituted committee established to protect the rights and welfare of human participants. The IRB operates under procedures set forth in the regulations of the US Department of Health and Human Services and in the Federal‐wide Assurance granted to Westat by the Office for Human Research Protections. IRB approval is required before research may begin, continue, or be changed by the research team. Westat is committed to upholding regulatory and ethical standards through an FWA number, FWA00005551, issued by OHRP. Westat's IRB Organization number is IORG0000410, and Westat's IRB number is 00000695. The Westat IRB reviewed the Healthy Schools Randomized Trial, Project 6166, and determined the project is a program evaluation and exempt from IRB review on July 24, 2013.The research team received funding from The JPB Foundation (Grant/award #207) for this study, which was part of the Healthy Schools Randomized Trial.


Nitroxide-mediated polymerization is now a mature technique, at 35 years of age. During this time, several variants have been developed: enhanced spin capture polymerization (ESCP), photoNMP (NMP2), chemically initiated NMP (CI-NMP), spin label NMP (SL-NMP), and plasmon-initiated NMP (PI-NMP). This mini-review is devoted to the features and applications of these variants. The first report on alkoxyamines was published by Jones and Major in 1927  [1]. NonThe first valuable application of alkoxyamines was reported by Rizzardo and coll.  when theAll these investigations led to the development of variants of NMP. The variants discussed hereafter report non-conventional procedures for NMP , non-thermal initiation , and non-conventional initiation . In situ NMP corresponds to the in situ generation of alkoxyamines, unlike the conventional NMP, for which previously prepared alkoxyamines are used, and this has been thoroughly reviewed by Detrembleur and coll.  and GrisInterestingly, all the variants of NMP have been discovered in the last decade , and all3•, generated by the homolysis of alkoxyamine (dormant species) R1R2NOR3, affords an excess of nitroxide R1R2NO•, the persistent species, which favors the re-formation of alkoxyamine via the cross-coupling reaction with the alkyl radical R3•. The main consequence of the kinetics of 1  calculations showed that the homolysis requires three steps : (i) ligNMP2 can be applied either in bulk  or for SNMP2 is now an efficient approach for lithography . It has 7 was reported, with a 10-fold increase in kd . De. De9 carA decade ago, plasmon-induced chemistry emerged, and has since raised a keen interest ,80. The The synthetic potential of plasmon-induced transformations led us towards its application to surface-assisted polymerization, which can provide a novel tool for the design of materials with controlled properties. Thus, a surface covered with a layer of polymer may dramatically change the properties of the material, provided that the composition and the size of the polymer layer are well defined and controlled. Moreover, such material must be both easily accessible and cheaply processed. Up to now, the most convenient approach has been to use surface-initiated controlled radical polymerization techniques. However, such an approach requires specific procedures to remove all initiators that are not attached to the surface. Obviously, in such a case the plasmon-induced polymerization can sufficiently improve the creation of the targeted materials. 11 was attached onto the gold surface via diazonium chemistry. Then, upon laser irradiation at 785 nm, the homolysis of the C–ON bond of the grafted alkoxyamine occurred at room temperature, initiating radical polymerization of N-isopropyl acrylamide (NIPAM) and of styrene boronic acid (VBA). As the homolysis of the C–ON bond was controlled by the plasmon effect, it was possible to prepare a block co-polymer of 15 NIPAM units and 15 VBA units. This new material was applied to the detection of glycoproteins using surface enhanced Raman spectroscopy (SERS).The first application of plasmon energy for the polymerization was proposed by Baumberg ,100, wheTwo among the five new variants of NMP—ESCP and NMP2—are already commonly used for the preparation of new materials. The other three variants—CI–NMP, SL–NMP, and PI–NMP—have been developed more recently and exhibit a high potential: CI–NMP should find application in self-healing polymers by combining orthogonal reactivity , SL–NMP is interesting for the investigation of materials prepared using PISA techniques or for the preparation of SORP using radical polymerization of monomers carrying persistent radicals, and PI–NMP is highly valuable for the preparation of smart materials using metal- and UV-light-free polymerization at room temperature.