{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,28]],"date-time":"2025-11-28T10:12:04Z","timestamp":1764324724812,"version":"3.46.0"},"reference-count":14,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2025,11,28]],"date-time":"2025-11-28T00:00:00Z","timestamp":1764288000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Algorithms"],"abstract":"<jats:p>Background: Stepped-wedge cluster randomized trials (SW-CRTs) are increasingly used to evaluate population-level interventions, but trial validity depends on timely cluster transitions. Rollout feasibility is often assumed rather than modelled. In the context of a planned national trial of CPR training kiosks, we developed a Monte Carlo simulation algorithm to quantify logistical feasibility under uncertainty. Methods: A stochastic Monte Carlo algorithm was implemented to simulate deploying 100 CPR kiosks across eight Canadian cities under four team structures. Inputs included productivity (0.8\u20131.2 kiosks\/day), disruption probabilities (weather, venue access, technical failure, staff illness, transport delays), and cost parameters (salaries, per diems, travel). Each scenario was simulated across 3000 iterations. Outputs included per-city feasibility (p \u2264 60 days), total project duration, and risk\u2013cost trade-offs. Results: Single-team strategies required 9\u201310 months for full rollout, with winter-exposed cities such as Halifax and Charlottetown having up to 30% probability of exceeding 60 days. Two-team strategies halved rollout time (4\u20135 months) and achieved &gt;95% on-time rollout across cities. Adding a third onsite staff member reduced risk by 5\u201315% with modest additional cost (~CAD 1500\u20132000 per city). Risk\u2013cost analysis identified two teams with three staff as the most reliable strategy. Conclusions: Monte Carlo simulation provides a practical framework for assessing rollout feasibility in SW-CRTs. Applied to CPR kiosk deployment, it highlights the importance of staffing, seasonality, and city-level context. The approach is generalizable to other national interventions requiring phased rollout under uncertainty.<\/jats:p>","DOI":"10.3390\/a18120747","type":"journal-article","created":{"date-parts":[[2025,11,28]],"date-time":"2025-11-28T09:56:02Z","timestamp":1764323762000},"page":"747","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["A Monte Carlo Simulation Algorithm to Assess Rollout Feasibility in Stepped-Wedge Trials: A Case Study of National CPR Training Kiosk Deployment"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8263-0556","authenticated-orcid":false,"given":"Robert","family":"Ohle","sequence":"first","affiliation":[{"name":"Clinical Science Division, Northern Ontario School of Medicine, Sudbury, ON P3E 2C6, Canada"},{"name":"Health Science North Research Institute, Sudbury, ON P3E 2H3, Canada"},{"name":"Department of Emergency Medicine, Health Sciences North, Sudbury, ON P3E 5J1, Canada"}]},{"given":"Sarah","family":"McIsaac","sequence":"additional","affiliation":[{"name":"Clinical Science Division, Northern Ontario School of Medicine, Sudbury, ON P3E 2C6, Canada"},{"name":"Health Science North Research Institute, Sudbury, ON P3E 2H3, Canada"},{"name":"Department of Anesthesia and Critical Care, Health Science North, Sudbury, ON P3E 5J1, Canada"}]}],"member":"1968","published-online":{"date-parts":[[2025,11,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"413","DOI":"10.1503\/cmaj.150544","article-title":"Out-of-hospital cardiac arrest in high-rise buildings: Delays to patient care and effect on survival","volume":"188","author":"Drennan","year":"2016","journal-title":"CMAJ"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1186\/s13054-020-2773-2","article-title":"The global survival rate among adult out-of-hospital cardiac arrest patients who received cardiopulmonary resuscitation: A systematic review and meta-analysis","volume":"24","author":"Yan","year":"2020","journal-title":"Crit. Care"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1377","DOI":"10.1001\/jama.2013.278483","article-title":"Association of national initiatives to improve cardiac arrest management with rates of bystander intervention and patient survival after out-of-hospital cardiac arrest","volume":"310","author":"Wissenberg","year":"2013","journal-title":"JAMA"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1016\/j.resuscitation.2011.07.016","article-title":"Resuscitation feedback and targeted education improves quality of pre-hospital resuscitation in Scotland","volume":"83","author":"Lyon","year":"2012","journal-title":"Resuscitation"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"100","DOI":"10.1016\/j.resuscitation.2015.07.026","article-title":"Outcomes for out-of-hospital cardiac arrests across 7 Asian countries: Pan-Asian Resuscitation Outcomes Study","volume":"96","author":"Ong","year":"2015","journal-title":"Resuscitation"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1447","DOI":"10.1001\/jama.2010.1392","article-title":"Chest compression-only CPR by lay rescuers and survival from out-of-hospital cardiac arrest","volume":"304","author":"Bobrow","year":"2010","journal-title":"JAMA"},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Simmons, K.M., McIsaac, S.M., and Ohle, R. (2023). Impact of community-based interventions on out-of-hospital cardiac arrest outcomes: A systematic review and meta-analysis. Sci. Rep., 13.","DOI":"10.1038\/s41598-023-35735-y"},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Prost, A., Binik, A., Abubakar, I., Roy, A., De Allegri, M., Mouchoux, C., Dreischulte, T., Ayles, H., Lewis, J.J., and Osrin, D. (2015). Logistic, ethical, and political dimensions of stepped wedge trials: Critical review and case studies. BMC Med. Res. Methodol., 15.","DOI":"10.1186\/s13063-015-0837-4"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"e017290","DOI":"10.1136\/bmjopen-2017-017290","article-title":"The use of feasibility studies in stepped-wedge trials: A review","volume":"7","author":"Kristunas","year":"2017","journal-title":"BMJ Open"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"h391","DOI":"10.1136\/bmj.h391","article-title":"The stepped wedge cluster randomized trial: Rationale, design, analysis, and reporting","volume":"350","author":"Hemming","year":"2015","journal-title":"BMJ"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1801","DOI":"10.1161\/CIRCULATIONAHA.113.001953","article-title":"Identifying locations for public access defibrillators using mathematical optimization","volume":"127","author":"Chan","year":"2013","journal-title":"Circulation"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1186\/s40545-022-00411-5","article-title":"Management of COVID-19 vaccines cold chain logistics: A scoping review","volume":"15","author":"Fahrni","year":"2022","journal-title":"J. Pharm. Policy Pract."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1322","DOI":"10.2105\/AJPH.89.9.1322","article-title":"Evaluating the public health impact of health promotion interventions: The RE-AIM framework","volume":"89","author":"Glasgow","year":"1999","journal-title":"Am. J. Public Health"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1007\/s10488-010-0319-7","article-title":"Outcomes for implementation research: Conceptual distinctions, measurement challenges, and research agenda","volume":"38","author":"Proctor","year":"2011","journal-title":"Adm. Policy Ment. 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