Practical Benchmark Research Articles

A Prescriptive Analytics Framework for Optimal Policy Deployment Using Heterogeneous Treatment Effects

We define a prescriptive analytics framework that addresses the needs of a constrained decision-maker facing, ex ante, unknown costs and benefits of multiple policy levers. The framework is general in nature and can be deployed in any utility-maximizing context, public or private. It relies on randomized field experiments for causal inference, machine learning for estimating heterogeneous treatment effects, and on the optimization of an integer linear program for converting predictions into decisions. The net result is the discovery of individual-level targeting of policy interventions to maximize overall utility under a budget constraint. The framework is set in the context of the four pillars of analytics and is especially valuable for companies that already have an existing practice of running A/B tests. The key contribution of this work is to develop and operationalize a framework to exploit both within- and between-treatment arm heterogeneity in the utility response function in order to derive benefits from future (optimized) prescriptions. We demonstrate the value of this framework as compared to benchmark practices—i.e., the use of the average treatment effect, uplift modeling, as well as an extension to contextual bandits—in two different settings. Unlike these standard approaches, our framework is able to recognize, adapt to, and exploit the (potential) presence of different subpopulations that experience varying costs and benefits within a treatment arm while also exhibiting differential costs and benefits across treatment arms. As a result, we find a targeting strategy that produces an order of magnitude improvement in expected total utility for the case where significant within- and between-treatment arm heterogeneity exists.

DECONbench: a benchmarking platform dedicated to deconvolution methods for tumor heterogeneity quantification

BackgroundQuantification of tumor heterogeneity is essential to better understand cancer progression and to adapt therapeutic treatments to patient specificities. Bioinformatic tools to assess the different cell populations from single-omic datasets as bulk transcriptome or methylome samples have been recently developed, including reference-based and reference-free methods. Improved methods using multi-omic datasets are yet to be developed in the future and the community would need systematic tools to perform a comparative evaluation of these algorithms on controlled data.ResultsWe present DECONbench, a standardized unbiased benchmarking resource, applied to the evaluation of computational methods quantifying cell-type heterogeneity in cancer. DECONbench includes gold standard simulated benchmark datasets, consisting of transcriptome and methylome profiles mimicking pancreatic adenocarcinoma molecular heterogeneity, and a set of baseline deconvolution methods (reference-free algorithms inferring cell-type proportions). DECONbench performs a systematic performance evaluation of each new methodological contribution and provides the possibility to publicly share source code and scoring.ConclusionDECONbench allows continuous submission of new methods in a user-friendly fashion, each novel contribution being automatically compared to the reference baseline methods, which enables crowdsourced benchmarking. DECONbench is designed to serve as a reference platform for the benchmarking of deconvolution methods in the evaluation of cancer heterogeneity. We believe it will contribute to leverage the benchmarking practices in the biomedical and life science communities. DECONbench is hosted on the open source Codalab competition platform. It is freely available at: https://competitions.codalab.org/competitions/27453.

An Integrated Approach to Municipal Solid Waste Recycling Performance Evaluation by Incorporating Local Demographic Features

Recycling municipal solid waste has become a challenging task for municipalities. Appropriate recycling efficiency evaluations are, thus, essential to find practical benchmark learning targets for inefficient municipal solid waste authorities (MSWAs). This study developed a recycling performance evaluation procedure by subgrouping MSWAs with prominent local demographic features, such as population density, ratio of senior citizens, tourism index etc. Principal recycling relevant factors for MSWAs in each group were then collected, and data envelopment analysis (DEA) was applied for efficiency evaluation and benchmark learning targets. A case study of 181 MSWAs in Taiwan demonstrated the suitability of the proposed procedures. An assessment of the required efforts for efficiency improvements revealed that, in an unsegregated scenario, inefficient MSWAs representing a rural subgroup required maximum efforts to fulfill the efficiency targets, which was on average 61% higher than that determined in their respective subgroup. Furthermore, the unsegregated scenario revealed proximal efficiency results for the urban subgroup. The results indicated that consideration of local demographic features was essential for a fair assessment of recycling efficiency. Additionally, evaluating MSWAs with similar local demographic features was superior in obtaining appropriate benchmark learning targets for the inefficient MSWAs and, consequently, exhibited practicality for improving walkthroughs to achieve the efficiency goal.

Detecting entanglement of quantum channels

Entanglement is the crucial resource for different quantum information processing tasks. While conventional studies focus on the entanglement of bipartite or multipartite quantum states, recent works have extended the scenario to the entanglement of quantum channels, an operational quantification of the channel entanglement manipulation capability. Based on the recently proposed channel entanglement resource framework, here we study a further task of resource detection—witnessing entanglement of quantum channels. We first introduce the general framework and show how channel entanglement detection is related to the Choi state of the channel, enabling channel entanglement detection via conventional state entanglement detection methods. We also consider entanglement of multipartite quantum channels and use the stabilizer formalism to construct entanglement witnesses for circuits consisting of controlled-Z gates. We study the effectiveness of the proposed detection methods and compare their performance for several typical channels. Our work paves the way for systematic theoretical studies of channel entanglement and practical benchmarking of noisy intermediate scaled quantum devices.

Multi visual and textual embedding on visual question answering for blind people

Visual impairment community, especially blind people have a thirst for assistance from advanced technologies for understanding and answering the image. Through the development and intersection between vision and language, Visual Question Answering (VQA) is to predict an answer from a textual question on an image. It is essential and ideal to help blind people with capturing the image and answering their questions automatically. Traditional approaches often utilize the strength of convolution and recurrent networks, which requires a great effort for learning and optimizing. A key challenge in VQA is finding an effective way to extract and combine textual and visual features. To take advantage of previous knowledge in different domains, we propose BERT-RG, the delicate integration of pre-trained models into feature extractors, which relies on the interaction between residual and global features in the image and linguistic features in the question. Moreover, our architecture integrates a stacked attention mechanism that exploits the relationship between textual and visual objects. Specifically, the partial regions of images interact with partial keywords in question to enhance the text-vision representation. Besides, we also propose a novel perspective by considering a specific question type in VQA. Our proposal is significantly meaningful enough to develop a specialized system instead of putting forth the effort to dig for unlimited and unrealistic approaches. Experiments on VizWiz-VQA, a practical benchmark dataset, show that our proposed model outperforms existing models on the VizWiz VQA dataset in the Yes/No question type.

Benchmarking total hip replacement constructs using noninferiority analysis: the New Zealand joint registry study

BackgroundThe aim of this study was to compare the relative performance of total hip replacement constructs and discern if there is substantial variability in performance in currently commonly used prostheses in the New Zealand Joint Registry (NZJR) using a noninferiority analysis.MethodsAll patients who underwent a primary total hip replacement (THR) registered in the NZJR between 1st January 1999 to June 2020 were identified. Using a noninferiority analysis, the performance of hip prostheses were compared with the best performing contemporary construct. Construct failure was estimated using the 1-Kaplan Meier survival function method to estimate net failure. The difference in failure between the contemporary benchmark and other constructs was examined.ResultsIn total 135,432 THR were recorded comprising 1035 different THR constructs. Notably 328 constructs were used just once. Forty-eight constructs (62,251 THR) had > 500 procedures at risk at 3 years post-primary of which 28 were inferior by at least 20% relative risk of which, 10 were inferior by at least 100% relative risk. Sixteen constructs were identified with > 500 procedures at risk at 10 years with 9 inferior by at least 20%, of which one was inferior by > 100% relative risk. There were fewer constructs noninferior to the best practice benchmark when we performed analysis by gender. In females at 10 years, from 5 constructs with > 500 constructs at risk, 2 were inferior at the 20% margin. In males at 10 years, there were only 2 eligible constructs of which one was inferior at the 20% margin.ConclusionsWe discerned that there is substantial variability in construct performance and at most time points, just over half of constructs are inferior to the best performing construct by at least 20%. These results can facilitate informed decision-making when considering THR surgery.

A critical appraisal of registry-based objective performance goals in peripheral arterial disease

The multidisciplinary Superficial Femoral Artery-Popliteal EvidencE Development (SPEED) Study Group, under the auspices of the Registry Assessment of Peripheral Interventional Devices (RAPID) partnership, recently published objective performance goals for peripheral vascular interventions in the femoropopliteal arteries. Retrospective outcomes from the Vascular Quality Initiative provided the sole study data source. Strengths and weaknesses of this landmark effort are examined. Critical concerns include the substantial risks of ascertainment bias, flawed end point selection, sparse and variable capture of midterm follow-up data, and lack of expected discrimination between treatment modalities. The current Vascular Quality Initiative registry data thus appear insufficiently robust for the generation of objective performance goals and practice benchmarks; suggestions for redesign are provided. The impact of the statutory framework of the US Food and Drug Administration on device approval pathways and the maturation of an evidence-based approach to peripheral vascular intervention is explored.

IRPA practical guidance for engagement with the public on radiation and risk

The International Radiation Protection Association, IRPA, promotes the worldwide enhancement of professional competence, radiation protection (RP) culture and practice by providing benchmarks of good practice, as well as encouraging the application of the highest standards of professional conduct, skills and knowledge for the benefit of individuals and society. Enhancing public understanding of radiation and risk is highlighted by experiences from past emergencies, including the accident at Tokyo Electric Power Company’s (TEPCO) Fukushima Daiichi Nuclear Power Plant in 2011 and the following post-disaster recovery, as one of the most important challenges, and this challenge is common across almost all public interfaces regarding radiation and risk. To this end IRPA has been continuing a Task Group activity for Public Understanding since 2013. After a series of workshops in various regions of the world, the IRPA draft guidance was developed and issued for consultation of the Associate Societies in 2019. Through these processes, IRPA received a lot of helpful comments and suggestions. IRPA finally published ‘Practical Guidance for Engagement with the Public on Radiation and Risk’ on the IRPA website in October 2020. The objective of the guidance is two-fold. Firstly, it is to enthuse all of us in our profession to become more active public advocates for RP. Secondly, it is to provide information, experiences and techniques to help us to become more effective and comfortable in this challenging task. This paper provides a key summary of the published IRPA guidance.

The mitigation hierarchy in environmental impact assessment and related legislation as a tool for species conservation: A case study of western chimpanzees and mining development

Global biodiversity loss is occurring at an alarming rate, with a growing consensus that we are entering a sixth mass extinction. Rapid human development and associated habitat loss, principally through agriculture, infrastructure and extractive industries, is a significant contributor. The critically endangered western chimpanzee (Pan troglodytes verus) is at the nexus of the development-habitat loss conflict with 83% of the subspecies occurring outside protected areas. To protect its habitat, robust regulation of large-scale development, in particular through Environmental Impact Assessment (EIA) procedures that adequately incorporate the Mitigation Hierarchy Principles (MHPs), is required. We developed a framework to review EIA and related legislation in all eight western chimpanzee range countries and assessed how well they incorporate MHPs, focusing specifically on mining activity. Costa Rica was selected as a benchmark of good practice, based on the recognised quality of its biodiversity laws. Overall performance of the eight countries fell substantially below that of Costa Rica. Whilst isolated good examples were identified, the overall approach legislates for broad concepts but fails to deliver on detailed provisions. As recommended by the current regional action plan for the conservation of western chimpanzees, all countries would benefit from urgent legislative reform to better incorporate MHPs within EIA procedures. This study provides recommendations in that regard together with a replicable tool for assessing EIA legislation in other jurisdictions.

Human capital, risk and the World Bank’s reintermediation in global development

This article examines an attempt to reconstitute global development governance in a context of growing influence for private finance. We focus on the World Bank’s Human Capital Project (HCP) and Human Capital Index (HCI), which have stated aims of promoting economic growth and accelerating progress towards achievement of the Sustainable Development Goals. Informed by a review of publicly available World Bank materials, we argue that, through its HCP and HCI, the World Bank is responding to its own institutional sidelining in development financing and governance with a strategy of reintermediation. Its leaders have pursued a system of governance in which the World Bank creates and instrumentalises knowledge on human capital – an asset to be accumulated through judicious investments in markets for self-betterment. Through its HCI the World Bank has expanded its global benchmarking practices, encompassing new domains and quantified predictions of future productivity, in the hope of shaping domestic policy processes. Its leaders propose to use HCI scores to signal risk to investors and political leaders, triggering political shocks that will spur policy reform. Crucially, these efforts seek to reassert the World Bank’s epistemic authority and financing clout as the influence of its own lending wanes. Supplemental data for this article is available online at https://doi.org/10.1080/01436597.2021.1953980 .

The effects of using stroboscopic training on sports performance

Stroboscopic training is a form of athletic training during which the individual performs a motor task under intermittently opaque visual conditions. The purpose of this training is to enhance subsequent performance under normal visual conditions as a result of shifting attentional focus within the multisensory integration process. The training performed with the help of this technology that uses specially designed glasses increases the contribution of other somatosensory afferents to motor control by refocusing the individual’s attention on proprioceptive feedback. Other benefits of stroboscopic training include improved short-term visual memory, improved capacity for anticipation as well as increased ability to focus in general but particularly on the central visual field and thus produce coherent movements. The current paper is a metaanalysis of the literature on stroboscopic training and its benefits for professional sport. In sports using stroboscopic (strobe) glasses, for example in hockey, basketball, football, volleyball, baseball or tennis, positive effects on some skills have been identified and training and testing protocols have been described. The aim of this paper is to highlight some practical and methodological benchmarks resulting from the use of stroboscopic training in various sports, and then transfer them to climbing training in order to enhance performance in this sport.

Leveraging Blockchain Technology for Indian Healthcare system: An assessment using value-focused thinking approach

Indian Healthcare system is a complex and distinguished structure due to variety of factors viz. population size it serves, presence of organized and unorganized services of healthcare, economic disparity and governance structure among others. Extant research emphasizes on the aspects like transparency, trust, disintermediation, non-repudiation, benchmarking of processes and practices, traceability and data integrity among others to stimulate the Indian Healthcare system for an improvised and more effective format. Blockchain Technology is recent innovation that offers many of these aforementioned aspects as a feature to the host systems. However, it is critical to understand and articulate the utility of Blockchain Technology specific to the Indian Healthcare system. Further, it is important to gauge the requirement elicitation of key stakeholders for Blockchain Technology adoption in Indian Healthcare system w.r.t any attribute prioritization/customization or design considerations (Consensus mechanism, type of blockchain, smart contracts etc.). There have been some research works on aspects of Blockchain applications in Indian Healthcare but lack a strong perspective of stakeholder requirements. We use Value-Focused Thinking framework based on discussions with the stakeholders to address the above mentioned research premise. We identify Fundamental Objectives and Strategic Objectives from the stakeholder interactions that contribute to the strategic goal. This is a niche work with a significant analytical contribution from the information systems perspective of Blockchain Technology adoption in the Indian Healthcare ecosystem given the light of premises from realms of human agents, behavioural and applications requirement from a stakeholder viewpoint.

Private Equity Benchmarking for Asset Owners and Investment Managers

This works focuses on the challenges posed by benchmarking private equity performance and the solutions that have evolved in practice. The paper puts the practical approaches used by investors into four general categories, and describes the relevant characteristics that distinguish each category, the typical circumstances in which they normally arise, and the areas in which each presents opportunities for improvement. The authors’ perspective is neutral as to which method is preferred or superior, recognizing that each one presents particular advantages and challenges. The intent is to demonstrate the relationship among the different approaches that eventually should rest on similar underlying principles of objectivity, efficiency, and transparency. The intended audience includes institutional asset owners with significant allocations to private equity, that need to adequately measure the value added to their portfolio by direct and fund investment, as well as investment managers who need to track how the performance of their strategies and implementations compares to that of their peers. <b>TOPICS:</b>Private equity, performance measurement <b>Key Findings</b> ▪ Analyze the ways the investment industry has evolved to tackle the challenges with private equity benchmarking in practice. ▪ Reduce the reliance on subjective measures like appraisal values and heuristic groupings, and focus on objective measures like cash flows, transacted values, and efficient benchmark portfolios. ▪ Evolve beyond static measures of performance to those that suggest the confidence intervals that differentiate between skill and luck.

Entanglement-Assisted Communication Surpassing the Ultimate Classical Capacity.

Entanglement underpins a variety of quantum-enhanced communication, sensing, and computing capabilities. Entanglement-assisted communication (EACOMM) leverages entanglement preshared by communicating parties to boost the rate of classical information transmission. Pioneering theory works showed that EACOMM can enable a communication rate well beyond the ultimate classical capacity of optical communications, but an experimental demonstration of any EACOMM advantage remains elusive. In this Letter we report the implementation of EACOMM surpassing the classical capacity over lossy and noisy bosonic channels. We construct a high-efficiency entanglement source and a phase-conjugate quantum receiver to reap the benefit of preshared entanglement, despite entanglement being broken by channel loss and noise. We show that EACOMM beats the Holevo-Schumacher-Westmoreland capacity of classical communication by up to 16.3%, when both protocols are subject to the same power constraint at the transmitter. As a practical performance benchmark, we implement a classical communication protocol with the identical characteristics for the encoded signal, showing that EACOMM can reduce the bit-error rate by up to 69% over the same bosonic channel. Our work opens a route to provable quantum advantages in a wide range of quantum information processing tasks.

Walking the talk? A multiple-case study of quality management implementation in China

Focusing on the manufacturing industry in China, the study explores factors that contribute to possible implementation gaps between companies’ actual practices and the commonly recognized core quality management (QM) practices. In-depth interviews were conducted with production managers, quality managers, and executives of 11 manufacturing companies in China. The selected case companies vary by firm size, ownership, and markets they operate. Qualitative analysis was conducted using NVivo software program. When assessed in comparison with commonly recognized core QM practices, the case companies showed implementation gaps. The implementation gap refers to the lack of comprehensiveness of QM core practices implemented in an individual company against the benchmark practices. Moderate or large implementation gaps were found in seven out of 11 case companies. The study further explores the contextual and cultural factors that contribute to the QM implementation gaps. Case analysis identified that building of quality-centric culture plays a key role in closing the QM implementation gaps. Company ownership is another important indicator for the QM implementation gaps.

Phosphate Elimination and Recovery Lightweight (PEARL) membrane: A sustainable environmental remediation approach

Aqueous phosphate pollution can dramatically impact ecosystems, introducing a variety of environmental, economic, and public health problems. While novel remediation tactics based on nanoparticle binding have shown considerable promise in nutrient recovery from water, they are challenging to deploy at scale. To bridge the gap between the laboratory-scale nature of these nanostructure solutions and the practical benchmarks for deploying an environmental remediation tool, we have developed a nanocomposite material. Here, an economical, readily available, porous substrate is dip coated using scalable, water-based processes with a slurry of nanostructures. These nanomaterials have tailored affinity for specific adsorption of pollutants. Our Phosphate Elimination and Recovery Lightweight (PEARL) membrane can selectively sequester up to 99% of phosphate ions from polluted waters at environmentally relevant concentrations. Moreover, mild tuning of pH promotes at will adsorption and desorption of nutrients. This timed release allows for phosphate recovery and reuse of the PEARL membrane repeatedly for numerous cycles. We combine correlative microscopy and spectroscopy techniques to characterize the complex microstructure of the PEARL membrane and to unravel the mechanism of phosphate sorption. More broadly, through the example of phosphate pollution, this work describes a platform membrane approach based on nanostructures with specific affinity coated on a porous structure. Such a strategy can be tuned to address other environmental remediation challenges through the incorporation of other nanomaterials.

Three-dimensional residual channel attention networks denoise and sharpen fluorescence microscopy image volumes.

We demonstrate residual channel attention networks (RCAN) for the restoration and enhancement of volumetric time-lapse (four-dimensional) fluorescence microscopy data. First we modify RCAN to handle image volumes, showing that our network enables denoising competitive with three other state-of-the-art neural networks. We use RCAN to restore noisy four-dimensional super-resolution data, enabling image capture of over tens of thousands of images (thousands of volumes) without apparent photobleaching. Second, using simulations we show that RCAN enables resolution enhancement equivalent to, or better than, other networks. Third, we exploit RCAN for denoising and resolution improvement in confocal microscopy, enabling ~2.5-fold lateral resolution enhancement using stimulated emission depletion microscopy ground truth. Fourth, we develop methods to improve spatial resolution in structured illumination microscopy using expansion microscopy data as ground truth, achieving improvements of ~1.9-fold laterally and ~3.6-fold axially. Finally, we characterize the limits of denoising and resolution enhancement, suggesting practical benchmarks for evaluation and further enhancement of network performance.

P580 Benchmarking IBD Pharmacy Services to optimise, strengthen and align IBD Expert Pharmacy Practice

Abstract Background UK IBD Standards 2019 (ibduk.org) for the first time embed and describe Specialist Pharmacy Services (SPS) as an integral part of the IBD multidisciplinary team (MDT) and enable recognition and commissioning of Expert Pharmacists in IBD (EPharmIBD). The Benchmarking Tool, comprised of the IBD Patient Survey and Service Self-Assessment 2019/2020 provides a benchmark of expert pharmacy practice. Methods The Benchmarking Tool developed by IBD UK to drive quality defines A-D descriptors for all IBD standards (A=’excellent, proactive’ to D=’minimal, inadequate’ care). Descriptors for 4 (7%) standards describing SPS were developed through an e-Delphi process by IBD UK with EPharmIBD representation. Royal Pharmaceutical Society standards and SPS feedback were used to define descriptors for leadership, medicines expert role and MDT working. All UK IBD services were asked to complete the self-assessment between Oct 2019 and Jan 2020. Results 10,222 IBD patients complete the IBD Patient Survey 166 (72%) paediatric and adult IBD services took part across the UK. MDT Standard 46% (n=81/166) of all IBD Services have pharmacist input to the IBD MDT, but only 13% of all adult services (n = 18/134) met or exceeded the standard for 0.6 WTE EPharmIBD /250,000 population. Leadership role 76% (n=98/129) of services with IBD leadership team work with a pharmacist of which 48% (n=47/98) work with an EPharmIBD on the annual formulary review. Of these teams 66% (n=31/47) work with an EPharmIBD on annual protocol/policy review, with actions and outcomes, actively develop pharmacy services within IBD. Medicines expert role Ward pharmacists in 95% (n=157/166) of IBD Services have access to an advanced generalist pharmacist for advice. Of these services 54% (n=84/157) are supported by an EPharmIBD but in only 41% (n=34/84) of these patients and ward pharmacists have access to an EPharmIBD on admission and during their stay for medication review, optimisation and personalised consultation. Conclusion Benchmarking shows a low level of pharmacy IBD expertise in the UK with a minority of services, ward pharmacists and patients having access to an EPharmIBD. Few IBD leadership teams work with an EPharmIBD and a small number of services have adequate EPharmIBDs commissioned. In contrast where services report meeting the IBD Standards criteria for the number of EPharmIBDs, patients responding to the Patient Survey were more likely to be given appropriate information about potential treatments to help them make informed decisions. This highlights the high need for advanced competencies and prioritisation of service commissioning in IBD.The pharmacy profession needs to respond urgently to this challenge to ensure high quality pharmaceutical care for IBD patients.

"Good practices" in pediatric clinical care for disorders/differences of sex development.

To define, benchmark, and publicize elements of quality care (i.e., "good practices") for pediatric patients with disorders/differences of sex development (DSD). Principles of quality care were identified by literature review; consensus exists for 11 good practices and adherence was evaluated through online survey of 21 North American clinical sites. Strong uptake was observed for many practices, particularly specialty participation (n ≥ 17 of 21 sites for most core specialties); point of contact (n = 18); expertise in gender dysphoria/dissatisfaction (n = 20); and DSD-specific continuing medical education (n = 18). Greater variability was apparent for frequency of peer support referrals (n = 12 universally practiced); standardized questionnaires for routine assessment of psychosocial adaptation (n = 13) and gender development (n = 10); consistently clarifying patient/family values in decision-making (n = 15); genital exam protocols that exclude trainee education as primary reason (n = 15); and internal patient-tracking efforts (n = 5-10 of 20 sites). This study employed a novel approach to designate DSD good practices and identified areas of consistency and variation in these DSD clinical practices. Good practice benchmarking facilitates quality assessment within and across sites, promotes continuous improvement, and empowers stakeholders in locating and delivering high quality care.

Co-creating an assistive technology peer-support community: learnings from AT Chat

Purpose Inclusion is a core philosophy for health practitioners and human service users, and co-production is a way to achieve inclusion. Australia’s assistive technology (AT) community seeks to include and amplify the voices of service and product users at multiple levels. Implementation of genuine partnerships for inclusion is however challenging. This paper describes the iterative co-design process undertaken to structure and deliver a peer-led information and support program, enabling AT users and supporters to build their AT decision making capability and share their expertise with each other and the broader community. Methods A living labs approach was grounded in co-design principles and drew on the peer education, AT competency and capability-building knowledge base. Methods included embedding intersectional capabilities within the service, and the engagement of over 600 people in design thinking and program iterations through surveys, focus groups, journey mapping and think tanks. Results A national, peer-led, co-designed online community for AT users was established and has been running since 2017. The community of 5000 users contribute to a peer-led information and support initiative geared to share expertise and build AT decision making capability. Conclusions Service delivery by the AT user community and for the AT user community requires a commitment to co-design, and an engagement with concepts of risk, competency, scope of practice and capability. The learnings from AT Chat have implications for AT services on this journey everywhere. Implications for rehabilitation Active co-design of AT services meets human rights and good practice benchmarks required by contemporary services. Foregrounding AT users within program design and delivery, brings a range of positive outcomes and possibilities for the way services are delivered. AT users have substantial untapped potential which brings tangible outcomes for other AT users, health professionals, service provider organizations and for society. Development of paid roles and pathways to recognize the skills of AT users, and indeed AT communities has potential to improve AT user self-efficacy as well as to contribute to the AT workforce.