Goal Of Planning Research Articles

Clinical Implementation and Dosimetric Evaluation of a Robust Proton Lattice Planning Strategy Using Primary and Robust Complementary Beams

Pencil-beam scanning proton therapy has been considered a potential modality for the 3D form of spatially fractionated radiation therapy called lattice therapy. However, few practical solutions have been introduced in the clinic. Existing limitations include degradation in plan quality and robustness when using single-field versus multifield lattice plans, respectively. We propose a practical and robust proton lattice (RPL) planning method using multifield and evaluate its dosimetric characteristics compared to clinically acceptable photon lattice plans. Seven cases previously treated with photon lattice therapy were used to evaluate a novel RPL planning technique using 2-orthogonal beams: a primary beam (PB) and a robust complementary beam (RCB) that deliver 67% and 33%, respectively, of the prescribed dose to vertices inside the gross target volume (GTV). Only RCB is robustly optimized for setup and range uncertainties. The number and volume of vertices, peak-to-valley dose ratios (PVDRs), and volume of low dose to GTV of proton and photon plans were compared. The RPL technique was then used in the treatment of 2 patients and their dosimetric parameters were reported. The RPL strategy was able to achieve the clinical planning goals. Compared to previously treated photon plans, the average number of vertices increased by 30%, the average vertex volume by 49% (18.2 ± 25.9 cc vs 12.2 ± 14.5 cc, P = .21), and higher PVDR (10.5 ± 4.8 vs 2.5 ± 0.9, P < .005) was achieved. In addition, RPL plans show more conformal dose with less low dose to GTV (V30%, 60.9% ± 7.2% vs 81.6% ± 13.9% and V10%, 88.3% ± 4.5% vs 98.6% ± 3.6% [P < .01]). The RPL plan for 2 treated patients showed PVDRs of 4.61 and 14.85 with vertices-to-GTV ratios of 1.52% and 1.30%, respectively. A novel RPL planning strategy using a pair of orthogonal beams was developed and successfully translated to the clinic. The proposed method can generate better quality plans, a higher number of vertices, and higher PVDRs than currently used photon lattice plans.

Achieving urban vibrancy through effective city planning: A spatial and temporal perspective

Achieving urban vibrancy is a critical goal for urban planning and policy-making, and the city's physical plan plays an important role in shaping and supporting urban vibrancy. However, the effectiveness of urban planning strategies in optimizing resource allocation and fostering a vibrant city remains unclear. This study aims to contribute to this understanding by exploring the spatial and temporal effects underlying the association between urban vibrancy and urban forms. Using mobile-phone location-request data along with urban nighttime light data as a proxy for urban vibrancy in Shenzhen, China, we conducted a geographically and temporally weighted regression (GTWR) analysis to examine the relationship between land use, street configuration, and urban vibrancy. The results showed that a diverse land use mix and the proportions of land allotted for sports and cultural usage, parks, and greenspace generally have a positive impact on urban vibrancy. We noted the facilitating role of degree centrality and closeness centrality on urban vibrancy, compared to the negative impact of betweenness centrality. Our analysis of local spatial variations in the influence of road networks suggests a potential connectivity threshold for attracting people to specific areas. Finally, we identified a divergence between weekdays and weekends in terms of temporal variations.

Urban biodiversity conservation: A framework for ecological network construction and priority areas identification considering habit differences within species

The construction of ecological networks within the context of urbanization is an effective approach to cope with the challenges of urban biodiversity decline, representing a crucial goal in urban planning and development. However, existing studies often overlook the richness and uniqueness within species communities by homogenizing traits of species in the same class. This study proposes a framework for constructing and optimizing ecological networks focused on differential conservation within the same class. By classifying birds into three groups (specialists of water, forest or urban areas) based on their ecological requirements and urbanization tolerance, we constructed an ecological network tailored to their distinct migratory dispersal patterns. We then identified strategic areas including pinch points, barriers, and breakpoints specific to each bird group. Our findings reveal notable variations in suitable habitat distribution among different bird groups in urban environments. Corridor layouts varied according to habitat preferences and migratory dispersal patterns. Despite these differences, urban built-up areas persist as central hubs for the distribution of suitable habitats for 75% of bird species, with peripheral mountain-plain transition areas constituting 63% of crucial dispersal corridors. This emphasizes the critical role of urban built-up areas in maintaining biodiversity and ecological connectivity. Prioritizing connectivity between central urban areas and distant natural spaces is imperative. Our approach innovatively classifies and constructs networks to identify strategic areas with diverse species-specific attributes, providing valuable spatial information for land planning and guiding solutions to enhance target species. While the primary focus is on bird conservation in Beijing, our framework is broadly applicable to global biodiversity management and green planning under urbanization challenges. Overall, this study offers innovative insights for urban planning development and serves as decision support for prioritizing urban actions.

Identification of critical success factors (CSFs) for successful project management in manufacturing sector

PurposeThis research has been carried out to study the impact of critical success factors (CSFs) on successful project management of projects in the manufacturing sector. These success factors will pave the way for the successful completion of projects for the manufacturing sector. CSFs play a vital role in the timely conclusion of projects in any organization. For the projects to be successful certain essential factors must be taken into account. These essential factors are identified through this research.Design/methodology/approachDuring this study an adaptive survey of the literature was conducted, after a detailed literature review certain success factors were identified for project management in the manufacturing sector. The number of success factors was reduced to 40 factors based on the level of incidence in the literature. The length of the questionnaire was also given due importance to make the survey more interesting and effective. After that Fuzzy Delphi Method (FDM) was employed to screen the most essential factors. In the end, the Fuzzy Analytical Hierarchical Process (FAHP) was used to rank these factors in order of importance.FindingsProject Manager Leadership Skills, Economic Environment, Top Management Support, Project Planning, Clear and realistic Goals, and Financial Support have come out to be the most important CSFs for successful project management in the manufacturing sector.Originality/valueThis is novel research to identify CSFs for project management in the manufacturing sector. Previously, most of the studies remained focused on construction and software projects.

Everything, everywhere, all at once

The development and early distribution of the COVID-19 vaccine was both a singular achievement and missed opportunity. In this paper, I argue that the consensus regarding the goals of an effective and morally responsible vaccine distribution program were often eschewed in favor of a reversion to the problematic pre-pandemic healthcare distribution practices. I examine the goals of vaccine planning in terms of the public health, economic and social impacts of a distribution plan against the “first come, first served” strategies that were ultimately employed. I maintain that the failure to implement a coherent top- -down vaccine policy resulted in a proliferation of vaccine distribution programs that undermined efforts to combat the virus while also increasing pre-existing inequities in the healthcare system. The distribution of the vaccine according to a phased rollout strategy for individual groups often limited access to the vaccine for those most likely to suffer the worst outcomes of the disease. Future pandemic planning must learn from these outcomes and employ new technologies to limit the contagion and target at-risk groups most effectively.

Diverse experiences by active travel for carbon neutrality: A longitudinal study of residential context, daily travel and experience types

Two key goals for sustainable spatial planning are to promote low-carbon travel in daily life and to enhance human wellbeing through diverse human-environment interactions. Yet, the integration of these goals has been underexplored. This study investigates the potential for experiential diversity via active travel in different residential contexts within the Gävle city-region, Sweden. Over 15 months, we collected spatiotemporal data from 165 participants, analyzing 4,362 reported experiences and 13,192 GPS-derived travel trajectories. Our analysis uncovered a significant spatial discrepancy: while the travelled distances to locations of positive experiences typically ranged from 1.5 km to 5 km, active travel predominated only within 1.5 km. This discrepancy persisted across urban, suburban, and peripheral contexts. Although residents in different contexts reported the same types of experiences, urban dwellers travelled about 50 % farther for nature experiences compared with other positive experiences, whereas peripheral dwellers travelled twice the distance for urbanicity experiences compared with other positive experiences. Consequently, urban residents mostly relied on active travel for urbanicity experiences and motorised travel for nature experiences, with the reverse trend observed among peripheral dwellers. These results illustrate the importance of spatial scale for promoting diverse positive experiences via active travel, regardless of residential context. Effective planning strategies may include enhancing environmental diversity near homes and developing infrastructure that favours active over motorised travel for short to moderate distances.

Implementation of training and coaching to improve goal planning and family engagement in early childhood home visiting

Early childhood home visiting services aim to support child and family health and development, yet challenges engaging and retaining families persist. One promising strategy to improve family engagement involves enhancing the capacity of the home visiting workforce to partner with families to set and implement service goals that align with families’ needs and preferences. This study examined implementation of ‘Goal Plan Strategies’ (GPS), a training and coaching innovation designed to improve family-centered goal planning. Aims were to evaluate (1) the extent to which training and eight sessions of audio-based coaching were implemented with fidelity, (2) whether coaching fidelity was associated with home visitors’ perceptions of coaching and confidence using goal planning strategies, and (3) whether GPS was perceived as feasible, acceptable, and useful by coaches and home visitors. Home visitors (N = 22) and coaches (N = 10) took part in GPS and completed surveys, session logs, and interviews. Training and coaching sessions were observed and coded for fidelity (e.g., dose, adherence, quality). GPS was implemented with high levels of fidelity. Findings support feasibility, acceptability, and usefulness of GPS, overall, and suggest the need to examine coaching dosage and overlap with other implementation supports more closely. Findings highlight the benefits of audio-based coaching, mentoring of coaches, and observational measures of implementation fidelity.

Randomized Controlled Trial of Occupational Performance Coaching for Adults With Multiple Sclerosis

ObjectiveTo determine if the receipt of occupational performance coaching (OPC) by adults living with multiple sclerosis (MS) improves participants’ satisfaction with performance in daily activities (primary outcome); improves perceived performance in daily activities, resilience, autonomy, and participation; and reduces illness intrusiveness and effect of MS (secondary outcomes). DesignTwo-group randomized clinical trial with a waitlist control. SettingCommunity. ParticipantsConvenience sample of adults with MS were recruited through a research registry. Eighty-three individuals were approached; 35 were assessed for eligibility and 31 were enrolled and 30 completed baseline assessment (Final sample size, N=30). Participants were English-speaking, were without serious cognitive impairment or severe depression, and were not receiving other coaching interventions. InterventionsSix telephone sessions of OPC were delivered by a trained facilitator over 10 weeks. Initial sessions focused on goal setting, prioritization, and action planning. Subsequent sessions involved goal and action plan review, discussion of facilitators and barriers, and goal and plan refinement. Main Outcome MeasuresPrimary outcome was participants’ satisfaction with performance in daily activities, as measured by the Canadian Occupational Performance Measure (COPM). Secondary outcome measures included the COPM performance rating, Connor-Davidson Resilience Scale, Impact on Participation and Autonomy Questionnaire, Adapted Illness Intrusiveness Rating Scale, and MS Impact Scale. Measures were administered by a blinded assessor at baseline, 10 weeks, and 2 months. ResultsParticipants in the intervention and waitlist control groups were equivalent on demographic and outcome measures at baseline. At 10 weeks, the intervention group had significantly higher COPM ratings for both satisfaction (P<.001) and performance (P=.002). No other outcomes were significantly different. For the intervention group, the benefits of OPC were maintained at 2 months. ConclusionsOPC led to improved satisfaction with performance and performance in daily activities. Future research with a larger sample is needed to determine other effects and who benefits most from OPC.

How China's agribusiness achieves reciprocal symbiosis with farmers? A comparative analysis of the investment sector

AbstractAgribusiness facilitating market access for farmers is a key strategy for driving rural industrial rejuvenation in China. However, the persistent cooperative conundrum poses challenges to the integration of agribusiness and farmer interests. Utilizing goal planning analysis, this study delves into the profit‐driven behavioral logic of agribusiness and farmers to elucidate the conditions that influence their reciprocal symbiosis across various investment sectors. Through the crisp‐set qualitative comparative analysis method, this investigation parses data from 109 instances of agribusiness initiatives in rural areas, identifying four pivotal conditions conducive to reciprocal symbiosis: the farmers' information abundance (in production/processing and sales), incentive policies (in production), agribusiness's professional capabilities (in productive services), and the scale of demand (in productive services). Additionally, five principal sufficient conditions emerge: “Investment in production * information abundance of farmers * ~natural risk”, “Investment in production * natural risk * professional ability of farmers * profit sharing”, “Investment in processing and sales * information abundance of farmers * ~market risk * ~bidirectional specificity”, “Investment in processing and sales * bidirectional specificity * market risk * ~profit sharing”, and “Investment in productive services * professional ability of agribusiness * demand scale”. These findings illuminate the multifaceted interactions that underpin successful agribusiness‐farmer synergies [EconLit Citations: L23].

Foreign Workers and Human Rights Violations: Malaysia’s Response to COVID-19 and The Way Forward

Foreign workforce has significantly contributed to Malaysia’s economy, and this country has been relying on them for decades. Unfortunately, Malaysia was already entangled with the country’s treatment of foreign workers even before the onset of COVID-19. As a government suppression attempt to flatten the COVID-19 pandemic curve, Malaysian efforts to deal with the situation seem to be at the lowest point. Despite the government’s commitment not to detain them throughout the screening process, foreign workers have been held in immigration depots regardless of their legal status. In addition, the overcrowded immigration depot makes it hard to exercise physical distance, hampers the quarantine process, and unequal health care facilities in detention centres. This situation captured worldwide attention since it violated human rights legislation. The protection of workers’ rights is also in tandem with the United Declaration of Human Rights and Sustainable Development Goals 2030 (SDG) 8.8, encouraging and ensuring everyone’s right to a safe and healthy workplace is protected. This paper employed thematic analysis using ATLAS.ti 9 software to evaluate the government’s suppression efforts and human rights violations during COVID-19. The findings propose numerous suggestions, including an emergency review of the admission process for foreign workers to Malaysia. The inconsistency in the government policy had hampered the country’s mission of becoming a developed nation. It thus hindered the advancement of innovation and technology, as in the Twelfth Malaysian Plan and Sustainable Development Goals 2030.

Unpacking the prevalence: A warning against overstating the recently narrowed gap for Black autistic youth.

Recent findings from the Centers for Disease Control and Prevention's (CDC) Autism and Developmental Disabilities Monitoring (ADDM) Network's 2020 prevalence report indicate that disparities in autism diagnoses between Black and White youth have narrowed, reflecting improved screening, awareness, and access to services (Maenner et al., 2023. Morbidity and Mortality Weekly Report. Surveillance Summaries (Washington, D.C.: 2002), 72, 1-14.). Claims of reducing disparities beyond prevalence rates, however, are not fully supported, as indicated by the reality that Black youth whose screenings indicate autistic traits are still not being referred for full evaluation or early intervention services at the same rate as their White peers (Major et al., 2020. Autism, 24, 1629-1638; Smith et al., 2020. Pediatrics, 145, S35-S46.). Black 8-year-olds identified as autistic still experience disparate educational placements (Waitoller et al., 2010. The Journal of Special Education. 44, 29-49.) where services may not be autism-specific or have Individual Education Plan goals only focused on "behavior problems" (Severini et al., 2018. Journal of Autism and Developmental Disorders, 48, 3261-3272.), are served in the most restrictive environments (Skiba et al., 2006. Exceptional Children, 72, 411-424.) and lack consistent augmentative and alternative communication support (Pope et al., 2022. American Journal of Speech-Language Pathology, 31, 2159-2174.). Additionally, ADMM researchers report consistent disparities in the identification of co-occurring intellectual disability where Black autistic children have significantly more co-occurrences than White autistic children. The purpose of this commentary is to first examine the assertion that the narrowed gap indicates, "…improved…access to services among historically underserved groups," (p. 9) (Maenner et al., 2023. Morbidity and Mortality Weekly Report. Surveillance Summaries (Washington, D.C.: 2002), 72, 1-14.). We will then recommend strategies to address the ongoing disparities.

Transforming evidence-based clinical guidelines into implementable clinical decision support services: the CAREPATH study for multimorbidity management.

The CAREPATH Project aims to develop a patient-centered integrated care platform tailored to older adults with multimorbidity, including mild cognitive impairment (MCI) or mild dementia. Our goal is to empower multidisciplinary care teams to craft personalized holistic care plans while adhering to evidence-based guidelines. This necessitates the creation of clear specifications for clinical decision support (CDS) services, consolidating guidance from multiple evidence-based clinical guidelines. Thus, a co-creation approach involving both clinical and technical experts is essential. This paper outlines a robust methodology for generating implementable specifications for CDS services to automate clinical guidelines. We have established a co-creation framework to facilitate collaborative exploration of clinical guidelines between clinical experts and software engineers. We have proposed an open, repeatable, and traceable method for translating evidence-based guideline narratives into implementable specifications of CDS services. Our approach, based on international standards such as CDS-Hooks and HL7 FHIR, enhances interoperability and potential adoption of CDS services across diverse healthcare systems. This methodology has been followed to create implementable specifications for 65 CDS services, automating CAREPATH consensus guideline consolidating guidance from 25 selected evidence-based guidelines. A total of 296 CDS rules have been formally defined, with input parameters defined as clinical concepts bound to FHIR resources and international code systems. Outputs include 346 well-defined CDS Cards, offering clear guidance for care plan activities and goal suggestions. These specifications have led to the implementation of 65 CDS services integrated into the CAREPATH Adaptive Integrated Care Platform. Our methodology offers a systematic, replicable process for generating CDS specifications, ensuring consistency and reliability across implementation. By fostering collaboration between clinical expertise and technical proficiency, we enhance the quality and relevance of generated specifications. Clear traceability enables stakeholders to track the development process and ensure adherence to guideline recommendations.

Implementasi Planning Programming Budgeting System Dalam Manajemen Pembiayaan Pendidikan

The importance of financing management in education is to ensure the success of educational institutions both academically and financially. A well-managed financing system helps ensure that funds are allocated efficiently and effectively, improving the quality of education and providing benefits to students and educators. Planning Programming Budgeting System is a management method used to allocate limited resources effectively in an organization. It involves goal setting, plan creation, budgeting, and progress tracking. This helps agencies to prioritize their goals and ensure that they use their resources in a responsible and effective manner. The research method used in this study is a descriptive research method, where this research establishes a qualitative approach with literature studies. The result of the research is the implementation of the Planning Programming Budgeting System (PPBS) aims to create a comprehensive, consistent, and transparent reporting framework for educational institutions. By using this system, the management of funding allocation can be accounted for through cost control, financial projections, tracking, and cost reporting. The PPBS system effectively manages education financing by ensuring the provision of reliable, transparent, and accurate financial data in a timely manner. This ultimately improves the financial stability and sustainability of the institution, as well as the quality of education for its students.

Diagnostic evaluation of skeletal cephalometric parameters and photograph-Based soft tissue parameters in Malwa Population

The primary goal of orthodontic diagnostic and treatment planning is to create a balanced and aesthetically attractive face. During the decades-long period of cephalometric dominance, the "aesthetic" of the face was predominantly used to describe the profile as observed on a lateral cephalogram However, the paradigm has now shifted to soft tissue-based diagnosis and treatment planning. This creates the need for soft tissue-based analysis especially on photographs considering its evaluation of myriad populations. To evaluate the skeletal cephalometric parameters and photograph-based soft tissue parameters in the Malwa population. The study was conducted using 50 lateral cephalometric radiographs and 50 profile photographs. Data were analyzed for probability distribution using the Shapiro-Wilk test. Descriptive statistics were performed and data were presented as median and inter-quartile range. Correlation between the variables was assessed using Spearman’s correlation coefficient. P value &amp;#60; .05 was considered statistically significant. Our reported values of both photographic and lateral cephalogram parameters are different not only from the international population, but also different values are observed from the not only Indian population, but also from various subsets of the Indian population. Therefore, the average value of lateral profile photographic parameters as well as cephalometric parameters in my study can be used as floating norms for the Malwa population.

Optimal Decision on Pricing and Replenishment of Vegetable Products Based on Goal Planning

Developing replenishment and pricing plans has always been the key for fresh food supermarkets to gain more profits. This paper analyzes various situations and provides the optimal solution through Spearman correlation analysis, Lasso regression, goal programming and other methods and models. We use normality testing and box plots to present the distribution patterns of major categories and individual products from both vertical and horizontal perspectives. Establish a single objective programming model and solve it with Lingo to obtain a maximum profit of 98513 yuan for 7 days. The largest total replenishment amount is for the flower and leaf category, the smallest is for edible mushrooms, the highest average cost markup rate is for aquatic roots and stems, and the lowest is for cauliflower. This has certain reference value and theoretical significance for fresh food supermarkets to formulate replenishment and pricing plans.

Beyond conventional bounds: Surpassing system limits for stereotactic ablative (SAbR) lung radiotherapy using CBCT-based adaptive planning system.

Online adaptive radiotherapy relies on a high degree of automation to enable rapid planning procedures. The Varian Ethos intelligent optimization engine (IOE) was originally designed for conventional treatments so it is crucial to provide clear guidance for lung SAbR plans. This study investigates using the Ethos IOE together with adaptive-specific optimization tuning structures we designed and templated within Ethos to mitigate inter-planner variability in meeting RTOG metrics for both online-adaptive and offline SAbR plans. We developed a planning strategy to automate the generation of tuning structures and optimization. This was validated by retrospective analysis of 35 lung SAbR cases (total 105 fractions) treated on Ethos. The effectiveness of our planning strategy was evaluated by comparing plan quality with-and-without auto-generated tuning structures. Internal target volume (ITV) contour was compared between that drawn from CT simulation and from cone-beam CT (CBCT) at time of treatment to verify CBCT image quality and treatment effectiveness. Planning strategy robustness for lung SAbR was quantified by frequency of plans meeting reference plan RTOG constraints. Our planning strategy creates a gradient within the ITV with maximum dose in the core and improves intermediate dose conformality on average by 2%. ITV size showed no significant difference between those contoured from CT simulation and first fraction, and also trended towards decreasing over course of treatment. Compared to non-adaptive plans, adaptive plans better meet reference plan goals (37%vs. 100% PTV coverage compliance, for scheduled and adapted plans) while improving plan quality (improved GI (gradient index) by 3.8%, CI (conformity index) by 1.7%). We developed a robust and readily shareable planning strategy for the treatment of adaptive lung SAbR on the Ethos system. We validated that automatic online plan re-optimization along with the formulated adaptive tuning structures can ensure consistent plan quality. With the proposed planning strategy, highly ablative treatments are feasible on Ethos.

Risk perceptions and experience in child protection decision-making: A comparative study of student social workers in Wales and Aotearoa New Zealand

Decision making in child protection is the product of interacting factors between workers, organizations, families, and macro social structures. Individual perceptions of risk, safety, and harm, as one piece of this complex puzzle, are important to understand. This article reports on a comparative study of social work students in two countries: Wales and Aotearoa New Zealand. Using a mixed methods survey and a staged vignette (in which the situation becomes progressively more serious), we found there were similarities between respondents from the two countries in their perceptions of risk, safety and harm, and their reasoning processes. Beneath this broad consensus, respondents from Wales rated the level of harm to the children lower at earlier stages but were more likely to say the case should meet the threshold for statutory intervention. Risk-averse respondents were more likely to conclude the children experienced serious harm and also that the case should meet the threshold for statutory intervention. These differences largely disappeared by the concluding stage. Qualitative analysis shows that the reasoning processes used to explain risk, safety, and plan goals were similar between the two countries. Some nuanced differences emerged in relation to a risk-averse group fromAotearoa New Zealandemphasizing the importance of continuing engagement with professional services as a sign of change. Implications are discussed, particularly for workforce development and the needs of newly qualified social workers.

Preparing Future Pediatric Care Providers with a Clinical Informatics Elective.

Clinical informatics (CI) has reshaped how medical information is shared, evaluated, and utilized in health care delivery. The widespread integration of electronic health records (EHRs) mandates proficiency among physicians and practitioners, yet medical trainees face a scarcity of opportunities for CI education. We developed a CI rotation at a tertiary pediatric care center to teach categorical pediatric, pediatric-neurology, and medicine-pediatric residents foundational CI knowledge and applicable EHR skills. Created in 2017 and redesigned in 2020, a CI rotation aimed to provide foundational CI knowledge, promote longitudinal learning, and encourage real-world application of CI skills/tools. Led by a team of five physician informaticist faculty, the curriculum offers personalized rotation schedules and individual sessions with faculty for each trainee. Trainees were tasked with completing an informatics project, knowledge assessment, and self-efficacy perception survey before and after rotation. Paired t-test analyses were used to compare pre- and postcurriculum perception survey. Thirty-one residents have completed the elective with their projects contributing to diverse areas such as medical education, division-specific initiatives, documentation improvement, regulatory compliance, and operating plan goals. The mean knowledge assessment percentage score increased from 77% (11.6) to 92% (10.6; p ≤ 0.05). Residents' perception surveys demonstrated improved understanding and confidence across various informatics concepts and tools (p ≤ 0.05). Medical trainees are increasingly interested in CI education and find it valuable. Our medical education curriculum was successful at increasing residents' understanding, self-efficacy, and confidence in utilizing CI concepts and EHR tools. Future data are needed to assess the impact such curricula have on graduates' proficiency and efficiency in the use of CI tools in the clinical workplace.

Comparison of 3D computer-assisted planning with and without patient-specific instrumentation for severe bone defects in reverse total shoulder arthroplasty

BackgroundPreoperative planning is an integral aspect of managing complex deformity in reverse shoulder arthroplasty (RSA). The purpose of this study was to compare the success of patient specific instrumentation (PSI) and 3D computer-assisted planning with standard instrumentation (Non-PSI) in achieving planned corrections of the glenoid among patients undergoing RSA with severe bony deformity requiring glenoid bone grafts. MethodsA retrospective case-control study was performed, including all patients that underwent RSA with combined bone grafting procedures (BIO-RSA or structural bone grafting) for severe glenoid deformity by a single between June 2016 and July 2023. Patients were required to have preoperative and postoperative CT scans as well as preoperative 3D planning performed for inclusion. Patients were divided into two groups based on the use of 3D computer-assisted planning with or without PSI (PSI vs. Non-PSI). The corrected inclination and version were measured by two separate reviewers on preoperative and postoperative 2D CT scans and compared to their corresponding preoperative planning goals utilizing bivariate analyses. ResultsWe identified 45 patients that met our inclusion criteria (22 PSI and 23 Non-PSI). Preoperative inclination (mean ± SD) (PSI 10.12° ± 15.86°, Non-PSI 9.43° ± 10.64°; P = 0.864) and version (PSI -18.78° ± 18.3°, Non-PSI -17.82° ± 11.49°; P = 0.835) measurements were similar between groups. No significant differences in the mean deviation (error) between the postoperative and planned inclination (PSI 5.49° ± 3.72; Non-PSI 6.91° ± 5.05; P = 0.437) and version (PSI 8.37° ± 5.7; Non-PSI 5.37° ± 4.43; P = 0.054) were found between groups. No difference in the rate of outliers (>10° error) was noted in inclination (P = 0.135) or version (P = 0.445) between groups. Greater planned version correction was correlated with greater error when PSI was utilized (PSI r = 0.519, P = 0.013; Non-PSI r = 0.362, P = 0.089). ConclusionBoth PSI and 3D computer-assisted planning without PSI (Non-PSI) appear to be useful techniques to achieve version and inclination correction among patients undergoing RSA with severe glenoid deformity required glenoid bone grafting with no clear superiority of one method over the other. Surgeons should be aware that when utilizing PSI, slightly greater error in achieving version goals may occur as version correction is increased.

Gendered spaces in islamic cities: Bridging sharia law and urban planning goals

Gendered spaces in islamic cities: Bridging sharia law and urban planning goals