Implementation Decisions Research Articles

Training, validation, and clinical implementation of a deep-learning segmentation model for radiotherapy of loco-regional breast cancer

AimTo train and validate a comprehensive deep-learning (DL) segmentation model for loco-regional breast cancer with the aim of clinical implementation. MethodsDL segmentation models for 7 clinical target volumes (CTVs) and 11 organs at risk (OARs) were trained on 170 left-sided breast cancer cases from two radiotherapy centres in Norway. Another 30 patient cases were used for validation, which included the evaluation of Dice similarity coefficient and Hausdorff distance, qualitative scoring according to clinical usability, and relevant dosimetric parameters. The manual inter-observer variation (IOV) was also evaluated and served as a benchmark. Delineation of the target volumes followed the ESTRO guidelines. ResultsBased on the geometric similarity metrics, the model performed significantly better than IOV for most structures. Qualitatively, no or only minor corrections were required for 14% and 71% of the CTVs and 72% and 26% of the OARs, respectively. Major corrections were required for 15% of the CTVs and 2% of the OARs. The most frequent corrections occurred in the cranial and caudal parts of the structures. The dose coverage, based on D98 > 95%, was fulfilled for 100% and 89% of the breast and lymph node CTVs, respectively. No differences in OAR dose parameters were considered clinically relevant. The model was implemented in a commercial treatment planning system, which generates the structures in 1.5 min. ConclusionConvincing results from the validation led to the decision of clinical implementation. The clinical use will be monitored regarding applicability, standardization and efficiency.

Decision-support systems for ambulatory care, including pandemic requirements: using mathematically optimized solutions

BackgroundThe healthcare sector poses many strategic, tactic and operational planning questions. Due to the historically grown structures, planning is often locally confined and much optimization potential is foregone.MethodsWe implemented optimized decision-support systems for ambulatory care for four different real-world case studies that cover a variety of aspects in terms of planning scope and decision support tools. All are based on interactive cartographic representations and are being developed in cooperation with domain experts. The planning problems that we present are the problem of positioning centers for vaccination against Covid-19 (strategical) and emergency doctors (strategical/tactical), the out-of-hours pharmacy planning problem (tactical), and the route planning of patient transport services (operational). For each problem, we describe the planning question, give an overview of the mathematical model and present the implemented decision support application.ResultsMathematical optimization can be used to model and solve these planning problems. However, in order to convince decision-makers of an alternative solution structure, mathematical solutions must be comprehensible and tangible. Appealing and interactive decision-support tools can be used in practice to convince public health experts of the benefits of an alternative solution. The more strategic the problem and the less sensitive the data, the easier it is to put a tool into practice.ConclusionsExploring solutions interactively is rarely supported in existing planning tools. However, in order to bring new innovative tools into productive use, many hurdles must be overcome.

Commodity risk assessment of Malus domestica plants from Turkey.

The European Commission requested the EFSA Panel on Plant Health to prepare and deliver risk assessments for commodities listed in Commission Implementing Regulation (EU) 2018/2019 as ‘High risk plants, plant products and other objects’. This Scientific Opinion covers plant health risks posed by dormant grafted plants, rootstocks, budwood and scions of Malus domestica imported from Turkey, taking into account the available scientific information, including the technical information provided by Turkey. All pests associated with the commodities were evaluated against specific criteria for their relevance for this opinion. Three quarantine pests (Anoplophora chinensis, Lopholeucaspis japonica and tomato ringspot virus), one protected zone quarantine pest (Erwinia amylovora) and eight non‐regulated pests (Calepitrimerus baileyi, Cenopalpus irani, Cicadatra persica, Diplodia bulgarica, Hoplolaimus galeatus, Malacosoma parallela, Pratylenchus loosi and Pyrolachnus pyri) that fulfilled all relevant criteria were selected for further evaluation. For E. amylovora, special requirements are specified in Commission Implementing Regulation (EU) 2019/2072. Based on the information provided in the dossier, the specific requirements for E. amylovora were not met. For Anoplophora chinensis, special measures are specified in Commission Implementing Decision (EU) 2012/138. The exporting country does meet the requirement for a certificate regarding plants for planting that originate from Turkish provinces other than Istanbul. For the 10 remaining selected pests, the risk mitigation measures proposed in the technical dossier from Turkey were evaluated taking into account the possible limiting factors. For the selected pests an expert judgement is given on the likelihood of pest freedom taking into consideration the risk mitigation measures acting on the pest, including uncertainties associated with the assessment. The degree of pest freedom varies among the pests evaluated, with D. bulgarica being the pest most frequently expected on the imported plants. The expert knowledge elicitation indicated with 95% certainty that between 9,863 and 10,000 bundles (consisting of 10 or 25 plants each) per 10,000 would be free from D. bulgarica.

Commodity risk assessment of Acer palmatum plants grafted on Acer davidii from China.

The European Commission requested the EFSA Panel on Plant Health to prepare and deliver risk assessments for commodities listed in Commission Implementing Regulation (EU) 2018/2019 as ‘High risk plants, plant products and other objects’. This Scientific Opinion covers plant health risks posed by 2‐year‐old bare rooted plants for planting of Acer palmatum grafted on rootstocks of Acer davidii imported from China to the EU, taking into account the available scientific information, including the technical information provided by China. All pests associated with the commodity were evaluated against specific criteria for their relevance for this Scientific Opinion. Twenty‐two pests that fulfilled all relevant criteria were selected for further evaluation. For 20 pests, the risk mitigation measures described in the technical dossier from China were evaluated taking into account the possible limiting factors. For these pests, an expert judgement is given on the likelihood of pest freedom taking into consideration the risk mitigation measures acting on the pest, including uncertainties associated with the assessment. While the estimated degree of pest freedom varied among pests, Lopholeucaspis japonica was the pest most frequently expected on the commodity. The Expert Knowledge Elicitation indicated, with 95% certainty, that 9,336 or more bare rooted plants per 10,000 will be free from L. japonica. For Anoplophora chinensis and Anoplophora glabripennis, the Panel considers that China applies the relevant measures as specified in Commission Implementing Decision (EU) 2012/138 and Commission Implementing Decision (EU) 2015/893.

Emerging Therapies for COVID-19: The Value of Information From More Clinical Trials

ObjectivesThe COVID-19 pandemic necessitates time-sensitive policy and implementation decisions regarding new therapies in the face of uncertainty. This study aimed to quantify consequences of approving therapies or pursuing further research: immediate approval, use only in research, approval with research (eg, emergency use authorization), or reject. MethodsUsing a cohort state-transition model for hospitalized patients with COVID-19, we estimated quality-adjusted life-years (QALYs) and costs associated with the following interventions: hydroxychloroquine, remdesivir, casirivimab-imdevimab, dexamethasone, baricitinib-remdesivir, tocilizumab, lopinavir-ritonavir, interferon beta-1a, and usual care. We used the model outcomes to conduct cost-effectiveness and value of information analyses from a US healthcare perspective and a lifetime horizon. ResultsAssuming a $100 000-per-QALY willingness-to-pay threshold, only remdesivir, casirivimab-imdevimab, dexamethasone, baricitinib-remdesivir, and tocilizumab were (cost-) effective (incremental net health benefit 0.252, 0.164, 0.545, 0.668, and 0.524 QALYs and incremental net monetary benefit $25 249, $16 375, $54 526, $66 826, and $52 378). Our value of information analyses suggest that most value can be obtained if these 5 therapies are approved for immediate use rather than requiring additional randomized controlled trials (RCTs) (net value $20.6 billion, $13.4 billion, $7.4 billion, $54.6 billion, and $7.1 billion), hydroxychloroquine (net value $198 million) is only used in further RCTs if seeking to demonstrate decremental cost-effectiveness and otherwise rejected, and interferon beta-1a and lopinavir-ritonavir are rejected (ie, neither approved nor additional RCTs). ConclusionsEstimating the real-time value of collecting additional evidence during the pandemic can inform policy makers and clinicians about the optimal moment to implement therapies and whether to perform further research.

Mitigating Climate Change Impacts in Buildings using Passive Design Strategies: Putting Costs to Contexts

Across the global construction industry, climate change mitigation is achieved using design and construction practices that optimise energy efficiency. The scope of these practices varies with regional contexts. In Nigeria and other regions, their adoption is slow due to the absence of cost benchmarks to drive their implementation decisions. In this study, we appraised the first cost premium (FCP) and the payback periods of selected passive designs strategies (PDS) in retrofitted residential buildings. Using cost data from two categories of 150 retrofitted residential building designs, analytical estimating processes showed that integrating five PDS would attract FCP totaling ₦ 3,612.17/m2 and ₦ 9,250.00/m2 for bungalow and maisonette buildings. Procuring these FCPs also has varying levels of reduction in energy consumption that are necessary to mitigate the impacts of climate change. The financial benefits in energy savings from two PDS (roof insulation and overhang) could only pay-off the FCP for bungalows with cost-savings of 81%, while reducing the FCP for maisonettes by 70% in one year. The discounted FCP after one year becomes zero for the bungalow and ₦ 2,650.00/m2 for the maisonette. The short-term payback periods provide a significant incentive for developers to adopt energy-efficient designs in building development.

A Systematic Framework for Prioritizing Burden of Disease Data Required for Vaccine Development and Implementation: The Case for Group A Streptococcal Diseases.

Vaccine development and implementation decisions need to be guided by accurate and robust burden of disease data. We developed an innovative systematic framework outlining the properties of such data that are needed to advance vaccine development and evaluation, and prioritize research and surveillance activities. We focus on 4 objectives—advocacy, regulatory oversight and licensure, policy and post-licensure evaluation, and post-licensure financing—and identify key stakeholders and specific requirements for burden of disease data aligned with each objective. We apply this framework to group A Streptococcus, a pathogen with an underrecognized global burden, and give specific examples pertinent to 8 clinical endpoints. This dynamic framework can be adapted for any disease with a vaccine in development and can be updated as vaccine candidates progress through clinical trials. This framework will also help with research and innovation priority setting of the Immunization Agenda 2030 (IA2030) and accelerate development of future vaccines.

Digital Commons to Hyku: An Institutional Repository Migration at a Small Liberal Arts University

Introduction: Pacific University Libraries has had an institutional repository since 2009, when it selected Digital Commons to host a collection of theses and dissertations. Since then, the scope of the services has grown to include publishing open access journals as well as housing the books published by Pacific University Press—a library-born, hybrid, open access press. As our needs have changed, and with Elsevier’s acquisition of bepress in 2017, the University migrated from bepress’ Digital Commons platform to an open source Hyku platform hosted by Ubiquity Repositories. Description of Program: As the first academic institution working with Ubiquity Repositories on migration and implementation, we were involved in the process of data extraction, normalization, mapping, ingest, and validation. Lessons Learned: We learned the importance of having a mutual understanding of a platform’s goals, data structure and mapping, and standards in implementation decisions. Next Steps: As higher education continues to adapt to the changes brought by COVID-19, it has never seemed more important to utilize platforms that share the values of libraries worldwide. We hope that migrating to an open source platform will be a step toward more open scholarship, despite the current challenges and resource scarcity brought about by the pandemic.

Optimal Management of Patients with Severe Coronary Artery Disease following Multidisciplinary Heart Team Approach-Insights from Tertiary Cardiovascular Care Center.

Background: The purpose of this retrospective study was to investigate outcomes of patients with severe coronary artery disease (CAD) after implementing various treatment strategies following multidisciplinary Heart Team (MHT) discussion. Methods Primary and secondary endpoints and quality of life during a mean (SD) follow-up of 37 (14) months of patients with severe CAD (three-vessel [3-VD] or/and left main [LM] disease) qualified after MHT discussion to optimal medical treatment (OMT) alone, OMT and coronary artery bypass grafting (CABG), or OMT and percutaneous coronary intervention (PCI) were evaluated. As the primary endpoint, major adverse cardiac or cerebrovascular events (MACCE) (i.e., death from any cause, stroke, myocardial infarction, or repeat/need for revascularization) were considered. Result: From 2016 to 2019, 176 MHT meetings were held, and a total of 1286 participants with severe CAD and completely implemented MHT decisions (OMT, CABG, or PCI for 251, 356, and 679 patients, respectively) were included. The occurrence of the primary endpoint was significantly increased in OMT-group (154 (61.4%) vs. CABG and PCI groups—110 (30.9%) and 302 (44.5%) patients, respectively (p < 0.05). For interventional strategies only—CABG was associated with reduced rates of MACCE and repeat revascularization, while the superiority of PCI for stroke and disabling stroke was observed (p < 0.05). The general health status assessed at the end of the follow-up was significantly better for patients who underwent CABG or PCI than in the OMT group (p < 0.05). Conclusions: In this real-life study, we presented a single-center experience of providing optimal medical care for patients with severe CAD following MHT discussion.

Obesity prevention practices in early care and education settings: an adaptive implementation trial

BackgroundDespite the potential for Early Care and Education (ECE) settings to promote healthy habits, a gap exists between current practices and evidence-based practices (EBPs) for obesity prevention in childhood.MethodsWe will use an enhanced non-responder trial design to determine the effectiveness and incremental cost-effectiveness of an adaptive implementation strategy for Together, We Inspire Smart Eating (WISE), while examining moderators and mediators of the strategy effect. WISE is a curriculum that aims to increase children’s intake of carotenoid-rich fruits and vegetables through four evidence-based practices in the early care and education setting. In this trial, we will randomize sites that do not respond to low-intensity strategies to either (a) continue receiving low-intensity strategies or (b) receive high-intensity strategies. This design will determine the effect of an adaptive implementation strategy that adds high-intensity versus one that continues with low-intensity among non-responder sites. We will also apply explanatory, sequential mixed methods to provide a nuanced understanding of implementation mechanisms, contextual factors, and characteristics of sites that respond to differing intensities of implementation strategies. Finally, we will conduct a cost effectiveness analysis to estimate the incremental effect of augmenting implementation with high-intensity strategies compared to continuing low-intensity strategies on costs, fidelity, and child health outcomes.DiscussionWe expect our study to contribute to an evidence base for structuring implementation support in real-world ECE contexts, ultimately providing a guide for applying the adaptive implementation strategy in ECE for WISE scale-up. Our work will also provide data to guide implementation decisions of other interventions in ECE. Finally, we will provide the first estimate of relative value for different implementation strategies in this setting.Trial registrationNCT05050539; 9/20/21.

Ranking Of Indonesia Sedimentary Basin And Storage Capacity Estimates For Co2 Geological Storage

The various possible strategies to combat global warming are explored within a wideranging of efforts. Practical solutions will need to stop or even reverse the build-up of CO2 in the environment by using existing technology that has not been integrated, carbon dioxide capture and storage (CCS) (Hansson, 2008). The main objectives of this study are to develop criteria for sedimentary basins ranking system in terms of their suitability for CO2 storage and estimate the storage capacity available. We adapt the method developed by Bachu (2003) to the Indonesia geological characteristics. Once the criteria has been developed and the basins ranked based on their suitability, oil and gas fields located within these basins were estimated their potential storage capacity using the methodology developed by Carbon Sequestration Leadership Forum (CSLF). From 60 identified sedimentary basins, Kutei, Tarakan and South Sumatera basins are respectively positioned in top three of the ranking system. Well known geological structure, adequate data, relatively stable geological structure and established infrastructures are the main factors make these basins have higher suitability. Estimation result showed from 48 fields that are considered depleted from their Np/Ult ratio (hydrocarbon cumulative production over ultimate recovery), Riau and South Sumatera region have large storage capacities which are around 229 and 144 MtCO2 respectively. The ranking of Indonesia sedimentary basins can then be used in making decisions for the large-scale implementation of CCS Project. The potential storage capacity might increase as data more available. The estimates resulted from this study is not a conclusive estimation where degree of geological and economic uncertainty associated with a capacity estimate is still high. However, from this estimation shows that Indonesia has huge potential of CO2 storage in depleted oil and gas reservoirs

The Determinants Factors for Solar Photovoltaic Implementation in Existing Building

Renewable energy contributes to the building sector's current global transition towards a sustainable energy system. Several renewable energy sources and solar photovoltaic have sparked great interest in reducing the dependency on fossil fuels and greenhouse gas emissions and mitigating global warming by harnessing the sun to power the energy. However, the exploitation of solar photovoltaic in an existing building requires various considerations with high uncertainty from the building owner. Thus, this study focuses on investigating determinant factors and their influence on the decision of solar photovoltaic implementation to ensure its success and efficiency. For this purpose, an extensive literature review conducted for the establishment of criteria. Then, a questionnaire survey was designed; and with the help of various stakeholders, consists of green building certified professionals to support the process in choosing the determinant factors. The outcome of the analysis from Exploratory Analysis of Principal Component Analysis with Varimax Rotation reveals that solar photovoltaic implementation is affected by economic, management, environmental, and technical factors. Optimizing the factors discussed in this paper provides insight into adopting renewable sources effectively. This paper also contributed to building knowledge to facilitate more research on factors in implementing solar photovoltaic projects in the future.

Evaluation framework for an efficient commuting carpool program

Hundreds of cities have already pledged to get to “net zero” by 2050. MaaS (Mobility as a Service) is a one of promising measures but commuting carpool program seems to be effective for concentrated commuting to factories in suburban areas where public transportation is insufficient. The commuting carpool is easy to understand as a service, but there are considered many parameters for designing it. Especially companies in Japan have a big role to implement its service because collaborations with public and private sectors are not sufficient viewpoint of carpooling infrastructures and financial supports. In this study, we propose an evaluation framework for companies with two phases: Basic design to make a decision for implementation through the feasibility studies, and Detailed design and Improvement to consider detailed implementation.We focus on practical evaluation framework for Basic design and conduct a case study on commuting to a newly constructed factory. We apply it to extract parameters which are necessary for the feasibility study. As for the effect of the introduction of the program, its service is able to reduce the number of vehicles by 30-66% and CO2 emissions by 373-800 tons per year.

Trio genome sequencing for developmental delay and pediatric heart conditions: A comparative microcost analysis

PurposeGenome sequencing (GS) can aid clinical management of multiple pediatric conditions. Insurers require accurate cost information to inform funding and implementation decisions. The objective was to compare the laboratory workflows and microcosts of trio GS testing in children with developmental delay (DD) and in children with cardiac conditions. MethodsCost items related to each step in trio GS (child and 2 parents) for both populations were identified and measured. Program costs over 5 years were estimated. Probabilistic and deterministic analyses were conducted. ResultsThe mean cost per trio GS was CAD$6634.11 (95% CI = 6352.29-6913.40) for DD and CAD$8053.10 (95% CI = 7699.30-8558.10) for cardiac conditions. The 5-year program cost was CAD$28.11 million (95% CI = 26.91-29.29) for DD and CAD$5.63 million (95% CI = 5.38-5.98) for cardiac conditions. Supplies constituted the largest cost component for both populations. The higher cost per sample for the population with cardiac conditions was due to the inclusion of pharmacogenomics, higher bioinformatics labor costs, and a more labor intensive case review. ConclusionThis analysis indicated important variation in trio GS workflow and costs between pediatric populations in a single institution. Enhanced understanding of the clinical utility and costs of GS can inform harmonization and implementation decision-making.

Are Australian Mental Health Services Ready for Therapeutic Virtual Reality? An Investigation of Knowledge, Attitudes, Implementation Barriers and Enablers.

Therapeutic virtual reality (VR) has the potential to address the challenges of equitable delivery of evidence-based psychological treatment. However, little is known about therapeutic VR regarding the perspectives and needs of real-world service providers. This exploratory study aimed to assess the acceptability, appropriateness, and feasibility of therapeutic VR among clinicians, managers, and service staff working in mental healthcare and explore potential implementation barriers and enablers. Eighty-one staff from a network of private psychiatric hospitals in Victoria, Australia (aged M + SD: 41.88 + 12.01 years, 71.6% female; 64% clinical staff) completed an online survey, which included the Acceptability of Intervention Measure (AIM), Appropriateness of Intervention Measure (IAM), and Feasibility of Intervention Measure (FIM). While 91% of participants had heard about VR technology, only 40% of participants had heard of therapeutic VR being used in mental healthcare, and none had used therapeutic VR in a clinical setting. Most participants perceived VR to be acceptable (84%), appropriate (69%), and feasible (59%) to implement within their role or service and envisioned a range of possible applications. However, participants expressed concerns regarding safety, efficacy, and logistical challenges across clinical settings. Findings suggest a strong interest for therapeutic VR among Australian mental health providers working in the private system. However, dissemination efforts should focus on addressing identified barriers to ensure mental health providers are adequately informed and empowered to make implementation decisions.

Eliciting willingness-to-pay to prevent hospital medication administration errors in the UK: a contingent valuation survey

Medication errors are common in hospitals. These errors can result in adverse drug events (ADEs), which can reduce the health and well-being of patients’, and their relatives and caregivers. Interventions...

Method to Identify the Likelihood of Death in Residential Buildings during Coastal Flooding

Tools exist to predict fatalities related to floods, but current models do not focus on fatalities in buildings. For example, Storm Xynthia in France in 2010 resulted in 41 drowning deaths inside buildings. Therefore, there has been increasing recognition of the risk of people becoming trapped in buildings during floods. To identify buildings which could expose their occupants to a risk of death in the case of flooding, we propose the use of the extreme vulnerability index (VIE index), which identifies which buildings are at greatest risk of trapping people during floods. In addition, the “mortality function method” is used to further estimate the expected number of fatalities based on (1) groups of vulnerable people (e.g., aged or disabled), (2) the location of buildings in relation to major watercourses, and (3) the configuration of buildings (e.g., single or multiple entries and single or multiple stories). The overall framework is derived from case studies from Storm Xynthia which give a deterministic approach for deaths inside buildings for coastal floods, which is suited for low-lying areas protected by walls or sandy barriers. This methodology provides a tool which could help make decisions for adaptation strategy implementation to preserve human life.

The Adopted Weight of Asbestos-Containing Products Versus Results of Stocktaking in the Area of Poland

Abstrakt The date assumed as the beginning of the pandemic in Poland is March 4 2020, the date of the first confirmed case of the virus. The article presents the actions undertaken by the management of underground hard coal mining plants concerning the risk of epidemic related to SARS-CoV-2. This work shows a set of implemented recommendations, guidelines and decisions which were established after the appearance of the first wave of cases in Poland. What is more, it discusses measures aiming at reducing the risk of spreading the coronavirus among the mineworkers. The suggestions for different variants of the decision-making process concerning the pandemic and which have an enormous impact on the operating expenses of the company are also made. © 2020 Polish Mineral Engineering Society. All rights reserved.

Respiratory Syncytial Virus-Associated Hospital Admissions and Bed Days in Children

Respiratory syncytial virus (RSV) is a leading cause of respiratory tract infections (RTIs) in young children. High-quality country-specific estimates of bed days and length of stay (LOS) show the population burden of RSV-RTI on secondary care services and the burden among patients, and can be used to inform RSV immunization implementation decisions. We estimated the hospital burden of RSV-associated RTI (RSV-RTI) in children under 5 years in 7 European countries (Finland, Denmark, Norway, Scotland, England, the Netherlands, and Italy) using routinely collected hospital databases during 2001-2018. We described RSV-RTI admission rates during the first year of life by birth month and assessed their correlation with RSV seasonality in 5 of the countries (except for England and Italy). We estimated average annual numbers and rates of bed days for RSV-RTI and other-pathogen RTI, as well as the hospital LOS. We found that infants born 2 months before the peak month of RSV epidemics more frequently had the highest RSV-RTI hospital admission rate. RSV-RTI hospital episodes accounted for 9.9-21.2 bed days per 1000 children aged <5 years annually, with the median (interquartile range) LOS ranging from 2 days (0.5-4 days) to 4 days (2-6 days) between countries. Between 70% and 89% of these bed days were in infants aged <1 year, representing 40.3 (95% confidence interval [CI], 40.1-40.4) to 91.2 (95% CI, 90.6-91.8) bed days per 1000 infants annually. The number of bed days for RSV-RTI was higher than that for RTIs associated with other pathogens in infants aged <1 year, especially in those <6 months. RSV disease prevention therapies (monoclonal antibodies and maternal vaccines) for infants could help prevent a substantial number of bed days due to RSV-RTI. "High-risk" birth months should be considered when developing RSV immunization schedules. Variation in LOS between countries might reflect differences in hospital care practices.

OAuth 2.0 : Architectural design augmentation for mitigation of common security vulnerabilities

OAuth 2.0 is a widely used authorization protocol for cloud based web services and is used by many big firms such as Google, Facebook, Microsoft for granting limited access to the data. OAuth 2.0 has a flexible design and can be implemented and configured in a number of ways according to the use case. However, each of these implementation decisions and configuration choices come with their respective security implications. In our research, we carry out a simulation of the OAuth 2.0 protocol and suggest additional features which can augment the architectural design and enhance overall security effectiveness of the protocol. The protocol classifies third-party client apps based on their ability to maintain the confidentiality of the secret keys and the method used by them to register with the authorization servers. The protocol further offers various options to send access tokens to third-party client apps. In our research, we suggest converging these different third-party client app types and implementation options into a single uniform client app type and operational flow, thereby reducing the complexity in decision making, implementation, security misconfigurations and maintenance of different codebases. We also propose incorporating 2FA (Two Factor Authentication) as a feature for authentication of third-party client apps in addition to the existing mechanism of basic authentication through client secret. We also advocate measures to utilize digital signatures and cryptography to mitigate the common risks and vulnerabilities associated with misuse of tokens, which are issued and exchanged at various stages of the OAuth process including access to protected resources.