Initial Lessons Research Articles

Promoting Race and Ethnic Diversity in a Hospital-Based Randomized Clinical Trial to Address Untreated Alcohol Use Disorder: Initial Lessons Learned.

This study aimed to describe initial experiences and lessons learned conducting a trial focused on recruiting racially and ethnically diverse hospitalized patients with untreated alcohol use disorder (AUD). The parent trial is comparing the effectiveness of strategies including Brief Negotiation Interview (BNI), facilitated initiation of medications for AUD, and computer-based training for cognitive behavioral therapy (CBT4CBT) on AUD treatment engagement post-hospitalization. Guided by the Framework for Reporting Adaptations and Modifications-Enhanced, we catalogued protocol changes and evaluated outcomes using study and electronic medical record data during the first 18 months of recruitment. Recipients: (1) Selected entry criterion to intentionally include individuals most likely impacted by structural racism, (2) developed multipronged recruitment approaches, and (3) selected bilingual, multicultural, and ethnically diverse research staff. Intervention: (1) Added scripts in the BNI to consider how cultural factors influence and how racism may impact, alcohol use, and AUD treatment engagement, (2) offered tablets as a compensation alternative with support for CBT4CBT initiation (as relevant), and (3) anticipate and troubleshoot internet access challenges. Setting: (1) Identified community-based AUD treatment options with Spanish-speaking services and (2) identified resources to address social determinants of health. Study: (1) Audited data to monitor whether diverse enrollment is occurring. Among n = 132 randomized as of March 1, 2024, 25% endorsed Black, 24% endorsed Latine, 58% endorsed White, 1% endorsed Indigenous, and 15% endorsed race not listed or declined to disclose. We observed no difference by race or ethnicity in recruitment or retention experiences. Multilevel practices within a hospital-based AUD-focused trial can promote recruitment and retention of a racially and ethnically diverse sample.

Development, Evaluation, and Initial Findings of New York State Department of Health Community Drug Checking Pilot Programs.

The illicit drug landscape in the United States is dynamic, featuring a risky and erratic drug supply. Drug checking programs (DCP) have been successfully implemented and studied extensively in Canada and Europe but are scarce in the United States. Integrating DCP at harm reduction programs provides an opportunity to engage people at the point-of-care and deliver a combination of harm reduction services, access to healthcare services, and linkages to treatment. The New York State Department of Health (NYSDOH) developed and supports operation of 8 pilot community DCP sites throughout the state. The DCP were trained to utilize Fourier-transform infrared spectroscopy (FTIR) technology to deliver real-time results to participants. The NYSDOH community DCP pilot began development in 2022. Partnerships were formed across multiple domains including other DCP, universities, forensic laboratories, syringe service and harm reduction programs, and legal and regulatory offices within the NYSDOH. The first pilot sites began operating in mid-2023 and program expansion is on-going. Evaluation staff were extensively engaged in development and implementation phases. Qualitative evaluation focused on barriers, facilitators, and lessons learned from program staff and technicians. Quantitative evidence was gathered to assess the reach of the DCP and accuracy of results attained by drug checking technicians during their training periods. Drug checking results helped characterize the illicit drug supply. Development and implementation of DCP in NYS was facilitated by strong partnerships across sectors including public health and harm reduction. DCP may involve diverse partners who do not regularly collaborate, and health departments are positioned to build relationships and convene partners for program implementation. Evaluation findings highlight the importance of facilitating on-going training and technical assistance to DCP for quality assurance. The initial successes and lessons learned from the NYSDOH DCP demonstrate state public health departments' ability to successfully deploy this innovative harm reduction strategy.

Toward a CRISPR-based mouse model of Vhl-deficient clear cell kidney cancer: Initial experience and lessons learned

CRISPR is revolutionizing the ability to do somatic gene editing in mice for the purpose of creating new cancer models. Inactivation of the VHL tumor suppressor gene is the signature initiating event in the most common form of kidney cancer, clear cell renal cell carcinoma (ccRCC). Such tumors are usually driven by the excessive HIF2 activity that arises when the VHL gene product, pVHL, is defective. Given the pressing need for a robust immunocompetent mouse model of human ccRCC, we directly injected adenovirus-associated viruses (AAVs) encoding sgRNAs against VHL and other known/suspected ccRCC tumor suppressor genes into the kidneys of C57BL/6 mice under conditions where Cas9 was under the control of one of two different kidney-specific promoters (Cdh16 or Pax8) to induce kidney tumors. An AAV targeting Vhl, Pbrm1, Keap1, and Tsc1 reproducibly caused macroscopic ccRCCs that partially resembled human ccRCC tumors with respect to transcriptome and cell of origin and responded to a ccRCC standard-of-care agent, axitinib. Unfortunately, these tumors, like those produced by earlier genetically engineered mouse ccRCCs, are HIF2 independent.

Access of Low-Resource Areas to ASCO Quality Initiatives: Initial Experience and Lessons Learned.

With the aim of improving the quality of cancer care globally, ASCO began to offer its quality improvement programs to interested international oncology practices. In this manuscript, we describe the experiences with ASCO quality initiatives in low- and middle-income countries (LMICs). The experience acquired from different practices in Latin America and Africa was reviewed and various action steps were summarized. Encountered challenges and implemented solutions to mitigate these challenges were identified to list as lessons learned for oncology practices in LMICs or low-resource settings to use in their future quality improvement initiatives and providing a proactive approach for those practices considering starting quality improvement programs. Having programs tailored to LMICs may facilitate the participation of more practices and help them take advantage of these programs to enhance patient care. The preliminary data and learning are promising and demonstrate that participation in quality improvement activities can have a positive effect. Although this early experience is encouraging, each country and resource-limited practice will have its own unique challenges as highlighted in this article. Having more practices participate will further enhance the knowledge base, build experience in addressing challenges, and enable oncology patients to reap the benefits worldwide.

Enhancing Ci3T Professional Learning: Initial Lessons Learned from Ci3T Implementers

Enhancing Ci3T Professional Learning: Initial Lessons Learned from Ci3T Implementers

Tool surface texturing by shot peening: initial results and lessons learned

Abrasive and adhesive wear is a major issue in sheet metal forming processes. Although different solutions exist to reduce its impact, there is still room for progress. Surface texturing presents a big potential for tribological behaviour improvement by introducing oil retention voids on the surface. However, the economic efficiency of the surface functionalization is paramount for its implementation in industrial processes. In the present study, a widely known technology, shot peening, is applied for the creation of the voids. A grinding+polishing process is then applied to ensure a flat load bearing area. The textures are generated in 1.2379 tool steel blocks hardened at 60 HRc that emulate the tool. Different shot peening strategies are evaluated by carrying out strip drawing tests with AA5754H111 aluminium alloy sheets. Contact pressures up to 25 MPa are applied and the adhesive wear reduction potential is evaluated. First results point out the potential of this solution although the applied shot peening strategy needs to be carefully defined.

Early experiences evaluating the HPE/Cray ecosystem for AMD GPUs

SummaryThe Oak Ridge Leadership Computing Facility (OLCF) has a long history of supporting and promoting GPU‐accelerated computing starting with the deployment of the Titan supercomputer in 2021 and continuing with the Summit supercomputer which has a theoretical peak performance of approximately 200 petaflops. Because the majority of Summit's computational power comes from its 27,972 GPUs, users must port their applications to one of the supported programming models in order to make efficient use of the system. To prepare the transition to Frontier, the OLCF's exascale supercomputer, users will need to adapt to an entirely new ecosystem which will include new hardware and software technologies. First, users will need to familiarize themselves with the AMD Radeon GPU architecture. Furthermore, users who have been previously relying on CUDA will need to transition to the Heterogeneous‐Computing Interface for Portability (HIP) or one of the other supported programming models (e.g., OpenMP, OpenACC). In this work, we describe our initial experiences and lessons learned in porting three applications or proxy apps currently running on Summit to the HPE/Cray ecosystem to leverage the compute power from AMD GPUs: minisweep, GenASiS, and Sparkler. Each one is representative of current production workloads utilized at the OLCF, different programming languages, and different programming models.

Lifespan research in Kenya, Namibia, and South Africa: Cohort profile of the Africa long life study

Most personality science is conducted with samples from wealthy Western countries, home to only 11% of the world’s population. Longitudinal studies have been particularly informative for psychology, but they are virtually absent from the rest of the world. The Africa Long Life Study (ALLS) brings African perspectives to lifespan research in personality and mental health. Large ( N = ∼1000), relatively-representative samples of 18-year-olds were recruited from throughout Namibia, Kenya, and South Africa in 2022. Participants complete two surveys each year. At the time of the fifth wave, we describe here the goals of the ALLS with emphasis on personality psychology, and the contextualized measurement and methodological approaches we have developed, including the process of finding participants again at later waves. Sample characteristics and retention and attrition over the first three waves are reported. Initial lessons learned and reflections on conducting longitudinal research and personality science in Africa are discussed.

Initial carbon capture pilot study in Solvay soda ash process

Aqueous ammonia is an alternative solvent for CO2 capture that has many advantages. In recent years, researchers have investigated ammonia as a promising solvent for CO2 capture from various gases. A significant emitter of carbon dioxide from the chemical sector is the soda ash industry. Since ammonia is an auxiliary substrate in soda production, it can easily be used to capture CO2 from tail gas streams. After CO2 absorption, process liquids can be returned to the production process, helping to reduce the use of raw materials.The main source of CO2 emissions to the atmosphere in the Solvay Process is the post-carbonation gas from the carbonating tower. It has been demonstrated that this process can be intensified and the use of calcium carbonate in the form of limestone is reduced by returning the carbon dioxide to the process. Stoichiometrically, one kg of avoided CO2 saves approximately 2.27 kg of limestone. This paper presents the initial results and lessons learned from the operation of the pilot plant for CO2 capture from tail gas streams of the Solvay Process. The process has been tested and implemented in a pilot plant with a gas flow rate of up to 4000 m3n/h. The influence of various process parameters has been investigated.

Conflict disruptions of epistemic communities: initial lessons from the impact of the Russian invasion of Ukraine

ABSTRACT The war in Ukraine has highlighted that the stability of the epistemic communities is not immune to the disruptions caused by international conflicts. This paper explores why some epistemic communities (ECs) continue to function with little change, some adapt, and some cease to exist in times of disruption. It also explores different factors that might explain their resilience to such shocks, thereby shedding light on resilience capacities among these communities. We review case studies of three ECs: the European Space Agency (ESA), Intergovernmental Panel on Climate Change (IPCC), and the Arctic Council (AC). The results of this study contribute to our understanding of the possible ways of conceiving the epistemic communities differently than we had in the past, in light of disruptions caused by the war in Ukraine.

Digital Phenotyping for Mood Disorders: Methodology-Oriented Pilot Feasibility Study.

In the burgeoning area of clinical digital phenotyping research, there is a dearth of literature that details methodology, including the key challenges and dilemmas in developing and implementing a successful architecture for technological infrastructure, patient engagement, longitudinal study participation, and successful reporting and analysis of diverse passive and active digital data streams. This article provides a narrative rationale for our study design in the context of the current evidence base and best practices, with an emphasis on our initial lessons learned from the implementation challenges and successes of this digital phenotyping study. We describe the design and implementation approach for a digital phenotyping pilot feasibility study with attention to synthesizing key literature and the reasoning for pragmatic adaptations in implementing a multisite study encompassing distinct geographic and population settings. This methodology was used to recruit patients as study participants with a clinician-validated diagnostic history of unipolar depression, bipolar I disorder, or bipolar II disorder, or healthy controls in 2 geographically distinct health care systems for a longitudinal digital phenotyping study of mood disorders. We describe the feasibility of a multisite digital phenotyping pilot study for patients with mood disorders in terms of passively and actively collected phenotyping data quality and enrollment of patients. Overall data quality (assessed as the amount of sensor data obtained vs expected) was high compared to that in related studies. Results were reported on the relevant demographic features of study participants, revealing recruitment properties of age (mean subgroup age ranged from 31 years in the healthy control subgroup to 38 years in the bipolar I disorder subgroup), sex (predominance of female participants, with 7/11, 64% females in the bipolar II disorder subgroup), and smartphone operating system (iOS vs Android; iOS ranged from 7/11, 64% in the bipolar II disorder subgroup to 29/32, 91% in the healthy control subgroup). We also described implementation considerations around digital phenotyping research for mood disorders and other psychiatric conditions. Digital phenotyping in affective disorders is feasible on both Android and iOS smartphones, and the resulting data quality using an open-source platform is higher than that in comparable studies. While the digital phenotyping data quality was independent of gender and race, the reported demographic features of study participants revealed important information on possible selection biases that may result from naturalistic research in this domain. We believe that the methodology described will be readily reproducible and generalizable to other study settings and patient populations given our data on deployment at 2 unique sites.

Use of deep learning model for paediatric elbow radiograph binomial classification: initial experience, performance and lessons learnt

Abstract Introduction: In this study, we aimed to compare the performance of a convolutional neural network (CNN)-based deep learning model that was trained on a dataset of normal and abnormal paediatric elbow radiographs with that of paediatric emergency department (ED) physicians on a binomial classification task. Methods: A total of 1,314 paediatric elbow lateral radiographs (patient mean age 8.2 years) were retrospectively retrieved and classified based on annotation as normal or abnormal (with pathology). They were then randomly partitioned to a development set (993 images); first and second tuning (validation) sets (109 and 100 images, respectively); and a test set (112 images). An artificial intelligence (AI) model was trained on the development set using the EfficientNet B1 network architecture. Its performance on the test set was compared to that of five physicians (inter-rater agreement: fair). Performance of the AI model and the physician group was tested using McNemar test. Results: The accuracy of the AI model on the test set was 80.4% (95% confidence interval [CI] 71.8%–87.3%), and the area under the receiver operating characteristic curve (AUROC) was 0.872 (95% CI 0.831–0.947). The performance of the AI model vs. the physician group on the test set was: sensitivity 79.0% (95% CI: 68.4%–89.5%) vs. 64.9% (95% CI: 52.5%–77.3%; P = 0.088); and specificity 81.8% (95% CI: 71.6%–92.0%) vs. 87.3% (95% CI: 78.5%–96.1%; P = 0.439). Conclusion: The AI model showed good AUROC values and higher sensitivity, with the P-value at nominal significance when compared to the clinician group.

Worldwide Regulatory Reliance: Launching a Pilot on a Chemistry, Manufacturing, and Control Post Approval Change for a Vaccine.

When an initial marketing authorization of a pharmaceutical product is granted, a substantial number of chemistry, manufacturing, and control (CMC) post approval changes (PACs) have to be managed by the manufacturers. Despite efforts undertaken over the years by multiple regulatory jurisdictions, there is still heterogeneity in terms of regulatory requirements and timelines across national regulatory authorities (NRAs). This creates complexity in managing global CMC PACs, putting the supply of medical products at risk. Regulators have developed regulatory mechanisms that aim at accelerating the reviews and approvals of PACs by NRAs. The World Health Organization (WHO) is supporting the concept of "reliance" among NRAs, which are encouraged to rely on the assessment completed by a "highly performing authority". The objective is to accelerate the overall process for PACs, ultimately fostering more equitable and timely access to medical products for populations who need them. With the support of Health Canada, WHO, Pan American Health Organization, and the Paul-Ehrlich-Institut, Sanofi has launched a pilot using the principles of reliance for a CMC PAC for a vaccine, with 21 NRAs who accepted to participate in the pilot. The objective of this pilot was to apply these principles to reduce the approval timeline to a maximum of 6 months in all countries after an initial approval is granted by a reference authority. We discuss the opportunities and challenges of implementing reliance principles for CMC PACs. We also describe the pilot experience by sharing initial lessons learned from the Step 1 of this pilot, which consisted of engaging the reference authority and the NRAs.

High Vacuum Capable Fused Filament Fabrication 3D Printer, Part II: High-Temperature Polymers Suitable for In-Space Manufacturing

The ability to additively manufacture structures on-orbit has the potential to fundamentally alter the traditional paradigm for how large spacecraft are constructed and launched into space. The space environment presents several unique challenges for additive manufacturing, including the need to operate in a vacuum. This paper presents the design, analysis, and test results for a passively cooled fused filament fabrication (FFF) 3D printer capable of manufacturing parts out of engineering-grade thermoplastics in the vacuum of space. Four high-temperature materials were successfully printed in high vacuum, including polyetherketoneketone, carbon-nanotube–polyetherketoneketone, polyetherimide, and carbon-nanotube–polyetherimide. Over 100 test coupons were printed in a vacuum and tested to confirm the feasibility of applying the FFF process in this environment. Lessons learned were documented throughout the vacuum printing test campaigns and are discussed here. This paper is part of a two-part series. Part I presented results for using a low-temperature hotend capable of printing hobby-grade materials in high vacuum and documented initial findings and lessons learned. Part II presents the results for a high-temperature hotend capable of printing engineering-grade plastics that are suitable for on-orbit manufacturing. The combined results of the two papers in this series can be used to inform future on-orbit additive manufacturing.

Metformin for overweight and OBese chILdren with bIpolar spectrum disorders Treated with second-generation antipsYchotics (MOBILITY): Initial Findings and Lessons Learned From a Large Pragmatic Trial

Metformin for overweight and OBese chILdren with bIpolar spectrum disorders Treated with second-generation antipsYchotics (MOBILITY): Initial Findings and Lessons Learned From a Large Pragmatic Trial

High Vacuum Capable Fused Filament Fabrication 3D Printer, Part I: Low-Temperature Polymers and Early Lessons Learned

On-orbit manufacturing and assembly have become major research and development topics for government and commercial entities seeking the capability to build very large structures in space. Additive manufacturing is well suited to this paradigm since the process is highly automated, produces little material waste, and allows for a large degree of geometric freedom. This paper presents a design for a 3D printer that operates in high vacuum. The vacuum 3D printer has completed multiple thermal vacuum test campaigns, with dozens of parts printed to date using low-temperature thermoplastics. Testing of material coupons shows that samples printed in vacuum have strength properties generally within a standard deviation of samples printed at ambient pressure. The overall results from multiple successful tests of the vacuum 3D printer promote the feasibility of on-orbit additive manufacturing while exposed to the space environment. This paper is part one of a two-part series. Part I presents the results using a low-temperature hotend capable of printing hobby-grade materials and documents some initial findings and lessons learned for applying FFF in vacuum. Part II presents the results for a high-temperature hotend capable of printing engineering grade plastics that are suitable for on-orbit manufacturing. The combined results of the two papers in this series can be used to inform future on-orbit additive manufacturing applications as well as potential uses on future moon missions.

Deploying Bots in Healthcare to Find Revenue Cycle Improvements.

Doing more with less has been a business mantra for decades. Healthcare leaders have implemented flex scheduling and job sharing, streamlined workflows, committed to process improvement techniques such as Lean, hired retirees, gained efficiencies from remote work ... and the list goes on. Each tactic has yielded productivity improvements, yet the need to do more with less continues. Postpandemic challenges include staff recruitment and retention, labor inflation, and dwindling margins, all of which must be addressed while maintaining corporate cultures. The journey with bots described here started in this dynamic environment, and the work has not been single-threaded. The organization featured here-an integrated delivery network-has digital front-door and back-end robotic process automation (RPA) projects underway. The digital front-door initiative supports patient self-registration and automates authorizations and insurance verification processes. The back-end patient financial services RPA project replaces and enhances existing technology. Revenue cycle as a multidepartment function is leadership's poster child for RPA, and the revenue cycle team is tasked to demonstrate the value of the technology. This article covers the initial steps and lessons learned in the process.

Initial outcomes and lessons learned from implementation of an online diversity & inclusion community

BackgroundThere is an opportunity to build online communities and digitize inclusive excellence such that all students, staff, and faculty can benefit. However, literature illustrating actionable strategies for creating online communities and mitigating barriers related to engagement is limited. PurposeWe evaluated the feasibility, functionality, and usage of a college of nursing’s (CON) online diversity and inclusion communication platform (i.e., D&I Community). MethodsFrom survey and college-wide discussion, we found that CON members are interested in employing opportunities for diversity, equity, and inclusion (DEI) discussions and engaging with DEI resources, but lack of time, competing priorities, and lack of awareness of the D&I Community were barriers to participation. DiscussionWe are prepared to modify processes to improve engagement and promote a sense of belonging for all CON members. ConclusionImplementation and sustainability of this D&I Community require continual resource investment. Scalability can be considered once processes have been fully refined.

PECULIARITIES OF IMPROVING STUDENTS' HEALTH BY MEANS OF SWIMMING

The article analyzes the use of modern methods in the process of swimming classes to improve the physical condition of students of higher education. The effectiveness of systematic swimming lessons on improving health indicators of students was studied. A low level of health among students who lead a sedentary lifestyle was determined. The motivational aspects of the involvement of student youth in active swimming lessons have been determined. It was found that when teaching proper breathing in an unfamiliar environment for initial swimming lessons, it is recommended to spend up to 40% of the class time on breathing exercises, thus, students who are just learning to swim will more easily overcome the barrier of fear in the water environment. Thus, swimming lessons are shown with various health conditions for students of special medical groups. In addition- in the above recommendations, you can add add the following when mastering the skill of breathing in an unusual environment for initial swimming training. Early multi-level swimming programs are recommended for all children to help them overcome their fear of water, improve pool performance and improve swimming performance. This will eventually increase the percentage of adults who can swim. It is necessary to create a favorable environment for the classes of students with mild and severe disabilities. For this, it is necessary to adapt run swimming programs. The variety of aspects of physical training, the specifics and features of swimming represent the best pedagogical conditions for the development of emotional and volitional stability during classes in this type of pedagogical activity.

Novel Design and Implementation of an Integrated Behavioral Health Program in a National Risk-Bearing Eldercare Company: Initial Lessons Learned

Novel Design and Implementation of an Integrated Behavioral Health Program in a National Risk-Bearing Eldercare Company: Initial Lessons Learned