Navigation Protocol Research Articles

Electromagnetic neuronavigation in neuroendoscopy. Navigation proposal for the LOTTA ventriculoscope. Technical note

Background and objectiveNeuronavigation in ventriculoscopy has been described in several papers. However, there are different ventriculoscopes and navigation systems. Because of these different combinations, it is difficult to find detailed navigation protocols for each ventriculoscope. We describe, step by step, a simple method to navigate both the trajectory to reach the ventricular system and the intraventricular work for the LOTTA ventriculoscope. MethodsWe used a rigid ventriculoscope (LOTTA, KarlStorz) with an electromagnetic stylet (S8-StealthSystem, Medtronic) as the main navigation tool. The protocol is based on a 3D printed trocar or alternatively, on a modification of the original trocar for extraventricular phase navigation and a modified pediatric nasogastric tube for intraventricular phase navigation. ResultsThe protocol can be set up in less than 10min. The extraventricular part is navigated by inserting the electromagnetic stylet inside the 3D printed trocar or inside the original modified trocar. Intraventricular navigation is performed by combining a modified pediatric nasogastric tube with the electromagnetic stylet inside the working channel of the endoscope. The most critical point is to obtain a blunt, bloodless approach to the ventricle and to achieve perfect alignment of all target structures by means of previously planned pure straight trajectories. ConclusionsThis protocol is easy to set up, avoids rigid head fixation, bulky optical navigation accessories, while allows continuous navigation of both parts of the surgery. Since we have implemented this protocol, we have seen a significant improvement in both simple and complex neuroendoscopy procedures as the surgery is dramatically simplified.

The hawk eye scan: Halyomorpha halys detection relying on aerial tele photos and neural networks

This paper faces the challenge of monitoring the Brown Marmorated Stink Bug (H.halys) (Halyomorpha halys) within orchards, utilizing drones, and computer vision. H.halys is an invasive species originating from East Asia, that is extremely polyphagous and poses a significant threat to various crops. Our first contribution is a drone navigation protocol, which ensures risk-free drone flights in cluttered orchard environments, preserving image quality and avoiding obstacles. We then create a pioneering H.halys dataset consisting of aerial telephotos captured in the field autonomously by the drone. The dataset allows the development and evaluation for the first time of multiple ML models for H.halys detection in the field. We trained YOLOv5, YOLOv8, RetinaNet, and Faster-RCNN models using different learning methodologies, exploiting different percentages of images without the bug, and using different slicing procedures for the images. The Medium YOLOv5 model trained with all images containing a bug detects the largest number of H.halys on the testing set and overall performs the best, while RetinaNet and Faster-RCNN provide the best trade-off between precision and recall. Models vary in their ability to handle occluded H.halys and bug-free images, which are common since the presence of the bug cannot be predicted before capturing a photo. These results show promising potential for automating H.halys monitoring, despite the image complexity and the early dataset stage. Our work marks a significant step towards enhancing smart agriculture practices due to the simplicity of the data acquisition process and the off-the-shelf hardware selection.

Rapid brain MRI for image-guided ventricular catheter placement in pediatric patients: protocol and preliminary clinical outcomes.

Neuronavigation is a useful adjunct for catheter placement during neurosurgical procedures for hydrocephalus or ventricular access. MRI protocols for navigation are lengthy and require sedation for young children. CT involves ionizing radiation. In this study, the authors introduce the clinical application of a 1-minute rapid MRI sequence that does not require sedation in young children and report their preliminary clinical experience using this technique in their pediatric population. All patients who underwent ventricular catheter placement at a children's hospital using a rapid noncontrast MRI protocol, standard MRI, or head CT from July 2021 to August 2023 were included. Type of procedure, etiology of hydrocephalus, ventricle configuration and size, morphology of ventricles, need for adjunctive intraoperative ultrasound, duration of procedure, accuracy of catheter placement, and need for proximal revision within 90 days were retrospectively recorded and compared across imaging modalities. Sixty-eight patients underwent 83 procedures: 21 underwent CT navigation, 29 standard MRI, and 33 rapid MRI. Patients who received standard MRI more often had tumor etiology, while those who underwent CT and rapid MRI had posthemorrhagic etiology (χ2 = 13.04, p = 0.042). Intraoperative ultrasound was required for 1 patient in the standard MRI group and 1 patient in the CT group. There was no difference in procedure time across groups (p = 0.831). On multivariable analysis, procedure time differed by procedure type, where external ventricular drain placement and proximal revision were faster (p < 0.001 and p < 0.028, respectively). Proximal revision due to obstruction within 90 days occurred in 3 cases (in the same patient with complex loculated hydrocephalus) in the rapid MRI group and 2 cases in the CT group. Although this study was not powered for statistical inference, the authors report on the clinical use of a 1-minute rapid MRI sequence for neuronavigation in hydrocephalus or ventricular access surgery. There were no instances in which intraoperative ultrasound was required as an adjunct for procedures navigated with rapid MRI, and intraoperative time did not differ from that of standard navigation protocols.

Improving mixed-reality neuronavigation with blue-green light: a comparative multimodal laboratory study.

This study aimed to rigorously assess the accuracy of mixed-reality neuronavigation (MRN) in comparison with magnetic neuronavigation (MN) through a comprehensive phantom-based experiment. It introduces a novel dimension by examining the influence of blue-green light (BGL) on MRN accuracy, a previously unexplored avenue in this domain. Twenty-nine phantoms, each meticulously marked with 5-6 fiducials, underwent CT scans as part of the navigation protocol. A 3D model was then superimposed onto a 3D-printed plaster skull using a semiautomatic registration process. The study meticulously evaluated the accuracy of both navigation techniques by pinpointing specific markers on the plaster surface. Precise measurements were then taken using digital calipers, with navigation conducted under three distinct lighting conditions: indirect white light (referred to as no light [NL]), direct white light (WL), and BGL. The research enlisted two operators with distinct levels of experience, one senior and one junior, to ensure a comprehensive analysis. The study was structured into two distinct experiments (experiment 1 [MN] and experiment 2 [MRN]) conducted by the two operators. Data analysis focused on calculating average and median values within subgroups, considering variables such as the type of lighting, precision, and recording time. In experiment 1, no statistically significant differences emerged between the two operators. However, in experiment 2, notable disparities became apparent, with the senior operator recording longer times but achieving higher precision. Most significantly, BGL consistently demonstrated a capacity to enhance accuracy in MRN across both experiments. This study demonstrated the substantial positive influence of BGL on MRN accuracy, providing profound implications for the design and implementation of mixed-reality systems. It also emphasized that integrating BGL into mixed-reality environments could profoundly improve user experience and performance. Further research is essential to validate these findings in real-world settings and explore the broader potential of BGL in a variety of mixed-reality applications.

Review and Analysis of the Collision Incident between Cargo Ship Edmy and Fishing Vessel Tornado: Extracting Lessons from a Case

This study reviews an investigation report that involves collision incident between the Cargo Ship Edmy and the Fishing Vessel Tornado. After conducting a thorough analysis of the incident, it was concluded that the collision occurred due to a confluence of factors, namely excessive dependence on navigation equipment and inadequate utilisation of the navigation tools at hand. Consequently, a number of valuable insights have been identified with the aim of improving maritime safety. The study highlights the significance of evaluating and enhancing watchkeeping protocols. This encompasses the establishment of the minimum prerequisites for bridge configuration and surveillance in diverse sailing situations, with the aim of guaranteeing sufficient attentiveness and proactive navigation. Additionally, the research emphasises the importance of establishing the closest point of approach and time to the closest point of approach parameters within Automatic Radar Plotting Aids. The implementation of these values and their prominent placement in close proximity to radars, coupled with the incorporation of alarms within the Automatic Radar Plotting Aid system, serves to augment the level of awareness among bridge personnel pertaining to the importance of upholding appropriate separation distances to ensure safety. The study underscores the importance of improving the standing orders of the master. This entails the revision of the standing orders to incorporate the insights gained, which includes the proscription of engaging in paperwork or utilising autonomous equipment in the absence of a backup lookout. The study endeavours to enhance safety practises and mitigate the occurrence of comparable incidents in the future by examining and addressing the lessons derived from them. This highlights the significance of striking a harmonious equilibrium between the utilisation of navigation equipment as valuable instruments, while simultaneously upholding the ongoing dependence on human judgement, sustaining situational awareness, and adhering to appropriate navigation protocols.

Greedy routing optimisation in hyperbolic networks

Finding the optimal embedding of networks into low-dimensional hyperbolic spaces is a challenge that received considerable interest in recent years, with several different approaches proposed in the literature. In general, these methods take advantage of the exponentially growing volume of the hyperbolic space as a function of the radius from the origin, allowing a (roughly) uniform spatial distribution of the nodes even for scale-free small-world networks, where the connection probability between pairs decays with hyperbolic distance. One of the motivations behind hyperbolic embedding is that optimal placement of the nodes in a hyperbolic space is widely thought to enable efficient navigation on top of the network. According to that, one of the measures that can be used to quantify the quality of different embeddings is given by the fraction of successful greedy paths following a simple navigation protocol based on the hyperbolic coordinates. In the present work, we develop an optimisation scheme for this score in the native disk representation of the hyperbolic space. This optimisation algorithm can be either used as an embedding method alone, or it can be applied to improve this score for embeddings obtained from other methods. According to our tests on synthetic and real networks, the proposed optimisation can considerably enhance the success rate of greedy paths in several cases, improving the given embedding from the point of view of navigability.

Abstract A039: Translating research into practice: Results of a community-engaged, city-wide breast cancer patient navigation implementation study to reduce disparities

Abstract Introduction: Delays in accessing breast cancer care contribute to poor outcomes among women of color and those underinsured. Patient navigation is one of few proven interventions that overcome inequity in cancer care delivery, yet there is a need to address barriers to widespread implementation. Methods: Led by a city-wide coalition of multi-sector stakeholders, we conducted a Type 1 hybrid clinical effectiveness-implementation trial across five hospitals in Boston to test the impact of navigation on timely initiation of breast cancer treatment, while also exploring implementation outcomes including acceptability of and fidelity to an evidence-informed 11-step navigation protocol. A randomized cluster stepped wedge study design allowed for rolling out a multi-level navigation protocol iteratively in real life practices from 2019 through 2022. Hospital cancer registries sourced eligible cancer cases, while electronic medical record abstraction documented timely treatment, defined as within 60 or 90 days depending on the diagnosis. Odds ratios adjusted for time by calendar quarter and accounted for clustering by study site. Fidelity to protocol was measured using navigator documentation of interactions with patients and conducting social needs screenings. Key informant interviews and field observations were conducted to assess acceptability. Results: A total of 1,732 women with newly diagnosed breast cancer were included in the intent to treat analysis (553 historical control period, 1,179 intervention period). By study design, the majority of women were nonwhite (80%) and more than half were non-English speaking and on public health insurance. During the intervention period, 50% (n=587) had no documented evidence of receiving any contact from a navigator, 15% (n=181) had only one documented interaction with the navigator while 35% (n=407) were navigated and received social needs screens in accordance with study protocol. Compared with historical controls, navigated patients who received a social needs screen had twice the odds of receiving timely treatment (aOR 2.06, 95% CI 1.39, 3.06), those who had only one documented interaction with the navigator had 1.4 greater odds of timely treatment (aOR 1.44, 95% CI 1.08, 1.93) and those with no documented evidence of navigation were no more likely to receive timely treatment (aOR 1.42, 95% CI 0.81, 2.48. We found variability in how navigators identified patients, with significant disruption during the COVID pandemic. Navigators found navigation protocols and social needs screening acceptable, and patients reported feeling supported when asked about social needs. The study protocol formalized the navigation process within and across hospitals, yet tension for change in existing workflows and complexity in documentation served as barriers to adoption. Conclusions: Receipt of navigation is associated with more timely care among a diverse group of women at risk for poor outcomes. Despite stakeholder engagement, implementation of evidence-based breast cancer patient navigation remains suboptimal. Citation Format: Tracy A. Battaglia, Karen M. Freund, Jennifer S. Haas, Stephenie C. Lemon, Translating Research Into Practice (TRIP) Consortium. Translating research into practice: Results of a community-engaged, city-wide breast cancer patient navigation implementation study to reduce disparities [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr A039.

Vestibular damage affects the precision and accuracy of navigation in a virtual visual environment.

Vestibular information is available to the brain during navigation, as are the other self-generated (idiothetic) and external (allothetic) sensorimotor cues that contribute to central estimates of position and motion. Rodent studies provide strong evidence that vestibular information contributes to navigation but human studies have been less conclusive. Furthermore, sex-based differences have been described in human navigation studies performed with the head stationary, a situation where dynamic vestibular (and other idiothetic) information is absent, but sex differences in the utilization of vestibular information have not been described. Here, we studied men and women with severe bilateral vestibular damage as they navigated through a visually barren virtual reality environment and compared their performance to normal men and women. Two navigation protocols were employed, which either activated dynamic idiothetic cues ('dynamic task', navigate by turning, walking in place) or eliminated them ('static task', navigate with key presses, head stationary). For both protocols, we employed a standard 'triangle completion task' in which subjects moved to two visual targets in series and then were required to return to their perceived starting position without localizing visual information. The angular and linear 'accuracy' (derived from response error) and 'precision' (derived from response variability) were calculated. Comparing performance 'within tasks', navigation on the dynamic paradigm was worse in male vestibular-deficient patients than in normal men but vestibular-deficient and normal women were equivalent; on the static paradigm, vestibular-deficient men (but not women) performed better than normal subjects. Comparing performance 'between tasks', normal men performed better on the dynamic than the static paradigm while vestibular-deficient men and both normal and vestibular-deficient women were equivalent on both tasks. Statistical analysis demonstrated that for the angular precision metric, sex had a significant effect on the interaction between vestibular status and the test paradigm. These results provide evidence that humans use vestibular information when they navigate in a virtual visual environment and that men and women may utilize vestibular (and visual) information differently. On our navigation paradigm, men used vestibular information to improve navigation performance, and in the presence of severe vestibular damage, they utilized visual information more effectively. In contrast, we did not find evidence that women used vestibular information while navigating on our virtual task, nor did we find evidence that they improved their utilization of visual information in the presence of severe vestibular damage.

Hub-and-Spoke centralized intervention to optimize colorectal cancer screening and follow-up: A pragmatic, cluster-randomized controlled trial protocol

BackgroundGuidelines recommend screening for colorectal cancer (CRC), but participation and abnormal test follow up rates are suboptimal, with disparities by demography. Evidence-based interventions exist to promote screening, but community adoption and implementation are limited. MethodsThe San Diego Accelerating Colorectal Cancer Screening and Follow-up through Implementation Science (ACCSIS) program is an academic-community partnership testing regional implementation of a Hub-and-Spoke model for increasing CRC screening and follow-up. The “hub” is a non-academic, non-profit organization that includes 17 community health center (CHC) systems, serving over 190 rural and urban clinic sites. The “spokes” are 3 CHC systems that oversee 11–28 clinics each, totaling over 60 clinics. Using a cluster-randomized trial design, 9 clinics were randomized to intervention and 16 to usual care. Within intervention clinics, approximately 5000 eligible patients not up-to-date with CRC screening per year were identified for intervention. Interventions include an invitation primer, a mailed fecal immunochemical test with completion instructions, and phone and text-based reminders (hub) and patient navigation protocol to promote colonoscopy completion after abnormal FIT (spoke). Outcomes include: 1) proportion of patients up-to-date with screening after three years in intervention versus non-intervention clinics; 2) proportion of patients with abnormal FIT completing colonoscopy within six months of the abnormal result. Implementation science measures are collected to assess acceptability, intervention and usual care adaptations, and sustainability of the intervention strategies. ConclusionThis large-scale, regional cluster randomized trial among CHCs serving diverse populations is anticipated to accelerate progress in CRC prevention in underserved populations.Trial registration: NCT04941300

Improving autonomous robotic navigation using IFC files

The navigation of robotic systems in construction sites often relies on sensor data from the robot. While mapping and navigation protocols such as simultaneous localization and mapping (SLAM) are quite useful for navigation, they often require a preliminary mapping of the site, which is usually done manually. Waypoint generation for certain tasks, such as 3D scanning, cannot be done before obtaining said preliminary map, which can be tedious. Building information model (BIM) files contain rich semantic information about buildings; therefore, it is worth considering an approach where the information in BIM is leveraged to minimize the need for manual preliminary mapping of sites. This study proposes a methodology to get information from BIM—in the form of IFC files—to an autonomous robotic system (ARS) in the form of navigation maps, simulation environments, JSON files with useful semantic information, and proposed waypoints for stop-and-go missions. The schedule element present in IFC is used to generate obstacle maps relevant to the level of construction progress at the time the ARS is deployed. The results are validated with a case study of the entire process from the IFC file input to the waypoint generation for an ARS to complete a 3D reconstruction of an indoor space.

Colorectal cancer and digital/live screening navigation: Promoting prevention through personalized recommendations and access.

10566 Background: This project evaluates the effectiveness of an advocacy organization-led digital and live navigation framework aimed at colorectal cancer (CRC) screening completion. The Colorectal Cancer Alliance’s screening quiz guides patients to a clinically valid, personalized CRC screening recommendation with a handoff to live navigation for those at risk. The framework utilizes digital innovation, targeted awareness, and financial support to support populations experiencing the greatest disparities and increase screening intention, behavior, and further health equity in colorectal cancer. This simple intervention is critical due to existing research consistently indicating on-time screening for CRC leads to favorable outcomes. Methods: In July 2022, the Alliance launched an enhanced quiz to improve the CRC screening navigation experience and increase engagement. The new survey instrument was restructured to streamline time to completion while preserving clinically accurate risk stratification. The follow-up navigation protocol was reordered from digital-first to live-first to leverage high-touch strategies earlier in the screening journey and dynamic content was added to the recommendation page to create a more personalized resource. The Alliance also deployed social media and influencer campaigns to increase outreach to at-risk communities. Results: The enhanced quiz delivered over 8,300 CRC screening recommendations and improved the average monthly completion rate (33%) and contact capture rate (14.4%) compared to the previous quiz in 2022 (24%; 8%). The median age of respondents was 55, and 37.2% of the respondents were between the ages of 45 and 64. Of the respondents, 26.7% were male and 73.3% were female. The majority were White (77.1%), 7.3% identified as Black/African American, 5.5% were Hispanic or Latino, and 3% were Asian. Most respondents were symptomatic (67.8%) but 8.1% were asymptomatic high-risk. Respondents (1,078) were triaged to live Alliance patient navigation. Conclusions: This digital and live navigation framework may serve as a strong solution in driving colorectal cancer screening and supporting shared-decision making conversations compared to other available interventions. The framework provides users with robust access to live navigation, educational resources, and support services for CRC screening and diagnosis. The Alliance is uniquely positioned to utilize its communications channels, social media and influencer campaigns to reach at-risk communities with credibility. Data attributed to specific campaigns are still being analyzed, and the Alliance will continue to optimize its navigation protocol and awareness efforts as quality improvement processes allow for a deeper understanding of more inclusive and impactful navigation experiences to close screening gaps among at-risk populations.

Lessons learned about policymaking: Moving an emergency department-initiated screening protocol to systemwide input in the development and implementation process.

Lessons learned about policymaking: Moving an emergency department-initiated screening protocol to systemwide input in the development and implementation process.

Context-Aware Navigation Protocol for Safe Driving in Vehicular Cyber-Physical Systems

A connected network of automated vehicles on roads can increase the driving safety of driverless vehicles (i.e., autonomous vehicles). The critical level of dangerous situations on the road while driving can be increased by the speed, orientation, and traffic density of the vehicles involved. Therefore, there is a need for a maneuvering mechanism that handles both the current driving vehicle and the oncoming vehicles headed toward an emergency zone (e.g., road hazard and road accident spot). In this paper, we present a context-aware navigation protocol (CNP) that enhances the safety of vehicles driving in urban roads. Firstly, CNP includes a collision avoidance module that builds on both vehicular networks and on-board sensors to track vehicles’ behaviors, and this module analyzes the driving risks to determine the necessary maneuvers in dangerous situations. Secondly, CNP establishes a collision mitigation strategy that limits the severity of collision damages in hazardous road during non-maneuverable scenarios. We conducted a theoretical analysis as well as extensive simulations to prove and evaluate the effectiveness of CNP. The results show that CNP can reduce communication overhead from a baseline scheme by up to 60% while the risk of road collisions is less than 5%.

Decentralised CAVs based on micro–macro flow control (MiMaFC) strategy for multi‐intersection traffic network

AbstractAdvanced intersection control systems have been created to alleviate traffic congestion. CAVs may benefit from cooperative navigation in order to address the regular traffic issue. Due to whole uncertainty in transportation network, the conventional motion planning for local areas may lead to undesirable effects in long run. In prior works, a micro–macro flow control (MiMaFC) strategy is used to investigate CAVs' navigation at unsignalised intersections by taking flow velocity and vehicle passing priority into account. To get a better understanding of motion control and how it can be utilised to impact traffic flow behaviour, this study expands the intersection navigation protocol and develops a velocity planning methodology based on the proposed MiMaFC technology. Correspondingly, cooperative navigation protocol used in the addressed architecture is specifically developed for CAVs that continually cross intersections. Further, spatio‐temporal velocity adaption mechanism is presented in this work. Depending on the vehicles' location and speed, CAVs might use either the MiMaFC‐based or self‐interested velocity strategy. Simulation results, which include a congested traffic network, are shown to demonstrate the proposed method's potential. The study found that the suggested motion planning framework may increase urban network mobility over a non‐supervised CAVs system.

A Multiple-Choice Maze-like Spatial Navigation Task for Humans Implemented in a Real-Space, Multipurpose Circular Arena

Spatial navigation is a key aspect of human behavior and it is still not completely understood. A number of experimental approaches exist, although most of the published data in the last decades have relied on virtual maze on-screen simulation or not-completely freely moving 3D devices. Some interesting recent developments, such as circular mazes, have contributed to analyze critical aspects of freely moving human spatial navigation in real space, although dedicated protocols only allow for simple approaches. Here, we have developed both specifically designed and home-assembled hardware equipment, and a customized protocol for spatial navigation evaluation in freely moving humans in a real space circular arena. The spatial navigation protocol poses an imitation of a real-space multiple-choice path maze with cul-de-sac and instances of non-linear movement. We have compared the results of this system to those of a number of validated, both virtual and real, spatial navigation tests in a group of participants. The system composed by hardware, the test protocol, and dedicated measure analysis designed in our laboratory allows us to evaluate human spatial navigation in a complex maze with a small and portable structure, yielding a highly flexible, adaptable, and versatile access to information about the subjects’ spatial navigation abilities.

Patient navigator team perceptions on the implementation of a citywide breast cancer patient navigation protocol: a qualitative study

BackgroundIn 2018 Translating Research Into Practice (TRIP), an evidence-based patient navigation intervention aimed at addressing breast cancer care disparities, was implemented across six Boston hospitals. This study assesses patient navigator team member perspectives regarding implementation barriers and facilitators one year post-study implementation.MethodsWe conducted in-depth qualitative interviews at the six sites participating in the pragmatic TRIP trial from December 2019 to March 2021. Navigation team members involved with breast cancer care navigation processes at each site were interviewed at least 12 months after intervention implementation. Interview questions were designed to address domains of the Consolidated Framework for Implementation Research (CFIR), focusing on barriers and facilitators to implementing the intervention that included 1) rigorous 11-step guidelines for navigation, 2) a shared patient registry and 3) a social risk screening and referral program. Analysis was structured using deductive codes representing domains and constructs within CFIR.ResultsSeventeen interviews were conducted with patient navigators, their supervisors, and designated clinical champions. Participants identified the following benefits provided by the TRIP intervention: 1) increased networking and connections for navigators across clinical sites (Cosmopolitanism), 2) formalization of the patient navigation process (Goals and Purpose, Access to Knowledge and Information, and Relative Advantage), and 3) flexibility within the TRIP intervention that allowed for diversity in implementation and use of TRIP components across sites (Adaptability). Barriers included those related to documentation requirements (Complexity) and the structured patient follow up guidelines that did not always align with the timeline of existing site navigation processes (Relative Priority).ConclusionsOur analysis provides data using real-world experience from an intervention trial in progress, identifying barriers and facilitators to implementing an evidence-based patient navigation intervention for breast cancer care. We identified core processes that facilitated the navigators’ patient-focused tasks and role on the clinical team. Barriers encountered reflect limitations of navigator funding models and high caseload.Trial registrationClinical Trial Registration Number NCT03514433, 5/2/2018.

136 Implementing a Standardized Breast Cancer Patient Navigation Program to Advance Health Equity Across the City of Boston: Challenges and Opportunities

OBJECTIVES/GOALS: Translating Research into Practice (TRIP), a hybrid implementation pragmatic clinical trial and CTSA collaboration, aims to implement a standardized breast cancer patient navigation protocol across five sites in Boston, MA. The goal of this study was to assess individual and institutional barriers and facilitators to implementing this protocol. METHODS/STUDY POPULATION: From November 2019 to August 2020, researchers conducted ethnographic observations of Patient Navigators (PN) at three of the five participating sites. Each PN at each site was observed for two, four-hour blocks by researchers trained in ethnographic research. Observers took notes using TRIPs 11 Step Protocol as a guide, which includes identifying patients at risk for delays in care, screening and referring patients to resources for health-related social needs, and tracking patients across the care continuum. Fieldnotes were uploaded into Dedoose and coded deductively by four researchers using a comparison and consensus approach. Researchers analyzed the data to identify barriers and facilitators to both implementing each protocol step and maximizing navigations ability to promote health equity. RESULTS/ANTICIPATED RESULTS: Across all sites, PNs faced barriers to adhering to the TRIP Protocol due to practical workflow constraints including their level of engagement across the cancer care continuum. Although there are other staff members who engage in navigation activities, navigation is often viewed solely as the responsibility of the PN. Operationalizing navigation as a person rather than a process creates confusion around the role, and PNs are often seen as a catchall position when other staff do not know how to help a patient. The time that PNs spend on tasks unrelated to core navigation activities described in the TRIP Protocol prevents PNs from navigating patients most at risk for delays in care. A lack of continuity across the care continuum can create role confusion for the PNs. DISCUSSION/SIGNIFICANCE: Patient Navigation can promote health equity; however, any task that pulls PNs away from navigating patients most at risk for delays in care diminishes this potential. PNs abilities to enact the TRIP protocol, which they saw as valuable, is circumscribed by the extent to which navigation is operationalized as a process within the institution.

Grandparents Raising Grandchildren: Applying Bioecological Theory to School Relationships and Grandparent Needs

This paper examines the development, sustainability and importance of positive working relationships between grandparents raising grandchildren (“grandparents”) and school district staff through the application of Bronfenbrenner’s bioecological theory of human development. Grandparents have unique needs and often lack adequate resources, knowledge, and support when engaging in their new and often sudden role as primary caregiver of a grandchild. Access to educational resources, adequate information, and school district support is critical as a grandchild transitions into their grandparent’s home. This inquiry aims to develop a conceptual framework for understanding how forming and maintaining positive working relationships between grandparents and school district staff will systematically and adequately address the educational needs of grandparents and their grandchild’s academic success. Tenets of the bioecological model include the application of proximal processes that outline the need for frequent and regular interactions between a person and their environment over extended periods of time. The purpose of this study is to develop positive pathways of support through the application of the interconnected elements of proximal processes of the bioecological theory including process, person, context, and time, and the five bioecological interactive (micro-, meso-, exo-, macro-, chrono-) systems of human development. More specifically, educational needs of grandparents as caregivers are addressed through tenets of the bioecological theory to inform school districts and encourage the development of positive working relationships and effective education navigation protocols to better serve this unique and growing population.

AIS-based near-collision database generation and analysis of real collision avoidance manoeuvres

AbstractEconomic and technological development has increased the amount, density and complexity of maritime traffic, which has resulted in new challenges. One challenge is conforming to the distinct evasion manoeuvres required by vessels entering into near-collision situations (NCSs). Existing rules are vague and do not precisely dictate which, when and how collision avoidance manoeuvres (CAMs) should be executed. The automatic identification system (AIS) is widely used for vessel monitoring and traffic control. This paper presents an efficient, scalable method for processing large-scale raw AIS data using the closest point of approach (CPA) framework. NCSs are identified to create a database of historical traffic data. Important features describing CAMs are defined, estimated and analysed. Applications on a high-quality real-world data set show promising results for a subset of the identified situations. Future applications may play a significant role in the maritime regulatory framework, navigation protocol compliance evaluation, risk assessment, automatic collision avoidance, and algorithm design and testing for autonomous vessels.

Fluoroless intravascular ultrasound image-guided liver navigation in porcine models

BackgroundAn intravascular ultrasound catheter (IVUSc) was developed for intracardiac ultrasound to assess interventions with compelling results. However, intrahepatic vascular exploration was rarely tested and was always associated with X-ray techniques. The aim of this study was to demonstrate the feasibility to navigate through the whole liver using an IVUSc, providing high-quality images and making it unnecessary to use ionizing radiation.MethodsAn ex vivo pig visceral block and an in vivo pig model were used in this study. The IVUS equipment was composed of an US system, and of an 8 French lateral firing IVUSc capable of producing 90-degree sector images in the longitudinal plane. After accessing the intravascular space with the IVUSc into the models, predetermined anatomical landmarks were visualized from the inferior vena cava and hepatic veins and corroborated.ResultsIVUS navigation was achieved in both models successfully. The entire navigation protocol took 87 and 48 min respectively, and 100% (21/21) and 96.15% (25/26) of the landmarks were correctly identified with the IVUSc alone in the ex vivo and in vivo models respectively. IVUS allowed to clearly visualize the vasculature beyond third-order branches of the hepatic and portal veins.ConclusionsA complete IVUS liver navigation is feasible using the IVUSc alone, making it unnecessary to use ionizing radiation. This approach provides high-definition and real-time images of the complex liver structure and offers a great potential for future clinical applications during diagnostic and therapeutic interventions.