Pilot Effort Research Articles

Contextualising samples: supporting reference genomes of European biodiversity through sample and associated metadata collection

The European Reference Genome Atlas (ERGA) consortium aims to generate a reference genome catalogue for all of Europe's eukaryotic biodiversity. The biological material underlying this mission, the specimens and their derived samples, are provided through ERGA’s pan-European network. To demonstrate the community’s capability and capacity to realise ERGA’s ambitious mission, the ERGA Pilot project was initiated. In support of the ERGA Pilot effort to generate reference genomes for European biodiversity, the ERGA Sampling and Sample Processing committee (SSP) was formed by volunteer experts from ERGA’s member base. SSP aims to aid participating researchers through (i) establishing standards for and collecting of sample/specimen metadata; (ii) prioritisation of species for genome sequencing; and (iii) development of taxon-specific collection guidelines including logistics support. SSP serves as the entry point for sample providers to the ERGA genomic resource production infrastructure and guarantees that ERGA’s high-quality standards are upheld throughout sample collection and processing. With the volume of researchers, projects, consortia, and organisations with interests in genomics resources expanding, this manuscript shares important experiences and lessons learned during the development of standardised operational procedures and sample provider support. The manuscript details our experiences in incorporating the FAIR and CARE principles, species prioritisation, and workflow development, which could be useful to individuals as well as other initiatives.

Writing in Elementary Students With Language-Based Learning Disabilities: A Pilot Study to Examine Feasibility and Promise.

Although children with language-based learning disabilities (LLD) demonstrate significant difficulties with writing, empirical evidence to support interventions is sparse. Therefore, the purpose of this pilot study was to examine the feasibility and promise of a writing intervention for fourth- and fifth-grade students with LLD (WILLD: writing in students with LLD). The intervention components included word-, sentence-, and discourse-level writing processes and instructional practices using self-regulation strategies. Participants for this study were 15 students with LLD, recruited from three different schools. Students' writing was assessed using a sentence probe task and obtaining an informative paragraph writing sample as a measure of proximal writing outcomes. Trained speech-language pathologists (SLPs) and special educators delivered the intervention in a small-group format over 12 weeks. Using a within-group pre-post design, we examined changes in writing outcomes before and after the intervention. Results indicated that the intervention helped students improve their informative writing skills; students' writing quality showed a statistically significant increase, and grammatical errors showed a significant decrease. Evidence from this pilot effort indicates that WILLD was feasible and appears to show promise for improving writing outcomes for fourth- and fifth-grade students with LLD when delivered by SLPs and special educators in a small-group format. Implications of the results and directions for future research are discussed. https://doi.org/10.23641/asha.26053132.

Latest order in California prison suit will launch treatment pilot effort

Latest order in California prison suit will launch treatment pilot effort

A one health approach for monitoring antimicrobial resistance: developing a national freshwater pilot effort.

Antimicrobial resistance (AMR) is a world-wide public health threat that is projected to lead to 10 million annual deaths globally by 2050. The AMR public health issue has led to the development of action plans to combat AMR, including improved antimicrobial stewardship, development of new antimicrobials, and advanced monitoring. The National Antimicrobial Resistance Monitoring System (NARMS) led by the United States (U.S) Food and Drug Administration along with the U.S. Centers for Disease Control and U.S. Department of Agriculture has monitored antimicrobial resistant bacteria in retail meats, humans, and food animals since the mid 1990's. NARMS is currently exploring an integrated One Health monitoring model recognizing that human, animal, plant, and environmental systems are linked to public health. Since 2020, the U.S. Environmental Protection Agency has led an interagency NARMS environmental working group (EWG) to implement a surface water AMR monitoring program (SWAM) at watershed and national scales. The NARMS EWG divided the development of the environmental monitoring effort into five areas: (i) defining objectives and questions, (ii) designing study/sampling design, (iii) selecting AMR indicators, (iv) establishing analytical methods, and (v) developing data management/analytics/metadata plans. For each of these areas, the consensus among the scientific community and literature was reviewed and carefully considered prior to the development of this environmental monitoring program. The data produced from the SWAM effort will help develop robust surface water monitoring programs with the goal of assessing public health risks associated with AMR pathogens in surface water (e.g., recreational water exposures), provide a comprehensive picture of how resistant strains are related spatially and temporally within a watershed, and help assess how anthropogenic drivers and intervention strategies impact the transmission of AMR within human, animal, and environmental systems.

Intermittent boundary control for fixed-time stability of reaction–diffusion systems

This work is a pilot effort to investigate the fixed-time stability (FxTS) of reaction–diffusion systems under aperiodically intermittent boundary control (AIBC). The average control rate and a new Lyapunov function are proposed to overcome the challenges of handling the FxTS of reaction–diffusion systems with AIBC. Moreover, the proposed method is applicable to the study of finite-time stability and exponential stability of reaction–diffusion systems under AIBC. Based on the Wirtinger’s inequality and the Lyapunov method, a FxTS criterion for a reaction–diffusion system with AIBC is given. Finally, two examples are discussed along with the simulated results to verify the effectiveness of the proposed method.

Mapping invasive alien plants through citizen science: shortlisting species of concern for the Nilgiris

Species introduced from elsewhere are known as alien species. They may be introduced as crop plants or ornamental plants, or for timber. A small proportion of introduced species can become invasive thereby spreading at the cost of native species and habitats, negatively affecting biodiversity, food security, and human wellbeing. Despite the growing recognition of the threat of invasive alien species, we still lack information about the distribution and abundance of species widely accepted to be invasive. To address this information gap regarding invasive alien species distributions, we initiated a pilot citizen science effort to create an atlas of invasive plants in the Moyar-Bhavani landscape of the Nilgiri District. We aimed, through this pilot effort, to develop and test user-friendly mapping protocols and develop an interface for citizen scientists to use. Ultimately, we hope to create a model that can be scaled up to large conservation landscapes, such as the Western Ghats, the central Indian Highlands, and the Himalaya.

In Search of Alignment between Learning Analytics and Learning Design: A Multiple Case Study in a Higher Education Institution

Learning design (LD) has increasingly been recognized as a significant contextual element for the interpretation and adoption of learning analytics (LA). Yet, few studies have explored how instructors integrate LA feedback into their learning designs, especially within open automated feedback (AF) systems. This research presents a multiple-case study at one higher education institution to unveil instructors’ pilot efforts in using an open AF system to align LA and LD within their unique contexts, with the goal of delivering personalized feedback and tailored support. A notable finding from these cases is that instructors successfully aligned LA with LD for personalized feedback through checkpoint analytics in highly structured courses. Moreover, they relied on checkpoint analytics as an evaluation mechanism for evaluating impact. Importantly, students perceived a stronger sense of instructors’ support, reinforcing previous findings on the effectiveness of personalized feedback. This study contributes essential empirical insights to the intersection of learning analytics and learning design, shedding light on practical ways educators align LA and LD for personalized feedback and support.

A Flexible and Stretchable Temperature Sensor Based on Contact Electrification for Robotic Sensing

With the rapid development of robotic systems, an increasing number of various sensitive sensors are needed to meet the requirement of data collection for unmanned detection and monitoring technology. Among various external stimuli information, temperature sensing is an essential important function that can avoid high-temperature scalding injuries, achieve robot detection of environmental, and human-machine interfaces applications. However, most of the existing temperature sensors for robotic sensing are realized by rigid materials, which have the disadvantage of not being able to adapt to an arbitrarily curved surface. Also, most of the sensors are thermistor-based approaches, which faces challenges in developing a low-cost robotic system since external power is required to obtain the sensing signal. In this work, a self-powered and stretchable temperature sensor based on Triboelectric Nanogenerator (TENG) technology was developed. The principle of TENG is the coupling effect of triboelectric charge transfer and electrostatic induction effects, which can generate different magnitudes of electrical signals when subjected to external stimuli, including temperature. To this end, this study is a pilot effort toward validating the sensitivity of TENG electrical output on different temperature effects. The surface potential of materials is explored under different temperatures by Kelvin probe force microscopy (KPFM), which shows the feasibility of self-powered temperature sensor. The proposed temperature sensor is composed of highly resilient materials physiological saline as liquid electrode encapsulated with Ecoflex as triboelectric layer, which has the advantage of biocompatibility. The temperature sensing performance was successfully maintained at 200% stretch. Owing to its flexible, bendable and stretchable characteristics, the self-powered temperature-sensitive sensor has been successfully demonstrated on a robot hand, which can read the information and respond to different temperatures through the feedback system. Overall, this self-powered temperature-sensitive sensor has great potential to be an emerging tool for human-robot interaction and automatic detection.

UAS remote sensing applications to abrupt cold region hazards

Unoccupied aerial systems (UAS) are an established technique for collecting data on cold region phenomenon at high spatial and temporal resolutions. While many studies have focused on remote sensing applications for monitoring long term changes in cold regions, the role of UAS for detection, monitoring, and response to rapid changes and direct exposures resulting from abrupt hazards in cold regions is in its early days. This review discusses recent applications of UAS remote sensing platforms and sensors, with a focus on observation techniques rather than post-processing approaches, for abrupt, cold region hazards including permafrost collapse and event-based thaw, flooding, snow avalanches, winter storms, erosion, and ice jams. The pilot efforts highlighted in this review demonstrate the potential capacity for UAS remote sensing to complement existing data acquisition techniques for cold region hazards. In many cases, UASs were used alongside other remote sensing techniques (e.g., satellite, airborne, terrestrial) and in situ sampling to supplement existing data or to collect additional types of data not included in existing datasets (e.g., thermal, meteorological). While the majority of UAS applications involved creation of digital elevation models or digital surface models using Structure-from-Motion (SfM) photogrammetry, this review describes other applications of UAS observations that help to assess risks, identify impacts, and enhance decision making. As the frequency and intensity of abrupt cold region hazards changes, it will become increasingly important to document and understand these changes to support scientific advances and hazard management. The decreasing cost and increasing accessibility of UAS technologies will create more opportunities to leverage these techniques to address current research gaps. Overcoming challenges related to implementation of new technologies, modifying operational restrictions, bridging gaps between data types and resolutions, and creating data tailored to risk communication and damage assessments will increase the potential for UAS applications to improve the understanding of risks and to reduce those risks associated with abrupt cold region hazards. In the future, cold region applications can benefit from the advances made by these early adopters who have identified exciting new avenues for advancing hazard research via innovative use of both emerging and existing sensors.

Diabetic retinopathy in China: Epidemiology, screening and treatment trends-A review.

Diabetic retinopathy (DR) is the leading cause of vision impairment in the global working-age population. In China, with one-third of the world's diabetes population estimated at 141 million, the blindness prevalence due to DR has increased significantly. The country's geographic variations in socioeconomic status have led to prominent disparities in DR prevalence, screening and management. Reported risk factors for DR in China include the classic ones, such as long diabetes duration, hyperglycaemia, hypertension and rural habitats. There is no national-level DR screening programme in China, but significant pilot efforts are underway for screening innovations. Novel agents with longer durations, noninvasive delivery or multi-target are undergoing clinical trials in China. Although optimised medical insurance policies have enhanced accessibility for expensive therapies like anti-VEGF drugs, further efforts in DR prevention and management in China are required to establish nationwide cost-effective screening programmes, including telemedicine and AI-based solutions, and to improve insurance coverage for related out-of-pocket expenses.

Exchanging genomics reports between pathology labs and medical centers using the Minimal Clinical Oncology Data Element (mCODE) FHIR implementation guide.

e13575 Background: The automated transfer of discrete molecular data from pathology labs into the electronic health record (EHR) is rapidly becoming commonplace and is designed to facilitate clinical decision making. Simple genomic changes are represented in existing EHR data transfer standards, but current data standards lack clinical fields that correspond to treatment insights such as associated medications and potential clinical trials. To address this, the mCODE effort defines a consensus oncology data standard that facilitates lightweight transmission of data from patients with cancer. mCODE’s support of genomic data leverages efforts by the HL7 Clinical Genomics Working Group (HL7 CGWG) focusing on oncology. Here, we describe pilot efforts involving both a pathology partner and academic medical centers to extend mCODE FHIR (Fast Healthcare Interoperability Resources) implementation guide (IG) support of genomic data for data interchange and clinical decision support use cases. Methods: From 2021-2022, validation of the mCODE FHIR IG genomic data elements was performed in CodeX, a FHIR accelerator program. These elements encompassed: lab facility, test order information, pathologist, patient demographics, specimen, molecular studies and therapeutic implications. Genomic FHIR data elements were selected for their conciseness and clinical relevance for inclusion in the mCODE FHIR IG under the supervision of two oncology informaticians. As part of the mCODE FHIR IG pilot, synthetic solid tumor molecular patient reports were generated by Tempus Labs. These synthetic molecular reports were transformed into mCODE-conformant FHIR files for transfer. The mCODE IG can be found at http://hl7.org/fhir/us/mcode/ . Results: Over 50 Tempus data elements were analyzed and found to be readily mapped to mCODE genomics elements. Two categories of data elements required additional transformation: 1. Data elements requiring additional genomic database annotations; 2. FHIR syntax constraints like the concatenation of medications in the same drug class. The mCODE file was transmitted to Vanderbilt and the Children's Hospital LA from Tempus for decoding and downstream uses. This effort further informed the HL7 CGWG of needed IG clarifications for compatibility with other standardization efforts and genomic use cases. Conclusions: mCODE’s support of genomic data elements provides a lightweight genomics interchange standard compatible with an existing pathology lab report. Mapping from existing molecular pathology reports to mCODE required nominal alterations. Furthermore, mCODE’s alignment with HL7 genomics efforts ensure FHIR-based compatibility in other clinical domains and with developing international standards. Continued pathology lab and academic medical center collaboration is essential for mCODE refinement and adoption.

Kindling Research Competence Development in a University: Reflections on a Pilot Effort

Kindling Research Competence Development in a University: Reflections on a Pilot Effort

Remains Containment Considerations for Death in Low-Earth Orbit

BACKGROUND: Maintenance and disposition of decedent remains during spaceflight require the isolation of biohazardous products of decomposition in microgravity and in the absence of refrigeration. Containment and isolation options would preferably offer sufficient time to enable crew and ground support teams to determine appropriate disposition of remains and even potentially return remains to the Earth. The pilot study described herein undertook an effort to develop a postmortem containment unit for the isolation and maintenance of decedent remains in a microgravity environment.METHODS: Commercial off-the-shelf containment units were modified to meet the needs of a microgravity spaceflight environment and to offer the best likelihood of successful containment and management of remains. A subsequent evaluation of modified containment unit performance was undertaken utilizing human cadavers, with measurement and analysis of volatile off-gassing over time followed by impact testing of the units containing cadaverous remains in a simulated spaceflight vehicle seat.RESULTS: Modifications were implemented without significant negative design impact. Failure was observed in one modified unit after 9 d and attributed to improper filter application. The remaining unit successfully contained remains beyond the intended endpoint of the study.DISCUSSION: These pilot efforts offer important insight into the development of effective postmortem containment options for future spaceflight. Further study is needed to ensure repeatability of the findings and to further characterize the failure modes of the modified units evaluated, the impact of microgravity conditions, and the identification of additional modifications that would improve remains disposition.Houser T, Lindgren KN, Mazuchowski EL II, Barratt MR, Haines DC, Jayakody M, Blue RS, Bytheway JA, Stepaniak PC. Remains containment considerations for death in low-Earth orbit. Aerosp Med Hum Perform. 2023; 94(5):368-376.

Olfactory neuronal cells as a promising tool to realize the "druggable genome" approach for drug discovery in neuropsychiatric disorders.

"Druggable genome" is a novel concept that emphasizes the importance of using the information of genome-wide genetic studies for drug discovery and development. Successful precedents of "druggable genome" have recently emerged for some disorders by combining genomic and gene expression profiles with medical and pharmacological knowledge. One of the key premises for the success is the good access to disease-relevant tissues from "living" patients in which we may observe molecular expression changes in association with symptomatic alteration. Thus, given brain biopsies are ethically and practically difficult, the application of the "druggable genome" approach is challenging for neuropsychiatric disorders. Here, to fill this gap, we propose the use of olfactory neuronal cells (ONCs) biopsied and established via nasal biopsy from living subjects. By using candidate genes that were proposed in a study in which genetic information, postmortem brain expression profiles, and pharmacological knowledge were considered for cognition in the general population, we addressed the utility of ONCs in the "druggable genome" approach by using the clinical and cell resources of an established psychosis cohort in our group. Through this pilot effort, we underscored the chloride voltage-gated channel 2 (CLCN2) gene as a possible druggable candidate for early-stage psychosis. The CLCN2 gene expression was associated with verbal memory, but not with other dimensions in cognition, nor psychiatric manifestations (positive and negative symptoms). The association between this candidate molecule and verbal memory was also confirmed at the protein level. By using ONCs from living subjects, we now provide more specific information regarding molecular expression and clinical phenotypes. The use of ONCs also provides the opportunity of validating the relationship not only at the RNA level but also protein level, leading to the potential of functional assays in the future. Taken together, we now provide evidence that supports the utility of ONCs as a tool for the "druggable genome" approach in translational psychiatry.

A biopsychosocial-spiritual wellness check program for internal medicine residents: A brief report.

The pandemic has significantly impacted medical residents. We created and implemented a biannual biopsychosocial-spiritual Wellness Check Program (WCP) to help internal medicine residents self-assess for burnout, enhance resilience, and to promote early identification and referral to mental health services. We report the preliminary findings from our quality improvement pilot effort at Loma Linda University Health (LLUH). Residents participated in biannual sessions with licensed therapists employed by Loma Linda University, Office of Physician Vitality (OPV). Visits consisted of an evidence-guided discussion about general wellbeing, relationships, family life, coping strategies, and referrals. Archived, confidential WCP session notes between July 1, 2019 and December 31, 2019 were reviewed and a simple tally system was used to record coping strategies, concerns, and referrals made. Partner and family issues were the most prevalent concern, followed by mental health issues, and relationships with colleagues, faculty, or staff. Most residents described several coping strategies: 66.36% listed two to three, and 26.36% listed four or more. Referrals were offered to community or employee assistance program therapists, follow-up with the OPV, psychiatry, couple counseling, given Web based psychoeducational links, or referred to their program director. Nine other residencies requested the WCP providing anecdotal evidence of its feasibility and usefulness. As the pandemic surged, these visits normalized reflections about wellbeing, intentional coping strategies, and resilience practices. We continue to gather data to refine and further structure this program and help residents monitor and address their resilience needs and wellness. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Biannual Administration of a Slide Exam to Residents to Prepare them for Board Examinations: A Pilot Effort

Abstract Introduction/Objective To enhance surgical pathology education and allow residents to self-assess their progress, a pilot effort was made to twice a year administer a slide exam simulating the microscopic component of the American Board of Pathology anatomic pathology examination to a cohort of residents. Methods/Case Report The subjects were pathology residents in a mid-size academic program typically consisting of 12 residents. The quizzes were held twice a year from fall 2019 to fall 2021. In the fall of 2019, the exam consisted of 20 glass slides with accompanying history for which the residents were required to provide a free text diagnosis. After the onset of the coronavirus pandemic, the exam was transitioned to virtual microscopy using whole slide imaging similar to the board exam. The answers of the trainees were graded in comparison to the clinical diagnoses. The residents’ opinions of the exercise were anonymously assessed via a survey. Results (if a Case Study enter NA) Overall, resident performance roughly correlated with post-graduate year with a gradual improvement in performance every year. All residents agreed (with 84.1% of them “strongly” agreeing) that this exercise benefited their education. After two years of seasonal examination, there was an increasing trend showing more residents, including junior ones, becoming more confident in their preparation for the anatomic pathology board exam. Conclusion Though the sample size in this study is small, it demonstrates that regular administration of a slide exam to residents can be used to help residents assess their progress and help them feel more confident in their preparation and training for board exams.

Evaluating the feasibility of the Community Score Card and subsequent contraceptive behavior in Kisumu, Kenya

BackgroundWomen seeking family planning services from public-sector facilities in low- and middle-income countries sometimes face provider-imposed barriers to care. Social accountability is an approach that could address provider-imposed barriers by empowering communities to hold their service providers to account for service quality. Yet little is known about the feasibility and potential impact of such efforts in the context of contraceptive care. We piloted a social accountability intervention—the Community Score Card (CSC)—in three public healthcare facilities in western Kenya and use a mix of quantitative and qualitative methodologies to describe the feasibility and impact on family planning service provision.MethodsWe implemented and evaluated the CSC in a convenience sample of three public-sector facility-community dyads in Kisumu County, Kenya. Within each dyad, communities met to identify and prioritize needs, develop corresponding indicators, and used a score card to rate the quality of family planning service provision and monitor improvement. To ensure young, unmarried people had a voice in identifying the unique challenges they face, youth working groups (YWG) led all CSC activities. The feasibility and impact of CSC activities were evaluated using mystery client visits, unannounced visits, focus group discussions with YWG members and providers, repeated assessment of score card indicators, and service delivery statistics.ResultsThe involvement of community health volunteers and supportive community members – as well as the willingness of some providers to consider changes to their own behaviors—were key score card facilitators. Conversely, community bias against family planning was a barrier to wider participation in score card activities and the intractability of some provider behaviors led to only small shifts in quality improvement. Service statistics did not reveal an increase in the percent of women receiving family planning services.ConclusionSuccessful and impactful implementation of the CSC in the Kenyan context requires intensive community and provider sensitization, and pandemic conditions may have muted the impact on contraceptive uptake in this small pilot effort. Further investigation is needed to understand whether the CSC – or other social accountability efforts – can result in improved contraceptive access.

The Pacific Drought Knowledge Exchange: A Co-Production Approach to Deliver Climate Resources to User Groups

Drought is a growing threat to hydrological, ecological, agricultural, and socio-cultural systems of the tropics, especially tropical islands of the Pacific where severe droughts can compromise food and water security. Overcoming barriers to knowledge sharing between land managers and researchers is a critical cross-sector strategy for engaging and mitigating or adapting to drought. Here we describe the establishment and functioning of the Pacific Drought Knowledge Exchange (PDKE), which provides users with easier access to: (1) sector- and geography-specific climate information; (2) better and more comprehensive information; (3) improved technical assistance; and (4) a more collaborative information-transfer environment through participation in knowledge co-production. We focus on our collaborative work with managers of important tropical dryland ecosystems from three distinct geographies to pilot the collaborative development of climate change, climate variability, and drought “portfolios” featuring site-specific historical and forecasted future information. This information was then used to collaboratively produce factsheets that partners used to: (i) better understand past and projected climate for specific management units; (ii) integrate new climate knowledge into management planning; and (iii) support climate-focused educational and outreach efforts. This pilot effort demonstrates the successful application of climate-focused co-production in dry tropical landscapes.

PheNominal: an EHR-integrated web application for structured deep phenotyping at the point of care

BackgroundClinical phenotype information greatly facilitates genetic diagnostic interpretations pipelines in disease. While post-hoc extraction using natural language processing on unstructured clinical notes continues to improve, there is a need to improve point-of-care collection of patient phenotypes. Therefore, we developed “PheNominal”, a point-of-care web application, embedded within Epic electronic health record (EHR) workflows, to permit capture of standardized phenotype data.MethodsUsing bi-directional web services available within commercial EHRs, we developed a lightweight web application that allows users to rapidly browse and identify relevant terms from the Human Phenotype Ontology (HPO). Selected terms are saved discretely within the patient’s EHR, permitting reuse both in clinical notes as well as in downstream diagnostic and research pipelines.ResultsIn the 16 months since implementation, PheNominal was used to capture discrete phenotype data for over 1500 individuals and 11,000 HPO terms during clinic and inpatient encounters for a genetic diagnostic consultation service within a quaternary-care pediatric academic medical center. An average of 7 HPO terms were captured per patient. Compared to a manual workflow, the average time to enter terms for a patient was reduced from 15 to 5 min per patient, and there were fewer annotation errors.ConclusionsModern EHRs support integration of external applications using application programming interfaces. We describe a practical application of these interfaces to facilitate deep phenotype capture in a discrete, structured format within a busy clinical workflow. Future versions will include a vendor-agnostic implementation using FHIR. We describe pilot efforts to integrate structured phenotyping through controlled dictionaries into diagnostic and research pipelines, reducing manual effort for phenotype documentation and reducing errors in data entry.

What to Expect When You Don’t Know What You are Expecting: Vigilance and the Monitoring and Evaluation of an Uncertain World

Complexity and uncertainty are long-standing challenges for global development projects. Coping with both requires flexibility and adaptation, the ability to identify unexpected circumstances, seize opportunities, and respond to threats. Vigilance is critical; it resides within the domains of monitoring, evaluation, and learning. In practice, maintaining vigilance is difficult, partly because effective vigilance has a dual nature. Normal, Type 1 vigilance, is anchored in knowing what to look for. It demands focus and attention to designated indicators. Type 2 vigilance looks for what project preparations failed to anticipate. It demands defocusing and openness; it sits outside contemporary design of monitoring and evaluation as it must question the assumptions in project design and implementation. We consider the role of both types of vigilance in global development and difficulties in maintaining both simultaneously. We identify pathways for improving the practice of vigilance and suggest practical steps in a template for pilot efforts.