Pilot Experience Research Articles

Leveraging VA geriatric emergency department accreditation to improve elder abuse detection in older Veterans using a standardized tool.

Elder abuse (EA) is common and has devastating health impacts, yet most cases go undetected limiting opportunities to intervene. Older Veterans receiving care in the Veterans Health Administration (VHA) represent a high-risk population for EA. VHA emergency department (ED) visits provide a unique opportunity to identify EA, as assessment for acute injury or illness may be the only time isolated older Veterans leave their home, but most VHA EDs do not have standardized EA assessment protocols. To address this, we assembled an interdisciplinary team of VHA social workers, physicians, nurses, intermediate care technicians (ICTs; former military medics and corpsmen who often conduct screenings in VHA EDs) and both VHA and non-VHA EA subject matter experts to adapt the Elder Mistreatment Screening and Response Tool (EM-SART) to pilot in the Louis Stokes Cleveland VA Medical Center geriatric ED (GED) program. The cornerstone of their approach is an interdisciplinary GED consultation led by ICTs and nurses who screen high-risk older Veterans for geriatric syndromes and unmet needs. The adapted EM-SART was integrated into the electronic health record and GED workflow in December 2020. By July 2022, a total of 251 Veterans were screened with nine (3.6%) positive on the prescreen and five (2%) positive on the comprehensive screen. Based on the first-year pilot experience, the interdisciplinary team was expanded and convened regularly to further adapt the EM-SART for wider use in VHA, including embedding flexibility for both licensed and nonlicensed clinicians to complete the screening tool and tailoring response options to be specific to VHA policy and resources. The national momentum for VHA EDs to improve care for older Veterans and secure GED accreditation offers unique opportunities to embed this evidence-based approach to EA assessment in the largest integrated health system in the United States.

Mobile Money and the importance of timely, complete payments to frontline health campaign workers in the fight to eradicate polio: pilot experience from a World Health Organization digital payment platform in Africa

BackgroundIn response to the increase in vaccine-derived poliovirus type 2 in Côte d’Ivoire, Mali, and many other African countries from 2017 to 2019, concentrated efforts are needed to improve the effectiveness of vaccination campaigns. Frontline polio health campaign worker engagement and job retention are critical to successful campaign implementation, as well as timely, in-full payment to these workers via an electronic system.MethodsThe Global Polio Eradication Initiative and its partners designed a road map to implement the World Health Organization Mobile Money digital payment system for health campaign workers across designated African Region countries and country-specific areas. The road map included: (1) strategy communication about Mobile Money to key stakeholders; (2) prioritization of Mobile Money pilot countries; (3) establishment of a digital finance team to support Mobile Money rollout for polio campaigns; (4) implementation of Mobile Money in select pilot areas; and (5) documentation by the digital finance team of Mobile Money implementation across pilot areas. At the country-specific level, and as described in the first pilot campaign in Côte d’Ivoire, implementation of Mobile Money occurred in 3 phases: precampaign, campaign, and postcampaign.ResultsMobile Money was piloted in Côte d’Ivoire, Democratic Republic of the Congo, Ghana, Mali, and Republic of the Congo. Although program reach varied by country, the percentages of payments successfully made via Mobile Money in pilot countries were high: In campaign round 1, 99% of campaign workers in 2 regions in Mali, and 99% of campaign workers in 5 districts in Ghana were paid successfully. In Cote d’Ivoire, Mobile Money was piloted in all 113 districts for campaign rounds 1, 2 and 3, and in 4 districts in Abidjan for campaign round 3. In rounds 1, 2 and 3, 99.6%, 99.6%, and 99.9% of payments to polio health campaign workers, respectively, were made successfully.ConclusionImplementation of the Mobile Money pilot program, particularly across Côte d’Ivoire, demonstrates the value of an electronic payment system in addressing frontline polio health campaign worker need for timely, in-full payment. The World Health Organization-led Mobile Money pilot program can serve as a model for agencies committed to delivering greater efficiencies and improved health campaigns in resource-challenged settings.

Development of Digital Teaching Competence: Pilot Experience and Validation through Expert Judgment

The development of digital teaching competence is one of the fundamental requirements of what is known as the “knowledge society”. With the aim of evaluating, from an expert point of view, the design of a training itinerary oriented to the training development of non-university teachers under the t-MOOC architecture for the improvement of digital teaching competence (DTC), the following quantitative research is presented. For this purpose, a quantitative validation design was established using the expert judgement technique. To measure the level of the expert coefficient, the expert competence (K) index was calculated for a random sample of 292 subjects participating in the study: teachers belonging to preschool and primary schools in the Andalusian community. The responses of those experts who scored ≥0.8 on the external competence index were then selected. The results demonstrate the validity of the tool produced (T-MOOC) as well as the uniformity of the criteria of the experts participating in the evaluation. Consequently, the necessary structuring of personalised training plans supported by reference models is discussed.

GammaTile® (GT) as a brachytherapy platform for rapidly growing brain metastasis.

A subset of brain metastasis (BM) shows rapid recurrence post-initial resection or aggressive tumor growth between interval scans. Here we provide a pilot experience in the treatment of these BM with GammaTile® (GT), a collagen tile-embedded Cesium 131 (131Cs) brachytherapy platform. We identified ten consecutive patients (2019-2023) with BM that showed either (1) symptomatic recurrence while awaiting post-resection radiosurgery or (2) enlarged by >25% of tumor volume on serial imaging and underwent surgical resection followed by GT placement. Procedural complication, 30-day readmission, local control, and overall survival were assessed. For this cohort of ten BM patients, 3 patients suffered tumor progression while awaiting radiosurgery and 7 showed >25% tumor growth prior to surgery and GT placement. There were no procedural complications or 30-day mortality. All patients were discharged home, with a median hospital stay of 2 days (range: 1-9 days). 4/10 patients experienced symptomatic improvement while the remaining patients showed stable neurologic conditions. With a median follow-up of 186 days (6.2 months, range: 69-452 days), no local recurrence was detected. The median overall survival (mOS) for the newly diagnosed BM was 265 days from the time of GT placement. No patients suffered from adverse radiation effects. Our pilot experience suggests that GT offers favorable local control and safety profile in patients suffering from brain metastases that exhibit aggressive growth patterns and support the future investigation of this treatment paradigm.

A Pilot Experience with Improvisational Theater to Reduce Burnout in Psychiatric Residency

A Pilot Experience with Improvisational Theater to Reduce Burnout in Psychiatric Residency

Microsurgical revascularization of a symptomatic proximal vertebral artery: pilot experiences from a single center.

Vertebral artery stenosis and occlusion (VASO) is a high-risk factor for posterior circulation stroke. Post-stent restenosis and drug tolerance have facilitated the exploration of microsurgical vascular reconstruction. This study aims to evaluate the safety and efficacy of microsurgical reconstruction of the proximal VA. Twenty-nine patients (25 men, aged 63.2 years) who had symptoms of posterior circulation ischemia underwent microsurgical revascularization for proximal VASO were retrospectively included in this study. Procedural complications and clinical and angiographic outcomes were reviewed. Twelve, three, and five patients underwent VA endarterectomy, artery transposition, or both, respectively; seven patients underwent vertebral endarterectomy plus stent implantation; and two patients failed surgery because of the difficult exposure of the VA and the occurrence of vascular dissection. The perioperative period-related complications included seven cases of Horner's syndrome, five cases of hoarseness, and one case of chylothorax. No cases of perioperative stroke or death were reported. The mean follow-up period was 28.4 (8-62 months). Most patients improved clinically; however, the vertebrobasilar ischemia symptoms did not decrease significantly in two patients during the follow-up. Moreover, follow-up imaging was performed in all the patients, and no signs of anastomotic stenosis were reported. Microsurgical reconstruction is an alternative option that can effectively treat refractory proximal VASO disease and in-stent stenosis, with a high rate of postoperative vascular recirculation. Prospective cohort studies with larger sample sizes must be conducted to validate the above conclusions.

Comparison of Muscle Biopsy Features with Myositis Autoantibodies in Inflammatory Myopathies: A Pilot Experience

Abstract Background: Idiopathic inflammatory myopathies (IIM), also called autoimmune myositis, are heterogeneous. These include dermatomyositis (DM), inclusion body myositis, immune mediated necrotizing myopathy (IMNM), anti-synthetase syndrome (ASS), and overlap polymyositis. Classification of IIM has evolved from clinical to clinico-pathologic to the recent clinico-sero-pathologic with the discovery of myositis-specific antibodies (MSA) and myositis-associated antibodies. The various antibodies have shown association with specific phenotypes. Objective: To analyze muscle biopsy features with respect to each MSA and MAA to understand the frequency of findings in each entity. Materials and Methods: Biopsy-proven cases of IIM where myositis profile was available were included in the study after obtaining Institutional Ethics Committee (IEC) approval. In addition to the stains and enzyme histochemistry, immunohistochemistry with MHC class I and II and MxA was performed. Features like perifascicular atrophy, perifascicular necrosis, scattered necrosis, inflammation, etc. were analyzed. Myositis profile was performed by line-blot technique using a 16-antigen panel. Cases were divided into different autoantibody subgroups. Various clinical, demographic, and muscle biopsy features were studied with respect to each MSA and MAA. Results: There were a total of 64 cases. Mi2 (N = 18) was the most common autoantibody. Some of the salient observations included PFA with perivascular inflammation in Mi2; pediatric cases and microinfarcts in NXP2; no PFA or inflammation in MDA5; perifascicular necrosis in JO1; extensive necrosis with sparse inflammation in SRP; more inflammation in overlap myositis; MxA positivity in DM; and absent in ASS. Conclusion: This is a pilot study documenting differences in biopsy phenotype with each MSA and MAA which is comparable to the literature. These findings can be used to characterize IIM in seronegative biopsies.

Newborn screening for sickle cell disease in Butembo and Beni: a pilot experience in a highland region of the Democratic Republic of Congo.

sickle cell disease is an inherited autosomal recessive hemoglobin disorder resulting in acute and chronic systemic complications. Despite the high burden of sickle cell disease in the Democratic Republic of the Congo, limited data on disease prevalence is available and systematic screening is not offered to newborns. This study aimed to provide neonatal prevalence and associated factors to the phenotypic manifestation of sickle cell disease in an eastern region of the Democratic Republic of the Congo. the study was conducted from 20th April 2021 to 20th January 2022 in the cities of Beni and Butembo, involving live full-term newborns whose parents consented to participate. Blood was taken with heel pricks and analyzed using the point-of-care diagnostic tool HemoTypeSC™. We used Fisher´s exact test to compare frequencies between groups. P-value <0.05 was considered statistically significant. Results: of the 1195 newborns screened, 1122 (93.9%) were tested as having hemoglobin AA, 71 (5.9%) hemoglobin AS, 2 (0.2%) hemoglobin SS and none hemoglobin C. The mother´s ethnicity was significantly associated with the phenotypic expression of sickle cell disease. sickle cell disease prevalence is lower in Butembo and Beni than in other regions of the Democratic Republic of the Congo. However, it remains an alarming public health issue. Systematic newborn screening, parent/patient education and early management programs constitute an urgent need to be addressed by decision-makers.

Content validity for an autobiographical interview for older adults.

To validate a proposal for an autobiographical interview oriented to the typical older adult. Questions for a semi-structured autobiographical memory interview were designed and a protocol for its application was developed. Fourteen Speech and Language Pathologists judges and 14 older adults were used. Additionally, 2 interviews were conducted. Subsequently, content validity was obtained by means of Lawshe's classic procedure. Also, using a complementary evaluation for comprehensibility and length of the interview, as well as a data triangulation procedure with the judges and participants of the pilot experience. Of the 22 items evaluated, only 4 were above the critical reference value (0.49). The need to incorporate this measure of analysis in the context of respect, identity and agency of older adults is discussed as part of a change in thinking under the gaze of person-centered care and a communicative competence model. As well as the need to incorporate different cultural paradigms and the use of digital technologies.

Validez de contenido para una entrevista autobiográfica para adultos mayores

ABSTRACT Purpose To validate a proposal for an autobiographical interview oriented to the typical older adult. Methods Questions for a semi-structured autobiographical memory interview were designed and a protocol for its application was developed. Fourteen Speech and Language Pathologists judges and 14 older adults were used. Additionally, 2 interviews were conducted. Subsequently, content validity was obtained by means of Lawshe's classic procedure. Also, using a complementary evaluation for comprehensibility and length of the interview, as well as a data triangulation procedure with the judges and participants of the pilot experience. Results Of the 22 items evaluated, only 4 were above the critical reference value (0.49). Conclusion The need to incorporate this measure of analysis in the context of respect, identity and agency of older adults is discussed as part of a change in thinking under the gaze of person-centered care and a communicative competence model. As well as the need to incorporate different cultural paradigms and the use of digital technologies.

La culture d'agrumes dans les communautés agricoles chiliennes : Vers un développement durable

Cet article souligne l'importance des agrumes dans les communautés agricoles de la Province de Limarí du point de vue du développement agricole durable dans ces communautés, en soulignant les résultats de l'expérience des cultivateurs ruraux. D'abord, l'état de développement de la culture des agrumes au Chili est décrit. Ensuite, cette activité est traitée dans la perspective des communautés agricoles de Limarí. En troisième lieu, nous analysons une analyse pilote de la culture des agrumes dans la communauté agricole. Ce travail souligne l'attrait que présente le secteur des agrumes pour les communautés agricoles, en particulier la commercialisation du traditionnel citron jaune. Il se penche aussi sur l'implantation de programmes d'éducation agro-environnementale parmi ses habitants pour promouvoir le soin des ressources naturelles comme l'eau et la terre. La croissance et le développement de la culture des agrumes dans les communautés agricoles de Limarí doivent être consistants, avec une analyse de la disponibilité de ces ressources et leur utilisation responsable.

Pilot experience using a portable electrocardiography device for atrial fibrillation detection in an outpatient stroke clinic.

Pilot experience using a portable electrocardiography device for atrial fibrillation detection in an outpatient stroke clinic.

The Third Half: A Pilot Study Using Evidence-Based Psychological Strategies to Promote Well-Being among Doctoral Students

Over the last few years, various studies have reported decreasing well-being levels among doctoral students, who show a higher risk of suffering from psychological distress than the general population. Accordingly, European policies in higher education encourage well-being promotion programs among doctoral studies to enhance young researchers' well-being. However, programs using evidence-based practices for well-being promotion are not yet generalised in public universities. The present study describes a pilot experience designed to evaluate the efficacy of a well-being program among doctoral candidates of a public European university, the Autonomous University of Barcelona. 25 doctoral students (67% women) participated in a pre-post study consisting of six sessions of 3 h each and structured by the big five criteria coming from evidence-based practices for well-being promotion: outdoor green spaces exposure, physical activity, gamification, mentoring, positive and coaching psychology techniques. Results showed how participants experienced significant increases in several indicators of emotional well-being and decreased psychological distress after the Third Half program. These positive pilot results encourage further research and future replications to assess the impact of this evidence-based psychological program among the academic community. Results also lead the way towards the creation of healthier academic workplaces by implementing cost-effective interventions that improve researchers' psychosocial support and their overall well-being.

Bituminous pavement overlay of a porous asphalt mixture with ladle furnace slag: a pilot project.

This paper presents a pilot experience of applying a novel, high-performance and sustainable material for pavements: a Porous Asphalt (PA) mixture that incorporates Ladle Furnace Slag (LFS). The overlay of a thin surface layer of this material was applied to an existing bituminous pavement. The main investigative results included the validation of the laboratory mix design through large-scale mixing, laying, and compacting, followed by extensive laboratory and field tests. The results showed that the incorporation of up to 10% LFS in porous asphalt mixtures was feasible, with no need for preliminary physical or chemical treatments. The tests on the sustainable PA mixture revealed that its voids content, wear resistance, moisture susceptibility, and skid resistance were within regulatory limits. Neither workability nor compactability issues were observed in the execution of the pavement, and no ridging, rutting, cracking, or stripping were visible on the surface during the first months of use.

The Development of Rule-based AI Engagement Model for Air-to-Air Combat Simulation

Since the concept of Manned-UnManned Teaming(MUM-T) and Unmanned Aircraft System(UAS) can efficiently respond to rapidly changing battle space, many studies are being conducted as key components of the mosaic warfare environment. In this paper, we propose a rule-based AI engagement model based on Basic Fighter Maneuver(BFM) capable of Within-Visual-Range(WVR) air-to-air combat and a simulation environment in which human pilots can participate. In order to develop a rule-based AI engagement model that can pilot a fighter with a 6-DOF dynamics model, tactical manuals and human pilot experience were configured as knowledge specifications and modeled as a behavior tree structure. Based on this, we improved the shortcomings of existing air combat models. The proposed model not only showed a 100 % winning rate in engagement with human pilots, but also visualized decision-making processes such as tactical situations and maneuvering behaviors in real time. We expect that the results of this research will serve as a basis for development of various AI-based engagement models and simulators for human pilot training and embedded software test platform for fighter.

Hybrid positron emission tomography and magnetic resonance imaging in cardiac sarcoidosis diagnosis: a pilot experience

Hybrid positron emission tomography and magnetic resonance imaging in cardiac sarcoidosis diagnosis: a pilot experience

End-to-end test for lung SBRT: An Italian multicentric pilot experience

PurposeSet up a lung SBRT end-to-end (e2e) test and perform a multicentre validation. Material and methodsA group of medical physicists from four hospitals and the Italian Institute of Ionizing Radiation Metrology designed the present e2e test. One sub-group set up the test, while another tested its feasibility and ease of use. A satisfaction questionnaire was used to collect user feedback.Each participating centre (PC) received the ADAM breathing phantom, a microDiamond detector and radiochromic films. Following the e2e protocol, each PC performed its standard internal procedure for simulating, planning, and irradiating the phantom. Each PC uploaded its planning and treatment delivery data in a shared Google Drive. A single centre analyzed all the data. ResultsThe e2e test was successfully performed by all PCs. Participants' comments indicated that ADAM was well suited to the purpose and the protocol well described. All PCs performed the test in static and dynamic modes. The ratio between measured and planned point dose obtained by PC1, PC2, PC3, PC4 was: 0.99, 0.96, 1.01 and 1.01 (static track) and 0.99, 1.02, 1.01 and 0.94 (dynamic track). The gamma passing rates (3 % global, 3 mm) between planned and measured dose maps were 98.5 %, 94.0 %, 99.1 % and 94.0 % (static track) and 99.5 %, 96.5 %, 86.0 % and 94.5 % (dynamic track) for PC1, PC2, PC3 and PC4, respectively. ConclusionsAn e2e test for lung SBRT has been proposed and tested in a multicentre framework. The results and user feedback prove the validity of the proposed e2e test.

Enhancing Childhood Cancer Care In African Low-Middle Income Countries: A Tunisian Pilot Experience

<h3>Objectives</h3> Paediatric radiotherapy in African countries faces many challenges mainly due to socio-economic issues and scarcity of dedicated paediatric radiation oncologists. The IAEA is promoting paediatric radiation oncology through short fellowships programs within the framework of RAF6055 project. The Tunisian pilot experience integrated these fellows from French speaking countries into a 6-week Masterclass dedicated to paediatric radiotherapy. The program aimed to promote effective collaboration between African LMIC to improve the quality of paediatric radiotherapy practices. <h3>Methods</h3> Sessionswere organized by the Radiation Oncology Department of Abderrahmen Mami Teaching Hospital, under the auspices of the Tunisian Society of Radiation Oncology (STOR) and Faculty of Medicine of Tunis. Participants included Tunisian residents, African radiation oncologists involved in childhood cancer care, medical physicists and RTT's. The training program course materiel and practicum covered indications, techniques of irradiation and contouring workshops in most frequent childhood cancers. Courses were given by international and national experts in paediatric radiotherapy. Sessions were live-streamed in order to widen the knowledge access. Weekly contouring workshops were organized using an online platform (Proknow Elekta®) and aimed to learn the guidelines and best practices proposed by the experts and further integrate them into daily practice. A thirty-item survey was distributed to participants to evaluate the program's efficiency and impact on their clinical practice. <h3>Results</h3> A total of 35 participants attended the training program mainly from north and west Africa. Clinical areas covered by the program were considered relevant to learning objectives by 86.7% of participants. Overall organisation, including course quality, allocated time, dedicated technical material and expert's availability, was satisfying according to 93.3% of attendees. All participants reported a substantial benefit of the training program in term of updating knowledge and improving technical skills in paediatric radiotherapy. <h3>Conclusion</h3> Strengthening collaboration between African countries through targeted training programs is an accessible cost-effective strategy to improve childhood cancer care. Every effort should be made to promote these programs and support the role of existing paediatric radiation oncologists in these regions.

AI Curriculum for European High Schools: An Embedded Intelligence Approach

AbstractThis paper presents a proposal of specific curriculum in Artificial Intelligence (AI) for high school students, which has been organized as a two-year subject. The curriculum was designed based on two premises. The first one is that, although the proposal is targeted to scientific programmes, the involved students and teachers do not have any previous knowledge about AI. Accordingly, the teaching units have been designed with the aim of supporting teachers in a new discipline for them and, in addition, providing an introductory level to students. The main didactical objective is to establish the fundamentals of AI from a practical perspective, learning technical concepts by using them to solve specific problems. The approach that has been followed in the teaching units is focused on developing embedded intelligence solutions, that is, programming real-world devices which interact with real environments. To this end, and to address a second fundamental premise of low investment capability at schools, it has been decided to use Smartphones as the central technological element to implement such embedded intelligence at classes. This curriculum has been developed within the Erasmus + project entitled "AI + : Developing an Artificial Intelligence Curriculum adapted to European High School". The project was carried out by a team of AI experts and high school teachers who created the teaching units, and a group of students that tested them for three years, providing feedback to make the curriculum feasible for its introduction in schools in the short-term. The main results obtained from its implementation within the project scope are presented and discussed here, with the aim of contributing to the AIEd community progress by means of a practical pilot experience. Although the curriculum has been designed and tested at European level, it has been created with a general perspective of AI education, so it can be applied worldwide.

Improving Quality Metrics in Radiation Oncology: Implementation of Pretreatment Peer Review for Stereotactic Body Radiation Therapy in Patients with Thoracic Cancer

PurposeTraditional peer reviews occur weekly, and can take place up to 1 week after the start of treatment. The American Society for Radiation Oncology peer-review white paper identified stereotactic body radiation therapy (SBRT) as a high priority for contour/plan review before the start of treatment, considering both the rapid-dose falloff and short treatment course. Yet, peer-review goals for SBRT must also balance physician time demands and the desire to avoid routine treatment delays that would occur in the setting of a 100% pretreatment (pre-Tx) review compliance requirement or prolonging the standard treatment planning timeline. Herein, we report on our pilot experience of a pre-Tx peer review of thoracic SBRT cases. Methods and MaterialsFrom March 2020 to August 2021, patients undergoing thoracic SBRT were identified for pre-Tx review, and placed on a quality checklist. We implemented twice-weekly meetings for detailed pre-Tx review of organ-at-risk/target contours and dose constraints in the treatment planning system for SBRT cases. Our quality metric goal was to peer review ≥90% of SBRT cases before exceeding 25% of the dose delivered. We used a statistical process control chart with sigma limits (ie, standard deviations [SDs]) to access compliance rates with pre-Tx review implementation. ResultsWe identified 252 patients treated with SBRT to 294 lung nodules. When comparing pre-Tx review completion from initial rollout to full implementation, our rates improved from 19% to 79% (ie, from 1 sigma limit [SDs]) below to >2 sigma limits (SDs) above. Additionally, early completion of any form of contour/plan review (defined as any pre-Tx or standard review completed before exceeding 25% of the dose delivered) increased from 67% to 85% (March 2020-November 2020) to 76% to 94% (December 2020-August 2021). ConclusionsWe successfully implemented a sustainable workflow for detailed pre-Tx contour/plan review for thoracic SBRT cases in the context of twice-weekly disease site-specific peer-review meetings. We reached our quality improvement objective to peer review ≥90% of SBRT cases before exceeding 25% of the dose delivered. This process was feasible to conduct in an integrated network of sites across our system.