Pilot Phase Research Articles

PBL hybrid: An exploration of the concept of hybrid learning in a resource-constrained university context

In this paper, we explore the concept of hybrid learning in the context of a project aiming to transform the master programmes at Gulu University in Uganda by incorporating problem- and project-based learning (PBL) and the use of digital technologies to prepare graduates to lead community transformation and improve employability. Teachers are experimenting and piloting PBL and digital technologies. Based on the teachers' experiences this paper provides insights into how PBL and hybrid learning are being enacted by teachers and learners in the context of a resource-constrained university environment. What are the challenges of bringing these principles of hybrid learning and PBL together in a resource-constrained environment? The paper understands hybrid learning as the development of a new quality of learning environments that goes beyond a mere mixture of elements, e.g. digital and analogue, on-site and off-site. In this paper we are particularly concerned with exploring how the new PBL hybrid practices are developing, with a interest in how digital tools are integrated into teaching and learning. This paper is based on the results of a co-construction workshop with teachers and researchers based on their experiences from the first pilot phase. The results of the study suggest that flexibility is a core concept in relation to PBL-hybrid. Hybrid learning involves flexibility in terms of how learners carry out educational activities, how PBL is implemented, the use of many different technologies and the use of both analogue and digital learning tools and spaces. Moreover, to achieve hybrid learning, the types of flexibility and technologies, as well as the mix of digital and analogue tools, depend on the specific context of the educational activities, as well as on the competences of learners and teachers. As such, hybrid learning needs to be seen as a concept in relation to the contexts in which it unfolds. This insight is important for networked learning, which cuts across contexts, actors, materials/spaces and digital/analogue modalities.

Abstract PO1-16-12: The McPeak-Sirois Group Breast Metastases Registry

Abstract Background: In 2020, the McPeak-Sirois Group (MPSG), a Quebec-based breast cancer trials consortium, launched a feasibility pilot project to register prospectively cases of metastatic breast cancer (MBC). This Breast Metastases Registry (BMR) had the following objectives: a) to measure real-world progression-free and overall survival; b) to capture real-world evidence in efficacy of novel therapeutic approaches and c) to facilitate the development of clinical research projects in MBC. Methods: The pilot phase was initiated in three major academic hospitals with the intention of testing the feasibility of building a BMR and to assess barriers before extension to other hospitals in the province of Quebec. Funding was obtained through non-profit organizations and the pharmaceutical industry. The project was approved by a research ethics board and informed consent was obtained from each patient. The main inclusion criteria was a MBC diagnosis at the time of enrolment. Metastatic diseases were considered de novo if the metastatic condition was detected at the same time of the primary disease diagnosis or within the following 4 months. The information in the BMR relates to participants’ health status, including but not limited to hospitalizations, diagnoses, medications, medical procedures and imaging, pathology, genetic and laboratory results. In addition to the prospective data, the registry also captures information retrospective to the date of enrollment. Results: Between July 30, 2021 and April 22, 2023, a total of 427 patients were approached by a research nurse and 423 patients enrolled and 4 refused (99.2% participation rate). Approximately one third of the cohort was diagnosed between 2021-2023 (30.3%) while 69.7% were in 2002-2020 timeframe. The majority was either HR+/HER2- (55.3%) or HER2+ (26.9%). The median age at the time of MBC diagnosis was 57 years (Q1-Q3 range: 47-67 years). We observed that 57.9% of patients had a relapsed MBC while de novo MBC comprised 42.1% of the cohort with the highest percentage in the HER2+ group (59.6%). The median time between primary cancer and metastatic disease in those with relapsed MBC is shorter in triple negative breast cancer (28.9 months) compared to 71.4 months in HR+ disease. Among all lines of treatment for metastatic disease, independently of age at time of MBC diagnosis, 21% of patients participated in a clinical trial. Discussion: The pilot project demonstrated the acceptability and feasibility of building a MBC provincial registry as illustrated by the high participation rate (more than 99%). The next step is to expand the registry to other hospital sites in Quebec, however, the main difficulty is having the necessary manpower (oncology registrars) to ensure data entry. Over one third of the MBC patients presented as de novo disease (and more than half of these with HER2+ disease). This proportion of de novo MBC is unusually high and is likely due to a recruitment bias during the pilot phase as data entry was prioritised for de novo diagnoses over MBC at time of recurrence and patients were recruited at any time in their MBC trajectory and not only at the time of their MBC diagnosis. Clinical trial participation was higher in our cohort compared to the usually reported 5% participation rate. This may be due to recruitment bias but needs to be evaluated further. Conclusion: We have found that recruiting patients in a metastatic cancer registry and collecting their real-world data is not only feasible but well received by patients. The limiting factor for expansion to other hospitals is lack of oncology registrars. At maturity, the BMR will be a unique and powerful resource for breast cancer research and will allow researchers and their collaborators to unite their efforts to better understand how stage IV breast cancer is treated and how management of the disease can be improved. The BMR could also have the potential to improve participation in clinical trials and to stimulate clinical research. Citation Format: Julie Lemieux, Danielle Charpentier, Dominique Johnson, Nathalie Bolduc, Caty Blanchette, Claude Nadon, Sarkis Meterissian. The McPeak-Sirois Group Breast Metastases Registry [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO1-16-12.

Abstract PO4-20-01: A PROSPECTIVE PILOT STUDY OF MAMMOGRAPHIC PREDICTION OF WOMEN’S RISK (M-POWER) IN NIGERIA

Abstract Background There have been no sustained efforts at stemming the rising incidence and mortality from breast cancer in sub-Saharan African countries like Nigeria. Mammography is the gold standard for breast cancer screening and is associated with improved survival particularly among women 50 to 69. Reports from various parts of Nigeria show very low mammography screening uptake. Causes include lack of geographical access, financial issues (less than 5% of the population is covered by the National Health Insurance Scheme), lack of awareness and the increasing expertise gap from the continued brain drain, despite the already low number of radiologists in the country. Given these obstacles, our long-term goal is to devise a rational basis for identifying mammographic risk categories so that this resource can be deployed cost-effectively. We propose to carry out a 5-year prospective mammographic study in Nigerian women and to use machine learning to develop a risk prediction algorithm, so that following a single screening mammogram, the appropriate frequency of subsequent mammograms can be determined. Our immediate goal is to examine the feasibility of performing such a study. To this end, we have initiated a cross-sectional pilot study that will recruit up to 2000 women in multiple urban centers in Nigeria. Objective: To explore feasibility of creating a digital mammography image database representative of the radiological features of the breast of Nigerian women. Objective: To explore feasibility of creating a database that can be used to inform a predictive mammographic risk model for breast cancer and identify the appropriate population that will benefit from breast cancer screening in Nigeria. Design This is a prospective, open-label, cross-sectional pilot study in 2000 eligible women in Nigeria and will include a single screening mammography examination. The mammography images will be read by the study radiologist. The Pilot phase will determine the feasibility and aid in the design of the of the Extension phase in which up to 20,000 participants will undergo yearly mammography examination for 5 years. Incident cases of breast cancer during the study period will permit the development of deep learning algorithms for predicting the risk of breast cancer in this population. Main Eligibility Criteria: Inclusion Criteria All consecutive women aged ≥40 years and < 65 years presenting for screening mammography at the participating institutions will be eligible. Signed study-specific written informed consent. Exclusion Criteria Complaint of a focal dominant lump or a bloody or clear nipple discharge. History of breast implants. Any woman who is pregnant or has reason to believe that she might be pregnant. Statistical Methods Analyses of continuous data will be summarized using descriptive statistics where the following parameters will be reported: Number of observations, Number of missing observations, Mean, Median, Standard deviation (SD), Minimum (Min), Maximum (Max) Categorical data will be presented with absolute and relative frequency (n and %). Present Accrual and Target accrual Two hundred ninety-six women have been enrolled and screening digital mammographic images using GE Digital mammography equipment have been obtained on all participants at 2 study sites in 2 cities in Southern Nigeria. The target accrual is 2000 participants over 12 months. Conclusion Our preliminary experience to date suggests the feasibility of proceeding with a larger prospective study to define mammographic risk groups in Nigerian women which will permit the rational allocation of resources for breast cancer prevention activities in this underserved population. Contact Information: Dr Toyin Shonukan at tshonukan@yemanjacancercare.org Citation Format: Oluwatoyin Shonukan, Hyelakumi Ibrahim, Esther Udoh, Wahab Egbeolu, Kanyinsola Oyeyinka, Jonas Haggstrom. A PROSPECTIVE PILOT STUDY OF MAMMOGRAPHIC PREDICTION OF WOMEN’S RISK (M-POWER) IN NIGERIA [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO4-20-01.

Abstract PO1-18-01: Patient Preferences for HR+/HER2- Metastatic Breast Cancer Treatments in Italy: A Qualitative Assessment

Abstract Objectives: Factors that influence treatment preferences of patients with hormone receptor-positive/HER2-negative (HR+/HER2-) metastatic breast cancer (mBC) are being investigated using discrete choice experiment (DCE) methodology. Appropriate attributes for the ongoing quantitative online survey phase were identified by this initial qualitative pilot study. Methods: To generate hypotheses and inform variables of the quantitative survey, the pilot phase consisted in online telephone interviews with patients with a diagnosis of Stage IV HR+/HER2- breast cancer at various stages of treatment. Interviews focused on exploring patients' perspectives on their interaction with physicians, preferences, and treatment experiences. Transcripts were coded using NVivo software to identify key themes. The ongoing DCE online survey aims to recruit patients meeting the same selection criteria as in the qualitative phase, also at various stages of treatment. Results: Fifteen mBC patients (median age, 43 years [range, 29-64]), including nine chemotherapy-treated and six without chemotherapy exposure, were enrolled in the pilot qualitative study. Eight and four patients reported receiving little information about their treatment plan and their risk status beyond the risk of relapse, respectively. Most participants did not know what to expect from their therapy but expressed trust in their physician’s decision in terms of treatment goals. Few patients (n=3) looked for a second opinion before starting treatment. Four out of fifteen patients declared that they were actively involved in their treatment plan decision, although all relied on their physician’s knowledge and decision. Reduced symptoms and improved quality of life (QoL) were patients’ main treatment goals, and side-effects and efficacy of treatment were their main concerns. When asked about the degree of acceptability of certain side effects, some participants considered hair loss and vomiting as unacceptable side effects, regardless of severity, while others considered them to be the most acceptable. This discrepancy is to be interpreted in the light of participants’ own treatment journey. Severity and duration of side-effects were mentioned by three patients as acceptability factors. In a choice task, patients were asked to express preferences between two hypothetical treatments. Efficacy (n=9) and administration mode (n=6) were spontaneously deemed important for treatment selection. While assessing the difference in risk between the two hypothetical treatments, ten patients explained that the main choice feature was extended progression-free survival (PFS) rate. Risk of infection and neutropenia (n=12) were concerns expressed by most patients in the post-COVID-19 period. Considering their substantial impact on QoL, alopecia (n=9) and vomiting (n=9) were presented by patients as particularly important, regardless of their degree of severity; whereas almost all patients reported that only severe fatigue (n=12), diarrhea (n=13) or nausea (n=13) would be an issue. These results allowed selection of the following attributes for further quantification of their preference weights in a DCE: PFS, risk of neutropenia, risk of alopecia, risk of vomiting, risk of diarrhea, risk of grade 3/4 side effects and mode of administration. Conclusions: This qualitative pilot study allowed for identification of what matters most to patients when selecting a treatment for mBC, which will be further assessed in the DCE. It also highlighted the need of patients with HR+/HER2- mBC for information about their treatment, potential side-effects, and health management. This research suggests that there is a need for patients to be more involved in treatment plans, and that taking patient preferences into account may help improve the treatment selection experiences. Citation Format: Grazia Arpino, Carmine De Angelis, Lorenzo Gerratana, Matteo Lambertini, Sarah Igidbashian, Martina Bellini, Serena Giuntoli, Xavier Guillaume, Julie Behillil, Claire Graziani-Taugeron. Patient Preferences for HR+/HER2- Metastatic Breast Cancer Treatments in Italy: A Qualitative Assessment [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO1-18-01.

Design and pilot results from the Million Veteran Program Return Of Actionable Results (MVP-ROAR) Study

As a mega-biobank linked to a national healthcare system, the Million Veteran Program (MVP) can directly improve the health care of participants. To determine the feasibility and outcomes of returning medically actionable genetic results to MVP participants, the program launched the MVP Return of Actionable Results (MVP-ROAR) Study, with familial hypercholesterolemia (FH) as an exemplar actionable condition. The MVP-ROAR Study consists of a completed single-arm pilot phase and an ongoing randomized clinical trial (RCT), in which MVP participants are recontacted and invited to receive clinical confirmatory gene sequencing testing and a telegenetic counseling intervention. The primary outcome of the RCT is 6-month change in low-density lipoprotein cholesterol (LDL-C) between participants receiving results at baseline and those receiving results after 6 months. The pilot developed processes to identify and recontact participants nationally with probable pathogenic variants in low-density lipoprotein receptor (LDLR) on the MVP genotype array, invite them to clinical confirmatory gene sequencing, and deliver a telegenetic counseling intervention. Among participants in the pilot phase, 8 (100%) had active statin prescriptions after 6 months. Results were shared with 16 first-degree family members. Six-month ΔLDL-C (low-density lipoprotein cholesterol) after the genetic counseling intervention was -37 mg/dL (95% CI: -12 to -61; P = .03). The ongoing RCT will determine between-arm differences in this primary outcome. While underscoring the importance of clinical confirmation of research results, the pilot phase of the MVP-ROAR Study marks a turning point in MVP and demonstrates the feasibility of returning genetic results to participants and their providers. The ongoing RCT will contribute to understanding how such a program might improve patient health care and outcomes. ClinicalTrials.gov ID NCT04178122.

Strengthening event-based surveillance (EBS): a case study from Afghanistan

SummaryThe sustained instability in Afghanistan, along with ongoing disease outbreaks and the impact of the COVID-19 pandemic, has significantly affected the country.During the COVID-19 pandemic, the country’s detection and response capacities faced challenges. Case identification was done in all health facilities from primary to tertiary levels but neglected cases at the community level, resulting in undetected and uncontrolled transmission from communities. This emphasizes a missed opportunity for early detection that Event-Based Surveillance (EBS) could have facilitated.Therefore, Afghanistan planned to strengthen the EBS component of the national public health surveillance system to enhance the capacity for the rapid detection and response to infectious disease outbreaks, including COVID-19 and other emerging diseases. This effort was undertaken to promptly mitigate the impact of such outbreaks.We conducted a landscape assessment of Afghanistan’s public health surveillance system to identify the best way to enhance EBS, and then we crafted an implementation work plan. The work plan included the following steps: establishing an EBS multisectoral coordination and working group, identifying EBS information sources, prioritizing public health events of importance, defining signals, establishing reporting mechanisms, and developing standard operating procedures and training guides.EBS is currently being piloted in seven provinces in Afghanistan. The lessons learned from the pilot phase will support its overall expansion throughout the country.

Navigating the peer-to-peer workflow in non-formal education through an innovative e-learning platform: a case study of the KIDS4ALLL educational project in Hungary and Italy

The digital revolution is affecting all aspects of life, radically transforming everyday tasks and routines. The ability to cope with new challenges in life, including new forms of learning are key skills in the 21st-century, however, education systems often struggle with tackling digital inequalities. A digital learning platform developed by the KIDS4ALLL educational project, implemented in face-to-face student interactions, aims to mitigate the divide and the resulting social disadvantages among children with and without migration/ethnic minority background. Analyzing data collected during the pilot phase of the project in two of the participating countries, Italy and Hungary, this paper examines how students and teaching staff adapt to a newly introduced digital learning tool based on peer-to-peer workflows. Firstly, it examines the role of educators' interpersonal competences in navigating the innovative learning activities and delves into how they use them and how they manage resources. Secondly, the study explores what attitudes and behaviors are observed among students engaged in the proposed peer-led activities, in particular in terms of their ability to cope with uncertainty and complexity. The analytical framework of the paper is based on two cultural dimensions offered by Hofstede, the index of uncertainty avoidance (UAI) and power distance (PDI), and it utilizes the personal, social and learning-to-learn competence of the eight LLL Key Competences as defined by the European Commission to conceptualize the skills of educators and students. Interpreting data from Italy and Hungary in their respective social and educational contexts, the study finds that the most important features that proved to be effective and useful during the pilot phase were the democratic power-relations between students and educators, the peer-to-peer scheme and its further development to the peer-for-peer approach. The child-friendly and real-life-related new curriculum and its appealing digital learning platform, embedded into a flexible, playful and child-centered pedagogical approach, were also successful. These are all complementing the traditional, formal school environment and pedagogy which, despite all developments in formal education in the past decades, can be characterized as teacher-centered and frontal.

Medical management and surgery versus medical management alone for symptomatic cerebral cavernous malformation (CARE): a feasibility study and randomised, open, pragmatic, pilot phase trial

The highest priority uncertainty for people with symptomatic cerebral cavernous malformation is whether to have medical management and surgery or medical management alone. We conducted a pilot phase randomised controlled trial to assess the feasibility of addressing this uncertainty in a definitive trial. The CARE pilot trial was a prospective, randomised, open-label, assessor-blinded, parallel-group trial at neuroscience centres in the UK and Ireland. We aimed to recruit 60 people of any age, sex, and ethnicity who had mental capacity, were resident in the UK or Ireland, and had a symptomatic cerebral cavernous malformation. Computerised, web-based randomisation assigned participants (1:1) to medical management and surgery (neurosurgical resection or stereotactic radiosurgery) or medical management alone, stratified by the neurosurgeon's and participant's consensus about the intended type of surgery before randomisation. Assignment was open to investigators, participants, and carers, but not clinical outcome event adjudicators. Feasibility outcomes included site engagement, recruitment, choice of surgical management, retention, adherence, data quality, clinical outcome event rate, and protocol implementation. The primary clinical outcome was symptomatic intracranial haemorrhage or new persistent or progressive non-haemorrhagic focal neurological deficit due to cerebral cavernous malformation or surgery during at least 6 months of follow-up. We analysed data from all randomly assigned participants according to assigned management. This trial is registered with ISRCTN (ISRCTN41647111) and has been completed. Between Sept 27, 2021, and April 28, 2023, 28 (70%) of 40 sites took part, at which investigators screened 511 patients, of whom 322 (63%) were eligible, 202 were approached for recruitment, and 96 had collective uncertainty with their neurosurgeon about whether to have surgery for a symptomatic cerebral cavernous malformation. 72 (22%) of 322 eligible patients were randomly assigned (mean recruitment rate 0·2 [SD 0·25] participants per site per month) at a median of 287 (IQR 67-591) days since the most recent symptomatic presentation. Participants' median age was 50·6 (IQR 38·6-59·2) years, 68 (94%) of 72 participants were adults, 41 (57%) were female, 66 (92%) were White, 56 (78%) had a previous intracranial haemorrhage, and 28 (39%) had a previous epileptic seizure. The intended type of surgery before randomisation was neurosurgical resection for 19 (26%) of 72, stereotactic radiosurgery for 44 (61%), and no preference for nine (13%). Baseline clinical and imaging data were complete for all participants. 36 participants were randomly assigned to medical management and surgery (12 to neurosurgical resection and 24 to stereotactic radiosurgery) and 36 to medical management alone. Three (4%) of 72 participants withdrew, one was lost to follow-up, and one declined face-to-face follow-up, leaving 67 (93%) retained at 6-months' clinical follow-up. 61 (91%) of 67 participants with follow-up adhered to the assigned management strategy. The primary clinical outcome occurred in two (6%) of 33 participants randomly assigned to medical management and surgery (8·0%, 95% CI 2·0-32·1 per year) and in two (6%) of 34 participants randomly assigned to medical management alone (7·5%, 1·9-30·1 per year). Investigators reported no deaths, no serious adverse events, one protocol violation, and 61 protocol deviations. This pilot phase trial exceeded its recruitment target, but a definitive trial will require extensive international engagement. National Institute for Health and Care Research.

Addressing barriers and identifying facilitators to support informed consent and recruitment in the Cavernous malformations A Randomised Effectiveness (CARE) pilot phase trial: insights from the integrated QuinteT recruitment intervention (QRI)

It was anticipated that recruitment to the Cavernous malformations: A Randomised Effectiveness (CARE) pilot randomised trial would be challenging. The trial compared medical management and surgery (neurosurgical resection or stereotactic radiosurgery) with medical management alone, for people with symptomatic cerebral cavernous malformation (ISRCTN41647111). Previous trials comparing surgical and medical management for intracranial vascular malformations failed to recruit to target. A QuinteT Recruitment Intervention was integrated during trial accrual, September 2021-April 2023 inclusive, to improve informed consent and recruitment. The QuinteT Recruitment Intervention combined iterative collection and analysis of quantitative data (28 trial site screening logs recording numbers/proportions screened, eligible, approached and randomised) and qualitative data (79 audio-recorded recruitment discussions, 19 interviews with healthcare professionals, 11 interviews with patients, 2 investigator workshops, and observations of study meetings, all subject to thematic, content or conversation analysis). We triangulated quantitative and qualitative data to identify barriers and facilitators to recruitment and how and why these arose. Working with the chief investigators and trial management group, we addressed barriers and facilitators with corresponding actions to improve informed consent and recruitment. Barriers identified included how usual care practices made equipoise challenging, multi-disciplinary teams sometimes overrode recruiter equipoise and logistical issues rendered symptomatic cavernoma diagnosis and assessment for stereotactic radiosurgery challenging. Facilitators identified included the preparedness of some neurosurgeons' to offer surgery to people otherwise offered medical management alone, multi-disciplinary team equipoise, and effective information provision presenting participation as a solution to equipoise regarding management. Actions, before and during recruitment, to improve inclusivity of site screening, approach and effectiveness of information provision resulted in 72 participants recruited following a 5-month extension, exceeding the target of 60 participants. QuinteT Recruitment Intervention insights revealed barriers and facilitators, enabling identification of remedial actions. Recruitment to a definitive trial would benefit from further training/support to encourage clinicians to be comfortable approaching patients to whom medical management is usually offered, and broadening the pool of neurosurgeons and multi-disciplinary team members prepared to offer surgery, particularly stereotactic radiosurgery. National Institute for Health and Care Research.

Implementation of an Institution-Wide Rules-Based Automated CT Protocoling System.

BACKGROUND. Examination protocoling is a noninterpretive task that increases radiologists' workload and can cause workflow inefficiencies. OBJECTIVE. The purpose of this study was to evaluate effects of an automated CT protocoling system on examination process times and protocol error rates. METHODS. This retrospective study included 317,597 CT examinations (mean age, 61.8 ± 18.1 [SD] years; male, 161,125; female, 156,447; unspecified sex, 25) from July 2020 to June 2022. A rules-based automated protocoling system was implemented institution-wide; the system evaluated all CT orders in the EHR and assigned a protocol or directed the order for manual radiologist protocoling. The study period comprised pilot (July 2020 to December 2020), implementation (January 2021 to December 2021), and postimplementation (January 2022 to June 2022) phases. Proportions of automatically protocoled examinations were summarized. Process times were recorded. Protocol error rates were assessed by counts of quality improvement (QI) reports and examination recalls and comparison with retrospectively assigned protocols in 450 randomly selected examinations. RESULTS. Frequency of automatic protocoling was 19,366/70,780 (27.4%), 68,875/163,068 (42.2%), and 54,045/83,749 (64.5%) in pilot, implementation, and postimplementation phases, respectively (p < .001). Mean (± SD) times from order entry to protocol assignment for automatically and manually protocoled examinations for emergency department examinations were 0.2 ± 18.2 and 2.1 ± 69.7 hours, respectively; mean inpatient examination times were 0.5 ± 50.0 and 3.5 ± 105.5 hours; and mean outpatient examination times were 361.7 ± 1165.5 and 1289.9 ± 2050.9 hours (all p < .001). Mean (± SD) times from order entry to examination completion for automatically and manually protocoled examinations for emergency department examinations were 2.6 ± 38.6 and 4.2 ± 73.0 hours, respectively (p < .001); for inpatient examinations were 6.3 ± 74.6 and 8.7 ± 109.3 hours (p = .001); and for outpatient examinations were 1367.2 ± 1795.8 and 1471.8 ± 2118.3 hours (p < .001). In the three phases, there were three, 19, and 25 QI reports and zero, one, and three recalls, respectively, for automatically protocoled examinations, versus nine, 19, and five QI reports and one, seven, and zero recalls for manually protocoled examinations. Retrospectively assigned protocols were concordant with 212/214 (99.1%) of automatically protocoled versus 233/236 (98.7%) of manually protocoled examinations. CONCLUSION. The automated protocoling system substantially reduced radiologists' protocoling workload and decreased times from order entry to protocol assignment and examination completion; protocol errors and recalls were infrequent. CLINICAL IMPACT. The system represents a solution for reducing radiologists' time spent performing noninterpretive tasks and improving care efficiency.

Adapting to an OpenBIM Building Permit Process: A Case Study Using the Example of the City of Vienna

The adoption of building information modelling (BIM) enables data-driven decision-making for many participants in the construction process. Building authorities are stakeholders that have not yet benefited from data integration using BIM. In many cases, parts of their processes have already improved through digitisation initiatives. Now they are on the threshold of a major digital transformation enabled by the integration of BIM into their processes. This study examines a building permit process based entirely on BIM, developed at the Vienna Building Authority in Austria. In a series of workshops with all important stakeholders, the current building permit process was captured in detail and transferred to a data-driven, BIM-based process. The study shows that the complete capture and digitisation of the building approval process not only enables the automation of traditional processes such as code compliance checks and neighbourhood hearings but also supports the introduction of innovative sub-processes such as a pre-check of BIM models and augmented reality-based hearings with neighbours (in a pilot phase). The results suggest that the developed process not only significantly increases the efficiency and transparency of building permit procedures, but also represents a decisive step towards integrating the authority into the BIM process of a building.

Short waits, happy patients and expert care, moving basic musculoskeletal care from the emergency department to a physiotherapist-led diversion pathway.

Patients with musculoskeletal conditions (MSKCs) are highly prevalent in ED. This project explores the impact of the pilot phase of a 'diversion pathway', which directed patients with MSKCs from the ED waiting room to an outpatient clinic led by advanced-scope physiotherapists. A prospective intervention study comparing care outcomes between patients in the 'diversion pathway' with usual ED care. The characteristics of patients considered eligible and non-eligible are described. Between May and December 2022, 1099 patients were diverted. For diverted patients, mean length of stay (LOS) in ED was reduced by 110 (95% confidence interval [CI]: 99-120) min and 4 h rule compliance improved by 19.3% compared to usual ED care. There were fewer patients who 'did not wait' (DNW) with the diversion pathway. The diverted group was young (median age 22 years and 41% paediatric), mostly low urgency, self-referred and arrived by private transport with minor limb trauma. The diversion pathway triage process appropriately identified 182 patients ineligible for diversion. 96.7% of patients reported satisfaction with care received from the diversion pathway. There was no change in ED representation rates for diverted patients. A new pathway resulted in reduced LOS, reduced DNW, high patient satisfaction and more people being discharged within 4 h for diverted patients compared to usual ED care. The pathway increased ED capacity, improved key ED performance metrics and safely expedited care delivery for patients.

What role does Skill Centre based consultancy serve in mathematics and statistics teaching communities of practice?

Mathematics and Statistics Teaching (MAST) is a staff facing service set up by the University of Bath Mathematics Resource Centre in September 2021. The service was created to collaborate with academics involved in mathematics and statistics teaching in their academic departments. In September 2023, MAST ended its pilot phase and entered a new growth phase fine-tuning existing structures and practices. During the pilot phase, MAST worked with academics consulting on enriching their programme of study and/or teaching practices. Specifically, the key principle that guides MAST is engaging in long-term sustainable collaborations with academic departments. As a means to address the key principle, we explore the potential of building communities of practice and supporting a wider network across the range of disciplines who encounter similar objectives. Facilitating a wider community of practice could be challenging, especially considering the tight schedule of the academics involved. We discuss our plans to cultivate communities of practice within departments and how we are working towards meeting our goal of establishing best practice and collecting evidence to support a wider community.

Improving Product Marketing by Predicting Early Reviewers on E-Commerce Websites

Customers now often consult online surveys before making a smart purchase decision. Much of the time, the early surveys of an item fundamentally affect the deals of that item later on.In this study, we move up and focus on the conduct characteristics of early analysts via their posted surveys on two actual enormous web based company stages, i.e., Amazon and Cry. To be clear, we divide an item's lifecycle into three discrete phases: the beginning, the middle, and the end. Early commentators are clients who have posted surveys during the pilot phase. We provide a quantitative portrait of the first reviewers based on their rating habits, the popularity of the items they reviewed, and the ratings of support they received from other users. We have viewed that as (1) Early commenter will often downgrade a higher average rating, and (2) An early analyst tends to publish more positive polls.

Tackling adversity through innovation: A pilot study exploring VR as a tool to identify and diagnose depression

AbstractIntroduction The final aim of the EXPERIENCE project is to enable individuals to record and share extended-personal realities in Virtual Reality (VR) - which entails the consideration of a person’s neurophysiological, psychological, and cognitive states. One prospective application is using this technology to aid in assessing symptoms of affective disorders.ObjectivesThe objective is to test the ability of a pre-designed VR environment to differentiate between individuals with depressive symptoms and healthy controls (HCs) via machine learning algorithms.Methods Conducted as a pilot study in Italy, we recruited 100 volunteers, comprising 50 HCs and 50 individuals with moderate depressive symptoms assessed via the PHQ-9. Through a 40–60-minute VR engagement, comprehensive data on cognitive (inc. cognitive flexibility, sustained attention, working memory, processing speed), behavioral (exploration, attentional bias), and physiological (heart-rate variability, skin conductance) variables was collected. Subsequently, an explainable artificial intelligence model (xAI) was trained on data from 80% of the sample and tested on the remaining 20% in terms of accuracy for between-group classification.ResultsFollowing an iterative process that considered both the importance assigned to each variable in the different models and the theoretical relevance of these variables to depression the final model achieved an average accuracy of 71% (with individual trials ranging from 64.5% to 77.1%). Key predictors included exploratory behaviors and heart-rate variability during both exploration and cognitive tasks.ConclusionsThese results are comparable, however remain below the levels of accuracy achieved based on fMRI and DTI data alone (around 80%). Nonetheless, the EXPERIENCE system, slated for refinement beyond this pilot phase, shows potential in integrating multimodal data for evaluating affective disorder symptoms, aiming for a more objective screening and diagnostic approach at a lower cost.AcknowledgementThe EXPERIENCE project is funded by the European Commission H2020 Framework Program, Grant No. 101017727.Disclosure of InterestNone Declared

Basic Training in Palliative Medicine for Internal Medicine Residents: Pilot Testing of a Canadian Model in Switzerland.

In Switzerland, palliative care (PC) clinical training is well established at undergraduate and specialist postgraduate levels. However, postgraduate nonspecialist training curricula are less documented. A structured curriculum for nonspecialist rotation within internal medicine (IM) in specialized PC wards is lacking. To pilot two versions of a PC nonspecialist curriculum for IM residents in Swiss PC units. In the pilot phase, two curricula-short immersion (3-10 weeks, based on the University of Toronto's Internal-Medicine PC Rotation) and standard nonspecialist (11-18 weeks, based on the Canadian Society of Palliative Care Physician Competencies)-were assessed using a mixed-method online survey. One university and two nonuniversity sites participated. The analysis was descriptive. Five residents and eight supervisors of five training rotations (July-October 2023) responded. Overall, curriculum quality and feasibility (content and time) received positive ratings across all groups, with high satisfaction concerning organization, educational design, learning support, climate, experience, and facilities. Nonuniversity sites were generally rated more positively than university sites. Qualitative feedback paralleled these findings, highlighting the curriculum's relevance and fit with learners' needs and suggesting potential simplifications and more personalized planning. Establishing short and standard duration curricula for a PC program is viable and well received by nonspecialist trainees. Future implementation should concentrate on personalized learning objectives and streamlining the content and structure of the competencies. Cooperation within various training settings (university and regional hospitals) as well as on an international level (e.g., Canada-Switzerland) may further improve the quality of the proposed training formats.

223 Enhancing the Impact of a Community Feedback Session Service Through Ongoing Evaluation

OBJECTIVES/GOALS: UNC-Chapel Hill’s CTSA implemented a community feedback session (CFS) service to help researchers gather actionable, authentic, and constructive feedback on their projects from community experts. Simultaneously, we conducted an ongoing, participatory evaluation process to improve the experience for researchers and community members. METHODS/STUDY POPULATION: Informed by the Community Engagement Studio model (Yoosten, 2015), a CFS is a 2-hour consultative session that includes facilitated discussion with community experts around topics or questions posed by a research team. UNC-Chapel Hill’s CTSA staff conducted 7 CFSs during the pilot phase of the service and collected evaluation surveys from researchers and community experts. We held a data party – a participatory evaluation method – to analyze and interpret survey data. Resulting recommendations were used to improve CFS materials and processes. We conducted 11 CFSs after the pilot phase, then analyzed survey data again to gauge improvement and make further adjustments to the service. We also surveyed researchers three months after their last CFS to assess the impact of community experts’ feedback on their studies. RESULTS/ANTICIPATED RESULTS: Since January 2022, 108 community experts have participated in 18 CFSs spanning 9 research projects. Data party interpretations of pilot evaluation data yielded several changes in service delivery; since those changes were instituted, all researchers have highly rated the service, unanimously recommending it to colleagues. Researchers praised well-structured sessions and productive engagement, citing direct benefits to their work and significant impact on recruitment processes 3 months post CFS. Community experts also echoed satisfaction, with 100% finding CFSs worthwhile and 95% desiring to participate again, emphasizing the sessions' supportive atmosphere. A community expert reported that the sessions 'made me feel seen and allowed for a greater understanding of what I have been dealing with.' DISCUSSION/SIGNIFICANCE: The CFS model allows research teams to elicit rapid and meaningful community input, which is key to improving research relevance and impact. Ongoing participatory evaluation of the service ensures continuous improvement, yielding more meaningful interactions and studies that reflect the perspectives of people affected by the research.

Study Details Evolution of Operator’s Completions in Vaca Muerta

_ This article, written by JPT Technology Editor Chris Carpenter, contains highlights of paper SPE 212574, “From Exploration to Development: The Completion Evolution in Vaca Muerta,” by Juan C. Bonapace, SPE, Luis A. Riolfo, and Rodrigo Zrain, Total, et al. The paper has not been peer reviewed. _ Operators in the Neuquén Basin have developed Vaca Muerta with different results. In the case of the operator whose work is featured in the complete paper, vertical exploratory wells almost 10 years ago have given way to a current development phase with multihorizontal well pads targeting different landings. The authors discuss how the operator has become more efficient and cost-effective by increasing production and reducing well-delivery-cycle time, while fostering the long-term sustainability of the project by reducing the environmental impact of operations. Evolution of Field Completions The authors focus on the operator’s Field A, where the most progress has been made over the years. The exploratory and appraisal phases of the development are detailed in the complete paper. Pilot Phase. The primary goal for this phase was to validate the productivity of two previously identified landing zones, namely Zones B and D. The wells were located near the vertical wells. Completion. The campaign program accounted for 12 drilled horizontal wells, only 10 of which were completed (two wells were lost because of drilling and casing-integrity issues). Well lateral length ranged between 1000 and 1500 m. The final well architecture was composed of three strings: a 13⅜-in. surface casing, a 9⅝-in. intermediate casing, and a 5½-in. production casing. The completion technique applied was plug-and-perf (PnP) and considered an average stage length of 100 m. Two base designs were defined for each landing zone according to the results obtained in the vertical exploratory wells. An initial sensitivity trial was completed in Zone B, with two different treatment sizes, base and alternative, designed to evaluate the effect on cost and production performance. The results showed a lower production for the wells with the alternative treatment. Operational Issues. Operational problems included casing restriction, detected only once in a well in Zone D during plug drillout operations; and well interference, in that one well presented a change in production during the flowback period on a new neighboring well. This was the result of reduced spacing because of drilling conditions between the new well and the pre-existing one. This phase showed wells in Zone B performing beyond expected production, while those in Zone D underperformed. Development Phase I. It was decided to locate all wells of this phase on the east side of the pilot in the dry-gas window. The main driver for this decision was expected lower CO2 production in this region, based on observations from appraisal wells. Completion. Initial development considered 20 horizontal wells, mainly targeting Zone B. Two additional target zones were added for testing, Zones A and C. In pursuing cost optimization for this development phase, a change to a slimmer architecture was made. Finally, 19 wells were completed. The final well architecture was composed of three strings: a 10¾-in. surface casing, a 7⅝-in. intermediate casing, and a final 4½-in. production casing.

Advancing schizophrenia care: Ongoing Study of a Mobile Application for Personalized Support

IntroductionPsychiatric care faces a significant challenge in the regular monitoring of patient states, predicting relapses, and ensuring treatment adherence. To address this, we aim to develop a mobile application tailored to individual patient needs. This application will revolutionize mental health care by offering real-time monitoring, education, evidence-based interventions, and enhanced communication between patients and clinicians.ObjectivesThis ongoing study seeks to develop and evaluate a mobile application for individuals with schizophrenia spectrum disorders, aiming to transform personalized mental health care by addressing critical challenges in psychiatric care.MethodsThe study follows a multi-phase approach, incorporating prototype development, a proof-of-concept trial, and a Randomized Controlled Efficacy Study (RCT). Each phase is informed by iterative stakeholder feedback, ensuring responsiveness to real-world needs and experiences. The research was approved by the Semmelweis University Regional and Institutional Committee of Science and Research Ethics (SE RKEB: 85/2023).ResultsIn the pilot phase, we have effectively tracked the daily well-being of participating patients through interactive activities and structured questionnaires. Our experiences in this phase promise to offer valuable insights for the psychiatric community, shedding light on the potential of personalized mental health care interventions.ConclusionsThis ongoing study represents a pivotal step towards redefining interventions for individuals with schizophrenia spectrum disorders. Early results signal a transformative potential in enhancing symptom management. As the study advances, deeper insights will emerge, emphasizing the profound impact of leveraging mobile technology in personalized mental health care.Disclosure of InterestNone Declared

Clinical and cost-effectiveness of individualised (early) patient-directed rehabilitation versus standard rehabilitation after surgical repair of the rotator cuff of the shoulder: protocol for a multicentre, randomised controlled trial with integrated Quintet Recruitment Intervention (RaCeR 2)

IntroductionDespite the high number of operations and surgical advancement, rehabilitation after rotator cuff repair has not progressed for over 20 years. The traditional cautious approach might be contributing to suboptimal...