Practical Considerations Research Articles

Abstract TP109: Quality Improvement Review and Practical Consideration of Hyperfine Portable Bedside Low-Field Magnetic Resonance Imaging in the Non-ICU Setting

Introduction: The Hyperfine portable low-field Magnetic Resonance Imaging (MRI) scanner (0.064 Tesla) was FDA approved in 2020. The use of portable low-field MRI (pMRI) has been best studied in ICU settings, although there has been interest in expanding this technology in floor level status stroke patients. Methods: We report our experience launching pMRI in our academic comprehensive stroke program in the non-ICU setting. From September 2021 to March 2022, 24 pMRI scans were performed (2 volunteers, 22 floor-status stroke patients). Our institutional pMRI protocol includes localizer, DWI, ADC, and FLAIR (24 minutes scan time). Good head position (GHP) was defined as the vertex of the head abutting the top of the helmet insert. Complete scans were defined as including all sequences and Partial scan included DWI/ADC. Results: Among 24 scans, most 17/24 (70.8%) were Complete and 2 scans were aborted after only localizer images. Six scans were Partial, due to patient discomfort in 4 (“feeling hot” [2], neck/back pain [2]), and technical issues with machine in 2. Among 22 scans that were Partial or Complete, 6 scans had poor head positioning. We noted that although there was initial GHP, the head could shift out due to gravity or patient self-adjustment due to discomfort. To combat the shift issue, the bed was placed in slight reverse Trendelenburg. We also implemented wedge padding for the lower back that improved comfort. After scan # 11, re-training was performed to include GHP updates. Before re-training, 6/11 (45.5%) had GHP, and afterwards, 11/11 (100%) had GHP. Our quality review also noted that artifact on the DWI/ADC mimicking restricted diffusion could be seen in the internal capsule and corpus callosum, and clinical teams were educated on this. Conclusions: The use of low-field pMRI in non-ICU settings is feasible. Our institutional QI experience suggests that patient selection and technical skill in GHP is a consideration. After adjusting our protocol, the rate of GHP increased from 45% to 100%. Clinical teams also need to be aware of artifact mimicking restricted diffusion in areas of tightly bound white matter tracks. Further studies are warranted to better maximize pMRI and understand the logistical barriers to successful implementation.

Measures of Ethics and Social Responsibility Among Undergraduate Engineering Students: Findings from a Longitudinal Study

Prior research on engineering students’ understandings of ethics and social responsibility has produced mixed and sometimes conflicting results. Seeking greater clarity in this area of investigation, we conducted an exploratory, longitudinal study at four universities in the United States to better understand how engineering undergraduate students perceive ethics and social responsibility and how those perceptions change over time. Undergraduate engineering students at four U.S. universities were surveyed three times: during their 1st (Fall 2015), 5th (Fall 2017), and 8th semesters (Spring 2019). The students who completed all three surveys (n = 226) comprise the sample that was analyzed in this paper for changes in their scores on five instruments: Fundamentals of Engineering/Situational Judgment, Moral Disengagement, ABET Engineering Work and Practice Considerations, Macroethics, and Political and Social Involvement Scale. We found that students modestly increased their knowledge of ethics and ability to apply that knowledge in situations calling for them to exercise judgment. In addition, they consistently indicated that health and safety considerations in engineering were of highest importance. They also showed steady levels of social consciousness over time, in contrast to other studies which detected a culture of increasing disengagement in engineering students throughout the four years of their undergraduate studies.

Ion transport and gas collision effects in a radio frequency quadrupole cooler: installation in the Eltrap solenoid and beam calculations

Radio frequency quadrupole coolers (RFQCs) are very suitable to cool ion beams with moderate energy spread, typically ions of exotic nuclear species (like $^{132}$ Sn $^{1+}$ ) as in the Selective Production of Exotic Species project at the Laboratori Nazionali di Legnaro, whose ion source supplies 40 keV ions. Beam dynamics includes ion–gas collisions (with a balance of cooling and diffusion effects), acceleration and deceleration and radiofrequency confinement, which can be supplemented by static magnetic field effects. Insertion of a prototype RFQC in the solenoid of the Eltrap machine is also discussed here, with innovations in beam extraction and in modelling, now also based on stochastic equations. Practical consideration on gas pumping and voltage distribution are also included. Typical limits of RFQC are discussed, with special attention to the extracted beam root mean square emittance, which is shown to strongly depend not only on cooler parameters, but also on extraction optics.

Pharmacologic Management of Sialorrhea in Neonatal and Pediatric Patients

Sialorrhea, defined as an excess flow of saliva or excessive secretions, is common in patients with cerebral palsy and other neurologic disorders and is associated with clinical complications such as increased risk of local skin reactions, infections, aspiration, pneumonia, and dehydration. Upon failure of non-pharmacologic measures, clinicians have several noninvasive pharmacologic options available to manage sialorrhea. This review of the literature provides detailed descriptions of medications used, efficacy, safety, and practical considerations for use of non-injectable pharmacologic agents. The literature search included published ­human studies in the English language in PubMed and Google Scholar from 1997 to 2022. Relevant citations within articles were also screened. A total of 15 studies representing 719 pediatric patients were included. Glycopyrrolate, atropine, scopolamine, and trihexyphenidyl all have a potential role for sialorrhea management in children; however, glycopyrrolate remains the most studied option with 374 (n = 52.0%) of the 719 patients included in the systematic review receiving this medication. Overall, glycopyrrolate showed similar efficacy but higher tolerability than its comparators in 2 comparative studies and is often considered the first-line agent. Patient-specific (age, route of administration) and medication-specific (dosage formulation, medication strength) considerations must be weighed when initiating a new therapy or switching to another medication upon treatment failure. Owing to the high propensity of adverse events with all agents, clinicians should consider initiating doses at the lower end of the dosage range, as previous studies have noted a dose-dependent relationship.

Tenecteplase for Acute Ischemic Stroke Thrombolysis: Practical Considerations and Real-World Implementation.

The only FDA-approved medical treatment for acute ischemic stroke (AIS) is alteplase (commonly referred to as "tPA"). The utilization of a newer fibrinolytic agent, tenecteplase, in routine stroke care is increasing because of recent clinical trial findings, streamlined clinical workflows, and cost-effectiveness. The stroke community is monitoring this development with considerable interest and special attention to the following questions: (1) Does the current evidence support superiority or noninferiority of tenecteplase compared with standard-of-care alteplase? (2) What are the ramifications of off-label treatment with tenecteplase? (3) And what are the real-world considerations when transitioning from alteplase to tenecteplase for AIS thrombolysis? This commentary provides a practical synthesis of the current evidence and discusses our institutional experience with tenecteplase including treatment considerations, off-label use, patient consent, stroke center accreditation, and cost savings. Necessary "Code Stroke" workflow changes to ensure a safe transition from alteplase to tenecteplase are detailed.

A Multidisciplinary Approach toward CMOS Capacitive Sensor Array for Droplet Analysis.

This paper introduces an innovative method for the analysis of alcohol-water droplets on a CMOS capacitive sensor, leveraging the controlled thermal behavior of the droplets. Using this sensing method, the capacitive sensor measures the total time of evaporation (ToE), which can be influenced by the droplet volume, temperature, and chemical composition. We explored this sensing method by introducing binary mixtures of water and ethanol or methanol across a range of concentrations (0-100%, with 10% increments). The experimental results indicate that while the capacitive sensor is effective in measuring both the total ToE and dielectric properties, a higher dynamic range and resolution are observed in the former. Additionally, an array of sensing electrodes successfully monitors the droplet-sensor surface interaction. However practical considerations such as the creation of parasitic capacitance due to mismatch, arise from the large sensing area in the proposed capacitive sensors and other similar devices. In this paper, we discuss this non-ideality and propose a solution. Also, this paper showcases the benefits of utilizing a CMOS capacitive sensing method for accurately measuring ToE.

You Can’t Make an Omelette without Breaking an Egg. Surveying Submerged Paleo-terrains with a Mechanical Excavator

Abstract Preserved Stone Age sites and prehistoric landscapes under water can often be challenging to find and access for archaeologists. In consequence, the Viking Ship Museum has, within recent years, frequently used mechanical excavators in archaeological surveys to find and delineate Stone Age sites and prehistoric landscape features. In this article, the authors provide an overview of the introduction of mechanical excavators in maritime archaeology. The respective advantages and limitations of the method are then discussed in light of different scientific and practical considerations. Finally, as a case study, we present our proposed best practice for the method using the recent archaeological survey at the development-led project of Lynetteholmen, Copenhagen. The authors conclude that using mechanical excavators to survey paleo-landscapes is a very effective but potentially destructive method. Most importantly, the method provides access to sediment depths and areas that are inaccessible to divers alone.

Privacy Rights and Social Media

Abstract: This paper delves into the intricate dynamics between privacy and social media, examining the challenges posed by the widespread sharing of personal information. Through a comprehensive lens encompassing legal, ethical, and societal dimensions, it sheds light on the evolving landscape of privacy concerns. The impact of digital connectivity on individual autonomy is explored, emphasizing the delicate balance required in the face of technological advancements. The abstract concludes with practical considerations for users, policymakers, and platform developers, urging a responsible approach to safeguarding privacy rights in our increasingly interconnected world.

Utilizing stable diffusion and fine-tuning models in advertising production and logo creation: An application of text-to-image technology

This article delves into the implementation of text-to-image technology, taking advantage of stable diffusion and fine-tuning models, in the realms of advertising production and logo design. The conventional methods of production often encounter difficulties concerning cost, time constraints, and the task of locating suitable imagery. The solution suggested herein offers a more efficient and cost-effective alternative, enabling the generation of superior images and logos. The applied methodology is built around stable diffusion techniques, which employ variational autoencoders alongside diffusion models, yielding images based on textual prompts. In addition, the process is further refined by the application of fine-tuning models and adaptation processes using a Low-Rank Adaptation approach, which enhances the image generation procedure significantly. The Stable Diffusion Web User Interface offers an intuitive platform for users to navigate through various modes and settings. This strategy not only simplifies the production processes, but also decreases resource requirements, while providing ample flexibility and versatility in terms of image and logo creation. Results clearly illustrate the efficacy of the technique in producing appealing advertisements and logos. However, it is important to note some practical considerations, such as the quality of the final output and limitations inherent in text generation. Despite these potential hurdles, the use of artificial intelligence-generated content presents vast potential for transforming the advertising sector and digital content creation as a whole.

Theoretical and Practical Considerations Regarding the Accounting and Tax Treatment of Factoring Operations in Romania

Theoretical and Practical Considerations Regarding the Accounting and Tax Treatment of Factoring Operations in Romania

Toxicogenomics Approaches to Address Toxicity and Carcinogenicity in the Liver.

Toxicogenomic technologies query the genome, transcriptome, proteome, and the epigenome in a variety of toxicological conditions. Due to practical considerations related to the dynamic range of the assays, sensitivity, cost, and technological limitations, transcriptomic approaches are predominantly used in toxicogenomics. Toxicogenomics is being used to understand the mechanisms of toxicity and carcinogenicity, evaluate the translational relevance of toxicological responses from in vivo and in vitro models, and identify predictive biomarkers of disease and exposure. In this session, a brief overview of various transcriptomic technologies and practical considerations related to experimental design was provided. The advantages of gene network analyses to define mechanisms were also discussed. An assessment of the utility of toxicogenomic technologies in the environmental and pharmaceutical space showed that these technologies are being increasingly used to gain mechanistic insights and determining the translational relevance of adverse findings. Within the environmental toxicology area, there is a broader regulatory consideration of benchmark doses derived from toxicogenomics data. In contrast, these approaches are mainly used for internal decision-making in pharmaceutical development. Finally, the development and application of toxicogenomic signatures for prediction of apical endpoints of regulatory concern continues to be area of intense research.

Perspectives on How Robotic Process Automation Is Transforming Accounting and Auditing Services*

ABSTRACTThe emergence of robotic process automation (RPA) and similar digital technologies is transforming the traditional business models of accounting and auditing services. Such emergence brings valuable benefits. Along with other technologies, RPA represents a significant tool in accounting and auditing services' new digital setting. Despite this, scholarly research on the subject is scarce, particularly concerning the implementation of RPA at accounting and auditing firms. This article provides a literature review of current academic research on RPA in accounting and auditing and proposes future research directions. The review clarifies the use cases of RPA in accounting and auditing. It also reveals that RPA implementation and preparation challenges stem from practical considerations as well as deficits in accountants' applicable education. Thus, the paper is relevant for educators and the accounting profession. Finally, by expanding the discussion of RPA beyond its current focus on accounting and auditing, the authors identify a need for more empirical research on the impact of RPA technology in the post‐implementation stage.

Bladder outlet obstruction in women: Advanced evaluation.

Herein, we provide a review of the indications, practical considerations, and interpretation of urodynamics (UDS) with or without fluoroscopy, as well as cystourethroscopy, for women with suspected bladder outlet obstruction (BOO). A narrative review was performed focusing on the current primary literature and society guidelines around advanced diagnostic modalities for female BOO patients. UDS studies help diagnose BOO by identifying high-pressure low-flow voiding patterns and/or the characteristic radiographic appearance of the bladder neck and urethra during micturition. Cystourethroscopy aids in evaluating structural aberrations of the bladder outlet, and in surgical planning. UDS studies and cystourethroscopy are useful adjuncts in carefully-selected female patients with suspected BOO.

Adaptive selection of the optimal strategy to improve precision and power in randomized trials.

Benkeser etal. demonstrate how adjustment for baseline covariates in randomized trials can meaningfully improve precision for a variety of outcome types. Their findings build on a long history, starting in 1932 with R.A. Fisher and including more recent endorsements by the U.S. Food and Drug Administration and the European Medicines Agency. Here, we address an important practical consideration: how to select the adjustment approach-which variables and in which form-to maximize precision, while maintaining Type-I error control. Balzer etal. previously proposed Adaptive Pre-specification within TMLE to flexibly and automatically select, from a prespecified set, the approach that maximizes empirical efficiency in small trials (N< 40). To avoid overfitting with few randomized units, selection was previously limited to working generalized linear models, adjusting for a single covariate. Now, we tailor Adaptive Pre-specification to trials with many randomized units. Using V-fold cross-validation and the estimated influence curve-squared as the loss function, we select from an expanded set of candidates, including modern machine learning methods adjusting for multiple covariates. As assessed in simulations exploring a variety of data-generating processes, our approach maintains Type-I error control (under the null) and offers substantial gains in precision-equivalent to 20%-43% reductions in sample size for the same statistical power. When applied to real data from ACTG Study 175, we also see meaningful efficiency improvements overall and within subgroups.

Healthcare access and delivery for people with intellectual and developmental disability in the United States: Policy, payment, and practice considerations

AbstractOver 7.5 million people (approximately 2% of the US population) with intellectual and developmental disability live in the United States with the vast majority living in the community and accessing healthcare from the general healthcare system. For over two decades, there has been a national recognition that people with IDD experience poorer health outcomes and experience barriers in access to healthcare. We describe the important legal and financial frameworks that influence access to health care for people with IDD in the US, including a summary of major federal laws and insurance programs that have shaped the landscape of health and social care in the community, evolving trends in payment models, and the risks and benefits of these models. Further, we provide a description of health care delivery models which have been developed to support healthcare for people with disabilities including coordinated care delivery models. Clinical training and support for non‐clinicians to attend to the particular health care needs of the population with IDD is critical yet is not widely available. Additionally, there remain significant access and quality gaps in healthcare for people with IDD. We conclude with a call for advances in health care quality, access and efforts to advance research and data collection to promote health equity for this population.

Cross-national comparisons of later-life cognitive function using data from the Harmonized Cognitive Assessment Protocol (HCAP): Considerations and recommended best practices.

The Harmonized Cognitive Assessment Protocol (HCAP) is a major innovation that provides, for the first time, harmonized data for cross-national comparisons of later-life cognitive functions that are sensitive to linguistic, cultural, and educational differences across countries. However, cognitive function does not lend itself to direct comparison across diverse populations without careful consideration of the best practices for such comparisons. This perspective discusses theoretical and methodological considerations and offers a set of recommended best practices for conducting cross-national comparisons of risk factor associations using HCAP data. Because existing and planned HCAP studies provide cognition data representing an estimated 75% of the global population ≥65 years of age, these recommended best practices will support high-quality comparative analyses of cognitive aging around the world. The principles described in this perspective are applicable to any researcher aiming to integrate or compare harmonized data on cognitive outcomes and their risk and protective factors across diverse populations.

Implementation of Body Worn Camera: Practical and Ethical Considerations

Body-worn cameras are increasingly being used as a violence prevention tool in inpatient mental health wards. However, there remains a limited understanding of this technology from an implementation perspective, such as protocols and best practice guidance if cameras are to be used in these settings. This study explores the perspectives of patients, mental health staff, and senior management to understand the practical and ethical issues related to the implementation of body-worn cameras. Semi-structured interviews (n = 64) with 24 patients, 25 staff from acute wards, six Mental Health Nursing Directors, and 9 community-based patients were conducted. Interviews were analysed using reflexive thematic analysis. Ethical approval was granted by the Health Research Authority. Findings from this study show that the implementation of BWC in healthcare settings requires careful consideration. The perspectives of patients and staff demonstrate the complex reality of implementation alongside the consideration of practical and ethical issues around implementation that are essential to ensures that wards recognise the need to assess their capacity to use the cameras in a way that is fair and consistent for all involved. The findings further highlight wider questions around power and autonomy in mental health care.

Advancing Glaucoma Care: Integrating Artificial Intelligence in Diagnosis, Management, and Progression Detection.

Glaucoma, the leading cause of irreversible blindness worldwide, comprises a group of progressive optic neuropathies requiring early detection and lifelong treatment to preserve vision. Artificial intelligence (AI) technologies are now demonstrating transformative potential across the spectrum of clinical glaucoma care. This review summarizes current capabilities, future outlooks, and practical translation considerations. For enhanced screening, algorithms analyzing retinal photographs and machine learning models synthesizing risk factors can identify high-risk patients needing diagnostic workup and close follow-up. To augment definitive diagnosis, deep learning techniques detect characteristic glaucomatous patterns by interpreting results from optical coherence tomography, visual field testing, fundus photography, and other ocular imaging. AI-powered platforms also enable continuous monitoring, with algorithms that analyze longitudinal data alerting physicians about rapid disease progression. By integrating predictive analytics with patient-specific parameters, AI can also guide precision medicine for individualized glaucoma treatment selections. Advances in robotic surgery and computer-based guidance demonstrate AI's potential to improve surgical outcomes and surgical training. Beyond the clinic, AI chatbots and reminder systems could provide patient education and counseling to promote medication adherence. However, thoughtful approaches to clinical integration, usability, diversity, and ethical implications remain critical to successfully implementing these emerging technologies. This review highlights AI's vast capabilities to transform glaucoma care while summarizing key achievements, future prospects, and practical considerations to progress from bench to bedside.

Optimizing Clinical Implementation of Hypofractionation: Comprehensive Evidence Synthesis and Practical Guidelines for Low- and Middle-Income Settings

The global cancer burden, especially in low- and middle-income countries (LMICs), worsens existing disparities, amplified by the rising costs of advanced treatments. The shortage of radiation therapy (RT) services is a significant issue in LMICs. Extended conventional treatment regimens pose significant challenges, especially in resource-limited settings. Hypofractionated radiotherapy (HRT) and ultra-hypofractionated/stereotactic body radiation therapy (SBRT) offer promising alternatives by shortening treatment durations. This approach optimizes the utilization of radiotherapy machines, making them more effective in meeting the growing demand for cancer care. Adopting HRT/SBRT holds significant potential, especially in LMICs. This review provides the latest clinical evidence and guideline recommendations for the application of HRT/SBRT in the treatment of breast, prostate, and lung cancers. It emphasizes the critical importance of rigorous training, technology, stringent quality assurance, and safety protocols to ensure precise and secure treatments. Additionally, it addresses practical considerations for implementing these treatments in LMICs, highlighting the need for comprehensive support and collaboration to enhance patient access to advanced cancer care.

Outcome measures for young people with adolescent idiopathic scoliosis: A qualitative exploration of healthcare professionals' perceptions and practices.

Limited knowledge exists on current use of patient reported outcome measures (PROMs) and performance measures for adolescents with idiopathic scoliosis (AIS), as well as health care professionals' (HCPs) perceived barriers and facilitators towards their use. This study's objectives were: 1) to explore current practice of HCPs when assessing outcomes for AIS 2) to understand perceived barriers and facilitators of HCPs to use PROMs 3) to understand perceived barriers and facilitators of HCPs to use performance measures. A qualitative study recruited a purposive sample of HCPs from a tertiary hospital in the United Kingdom. Mean years of experience managing individuals with AIS was 11.8 years; and included surgeons, physiotherapists and nurses, educated at Bachelor, Masters and Doctoral level. Consent to participate and demographic information were collected in advance of the interviews. In-depth, virtual semi-structured interviews were informed by a topic guide based on current evidence. Interviews of approximately 45 minutes were audio and video recorded and transcribed verbatim alongside written field notes. Data were coded and analysed using inductive thematic analysis, involving researchers with topic and methodological expertise and input from a patient representative. Two themes emerged regarding current practice of using PROMs routine practice and personal evaluations. Four themes emerged as barriers to using PROMs for individuals with AIS: priority and support (e.g., HCPs focus on providing care), practical challenges (e.g., inadequate PROMs), patient-related challenges (e.g., patient preferences) and knowledge, education, and perceived value. Two themes emerged as facilitators: quality existing measure (e.g., sufficient psychometric properties), and priority and support (e.g., research department/culture). Themes for barriers to use performance measures were practicality (e.g., need physical space) and perceived value and knowledge (e.g., PROMs are more important), while the one theme for facilitators was practical consideration (e.g., acceptability). Although HCPs perceived the value of using outcome measures, current practice indicates limited use for individuals with AIS. The findings revealed different barriers and facilitators to implement PROMs in practice. Adopting performance measure are limited due to lack of knowledge and perceived value alongside the practicality, while considering practical factors can improve the use of these measures in practice.