Private Practice Research Articles

The uses of 3-dimensional printing technology in orthodontic offices in North America

The purpose of this study was to examine the use of orthodontic 3-dimensional (3D) printing technology in North America and to understand why orthodontists are, or are not, incorporating 3D printing technology in their practices. A survey questionnaire was delivered on a secure online platform, RedCap (Case Western Reserve University Clinical and Translational Science Award; no. UL1TR002548). The survey consisted of 14-34 items with branching logic. The association between participant demographics and in-house 3D printing was assessed using a chi-square test of independence. A total of 518 responses were recorded. The highest number of responses came from respondents in the 36-45-year age group. Most of the respondents were practice owners; 46.9% had 3D printers in their office. Chi-square tests of independence were performed on the data to see which associations existed. The strongest statistical associations with using an in-house 3D printer are seen with patient load, practice type, years since residency, and orthodontist's position. Approximately 75% of orthodontists use 3D printing technology in some capacity in North America. Major factors that influenced orthodontists to incorporate 3D printing technology into their office were self-interest and research. Major factors that have prevented orthodontists from not incorporating 3D printing technology into their office were space for equipment/ventilation and digital workflow training deficit. Orthodontists use their 3D printers mostly to make plastic retainers from printed models. The strongest associations with using in-house 3D printers are seen in patient load, practice type, years since residency, and orthodontist position. Increasing patient load and being in private practice increases the likelihood of having a 3D printer.

The Use of a New Safe Angle Concept for Immediate Implant Placement in the Anterior Maxilla: A Cross-sectional Cone Beam Computed Tomography Study.

The current cross-sectional study aims to introduce a new method for the labiopalatal positioning and angulation of immediately placed dental implants in the anterior maxilla with relation to the type of abutment used (straight/angled abutment). Cone beam computed tomography scans from the database of a private practice were searched for patients who received immediate implants in anterior maxilla. After superimposition of the initial and post-operative scans, incisal/root angle (IRA), incisal/implant angle (IIA) and the difference between both angles were measured. Furthermore, assessment of whether the implant position would be lying within the safe angle or not. Age, gender, tooth/implant site and type of prosthetic abutment (straight/angled) were retrieved from patients' records. Seventy-four patients with a total of 95 immediate implants were selected for analysis. In regard to the type of abutment, 76 (80%) were straight, while 19 abutments (20%) were angled. Regardless of abutment type, 72 implants (75.8%) lay within the safe angle while 23 implants (24.2%) did not lie within the safe angle. All 19 implants with angled abutments were not lying within the safe angle. There was a statistically significant association between type of abutment, IRA, difference between IIA and IRA, gender and lying within the safe angle (P-value <0.001, OR = 19, P-value <0.001, Effect size = 0.904, P-value <0.001, Effect size = 1.209 and P-value <0.001, OR = 2.995 respectively). There was no statistically significant association between IIA, site or age and lying within the safe angle (P-value = 0.757, Effect size = 0.063, P-value = 0.200, Effect size = 0.184 and P-value = 0.387 Effect size = 0.208, respectively). There was a statistically significant association between IRA, difference between IIA and IRA and type of abutment (P-value = 0.001, Effect size = 0.762, P-value <0.001, Effect size = 1.056, respectively). The Safe Angle Concept can be used as a reliable planning tool to choose the correct IIP position in the anterior maxilla. Applying the safe angle concept will decrease the use of angled abutment for prosthetic correction.

Establishing a Value Proposition for a Pain and Comfort Management Private Practice: The Business Canvas

Establishing a Value Proposition for a Pain and Comfort Management Private Practice: The Business Canvas

A Multicenter Cohort Study on 301 Tissue-Level Implants: Cumulative Implant Survival Rate and Marginal Bone Level Change up to 4.5 Years.

To retrospectively determine the cumulative survival rate (CSR) and marginal bone level change (ΔMBL) around novel hybrid design tissue-level (TL) dental implants that support multiple-screw-retained restorations. Implant CSRs were analyzed at the implant and patient level using Kaplan-Meier estimates. ΔMBL was measured by comparing the periapical loading and follow-up visit radiographs using an improved standardized digital methodology based on image gray levels. ΔMBL outcomes were subject to linear mixed regression to identify potential risk factors. A total of 301 TL implants in 69 patients with an average age of 62.6 ± 11.7 years (range: 36 to 87 years) at the time of implant placement were considered for the analysis. All 301 implants were successfully restored and loaded. The 54-month CSRs at the implant and patient levels were 98.9% (95% CI: 96.7 to 99.6) and 95.3% (95% CI: 86.1 to 98.5), respectively. ΔMBL after a mean follow-up of 22 ± 10.7 months after loading was 0.00 ± 0.57 mm. None of the implant sites showed marginal bone loss exceeding 1.5 mm. Multivariate regression analysis revealed a significant association between ΔMBL and the loading protocol (P = .027) but not between ΔMBL and age or transgingival height. The high CSRs and stable peri-implant marginal bone levels support the use of recent TL implants, which have a hybrid design inherited from the bone-level implant-abutment connection, as a suitable treatment option for restoring partially or fully edentulous patients with a good mid-term prognosis. These results should be complemented by further prospective studies in a real-world multicenter private practice setup that represents the daily realities of implant treatment.

The future of private practice neurosurgery and the pitfalls of private equity.

The future of private practice neurosurgery and the pitfalls of private equity.

Surgical Efficiency Comparison Between Two Phacoemulsification Systems.

To assess the surgical efficiency in cataract surgery comparing two phacoemulsification systems. Prospective, consecutive-comparative study in a two-site private practice. Three hundred and one eyes undergoing standard or femtosecond laser-assisted (FLACS) cataract surgery with either the R-Evo Smart (BVI, Waltham, USA) and/or the Centurion Vision System (Alcon, Fort Worth, USA). Preoperative eye characteristics (degree of cataract using the lens opacities classification system LOCS III grading) and intraoperative outcomes (total ultrasound time and total estimated fluid aspirated/drainage bag weighting) were registered in all cases. One hundred and fifty-five eyes undergone cataract surgery with the R-Evo Smart and 146 eyes with the Centurion Vision System phacoemulsification systems. Mean cataract grade was 3.07 ± 0.78 and 2.96 ± 0.85 for the R-Evo Smart and Centurion Vision System groups, respectively (p = 0.12). Mean total ultrasound time was 18.99 ± 12.85 and 40.24 ± 21.91 seconds for the R-Evo Smart and Centurion Vision System groups, respectively (p < 0.01). Mean total estimated fluid aspirated/drainage bag weighting was 53.00 ± 14.56 g and 54.33 ± 14.88 cc for the R-Evo Smart and Centurion Vision System groups, respectively (p = 0.21). Considering non-FLACS surgery (98 eyes with the R-Evo Smart and 63 eyes with the Centurion Vision System), mean cataract grade was 2.95 ± 0.74 and 2.97 ± 0.91 for the R-Evo Smart and Centurion Vision System groups, respectively (p = 0.44). Mean total ultrasound time was 19.96 ± 11.20 and 42.84 ± 28.35 seconds for the R-Evo Smart and Centurion Vision System groups, respectively (p < 0.01). Mean total estimated fluid aspirated/drainage bag weighting was 55.95 ± 14.76 g and 55.97 ± 13.62 cc for the R-Evo Smart and Centurion Vision System groups, respectively (p = 0.49). No adverse events were found in the two groups of eyes. The objective measurement of surgical efficiency through total ultrasound time during lens removal and fluid consumption during both lens removal and irrigation/aspiration proved R-Evo Smart to be an efficient phacoemulsification platform, in comparison with the current standard of care Centurion Vision System.

Transitioning from Hospital-based to Office-based Practice

The decision to change your career path from a hospital-based practice, whether it's from being a hospital employee or a member of a private practice, can be an emotionally draining choice that is complex and overwhelming to say the least. There are many factors to consider before making this switch, but most importantly, one must realize it may be the hardest but most rewarding work in your career. While the physical, emotional and financial stresses placed on you while developing a practice can be rather demanding, on the flip side, if done correctly and the practice thrives, it can be a change that will bring you great pride and satisfaction, as well as personal reward and freedom.

Investigating the Trajectory and Associated Risk Factors of Clinical Outcomes for Early Childhood Disruptive Behavior Disorders Using Real World Data.

Disruptive behavior disorders (DBDs) are common mental health problems among early childhood American youth that, if poorly managed, pose costly psychological and societal burdens. There is limited real world evidence on how parent management training (PMT) - the evidence-based treatment model of choice - implemented in common practice settings within the United States influences the behavioral progress of early childhood DBDs, and the risk factors associated with poor outcomes. This study used data from a measurement feedback system implemented within a U.S.-based private practice to study how behavioral outcomes change as a function of PMT treatment engagement and associated risk factors for 4-7 year-old children diagnosed with DBDs. Over 50% of patients reached optimal outcomes after 10 appointments. Attending 24-29 appointments provided maximum treatment effect - namely, 75% of patients reaching optimal outcomes by end of treatment. Outcomes attenuate after reaching the maximum effect. Patients also had higher odds of reaching optimal outcomes if they had consistent attendance throughout the treatment course. Notable risk factors associated with lower odds of reaching optimal outcomes included Medicaid insurance-type, greater clinical complexity, and having siblings concurrently in treatment. Increased implementation of systems that monitor and provide feedback on treatment outcomes in U.S.-based practice settings and similar investigations using its data can further enhance 'real world' management of early childhood DBDs among American youth.

Gendered capital in psychotherapy: A thematic analysis of patients' experiences of the therapists' gender

Gendered capital in psychotherapy: A thematic analysis of patients' experiences of the therapists' gender

Promoting access to care in pyometra treatment: pathways to collaboration between high-quality, high-volume spay-neuter clinics and private practices.

To compare results from 2 previously published surveys aimed at determining how pyometra is treated in high-quality, high-volume spay-neuter clinics (HQHVSNCs) and private practices (PPs), with a specific focus on identifying opportunities for partnership between the clinic types to improve access to care in pyometra treatment. Responses from 123 PPs and 87 HQHVSNCs. A previously published survey of PPs conducted from June to July 2021 and a similar previously published survey of HQHVSNCs conducted from June to July 2020 were compared regarding demographics, pyometra treatment availability, estimated outcome, alternative outcome, disruption, cost, and protocol between HQHVSNCs and PPs. A comparison was also run of the surveys' responses regarding referral of a pyometra to an HQHVSNC by a PP. Although PPs estimated that economic euthanasia is the most likely alternative outcome for 13% of patients unable to access care at their practice, 80% would be reluctant to refer to an HQHVSNC. The 3 primary reasons indicated by PPs with a reluctance to refer were a perceived lack of prompt appointment availability (20%), lack of aftercare (18%), and lack of adequate equipment (14%). In contrast, most HQHVSNCs estimated that they generally accept referrals the same day (50%) or the next day (30%) and 95% of HQHVSNCs reported having the resources needed to treat most pyometras. There are several opportunities for partnership between PPs and HQHVSNCs in the treatment of pyometra. The most frequent concerns expressed by PPs regarding referral to HQHVSNCs were not shared by HQHVSNCs or could be ameliorated by referral to an HQHVSNC for surgery and transfer back to the PP for aftercare.

Peri-Operative Impact of Cannabis Use in Conjunction With Elective Primary Breast Augmentation in a Private Practice.

Background The consumption of recreational and medicinal cannabis in the United States continues to increase. Understanding the effects of cannabis in patients undergoing elective primary breast augmentation (EPBA) is of paramount importance with the expanding rates of reported cannabis consumption. Objectives This study aims to analyze the peri-operative impact of cannabis use in conjunction with EPBA in a single-surgeon practice in San Francisco, California. Methods A retrospective chart review was performed of 134 adult female patients undergoing EPBA from August 2018 to January 2022 within a single-surgeon practice plastic surgery office. Cannabis use was self-reported as current use or former use. Cohorts were grouped as cannabis users and cannabis non-users. Results Of the 134 patient charts identified for analysis, 58 (43.3%) reported cannabis use. Cannabis users were significantly younger than cannabis non-users (26.8 years versus 31.5 years, P<0.001). No significant differences were found between groups among intra-operative blood loss, post-operative complication rates, post-operative narcotic use, or intra-operative anesthetic requirements. The incidence of adverse events, including wound breakdown, skin necrosis, and capsular contracture requiring reoperation, did not differ significantly between cannabis users and cannabis non-user groups. Ninety-six percent of patients had their implants placed subpectorally, and all procedures were done using a Keller funnel. Eighty-three percent of patients had Sientra implants, and 96% of all implants were silicone gel implants. All procedures were done under general anesthesia. Patients were followed for up to two years. Discussion This review found no significant differences in peri-operative and post-operative outcomes between cannabis users and cannabis non-users.

The linear pattern of therapeutic alliance development: Exploring the relationship between alliance trajectories over time and the outcomes of systemic psychotherapy treatment for adaptation disorders

AbstractObjectiveThis study aimed to determine the trajectories of therapeutic alliance development in individual systemic psychotherapy for adults with adaptation disorders and the differences in alliance development between groups with different treatment outcomes.MethodThe longitudinal quasi‐experiment included 20 patients undergoing individual outpatient psychotherapy treatment in private practice for over a year. Therapeutic alliance was evaluated three times, by the psychotherapist and the patient simultaneously. Treatment outcomes were estimated twice based on patient ratings. Their clinical significance was assessed using the Reliable Change Index, analysis of variance for independent groups and trend analysis. The analyses concerned global therapeutic alliance and its three dimensions: goals, tasks and bonds.ResultsThe study supported the hypothesised linear trend. It also confirmed a greater increase in alliance quality over the course of treatment in patients whose therapy was more successful.ConclusionThe results indicate that, in patients with adaptation disorders, alliance development in systemic therapy follows a stable linear trend. The linear change observed for global therapeutic alliance is paralleled by similar trends in goals, tasks and bonds. Strong alliance correlates with better treatment outcomes.

ChatGPT in private practice: The opportunities and pitfalls of novel technology.

This article explores the transformative impact of OpenAI and ChatGPT on Australian medical practitioners, particularly psychiatrists in the private practice setting. It delves into the extensive benefits and limitations associated with integrating ChatGPT into medical practice, summarising current policies and scrutinising medicolegal implications. A careful assessment is imperative to determine whether the benefits of AI integration outweigh the associated risks. Practitioners are urged to review AI-generated content to ensure its accuracy, recognising that liability likely resides with them rather than with AI platforms, despite the lack of case law specific to negligence and AI in the Australian context at present. It is important to employ measures that ensure patient confidentiality is not breached and practitioners are encouraged to seek counsel from their professional indemnity insurer. There is considerable potential for future development of specialised AI software tailored specifically for the medical profession, making the use of AI more suitable for the medical field in the Australian legal landscape. Moving forward, it is essential to embrace technology and actively address its challenges rather than dismissing AI integration into medical practice. It is becoming increasingly essential that both the psychiatric community, medical community at large and policy makers develop comprehensive guidelines to fill existing policy gaps and adapt to the evolving landscape of AI technologies in healthcare.

Feasibility and acceptability of a primary care mentoring programme for undergraduate students

ABSTRACT Mentoring plays a crucial role in increasing the attractiveness of primary care careers for medical students. Based on a literature review and structured group discussions, the authors developed a primary care mentoring platform centred on undergraduate medical students’ needs. All second- to sixth-year students were invited to enrol into the programme by choosing a mentor from an online platform, which was pilot tested during one academic year (2021–2022) with 16 mentors. Fifteen mentees enrolled into the pilot programme. The evaluation assessed the procedures’ feasibility as well as the student-centeredness and acceptability of the programme. Mentees completed a quantitative survey evaluating satisfaction and the mentoring relationship’s personal and content aspects. Mentors’ feedback was collected during focus groups discussing the programme’s acceptability and practical aspects. Both mentees and mentors expressed high levels of satisfaction with the programme. Mentees rated their mentoring relationships highly across most aspects. Mentees’ content-related needs included postgraduate training, meeting an inspiring person, work-life balance, and questions about running a private practice. Mentors described the programme as a rewarding experience. They enjoyed the flexible structure that allowed them to adapt to the mentees’ individual needs. Maintaining the relationship was mostly the mentors’ responsibility. Further structured guidance from the programme coordinators was identified as potentially beneficial for future implementation. The findings highlight the feasibility and the advantages of a flexible, student-centred mentoring programme. The programme attracted students interested in primary care from all levels of undergraduate education. Such programmes may contribute to fostering students’ interest in primary care careers.

Supportive therapy following peri-implantitis treatment: A retrospective study on compliance.

The compliance rate with supportive therapy following peri-implantitis treatment (SPIT) remains unknown. The present retrospective study was carried out to assess the compliance rate and the factors influencing compliance in a private practice setting. Patients were divided into three groups according to compliance rate: regular compliance (RC ≥2 SPIT/year), erratic compliance (EC <2 SPIT/year), and non-compliance (NC <1 SPIT/year). Overall, 17 patient- (n = 8) and site-related variables (n = 9) were explored as potential confounders of compliance. The Chi2 test was applied to assess the association between categorical variables and determine the odds ratio (OR). The study comprised 159 patients restored with 1075 implants, of which 469 were treated for peri-implantitis and met the inclusion criteria. A total of 57.2% were RC, 25.8% EC, and 17% NC. The multivariate analysis showed that smoking and grade C periodontitis reduced the likelihood of RC (OR = 0.28, p < .001) when compared to complete edentulism or non-smoking. Moreover, age demonstrated being associated with follow-up when SPIT was interrupted in EC and NC (OR = 0.94, p = .007). Comprehensive information, provided prior to peri-implantitis treatment, regarding the importance of adhering to SPIT after peri-implantitis treatment to achieve/maintain peri-implant health, resulted in ~60% regular compliance rate (NCT05772078).

Prevalence of Peri-Implant Mucositis, Peri-Implantitis and Associated Risk Indicators of Implants with and without Laser-Microgrooved Collar Surface: A Long-Term (≥20 Years) Retrospective Study.

The aim of the current study was to retrospectively investigate the prevalence of peri-implant mucositis (PIM) and peri-implantitis (P) in a long-term follow-up (≥20 years) of implants with the same body design and body surface but different collar surfaces with laser-microtextured grooves (LMGSs) vs. no laser-microtextured grooves (no-LMGSs) in private practice patients. Furthermore, several patient-related, implant-related, site-, surgical-, and prosthesis-related potential disease risk factors were analyzed. A chart review of patients receiving at least one pair of implants (one with an LMGS and the other without LMGS) in the period 1993-2002 was used. Chi-square analysis was used to determine if a statistically significant difference between the investigated variables and PIM/P was present. Possible risk factors were statistically evaluated by a binary logistic regression analysis. A total of 362 patients with 901 implant-supported restorations (438 with LMGS and 463 no-LMGS) were included in the study. The cumulative survival rates of implants at 5, 10, 15, and 20 years were 98.1%, 97.4%, 95.4%, and 89.8%, respectively, for the LMGS group, and 93.2%, 91.6%, 89.5%, and 78.3% for the no-LMGS group. The difference was statistically significant at all timepoints (p < 0.05). In total, at the end of the follow-up period, 45.7% of patients and 39.8% of implants presented PIM, and 15.6% of patients and 14% of implants presented P. A total of 164 LMGS implants (37.4%) and 195 no-LMGS implants (42.1%) presented peri-implant mucositis, while 28 (6.3%) of LMGS implants and 98 (21.1%) no-LMGS implants demonstrated peri-implantitis. Differences between LMGS implants and no-LMGS implants were statistically significant (p < 0.05). The binary logistic regression identified collar surface, cigarette smoking, histories of treated periodontitis, and lack of peri-implant maintenance as risk factors for P. After at least 20 years of function in patients followed privately, LMGS implants compared to no-LMGS implants presented a statistically and significantly lower incidence of P. Implant collar surface, cigarette smoking, previously treated periodontitis, and lack of peri-implant maintenance are factors with significant association to P.

Analysing the effectiveness of Just-A-Minute Optometry Clinical Pearls: a micro-learning tool in continuing optometry education

ABSTRACT Clinical relevance Just-A-Minute Clinical Pearls as a microlearning concept may be beneficial in enhancing optometry and ophthalmology practice globally. Background Medical education often witnesses a gap in effectively translating the learnings into clinical practice, pointing to the complex and traditional teaching methods as hindrances. The present work studied the usefulness and acceptability of Just-A-Minute Optometry Clinical Pearls, a micro-learning tool, among optometrists and ophthalmologists. Methods Just-A-Minute Optometry clinical pearls were developed by the optometry team of LV Prasad Eye Institute and shared (via email) among optometrists and ophthalmologists on a daily basis between June 2021 to May 2022. In the middle of the project, the recipients were invited to participate in an online survey. The variables studied included frequency of checking clinical pearls, simplicity of their content, grasping speed, most used subspeciality pearls, knowledge gain and retention, practice applicability, overall learning experience, and the likelihood of recommending it to a friend. Results Among 150 respondents, 103 (68.7%) were ophthalmologists, and 46 (30.7%) were optometrists. The majority were from private (n = 64, 42.7%) and institutional (n = 48, 32%) practices, with 102 (68.4%) having more than five years and 21 (14%) having 2–5 years of experience. About 115 (77%) respondents checked clinical pearls every day, 147 (99%) found the format easy, and 131 (88%) could grasp the content within one minute. They felt that JAM-OCP ‘always’ enhanced clinical knowledge (n = 108, 72%) and clinical applicability (n = 82, 55%) and helped in knowledge retention (n = 123, 84%). The responses to the clinical application significantly varied (Chi-square tests) among subgroups of education qualification (p < 0.001) and practice types (p < 0.03). Conclusions The Just-A-Minute Optometry Clinical Pearls were beneficial to optometrists and ophthalmologists in their practices. This, as a tele-education tool, supports continuing optometry education across the globe.

Development of short forms for screening children's dental caries and urgent treatment needs using item response theory and machine learning methods.

Surveys can assist in screening oral diseases in populations to enhance the early detection of disease and intervention strategies for children in need. This paper aims to develop short forms of child-report and proxy-report survey screening instruments for active dental caries and urgent treatment needs in school-age children. This cross-sectional study recruited 497 distinct dyads of children aged 8-17 and their parents between 2015 to 2019 from 14 dental clinics and private practices in Los Angeles County. We evaluated responses to 88 child-reported and 64 proxy-reported oral health questions to select and calibrate short forms using Item Response Theory. Seven classical Machine Learning algorithms were employed to predict children's active caries and urgent treatment needs using the short forms together with family demographic variables. The candidate algorithms include CatBoost, Logistic Regression, K-Nearest Neighbors (KNN), Naïve Bayes, Neural Network, Random Forest, and Support Vector Machine. Predictive performance was assessed using repeated 5-fold nested cross-validations. We developed and calibrated four ten-item short forms. Naïve Bayes outperformed other algorithms with the highest median of cross-validated area under the ROC curve. The means of best testing sensitivities and specificities using both child-reported and proxy-reported responses were 0.84 and 0.30 for active caries, and 0.81 and 0.31 for urgent treatment needs respectively. Models incorporating both response types showed a slightly higher predictive accuracy than those relying on either child-reported or proxy-reported responses. The combination of Item Response Theory and Machine Learning algorithms yielded potentially useful screening instruments for both active caries and urgent treatment needs of children. The survey screening approach is relatively cost-effective and convenient when dealing with oral health assessment in large populations. Future studies are needed to further leverage the customize and refine the instruments based on the estimated item characteristics for specific subgroups of the populations to enhance predictive accuracy.

Current patient care of systematic lupus erythematosus in Rhineland-Palatinate and Saarland

Systemic lupus erythematosus (SLE) is aclinically heterogeneous autoimmune disease that is associated with great suffering for those affected, as well as high socioeconomic costs. Early diagnosis and adequate medical care are essential for amild course of the disease. However, there is a lack of current figures and data on the care situation of patients in the area. Atotal of 1546 general practitioners, rheumatologists, neurologists, nephrologists and dermatologists in Rhineland-Palatinate and Saarland were interviewed by fax or mail using aquestionnaire regarding epidemiology, symptoms, therapy and therapy success. In addition, there was the possibility of making suggestions for improvement. Five out of six of the 635 reported SLE patients were female. The most common main symptoms were arthralgia, fatigue, myalgia, and skin changes. Of the patients, 68% received antimalarials (AMs), whereas 46% were treated with glucocorticoids (GCs) and 50% with an immunosuppressant (IS), mainly methotrexate. In terms of comorbidities, patients suffered mainly from cardiovascular disease, fibromyalgia syndrome and depression. Rheumatologists also frequently described anaemia, diabetes mellitus and osteoporosis. Compared with guideline recommendations, the low rate of AMs in therapy was particularly striking in patients not treated by rheumatologists (35% on average compared with 81% for rheumatologists). Additionally, (sustained) high doses of GCs are not in line with literature recommendations. In the free text field, the main requests were for more rheumatologists in private practice and faster appointment scheduling, as well as better communication and networking. In addition, the desire for more training and education was frequently expressed..

Between Privacy and Utility: On Differential Privacy in Theory and Practice

Differential privacy (DP) aims to confer data processing systems with inherent privacy guarantees, offering strong protections for personal data. But DP’s approach to privacy carries with it certain assumptions about how mathematical abstractions will be translated into real-world systems, which—if left unexamined and unrealized in practice—could function to shield data collectors from liability and criticism, rather than substantively protect data subjects from privacy harms. This article investigates these assumptions and discusses their implications for using DP to govern data-driven systems. In Parts 1 and 2, we introduce DP as, on one hand, a mathematical framework and, on the other hand, a kind of real-world sociotechnical system, using a hypothetical case study to illustrate how the two can diverge. In Parts 3 and 4, we discuss the way DP frames privacy loss, data processing interventions, and data subject participation, arguing it could exacerbate existing problems in privacy regulation. In part 5, we conclude with a discussion of DP’s potential interactions with the endogeneity of privacy law, and we propose principles for best governing DP systems. In making such assumptions and their consequences explicit, we hope to help DP succeed at realizing its promise for better substantive privacy protections.