Reliable Feedback Research Articles

Investigation of the Influence of Pulse Duration and Application Mode on Microsecond Laser Microsurgery of the Retinal Pigment Epithelium.

Optical microsurgery confined to the retinal pigment epithelium (RPE) requires locally optimized laser parameters and reliable real-time feedback dosimetry (RFD) to prevent unwanted neuroretinal overexposure. This study aimed to compare pulses of different durations and application modes (single, ramp, burst). Moreover, optical coherence tomography (OCT)-based RFD was investigated in an ex vivo experiment, utilizing nine porcine eyes that were exposed to laser pulses of 8, 12, 16 and 20 µs duration (wavelength: 532 nm, exposure area: 90 × 90 µm2, radiant exposure: 247 to 1975 mJ/µm2). Simultaneously, time-resolved OCT M-scans were recorded (central wavelength: 870 nm, scan rate: 85 kHz) for RFD. Post irradiation, retinal changes were assessed with color fundus photography (CFP) and cross-sectional OCT B-scans. RPE cell damage was quantified via fluorescence-based cell viability assay and compared to the OCT dosimetry feedback. Our experiments indicate cumulative RPE damage for pulse bursts of 16 µs and 20 µs, whereas no cumulative effects were found for pulse durations of 8 µs and 12 µs applied in ramp mode. According to statistical analysis, OCT-RFD correctly detected RPE cell damage with 96% sensitivity and 97% specificity using pulses of 8 µs duration in ramp mode.

ID: 209013 Combining Remote Programming and Remote Monitoring Towards a Closed-Loop DBS System

Deep Brain Stimulation (DBS) is an effective therapy for Parkinson’s Disease (PD). However, it is currently applied in an open-loop fashion and symptom management relies on iterative programming. The field is trending towards closed-loop solutions that enable stimulation parameters to be adjusted in real-time in response to patient-specific feedback signals. Identifying reliable and robust feedback signals is a challenge in developing closed-loop DBS solutions. As such, in this study, we aim to combine remote monitoring and remote programming to identify specific sensor signals that correlate with DBS programming and symptom profile changes.

Hybrid-disturbance-observer-based interaction control for a fully actuated UAV with tether-based positioning system

PurposeThis paper aims to tackle the problem for a fully actuated unmanned aerial vehicle (FUAV) to perform physical interaction tasks in the Global Positioning System-denied environments without expensive motion capture system (like VICON) under disturbances.Design/methodology/approachA tether-based positioning system consisting of a universal joint, a tether-actuated absolute position encoder and an attitude sensor is designed to provide reliable position feedback for the FUAV. To handle the disturbances, including the tension force caused by the taut tether, model uncertainties and other external disturbances such as aerodynamic disturbance, a hybrid disturbance observer (HDO) combining the position-based method and momentum-based technology with force sensor feedback is designed for the system. In addition, an HDO-based impedance controller is built to allow the FUAV interacting with the environment and meanwhile rejecting the disturbances.FindingsExperimental validations of the proposed control algorithm are implemented on a real FUAV with the result of nice disturbance rejection capability and physical interaction performance.Originality/valueA cheap alternative to indoor positioning system is proposed, with which the FUAV is able to interact with external environment and meanwhile reject the disturbances under the help of proposed hybrid disturbance observer and the impedance controller.

Convolutional neural network classifies visual stimuli from cortical response recorded with wide-field imaging in mice

Objective. The optic nerve is a good location for a visual neuroprosthesis. It can be targeted when a subject cannot receive a retinal prosthesis and it is less invasive than a cortical implant. The effectiveness of an electrical neuroprosthesis depends on the combination of the stimulation parameters which must be optimized, and an optimization strategy might be performing closed-loop stimulation using the evoked cortical response as feedback. However, it is necessary to identify target cortical activation patterns and to associate the cortical activity with the visual stimuli present in the visual field of the subjects. Visual stimuli decoding should be performed on large areas of the visual cortex, and with a method as translational as possible to shift the study to human subjects in the future. The aim of this work is to develop an algorithm that meets these requirements and can be leveraged to automatically associate a cortical activation pattern with the visual stimulus that generated it. Approach. Three mice were presented with ten different visual stimuli, and their primary visual cortex response was recorded using wide-field calcium imaging. Our decoding algorithm relies on a convolutional neural network (CNN), trained to classify the visual stimuli from the correspondent wide-field images. Several experiments were performed to identify the best training strategy and investigate the possibility of generalization. Main results. The best classification accuracy was 75.38% ± 4.77%, obtained pre-training the CNN on the MNIST digits dataset and fine-tuning it on our dataset. Generalization was possible pre-training the CNN to classify Mouse 1 dataset and fine-tuning it on Mouse 2 and Mouse 3, with accuracies of 64.14% ± 10.81% and 51.53% ± 6.48% respectively. Significance. The combination of wide-field calcium imaging and CNNs can be used to classify the cortical responses to simple visual stimuli and might be a viable alternative to existing decoding methodologies. It also allows us to consider the cortical activation as reliable feedback in future optic nerve stimulation experiments.

A multi-institutional study using artificial intelligence to provide reliable and fair feedback to surgeons

BackgroundSurgeons who receive reliable feedback on their performance quickly master the skills necessary for surgery. Such performance-based feedback can be provided by a recently-developed artificial intelligence (AI) system that assesses a surgeon’s skills based on a surgical video while simultaneously highlighting aspects of the video most pertinent to the assessment. However, it remains an open question whether these highlights, or explanations, are equally reliable for all surgeons.MethodsHere, we systematically quantify the reliability of AI-based explanations on surgical videos from three hospitals across two continents by comparing them to explanations generated by humans experts. To improve the reliability of AI-based explanations, we propose the strategy of training with explanations –TWIX –which uses human explanations as supervision to explicitly teach an AI system to highlight important video frames.ResultsWe show that while AI-based explanations often align with human explanations, they are not equally reliable for different sub-cohorts of surgeons (e.g., novices vs. experts), a phenomenon we refer to as an explanation bias. We also show that TWIX enhances the reliability of AI-based explanations, mitigates the explanation bias, and improves the performance of AI systems across hospitals. These findings extend to a training environment where medical students can be provided with feedback today.ConclusionsOur study informs the impending implementation of AI-augmented surgical training and surgeon credentialing programs, and contributes to the safe and fair democratization of surgery.

𝑯∞ reliable fuzzy control for vehicle dynamics stability

This article introduces a reliable control scheme for a four-wheel vehicle. This scheme assumes that actuators fail and external disturbances occur to the system. In contrast to existing results, this study assumes the actuator fault model includes linear and nonlinear terms, and an output feedback controller is designed to improve vehicle stability and handling when actuators fail. Using Takagi-Sugeno (T-S) fuzzy models, a reliable fuzzy static output feedback (SOF) controller is designed to address the nonlinear aspect of the system. Based on the non-quadratic Lyapunov function with auxiliary matrices, less conservative sufficient conditions are established such that the closed-loop system is stable with a γ level of H_∞ performance against external disturbances. Furthermore, using an appropriate model transformation, a set of linear matrix inequalities (LMIs) is formulated to synthesize the controller gains. The proposed scheme is then tested using numerical experiments to demonstrate potential applications and validate its effectiveness.

Gaussian mixture model based radio environment mapping for an underlay Device‐to‐Device network

AbstractEfficient management of the scant radio resources in densely deployed Device‐to‐Device (D2D) and IoT networks in 5G+ and 6G wireless era would require continuous and reliable information feedback regarding the actual on‐ground resource utilization. Toward that goal, radio environment maps (REM) are becoming increasingly important as they provide critical information relevant for network management. REM essentially entails the estimation of the radio environment at unsampled locations using the values measured by a few dedicated REM sensors by interpolation. Hence, the accuracy of REM is dependent upon two major factors (1) the sensor deployment and (2) the interpolation scheme. So far, the ordinary Kriging (OK) with randomly deployed sensors is the most prevalent method of REM creation. However, the underlying assumption in OK is that the radio environment conforms to a Gaussian spatial random field (GSRF). In reality, the spatial random field generated by a D2D network displays non‐Gaussian characteristics. Hence, a variational Bayesian based Gaussian mixture model enabled Kriging (VK) method has been proposed in this work which achieves better interpolation accuracy than OK with a lower run‐time computational complexity. A comparison of various sensor deployment schemes on the basis of REM accuracy in fading channel conditions has also been conducted. Additionally, a spatial‐correlation based method has been proposed to estimate the minimum number of required REM sensors to ensure reliable REM performance. The simulation results indicate a superiority of hexagonal deployment of sensors over other schemes and establish VK as a more accurate interpolation algorithm than OK.

Assessing interactional competence in secondary schools

AbstractInteractional competence (IC) is a crucial component of teaching and assessing speaking in second/foreign languages in general. However, SLA research based on Conversation Analysis (CA) has shown that IC is a complex phenomenon, and while a qualitative approach to assessing IC is needed, it is time-consuming. At the same time, assessment in the foreign-language classroom has to be both manageable for teachers and it should provide learners with reliable and supportive feedback about their specific strengths and weaknesses. This paper offers some solutions for these issues. It will draw on previous proposals in CA to employ generic organizations of practice as a way to manage the complexity of the IC concept. Second, it will show how one of these organizations – action accomplishment – can be operationalized for assessment purposes in public-school classrooms. This includes a discussion of the CEFR Companion’s approach to ‘action’. Finally, it will present a possible rubric for action accomplishment. Our approach to assessing will be illustrated through the analysis of a sample role play with two foreign-language learners from a corpus of 14 2–4 minute role plays, recorded with beginning-to-intermediary-level learners of English as a foreign language in two German secondary schools.

Continuous Real-Time Neuropsychological Testing during Resection Phase in Left and Right Prefrontal Brain Tumors.

Executive functions are multi-component and are based on large-scale brain networks. For patients undergoing brain surgery in the prefrontal cortex, resection in the anterior prefrontal sites is assisted by continuous monitoring of their performance on several tasks measuring components of executive functions. In this study, we did not test patients during direct cortical stimulation, but during resection itself. We chose tests routinely used to assess executive functions and included them in a protocol for left (LH) and right (RH) hemisphere prefrontal resections. This protocol is meant to be used during real-time neuropsychological testing (RTNT)-an already established monitoring technique. We retrospectively reviewed a consecutive series of 29 adult patients with glioma in the superior and middle frontal areas who performed the RTNT sequence throughout the resection phase. The testing protocol comprised 10 tests for LH frontal resections and 9 tests for RH frontal resections. RH patients showed a median performance on RTNT with significantly lower scores for visuo-spatial attention and emotion processing (95% Confidence Interval Lower bound of 66.55 and 82.57, respectively, χ2 (7) = 32.8, p < 0.001). LH patients showed a median performance on RTNT, with significantly lower scores for selective attention and working memory (95% Confidence Interval Lower bound of 51.12, χ2 (5) = 20.31 p < 0.001) and minimum scores for the same task and for the Stroop test (χ2 (5) = 17.86, p < 0.005). The delta for accuracy between the first and the last RTNT run was not statistically significant (RH patients: χ2 (7) = 10.49, p > 0.05, n.s.; LH patients: χ2 (5) = 3.35, p > 0.05, n.s.). Mean extent of resection was 95.33% ± 9.72 for the RH group and 94.64% ± 6.74 for the LH group. Patients showed good performance post- vs. pre-surgery. The greater difference in the number of LH patients scoring within the normal range was found for the symbol-digit modality test (83.3% to 62%), Stroop test (100% to 77%) and short-term memory (84.61% to 72.72%) and working memory (92.3% to 63.63%). For RH patients, the main changes were observed on the clock drawing test (100% to 77.7%) and cognitive estimation (100% to 72.7%). Frontal RTNT offers continuous and reliable feedback on the patients' cognitive status during resection in frontal areas.

ACCURACY OF ACETABULAR ALIGNMENT USING INERTIAL AND OPTICAL NAVIGATION SYSTEMS DURING HIP ARTHROPLASTY

Navigation in total hip arthroplasty has been shown to improve acetabular positioning and can decrease the incidence of mal-positioned acetabular components. The aim of this study was to assess two surgical guidance systems by comparing intra-operative measurements of acetabular component inclination and anteversion with a post-operative CT scan.We prospectively collected intra-operative navigation data from 102 hips receiving conventional THA or hip resurfacing arthroplasty through either a direct anterior or posterior approach. Two guidance systems were used simultaneously: an inertial navigation system (INS) and optical navigation system (ONS). Acetabular component anteversion and inclination was measured on a post-operative CT.The average age of the patients was 64 years (range: 24-92) and average BMI was 27 kg/m2 (range 19-38). 52% had hip surgery through an anterior approach. 98% of the INS measurements and 88% of the ONS measurements were within 10° of the CT measurements. The mean (and standard deviation) of the absolute difference between the post-operative CT and the intra-operative measurements for inclination and anteversion were 3.0° (2.8) and 4.5° (3.2) respectively for the ONS, along with 2.1° (2.3) and 2.4° (2.1) respectively for the INS. There was significantly lower mean absolute difference to CT for the INS when compared to ONS in both anteversion (p&lt;0.001) and inclination (p=0.02).Both types of navigation produced reliable and reproducible acetabular cup positioning. It is important that patient-specific planning and navigation are used together to ensure that surgeons are targeting the optimal acetabular cup position. This assistance with cup positioning can provide benefits over free-hand techniques, especially in patients with an altered acetabular structure or extensive acetabular bone loss.In conclusion, both ONS and INS allowed for adequate acetabular positioning as measured on postoperative CT, and thus provide reliable intraoperative feedback for optimal acetabular component placement.

Adaptive Modulation for FSO IM/DD Systems With Multiple Transmitters and Receivers

Atmospheric turbulence is a major impairment in free space optical (FSO) communication systems. Since turbulence induced fading exhibits quasi-static characteristics, reliable feedback of channel state information is possible allowing the implementation of adaptive transmission. In this letter, we consider multiple-input single-output (MISO) and single-input multiple-output (SIMO) FSO systems with pulse position modulation (PPM) and pulse amplitude modulation (PAM). We propose an adaptive algorithm where the modulation size/type is adjusted according to the channel fading conditions. We formulate the design of adaptive algorithm to maximize the spectral efficiency under peak and average power constraints while maintaining a targeted value of outage probability. We present extensive Monte Carlo simulations to demonstrate the performance of proposed adaptive scheme over turbulence channels.

Rapid On-Site Microscopy and Mapping of Diagnostic Biopsies for See-And-Treat Guidance of Localized Prostate Cancer Therapy.

Prostate cancer continues to be the most diagnosed non-skin malignancy in men. While up to one in eight men will be diagnosed in their lifetimes, most diagnoses are not fatal. Better lesion location accuracy combined with emerging localized treatment methods are increasingly being utilized as a treatment option to preserve healthy function in eligible patients. In locating lesions which are generally <2cc within a prostate (average size 45cc), small variance in MRI-determined boundaries, tumoral heterogeneity, patient characteristics including location of lesion and prostatic calcifications, and patient motion during the procedure can inhibit accurate sampling for diagnosis. The locations of biopsies are recorded and are then fully processed by histology and diagnosed via pathology, often days to weeks later. Utilization of real-time feedback could improve accuracy, potentially prevent repeat procedures, and allow patients to undergo treatment of clinically localized disease at earlier stages. Unfortunately, there is currently no reliable real-time feedback process for confirming diagnosis of biopsy samples. We examined the feasibility of implementing structured illumination microscopy (SIM) as a method for on-site diagnostic biopsy imaging to potentially combine the diagnostic and treatment appointments for prostate cancer patients, or to confirm tumoral margins for localized ablation procedures. We imaged biopsies from 39 patients undergoing image-guided diagnostic biopsy using a customized SIM system and a dual-color fluorescent hematoxylin & eosin (H&E) analog. The biopsy images had an average size of 342 megapixels (minimum 78.1, maximum 842) and an average imaging duration of 145 s (minimum 56, maximum 322). Comparison of urologist's suspicion of malignancy based on MRI, to pathologist diagnosis of biopsy images obtained in real time, reveals that real-time biopsy imaging could significantly improve confirmation of malignancy or tumoral margins over medical imaging alone.

Development and evaluation of a sensory panel for collecting reliable player perceptions of third-generation synthetic turf football surfaces

Perceptions of synthetic surfaces used in football can vary considerably between players, and obtaining reliable feedback is challenging. The aim of this study was to develop a suitable process and evaluate the merits of establishing a sensory panel to assess the subjective attributes of third generation synthetic turf surfaces (3G turf) used in football. Focus groups with 12 male and 13 female footballers were conducted on an outdoor 3G turf pitch to develop a common language to describe sensory feedback related to player–surface interactions. Post-session analysis revealed two main themes related to player–surface interactions: hardness and grip. These themes were broken down further into five sensory attributes (Movement Speed, Slip, Movement Confidence, Leg Shock and Give) which were investigated further in an indoor test area containing ten 3G turf surfaces with controlled surface properties. A panel consisting of 18 University footballers (11 male and 7 female) undertook a screening and training session to refine the language associated with the sensory attributes and become familiar with the testing protocol. During a final evaluation session, players were asked to discriminate between surfaces using the paired comparison method for each of the sensory attributes. Player consistency remained similar between the screening and evaluation sessions whilst the panel’s ability to discriminate between surfaces improved during the evaluation session. Sensory training can therefore be a useful approach to aid players in differentiating between surfaces and lead to a greater understanding of athlete perceptions of surface attributes.

Accuracy of acetabular component alignment with surgical guidance systems during hip arthroplasty

Navigation in total hip arthroplasty has been shown to improve acetabular positioning and can decrease the incidence of mal-positioned acetabular components. This study aimed to assess two surgical guidance systems by comparing intra-operative measurements of acetabular component inclination and anteversion with a post-operative CT scan. We prospectively collected intra-operative navigation data from 102 hips receiving conventional THA or hip resurfacing arthroplasty through either a direct anterior or posterior approach. Two guidance systems were used simultaneously: an inertial navigation system (INS) and an optical navigation system (ONS). Acetabular component anteversion and inclination were measured on a post-operative CT. The average age of the patients was 64years (range: 24-92) and the average BMI was 27kg/m2 (range 19-38). 52% had hip surgery through an anterior approach. 98% of the INS measurements and 88% of the ONS measurements were within 10° of the CT measurements. The mean (and standard deviation) of the absolute difference between the postoperative CT and the intra-operative measurements for inclination and anteversion were 3.0° (2.8) and 4.5° (3.2) respectively for the ONS, along with 2.1° (2.3) and 2.4° (2.1) respectively for the INS. There was a significantly lower mean absolute difference to CT for the INS when compared to ONS in both anteversions (p<0.001) and inclination (p=0.02). We found that both inertial and optical navigation systems allowed for adequate acetabular positioning as measured on postoperative CT, and thus provide reliable intraoperative feedback for optimal acetabular component placement. Therapeutic Level II.

Can photoluminescence quenching be a predictor for perovskite solar cell efficiencies?

Bromide-based perovskites have large bandgaps, making them attractive for tandem solar cells developed to overcome the Shockley-Queisser limit. A perovskite solar cell architecture employs transporting layers to improve charge extraction and transport. Due to the wide variety of materials and preparation methods, it is critical to devise fast screening methods to rank transporting layers. Herein, we evaluate perovskite fluorescence quenching followed by time- and energy-resolved photoluminescence (TER-PL) and analyse the intensity dependence as a potential method to qualify charge-transporting layers rapidly. The capability of the technique was evaluated with TiO2/FAPbBr3 and SnO2/FAPbBr3, the most commonly used electron transporting layers, which were prepared using standard protocols to make best-performing devices. The results revealed that TiO2 is the most effective quencher due to the higher density of states in the conduction band, consistent with Marcus-Gerischer's theory. However, record-performance devices use SnO2 as the electron transport layer. This shows that the relationship between photoluminescence quenching and device performance is not bidirectional. Therefore, additional measurements like conductivity are also needed to provide reliable feedback for device performance.

Application of Unconditioned Nanostructured Thermoplastic-Based Strain Gauge Sensor in Wearable Electronics

Wearable electronics is now revolutionizing the world of smart sensors offering tremendous solutions to a variety of applications that span from biomedical market to gaming and fashion sectors. In this scenario, physical sensors play a crucial role since they offer fast and reliable feedback on human motion, even for fine gestures, and can detect vital physiological parameters such as breathing and heart beating, while being able to be easily integrated into textile. Among wearable physical sensors, thermoplastic materials are utilized for their sensitivity and high stretchability. Moreover, these materials exhibit a good chemical resistance and implement low-cost manufacturing processes. In this work, we report a full characterization of a new thermoplastic nanocomposite material comparing its performances with and without preconditioning for strain up to 20%. Together with a measured gauge factor (GF) of about 10, sensors without preconditioning exhibit very good stability and they result to be a good candidate for wearable applications. We demonstrate this statement by analyzing the performance of a smart wristband prototype that integrates these strain gauges, obtaining very high performance of the sensors without prestrain in gesture recognition tasks with an accuracy and <inline-formula xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink"> <tex-math notation="LaTeX">${F}$ </tex-math></inline-formula> -score of about 94%.

A Sunflower‐Inspired Sun‐Tracking System Directed by an Ionic Liquid Photodetector

AbstractSunflower‐inspired sun‐tracking systems have been arousing intensive investigations owing to their benefits to improve the efficiency of solar energy collection. Photodetector based on photosensitive semiconductors is a mainstream choice in the sun‐tracking system, which directs solar collectors always facing the sun. However, photosensitive semiconductors to date have usually hidden the disadvantages of environmental pollution after disposal. As for these problems, this work develops a green ionic liquid‐based photodetector, which displays reliable electrical feedback in response to sunlight. This liquid sunlight detector can be readily recycled with less laborious and costly operations. It obeys a light sensing mechanism of photothermal conversion, so it does not involve the problems related to dark current and light saturation. As a practical demonstration, the ionic liquid‐based photodetector is assembled into a sun‐tracking system, which successfully pursues the moving sun in a real time. When such a sun‐tracking system is in tandem with optical fiber concentrator, sunlight can be efficiently collected and transported to desired position.

Preventing pediatric catheter-associated urinary tract infections utilizing urinary catheter Kamishibai cards (K-cards)

We instituted Kamishibai (K-card rounding) with the goals of improving indwelling urinary catheter maintenance bundle reliability and decreasing catheter-associated urinary tract infection (CAUTI) rates. In a free-standing children's hospital, we undertook a hospital-wide quality improvement project from January 2019 to June 2021 after developing a K-card based on our urinary catheter maintenance bundle. Auditors used K-cards to ask standardized questions during weekly rounds. Bundle reliability and CAUTI rates were analyzed prospectively. During the study period, 826 K-card audits were performed for 657 unique patients. While overall maintenance bundle reliability remained stable at 84%, there was a statistically significant improvement in reliability to the bundle element "medical discussion of need for the urinary catheter" from 88% to 94% (P=.01). The hospital-wide CAUTI rate significantly decreased (incidence rate ratio, 0.38; 95% CI, 0.15-0.93; P=.04). Hospital-wide urinary catheter K-card rounding facilitated standardized data collection, discussion of reliability and real-time feedback to nurses. Maintenance bundle reliability remained stable after implementation, accompanied by a significant decrease in the CAUTI rate. Implementation of hospital-wide urinary catheter K-card rounding was associated with reduction in CAUTI rates. The project demonstrated likelihood of reproducibility with support of a multidisciplinary team.

Event-triggered fuzzy finite-time reliable control for dynamic positioning of nonlinear unmanned marine vehicles

This paper studies the fuzzy finite-time reliable dynamic positioning (DP) control for nonlinear unmanned marine vehicles. Firstly, the motion dynamics of nonlinear unmanned marine vehicles is modeled by the Takagi-Sugeno (T-S) fuzzy system. Secondly, a fuzzy state observer is designed to estimate the immeasurable position and velocity of unmanned marine vehicles. In order to decrease the frequency of data transmission of actuators and sensors, a dynamic event-triggered mechanism is presented based on unmanned marine vehicles information and the estimation error. Then, a fuzzy event-triggered reliable output feedback control method is presented by finite-time theory to tackle the actuator faults problem occurring in unmanned marine vehicles. The sufficient finite-time stable conditions in the form of LMIs are established via constructing finite-time Lyapunov-Krasovskii functional. Ultimately, the computer simulation results and comparisons with the existing control methods verify the advantages of the presented control method.

Public Servants

Abstract Several political philosophers have recently pointed out that current electoral democracies fail to facilitate accurate and reliable feedback on the performance of public officials. Rather than rejecting democracy as a hopeless ideal, we defend an institutional reform called Service Responsibility, which introduces a superior incentive structure that better aligns the interests of citizens and public officials. Service Responsibility requires increasing or decreasing the income of public officials insofar as they succeed or fail to achieve democratically chosen goals. Later, we consider an alternative institutional scheme, recently proposed by Claudio López-Guerra: Piloting Responsibility. According to this alternative proposal, public officials must utilize a public provider whenever they seek out a basic service. We show that Piloting Responsibility fails to realize the democratic ideal because it generates a perverse incentive structure for public officials. We conclude that Service Responsibility outperforms both the status quo and Piloting Responsibility as an institutional scheme for ensuring competent governance and public justification.