To see the other types of publications on this topic, follow the link: Multi-site collaborative studie.
Journal articles on the topic 'Multi-site collaborative studie'
Create a spot-on reference in APA, MLA, Chicago, Harvard, and other styles
Consult the top 50 journal articles for your research on the topic 'Multi-site collaborative studie.'
Next to every source in the list of references, there is an 'Add to bibliography' button. Press on it, and we will generate automatically the bibliographic reference to the chosen work in the citation style you need: APA, MLA, Harvard, Chicago, Vancouver, etc.
You can also download the full text of the academic publication as pdf and read online its abstract whenever available in the metadata.
Browse journal articles on a wide variety of disciplines and organise your bibliography correctly.
1
Coulter, Anne Hendren. "NIH Funds Multi-Site, Collaborative ACM Studies in Portland, Oregon." Alternative and Complementary Therapies 6, no. 1 (February 2000): 32–37. http://dx.doi.org/10.1089/act.2000.6.32.
Full text
2
Caruso, Rebecca, Theodore Myatt, and Barbara E. Bierer. "Innovation in biosafety oversight: The Harvard Catalyst Common Reciprocal IBC Reliance Authorization Agreement." Journal of Clinical and Translational Science 4, no. 2 (February 26, 2020): 90–95. http://dx.doi.org/10.1017/cts.2019.405.
Full textAbstract:
AbstractIncreasingly, basic, translational, and clinical research has become more collaborative, resulting in multi-institutional studies that involve common approaches to a central question. For multi-institutional projects that involve recombinant or synthetic nucleic acids, Institutional Biosafety Committee (IBC) review is generally required at each separate site. Duplicative review may result in both administrative costs and delays, without evidence of increased safety or protections, and investigator frustration. To address these inefficiencies, IBC leaders drafted a collaborative IBC Reliance Authorization Agreement. The Agreement allows one or more institutions to cede IBC review to a reviewing IBC that accepts the responsibility. The ability to cede IBC review, and the ability to rely on one decision on behalf of all collaborating institutions for a given protocol, removes delays in approval of multi-center protocols, and collaborating principal investigators are able to focus on research rather than administrative tasks. In the process, we found promotion of this collaborative model led to stronger connections among institutions and among IBC members. The requirement for IBC member representation from the local community, however, limits its broader dissemination; we make several recommendations to mitigate this challenge.
3
Lambert, Megan, Benjamin Farrar, Elias Garcia-Pelegrin, Stephan Reber, and Rachael Miller. "ManyBirds: A multi-site collaborative Open Science approach to avian cognition and behavior research." Animal Behavior and Cognition 9, no. 1 (February 1, 2022): 133–52. http://dx.doi.org/10.26451/abc.09.01.11.2022.
Full textAbstract:
Comparative cognitive and behavior research aims to investigate cognitive evolution by comparing performance in different species to understand how these abilities have evolved. Ideally, this requires large and diverse samples; however, these can be difficult to obtain by single labs or institutions, leading to potential reproducibility and generalization issues with small, less representative samples. To help mitigate these issues, we are establishing a multi-site collaborative Open Science approach called ManyBirds, with the aim of providing new insight into the evolution of avian cognition and behavior through large-scale comparative studies, following the lead of exemplary ManyPrimates, ManyBabies and ManyDogs projects. Here, we outline a) the replicability crisis and why we should study birds, including the origin of modern birds, avian brains and convergent evolution of cognition; b) the current state of the avian cognition field, including a ‘snapshot’ review; c) the ManyBirds project, with plans, infrastructure, limitations, implications and future directions. In sharing this process, we hope that this may be useful for other researchers in devising similar projects in other taxa, like non-avian reptiles or mammals, and to encourage further collaborations with ManyBirds and related ManyX projects. Ultimately, we hope to promote collaboration between ManyX projects to allow for wider investigation of the evolution of cognition across all animals, including potentially humans.
4
Yao, Junfeng, Longhao Yan, Zhuohang Xu, Ping Wang, and Xiangmo Zhao. "Collaborative Decision-Making Method of Emergency Response for Highway Incidents." Sustainability 15, no. 3 (January 22, 2023): 2099. http://dx.doi.org/10.3390/su15032099.
Full textAbstract:
With the continuous increase in highway mileage and vehicles in China, highway accidents are also increasing year by year. However, the on-site disposal procedures of highway accidents are complex, which makes it difficult for the emergency department to fully observe the accident scene, resulting in the lack of sufficient communication and cooperation between multiple emergency departments, making the rescue efficiency low and wasting valuable rescue time, and causing unnecessary injury or loss of life due to the lack of timely assistance. Thus, this paper proposes a multi-agent-based collaborative emergency-decision-making algorithm for traffic accident on-site disposal. Firstly, based on the analysis and abstraction of highway surveillance videos obtained from the Shaanxi Provincial Highway Administration, this paper constructs an emergency disposal model based on Petri net to simulate the emergency on-site disposal procedures. After transforming the emergency disposal model into a Markov game model and applying it to the multi-agent deep deterministic strategy gradient (MADDPG) algorithm proposed in this paper, the multiple agents can optimize the emergency-decision-making and on-site disposal procedures through interactive learning with the environment. Finally, the proposed algorithm is compared with the typical algorithm and the actual processing procedure in the simulation experiment of an actual Shaanxi highway traffic accident. The results show that the proposed emergency-decision-making method could greatly improve collaboration efficiency among emergency departments and effectively reduce emergency response time. This algorithm is not only superior to other decision-making algorithms such as genetic algorithm (EA), evolutionary strategy (ES), and deep Q network (DQN), but also reduces the disposal processes by 28%, 28%, and 42%, respectively, compared with the actual disposal process in three emergency disposal cases. In summary, with the continuous development of information technology and highway management systems, the multi-agent-based collaborative emergency-decision-making algorithm will contribute to the actual emergency response process and emergency disposal in the future, improving rescue efficiency and ensuring the safety of individuals. The on-site disposal procedure of freeway accidents is complicated, and the emergency response time is limited, which makes it difficult for emergency response departments to fully observe the accident scene, leading to the lack of sufficient communication and team cooperation among multiple emergency departments. This paper proposes a multi-agent-based collaborative emergency-decision-making algorithm for traffic accident on-site disposal. Firstly, through analyzing freeway surveillance videos obtained from the Shaanxi Provincial Freeway Administration, this paper constructs an emergency disposal model based on Petri net to simulate the emergency on-site disposal procedures. Then, an emergency-decision-making method based on a multi-agent deep deterministic policy gradient algorithm is proposed to optimize the emergency-decision-making and on-site disposal procedures. Finally, the proposed algorithm is compared with the typical algorithm in a simulation experiment of an actual Shaanxi freeway traffic accident, and the difference between the proposed algorithm and the actual processing procedure is also analyzed. The results show that the proposed emergency-decision-making method could greatly improve team collaboration efficiency among emergency departments and effectively reduce emergency response time. This algorithm is not only superior to other decision-making algorithms, but also reduces the disposal processes by 28%, 28%, and 42%, respectively, compared with the actual disposal process in the three studied cases. It is believed that the continuous development of information technology and freeway management systems will help to improve actual emergency response times and emergency drills in the future.
5
Randell, Rebecca, Stephanie Wilson, and Peter Woodward. "Variations and Commonalities in Processes of Collaboration: The Need for Multi-Site Workplace Studies." Computer Supported Cooperative Work (CSCW) 20, no. 1-2 (October 27, 2010): 37–59. http://dx.doi.org/10.1007/s10606-010-9127-6.
Full text
6
Adams, Heather R., Sara Defendorf, Amy Vierhile, Jonathan W. Mink, Frederick J. Marshall, and Erika F. Augustine. "A novel, hybrid, single- and multi-site clinical trial design for CLN3 disease, an ultra-rare lysosomal storage disorder." Clinical Trials 16, no. 5 (June 11, 2019): 555–60. http://dx.doi.org/10.1177/1740774519855715.
Full textAbstract:
Background Travel burden often substantially limits the ability of individuals to participate in clinical trials. Wide geographic dispersion of individuals with rare diseases poses an additional key challenge in the conduct of clinical trials for rare diseases. Novel technologies and methods can improve access to research by connecting participants in their homes and local communities to a distant research site. For clinical trials, however, understanding of factors important for transition from traditional multi-center trial models to local participation models is limited. We sought to test a novel, hybrid, single- and multi-site clinical trial design in the context of a trial for Juvenile Neuronal Ceroid Lipofuscinosis (CLN3 disease), a very rare pediatric neurodegenerative disorder. Methods We created a “hub and spoke” model for implementing a 22-week crossover clinical trial of mycophenolate compared with placebo, with two 8-week study arms. A single central site, the “hub,” conducted screening, consent, drug dispensing, and tolerability and efficacy assessments. Each participant identified a clinician to serve as a collaborating “spoke” site to perform local safety monitoring. Study participants traveled to the hub at the beginning and end of each study arm, and to their individual spoke site in the intervening weeks. Results A total of 18 spoke sites were established for 19 enrolled study participants. One potential participant was unable to identify a collaborating local site and was thus unable to participate. Study start-up required a median 6.7 months (interquartile range = 4.6–9.2 months). Only 33.3% (n = 6 of 18) of spoke site investigators had prior clinical trial experience, thus close collaboration with respect to study startup, training, and oversight was an important requirement. All but one participant completed all study visits; no study visits were missed due to travel requirements. Conclusions This study represents a step toward local trial participation for patients with rare diseases. Even in the context of close oversight, local participation models may be best suited for studies of compounds with well-understood side-effect profiles, for those with straightforward modes of administration, or for studies requiring extended follow-up periods.
7
Walker, Helen, Lindsay Tulloch, Karen Boa, Gordon Ritchie, and John Thompson. "A multi-site survey of forensic nursing assessment." Journal of Forensic Practice 21, no. 2 (May 13, 2019): 124–38. http://dx.doi.org/10.1108/jfp-11-2018-0045.
Full textAbstract:
Purpose A major difficulty identified many years ago in psychiatric care is the shortage of appropriate instruments with which to carry out valid and reliable therapeutic assessments which are behaviourally based and therefore appropriate for use in a variety of contexts. The aim of this project was to ascertain the utility of a forensic nursing risk assessment tool - Behavioural Status Index (BEST-Index). The paper aims to discuss these issues. Design/methodology/approach A multi-site cross-sectional survey was undertaken using mixed method design. Quantitative data was generated using BEST-Index to allow comparisons across three different levels of security (high, medium and low) in Scotland and Ireland. Qualitative data were gathered from patients and multi-disciplinary team (MDT) members using semi-structured interviews and questionnaire. Findings Measured over an 18-month period, there was a statistically significant improvement in behaviour, when comparing patients in high and medium secure hospitals. Two key themes emerged from patient and staff perspectives: “acceptance of the process” and “production and delivery of information”, respectively. The wider MDT acknowledge the value of nursing risk assessment, but require adequate information to enable them to interpret findings. Collaborating with patients to undertake risk assessments can enhance future care planning. Research limitations/implications Studies using cross-section can only provide information at fixed points in time. Practical implications The BEST-Index assessment tool is well established in clinical practice and has demonstrated good utility. Originality/value This project has served to highlight the unique contribution of BEST-Index to both staff and patients alike and confirm its robustness and versatility across differing levels of security in Scottish and Irish forensic mental health services.
8
Yang, J., W. Huang, H. Zhang, and H. Li. "RESEARCH AND ENGINEERING PRACTICE OF EMERGENCY GEOGRAPHIC INFORMATION COLLABORATIVE SERVICE MODE WITH CROWDSOURCED DATA." International Archives of the Photogrammetry, Remote Sensing and Spatial Information Sciences XLIII-B4-2021 (June 30, 2021): 209–14. http://dx.doi.org/10.5194/isprs-archives-xliii-b4-2021-209-2021.
Full textAbstract:
Abstract. China is a disaster prone country. In recent years, the national functional departments have been committed to the construction of emergency surveying and mapping support capacity. However, the data owned by government departments are often systematic, accurate and authoritative, but the real-time is not enough. The improvement of data update efficiency requires a lot of resources. The main body of emergency management is also mainly government departments, which lacks public participation and interaction. The application of volunteer geographic information in China's emergency management has not yet formed a scale. This article will mainly studies the mechanism of volunteer information in emergency management, the multi-source emergency geographic information collaborative service mode with volunteer participation, and take specific engineering practices as an example to introduce the national Geographic Information Public Service Platform for Disaster Emergency, and try to solve the problems about real-time disaster site information acquisition, multi-source information online integration and collaborative services, and rapid customization and release of user-oriented emergency topics in multiple emergency scenarios Issues.
9
Rider, Elizabeth A., Deborah D. Navedo, and William T. Branch, Jr. "Training interprofessional faculty in humanism and professionalism: a qualitative analysis of what is most important." International Journal of Whole Person Care 9, no. 1 (January 17, 2022): 46–47. http://dx.doi.org/10.26443/ijwpc.v9i1.340.
Full textAbstract:
Introduction: The capacity of healthcare professionals to work collaboratively influences faculty and trainees’ professional identity formation, well-being, and care quality. Part of a multi-institutional project*, we created the Faculty Fellowship for Leaders in Humanistic Interprofessional Education at Boston Children’s Hospital/ Harvard Medical School. We aimed to foster trusting relationships, reflective abilities, collaboration skills, and work together to promote humanistic values within learning environments. Objective: To examine the impact of the faculty fellowship from participants’ reports of “the most important thing learned”. Methods: We studied participants’ reflections after each of 16 1½ hour fellowship sessions. Curriculum content included: highly functioning teams, advanced team formation, diversity/inclusion, values, wellbeing/renewal/burnout, appreciative inquiry, narrative reflection, and others. Responses to “What was the most important thing you learned?” were analyzed qualitatively using a positivistic deductive approach. Results: Participants completed 136 reflections over 16 sessions–77% response rate (136/176). Cohort was 91% female; mean age 52.6 (range 32-65); mean years since completion of highest degree 21.4; 64% held doctorates, 36% master’s degrees. 46% were physicians, 27% nurses, 18% social workers, 9% psychologists. 27% participated previously in a learning experience focusing on interprofessional education, collaboration or practice. Most important learning included: Relational capacities/ Use of self in relationships 96/131 (73%); Attention to values 46/131 (35%); Reflection/ Self-awareness 44/131 (34%); Fostering humanistic learning environments 21/131 (16%). Discussion: Results revealed the importance of enhancing relational capacities and use of self in relationships including handling emotions; attention to values; reflection/self-awareness and recognition of assumptions; and fostering humanistic learning environments. These topics should receive more emphasis in interprofessional faculty development programs and may help identify teaching priorities. *Supported in part by a multi-institutional grant from the Josiah Macy, Jr. Foundation (Dr. Branch as PI; Dr. Rider as site PI).
10
Barnes Lipscomb, Valerie. "“The play’s the thing”: theatre as a scholarly meeting ground in age studies." International Journal of Ageing and Later Life 7, no. 2 (April 12, 2013): 117–41. http://dx.doi.org/10.3384/ijal.1652-8670.1272a6.
Full textAbstract:
Addressing three current critical turns in gerontology, this article proposes the theatre as a fertile ground for various theoretical angles in age studies - including the performative on and off stage, the narrative in the script and the critical questioning of age and ageism in the multiple realities of performance. Beginning from a shared site in the theatre, researchers may be able to establish greater common ground, resulting not only in multi-disciplinary efforts but also in truly interdisciplinary work. With a foundation in performance studies, this article suggests promising directions for age studies and theatre scholarship by examining three aspects of theatrical production: a play script, Jan de Hartog’s popular The Fourposter (1951); a collaborative development of a script and production, Jeanette Mathewes Stevens’ 2010 senior drama ElderSpeak; and a performance, a 2011 song-and-dance revue staged by an established senior theatre troupe, the Sarasota Senior Theater.
11
Beattie, Debra, Stuart Cunningham, Richard Jones, and Oksana Zelenko. "‘I Use Online so the Counsellors can't Hear Me Crying’: Creating Design Solutions for Online Counselling." Media International Australia 118, no. 1 (February 2006): 43–52. http://dx.doi.org/10.1177/1329878x0611800107.
Full textAbstract:
This article reviews a project which has produced creative design solutions for the development of online counselling in collaboration with Australia's largest youth telephone counselling service, Kids Helpline (KHL). Our discussion focuses on the shape of interaction design research conducted against the dual background of young people's multi-literacies and professional counselling practice. Existing text-based communication tools already available for Kids Helpline's clients were integrated with graphical image-based tools, while engaging young people in problem-solving and empowerment during online counselling sessions. The paper considers the fashioning of a conducive design and interactive communication environment for distressed young people and the independent evaluation of the new site design. Preliminary results are that young people report a greater sense of control and comfort in their net-based interaction with a counsellor.
12
Baylis, J., C. Heyd, B. Thoma, A. Hall, T. Chaplin, A. Petrosoniak, T. McColl, M. O'Brien, J. Deshaies, and K. Caners. "LO13: Development of a national, standardized simulation case template." CJEM 22, S1 (May 2020): S11. http://dx.doi.org/10.1017/cem.2020.69.
Full textAbstract:
Innovation Concept: A major barrier to the development of a national simulation case repository and multi-site simulation research is the lack of a standardized national case template. This issue was recently identified as a priority research topic for Canadian simulation based education (SBE) research in emergency medicine (EM). We partnered with the EM Simulation Education Researchers Collaborative (EM-SERC) to develop a national simulation template. Methods: The EM Sim Cases template was chosen as a starting point for the consensus process. We generated feedback on the template using a three-phase modified nominal group technique. Members of the EM-SERC mailing list were consulted, which included 20 EM simulation educators from every Canadian medical school except Northern Ontario School of Medicine and Memorial University. When comments conflicted, the sentiment with more comments in favour was incorporated. Curriculum, Tool or Material: In phase one we sought free-text feedback on the EM Sim Cases template via email. We received 65 comments from 11 respondents. An inductive thematic analysis identified four major themes (formatting, objectives, debriefing, and assessment tools). In phase two we sought free-text feedback on the revised template via email. A second thematic analysis on 40 comments from 12 respondents identified three broad themes (formatting, objectives, and debriefing). In phase three we sought feedback on the penultimate template via focus groups with simulation educators and technologists at multiple Canadian universities. This phase generated 98 specific comments which were grouped according to the section of the template being discussed and used to develop the final template (posted on emsimcases.com). Conclusion: We describe a national consensus-building process which resulted in a simulation case template endorsed by simulation educators from across Canada. This template has the potential to: 1. Reduce the replication of effort across sites by facilitating the sharing of simulation cases. 2. Enable national collaboration on the development of both simulation cases and curricula. 3. Facilitate multi centre simulation-based research by removing confounders related to the local adoption of an unfamiliar case template. This could improve the rigour and validity of these studies by reducing inter-site variability. 4. Increase the validity of any simulation scenarios developed for use in national high-stakes assessment.
13
Goldsmith, Ben. "Sport and the Transformation of Australian Television." Media International Australia 155, no. 1 (May 2015): 70–79. http://dx.doi.org/10.1177/1329878x1515500109.
Full textAbstract:
This article examines the history of Australian broadcast television through the lens of sports programming. Ever since the introduction of the medium in Australia just before the 1956 Olympic Games, sports programming – both event coverage and sports-related content – has played a major role in defining television's forms, concerns and technologies, as well as in developing audiences for services and channels. Looking at a series of pivotal moments in Australian television history – the 1956 Olympics, the coming of colour, aggregation in the late 1980s, the launch of subscription television in 1995 and commercial free-to-air multi-channelling – the article examines sports programming as a site of both competition and collaboration between networks and services. It also discusses the role of sports in shaping the schedules and profiles of the two Australian public service broadcasters, before concluding with a look at the possible future of sport and Australian broadcast television.
14
Asep Nursalim and Nico Verdianto. "Dinamika Pengembangan Kurikulum Pendidikan Agama Islam di Madrasah: Studi Perbandingan Penerapan Subject Centered Curriculum di Kabupaten Bekasi." Attaqwa: Jurnal Ilmu Pendidikan Islam 16, no. 2 (August 3, 2020): 173–87. http://dx.doi.org/10.36835/attaqwa.v16i2.56.
Full textAbstract:
In the context of the dynamics of curriculum development in Indonesia, the PAI curriculum still faces various problems in its development. This is due to differences in school ownership status, school environment, and available human resources. This study aims to analyze the problem of the application of development, construction, and supporting factors and inhibitors of the PAI curriculum in MTs An-Najah Bekasi and MTs Al-Hidayah Bekasi. This study uses field research with multi-site studies at two different institutions in Bekasi Regency. The results showed that the curriculum construction of the two madrassas focused on Subject Centered Design, which focused on subjects. This research is still limited to the implementation of the PAI curriculum in the two madrassas, so it is hoped that there are still many other studies with different locations so that it can be used as a source of research. Whereas the most dominant determinants are human resources and infrastructure. Comparison of curriculum construction models in the two madrassas lies in the essence and depth of the material. From the data of the two madrassas, the collaborative curriculum becomes a curriculum redesign choice that is considered ideal and can be applied.
15
Ambarwati, Sri. "Implementation of Thematic Learning Curriculum 2013; Multi Site Study at MIN 2 Kediri and MIN 1 Kediri City." Jurnal Intelektual: Jurnal Pendidikan dan Studi Keislaman 10, no. 2 (September 17, 2020): 255–71. http://dx.doi.org/10.33367/ji.v10i2.1302.
Full textAbstract:
Abstract
This paper intends to answer the implementation of thematic learning in the 2013 curriculum. In addition, the authors examine the factors that support and obstruct the implementation of thematic learning in the 2013 curriculum. The type of research used is descriptive qualitative using interview, observation and documentation techniques. The research was conducted at 2 MIN in Kediri City. The results of the first study, Thematic Learning has a very important role in increasing students’ attention, learning activities, and understanding of the material being studied, because learning is more student-centered, provides direct experience to students, the separation of subjects is not very clear, presents concepts from various Subjects in a learning process, are flexible, learning outcomes can develop according to student interests and needs. Thematic learning to be successful is carried out by taking the stages of planning, implementation, and evaluation. Second, the supporting factors include: (a) infrastructure, (b) the existence of a remedial teaching program, (c) the existence of training on the 2013 curriculum, (d) teacher creativity, (e) use of appropriate methods, (f) the existence of ice breaking in learning. meanwhile, inhibiting factors in the implementation of thematic learning in the 2013 curriculum include: (a) internal students, (b) teachers do not understand the 2013 curriculum, (c) teachers are less creative in collaborating learning methods, (d) lack of parental support, ( e) less supporting infrastructure, and (f) no previous training.
16
Aase, Karina, Veslemøy Guise, Stephen Billett, Stephen Johan Mikal Sollid, Ove Njå, Olav Røise, Tanja Manser, Janet E. Anderson, and Siri Wiig. "Resilience in Healthcare (RiH): a longitudinal research programme protocol." BMJ Open 10, no. 10 (October 2020): e038779. http://dx.doi.org/10.1136/bmjopen-2020-038779.
Full textAbstract:
IntroductionOver the past three decades, extensive research has been undertaken to understand the elements of what constitutes high quality in healthcare. Yet, much of this research has been conducted on individual elements and their specific challenges. Hence, goals other than understanding the complex of factors and elements that comprises quality in healthcare have been privileged. This lack of progress has led to the conclusion that existing approaches to research are not able to address the inherent complexity of healthcare systems as characterised by a significant degree of performance variability within and across system levels, and what makes them resilient. A shift is, therefore, necessary in such approaches. Resilience in Healthcare (RiH) adopts an approach comprising a comprehensive research programme that models the capacity of healthcare systems and stakeholders to adapt to changes, variations and/or disruptions: that is, resilience. As such, RiH offers a fresh approach capable of capturing and illuminating the complexity of healthcare and how high-quality care can be understood and advanced.Methods and analysisMethodologically, to illuminate what constitutes quality in healthcare, it is necessary to go beyond single-site, case-based studies. Instead, there is a need to engage in multi-site, cross-national studies and engage in long-term multidisciplinary collaboration between national and international researchers interacting with multiple healthcare stakeholders. By adopting such processes, multiple partners and a multidisciplinary orientation, the 5-year RiH research programme aims to confront these challenges and accelerate current understandings about and approaches to researching healthcare quality.The RiH research programme adopts a longitudinal collaborative interactive design to capture and illuminate resilience as part of healthcare quality in different healthcare settings in Norway and in five other countries. It combines a meta-analysis of detailed empirical research in Norway with cross-country comparison from Australia, Japan, Netherlands, Switzerland and the UK. Through establishing an RiH framework, the programme will identify processes with outcomes that aim to capture how high-quality healthcare provisions are achieved. A collaborative learning framework centred on engagement aims to systematically translate research findings into practice through co-construction processes with partners and stakeholders.Ethics and disseminationThe RiH research programme is approved by the Norwegian Centre for Research Data (No. 864334). The empirical projects selected for inclusion in this longitudinal research programme have been approved by the Norwegian Centre for Research Data or the Regional Committees for Medical and Health Research Ethics. The RiH research programme has an embedded publication and dissemination strategy focusing on the progressive sharing of scientific knowledge, information and results, and on engaging with the public, including relevant patient and stakeholder representatives. The findings will be disseminated through scientific articles, PhD dissertations, presentations at national and international conferences, and through social media, newsletters and the popular media.
17
Mittman, Brian S., James W. Dearing, Kathleen Mazor, and James Nutter. "Dissemination, implementation, and quality improvement research within the HMO Cancer Research Network." Journal of Clinical Oncology 31, no. 31_suppl (November 1, 2013): 215. http://dx.doi.org/10.1200/jco.2013.31.31_suppl.215.
Full textAbstract:
215 Background: The HMO Cancer Research Network, funded by the National Cancer Institute, provides infrastructure support to facilitate cancer research in non-profit integrated healthcare delivery systems. A key CRN goal to improve quality and outcomes through research and research-based methods for accelerating implementation of innovations in cancer care. Methods: The CRN is led by a Steering Committee and an Executive Committee. CRN Scientific Working Groups support activity within distinct areas; the CRN Communication and Dissemination Scientific Working Group (C&D SWG) supports the design, conduct and reporting of research on (1) communication and decision makin in cancer care and (2) dissemination and implementation of cancer research findings and best practices. C&D SWG activities include monthly calls presenting C&D research resources, project ideas and funding opportunities; individual consultation and technical assistance to support CRN researchers developing funding applications and conducting research in relevant areas; and mentorship for CRN Scholars. General CRN resources to facilitate research to improve cancer care quality include a multi-institution Virtual Data Warehouse with accompanying query tools to facilitate preparatory-to-research and collaborative research studies and specific cancer-related data items; funding for Developmental and Pilot Studies; and an Outreach and External Collaborations Core to facilitate research collaborations among (a) CRN institution-based scientists, (b) scientists at other institutions, and (c) clinical and operations partners. Results: The CRN C&D SWG continues to stimulate increased awareness and interest in conducting dissemination and implementation studies and quality improvement research in cancer care, and to support the development of new project ideas and funding applications and the successful completion and publication of such studies. Conclusions: CRN activities facilitate innovative multi-site, multi-disciplinary cancer studies in the integrated delivery system setting, and motivate continued evolution of CRN institutions as the nation's premier learning health care systems. Supported by U24 CA171524.
18
Morrato, Elaine H., and Lindsay Lennox. "2563 National dissemination of the accrual to clinical trials (ACT) network across the Clinical and Translational Science Award (CTSA) Consortium." Journal of Clinical and Translational Science 2, S1 (June 2018): 44. http://dx.doi.org/10.1017/cts.2018.172.
Full textAbstract:
OBJECTIVES/SPECIFIC AIMS: The ACT Network was developed by 46 members of the CTSA Program hubs in collaboration with NCATS to help investigators explore and validate feasibility of clinical studies in real-time using linked electronic health record data for cohort discovery. ACT is being disseminated nationally across the CTSA consortium. METHODS/STUDY POPULATION: Diffusion of Innovation Theory and Lean Start-Up principles inform dissemination strategies. Core materials were developed nationally and are being tailored to meet local CTSA dissemination norms. An advisory board, with expertise in communications, journalism, customer channel management, pharmaceutical commercialization and health IT entrepreneurship, is providing strategic advice to develop and refine dissemination strategies. Evaluation of dissemination methods will include network usage and web analytics for the ACT Network’s interactive digital content and log-in portal, and surveys-interviews of ACT users using the RE-AIM implementation framework. RESULTS/ANTICIPATED RESULTS: Formative research identified ACT’s primary value proposition for clinical researchers: “Explore patient populations in depth, in real time, from your desktop;” “Confirm study feasibility by iteratively testing and refining inclusion and exclusion criteria;” “Demonstrate feasibility in funding proposals and IRB submissions;” and “Identify collaborating sites for multi-site studies by searching for patients across the CTSA network.” Early dissemination metrics, including number-type of registered users, queries performed, and web analytics, will be presented. DISCUSSION/SIGNIFICANCE OF IMPACT: Researchers nationwide face common barriers in accruing enough participants for clinical trials. The inability to identify the right number and type of people to participate often makes clinical trials slow and costly. Better cohort discovery at the protocol development phase is a necessary requirement. By end of 2018, the ACT Network will reach 60% of the CTSA consortium providing a new tool for investigators to improve the design and execution of clinical trials.
19
Cashmore, Judy, Daryl J. Higgins, Leah M. Bromfield, and Dorothy A. Scott. "Recent Australian child protection and out-of-home care research: What’s been done – and what needs to be done?" Children Australia 31, no. 2 (2006): 4–11. http://dx.doi.org/10.1017/s103507720001107x.
Full textAbstract:
A research-led reform strategy is urgently required in the field of child protection in Australia. While international research can be a valuable resource, a strong research base which is relevant to this country’s needs, legislation and service systems is essential. Two recent audits of Australian research completed over the past decade – one on out-of-home care and the other on child protection more broadly – have highlighted significant gaps in existing research. There is a number of important topics that have not been addressed – as well as an over-reliance on small-scale, qualitative studies and a very low level of funding for research. This paper explores these gaps and identifies crucial areas for development, encompassing: the development of a national child protection and out-of-home care research agenda; adequate funding for research, especially for multi-site, cross-jurisdictional studies; and closer collaboration between researchers, policymakers and practitioners to close the gap between what we know and what we do.
20
Cebulla, Andreas, and David Wilkinson. "Responses to an Ageing Workforce: Germany, Spain, the United Kingdom." Business Systems Research Journal 10, no. 1 (April 1, 2019): 120–37. http://dx.doi.org/10.2478/bsrj-2019-0009.
Full textAbstract:
AbstractBackground: An ageing workforce is a challenge for businesses that are increasingly expected to adapt workplaces to enable employees to remain in work longer. Emerging evidence highlights employer practices to attract or retain older workers. This paper explores employers’ motivations for introducing measures to accommodate an older workforce in three European case study countries. Objectives: The objective is to illustrate and understand different approaches to, and stages in, adjusting workplaces to accommodate an ageing workforce. Methods/Approach: The study combines case studies, including site visits and interviews, with expert consultations. Results: The research finds marked between-country differences, with United Kingdom case studies highlighting a strong emphasis on age-neutral practices shaped by legislation; age-confident practices in Germany resulting from collaborative arrangement between employers and trades unions (with legislation permissive towards age discrimination); business in Spain remaining relatively inactive, despite evidence of people expecting to work longer in life. Conclusions: Diverging employer motivations and responses to the challenge of an ageing workforce risk a multi-speed Europe in age-confident workplace innovation. A concerted effort that draws on the multiple factors that motivate initiative would be required to achieve good working conditions for older workers across Europe.
21
Urrutia-Fucugauchi, Jaime, Ligia Perez-Cruz, and Araxi O. Urrutia. "Chicxulub museum, geosciences in Mexico, outreach and science communication – built from the crater up." Geoscience Communication 4, no. 2 (May 10, 2021): 267–80. http://dx.doi.org/10.5194/gc-4-267-2021.
Full textAbstract:
Abstract. The Chicxulub science museum is special, in that it is built around an event in geological time representing a turning point in the planet's history and which brings together the Earth system components. Studies on the Chicxulub impact, mass extinction and Cretaceous–Paleogene boundary provide an engaging context for effective geoscience communication, outreach and education. The museum is part of a research complex in Yucatán Science and Technology Park in Mexico. Natural history museums with research components allow for the integration of up-to-date advances, expanding their usefulness and capabilities. The impact ranks among the major single events shaping Earth's history, triggering global climatic change and wiping out ∼76 % of species. The ∼200 km Chicxulub crater is the best preserved of three large terrestrial multi-ring impact structures, being a natural laboratory for investigating impact dynamics, crater formation and planetary evolution. The initiative builds on the interest that this geological site has for visitors, scholars and students by developing wide-reaching projects, a collaboration network and academic activities. The Chicxulub complex serves as a hub for multi- and interdisciplinary projects on the Earth and planetary sciences, climate change and life evolution, fulfilling a recognized task for communication of geosciences. After decades of studies, the Chicxulub impact remains under intense scrutiny, and this programme with the core facilities built inside the crater will be a major player.
22
Sutton, Thomas L., Rodney F. Pommier, Skye C. Mayo, Erin W. Gilbert, Pavlos Papavasiliou, Michele Babicky, Jon Gerry, Brett C. Sheppard, and Patrick J. Worth. "Similar Outcomes in Minimally Invasive versus Open Management of Primary Pancreatic Neuroendocrine Tumors: A Regional, Multi-Institutional Collaborative Analysis." Cancers 14, no. 6 (March 9, 2022): 1387. http://dx.doi.org/10.3390/cancers14061387.
Full textAbstract:
In pancreatic neuroendocrine tumors (PNETs), the impact of minimally invasive (MI) versus open resection on outcomes remains poorly studied. We queried a multi-institutional pancreatic cancer registry for patients with resected non-metastatic PNET from 1996–2020. Recurrence-free (RFS), disease-specific survival (DSS), and operative complications were evaluated. Two hundred and eighty-two patients were identified. Operations were open in 139 (49%) and MI in 143 (51%). Pancreaticoduodenectomy was performed in 77 (27%, n = 23 MI), distal pancreatectomy in 184 (65%, n = 109 MI), enucleation in 13 (5%), and total pancreatectomy in eight (3%). Median follow-up was 50 months. Thirty-six recurrences and 13 deaths from recurrent disease yielded 5-year RFS and DSS of 85% and 95%, respectively. On multivariable analysis, grade 1 (HR 0.07, p < 0.001) and grade 2 (HR 0.20, p = 0.002) tumors were associated with improved RFS, while T3/T4 tumors were associated with worse RFS (OR 2.78, p = 0.04). MI resection was not associated with RFS (HR 0.53, p = 0.14). There was insufficient mortality to evaluate DSS with multivariable analysis. Of 159 patients with available NSQIP data, incisional surgical site infections (SSIs), organ space SSIs, Grade B/C pancreatic fistulas, reoperations, and need for percutaneous drainage did not differ by operative approach (all p > 0.2). Nodal harvest was similar for MI versus open distal pancreatectomies (p = 0.16) and pancreaticoduodenectomies (p = 0.28). Minimally invasive surgical management of PNETs is equivalent for oncologic and postoperative outcomes.
23
Patterson, Kelli N., Kyle Horvath, Amanda Onwuka, Renata Fabia, Sheila Giles, Daniel J. Marx, Pablo Aguayo, et al. "108 Length of Stay per Total Body Surface Area Relative to Burn Mechanism: A Pediatric Injury Quality Improvement Collaborative (PIQIC) Study." Journal of Burn Care & Research 42, Supplement_1 (April 1, 2021): S72—S73. http://dx.doi.org/10.1093/jbcr/irab032.112.
Full textAbstract:
Abstract Introduction Studies on length of stay (LOS) per total body surface area (TBSA) burn in pediatric patients have been performed at single institutions and based on ranges of TBSA burn. A LOS to TBSA burn ratio of 1:1 has also been widely accepted but not confirmed over time across numerous institutions. The objective of this study was to use multi-institutional pediatric burn data to describe benchmarks associated with LOS per TBSA burn. Methods Data from the Pediatric Injury Quality Improvement Collaborative (PIQIC) were obtained for 1004 patients (n=1004) treated at five pediatric burn centers from July 2018-March 2020. LOS/TBSA burn ratios were calculated for each site. LOS/TBSA burn by institution and mechanism were analyzed. Generalized linear regression models were used to model the effect of hospital and burn mechanism on the LOS/TBSA ratio. Results Among the 1004 injuries, the most common burn mechanism was by scald (64%), followed by contact (16%) and flame (13%). The average LOS/TBSA burn ratio across all cases was 1.3 days (SD 2.2). Flame burns had a higher LOS/TBSA burn ratio than scald burns with a mean LOS/TBSA burn of 1.63 compared to 0.84. In adjusted models, scald burns, and chemical burns had the lowest LOS/TBSA burn ratio and electrical and friction burns had the highest LOS/TBSA burn ratio. The LOS/TBSA burn ratio was comparable across hospitals after adjustment for mechanism, with just Hospital 4 having a lower average LOS/TBSA burn of 0.49 days. Conclusions These data establish a multi-institutional ratio for the overall performance in LOS for pediatric burn patients. A LOS per TBSA ratio of about 1 was observed across PIQIC centers, except for a lower ratio at one center. Additionally, it provides evidence on the variance in LOS per TBSA burn relative to the sustained burn mechanism. Further collaborative data analysis will allow us to recognize specific patterns and outcomes in pediatric burn care, which is essential for the implementation of quality improvement standards.
24
Dhaini, Suzanne, Franziska Zúñiga, Dietmar Ausserhofer, Michael Simon, Regina Kunz, Sabina De Geest, and René Schwendimann. "Absenteeism and Presenteeism among Care Workers in Swiss Nursing Homes and Their Association with Psychosocial Work Environment: A Multi-Site Cross-Sectional Study." Gerontology 62, no. 4 (December 1, 2015): 386–95. http://dx.doi.org/10.1159/000442088.
Full textAbstract:
Background: Worker productivity is central to the success of organizations such as healthcare institutions. However, both absenteeism and presenteeism impair that productivity. While various hospital studies have examined the prevalence of presenteeism and absenteeism and its associated factors among care workers, evidence from nursing home settings is scarce. Objective: To explore care workers' self-reported absenteeism and presenteeism in relation to nursing homes' psychosocial work environment factors. Methods: We performed a cross-sectional study utilizing survey data of 3,176 professional care workers in 162 Swiss nursing homes collected between May 2012 and April 2013. A generalized estimating equation ordinal logistic regression model was used to explore associations between psychosocial work environment factors (leadership, staffing resources, work stressors, affective organizational commitment, collaboration with colleagues and supervisors, support from other personnel, job satisfaction, job autonomy) and self-reported absenteeism and presenteeism. Results: Absenteeism and presenteeism were observed in 15.6 and 32.9% of care workers, respectively. While absenteeism showed no relationship with the work environment, low presenteeism correlated with high leadership ratings (odds ratio [OR] 1.22, 95% confidence interval [CI] 1.01-1.48) and adequate staffing resources (OR 1.18, 95% CI 1.02-1.38). Conclusion: Self-reported presenteeism is more common than absenteeism in Swiss nursing homes, and leadership and staffing resource adequacy are significantly associated with presenteeism, but not with absenteeism.
25
Arije, Olujide, Ekerette Udoh, Kayode Ijadunola, Olusegun Afolabi, Joshua Aransiola, Godpower Omoregie, Oyebukola Tomori-Adeleye, et al. "Combination prevention package of interventions for reducing vulnerability to HIV among adolescent girls and young women in Nigeria: An action research." PLOS ONE 18, no. 1 (January 18, 2023): e0279077. http://dx.doi.org/10.1371/journal.pone.0279077.
Full textAbstract:
Background Adolescent girls and young women (AGYW) in Nigeria are especially at risk of HIV in Nigeria. Their vulnerability to HIV is linked to multiple concurrent sexual relationships, transgenerational sex, and transactional sex, amongst other factors. These factors have sociocultural contexts that vary across a multi-cultural country like Nigeria. The aim of this study was to use an innovative collaborative approach to develop a minimum HIV prevention package for AGYW which is responsive to sociocultural settings and based on combination HIV prevention. Methods We conducted action research to develop and implement actionable HIV prevention intervention models that address AGYW’s vulnerabilities to HIV in three Nigerian States and the Federal Capital Territory (FCT) Abuja. The action research adopted the breakthrough series (BTS) collaborative, which accelerates improvement through mutual learning. The BTS implementation involved rapid Plan-Do-Study-Act (PDSA) cycles: an iterative process to plan and implement a basket of interventions. Problems or problematic situations, termed change topics, for which interventions could be carried out were identified in each study location. Using participatory approaches during a series of meetings called learning sessions, specific and innovative interventions, termed change ideas, were developed. These learning sessions were conducted with young women groups and other stakeholders. The change ideas were tested, studied, adapted, adopted, or discarded at each participating site. Exposure to and uptake of the implemented interventions was assessed in the study areas using a household survey with 4308 respondents, 53 focus group discussions, and 40 one-on-one interviews in intervention and control study sites. Results Five categories of interventions were collaboratively developed, namely: Parental communication; Peer to peer interventions; Facilitator-led interventions; Non-traditional outlets for condoms, and Social media-based interventions. A good reach of the interventions was demonstrated as 77.5% of respondents reported exposure to at least one type of intervention. Nearly half of the respondents reported being exposed to the parental communication interventions, while 45.1% reported being exposed to the youth facilitator-driven interventions. Social media interventions had the lowest penetration. Also, there was between 15 to 20 positive percentage point difference between intervention and control for the uptake of HIV testing, and between 5 to 9 positive percentage point difference for uptake of male condoms. These differences were statistically significant at p<0.001. Conclusions Interventions developed through participatory approaches with young people and well-tailored to local realities can improve the acceptability and accessibility of programs that are able to reduce the risk of HIV infection among AGYW.
26
Holbein, Blair, Marie T. Rape, Barbara N. Hammack, Ann Melvin, Carson Reider, and Tamsin A. Knox. "Institutionally chartered Data and Safety Monitoring Boards: structured approaches to assuring participant safety in clinical research." Journal of Investigative Medicine 69, no. 5 (June 2021): 1050–55. http://dx.doi.org/10.1136/jim-2021-001779.
Full textAbstract:
Data and Safety Monitoring Boards (DSMBs) derived from the need to monitor large federally funded multi-center clinical trials and evolved to include commercial and other large and complex trials. Eventually, academic health centers also created institutionally focused trial monitoring mechanisms. The basic general principles that define traditional DSMBs extend to the institutional level. The primary responsibilities are assuring safety of the participants, preserving the integrity of the trial, and ensuring the reliability of the results. Institutionally chartered DSMBs meet these responsibilities but usually have fewer members, have a structure specific to the needs of the trial, are more focused and/or have different scope reviewing smaller, single site, higher risk, and investigator-initiated studies and are flexible to accommodate institution-specific requirements and approaches. Their purpose is to meet the responsibilities of oversight for safety and data integrity, ensure proper study design, rigor and conduct, as well as provide statistical support appropriate to the setting of the research. Academic health centers should recognize the importance and existence of institution level safety and data monitoring and provide support as much as possible. Investigators should have sufficient resources available to assemble DSMBs. The Clinical and Translational Science Awards Collaborative DSMB Workgroup provides an online manual to assist investigators.
27
Vissa, Madhav, Marsha Treadwell, and Naomi Bardach. "Improving Completion Rates of Transcranial Doppler Ultrasounds in Children with Sickle Cell Disease Using Quality Improvement Efforts: In-Clinic Vs. Population-Based Assessments." Blood 138, Supplement 1 (November 5, 2021): 1886. http://dx.doi.org/10.1182/blood-2021-151269.
Full textAbstract:
Abstract Introduction: People living with sickle cell disease (SCD) are at risk for stroke due to progressive cerebral vasculopathy. The Stroke Prevention Trial in Sickle Cell Anemia (STOP) study showed that transfusion therapy in patients with abnormal cerebral blood flow velocities measured by transcranial doppler (TCD) ultrasound significantly reduced the risk for stroke. Based on the STOP and STOP II studies, the National Heart, Lung and Blood Institute (NHLBI) and American Society of Hematology (ASH) recommend annual TCD screenings for children with HbSS and HbSb0 genotypes from age 2-16. Despite this recommendation, studies show that fewer than half of eligible children with SCD complete annual TCD screening. Recently, Cabana and Treadwell et al. (2020) found high TCD referral and completion rates in a multi-site quality improvement (QI) initiative (85% baseline) using chart review. Another feasible approach to tracking guideline adherence uses administrative claims data which are derived from diagnostic and billing codes from statewide claims. Claims data can be used to assess population estimates for a clinic or a state, for all eligible patients, including those who may not routinely access care. In this study, we use administrative claims to assess TCD completion rates in the same clinics participating in the aforementioned QI initiative. We hypothesized that, population level rates would be lower than those assessed via chart review and that QI strategies may not lead to sustained TCD completion rates. Methods: Between August 2017 to August 2018, a QI initiative within the Pacific Sickle Cell Regional Collaborative (PSCRC) was conducted to improve referral and completion rates of TCD screenings. Site leads participated in a monthly QI learning collaborative, implementing and reporting on Plan-Do-Study-Act (PDSA) cycles, with bimonthly chart review data collection. Medicaid administrative claims from the four states with participating clinics, from 2017, 2018 (to assess baseline and post-QI initiative performance) and 2019 (to assess sustainability), were used to assess rates of TCD completion in the eligible pediatric population, using the specifications of a previously validated quality measure by Reeves et al (2019). Annual TCD completion rates and changes in completion rates over time were assessed for each site and state. Results: Five sites from four states in the PSCRC were included in the analysis. There was large variability in the number of eligible patients in each clinic (13-75) and state (23-588). Based on administrative claims, TCD clinic-level completion rates at baseline ranged from 41.7% to 69.2% at individual clinics. After 12 months of QI participation, TCD completion rates improved at all sites (range 4.6% to 29.2%). The site with the largest change improved TCD completion rate from 41.7% to 70.8% (n=24). All but one site had a decrease in TCD completion rate after completing the QI initiative and in 2019, TCD completion rates were within 10% of baseline completion rates at all sites (range -8.2% to 8.3%). At the statewide level, one state had a sustained improvement in TCD completion (improvement from baseline: 8.8%). In three of the four states providing data, TCD completion rates decreased from baseline (range -0.7% to -12.6%). Discussion: In a regional collaborative, we found improvements in TCD completion in the setting of a QI initiative focused on TCD, which were not sustained in the year after. This suggests the need for a systems-level approach to improvement, leading to feasible sustainability when no longer the focus of a collaborative. In addition, our data show that, when using administrative claims, rates of TCD completion are lower than rates when using chart review data (41.7% to 69.2% vs. 85% by chart review noted in prior publication). Thus, while site-specific medical record review provides insight into the quality of care for patients seen in the clinic, administrative claims data allow for a global understanding of the quality of care for the clinic population at risk, including those who do not attend clinic regularly. This suggests additional potential focus for quality improvement initiatives, such as systems to optimize outreach to patients who may not routinely access care. This type of outreach may best be done by health plans, potentially in partnership with sickle cell specialists, and would be an important tool for improving health for children with SCD. Disclosures Vissa: Global Blood Therapeutics Inc: Research Funding. Treadwell: National Alliance of Sickle Cell Centers: Other: Early Evaluation of the Use of Crizanlizumab in Sickle Cell Disease.
28
Williams-Jones, Glyn, Hazel Rymer, Guillaume Mauri, Joachim Gottsmann, Michael Poland, and Daniele Carbone. "Toward continuous 4D microgravity monitoring of volcanoes." GEOPHYSICS 73, no. 6 (November 2008): WA19—WA28. http://dx.doi.org/10.1190/1.2981185.
Full textAbstract:
Four-dimensional or time-lapse microgravity monitoring has been used effectively on volcanoes for decades to characterize the changes in subsurface volcanic systems. With measurements typically lasting from a few days to weeks and then repeated a year later, the spatial resolution of theses studies is often at the expense of temporal resolution and vice versa. Continuous gravity studies with one to two instruments operating for a short period of time (weeks to months) have shown enticing evidence of very rapid changes in the volcanic plumbing system (minutes to hours) and in one case precursory signals leading to eruptive activity were detected. The need for true multi-instrument networks is clear if we are to have both the temporal and spatial reso-lution needed for effective volcano monitoring. However, the high cost of these instruments is currently limiting the implementation of continuous microgravity networks. An interim approach to consider is the development of a collaborative network of researchers able to bring multiple instruments together at key volcanoes to investigate multitemporal physical changes in a few type volcanoes. However, to truly move forward, it is imperative that new low-cost instruments are developed to increase the number of instruments available at a single site. Only in this way can both the temporal and spatial integrity of monitoring be maintained. Integration of these instruments into a multiparameter network of continuously recording sensors is essential for effective volcano monitoring and hazard mitigation.
29
Przystal*, Justyna M., Sridevi Yadavilli*, Christina Colman Abadi*, Viveka Nand Yadav, Sandra Laternser, Chiara Cianciolo Cosentino, Sebastian M. Waszak, et al. "DIPG-64. INTERNATIONAL PRECLINICAL DRUG DISCOVERY AND BIOMARKER PROGRAM INFORMING AN ADOPTIVE COMBINATORIAL TRIAL FOR DIFFUSE MIDLINE GLIOMAS." Neuro-Oncology 22, Supplement_3 (December 1, 2020): iii300. http://dx.doi.org/10.1093/neuonc/noaa222.109.
Full textAbstract:
Abstract INTRODUCTION DMG-ACT (DMG- multi-arm Adaptive and Combinatorial Trial) aims to implement a highly innovative clinical trial design of combinatorial arms for patients with diffuse midline gliomas (DMGs) at all disease stages that is adaptive to pre-clinical data generated in eight collaborating institutions. The goals of the team are to: i) rapidly identify and validate promising drugs for clinical use, and ii) predict biomarkers for promising drugs. METHODS In vitro (n=15) and in vivo (n=8) models of DMGs across seven institutions were used to assess single and combination treatments with ONC201, ONC206, marizomib, panobinostat, Val-083, and TAK228. In vivo pharmacokinetic assays using clinically relevant dosing of ONC201, ONC206, and panobinostat were performed. Predictive biomarkers for ONC201 and ONC206 were identified using extensive molecular assays including CRISPR, RNAseq, ELISA, FACS, and IHC. RESULTS Inhibitory concentrations (IC50) were established and validated across participating sites. In vivo validation of single and combination drug assays confirmed drug efficacy as increased survival for: ONC201 (p=0.01), ONC206 (p=0.01), ONC201+ONC206 (p=0.02), and ONC201+panobinostat (p=0.01). Marizomib showed toxicity in murine/zebrafish PDXs models. Murine pharmacokinetic analysis showed peak brain levels of ONC201 and ONC206 above pre-clinical IC50. Molecular testing and analyses of existing drug screen across 537 cancer cell lines validated mitochondrial stress and ATF4 as the main targets induced by ONC201/6. CONCLUSION Thorough preclinical testing in a multi-site laboratory setting is feasible and identified ONC201 in combination with ONC206 as promising therapeutics for DMGs. Preclinical and correlative-clinical studies are ongoing.
30
Pergola, G., T. Quarto, M. Papalino, P. Di Carlo, P. Selvaggi, B. Gelao, G. Blasi, and A. Bertolino. "Association of Inter-individual Differences in Imaging Markers with Schizophrenia Phenotypes." European Psychiatry 41, S1 (April 2017): S43—S44. http://dx.doi.org/10.1016/j.eurpsy.2017.01.193.
Full textAbstract:
IntroductionNeuroimaging studies have identified several candidate biomarkers of schizophrenia. However, it is unclear whether the considerable variability in these neurobiological correlates between patients can be translated into the clinical setting.ObjectivesWe aimed to identify neuroimaging predictors of clinical course in patients with schizophrenia. Combined with the identification of genetically determined markers of schizophrenia risk, our studies aimed to elucidate the biological basis and the clinical relevance of inter-individual variability between patients.MethodsWe included over 150 patients with schizophrenia and 279 healthy volunteers across five neuroimaging centers in the framework of the IMAGEMEND project [1]. We performed multiple studies on MRI scans using random forests and ROC curves to predict clinical course. Data from healthy controls served to normalize the data from the clinical population and to provide a benchmark for the findings.ResultsWe identified ensembles of neuroimaging markers and of genetic variants predictive of clinical course. Results highlight that (i) brain imaging carries significant clinical information, (ii) clinical information at baseline can considerably increase prediction accuracy.ConclusionThe methodological challenges and the results will be discussed in the context of recent findings from other multi-site studies. We conclude that brain imaging data on their own right are relevant to stratify patients in terms of clinical course; however, complementing these data with other modalities such as genetics and clinical information is necessary to further develop the field towards clinical application of the predictions.Disclosure of interestGiulio Pergola is the academic supervisor of a Hoffmann-La Roche Collaboration grant that partially funds his salary.
31
Daveson, Barbara A., Samuel Frederic Allingham, Sabina Clapham, Claire E. Johnson, David C. Currow, Patsy Yates, and Kathy Eagar. "The PCOC Symptom Assessment Scale (SAS): A valid measure for daily use at point of care and in palliative care programs." PLOS ONE 16, no. 3 (March 25, 2021): e0247250. http://dx.doi.org/10.1371/journal.pone.0247250.
Full textAbstract:
Background Very few measures are used successfully as part of routine care within national palliative care outcome programs. Only a handful of studies examine these measures. The aim of this study is to evaluate the validity of a measure used in a national outcomes program: the Palliative Care Outcomes Collaboration Symptom Assessment Scale (PCOC SAS). Methods A retrospective multi-site cohort study with secondary analysis of routinely collected patient-level data to assess PCOC SAS’s internal consistency, construct validity, reliability, interpretability, acceptability and sensitivity. The analyses used two sets, with data collected by inpatient and community palliative care services registered with the Australian national PCOC. Results Dataset one included 1,117 patients receiving palliative care from 21 services. Dataset two included 5,294 patients receiving palliative care from 119 PCOC services. PCOC SAS demonstrated the ability to detect and discriminate distress by palliative care phase, functional status and diagnosis. Excellent and good convergent and discriminant validity were demonstrated. Fair through to substantial inter-rater and intra-rater reliability levels were evidenced. Sufficient interpretability resulted along with necessary levels of acceptability and sensitivity. Conclusion PCOC SAS is a valid and reliable patient-reported outcome measure suitable for use in routine clinical care with patients requiring palliative and or end-of-life care, including in national outcomes programs.
32
Pillinger, Kelly E., Ripal Jariwala, PharmD; Nicholas J. Mercuro, Laura N. Cwengros, Susan L. Davis, Susan L. Davis, and Haley Appaneal. "184. Pharmacist role in antimicrobial stewardship research: a 30-year experience." Open Forum Infectious Diseases 7, Supplement_1 (October 1, 2020): S98—S99. http://dx.doi.org/10.1093/ofid/ofaa439.228.
Full textAbstract:
Abstract Background Antimicrobial stewardship program (ASP) guidance from the Centers for Disease Control and Prevention recommends co-leadership of both an infectious-diseases (ID) physician and ID-trained pharmacist. Pharmacists play a key role in the therapeutic management, administration, and implementation of ASP interventions. The purpose of this study, conducted on behalf of the Society of Infectious Diseases Pharmacists, was to describe the involvement of pharmacists in publications of ASP interventional research. Methods A PubMed search was conducted to identify publications in the United States and Canada from 1990–2019 including “antimicrobial (or antibiotic) stewardship” or “antimicrobial (or antibiotic) intervention.” Articles were screened for active interventions with comparator arms. A random subset of 100 pharmacist-authored manuscripts were selected using a time-based clustering strategy to review specific study designs, populations, interventions, and endpoints. Results Of 1,426 publications, 340 met inclusion. Two-thirds (228/340) of all interventional antimicrobial stewardship studies included a pharmacist author. Pharmacists were lead authors in 59% (135/228) of studies that included a pharmacist. Among the randomized subset of pharmacist-authored manuscripts (n=100), the average impact factor of journals with pharmacists as the first author was 3.52, compared to 5.25 as middle authors. Most studies were inpatient focused (89%), included adults (81%), and conducted in a single-site setting (84%). Pediatrics, immunocompromised, post-acute care, and ambulatory populations comprised less than 10% of the publications. The most common interventions described were audit and feedback (55%), guideline implementation (49%), and education (40%). Endpoints included drug utilization (66%), clinical outcomes (57%), safety events (46%), cost (40%), and appropriateness of therapy (35%). Figure 1. Conclusion Pharmacists have an integral role in publication and dissemination of ASP research. Opportunities exist in multi-site collaboration as well as research in ambulatory, pediatric, and immunocompromised groups. Future research endpoints should be practical, generalizable, and patient-centered. Disclosures Kelly E. Pillinger, PharmD, BCIDP, Pharmacy Times (Other Financial or Material Support, Speaker) Haley Appaneal, PharmD, Shionogi (Grant/Research Support)
33
Lillie, M. C., and C. E. Budd. "DIET ISOTOPE ANALYSIS AND RELATED STUDIES IN PREHISTORIC UKRAINE: FACT, FICTION AND FANTASY." Archaeology and Early History of Ukraine 37, no. 4 (December 23, 2020): 251–67. http://dx.doi.org/10.37445/adiu.2020.04.20.
Full textAbstract:
The authors consider scientific studies of Ukrainian skeletal material across the Epipalaeolithic to Eneolithic periods and offer some observations in relation to the efficacy of studies undertaken by different researchers. Firstly, the authors summarize the results of their own research since the original research undertaken by Lillie in the early 1990s, and present period based overviews (fig. 1—3) which discuss the nature of the evidence, the fact that fish remains important across the periods studied. The data also highlights the fact that by the Eneolithic period different culture groups are following distinct subsistence strategies. This is obviously marked by western dietary pathways linked to the integration of agro-pastoralism (and associated to presumed Trypillia farming groups at Verteba Cave), and those of the eastern hunter-fisher-foragers in the Dnieper region at Igren VIII and Molukhov Bugor.
Interestingly the chronological separation between these two sites is also linked to dietary variability. At the earlier site of Igren VIII there is diet isotope evidence for a relatively heavy reliance on freshwater resources as ca. 4300—4000 cal BC, whilst at the latter site of Molukhov Bugor, at 3950—3700 cal BC, a reduction in the reliance on freshwater resources is in evidence. This is accompanied by evidence for a broader spectrum approach to the exploitation of the wild resources in and around the Dnieper Rapids region. Radiocarbon dating is shown to be affected by the FRE at the sites in and around the Dnieper system. This is clearly not the case at Verteba Cave because the freshwater reservoir effect is not associated with dietary pathways that place a reliance on terrestrial resources.
The authors discuss the dating (fig. 4—6) and mobility and dietary isotope studies that they undertook at this location and contextualize these by comparison to the work of other researchers. It is suggested that some issues occur in relation to the different research groups activities at Verteba Cave, and the fact that there is a clear need for a more considered approach to the data presented by these other groups is highlighted. It could be argued that a lack of detailed knowledge and collaboration occurs despite the fact that there are clear overlaps between research agendas. The authors conclude with a call for targeted multi-disciplinary analyses aimed at whole cemetery studies in order to further enhance our understanding of socio-economic and societal developments during the early to mid-Holocene in Ukraine.
34
Rodriguez, Anna, Peter Smielewski, Eric Rosenthal, and Dick Moberg. "Medical Device Connectivity Challenges Outline the Technical Requirements and Standards For Promoting Big Data Research and Personalized Medicine in Neurocritical Care." Military Medicine 183, suppl_1 (March 1, 2018): 99–104. http://dx.doi.org/10.1093/milmed/usx146.
Full textAbstract:
Abstract Brain injuries are complicated medical problems and their management requires data from disparate sources to extract actionable information. In neurocritical care, interoperability is lacking despite the perceived benefits. Several efforts have been underway, but none have been widely adopted, underscoring the difficulty of achieving this goal. We have identified the current pain points of data collection and integration based on the experience with two large multi-site clinical studies: Transforming Research And Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI) in the United States and Collaborative European Neuro Trauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) in Europe. The variability of measurements across sites remains a barrier to uniform data collection. We found a need for annotation standards and for a standardized archive format for high-resolution data. Overall, the hidden cost for successful data collection was initially underestimated. Although the use of bedside data integration solutions, such as the Moberg’s Component Neuromonitoring System (Moberg Research, Inc., Ambler, PA, USA) or ICM+ software (Cambridge Enterprise, Cambridge, UK), facilitated the homogenous collection of synchronized data, there remain issues that need to be addressed by the neurocritical care community. To this end, we have organized a Working Group on Neurocritical Care Informatics, whose next step is to create an overarching informatics framework that takes advantage of the collected information to answer scientific questions and to accelerate the translation of trial results to actions benefitting military medicine.
35
Blake, Holly, Sarah Somerset, Ikra Mahmood, Neelam Mahmood, Jessica Corner, Jonathan K. Ball, and Chris Denning. "A Qualitative Evaluation of the Barriers and Enablers for Implementation of an Asymptomatic SARS-CoV-2 Testing Service at the University of Nottingham: A Multi-Site Higher Education Setting in England." International Journal of Environmental Research and Public Health 19, no. 20 (October 12, 2022): 13140. http://dx.doi.org/10.3390/ijerph192013140.
Full textAbstract:
Asymptomatic testing for SARS-CoV-2 RNA has been used to prevent and manage COVID-19 outbreaks in university settings, but few studies have explored their implementation. The aim of the study was to evaluate how an accredited asymptomatic SARS-CoV-2 testing service (ATS) was implemented at the University of Nottingham, a multi-campus university in England, to identify barriers and enablers of implementation and to draw out lessons for implementing pandemic response initiatives in higher education settings. A qualitative interview study was conducted with 25 ATS personnel between May and July 2022. Interviews were conducted online, audio-recorded, and transcribed. Participants were asked about their experience of the ATS, barriers and enablers of implementation. Transcripts were thematically analysed. There were four overarching themes: (1) social responsibility and innovation, (2) when, how and why people accessed testing, (3) impact of the ATS on the spread of COVID-19, and (4) lessons learned for the future. In establishing the service, the institution was seen to be valuing its community and socially responsible. The service was viewed to be broadly successful as a COVID-19 mitigation approach. Challenges to service implementation were the rapidly changing pandemic situation and government advice, delays in service accreditation and rollout to staff, ambivalence towards testing and isolating in the target population, and an inability to provide follow-up support for positive cases within the service. Facilitators included service visibility, reduction in organisational bureaucracy and red tape, inclusive leadership, collaborative working with regular feedback on service status, flexibility in service delivery approaches and simplicity of saliva testing. The ATS instilled a perception of early ‘return to normality’ and impacted positively on staff feelings of safety and wellbeing, with wider benefits for healthcare services and local communities. In conclusion, we identified common themes that have facilitated or hindered the implementation of a SARS-CoV-2 testing service at a university in England. Lessons learned from ATS implementation will inform future pandemic response interventions in higher education settings.
36
Solbak, Nathan, Erin Thompson, Lindsay Long, Michelle Bailey, Daina Thomas, and David Johnson. "Scale and spread of quality improvement initiatives for bronchiolitis management in Alberta emergency departments." Canadian Journal of Emergency Nursing 45, no. 2 (July 12, 2022): 14–15. http://dx.doi.org/10.29173/cjen178.
Full textAbstract:
Background: Acute viral bronchiolitis is among the most common illnesses seen in the emergency department (ED) and is the leading cause of infant hospitalization in Canada. Practice guidelines do not recommend routine use of certain diagnostic tests and medications in managing bronchiolitis, yet prior studies suggest that low-value interventions are routinely administered to patients with bronchiolitis. Successful implementation of quality improvement at the Alberta Children’s Hospital suggested that low-value interventions and tests can be improved. Yet, practice variation and potential opportunities to improve bronchiolitis management are likely present in EDs in urban and rural settings.
Implementation: The project is a collaboration between the Maternal Newborn Child and Youth Strategic Clinical Network (MNCY SCN), the Improving Health Outcomes Together Team (IHOT), and Physician Learning Program (PLP) under the umbrella of the AHS Ernst & Young Clinical Appropriateness Theme recommendations to expand and scale initiatives to reduce unnecessary tests to improve patient safety. A provincial Bronchiolitis Steering Committee, led by two Physician Initiative Leads, was formed to guide the project and implementation at 16 facilities across Alberta.
Site implementation includes two key aspects:
Audit & Feedback (A&F) – review practice data, facilitated discussion with clinicians, and identify enablers and barriers to practice change
Site Specific Implementation Plan – options for sites include use of posters, tools, resources; utilization of ConnectCare (order sets); and staff and physician education
Qualitative interviews with site-champions will provide perspectives and feedback on enablers and barriers to change. Discussions from the A&F sessions, in addition to the qualitative interviews will be coded and analyzed based on the Consolidated Framework for Implementation Research and Theoretical Domains Framework.
Resources required included clinical leads, project management, data/dashboards, educational posters, updated order sets, and a central location for staff and physician to access bronchiolitis materials (via SharePoint).
Evaluation Methods: The primary objective of the study is a reduction of chest x-ray utilization. Chest x-rays utilization can be readily obtained from administrative data at all sites in the project. Secondary measures include medications (PIN) and respiratory viral testing. There is strong evidence to support that medications and respiratory viral testing do not impact bronchiolitis management. The project addresses patient safety and outcomes by reducing the use of low-value interventions and tests in the ED and enables resources to be directed towards evidence-based care. As ConnectCare is phased into all facilities across Alberta, additional metrics will be incorporated into reports and updates to participating sites.
Results: The first phase of the project took place from September to November 2021, with rollout to six facilities (four EDs and two inpatient units). A total of 151 physicians attended the audit and group feedback sessions. Site-specific planning sessions and qualitative interviews with site-champions are planned, and the next phase of the project will continue with spread and scale to regional EDs (n=5), urban (n=2) and rural (n=4) locations in fall 2022.
Advice and Lessons Learned:
The partnership with MNCY SCN, PLP, IHOT, and two Clinician Leads has been beneficial for establishing a team-based multi-disciplinary approach to address needs as they arise and the ability to work together with site champions.
Identifying and collaborating with site champions is necessary for establishing relationships and trust prior to conducting audit and feedback sessions and addressing practice change. Site champions understand the contextual factors of their facility and how to best utilize enablers or address barriers for practice change. Initiation of these working relationships need to take place months before implementation and ideally develop through existing networks.
Timing and flexibility are crucial for successful implementation. Rescheduling launch dates, adjusting session time, validating data, and adjusting to external factors such as delays in ConnectCare rollouts and pressures on the healthcare system brought on by the COVID-19 pandemic were experienced in the planning and initiating phases of the project. These lessons will be carried forward as we plan for the second part of spread and scale in Fall 2022.
37
Quinn, Diana, Edward Cioffi, Steve Hill, Mat Kor, Anna-Clare Longford, Robert Moller, and Pramila Rathore. "Implementing work-integrated learning in online construction management courses." Journal of University Teaching and Learning Practice 16, no. 1 (January 1, 2019): 122–36. http://dx.doi.org/10.53761/1.16.1.9.
Full textAbstract:
Implementing online learning can pose serious pedagogical challenges particularly when programs contain work-integrated learning (WIL) components. One such component is the site visit, where student groups are led by subject matter experts through an authentic environment. These WIL experiences help students relate the theory learnt in classrooms to practice. Construction management students particularly benefit from repeated visits to the same building site to appreciate the spatial and temporal constraints and how they change over the life of the building project. Unfortunately, logistics and occupational health and safety concerns have increasingly limited the inclusion of site visits in school and university curricula. Online construction management students are widely dispersed and therefore it is impractical to include shared physical site visits in the curriculum, although students are able to observe locally-based construction sites and report back their findings. In response, universities have collaborated with construction companies and, using significant federal funding, created an interactive learning environment that follows the construction of an eight-storey building over time. This high quality resource is a type of virtual WIL that has been primarily used in face-to-face teaching. In this case study we implement this resource in a fully online construction management course and create three comparatively low-cost environments that demonstrate the construction of residential, industrial, and multi-storey building construction sites, for implementation in another two online construction courses. As an enhancement, within these new environments are embedded images, explanatory videos and documents which students can interact with to create a virtual tour that can be embedded directly alongside the concepts being studied in their weekly learning materials. In addition, these tours are linked to specific online learning activities designed to motivate students to reflect on and refine their understandings based on the authentic context they are experiencing. To better understand the processes involved in this collaboration between school academics, staff from a central teaching innovation unit, and two construction companies, the business processes employed were modelled using a swimlane diagram. Insights into the practicalities of implementing these virtual tours are shared. The experiential learning outcomes of students using virtual WIL are comparable to traditional site visits. Initial online student feedback of small cohorts of online students has been overwhelmingly positive and encouraging for the development of more interactive virtual tours. The implementation of virtual tours and activities, blended with independent face-to-face site visits and assessment, forms an authentic, supported and constructively-aligned WIL experience for students undertaking fully online courses.
38
Aguilar, Dinora Virginia, Pablo Gonzalez-Montalvo, Hugo Romo, Daniela Arce, Margarita Gonzalez-Zamorano, Mayra Ivette Lopez-Ruiz, José De Jesús Loeza Oliva, et al. "Molecular and MRD-Based Characterization of Acute Lymphoblastic Leukemia in Mexico: Experience from the Mexico in Alliance with St. Jude "Bridge Project"." Blood 138, Supplement 1 (November 5, 2021): 1209. http://dx.doi.org/10.1182/blood-2021-154168.
Full textAbstract:
Abstract Background: Cancer is the second leading cause of death in Mexico among children 5-14 years. In 2017, Mexico in Alliance with St. Jude (MAS), a multi-site intersectoral collaboration, explored reasons for suboptimal outcomes for children with acute lymphoblastic leukemia (ALL). Results showed 82% of patients to be classified as high-risk and 30% of patients be missing standard molecular or minimal residual disease (MRD) studies needed to inform risk- group stratification. Making sense of the molecular characteristics was challenging in the context of variable access and lack of common denominators. These findings led to the development of the "Bridge Project"; a prospective quality improvement demonstration project aiming to bridge this access and quality gap through multi-site collaboration, centralization, and standardization. Methods: Six MAS collaborating hospitals, located in six different states (Mérida, Guadalajara, Sinaloa, Baja California, Chiapas, and Veracruz), have sent diagnostic samples for children 0-18 years old with suspected ALL to Hospital Infantil Teletón de Oncología (HITO), in Queretaro, which serves as the centralized laboratory for the MAS cooperative group. Access to the diagnostic panel is secured upfront through dedicated funding obtained from a local foundation. The first sample was shipped in July 2019. The consensus-derived diagnostic panel includes morphology, immunophenotype, karyotype, fluorescent in situ hybridization (FISH), molecular biology (RT-PCR) and flow cytometry (FC) MRD at two time points. Protocols vary by institution and MRD evaluation is only done if the institutional protocol incorporates MRD-evaluation into the risk-group stratification. Hospitals send several empty boxes prior to shipping patient samples to assess their regional shipping vendors and timelines. The also standardize data collection processes and use PDSA cycles to monitor sample quality and address issues with sample quality. HITO produces FC results (for diagnosis or MRD evaluation) and FISH/cytogenetic results within 3 to 21 days of sample arrival. Results: As of July 2021, the centralized lab has received samples from 217 patients with suspected ALL through this project and 93% of these samples have arrived within the 48hr target. Of these, 176 (81.1%) had confirmed ALL and 14 (6.4%) had acute myeloid leukemia (AML), 2 (0.9%) cases had other malignant conditions, and in 25 (11.5%) of the cases leukemia was ruled out. Among the 176 cases of confirmed ALL, 162 (92%) had B-cell lineage and 14 (8%) had T-cell lineage. FISH was reported for 172 (97.7%) patients and positive in 126 (73.2%) cases; 46 (26.7%) cases had reported gains, 34 (19.7%) detected t(12;21), 18 (10.4%) detected iAMP cr21, 8 (4.7%) detected breaks of the MLL gene t(4;11), 7 (4%) detected t(1;19), and 6 (3.4%) detected t(9;22). Four T-cell ALL cases had breaks CDKN2A del(9)(p21) and three cases had TRA/D rearrangement (14) (q11.2). Karyotype alterations were detected in 90 (52.3%) of the samples, of which 41 (23.8%) showed hyperdiploidy and 13 (7%) showed complex karyotype. One case of hypodiploid was identified. Day 15 MRD was assessed in 131 (80%) patients with B-cell lineage, Day 84 MRD was assessed in 99 (61.1%) patients with B-cell lineage, and Day 29 MRD in 8 (57.1%) patients with T-cell lineage whose treatment schema utilizes MRD-based stratification. Among B-lineage patients, 84% had MRD <1% at Day 15 and 94.9% MRD <0.01% at Day 84. Among T-cell lineage patients, 75% had MRD <0.01% at Day 29 and 80% MRD <0.01% at Day 84, but numbers for T-cell lineage were small. Conclusions: Given proper structural and financial supports, patients with suspected childhood ALL in Mexico can access a comprehensive diagnostic panel following a centralized laboratory approach. Preliminary results from the Bridge Project allow characterizing childhood ALL to a degree that has not been previously possible in Mexico. In this cohort, favorable characteristics such a t(12;21), gains, and hyperdiploidy are observed in frequencies similar to those reported in Hispanic cohorts in high-income countries. MRD results are for B-cell lineage are also consistent with the literature. Continued engagement in this project from hospitals in diverse geographic settings and with diverse patient populations will allow the MAS cooperative group to continue to improve the characterization of childhood ALL in Mexico. Figure 1 Figure 1. Disclosures No relevant conflicts of interest to declare.
39
Arvidson, Rhonda, and Stan Jones. "Ice Detection and Avoidance." International Oil Spill Conference Proceedings 2003, no. 1 (April 1, 2003): 453–56. http://dx.doi.org/10.7901/2169-3358-2003-1-453.
Full textAbstract:
ABSTRACT An extensive risk assessment of oil transportation in Prince William Sound, Alaska was finalized in 1996 that identified drifting icebergs, from Columbia Glacier, as one of the most significant oil spill risks remaining to be addressed. The Prince William Sound Regional Citizens’ Advisory Council (PWS RCAC) was a major participant in this risk analysis. As part of the groundwork for the ice detection project, PWS RCAC has also sponsered extensive studies of Columbia Glacier calving and drift patterns, iceberg size and distribution. A collaborative project, called the ice detection project, was developed by a multi stakeholder working group and provides an opportunity for an immediate and long-term solution using existing technology. One objective of the project is to verify the efficiency, effectiveness and reliability of existing radar technologies to provide mariners and the United States Coast Guard with real time information regarding ice conditions. A secondary objective is to promote the research and development through field testing of new and emerging technologies to determine the possible enhancement of conventional radar. In addition to PWS RCAC, stakeholders responsible for spearheading this project are: Alyeska Pipeline Service Company, Alaska Department of Environmental Conservation, Oil Spill Recovery Institute, United States Coast Guard, Prince William Sound Community College and National Oceanic and Atmospheric Administration. Each of the seven participants brings expertise and backing from the stakeholder they represent. The site chosen for the ice detection radar project is Reef Island (illustration 1), located adjacent to Bligh Reef, Prince William Sound. This location is ideal because of its proximity to Columbia Glacier, the source of the icebergs, as well as providing an unobstructed view of the shipping lanes. A fifty foot tower was installed at the site during the fall of 2001 and a conventional radar system is currently being configured for installation. The expectation is that the system will be up and running by July of 2002, giving real time information on ice in the tanker lanes to mariners in Prince William Sound. A second field test of an UHF radar prototype is planned for the summer of 2002. Field testing and ground truthing of the radar system is scheduled for the next five years.
40
Berlinger, Nancy. "HOUSING, AGING, AND HEALTH: NEW FINDINGS AND FRAMEWORKS FROM HOUSING-FOCUSED RESEARCH IN THE CONTEXT OF COVID-19." Innovation in Aging 6, Supplement_1 (November 1, 2022): 337. http://dx.doi.org/10.1093/geroni/igac059.1329.
Full textAbstract:
Abstract Older adults have been the most vulnerable population to severe illness, hospitalization, or death from COVID-19. During the pandemic, housing became a site of health and safety for some, while reinforced inequities for others due to underlying problems of affordability, accessibility, safety, and service access. This symposium showcases five housing-focused studies reflecting the pandemic context, including research by early-career investigators. The first speaker will present findings from a study of materials preserving promising practices and policy ideas generated by housing-focused pandemic responses to middle-income and low-income community-dwelling older adults. The second speaker will discuss narrative lessons from “avoidance hotels” – an infection-reduction strategy that transferred older adults from shelters to hotel rooms – with potential to guide planning for the needs of older adults facing homelessness and serious illness. The third speaker will analyze findings from multi-city research on the pandemic housing experiences of lower-income Black women, who faced severe intersectional threats to housing security. The fourth speaker will share data from a qualitative study of a Medicare-financed home care program for residents of HUD housing, including recommendations for improving experiences of participants and providers. The fifth speaker will describe the evolution of the pandemic-response roles of HUD service coordinators, based on findings from surveys in 2020 and 2021. We will conclude with audience discussion about ways for age-focused researchers to collaborate in crafting policy solutions and effective public narratives about housing equity in America's aging society.
41
Corrall, Sheila. "Capturing the contribution of subject librarians." Library Management 36, no. 3 (March 9, 2015): 223–34. http://dx.doi.org/10.1108/lm-09-2014-0101.
Full textAbstract:
Purpose – The strategic contribution of subject librarians as information specialists in the digital world has been questioned by institutional administrators, but others have identified expanded roles and new opportunities in learning and research support. The purpose of this paper is to investigate the application of Kaplan and Norton’s strategic management system of balanced scorecards and strategy maps to subject librarianship in universities, with particular reference to the intellectual capital represented and created in the structures, relationships, and know-how of liaison work. Design/methodology/approach – A literature review was used to define established and emergent roles, responsibilities and skillsets of subject librarians, including their reach beyond the library. A web site survey investigated goals, actions, and values related to liaison work in UK library strategies. Data were analyzed thematically to develop an exemplar map and assess its potential for evaluating the contribution of subject librarians. Findings – Core functions continue, with expanded scope and competencies. Collaboration and integrated services are key trends for mapping. Liaison work is poorly documented in existing strategies. Preliminary results suggest that strategy maps can be used to illustrate the strategic contribution of subject librarians. Research limitations/implications – The paper reports the early stages of a multi-phase project. The results are limited to the conceptual phase. The next phase will explore the development of both maps and balanced scorecards via case studies in different countries. Originality/value – There are few examples of library applications of strategy maps and balanced scorecards at unit or program level, and none with a focus on the intangible assets of subject librarians.
42
Wu, Yabin, Jianhua Hu, and Guanping Wen. "Study on Creep Characteristics of Water Saturated Phyllite." Sustainability 14, no. 19 (September 30, 2022): 12508. http://dx.doi.org/10.3390/su141912508.
Full textAbstract:
Phyllite is affected by its own bedding, stress environment and water-saturated conditions. There are great differences in its deformation and failure in engineering, and its creep characteristics are an important basis for evaluating the long-term stability of phyllite engineering. Therefore, this study carried out creep tests of water-saturated phyllite under different bedding angles and confining pressures, studied the coupling effect of factors that affect the creep characteristics of phyllite, and investigated and analyzed the deformation characteristics of a phyllite roadway support on site to provide basic support for phyllite roadway mine disaster control and collaborative mining research. The results showed the following: (1) When the bedding dip angle was 30~60°, under the control of the bedding, the sliding deformation along the bedding suddenly increased under the low-stress condition and the specimen did not undergo structural damage. It could continuously bear multi-level stress and generated creep deformation. In this case, a phyllite roadway should adopt the support method of combining flexibility and rigidity. (2) In the process of multi-stage stress loading, the creep instantaneous stress was directly proportional to the initial stress. When the stress was loaded to 50% of the failure strength, the instantaneous stress tended to be stable and maintained a linear, slightly increasing relationship with the stress. When the bedding angle was 30~60°, the creep deformation accounted for more than 50% of the total deformation. The bedding angles of 0° and 90° were dominated by the instantaneous strain during the stress loading process. For the flexible support of the roadway, the deformation caused by disturbance stress should be fully considered. (3) The uniaxial creep specimen mainly displayed compression shear tensile failure, with a small number of parallel cracks along the main fracture surface. The triaxial creep fracture mode changed to single shear failure. The confining pressure showed greater inhibition of the creep of the specimen with a bedding inclination of 0° and 90°. The strength design of the rigid support should refer to the original rock stress value of the roadway. The creep deformation and failure of the specimen with a bedding inclination of 30~60° were mainly controlled by the bedding. The included angle between the bedding dip angle and the maximum principal stress should be kept within 30~60° as far as possible in the roadway layout.
43
van Son, R., S. W. Jaw, J. Yan, V. Khoo, R. Loo, S. Teo, and G. Schrotter. "A FRAMEWORK FOR RELIABLE THREE-DIMENSIONAL UNDERGROUND UTILITY MAPPING FOR URBAN PLANNING." ISPRS - International Archives of the Photogrammetry, Remote Sensing and Spatial Information Sciences XLII-4/W10 (September 12, 2018): 209–14. http://dx.doi.org/10.5194/isprs-archives-xlii-4-w10-209-2018.
Full textAbstract:
<p><strong>Abstract.</strong> To optimise the use of limited available land, land-scarce cities such as Singapore are increasingly looking towards the underground in search of more space. A good understanding of what already exists underground is essential for the planning of underground spaces. In particular, utility services make up a significant part of what exists underground. To meet planning needs, the Singapore government has initiated efforts towards bringing records of existing utility networks together in a single database and share its contents to support planning, design, and construction of underground developments. However, these records can not be relied on to support these critical processes: They are not guaranteed to represent today’s state of the underground, are not accurate or of unknown accuracy, are inconsistently modelled, and may indicate as-design information instead of as-built information. This lack of reliability leads to an increase in cost and a loss in efficiency caused by the need to repeatedly survey to locate existing utility services on-site, and can have potentially disastrous outcomes when an excavation would damage existing services. Technological advances in utility surveying and mapping devices such as Ground Penetrating Radar (GPR) and gyroscopic pipeline mapping devices offer the potential of accurately mapping utilities in three dimensions (3D) at a large scale and high speed. However, a better understanding of the benefits and limitations of these technologies in a practical context is needed, as well as their suitability for mapping to support applications such as urban planning and land administration. The Digital Underground project is a collaboration between Singapore-ETH Centre, Singapore Land Authority and the City of Zürich that aims to develop a roadmap towards a reliable 3D utility map of Singapore. To enable the development of utility mapping standards and guidelines, the 3D mapping workflow for underground utilities is studied extensively based on market research, literature study, and case studies. This work presents the beginnings of a framework for 3D mapping of underground utilities as one of the initial results of the Digital Underground project as it is in progress. From these experiences, it can be concluded that, together with existing data, data captured using various surveying methods can indeed contribute to the establishment and maintenance of a consolidated and reliable utility map. To this end, a multi-sensor, multi-data 3D mapping workflow is proposed to integrate data captured using different surveying techniques during different moments in the development lifecycle of utilities. Based on this framework, this work also identifies areas for improvement and critical gaps to be bridged that will ultimately form part of the roadmap.</p>
44
Stein, Jacob Newton, Samuel Cykert, Christina Yongue, Eugenia Eng, Isabella Kathryn Wood, and Marjory Charlot. "Effect of an antiracism intervention on disparities in time to lung cancer surgery." Journal of Clinical Oncology 39, no. 15_suppl (May 20, 2021): 101. http://dx.doi.org/10.1200/jco.2021.39.15_suppl.101.
Full textAbstract:
101 Background: Racial disparities are well described in the management of early-stage lung cancer, with Black patients less likely to receive potentially curative surgery than non-Hispanic Whites. A multi-site pragmatic trial entitled Accountability for Cancer Care through Undoing Racism and Equity (ACCURE), designed in collaboration with community partners, eliminated racial disparities in lung cancer surgery through a multi-component intervention. The study involved real-time electronic health record (EHR) monitoring to identify patients not receiving recommended care, a nurse navigator who reviewed and addressed EHR alerts daily, and race-specific feedback provided to clinical teams. Timeliness of cancer care is an important quality metric. Delays can lead to disease progression, upstaging, and worse survival, and Black patients are more likely to experience longer wait times to lung cancer surgery. Yet interventions to reduce racial disparities in timely delivery of lung cancer surgery have not been well studied. We evaluated the effect of ACCURE on timely receipt of lung cancer surgery. Methods: We analyzed data of a retrospective cohort at five cancer centers gathered prior to the ACCURE intervention and compared results with prospective data collected during the intervention. We calculated mean time from clinical suspicion of lung cancer to surgery and evaluated the proportion of patients who received surgery within 60 days stratified by race. We performed a t-test to compare mean days to surgery and chi2 for the delivery of surgery within 60 days. Results: 1320 patients underwent surgery in the retrospective arm, 160 were Black. 254 patients received surgery in the intervention arm, 85 were Black. Results are summarized in Table. Mean time to surgery in the retrospective cohort was 41.8 days, compared with 25.5 days in the intervention cohort (p<0.01). In the retrospective cohort, 68.8% of Black patients received surgery within 60 days versus 78.9% of White patients (p<0.01). In the intervention, the difference between Blacks and Whites with respect to surgery within 60 days was no longer significant (89.41% of Black patients vs 94.67% of White patients, p=0.12). Conclusions: Racial disparities exist in the delivery of timely lung cancer surgery. The ACCURE intervention improved time to surgery and timeliness of surgery for Black and White patients with early-stage lung cancer. A combination of real-time EHR monitoring, nurse navigation, and race-based feedback markedly reduced racial disparities in timely lung cancer care. [Table: see text]
45
An, Zhisheng, Peizhen Zhang, Hendrik Vogel, Yougui Song, John Dodson, Thomas Wiersberg, Xijie Feng, Huayu Lu, Li Ai, and Youbin Sun. "Scientific drilling workshop on the Weihe Basin Drilling Project (WBDP): Cenozoic tectonic–monsoon interactions." Scientific Drilling 28 (December 1, 2020): 63–73. http://dx.doi.org/10.5194/sd-28-63-2020.
Full textAbstract:
Abstract. The Weihe Basin, enclosed by the Chinese Loess Plateau to the north and the Qinling Mountains to the south, is an outstanding, world-class continental site for obtaining high-resolution multi-proxy records that reflect environmental changes spanning most of the Cenozoic. Previous geophysical and sedimentary studies indicate that the basin hosts 6000–8000 m thick fluvial–lacustrine sedimentary successions spanning the Eocene to Holocene. This sedimentary record provides an excellent and unique archive to decipher long-term tectonic–climate interactions related to the uplift of the Tibetan Plateau, the onset/evolution of the Asian monsoon, and the development of the biogeography of East Asia. Owing to its location at the interface of the opposing westerly and Asian monsoon circulation systems, the Weihe Basin also holds enormous promise for providing a record of changes in these circulation systems in response to very different boundary conditions since the Eocene. To develop an international scientific drilling programme in the Weihe Basin, the Institute of Earth Environment, Chinese Academy of Sciences, organized a dedicated workshop with 55 participants from eight countries. The workshop was held in Xi'an, China, from 15 to 18 October 2019. Workshop participants conceived the key scientific objectives of the envisaged Weihe Basin Drilling Project (WBDP) and discussed technical and logistical aspects as well as the scope of the scientific collaboration in preparation for a full drilling proposal for submission to the International Continental Scientific Drilling Program (ICDP). Workshop participants mutually agreed to design a two-phase scientific drilling programme that will in a first phase target the upper 3000 m and in a second phase the entire up to 7500 m thick sedimentary infill of the basin. For the purpose of the 7500 m deep borehole, the world's only drill rig for ultra-deep scientific drilling on land, Crust 1, which previously recovered the entire continental Cretaceous sediments in the Songliao Basin, will be deployed in the WBDP.
46
Winter, Helen, Joanna Willis, Stephen Lang, Kay Drury, Jonathan Heywood, Jeremy Bewley, Natalie Blencowe, et al. "Building capacity and ensuring equity in clinical trials during the COVID-19 pandemic." Journal of Clinical Oncology 39, no. 15_suppl (May 20, 2021): e13598-e13598. http://dx.doi.org/10.1200/jco.2021.39.15_suppl.e13598.
Full textAbstract:
e13598 Background: The impact on cancer outcomes from the Covid-19 pandemic has yet to be determined. Concerns persist on screening, delays in diagnosis, treatment interruptions and outcomes of infection in the immunosuppressed. The need for agile working has been exemplified by establishment of Nightingale Hospitals, staff redeployment and sudden integration of virtual consultations into clinical working. With most cancer clinical trials halted, recruitment into COVID-19 research became essential and embedded into the everyday. Here we present how rapid implementation of COVID-19 randomised clinical trials within an NHS organisation during the pandemic was achieved. Methods: A COVID-19 senior facilitation committee was set up to provide oversight, maximise staff capacity and resource and prioritise studies. Specific strategies to maximise access and clinical trials recruitment for patients including children and those with solid tumours were designed. These included presence of a research nurse at clinical ward rounds and team meetings, the promotion of protocol and informed consent training to all including doctors in the acute settings and weekly research meetings to share-best practice. Reflecting on learnings from this time provide an opportunity to consider how we adjust working for our patients in the future. Results: The integration of research into the everyday working of clinical teams looking after patients with COVID-19 has become the norm. The provision of protocol and informed consent training for all levels of staff and the consideration of all patients for trials during clinical ward rounds and multi-disciplinary meetings, have ensured access to trials has become embedded. The integration of research nurses working, upskilling and prompting clinical colleagues has ensured equity of access and provided a research presence and focus during the busy clinical day. The adoption of cross-disciplinary working, sharing best practice and a culture of commitment and support to the trials ensures no patient is denied the opportunity to participate. Three RTCs opened over 7 weeks. At one site 1904 patients were screened for one of the randomised-controlled trials and over 18% of these patients (351) were recruited and 175 patients declined. Conclusions: The pandemic has had a devastating impact across the UK. However, a coordinated and collaborative multi-disciplinary approach has supported high recruitment and equity of access for patients into COVID-19 trials. Learnings from this work may lead to embedding clinical trials and access to translational research for cancer patients in the future as we recover from the full impact of the pandemic. COVID-19 research has demonstrated how increased recruitment accelerates access and implementation of new innovations and novel drug combinations.The full impact of improved access to cancer research in the future during COVID recovery is worthy of more research.
47
Wagner, Bernd, Thomas Wilke, Alexander Francke, Christian Albrecht, Henrike Baumgarten, Adele Bertini, Nathalie Combourieu-Nebout, et al. "The environmental and evolutionary history of Lake Ohrid (FYROM/Albania): interim results from the SCOPSCO deep drilling project." Biogeosciences 14, no. 8 (April 20, 2017): 2033–54. http://dx.doi.org/10.5194/bg-14-2033-2017.
Full textAbstract:
Abstract. This study reviews and synthesises existing information generated within the SCOPSCO (Scientific Collaboration on Past Speciation Conditions in Lake Ohrid) deep drilling project. The four main aims of the project are to infer (i) the age and origin of Lake Ohrid (Former Yugoslav Republic of Macedonia/Republic of Albania), (ii) its regional seismotectonic history, (iii) volcanic activity and climate change in the central northern Mediterranean region, and (iv) the influence of major geological events on the evolution of its endemic species. The Ohrid basin formed by transtension during the Miocene, opened during the Pliocene and Pleistocene, and the lake established de novo in the still relatively narrow valley between 1.9 and 1.3 Ma. The lake history is recorded in a 584 m long sediment sequence, which was recovered within the framework of the International Continental Scientific Drilling Program (ICDP) from the central part (DEEP site) of the lake in spring 2013. To date, 54 tephra and cryptotephra horizons have been found in the upper 460 m of this sequence. Tephrochronology and tuning biogeochemical proxy data to orbital parameters revealed that the upper 247.8 m represent the last 637 kyr. The multi-proxy data set covering these 637 kyr indicates long-term variability. Some proxies show a change from generally cooler and wetter to drier and warmer glacial and interglacial periods around 300 ka. Short-term environmental change caused, for example, by tephra deposition or the climatic impact of millennial-scale Dansgaard–Oeschger and Heinrich events are superimposed on the long-term trends. Evolutionary studies on the extant fauna indicate that Lake Ohrid was not a refugial area for regional freshwater animals. This differs from the surrounding catchment, where the mountainous setting with relatively high water availability provided a refuge for temperate and montane trees during the relatively cold and dry glacial periods. Although Lake Ohrid experienced significant environmental change over the last 637 kyr, preliminary molecular data from extant microgastropod species do not indicate significant changes in diversification rate during this period. The reasons for this constant rate remain largely unknown, but a possible lack of environmentally induced extinction events in Lake Ohrid and/or the high resilience of the ecosystems may have played a role.
48
Angelidou, Konstantia, Mary Glenn Fowler, Pat Flynn, Anne Coletti, Katie McCarthy, Renee Browning, James McIntyre, Sean S. Brummel, David E. Shapiro, and Camlin Tierney. "Enrollment and transition challenges in the International Maternal Pediatric and Adolescent AIDS Clinical Trials (IMPAACT) network’s PROMISE trial for resource-limited regions." Clinical Trials 17, no. 4 (March 19, 2020): 437–47. http://dx.doi.org/10.1177/1740774520912428.
Full textAbstract:
Background: We describe enrollment and accrual challenges in the “Promoting Maternal and Infant Survival Everywhere” (PROMISE) trial conducted in resource-limited countries, as well as the challenges in transitioning participants from the antepartum to the postpartum components of the study. Methods: PROMISE was a large multi-national randomized controlled trial of the safety and efficacy of interventions to reduce perinatal transmission of HIV-1 (HIV) during pregnancy and breastfeeding and of interventions to preserve maternal health after cessation of perinatal transmission risk. The PROMISE study included two protocols for HIV-infected pregnant women in resource-limited countries who intended to either breastfeed or formula-feed their infants and did not meet country criteria for antiretroviral treatment. The PROMISE breastfeeding protocol (1077BF) used a sequential randomization design with up to three randomizations (Antepartum, Postpartum, and Maternal Health). The PROMISE formula-feeding protocol (1077FF) had two randomizations (Antepartum and Maternal Health). Women presenting to the clinic during early or active labor or in the immediate postpartum period were registered as Late Presenters and screened to determine whether eligible to participate in the Postpartum randomization. Results: The study was conducted at 14 sites in seven countries and opened to enrollment in April 2011. A total of 3259 pregnant women intending to breastfeed and an additional 284 pregnant women intending to formula feed were randomized in the Antepartum component. A total of 204 Late Presenters were registered during labor or after delivery. Enrollment was high among breastfeeding women (representing 96% of the target of 3400 women) but was lower than expected among women intending to formula feed (28% of 1000 expected) and late-presenting women (8% of 2500 expected). The successful overall enrollment and final primary study analyses results were attributed to substantial preparation before the study opened, collaboration among all stakeholders, close study monitoring during implementation and the flexibility to change and streamline the protocol. Conclusions: Experiences from the PROMISE study illustrate the challenges of enrolling in longer term studies in the setting of rapidly evolving prevention and treatment standards priorities. The lessons learned will help the community, site investigators, and study coordinators in the design and implementation of future clinical trials.
49
Lalani, Tahaniyat, Jamie Fraser, Mark S. Riddle, Ramiro L. Gutierrez, Patrick W. Hickey, and David R. Tribble. "Deployment Infectious Disease Threats: IDCRP Initiatives and Vision Forward." Military Medicine 184, Supplement_2 (November 1, 2019): 26–34. http://dx.doi.org/10.1093/milmed/usz182.
Full textAbstract:
Abstract Background Infectious diseases pose a significant threat to health and readiness of military personnel deployed globally during wartime and peacekeeping activities. Surveillance and improvement in mitigation through research of infectious disease threats remain an integral part of Force Health Protection. Herein, we review research efforts of the Infectious Disease Clinical Research Program related to deployment and travel-related infections. Methods The objectives of the Deployment and Travel-Related Infections Research Area are to (1) provide epidemiologic and clinical data, including pathogen-specific estimates of disease incidence among deployed troops, (2) execute clinical trials and effectiveness studies to improve recommendations regarding prevention and treatment of infections during deployment, and (3) evaluate the knowledge and practice patterns of health care providers engaged in deployment/travel medicine and the impact on outcomes. The centerpiece protocol of the research area is the Deployment and Travel-Related Infectious Disease Risk Assessment, Outcomes, and Prevention Strategies cohort study (TravMil), which was initiated in 2010 and collects data on a broad range of deployment-related infections. Results To date, 4,154 deployed military personnel and traveling Department of Defense (DoD) beneficiaries have been enrolled in TravMil. Surveillance data collected through the TravMil study provide assessment of deployment and travel-related infectious disease threats, and the effectiveness of mitigation strategies. The incidence of travelers’ diarrhea, influenza-like illness, and undifferentiated febrile illness is 20.48%, 9.34%, and 6.16%, respectively. The cohort study also provides necessary infrastructure to execute clinical trials. The TrEAT TD clinical trial evaluated the effectiveness of single-dose antibiotic therapy for travelers’ diarrhea in the deployed setting. When compared to levofloxacin, azithromycin was not inferior; however, inferiority was not demonstrated with use of single dose of rifaximin. The trial findings supported the development of a deployment-related health guideline for the management of acute diarrheal disease. A clinical trial evaluating the effectiveness of rifaximin for prevention for travelers’ diarrhea (Prevent TD) is underway. Conclusions The research area has proven its ability to conduct impactful research, including the development of field-expedient diagnostics, the largest DoD multi-site travelers’ diarrhea randomized control trial in peacetime and combat settings, and informed Force Health Protection guidance. The research area continues to provide surveillance data to military commands via an established collaborative network of military treatment facilities, DoD laboratories (both within and outside the continental United States), foreign militaries, and academia. The conduct of clinical and translational research in a deployment setting presents significant challenges, most notably in recruitment/enrollment and compliance with study-related procedures during deployment.
50
Tadmor, Tamar, Andrei Braester, Najib Dally, Ariel Aviv, Yair Herishanu, Mona Yuklea, Lev Shvidel, et al. "A Novel Risk-Model to Predict Time to First Treatment (TTT) in Chronic Lymphocytic Leukemia Based on Heavy+Light Chain Immunoparesis and Serum Free Light Chain Analysis: Results from the Israeli CLL Study Group." Blood 132, Supplement 1 (November 29, 2018): 1849. http://dx.doi.org/10.1182/blood-2018-99-113771.
Full textAbstract:
Abstract Introduction: Chronic Lymphocytic Leukemia (CLL) is frequently accompanied by immune dysregulation. Hypogammaglobulinemia is one of the most important immune defects encountered, and all three classes of immunoglobulins (IgG, A and M) can be involved. Recently, novel heavy+light chain (HLC) immunoassays have become available that quantify the light chain types of each immunoglobulin class (e.g. IgGk and IgGl). These assays are measured in pairs and provide information on the isotype produced by a tumour (the "involved" HLC), the non-clonal ("uninvolved") HLC, and the ratio (e.g. IgGk/IgGl) - which indicates monoclonality. HLC assays have been shown to improve monitoring of plasma cell dyscrasias, but their role in CLL is yet to be studied. Methods This is a multi-center study performed in collaboration with the Israeli CLL Study Group and involved 10 medical centers. The cohort included 122 patients with CLL and 26 healthy controls. Baseline was defined as the time the blood sample was taken. Serum samples were analyzed for levels of IgG subclasses (IgG1, IgG2, IgG3, IgG4), heavy+light chains (HLC) (IgGκ, IgGλ, IgAκ, IgAλ, IgMκ or IgMλ) and free light chains (sFLC). HLC-pair suppression was defined as an abnormal HLC ratio and uninvolved HLC levels below the normal reference range (i.e. in g/L: IgGκ<3.84; IgGλ<1.91; IgAκ<0.57; IgAλ<0.44; IgMκ<0.19; IgMλ<0.12). HLC immunoparesis was defined as HLC isotype levels below the normal reference range, regardless of HLC ratio (i.e. HLC immunoparesis of at least 1 isotype indicates at least one of IgGκ, IgGλ, IgAκ, IgAλ, IgMκ or IgMλ below the normal reference range). Severe HLC-pair suppression or severe HLC immunoparesis was defined as a concentration of the uninvolved HLC or any HLC isotype that is suppressed by >50% below the normal reference range. The association of variables with time to first treatment (TTT) was performed with Cox proportional hazard model. Results Current analysis was performed on 105 CLL patients who had complete data available; median age was 68 years, 64% were males and Binet stage A, B, C, were 80%, 18.1% and 1.9% respectively. Median time from diagnosis to baseline measurements was 27 months (range 0-328 months). An abnormal sFLC ratio was identified in 70% (73/105) patients and summated k and λ concentrations (SFLC) were ≥70 mg/L in 18% of cases. An abnormal HLC ratio was present in 32% (34/105) patients, and 21% had HLC pair suppression of any 1 HLC isotype. HLC immunoparesis of 1, ≥2 and ≥3 isotypes was observed in 74 (70%), 58 (55%) and 36 (34%) of patients, respectively, with severe HLC immunoparesis identified in 40 patients (38%). Patients with IgG2 suppression were more frequently hospitalized due to infection with an Odds Ratio of 3.826 (p=0.031). In multivariate analysis, SFLC ≥70 mg/L and severe HLC immunoparesis were independently associated with TTT (HR 15.3, p<0.001; HR 80, p<0.001 respectively). Using these 2 variables, a risk-stratification model was constructed that separated CLL patients into 3 risk groups (with 0, 1 or 2 risk factors) with significantly different TTT (p<0.001, Figure 1). Patients with both risk factors (SFLC ≥70 mg/L and severe HLC immunoparesis) had the shortest TTT. Conclusions The findings presented here demonstrate that there is considerable potential for the use of HLC and FLC immunoassays to provide prognostic information in CLL. Figure 1. Figure 1. Disclosures Tadmor: PFIEZER: Consultancy; JNJ: Consultancy; ABBVIE: Consultancy; NOVARTIS: Consultancy; ROCHE: Research Funding. Aviv:ABBVIE: Consultancy; ROCHE: Research Funding. Herishanu:ROCHE: Research Funding; JNJ: Consultancy; ABBVIE: Consultancy. Shvidel:ROCHE: Consultancy, Research Funding; ABBVIE: Consultancy, Research Funding; JNJ: Consultancy. Rahimi-Levene:ABBVIE: Consultancy. Ruchlemer:ABBVIE: Consultancy; JNJ: Consultancy. Fogl:The Binding Site Group Ltd: Employment. Polliack:ROCHE: Research Funding; ABBVIE: Consultancy. Magal:The Binding Site: Employment. Townsend:The Binding Site Group Ltd: Employment.