Objectives: This article assesses best practices for producing 3D digital cranial models through structure-from-motion (SfM) photogrammetry, and whether the metric accuracy and overall presentation of photogrammetric models are comparable to physical crania. It is intended to present a user-friendly standard method of creating accurate digital skeletal models using Agisoft PhotoScan. Materials and methods:Approximately 200 photographs were taken of three different crania, and were separated into series consisting of 50, 75, 100, 150, and approximately 200 photos.Forty-five cranial models were created using different photo series and a variety of PhotoScan settings. These models were assessed based on defined qualitative criteria, and model measurement estimates were compared with physical skeletal measurements using Bland-Altman plots.Results: The majority of all models (37/45) produced measurement estimates with mean differences of 2 mm or less regardless of PhotoScan settings, and therefore demonstrated high levels of agreement with the physical measurements. Models created with 150 photographs and on "high" PhotoScan settings scored the highest in terms of qualitative appearance in the shortest amount of time.Discussion: In PhotoScan, it is recommended to create cranial models using 150 photographs and "high" settings; this produces digital cranial models that are comparable to physical crania in both appearance and proportion. SfM photogrammetry is a convenient, noninvasive, and rapid 3D modeling tool that can be used in almost any setting to produce digital models, and following the guidelines established here will ensure that these models are metrically accurate. K E Y W O R D S3D models, accuracy, anthropometry, measurement error, photogrammetry
Objectives: Identifying scurvy and rickets has important implications for understanding adaptations and variability among past communities, and bioarchaeologists now regularly evaluate these conditions. Due to the increased number of studies, cases with less clear-cut lesions and variable preservation are now frequently reported. Despite an improved understanding of the biological mechanisms for disease expression, there is a lack of consensus on the language used to express diagnostic certainty, limiting comparability. This article aims to address these issues and provide recommendations on more consistent diagnostic terminology using widely accepted diagnostic methodology based on biological mechanisms. Materials and Methods:We review diagnostic terms used in bioarchaeology by considering published cases of rickets, scurvy and co-occurrence alongside M.B.B.'s past project notes. We also consider differences in the diagnosis of rickets and scurvy in living and archeological individuals.Results: We provide recommendations on a framework that can be used to show diagnostic certainty in cases of rickets, scurvy, and co-occurrence. Core lesions of rickets and scurvy are used alongside a limited lexicon of diagnostic terminology based on the Istanbul protocol. Discussion: It is not the number of lesions that determines whether an individual is assigned to a particular diagnosis category, but rather the range and expression of lesions present. Avoiding a "tick-list" approach to core lesions of these diseases will be critical to ensure that identifying rickets and scurvy continues to contribute to understanding adaptations and variability among past communities. The framework allows more consistency in diagnostic certainty, facilitating greater comparability in research.
BackgroundAdaptations to implementation strategies are often necessary to support adoption and scale-up of evidence-based practices. Tracking adaptations to implementation strategies is critical for understanding any impacts on outcomes. However, these adaptations are infrequently collected. In this article we present a case study of how we used a new method during COVID-19 to systematically track and report adaptations to relational facilitation, a novel implementation strategy grounded in relational coordination theory. Relational facilitation aims to assess and improve communication and relationships in teams and is being implemented to support adoption of two Quadruple Aim Quality Enhancement Research Initiative (QA QUERI) initiatives: Care Coordination and Integrated Case Management (CC&ICM) and the Transitions Nurse Program for Home Health Care (TNP-HHC) in the Veterans Health Administration (VA).MethodsDuring 2021–2022, relational facilitation training, activities and support were designed as in-person and/or virtual sessions. These included a site group coaching session to create a social network map of care coordination roles and assessment of baseline relationships and communication between roles. Following this we administered the Relational Coordination Survey to assess the relational coordination strength within and between roles. COVID-19 caused challenges implementing relational facilitation, warranting adaptations. We tracked relational facilitation adaptations using a logic model, REDCap tracking tool based on the Framework for Reporting Adaptations and Modifications-Enhanced (FRAME) with expanded Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) dimensions, and member checking. Adaptations were analyzed descriptively and for themes using matrix content analysis.ResultsCOVID-19's impact within the VA caused barriers for implementing relational facilitation, warranting eight unique adaptations to the implementation strategy. Most adaptations pertained to changing the format of relational facilitation activities (n = 6; 75%), were based on external factors (n = 8; 100%), were planned (n = 8; 100%) and initiated by the QA QUERI implementation team (n = 8; 100%). Most adaptations impacted adoption (n = 6; 75%) and some impacted implementation (n = 2; 25%) of the CC&ICM and TNP-HHC interventions.DiscussionSystematically tracking and discussing adaptations to relational facilitation during the COVID-19 pandemic enhanced engagement and adoption of two VA care coordination interventions. The impact of these rapid, early course adaptations will be followed in subsequent years of CC&ICM and TNP-HHC implementation.
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