Background Few validated assessment tools are available to increase understanding and measure factors associated with sustainment of clinical practices, an increasingly recognized need among clinicians. We describe the development of the Clinical Sustainability Assessment Tool (CSAT), designed to assess factors that contribute to sustainable practices in clinical settings. Methods Sixty-four participants from clinical and research fields participated in concept mapping and were recruited to brainstorm factors that lead to sustained clinical practices. Once repeated factors were removed, participants sorted items based on similarity and rated them by importance and feasibility. Using concept mapping analyses, items were grouped into meaningful domains to develop an initial tool. We then recruited pilot sites and early adopters, for a total of 286 practicing clinicians, to pilot and evaluate the tool. Individuals were recruited from clinical settings across pediatric and adult medical and surgical subspecialties. The data were analyzed using confirmatory factor analysis (CFA) to test hypothesized subscale structure in the instrument. We used root mean square error of approximation (RMSEA) and the standardized root mean square residual (SRMR) to assess fit and thus the ability of CSAT to measure the identified domains. Results The concept mapping produced sorted statements that were edited into items that could be responded to, resulting in the creation of a tool with seven determinant domains and 47 items. The pilot and CFA testing resulted in a final CSAT instrument made up 35 items, five per domain. CFA results demonstrated very good fit of the seven domain structure of the CSAT (RMSEA = 0.049; SRMR = 0.049). Usability testing indicated the CSAT is brief, easy to use, easy to learn, and does not require extensive training. Additionally, the measure scored highly (18/20) on the Psychometric and Pragmatic Evidence Rating Scale (PAPERS). The seven final CSAT domains were engaged staff and leadership, engaged stakeholders, organizational readiness, workflow integration, implementation and training, monitoring and evaluation, and outcomes and effectiveness. Conclusions The CSAT is a new reliable assessment tool which allows for greater practical and scientific understanding of contextual factors that enable sustainable clinical practices over time.

In this prospective study, VMAT plans were chosen over IMRT 90% of the time. Compared to IMRT, VMAT plans used only one third of the MUs, had shorter treatment times, and similar sparing of OAR. Overall, VMAT provided similar dose homogeneity but less conformity in PTV irradiation compared to IMRT. This difference in conformity was not clinically significant.

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Prairie fens are globally vulnerable wetlands that are considered a conservation priority due to threats to their high biodiversity and hydrological functions. Establishing a thorough and repeatable plant sampling protocol is critical to evaluating conservation and management initiatives. Our goal was to evaluate a sample methodology designed to assess prairie fen plant diversity and determine if it produced results (1) representative of site diversity, (2) comparable among fens, and (3) efficient to collect. Nineteen fens between 8.5 and 28.4 ha were surveyed twice within one growing season during 2012 and 2013 field seasons using an area-proportional, random design. The turnover in species between spring and summer sampling periods within a site ranged from 8 to 50 %. Sample coverage of total estimated plant species richness ranged from 84.8 to 95.0 % with a mean of 90.1 %. We compared results from our areaproportional, random design to simulated random samples of 10, 15, 20, 25, 30, 35 and 40 quadrats per site. No significant difference was found in sample coverage per fen when using sampling rates of 25, 30, or 35 quadrats per site versus the area-proportional design. Shannon's diversity index and floristic quality index differed by sample period and number of quadrats sampled per fen. Our sample design produced acceptable levels of coverage and facilitated comparisons across fens. Our methodology could be applied to future research, restoration monitoring, and conservation planning efforts in Midwestern prairie fens.

PremiseHeterogeneity of biodiversity data from the collections, research, and management communities presents challenges for data findability, accessibility, interoperability, and reusability. Workflows designed with data collection, standards, dissemination, and reuse in mind will generate better information across geopolitical, administrative, and institutional boundaries. Here, we present our data workflow as a case study of how we collected, shared, and used data from multiple sources.MethodsIn 2012, we initiated the collection of biodiversity data relating to Michigan prairie fens, including data on plant communities and the federally endangered Poweshiek skipperling (Oarisma poweshiek).ResultsOver 23,000 occurrence records were compiled in a database following Darwin Core standards. The records were linked with media and biological, chemical, and geometric measurements. We published the data as Global Biodiversity Information Facility data sets and in Symbiota SEINet portals.DiscussionWe highlight data collection techniques that optimized transcription time, including the use of predetermined and controlled vocabulary, Darwin Core terms, and data dictionaries. The validity and longevity of our data were supported by voucher specimens, metadata with measurement records, and published manuscripts detailing methods and data sets. Key to our data dissemination was cooperation among partners and the utilization of dynamic tools. To increase data interoperability, we need flexible and customizable data collection templates, coding, and enhanced communication among communities using biodiversity data.

Background Few validated assessment tools are available to support sustainable implementation, an increasingly recognized need among clinicians. We describe the development of the Clinical Sustainability Assessment Tool, or CSAT, designed to assess factors that contribute to sustainable practices in clinical settings. Methods Fifty participants from clinical and research fields were recruited to brainstorm factors that lead to sustained clinical practices. Once repeated factors were removed, participants sorted remaining factors based on similarity. Using concept mapping analyses, we grouped these factors into meaningful domains and developed an initial tool. We then recruited 126 practicing clinicians to pilot and evaluate the tool. Individuals were recruited from clinical settings across pediatric (53%) and adult (47%) medical and surgical subspecialties, and averaged 11 years in their position. The data were analyzed using confirmatory factor analysis (CFA) to test hypothesized subscale structure in the instrument. We used root mean square error of approximation (RMSEA) and the standardized root mean square residual (SRMR) to assess fit and thus the ability of CSAT to measure the identified domains.Results The concept mapping resulted in seven domains and 47 items. The pilot and CFA resulted in 35 items, five per domain. The RMSEA of 0.084 and the SRMR of 0.075 indicated good fit. The final domains were: engaged staff and leadership, engaged stakeholders, organizational readiness, workflow integration, implementation and training, monitoring and evaluation, and outcomes and effectiveness. Conclusions The CSAT is a new reliable assessment tool which allows for greater practical and scientific understanding of contextual factors that enable sustainable clinical practices over time. The full CSAT instrument is available at https://sustaintool.org.

Introduction The process of treatment delivery involves a series of steps from patient evaluation, therapeutic simulation (simulation), followed by dosimetric treatment planning, pre-treatment quality assurance and plan verification, and ultimately treatment delivery. Each step has a strict precedence relationship, requiring the preceding task to be completed prior to the initiation of the next task. The minimum time for a patient to undergo treatment is based on the summation of times of the individual tasks. Nevertheless, patients are often scheduled based on factors that do not directly consider the overall time required to complete these steps. Materials and methods To better help in scheduling patients and to ensure quality and safety of treatment planning and delivery, we undertook a quality initiative based on team members tabulating time required to complete tasks required for treatment delivery. We established “fastest possible” turnaround times based how quickly a task could be accomplished if there were minimal or no competing obligations, as well as processing times under routine operating conditions. Results For urgent situations, we found that our center can accommodate treatment within 24 h. For routine plans using 3D conformal radiation, an approximately 1-week turnaround time is needed. For patients being treated with IMRT/VMAT an approximately 2-week turnaround time is needed. Conclusions The growing complexity of radiotherapy delivery also requires additional steps which has increased turnaround times from simulation to treatment compared to historical standards. We report our estimates for turnaround time based on plan type and acuity level. While our turnaround times may not be applicable to all centers, we believe that this exercise was helpful to facilitate inter- and intra- departmental communication regarding reasonable start times for patients.