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Background: To explore the design, delivery models and identify good and innovative practices in Memory Assessment Services (MAS) in England and Wales. Methods: A two-stage service evaluation comprising (1) on-line survey of MAS providers to identify features of the commissioning models, service design, delivery, and challenges alongside examples of good/innovative practice; (2) qualitative case studies using video/telephone interviews with key staff and people who had used the service. Results: The 49 respondents to the survey reported a shift in delivery of MAS post COVID and identified key areas for improvement, including a need for specialist staff, support for MCI and rarer dementias, and capacity for post diagnostic support. The 15 case studies illustrated good practice and innovation focusing on post diagnostic support, equity of access, working with external services/service location, MCI and rarer dementia and involving specialist staff. Conclusions: The evaluation speaks to the importance of (re)evaluation of services to identify local need and the importance of commissioning based on local need and innovative approaches that my sit outside of 'typical' MAS pathways. [ABSTRACT FROM AUTHOR]

In this study, we aimed to conduct a survey on the current clinical practice of, staffing for, commissioning of, and staff training for online adaptive radiotherapy (oART) in the institutions that installed commercial oART systems in Japan, and to share the information with institutions that will implement oART systems in future. A web-based questionnaire, containing 107 questions, was distributed to nine institutions in Japan. Data were collected from November to December 2023. Three institutions each with the MRIdian (ViewRay, Oakwood Village, OH, USA), Unity (Elekta AB, Stockholm, Sweden), and Ethos (Varian Medical Systems, Palo Alto, CA, USA) systems completed the questionnaire. One institution (MRIdian) had not performed oART by the response deadline. Each institution had installed only one oART system. Hypofractionation, and moderate hypofractionation or conventional fractionation were employed in the MRIdian/Unity and Ethos systems, respectively. The elapsed time for the oART process was faster with the Ethos than with the other systems. All institutions added additional staff for oART. Commissioning periods differed among the oART systems owing to provision of beam data from the vendors. Chambers used during commissioning measurements differed among the institutions. Institutional training was provided by all nine institutions. To the best of our knowledge, this was the first survey about oART performed using commercial systems in Japan. We believe that this study will provide useful information to institutions that installed, are installing, or are planning to install oART systems. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to validate the use of a model‐based dose calculation algorithm (MBDCA), Acuros BV, for high dose rate brachytherapy treatment planning for a community‐based hospital with a Bravos afterloader. Based on published AAPM recommendations, this work details a practical approach for community‐based clinics to complete initial validation of Acuros BV, in order to add a MBDCA to a TG‐43 based brachytherapy treatment planning program. Methods: Source dimensions and materials used in Acuros BV and TG‐43 source models were compared to the physical source. TG‐186 testing was completed with standardized test cases externally calculated with Monte Carlo compared to locally calculated with Acuros BV. Point doses calculated using TG‐43 were compared to those calculated with Acuros BV in water at various dose grid settings. Secondary dose check software was used to evaluate dose distributions resembling clinical patient plans, both in water and on CT datasets representative of patient anatomy. Results: The major source of discrepancy of source models was the length of modeled steel cable. TG‐186 testing showed that the largest differences between Monte Carlo and Acuros BV dose distributions were located along the source axis for cases calculated in water, as well as located in regions of high dose gradients and within the applicator for the case calculated with a generic shielded applicator. An audit of point doses calculated with both TG‐43 and Acuros BV in water found that dose grid settings significantly affected agreement. Secondary dose check software indicated that Acuros BV functioned satisfactorily, and a 5% threshold was adopted for secondary dose checks on gynecologic plans. Conclusion: This validation process indicated that Acuros BV met expected standards and affirmed its suitability for integration into this clinical practice's brachytherapy treatment planning. [ABSTRACT FROM AUTHOR]

Abstract Background To explore the design, delivery models and identify good and innovative practices in Memory Assessment Services (MAS) in England and Wales. Methods A two-stage service evaluation comprising (1) on-line survey of MAS providers to identify features of the commissioning models, service design, delivery, and challenges alongside examples of good/innovative practice; (2) qualitative case studies using video/telephone interviews with key staff and people who had used the service. Results The 49 respondents to the survey reported a shift in delivery of MAS post COVID and identified key areas for improvement, including a need for specialist staff, support for MCI and rarer dementias, and capacity for post diagnostic support. The 15 case studies illustrated good practice and innovation focusing on post diagnostic support, equity of access, working with external services/service location, MCI and rarer dementia and involving specialist staff. Conclusions The evaluation speaks to the importance of (re)evaluation of services to identify local need and the importance of commissioning based on local need and innovative approaches that my sit outside of ‘typical’ MAS pathways.

Purpose: To show the workflow for the commissioning of a MRlinac, and some proposed tests; off-axis targets, output factors for small fields, dose in inhomogeneities, and multileaf collimator quality assurance (MLC QA). Methods: The tests were performed based on TG-142, TG-119, ICRU 97, TRS-398, and TRS-483 recommendations as well as national regulations for radiation protection and safety. Results: The imaging tests are in agreement with the protocols. The radiation isocenter was 0.34 mm, and for off-axis targets location was up to 0.88 mm. The dose profiles measured and calculated in treatment planning system (TPS) passed in all cases the gamma analysis of 2%/2 mm (global dose differences). The output factors of fields larger than 2 cm × 2 cm are in agreement with the model of the MRlinac in the TPS. However, for smaller fields, their differences are higher than 10%. Picket fence test for different gantry angles showed a maximum leaf deviation up to 0.2 mm. Displacements observed in treatment couch adding weight (50 kg) are lower than 1 mm. Cryostat, bridge, and couch attenuation was up to 1.2%, 10%, and 24%, respectively. Conclusion: The implemented tests confirm that the studied MRlinac agrees with the standards reported in the literature and that the strict tolerances established as a baseline should allow a smoother implementation of stereotactic treatments in this machine.

Aim: To commission and validate commercial deformable image registration (DIR) systems (SmartAdapt® and Velocity™) using task group 132 (TG-132) digital phantom datasets. Additionally, the study compares and verifies the DIR algorithms of the two systems. Materials and Methods: TG-132 digital phantoms were obtained from the American Association of Physicists in Medicine website and imported into SmartAdapt® and Velocity™ systems for commissioning and validation. The registration results were compared with known shifts using rigid registrations and deformable registrations. Virtual head and neck phantoms obtained online (DIR Evaluation Project) and some selected clinical data sets from the department were imported into the two DIR systems. For both of these datasets, DIR was carried out between the source and target images, and the contours were then propagated from the source to the target image data set. The dice similarity coefficient (DSC), mean distance to agreement (MDA), and Jacobian determinant measures were utilised to evaluate the registration results. Results: The recommended criteria for commissioning and validation of DIR system from TG-132 was error

The improvement of efficiency in new and existing buildings is one of the key aspects in achieving the climate change targets promoted by international regulatory and technical bodies, and among the measures that deserve renewed attention is the balancing of hydronic systems. However, the balancing procedures currently applied have not been updated for decades and are still largely unimplemented, as they are mainly based on cumbersome and iterative procedures. This paper deals with the proposal and advanced adaptation of a non-iterative balancing method previously developed for air systems, known as the progressive flow method (PFM). The application to water systems of the PFM's concepts includes some aspects of an existing empirical method called the compensated method (CM) and overcomes its main limitations; moreover, the original PFM has been radically rethought in its implementation aspects, taking advantage of the tightness of water distribution systems, minimising instrumentation and the number of measurement operations, to definitively overcome the iterative nature of the currently applied methods. Experimental validation was carried out. Compared with a standard method, the enhanced PFM reduced the number of measurements by 48% and the number of balancing operations by 41%, achieving final flow rates within tolerances and the same configuration of balancing devices. [ABSTRACT FROM AUTHOR]

Introduction: This exploratory literature review seeks to examine the literature around commissioning processes in the co‐production of health and care services, focusing on two questions: How do health and care commissioning processes facilitate and/or pose barriers to co‐production in service design and delivery? What are the contextual factors that influence these processes? Method: A systematic search of three databases (Medline, Public Health and Social Policy and Practice) and a search platform (Web of Science) was conducted for the period 2008–2023. A total of 2675 records were retrieved. After deduplication, 1925 were screened at title and abstract level. Forty‐seven reports from 42 United Kingdom and Ireland studies were included in the review. A thematic synthesis of included studies was conducted in relation to the research questions. Results: The review identified one overarching theme across the synthesised literature: the complexity of the commissioning landscape. Three interconnected subthemes illuminate the contextual factors that influence this landscape: commissioners as leaders of co‐production; navigating relationships and the collective voice. Conclusion: Commissioning processes were commonly a barrier to the co‐production of health and care services. Though co‐production was an aspiration for many commissioners, the political and economic environment and service pressures meant that it was often not fully realised. More flexible funding models, longer‐term pilot projects, an increased emphasis in social value across the health and care system and building capacity for strong leadership in commissioning is needed. Patient and Public Contribution: Patients and the public did not contribute to this review as it was a small piece of work following on from a completed project, with no budget for public involvement. [ABSTRACT FROM AUTHOR]

The specialist voluntary sector plays a crucial role in supporting survivors of sexual violence. However, in England, short-term funding underpins the sector's financial stability. This article examines sector leaders' ways of coping, resisting and being affected by funding practices. Using the concept of edgework, we show how funding and commissioning dynamics push individuals to the edge of service sustainability, job satisfaction, and emotional well-being. We examine how these edges are "worked," for example, by circumventing and remolding the edge. We offer an original way to theorize participants, make visible the emotional toll of service precarity and offer suggestions for support. [ABSTRACT FROM AUTHOR]

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Global streaming services' investment strategies in Europe have shifted the production landscape for scripted fiction. This article examines the commissioning patterns for scripted serial TV fiction through a comparative analysis of three small European markets: Flanders, Ireland and Norway. The analysis assesses the differences and similarities in the volumes of scripted fiction and how they evolved, focusing on the position of SVoD commissions in the total volumes based on a dataset of 411 unique titles and 609 title seasons of serial scripted fiction released between 2016 and 2023. It reveals that different economic and cultural contexts modulate global streamers' investments in local content, which in turn are an essential facet of global streamers' localization strategies in Europe. Our findings contribute to a more nuanced understanding of SVoD localization strategies within European markets, contextualizing the variations in investment and production patterns. [ABSTRACT FROM AUTHOR]

Purpose: A novel pulse normalization technology enabling the acquisition of low noise beam data without the use of a physical reference chamber has recently been commercially released. The purpose of this study was to characterize the use of this technology for beam scanning of small fields required in the commissioning of a stereotactic radiotherapy program. Methods: Three detectors (Edge diode, microDiamond, PinPoint) were used to acquire beam data under three conditions: with a reference chamber, with pulse normalization and no reference chamber (PN), and without pulse normalization and no reference chamber (nPN). Percent depth dose (PDD) scans were acquired for 0.5, 1.0, 2.0, and 3.0 cm2 field sizes and profiles were acquired at 1.4, 10, and 30 cm depths using continuous scanning. The coefficient of variation (CoV) was calculated for all beam data to compare signal‐to‐noise and gamma comparisons (1%, 1 mm) were calculated of the PN and nPN scans compared to the reference data. Results: Average 95th percentile CoV values were similar for all detectors across conditions, with PN data being comparable to reference data and minor increases observed for nPN data. Mean gamma pass rates for PN PDD scans exceeded 98% for all detectors. Profile gamma pass rates were 100% for all detectors at 1.4 and 10 cm depth. At 30 cm depth, profiles acquired with the PinPoint and microDiamond detectors had lower mean gamma pass rates than the Edge, at 95% and 95.7%, respectively. Conclusions: A novel pulse normalization technology was demonstrated to be effective for acquiring beam profiles and PDDs for small fields without the use of a physical reference chamber. Limitations in how the method is implemented led to some errors in data acquired using lower sensitivity detectors. When used with a diode, pulse normalization produced equivalent scans to those acquired with a reference chamber. [ABSTRACT FROM AUTHOR]

This article suggests why a different approach may be required for commissioning services from third sector providers than from, say, corporate or public providers. English systems for commissioning third sector providers contain both commodified elements (for example formal procurement, provider competition, commissioner–provider separation) and collaborative, relational elements (for example long-term collaboration, reliance on inter-organizational networks). When the two elements conflicted, commissioners and third sector organizations tended to try to work around the commodified elements in order to preserve and develop the collaborative aspects, which suggests that, in practice, they find de-commodified, collaborative methods better adapted to the commissioning of third sector organizations. When publicly-funded services are outsourced, governments still use multiple governance structures to retain some control over the services provided. Using realist methods the authors systematically compared this aspect of community health activities provided by third sector organizations in six English localities during 2020–2022. Two modes of commissioning coexisted. Commodified commissioning largely embodied Washington consensus models of formal, competitive procurement. A contrasting, collaborative mode of commissioning relied more upon relational, long-term co-operation and networking among organizations. When the two modes conflicted, commissioners often favoured the collaborative mode and sought to adjust their commissioning to make it less commodified. [ABSTRACT FROM AUTHOR]

Purpose: Experimental patient‐specific QA (PSQA) is a time and resource‐intensive process, with a poor sensitivity in detecting errors. Radiation therapy facilities aim to substitute it by means of independent dose calculation (IDC) in combination with a comprehensive beam delivery QA program. This paper reports on the commissioning of the IDC software tool myQA iON (IBA Dosimetry) for proton therapy and its clinical implementation at the MedAustron Ion Therapy Center. Methods: The IDC commissioning work included the validation of the beam model, the implementation and validation of clinical CT protocols, and the evaluation of patient treatment data. Dose difference maps, gamma index distributions, and pass rates (GPR) have been reviewed. The performance of the IDC tool has been assessed and clinical workflows, simulation settings, and GPR tolerances have been defined. Results: Beam model validation showed agreement of ranges within ± 0.2 mm, Bragg‐Peak widths within ± 0.1 mm, and spot sizes at various air gaps within ± 5% compared to physical measurements. Simulated dose in 2D reference fields deviated by ‐0.3% ± 0.5%, while 3D dose distributions differed by 1.8% on average to measurements. Validation of the CT calibration resulted in systematic differences of 2.0% between IDC and experimental data for tissue like samples. GPRs of 99.4 ± 0.6% were found for head, head and neck, and pediatric CT protocols on a 2%/2 mm gamma criterion. GPRs for the adult abdomen protocol were at 98.9% on average with 3%/3 mm. Root causes of GPR outliers, for example, implants were identified and evaluated. Conclusion: IDC has been successfully commissioned and integrated into the MedAustron clinical workflow for protons in 2021. IDC has been stepwise and safely substituting experimental PSQA since February 2021. The initial reduction of proton experimental PSQA was about 25% and reached up to 90% after 1 year. [ABSTRACT FROM AUTHOR]

Multiple tools are available for commissioning and quality assurance of deformable image registration (DIR), each with their own advantages and disadvantages in the context of radiotherapy. The selection of appropriate tools should depend on the DIR application with its corresponding available input, desired output, and time requirement. Discussions were hosted by the ESTRO Physics Workshop 2021 on Commissioning and Quality Assurance for DIR in Radiotherapy. A consensus was reached on what requirements are needed for commissioning and quality assurance for different applications, and what combination of tools is associated with this.For commissioning, we recommend the target registration error of manually annotated anatomical landmarks or the distance-to-agreement of manually delineated contours to evaluate alignment. These should be supplemented by the distance to discordance and/or biomechanical criteria to evaluate consistency and plausibility. Digital phantoms can be useful to evaluate DIR for dose accumulation but are currently only available for a limited range of anatomies, image modalities and types of deformations.For quality assurance of DIR for contour propagation, we recommend at least a visual inspection of the registered image and contour. For quality assurance of DIR for warping quantitative information such as dose, Hounsfield units or positron emission tomography-data, we recommend visual inspection of the registered image together with image similarity to evaluate alignment, supplemented by an inspection of the Jacobian determinant or bending energy to evaluate plausibility, and by the dose (gradient) to evaluate relevance. We acknowledge that some of these metrics are still missing in currently available commercial solutions.

In recent years, great efforts have been made to reach a consensus on heliostat testing best practices. A specific SolarPACES task was launched to provide a Heliostat Testing Guidelines document for single heliostat evaluation with a focus on prototype validation and qualification. Such guidelines are not well-suited for heliostat evaluation in operating commercial heliostat fields. The commercial implementation of the Central Receiver technology is burdened by the lack of a demonstrated cost-effective methodology to test solar fields, particularly during the commissioning and operation phases of the plant. To address heliostat characterization challenges, the SolarPACES funded Project “Analyze Heliostat Field” aims to set the basis towards a SolarPACES guideline for Heliostat Field Performance testing under a common framework. This is by means of a review of the existing methodologies, R&D and industrial stakeholders information sharing and preparation of a future quantitative comparison and validation plan. As part of the development of this project, several meetings and a workshop involving the SolarPACES community was organized to share knowledge and experience in the measurement and characterization of heliostat fields using a range of technologies and procedures. Research centers and companies from 5 different and distant countries have actively participated in these meetings, sharing their experiences, needs and interests. This paper summarizes the outcome of this international collaborative effort and the prospects for future close collaborations sustained over time.

Abstract Background Social and Therapeutic Horticulture (STH) is a process where trained practitioners work with plants and people to improve an individual’s physical and psychological health, communication and thinking skills. Evidence suggests that STH can support individuals with mental ill-health, however, current commissioning of STH within mental health care is limited. This study aimed to understand the barriers to commissioning STH in mental health care and to identify potential solutions to barriers, to support more widespread availability of services. Methods Individuals with a role in mental health care commissioning from across the UK were invited to take part in semi-structured interviews via zoom. Interviews explored factors influencing the mental health services they commission or refer to, their perception of the role of STH in mental health care and the barriers to commissioning STH, together with potential solutions to any barriers identified. Results Commissioners identified a lack of knowledge of STH and evidence of its effectiveness, and a culture which prioritises traditional medical models, as barriers to commissioning. Challenges for STH providers in responding to large-scale commissioning requirements were also highlighted as a barrier. Conclusions To upscale commissioning of STH in mental health care, STH interventions need to be embedded within NHS priorities and information on STH services and their effectiveness needs to be easily accessible to practitioners. The sector should also be supported in working collaboratively to enable commissioning of services at scale.

Abstract Background Despite several interventions demonstrating benefit to people living with dementia and their caregivers, few have been translated and implemented in routine clinical practice. There is limited evidence of the barriers and facilitators for commissioning and implementing health and social care interventions for people living with dementia. The aim of the current study was to explore the barriers and facilitators to commissioning and implementing health and social care interventions for people with dementia, using a dementia friendly exercise and physical activity-based intervention (PrAISED [Promoting Activity, Stability and Independence in Early Dementia and Mild Cognitive Impairment]) as a case study. Methods Qualitative semi-structured interviews were conducted with stakeholders from a range of backgrounds including individuals from health and social care, local government, the voluntary and community sector, universities, and research centres in England. The Consolidated Framework for Intervention Research (CFIR) was used to guide the design and analysis. Results Fourteen participants took part, including commissioning managers, service managers, partnership managers, charity representatives, commercial research specialists, academics/researchers, and healthcare professionals. Data were represented in 33 constructs across the five CFIR domains. Participants identified a need for greater support for people diagnosed with dementia and their caregivers immediately post dementia diagnosis. Key barriers included cost/financing, the culture of commissioning, and available resources. Key facilitators included the adaptability of the intervention, cosmopolitanism/partnerships and connections, external policy and incentives, and the use of already existing (and untapped) workforces. Conclusion Several barriers and facilitators for commissioning and implementing health and social care interventions for people with dementia were identified which need to be addressed. Recommended actions to facilitate the commissioning and implementation of dementia friendly services are: 1) map out local needs, 2) evidence the intervention including effectiveness and cost-effectiveness, 3) create/utilise networks with stakeholders, and 4) plan required resources.

Based on the technical renovation project of boiler make-up water system in a power plant in North China，the design characteristics and operation mode of ultrafiltration-first stage reverse osmosis-second stage reverse osmosis-electrodeionization（EDI） integrated membrane technology were introduced. The typical problems in different commissioning conditions of each main processing unit were analyzed，such as start-stop，normal operation，backwash，chemical cleaning，dosing and maintenance washing. The corresponding solutions and precautions were given from the aspects of pipeline design，control strategy and commissioning parameters. The long-term operation results after commissioning showed that the whole process system operated stably，the water index was qualified，and the conductivity was less than 0.1 μS/cm，silicon mass concentration was less than 10 μg/L，TOC was less than 200 μg/L. The economic benefits analysis showed that the new boiler feedwater system reduced the environmental pressure on the power plant， saved water intake costs，and the operating cost per ton of water was about 4.3 yuan. The operation and maintenance cost was relatively low，which could improve the quality and efficiency of the chemical water production system in the power plant.

Abstract Purpose To assess a large panel of MR compatible detectors on the full range of measurements required for a 0.35 T MR-linac commissioning by using a specific statistical method represented as a continuum of comparison with the Monte Carlo (MC) TPS calculations. This study also describes the commissioning tests and the secondary MC dose calculation validation. Material and methods Plans were created on the Viewray TPS to generate MC reference data. Absolute dose points, PDD, profiles and output factors were extracted and compared to measurements performed with ten different detectors: PTW 31010, 31021, 31022, Markus 34045 and Exradin A28 MR ionization chambers, SN Edge shielded diode, PTW 60019 microdiamond, PTW 60023 unshielded diode, EBT3 radiochromic films and LiF µcubes. Three commissioning steps consisted in comparison between calculated and measured dose: the beam model validation, the output calibration verification in four different phantoms and the commissioning tests recommended by the IAEA-TECDOC-1583. Main results The symmetry for the high resolution detectors was higher than the TPS data of about 1%. The angular responses of the PTW 60023 and the SN Edge were − 6.6 and − 11.9% compared to the PTW 31010 at 60°. The X/Y-left and the Y-right penumbras measured by the high resolution detectors were in good agreement with the TPS values except for the PTW 60023 for large field sizes. For the 0.84 × 0.83 cm2 field size, the mean deviation to the TPS of the uncorrected OF was − 1.7 ± 1.6% against − 4.0 ± 0.6% for the corrected OF whereas we found − 4.8 ± 0.8% for passive dosimeters. The mean absolute dose deviations to the TPS in different phantoms were 0 ± 0.4%, − 1.2 ± 0.6% and 0.5 ± 1.1% for the PTW 31010, PTW 31021 and Exradin A28 MR respectively. Conclusions The magnetic field effects on the measurements are considerably reduced at low magnetic field. The PTW 31010 ionization chamber can be used with confidence in different phantoms for commissioning and QA tests requiring absolute dose verifications. For relative measurements, the PTW 60019 presented the best agreement for the full range of field size. For the profile assessment, shielded diodes had a behaviour similar to the PTW 60019 and 60023 while the ionization chambers were the most suitable detectors for the symmetry. The output correction factors published by the IAEA TRS 483 seem to be applicable at low magnetic field pending the publication of new MR specific values.

[Objective] In the inaugural switching operation between Pipelines Q1 and Q2, which were originally used for heated and normaltemperature transmission of crude oil respectively in China, the approach of “transformation while operation” was employed, posing challenges such as complex process flows, demanding engineering implementation, and engagement of numerous offload and injection users. [Methods] To ensure a rational transformation and switching mode with minimal impact on normal production and operation, a comprehensive study was conducted on the hydraulic and thermal systems of these transmission pipelines. This study aimed to evaluate various factors influencing preheating and temperature dropping during commissioning, as well as the pros and cons of different switching modes. Simulation accuracy was checked for the preheating process after transforming Pipeline Q2, originally designed for normaltemperature transmission, into a heated transmission system. These simulation results were then verified with actual engineering data to ensure alignment with the practical requirements. Additionally, valuable field experience was gained from the transformation of Pipeline Q1, originally intended for heated transmission, into a normal-temperature transmission system. Based on these study findings, reasonable suggestions and recommendations were presented for key nodes in switching operations. [Results] The selection of the preheating method should be based on site-specific conditions when transforming in-service normal-temperature oil transmission pipelines into heated transmission systems. For instance, Pipeline Q2 should be treated by heating Russian oil to be transmitted in advance combined with preheating the pipeline with high-temperature Russian oil, aligning the commissioning process with the transmission requirements of Daqing oil.Likewise,appropriate measures should be taken to gradually reduce the temperature of oil products between stations during the transition from the heated to normal-temperature mode.This can be achieved through the quantitative transmission of oil products with a gradually decreasing temperature by batch.To facilitate this,heating stations along the route can be utilized to ensure a gradual temperature drop of the oil products between stations. [Conclusion] The study findings offer valuable insights for commissioning under switching operations of inservice crude oil pipelines.

This invited article presents a brief account of recent key Welsh government mental health strategy in relation to the development of the psychological workforce. We will allude to historical major challenges that have existed that include the relatively low numbers of psychological practitioners being trained and limited access to therapies such as CBT. Much of the article will discuss positive recent developments that have assisted the implementation of mental health workforce plans. These include planned expansion in clinical psychology numbers, the development of a new country wide Adult Lifespan Clinical Associate in Applied Psychology (CAAPs) MSc, and expansion in the pathways available for health board staff to gain specific therapy competencies (particularly in relation to cognitive behavioural therapy). There will be some discussion of the continuing challenges, and the article will conclude with a call for further collaboration between stakeholders to ensure that our common goal of improving psychological services for people living in Wales is realised. [ABSTRACT FROM AUTHOR]

Value based healthcare beyond the clinical domain is the focus of this case study. We share NSW Health's experiences in achieving value through a focus on outcomes in non-clinical and clinical support services using examples that demonstrate key aspects across the commissioning cycle. These include: the importance of stakeholder engagement in the planning phase to later success; the critical role of non-clinical services in patient experience; the opportunity to facilitate value by introducing new approaches in business areas such as procurement; and the role of clinical supports such as digital enablement to facilitate outcome-focussed clinical models. Applying a value lens to non-clinical services can increase the potential benefits to patients, clinicians and the system. What is known about the topic? Value based healthcare is a way of making transparent and equitable decisions about resource allocation to deliver better outcomes for individuals, health services and the system. What does this paper add? This paper reflects on the opportunity to deliver value based healthcare beyond clinical models of care, including in non-clinical and clinical support services, using a commissioning approach. What are the implications for practitioners? The learnings shared through the case studies presented can be applied by practitioners to their own projects to support value based approaches across all aspects of health care. This article belongs to the Special Issue: Value-based Healthcare. [ABSTRACT FROM AUTHOR]

Aim: To commission and validate commercial deformable image registration (DIR) systems (SmartAdapt® and Velocity™) using task group 132 (TG-132) digital phantom datasets. Additionally, the study compares and verifies the DIR algorithms of the two systems. Materials and Methods: TG-132 digital phantoms were obtained from the American Association of Physicists in Medicine website and imported into SmartAdapt® and Velocity™ systems for commissioning and validation. The registration results were compared with known shifts using rigid registrations and deformable registrations. Virtual head and neck phantoms obtained online (DIR Evaluation Project) and some selected clinical data sets from the department were imported into the two DIR systems. For both of these datasets, DIR was carried out between the source and target images, and the contours were then propagated from the source to the target image data set. The dice similarity coefficient (DSC), mean distance to agreement (MDA), and Jacobian determinant measures were utilised to evaluate the registration results. Results: The recommended criteria for commissioning and validation of DIR system from TG-132 was error <0.5*voxel dimension (vd). Translation only registration: Both systems met TG-132 recommendations except computed tomography (CT)-positron emission tomography registration in both systems (Velocity ~1.1*vd, SmartAdapt ~1.6*vd). Translational and rotational registration: Both systems failed the criteria for all modalities (For velocity, error ranged from 0.6*vd [CT-CT registration] to 3.4*vd [CT-cone-beam CT (CBCT) registration]. For SmartAdapt® the range was 0.6*vd [CT-CBCT] to 3.6*vd [CT-CT]). Mean ± standard deviation for DSC, MDA and Jacobian metrics were used to compare the DIR results between SmartAdapt® and Velocity™. Conclusion: The DIR algorithms of SmartAdapt® and Velocity™ were commissioned and their deformation results were compared. Both systems can be used for clinical purpose. While there were only minimal differences between the two systems, Velocity™ provided lower values for parotids, bladder, rectum, and prostate (soft tissue) compared to SmartAdapt. However, for mandible, spinal cord, and femoral heads (rigid structures), both systems showed nearly identical results. [ABSTRACT FROM AUTHOR]

Purpose: To show the workflow for the commissioning of a MRlinac, and some proposed tests; off-axis targets, output factors for small fields, dose in inhomogeneities, and multileaf collimator quality assurance (MLC QA). Methods: The tests were performed based on TG-142, TG-119, ICRU 97, TRS-398, and TRS-483 recommendations as well as national regulations for radiation protection and safety. Results: The imaging tests are in agreement with the protocols. The radiation isocenter was 0.34 mm, and for off-axis targets location was up to 0.88 mm. The dose profiles measured and calculated in treatment planning system (TPS) passed in all cases the gamma analysis of 2%/2 mm (global dose differences). The output factors of fields larger than 2 cm × 2 cm are in agreement with the model of the MRlinac in the TPS. However, for smaller fields, their differences are higher than 10%. Picket fence test for different gantry angles showed a maximum leaf deviation up to 0.2 mm. Displacements observed in treatment couch adding weight (50 kg) are lower than 1 mm. Cryostat, bridge, and couch attenuation was up to 1.2%, 10%, and 24%, respectively. Conclusion: The implemented tests confirm that the studied MRlinac agrees with the standards reported in the literature and that the strict tolerances established as a baseline should allow a smoother implementation of stereotactic treatments in this machine. [ABSTRACT FROM AUTHOR]

Purpose: To assess a large panel of MR compatible detectors on the full range of measurements required for a 0.35 T MR-linac commissioning by using a specific statistical method represented as a continuum of comparison with the Monte Carlo (MC) TPS calculations. This study also describes the commissioning tests and the secondary MC dose calculation validation. Material and methods: Plans were created on the Viewray TPS to generate MC reference data. Absolute dose points, PDD, profiles and output factors were extracted and compared to measurements performed with ten different detectors: PTW 31010, 31021, 31022, Markus 34045 and Exradin A28 MR ionization chambers, SN Edge shielded diode, PTW 60019 microdiamond, PTW 60023 unshielded diode, EBT3 radiochromic films and LiF µcubes. Three commissioning steps consisted in comparison between calculated and measured dose: the beam model validation, the output calibration verification in four different phantoms and the commissioning tests recommended by the IAEA-TECDOC-1583. Main results: The symmetry for the high resolution detectors was higher than the TPS data of about 1%. The angular responses of the PTW 60023 and the SN Edge were − 6.6 and − 11.9% compared to the PTW 31010 at 60°. The X/Y-left and the Y-right penumbras measured by the high resolution detectors were in good agreement with the TPS values except for the PTW 60023 for large field sizes. For the 0.84 × 0.83 cm2 field size, the mean deviation to the TPS of the uncorrected OF was − 1.7 ± 1.6% against − 4.0 ± 0.6% for the corrected OF whereas we found − 4.8 ± 0.8% for passive dosimeters. The mean absolute dose deviations to the TPS in different phantoms were 0 ± 0.4%, − 1.2 ± 0.6% and 0.5 ± 1.1% for the PTW 31010, PTW 31021 and Exradin A28 MR respectively. Conclusions: The magnetic field effects on the measurements are considerably reduced at low magnetic field. The PTW 31010 ionization chamber can be used with confidence in different phantoms for commissioning and QA tests requiring absolute dose verifications. For relative measurements, the PTW 60019 presented the best agreement for the full range of field size. For the profile assessment, shielded diodes had a behaviour similar to the PTW 60019 and 60023 while the ionization chambers were the most suitable detectors for the symmetry. The output correction factors published by the IAEA TRS 483 seem to be applicable at low magnetic field pending the publication of new MR specific values. [ABSTRACT FROM AUTHOR]

Background: Weight management services have not always benefitted everyone equally. People who live in more deprived areas, racially minoritised communities, those with complex additional needs (e.g., a physical or mental disability), and men are less likely to take part in weight management services. This can subsequently widen health inequalities. One way to counter this is to co-design services with under-served groups to better meet their needs. Using a case study approach, we explored how co-designed adult weight management services were developed, the barriers and facilitators to co-design, and the implications for future commissioning. Methods: We selected four case studies of adult weight management services in Southwest England where co-design had been planned, representing a range of populations and settings. In each case, we recruited commissioners and providers of the services, and where possible, community members involved in co-design activities. Interviews were conducted online, audio-recorded, transcribed verbatim, and analysed using thematic analysis. Results: We interviewed 18 participants (8 female; 10 male): seven commissioners, eight providers, and three community members involved in co-designing the services. The case studies used a range of co-design activities (planned and actualised), from light-touch to more in-depth approaches. In two case studies, co-design activities were planned but were not fully implemented due to organisational time or funding constraints. Co-design was viewed positively by participants as a way of creating more appropriate services and better engagement, thus potentially leading to reduced inequalities. Building relationships– with communities, individual community members, and with partner organisations– was critical for successful co-design and took time and effort. Short-term and unpredictable funding often hindered co-design efforts and could damage relationships with communities. Some commissioners raised concerns over the limited evidence for co-design, while others described having to embrace "a different way of thinking" when commissioning for co-design. Conclusions: Co-design is an increasingly popular approach to designing health in services but can be difficult to achieve within traditional funding and commissioning practices. Drawing on our case studies, we present key considerations for those wanting to co-design health services, noting the importance of building strong relationships, creating supportive organisational cultures, and developing the evidence base. [ABSTRACT FROM AUTHOR]

The sPHENIX experiment is a state-of-the-art jet and heavy flavor physics detector, which successfully recorded its first Au + Au collision data at 200 GeV at the Relativistic Heavy Ion Collider (RHIC). sPHENIX will provide heavy flavor physics measurements at RHIC, covering an unexplored kinematic region and unprecedented precision, to probe the parton energy loss mechanism, parton transport coefficients in quark–gluon plasma, and the hadronization process under various medium conditions. At the center of sPHENIX, the monolithic active pixel sensor (MAPS)-based VerTeX detector (MVTX) is a high-precision silicon pixel detector. The MVTX provides excellent position resolution and the capability of operating in continuous streaming readout mode, allowing precise vertex determination and recording a large data sample, both of which are particularly crucial for heavy flavor physics measurements. In this work, we will show the general performance of heavy-flavor hadron reconstruction. In addition, we will discuss the commissioning experience with sPHENIX. Finally, we will provide the projection of b-hadron and jet observables and discuss the estimated constraints on theoretical models. [ABSTRACT FROM AUTHOR]

Considering global warming and environmental problems, the importance of renewable energy sources is increasing day by day. In particular, the effects of wind and solar power, which are variable renewable power sources, on the power system necessitate their evaluation in terms of the reliability of the power system. Photovoltaic panels, which enable the conversion of solar power into electrical power with semiconductors, have started to take an important place in global energy investments today. Photovoltaic power plants increase the demand for this energy source with continuous energy conversion depending on sunshine duration and radiation intensity. Among the renewable energy sources, the most easily utilized energy source, regardless of geographical conditions, is the sun. To prevent the energy production of PV power plants from being interrupted, it is necessary to address and analyze all kinds of faults that will affect power production in order to increase the reliability of the system. Academic studies in this field are generally grouped under two topics: classification of faults or modeling of electrical faults. Based on this, in this study, the problems that occur during the installation and operation of photovoltaic systems are classified, and the relevant faults are modeled and simulated in MATLAB Simulink version 23.2 (R2023b). Thus, a scientific approach to the problems of photovoltaic power plant operating conditions has been gained, which will be the basis for academic studies. [ABSTRACT FROM AUTHOR]

The high peak current of the electron beam was found to be the key parameter for the THz SASE FEL at the Photo Injector Test facility at DESY in Zeuthen (PITZ). A multipurpose bunch compressor was implemented at PITZ to expand the parameter space of proof-of-principle studies on the tunable high-power accelerator-based THz source for pump-probe experiments at the European XFEL. The magnetic chicane, consisting of four rectangular dipole magnets, is designed with a bending angle of 19 degrees, due to limited space in the PITZ original beamline, to compress electron bunches with a beam momentum of 15–20 MeV/c and a charge up to 2 nC. The space charge effect and coherent synchrotron radiation are expected to drastically affect the bunch compressor performance for these parameters, thereby challenging the beam transport throughout the bunch compressor. A staged commissioning strategy was developed in order to achieve optimum bunch compressor operation. The first commissioning procedure establishes electron beam transport throughout the reference path and provides minimum beam momentum dispersion after the bunch compressor. This procedure yielded correlations between dipole magnet currents. As a result, the first bunch compression experiments were performed. [ABSTRACT FROM AUTHOR]

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Reducing building energy use, a linchpin of climate change mitigation, is a daunting challenge across the world. Gaining increasing attention, retro-commissioning (RCx) is a systematic process that can improve building energy performance. Using a techno-legal lens to review statutes and guides on RCx, this study reveals that in China, a national standard on building commissioning has taken effect yet RCx statutes are hitherto not found. The United States has RCx statutes enacted over 14 states; scrutinizing the statutes of five cities unveils similarities and differences in their scope of control and compliance requirements. In the absence of a specific RCx statute, the guide of Hong Kong, China provides detailed guidance for energy saving practices. While these findings can serve as reference for other places planning to formulate laws or guidance on RCx, the need to further study the effectiveness of mandating RCx for reducing building energy use is highlighted. A conceptual analysis of cost variation with statutory control, which could help policymakers consider from an economic perspective whether or to what extent statutory RCx requirements should be imposed, is also illustrated. This not only contributes insights to the pursuit of an optimal balance between statutory control and voluntary action for energy reduction but also adds to the debate on building energy policies. [ABSTRACT FROM AUTHOR]

Background: Ultra‐high dose rate radiation (UHDR) is being explored by researchers in promise of advancing radiation therapy treatments. Purpose: This work presents the commissioning of Varian's Flash Extension for research (FLEX) conversion of a Clinac to deliver UHDR electrons. Methods: A Varian Clinac iX with the FLEX conversion was commissioned for non‐clinical research use with 16 MeV UHDR (16H) energy. This involved addition of new hardware, optimizing the electron gun voltages, radiofrequency (RF) power, and steering coils in order to maximize the accelerated electron beam current, sending the beam through custom scattering foils to produce the UHDR with 16H beam. Profiles and percent depth dose (PDD) measurements for 16H were obtained using radiochromic film in a custom vertical film holder and were compared to 16 MeV conventional electrons (16C). Dose rate and dose per pulse (DPP) were calculated from measured dose in film. Linearity and stability were assessed using an Advanced Markus ionization chamber. Results: Energies for 16H and 16C had similar beam quality based on PDD measurements. Measurements at the head of the machine (61.3 cm SSD) with jaws set to 10×10 cm2 showed the FWHM of the profile as 7.2 cm, with 3.4 Gy as the maximum DPP and instantaneous dose rate of 8.1E5 Gy/s. Measurements at 100 cm SSD with 10 cm standard cone showed the full width at half max (FWHM) of the profile as 10.5 cm, 1.08 Gy as the maximum DPP and instantaneous dose rate of 2.E5 Gy/s. Machine output with number of pulses was linear (R = 1) from 1 to 99 delivered pulses. Output stability was measured within ±1% within the same session and within ±2% for daily variations. Conclusions: The FLEX conversion of the Clinac is able to generate UHDR electron beams which are reproducible with beam properties similar to clinically used electrons at 16 MeV. Having a platform which can quickly transition between UHDR and conventional modes (<1 min) can be advantageous for future research applications. [ABSTRACT FROM AUTHOR]

Four‐dimensional computed tomography (4DCT), which relies on breathing‐induced motion, requires realistic surrogate information of breathing variations to reconstruct the tumor trajectory and motion variability of normal tissues accurately. Therefore, the SimRT surface‐guided respiratory monitoring system has been installed on a Siemens CT scanner. This work evaluated the temporal and spatial accuracy of SimRT versus our commonly used pressure sensor, AZ‐733 V. A dynamic thorax phantom was used to reproduce regular and irregular breathing patterns acquired by SimRT and Anzai. Various parameters of the recorded breathing patterns, including mean absolute deviations (MAD), Pearson correlations (PC), and tagging precision, were investigated and compared to ground‐truth. Furthermore, 4DCT reconstructions were analyzed to assess the volume discrepancy, shape deformation and tumor trajectory. Compared to the ground‐truth, SimRT more precisely reproduced the breathing patterns with a MAD range of 0.37 ± 0.27 and 0.92 ± 1.02 mm versus Anzai with 1.75 ± 1.54 and 5.85 ± 3.61 mm for regular and irregular breathing patterns, respectively. Additionally, SimRT provided a more robust PC of 0.994 ± 0.009 and 0.936 ± 0.062 for all investigated breathing patterns. Further, the peak and valley recognition were found to be more accurate and stable using SimRT. The comparison of tumor trajectories revealed discrepancies up to 7.2 and 2.3 mm for Anzai and SimRT, respectively. Moreover, volume discrepancies up to 1.71 ± 1.62% and 1.24 ± 2.02% were found for both Anzai and SimRT, respectively. SimRT was validated across various breathing patterns and showed a more precise and stable breathing tracking, (i) independent of the amplitude and period, (ii) and without placing any physical devices on the patient's body. These findings resulted in a more accurate temporal and spatial accuracy, thus leading to a more realistic 4DCT reconstruction and breathing‐adapted treatment planning. [ABSTRACT FROM AUTHOR]

Abstract Background To improve health outcomes and address mounting costs pressures, policy-makers have encouraged primary care commissioners in the British National Health Service (NHS) to increase the usage of data in decision-making. However, there exists limited research on this topic. In this study, we aimed to understand how and why primary care commissioners use data (i.e. quantitative, statistical information) to inform commissioning, and what outcomes this leads to. Methods A realist evaluation was completed to create context-mechanism-outcome configurations (CMOs) relating to the contexts influencing the usage of data in primary care commissioning. Using a realist logic of analysis and drawing on substantive theories, we analysed qualitative content from 30 interviews and 51 meetings (51 recordings and 19 accompanying meeting minutes) to develop CMOs. Purposive sampling was used to recruit interviewees from diverse backgrounds. Results Thirty-five CMOs were formed, resulting in an overarching realist programme theory. Thirteen CMOs were identical and 3 were truncated versions of those formed in an existing realist synthesis on the same topic. Seven entirely new CMOs, and 12 refined and enhanced CMOs vis-à-vis the synthesis were created. The findings included CMOs containing contexts which facilitated the usage of data, including the presence of a data champion and commissioners’ perceptions that external providers offered new skillsets and types of data. Other CMOs included contexts presenting barriers to using data, such as data not being presented in an interoperable way with consistent definitions, or financial pressures inhibiting commissioners’ abilities to make evidence-based decisions. Conclusions Commissioners are enthusiastic about using data as a source of information, a tool to stimulate improvements, and a warrant for decision-making. However, they also face considerable challenges when using them. There are replicable contexts available to facilitate commissioners’ usage of data, which we used to inform policy recommendations. The findings of this study and our recommendations are pertinent in light of governments’ increasing commitment to data-driven commissioning and health policy-making.

This study reports the beam commissioning results for the first clinical RefleXion Linac.MethodsThe X1 produces a 6 MV photon beam and the maximum clinical field size is 40 × 2 cm2 at source-to-axis distance of 85 cm. Treatment fields are collimated by a binary multileaf collimator (MLC) system with 64 leaves with width of 0.625 cm and y-jaw pairs to provide either a 1 or 2 cm opening. The mechanical alignment of the radiation source, the y-jaw, and MLC were checked with film and ion chambers. The beam parameters were characterized using a diode detector in a compact water tank. In-air lateral profiles and in-water percentage depth dose (PDD) were measured for beam modeling of the treatment planning system (TPS). The lateral profiles, PDDs, and output factors were acquired for field sizes from 1.25 × 1 to 40 × 2 cm2 field to verify the beam modeling. The rotational output variation and synchronicity were tested to check the gantry angle, couch motion, and gantry rotation.ResultsThe source misalignments were 0.049 mm in y-direction, 0.66% out-of-focus in x-direction. The divergence of the beam axis was 0.36 mm with a y-jaw twist of 0.03°. Clinical off-axis treatment fields shared a common center in y-direction were within 0.03 mm. The MLC misalignment and twist were 0.57 mm and 0.15°. For all measured fields ranging from the size from 1.25 × 1 to 40 × 2 cm2 , the mean difference between measured and TPS modeled PDD at 10 cm depth was -0.3%. The mean transverse profile difference in the field core was -0.3% ± 1.1%. The full-width half maximum (FWHM) modeling was within 0.5 mm. The measured output factors agreed with TPS within 0.8%.ConclusionsThis study summarizes our specific experience commissioning the first novel RefleXion linac, which may assist future users of this technology when implementing it into their own clinics.

Introduction: Popularly, teletherapy (telecobalt/LA) equipment is based on a C-arm gantry system. Recently, a fast O-ring gantry system introduced a medical linear accelerator (LA) to smoothen the workflow of treatment of cancer patients because of the increasing trend of the number of cancer cases over the past few years. This study aimed to analyze the commissioning parameters and validation of the O-ring gantrybased LA for improved radiotherapy techniques. Material and Methods: Three-dimensional (3D) radiation field analyzer (RFA) used to commission Halcyon™ LA. It is used for measuring percent depth dose (PDD), profiles, and output factors. Results: TPS data was validated by comparing it with our measured data. Plans per the TG-119 protocol showed good agreement between treatment planning systems (TPS) calculated and measured doses. For patient-specific, QA plans showed good agreement with gamma evaluation criteria. Conclusion: Commissioning and validation of O-ring gantry system Halcyon™ LA was performed successfully. [ABSTRACT FROM AUTHOR]

This small-scale qualitative study, involving commissioners of carers' services, contextualized in academic and other literature, adds to an understanding of groupwork for carers within the context of an English legal framework. Five commissioners, from different parts of England, participated in an online focus group. The dataset was analyzed thematically using a reflexive Thematic Analysis approach. Three themes were developed from the data. One theme indicated that differing understandings of the purpose of group activities for carers co-existed in each area and another that system-wide blocks meant that the choice of provider depends on factors like ability to risk-manage the contract value rather than skills needed to serve whole populations. This led to a third theme of commissioners attempting to "engineer" the development of successful groupwork. The findings suggest that Community Social Work is likely to be successful in working with carers but may face challenges within a quasi-market approach. [ABSTRACT FROM AUTHOR]

To account for intra‐fractional tumor motion during dose delivery in radiotherapy, various treatment strategies are clinically implemented such as breathing‐adapted gating and irradiating the tumor during specific breathing phases. In this work, we present a comprehensive phantom‐based end‐to‐end test of breathing‐adapted gating utilizing surface guidance for use in particle therapy. A commercial dynamic thorax phantom was used to reproduce regular and irregular breathing patterns recorded by the GateRT respiratory monitoring system. The amplitudes and periods of recorded breathing patterns were analysed and compared to planned patterns (ground‐truth). In addition, the mean absolute deviations (MAD) and Pearson correlation coefficients (PCC) between the measurements and ground‐truth were assessed. Measurements of gated and non‐gated irradiations were also analysed with respect to dosimetry and geometry, and compared to treatment planning system (TPS). Further, the latency time of beam on/off was evaluated. Compared to the ground‐truth, measurements performed with GateRT showed amplitude differences between 0.03 ± 0.02 mm and 0.26 ± 0.03 mm for regular and irregular breathing patterns, whilst periods of both breathing patterns ranged with a standard deviation between 10 and 190 ms. Furthermore, the GateRT software precisely acquired breathing patterns with a maximum MAD of 0.30 ± 0.23 mm. The PCC constantly ranged between 0.998 and 1.000. Comparisons between TPS and measured dose profiles indicated absolute mean dose deviations within institutional tolerances of ±5%. Geometrical beam characteristics also varied within our institutional tolerances of 1.5 mm. The overall time delays were <60 ms and thus within both recommended tolerances published by ESTRO and AAPM of 200 and 100 ms, respectively. In this study, a non‐invasive optical surface‐guided workflow including image acquisition, treatment planning, patient positioning and gated irradiation at an ion‐beam gantry was investigated, and shown to be clinically viable. Based on phantom measurements, our results show a clinically‐appropriate spatial, temporal, and dosimetric accuracy when using surface guidance in the clinical setting, and the results comply with international and institutional guidelines and tolerances. [ABSTRACT FROM AUTHOR]

Background: To improve health outcomes and address mounting costs pressures, policy-makers have encouraged primary care commissioners in the British National Health Service (NHS) to increase the usage of data in decision-making. However, there exists limited research on this topic. In this study, we aimed to understand how and why primary care commissioners use data (i.e. quantitative, statistical information) to inform commissioning, and what outcomes this leads to. Methods: A realist evaluation was completed to create context-mechanism-outcome configurations (CMOs) relating to the contexts influencing the usage of data in primary care commissioning. Using a realist logic of analysis and drawing on substantive theories, we analysed qualitative content from 30 interviews and 51 meetings (51 recordings and 19 accompanying meeting minutes) to develop CMOs. Purposive sampling was used to recruit interviewees from diverse backgrounds. Results: Thirty-five CMOs were formed, resulting in an overarching realist programme theory. Thirteen CMOs were identical and 3 were truncated versions of those formed in an existing realist synthesis on the same topic. Seven entirely new CMOs, and 12 refined and enhanced CMOs vis-à-vis the synthesis were created. The findings included CMOs containing contexts which facilitated the usage of data, including the presence of a data champion and commissioners' perceptions that external providers offered new skillsets and types of data. Other CMOs included contexts presenting barriers to using data, such as data not being presented in an interoperable way with consistent definitions, or financial pressures inhibiting commissioners' abilities to make evidence-based decisions. Conclusions: Commissioners are enthusiastic about using data as a source of information, a tool to stimulate improvements, and a warrant for decision-making. However, they also face considerable challenges when using them. There are replicable contexts available to facilitate commissioners' usage of data, which we used to inform policy recommendations. The findings of this study and our recommendations are pertinent in light of governments' increasing commitment to data-driven commissioning and health policy-making. [ABSTRACT FROM AUTHOR]

Public services, such as health and other human services, are increasingly being delivered by third‐party providers (providers) under contract to public sector organisations (PSOs). While often advantageous to PSOs, this creates a fragmented service context which is difficult for consumers to navigate. Further, providers often deliver services under multiple contracts to multiple funders, with high reporting requirements, high administrative costs, and low operational sustainability. Policymakers have encouraged co‐commissioning—where PSOs come together to jointly commission services—to increase the efficiency and effectiveness of outsourcing. This article seeks to understand the costs of co‐commissioning in Australia, and consequently the enablers and barriers to co‐commissioning. This qualitative study is based on the early experiences of co‐commissioning by one of 31 Primary Health Networks (PHNs). Using transaction cost economics (TCE) theory, the study explains how the PHN started co‐commissioning services with other PHNs, before co‐commissioning with other types of organisations. The PHN also co‐commissioned relatively simple activities first, before moving on to more complex services. The insights provided using TCE theory help explain why co‐commissioning is initially complicated (and costly), requiring time to understand both the services to be commissioned and the governance requirements of each party involved. While initial transaction costs may be high when co‐commissioning, this may reflect organisational learning and capacity development costs ‐ therefore, costs are expected to reduce over time. Points for practitioners: Fragmentation in policy and funding also leads to fragmentation of human services and high costs to service providers.Co‐commissioning is where multiple funders pool funds and strategically commission services together.Co‐commissioning offers a way to reduce fragmentation and reduce costs to service providers, potentially offering better public value.Co‐commissioning can initially take time and resources to establish.Over time, as organisations learn, the cost of co‐commissioning reduces potentially offering benefits to funders, providers, and service users. [ABSTRACT FROM AUTHOR]

The purpose of this guideline is to provide a list of critical performance tests to assist the Qualified Medical Physicist (QMP) in establishing and maintaining a safe and effective quality assurance (QA) program. The performance tests on a linear accelerator (linac) should be selected to fit the clinical patterns of use of the accelerator and care should be given to perform tests which are relevant to detecting errors related to the specific use of the accelerator. Current recommendations for linac QA were reviewed to determine any changes required to those tests highlighted by the original report as well as considering new components of the treatment process that have become common since its publication. Recommendations are made on the acquisition of reference data, routine establishment of machine isocenter, basing performance tests on clinical use of the linac, working with vendors to establish QA tests and performing tests after maintenance and upgrades. The recommended tests proposed in this guideline were chosen based on consensus of the guideline's committee after assessing necessary changes from the previous report. The tests are grouped together by class of test (e.g., dosimetry, mechanical, etc.) and clinical parameter tested. Implementation notes are included for each test so that the QMP can understand the overall goal of each test. This guideline will assist the QMP in developing a comprehensive QA program for linacs in the external beam radiation therapy setting. The committee sought to prioritize tests by their implication on quality and patient safety. The QMP is ultimately responsible for implementing appropriate tests. In the spirit of the report from American Association of Physicists in Medicine Task Group 100, individual institutions are encouraged to analyze the risks involved in their own clinical practice and determine which performance tests are relevant in their own radiotherapy clinics. [ABSTRACT FROM AUTHOR]

Five complete MR‐conditionally approved ring sets, including fifteen tandems, and two additional rings, were commissioned at an institution intending to use them in an MRI planning environment with a Bravos HDR brachytherapy remote afterloader. Channel length, radiograph, autoradiograph, ring offset, and treatment interrupt measurements were performed, and applicators were assessed in both CT and MRI. During commissioning, one ring was found to be defective and was returned to the manufacturer for a replacement. The eventual complete applicator suite (including the replacement ring) was found to follow the manufacturer‐provided specifications, including those delineated in vendor‐provided 3D virtual models and those defined within the manufacturer's instructions for use documentation. Based on this work, an offset correction of −0.4 cm will be used for all tested rings using the Bravos system's internal distal dwell position correction feature during treatment preparation. This study reiterated the requirement for careful commissioning of each applicator intended for clinical service considering the intended use and the planned clinical environment and work processes. [ABSTRACT FROM AUTHOR]