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The Pinnacle3 Auto-Planning (AP) package is an automated inverse planning tool employing a multi-sequence optimisation algorithm. The nature of the optimisation aims to improve the overall quality of radiotherapy plans but at the same time may produce higher modulation, increasing plan complexity and challenging linear accelerator delivery capability.
Methods and materials:
Thirty patients previously treated with intensity-modulated radiotherapy (IMRT) to the prostate with or without pelvic lymph node irradiation were replanned with locally developed AP techniques for step-and-shoot IMRT (AP-IMRT) and volumetric-modulated arc therapy (AP-VMAT). Each case was also planned with VMAT using conventional inverse planning. The patient cohort was separated into two groups, those with a single primary target volume (PTV) and those with dual PTVs of differing prescription dose levels. Plan complexity was assessed using the modulation complexity score.
Plans produced with AP provided equivalent or better dose coverage to target volumes whilst effectively reducing organ at risk (OAR) doses. For IMRT plans, the use of AP resulted in a mean reduction in bladder V50Gy by 4·2 and 4·7 % (p ≤ 0·01) and V40Gy by 4·8 and 11·3 % (p < 0·01) in the single and dual dose level cohorts, respectively. For the rectum, V70Gy, V60Gy and V40Gy were all reduced in the dual dose level AP-VMAT plans by an average of 2·0, 2·7 and 7·3 % (p < 0·01), respectively. A small increase in plan complexity was observed only in dual dose level AP plans.
The automated nature of AP led to high quality treatment plans with improvement in OAR sparing and minimised the variation in achievable dose planning metrics when compared to the conventional inverse planning approach.
Delineating the proximal urethra can be critical for radiotherapy planning but is challenging on computerised tomography (CT) imaging.
Materials and methods:
We trialed a novel non-invasive technique to allow visualisation of the proximal urethra using a rapid sequence magnetic resonance imaging (MRI) protocol to visualise the urinary flow in patients voiding during the simulation scan.
Of the seven patients enrolled, four were able to void during the MRI scan. For these four patients, direct visualisation of urinary flow through the proximal urethra was achieved. The average volume of the proximal urethra contoured on voiding MRI was significantly higher than the proximal urethra contoured on CT, 4·07 and 1·60 cc, respectively (p = 0·02). The proximal urethra location also differed; the Dice coefficient average was 0·28 (range 0–0·62).
In this small, proof-of-concept prospective clinical trial, the volume and location of the proximal urethra differed significantly when contoured on a voiding MRI scan compared to that determined by a conventional CT simulation. The shape of the proximal urethra on voiding MRI may be more anatomically correct compared to the proximal urethra shape determined with a semi-rigid catheter in place.
This article analyzes the scant treatment of Muslims in medieval inquisitorial thought, focusing mainly on the late fourteenth-century Aragonese inquisitor Nicolau Eymeric's Directorium inquisitorum (1376). It argues for four contexts in which to understand his engagement with Islam. First, as background, is a longstanding Christian (although not inquisitorial) tradition categorizing Islam as a heresy, with which he did not substantially engage. Second is his own goal to extend inquisitorial authority to new subjects, in which he drew on previous inquisitorial thought about Jews. The third involves conflicts between church officials and the Crown of Aragon about jurisdiction over non-Christian subjects. The fourth centers on the supposition that he did not view Muslims living within Christendom as an especially covert or insidious threat requiring special investigation to uncover, which speaks to how he and other inquisitors viewed their role and the nature of the threats they aimed to counter. In broad terms, this article contributes to our understanding of one important way in which medieval Christianity engaged with other religions. It also provides a basis for understanding later developments in early modern Europe.
The use of an electronic hand hygiene monitoring system (EHHMS) decreased due to the coronavirus disease 2019 (COVID-19) pandemic. We analyzed dispenser use, hand hygiene (HH) badge use, and HH compliance to determine the effect of COVID-19 on EHHMS use and HH compliance. HH product shortages and other pandemic-induced challenges influenced EHHMS use.
This article challenges the unidimensional view of abusive supervisors and examines how employees respond to abuse when the transgressing boss also has a positive impact on others. Drawing on deonance and fairness theory, we propose competing hypotheses about the influence of prosocial impact. Specifically, we use deonance theory to suggest that prosocial impact might buffer the effects of abusive supervision. Alternatively, we incorporate fairness theory to predict that prosocial impact strengthens injustice perceptions and thereby worsens consequences of abuse. Two field studies show support for fairness theory, demonstrating that employees perceive greater injustice, and show stronger retaliatory behaviors, when the abusive supervisor makes a positive difference in the workplace. A final field study replicates these results, while also testing the underlying cognitive process employees use to assess the interplay between “good” and “bad” supervisory characteristics. This article contributes insights to abusive supervision, prosocial impact, organizational justice, and behavioral ethics literatures.
Background: Central-line–associated blood stream infections (CLABSIs) are linked with significant morbidity and mortality. A NHSN laboratory-confirmed bloodstream infection (LCBSI) has specific criteria to ascribe an infection to the central line or not. The criteria used to associate the pathogen to another site are restrictive. This objective to better classify CLABSIs using enhanced criteria to gain a comprehensive understanding of the error so that appropriate reduction efforts are utilized. Methods: We conducted a retrospective review of medical records with NHSN-identified CLABSI from July 2017 to December 2018 at 2 geographically proximate hospitals. Trained infectious diseases personnel from tertiary-care academic medical centers, the University of Virginia Health System, a 600-bed medical center in Charlottesville, Virginia, and Virginia Commonwealth University Health System with 865 beds in Richmond, Virginia, reviewed charts. We defined “overcaptured” or O-CLABSI into different categories: O-CLABSI-1 is bacteremia attributable to a primary infectious source; O-CLABSI-2 is bacteremia attributable to neutropenia with gastrointestinal translocation not meeting mucosal barrier injury criteria; O-CLABSI-3 is a positive blood culture attributable to a contaminant; and O-CLABSI-4 is a patient injecting line, though not officially documented. Descriptive analyses were performed using the χ2 and the Fisher exact tests. Results: We found a large number of O-CLABSIs on chart review (79 of 192, 41%). Overall, 56 of 192 (29%) LCBSIs were attributable to a primary infectious source not meeting NHSN definition. O-CLABSI proportions between the 2 hospitals were statistically different; hospital A identified 34 of 59 (58%) of their NHSN-identified CLABSIs as O-CLABSIs, and hospital B identified a 45 of 133 (34%) as O-CLABSIs (P = .0020) (Table 1). When comparing O-CLABSI types, hospital B had a higher percentage of O-CLABSI-1 compared to hospital B: 76% versus 64%. Hospital A had a higher proportion of O-CLABSI-2: 21 versus 7%. Hospitals A and B had similar proportion of O-CLABSI-3: 15% versus 18%. These values were all statistically significant (P < .0001). Discussions: The results of these 2 geographically proximate systems indicate that O-CLABSIs are common. Attribution can vary significantly between institutions, likely depending on differences in incidence of true CLABSI, patient populations, protocols, and protocol compliance. These findings have implications for interfacility comparisons of publicly reported data. Most importantly, erroneous attribution can result in missed opportunity to direct patient safety efforts to the root cause of the bacteremia and could lead to inappropriate treatment.
Disclosures: Michelle Doll, Research Grant from Molnlycke Healthcare
Men sexually interested in children of a specific combination of maturity and sex tend to show some lesser interest in other categories of persons. Patterns of men's sexual interest across erotic targets' categories of maturity and sex have both clinical and basic scientific implications.
We examined the structure of men's sexual interest in adult, pubescent, and prepubescent males and females using multidimensional scaling (MDS) across four datasets, using three large samples and three indicators of sexual interest: phallometric response to erotic stimuli, sexual offense history, and self-reported sexual attraction. The samples were highly enriched for men sexually interested in children and men accused of sexual offenses.
Results supported a two-dimensional MDS solution, with one dimension representing erotic targets' biological sex and the other dimension representing their sexual maturity. The dimension of sexual maturity placed adults and prepubescent children on opposite ends, and pubescent children intermediate. Differences between men's sexual interest in adults and prepubescent children of the same sex were similar in magnitude to the differences between their sexual interest in adult men and women. Sexual interest in adult men was no more associated with sexual interest in boys than sexual interest in adult women was associated with sexual interest in girls.
Erotic targets' sexual maturity and biological sex play important roles in men's preferences, which are predictive of sexual offending. The magnitude of men's preferences for prepubescent children v. adults of their preferred sex is large.
Demoralization is prevalent in patients with life-limiting chronic illnesses, many of whom reside in rural areas. These patients also have an increased risk of disease-related psychosocial burden due to the unique health barriers in this population. However, the factors affecting demoralization in this cohort are currently unknown. This study aimed to examine demoralization amongst the chronically ill in Lithgow, a town in rural New South Wales, Australia, and identify any correlated demographic, physical, and psychosocial factors in this population.
A cross-sectional survey of 73 participants drawn from Lithgow Hospital, the adjoining retirement village and nursing home, assessing correlating demographic, physical, psychiatric, and psychosocial factors.
The total mean score of the DS-II was 7.8 (SD 26.4), and high demoralization scores were associated with the level of education (p = 0.01), comorbid condition (p = 0.04), severity of symptom burden (p = <0.001), depression (p = <0.001), and psychological distress (p = <0.001). Prevalence of serious demoralization in this population was 27.4% according to a cutoff of a DS-II score ≥11. Of those, 11 (15%) met the criteria for clinical depression, leaving 9 (12.3%) of the cohort demoralized but not depressed.
Significance of results
Prevalence of demoralization was high in this population. In line with the existing literature, demoralization was associated with the level of education, symptom burden, and psychological distress, demonstrating that demoralization is a relevant psychometric factor in rural populations. Further stratification of the unique biopsychosocial factors at play in this population would contribute to better understanding the burdens experienced by people with chronic illness in this population and the nature of demoralization.
Electrospun coaxial fibers are used to create core/sheath fiber structures to act as growth-promoting scaffolds for in vitro dorsal root ganglia (DRG) cell cultures. The core was a conducting polymer, poly(3,4-ethylenedioxythiophene):poly(styrene sulfonate) (PEDOT:PSS), and the sheath was poly-L-lactic acid (PLLA), which created coaxial fibers with a conductive core and an insulating sheath. SEM analysis confirmed the conductivity of the core and insulation of the sheath. Several coaxial spinneret designs were tested with the best results obtained by using various annular spinning needle combinations. Using a 22G/16G and 22G/17G combination, fibers with diameters of 6.1 ± 2.4 µm and 3.3 ± 0.9 µm were spun, respectively. The fibers showed a Young’s modulus and hardness of 0.16 ± 0.13 and 0.02 ± 0.01 GPa for the larger diameters, and 0.7 ± 0.4 and 0.03 ± 0.03 GPa for the smaller diameter fibers. In vitro test cultures showed the fibers successfully directed chick DRG axonal outgrowth with low biotoxicity.
Background: Cervical spondylotic myelopathy (CSM) is the leading cause of spinal cord impairment. In a public healthcare system, wait times to see spine specialists and eventually access surgical treatment for CSM can be substantial. The goals of this study were to determine consultation wait times (CWT) and surgical wait times (SWT), and identify predictors of wait time length. Methods: Consecutive patients enrolled in the Canadian Spine Outcomes and Research Network (CSORN) prospective and observational CSM study from March 2015 to July 2017 were included. A data-splitting technique was used to develop and internally validate multivariable models of potential predictors. Results: A CSORN query returned 264 CSM patients for CWT. The median was 46 days. There were 31% mild, 35% moderate, and 33% severe CSM. There was a statistically significant difference in median CWT between moderate and severe groups; 207 patients underwent surgical treatment. Median SWT was 42 days. There was a statistically significant difference in SWT between mild/moderate and severe groups. Short symptom duration, less pain, lower BMI, and lower physical component score of SF-12 were predictive of shorter CWT. Only baseline pain and medication duration were predictive of SWT. Both CWT and SWT were shorter compared to a concurrent cohort of lumbar stenosis patients (p <0.001). Conclusions: Patients with shorter duration (either symptoms or medication) and less neck pain waited less to see a spine specialist in Canada and to undergo surgical treatment. This study highlights some of the obstacles to overcome in expedited care for this patient population.
As professors, we seek not only to impart knowledge about issues and concepts in American politics but also to engage and inspire students to become more knowledgeable and more active in politics. This article explains how a student-run exit poll conducted on Election Day 2016 accomplished both goals. Seven faculty members from four universities pooled our students and carried out an exit poll in the District of Columbia, Maryland, Virginia, and Ohio. By the time the polls closed, our students had spoken to more than 2,300 respondents, providing a memorable experience and creating a shared dataset that served as the centerpiece for many final class projects. Through this project, students gained hands-on experience in survey design, sampling, research ethics, polling, and data analysis.
Although research methods and statistics play an increasing role in political science and beyond, students all too often find statistics classes intimidating and boring. This need not be the case, however, because statistics classes provide opportunities to pose and answer questions about which students care. This article highlights four steps to making our methods and statistics classes more engaging and meaningful.