RTT advanced practice and how it can change the future of radiotherapy.

The radiation therapy (RT) landscape is continuously evolving, necessitating adaptation in roles and responsibilities of radiation therapists (RTTs). Advanced Practice Radiation Therapists (APRTs) have taken on a proactive role in expanding services and assuming responsibilities within multi-professional teams. A European Society for Radiotherapy and Oncology (ESTRO) brought geographically diverse and experienced RTTs together, to discuss how advanced practice (AP) in the RTT profession should be future-proofed and create a global platform for collaboration. Challenges in achieving consensus and standardisation of APRT was identified across jurisdictions, emphasising the importance of international collaboration. Whilst highlighting the pivotal role of APRTs in driving innovation, improving patient care, and navigating the complexities of modern RT practice, this position paper presents outcomes and recommendations from the workshop. Discussions highlighted the need for standardised role definitions, education frameworks, regulatory support, and career development pathways to enable the advancement of APRT effectively. Increasing networks and collaboration is recommended to ensure APRTs can shape the future of RT.

"I tried to appreciate it in a different way": Older lesbian, bisexual, and queer women's body image and embodiment across the life course.

We examined the life histories of older lesbian, bisexual, and queer women, focusing on the stories they told about their bodies and sexuality from early to later life. Guided by a narrative constructionist approach, a series of two life history interviews were conducted with 17 lesbian, bisexual, and queer women aged 65-86. Two themes were constructed through a narrative thematic analysis: Queering the Corset: Negotiating Gender Expression and (Aspirational) Aging Body Acceptance. Participants experienced body-related freedom through 'tomboy' expressions of physicality as children. This body autonomy was constrained in adolescence and adulthood due to heterosexist messages surrounding idealized femininity relayed by family and (heterosexual) men, which disrupted self-care yet catalyzed attuned, queer desire and positive embodiment. Women worked to accept their bodies as they aged; they experienced some body dissatisfaction in relation to age-related body changes, yet gratitude and pride in their older queer identities. The findings highlight concurrent positive and negative body image, and breadth of body-related experiences ranging from attunement and agency to discomfort and disruption throughout the life course. This work contributes to body image and embodiment research by moving beyond dominant (youthful) heteronormative perspectives by illuminating how ageism and heterosexism can shape body-related experiences.

Experiences implementing a Radiation therapist-led oncology prehabilitation program during COVID-19.

•Multi-modal prehabilitation prior to radiotherapy is valuable and achievable.•Radiation Therapists can be instrumental in developing prehab programs.•Multi-disciplinary care influences the patient's experience of cancer.•Validated screening tools can be easily incorporated into pre-radiotherapy assessments.•Online delivery of a prehabilitation program is feasible and safe.

"I think the best athletes use it": Masculinities and self-compassion among men varsity athletes.

We examined how men varsity athletes' embodiments of masculinities shaped their perceptions and experiences of self-compassion to manage sport-related challenges. Two semi-structured interviews were conducted with 11 men varsity athletes (20 interviews total). Vignettes depiciting athletes low and high in self-compassion were used as talk elicitation tools during interviews. Data were analyzed using reflexive thematic analysis and four themes were identified from the mens' accounts. Participants utilized self-compassion as a coping strategy in sport and other life-domains to maintain well-being. Self-compassion was used to balance self-criticism to support achievement striving efforts. The experience of contrasting masculine ideologies (hegemonic and inclusive) promoted and constrained the men's implementation of self-compassion. Traditional masculine narratives created tensions for participants who at times embodied the (mis)belief that self-compassion promotes complacency in the pursuit of athletic achievement. Findings contribute to understandings of men athletes' experiences of self-compassion and masculinities in relation to sport-related challenges and performance.

The Impact of a National Cyberattack Affecting Clinical Trials: The Cancer Trials Ireland Experience.

PURPOSE: Cyberattacks are increasing in health care and cause immediate disruption to patient care, have a lasting impact, and compromise scientific integrity of affected clinical trials. On the May 14, 2021, the Irish health service was the victim of a nationwide ransomware attack. Patient care was disrupted across 4,000 locations, including 18 cancer clinical trials units associated with Cancer Trials Ireland (CTI). This report analyses the impact of the cyberattack on the organization and proposes steps to mitigate the impact of future cyberattacks. METHODS: A questionnaire was distributed to the units within the CTI group; this examined key performance indicators for a period of 4 weeks before, during, and after the attack, and was supplemented by minutes of weekly conference call with CTI units to facilitate information sharing, accelerate mitigation, and support affected units. A total of 10 responses were returned, from three private and seven public hospitals. RESULTS: The effect of the attack on referrals and enrollment to trials was marked, resulting in a drop of 85% in referrals and 55% in recruitment before recovery. Radiology, radiotherapy, and laboratory systems are heavily reliant on information technology systems. Access to all was affected. Lack of preparedness was highlighted as a significant issue. Of the sites surveyed, two had a preparedness plan in place before the attack, both of these being private institutions. Of the eight institutions where no plan was in place, three now have or are putting a plan in place, whereas no plan is in place at the five remaining sites. CONCLUSION: The cyberattack had a dramatic and sustained impact on trial conduct and accrual. Increased cybermaturity needs to be embedded in clinical trial logistics and the units conducting them.

Instructor Social Support in the Group Physical Activity Context: Older Participants' Perspectives.

Instructors in organized physical activity classes can be a source of social support through their relationships with participants, influence on participants' interactions with each other, and design of activities. Grounded in interpretive description, the objective of this study was to examine older adults' experiences of and their perspectives on group physical activity instructors' supportive behaviors. Observations of 16 group physical activity classes (N = 295) and focus groups or interviews with N = 38 class participants aged ≥ 55 (n = 29 women) were conducted at four municipal recreation facilities in a Canadian city. Five themes shed light on how instructors provided social support: (a) supporting autonomous engagement, (b) developing caring connections, (c) fostering trust through expert instruction, (d) managing conflict directly and effectively, and (e) creating a climate where people want to go. Instructor training should consider older adults' social support needs and help instructors embody behaviors that support continued physical activity participation, thereby contributing to healthy aging.

'You're part of something bigger': interpersonal relationships and older Canadian men's body image.

OBJECTIVE: We examined older men's body image, with a focus on the role of interpersonal relationships in shaping their psychological adaptation to age-related body changes to appearance, function, and health. DESIGN: Qualitative narrative constructionist study. MAIN OUTCOME MEASURES: We conducted semi-structured interviews with 29 men aged 65-83. Data were analysed using thematic narrative analysis; we identified and interpreted patterns in and across the men's stories about their aging bodies. RESULTS: Narratives of purpose through meaningful engagement and belonging through connection permeated the men's accounts. Participants mitigated body-related changes and challenges through pleasurable physical, leisure, and community activities. They derived purpose from these activities as they kept them physically, cognitively, and socially engaged and thus relevant with advancing age, particularly post retirement. The men derived a sense of belonging through social connections. Relationships with family, friends, and community members shaped their capacity for meaningful engagement and associated psychological adjustment to age-related body changes. CONCLUSION: The findings point to the imperative need to consider how men negotiate their constantly changing, aging bodies within the context of interpersonal relationships, and highlight the role that later life belonging and purpose play in shaping how men experience their bodies as they grow older.

From minding the gap to widening the gap: Paralympic athletes' experiences of wellbeing during the postponement of the Tokyo 2020 games.

In March 2020, it was announced that the Tokyo Games would be postponed for one year due to the COVID-19 pandemic. While athletes commonly face challenges in sport such as injuries, the pandemic and rescheduling of the Games was an unexpected event that had serious potential to challenge the psychological wellbeing of athletes. Furthermore, it was an event that was simultaneously experienced by all athletes preparing for the Games. It provided a novel opportunity to explore how athletes navigated this challenging environment and the subsequent potential impact on their psychological wellbeing. It also provided a unique opportunity to engage para-athletes and explore how they experienced the pandemic and postponement. This manuscript draws on a larger qualitative study of 21 Canadian athletes (14 Olympic and seven Paralympic) who were on target to compete at the 2020 Games when the postponement was announced. For this manuscript, we focus on the accounts of seven Paralympic hopefuls and their experiences of adjusting to the postponement, while attending to the unique social identities of athletes with disabilities. Adopting a constructionist lens, semi-structured interviews were conducted at two time points. Through reflexive thematic analysis, we developed three themes. "We are all in the same boat. . . or are we?" describes the Paralympic hopefuls experiences early in the pandemic and how they felt united by the Canadian response to withdraw from the Games. It then discusses how, over time, they started to understand athletes with disabilities were being inequitably impacted by the pandemic and related public health measures. "Maybe it means more to them than us" examines how their perceptions changed as they acknowledged that although all athletes were facing a disruption to their sport careers, the implications were not the same for all. "Vulnerability and the Paralympic athlete" addresses how Paralympic athletes engaged with societal narratives about risk, vulnerability and disability and what this meant for the Paralympic Movement's response to the pandemic. "Honestly, I've experienced it before" examines how the Paralympic hopefuls drew on past experiences of injury to navigate the pandemic and the protective impact on their psychological wellbeing. Findings shed light on how systemic ableism interacted with the pandemic to magnify feelings of inferiority and further marginalization but also how para-athletes drew on past experiences to navigate challenges to their psychological wellbeing.

Social Support and Body Image in Group Physical Activity Programs for Older Women.

Physical declines with aging may negatively impact women's body image. Group physical activity can be a source of social support that may improve body image. We examined how social support experienced in group physical activity programs impacts older women's body image. Guided by interpretive description, we interviewed 14 women age 65 years and older who participated in group physical activity classes. Although women experienced both positive and negative body image, body image was generally positively impacted by physical activity. Four themes described social support processes that affected body image in the physical activity context: fitting in and being inspired through identifying with others; what is discussed and not discussed; providing comfort, understanding, and acceptance; and skilled and empathetic interactions with instructors. Understanding how social support in group physical activity can promote positive body image throughout aging can inform practical guidelines for facilitating and improving support in this context.

Rhinoplasty in a 3 Week Old: Surgical Challenges in the Setting of Severe Congenital Frontonasal Dysplasia.

OBJECTIVES: Congenital frontonasal dysplasia (CFND) is a rare heterogeneous collection of facial deformities. Due to the range of complexity, surgical management is not standardized. METHODS: We present a severe case of CFND and approach to managing multiple defects with a focus on rhinoplasty. RESULTS: This infant was born full term with a large mass instead of a nose, a bilateral cleft lip and palate, and hypertelorbitism. Our primary concerns initially were to address communication with the intracranial cavity, preserve a nasal lining, and improve nasal appearance and airway function in the short term without interfering with subsequent rhinoplasty and adult nasal appearance. CONCLUSIONS: This complex case of CFND is more severe than anything we encountered in our literature review and demonstrates the necessity for multidisciplinary approach to multiple craniofacial defects. Future plans for this patient include rhinoplasty with auricular graft, scar revision, and addressing tip support.

Influence of Tasking During Vestibular Testing.

Purpose The purpose of this study was to investigate the effectiveness of different types of tasking on the measurement of peak slow phase velocity (SPV) for caloric testing and rotary chair testing. Method This study evaluated the peak SPV response for caloric testing and rotary chair across five conditions. Three verbal, one tactile, and one condition without tasking were used for both caloric testing and rotary chair. The subjects consisted of 20 young adults (age range: 22-33 years, M = 26.65, SD = 3.72; seven male, 13 female) with normal vestibular function and no history of ear surgery or vestibular disorder. Study participation consisted of two visits with 24 hr minimum between each, one for caloric testing and one for rotary chair testing. The test completed at each visit was counterbalanced. Caloric Testing: The caloric irrigations were performed 5 times, with the ears randomized and tasking conditions randomized. Rotary Chair Testing: Rotary chair sinusoidal harmonic acceleration testing was performed 5 times at 0.08 Hz with the tasking conditions randomized. Results Tasking of any kind resulted in significantly larger peak SPV responses when compared to the no tasking condition for rotary chair testing. When comparing each type of tasking, no significant differences were noted. No significant difference was noted when comparing the conditions with tasking to the no tasking condition for caloric testing. Conclusions Clinically, either mental or tactile tasking can be utilized as a method to reduce VOR suppression during rotary chair testing. As no difference was found when comparing different verbal tasks to each other, the type of tasking can be catered to the patient. If verbal tasking cannot be completed, the braiding tactile task is a valid substitution. Caloric results varied widely across subjects and did not reach statistical significance, so conclusions on the need for tasking cannot be drawn.

Experiences With Social Participation in Group Physical Activity Programs for Older Adults.

Little is known about how social participation can be facilitated among older adults in group physical activity and its psychosocial benefits that contribute to successful aging. This study aimed to understand older adults' experiences with social participation in group physical activity programs. Using interpretive description methodology, 16 observations, eight focus groups, and two interviews with participants unable to attend focus groups were conducted with adults 55 years and older attending programs across four recreation facilities. Group programs were found to influence social participation through (a) a meaningful context for connecting and (b) instructors' expectations of social interaction. Social participation in these programs addressed psychosocial needs by (c) increasing social contact and interaction, (d) fostering social relationships and belonging, and (e) promoting regular engagement. Training for instructors should include balancing the physical aspects of program delivery with the social, while also considering older adults' diverse needs and preferences for social interaction.

Infectious titres of human papillomaviruses (HPVs) in patient lesions, methodological considerations in evaluating HPV infectivity and implications for the efficacy of high-level disinfectants.

BACKGROUND: Recent publications from a single research group have suggested that aldehyde-based high-level disinfectants (HLDs), such as ortho-phthalaldehyde (OPA), are not effective at inactivating HPVs and that therefore, patients may be at risk of HPV infection from medical devices. These results could have significant public health consequences and therefore necessitated evaluation of their reproducibility and clinical relevance. METHODS: We developed methods and used standardised controls to: (1) quantify the infectious levels of clinically-sourced HPVs from patient lesions and compare them to laboratory-derived HPVs, (2) evaluate experimental factors that should be controlled to ensure consistent and reproducible infectivity measurements of different HPV genotypes, and (3) determine the efficacy of select HLDs. FINDINGS: A novel focus forming unit (FFU) infectivity assay demonstrated that exfoliates from patient anogenital lesions and respiratory papillomas yielded infectious HPV burdens up to 2.7 × 103 FFU; therefore, using 2.2 × 102 to 1.0 × 104 FFU of laboratory-derived HPVs in disinfection assays provides a relevant range for clinical exposures. RNase and neutralising antibody sensitivities were used to ensure valid infectivity measures of tissue-derived and recombinant HPV preparations. HPV infectivity was demonstrated over a dynamic range of 4-5 log10; and disinfection with OPA and hypochlorite was achieved over 3 to >4 log10 with multiple genotypes of tissue-derived and recombinant HPV isolates. INTERPRETATION: This work, along with a companion publication from an independent lab in this issue, address a major public health question by showing that HPVs are susceptible to HLDs. FUNDING: Advanced Sterilization Products; US NIH (R01CA207368, U19AI084081, P30CA118100).

Collaboration behaviors within interactive exercise groups.

OBJECTIVE: The purpose of this study was to gain a better understanding of collaboration behaviors within interactive exercise groups. DESIGN: Qualitative study. MAIN OUTCOME MEASURES: Using semi-structured interviews, 16 individuals who exercise in small groups (e.g., workout partners, participants of interactive fitness classes) were recruited to (a) reflect on their experiences of collaboration within this context, and (b) identify behaviors that members demonstrate that help each other perform exercise tasks and achieve their exercise-related goals. Data were analyzed using thematic analysis. RESULTS: We identified three overarching themes (and 14 subthemes) reflecting participants' perceptions and experiences of collaboration in exercise groups including 'motivation building', 'intragroup coaching', and 'personal support'. These collaboration behaviors were noted by participants as important in shaping their continued exercise adherence, enjoyment, and relatedness. CONCLUSION: This study advances knowledge of the specific ways in which individuals can work together effectively within interactive exercise groups and provides a novel means of understanding how the group environment might best be leveraged to support exercise behavior.

Program of Active Consumer Engagement in Self-Management in Epilepsy: Replication and extension of a self-management randomized controlled trial.

OBJECTIVE: The Program of Active Consumer Engagement in Self-Management in Epilepsy (PACES) is an evidenced-based self-management intervention for adults with epilepsy. Prior randomized controlled trial (RCT) data show that PACES reduces depression and improves self-management, self-efficacy, and quality of life for 6 months postprogram. The objective of this study was to replicate a PACES RCT with key extensions: more diverse patient pool from community-based epilepsy centers; option for telephone-based participation; and longer follow-up (12 months with booster support for intervention group), to examine duration of impact and inform dissemination and implementation. METHODS: Participants were adults with chronic epilepsy (n = 101) without serious mental illness or substantive intellectual impairment, recruited from three epilepsy centers. Participants were randomly assigned to intervention or waitlist control groups. Outcomes included the Epilepsy Self-Management Scale (ESMS), Epilepsy Self-Efficacy Scale (ESES), Quality of Life in Epilepsy-31, Patient Health Questionnaire-9, and Generalized Anxiety Disorder-7, administered at baseline, postintervention (8 weeks), and 6 and 12 months postintervention. Intervention was an 8-week group of five to eight adults co-led by a psychologist and trained peer with epilepsy that met once per week by teleconference or in person at a hospital for 60-75 minutes. Topics included medical, psychosocial, cognitive, and self-management aspects of epilepsy, as well as community integration and epilepsy-related communication. Treatment group provided program evaluation. RESULTS: PACES participants (n = 49) improved relative to controls (n = 52) on the ESES (P < .022) and overall distress composite (P = .008). At 6 months, PACES participants remained improved on the ESES (P = .008) and composite (P = .001), and were improved on the ESMS (P = .005). At 12 months, PACES participants remained improved on the ESMS (P = .006) and were improved on an overall distress composite of combined measures (P = .018). Attrition was low (<6% in each group), and all program satisfaction ratings exceeded 4.0/5.0. SIGNIFICANCE: A consumer-generated epilepsy self-management program with broad psychosocial and medical emphasis can be effectively delivered by telephone or in person and facilitates long-term epilepsy self-management, adjustment, and coping up to 1 year after treatment.