Client-reported challenges and opportunities for improved antiretroviral therapy services uptake at a secondary health facility in Ghana.

Antiretroviral therapy (ART) regimens in African countries, including Ghana, are often faced with the challenge of treatment default. To maximize ART utilization and efficiency among people living with HIV (PLHIV), it is pertinent to ensure that ART-related challenges that clients encounter are identified and addressed holistically. A phenomenological qualitative study of thirty participants recruited through the purposive sampling technique was conducted using in-depth interviews from June to July 2021. Independent coding was done using Atlas ti. Sub-themes were developed from the codes, using the most expressive phrases, and grouped under two broad themes, challenges, and opportunities to maximise ART uptake. Ten different challenges, grouped into the health system and individual constraints were reported. Health system constraints included stigmatisation and discrimination by healthcare workers, queuing outside while waiting to be served, long waiting periods, non-communication of laboratory test results to clients, lack of proper education on side effects associated with ART, and language barrier. Individual constraints included financial constraints, perceived non-improvement in health outcomes, food insecurity, and forgetfulness. Opportunities identified for improved ART uptake were assuring ART clients of improved health outcomes, leveraging the good rapport between ART clients and healthcare providers, leveraging the better counselling services offered to PLHIV at the ART clinic, provision of varied ART treatment regimens to clients, routine communication of laboratory test results to clients, and leveraging clients' satisfaction with ART services at ART clinic. We recommend health system reforms targeting healthcare service delivery to PLHIV to encourage linkage, continuity, and retention in care and augmenting ART regimes with financial and nutritional support while encouraging status disclosure to a trusted family member.

A research on copyright issues impacting artists emotional states in the framework of artificial intelligence.

Art and artistic creation serve as a means for artists to communicate with their environment, society, and the external world. However, the protection of artistic creations, as forms of communication, is not only a right for artists but also serves as a crucial safeguard that nurtures them during the creative process. Beyond the traditional issues of copyright, the significant advancements in Artificial Intelligence (AI) in today's digital world have introduced a new debate regarding the ownership of copyright in artistic creations generated by AI. The question arises whether copyright belongs to the AI itself or to the individuals who guide the creative process behind it. In this study, based on the concepts of art, artistic creation, and emotional states, copyright issues will be examined. Data obtained from semi-structured in-depth interviews with artists and academic experts (eight artists, two communication experts, two law experts, and eight psychology experts) in the field will be analysed through content analysis to explore their perspectives regarding the discussion on emotional states, AI, and copyrights. The research highlights the variability of emotional states and their significant effects on individuals. Addressing the increasing trend of copyright issues, particularly within the framework of digitalization and inadequate legal regulations, it was found that artists' emotional states are negatively impacted by these problems. This negative influence can adversely affect artists' creativity and desire to produce. On the other hand, it was also identified that in artworks produced especially through AI, if artists' rights are not protected, there is a possibility of negative emotional states arising. In conclusion, suggestions are as follows: Emphasising the importance of awareness-raising educational activities nationally and internationally, national copyright law (in Northern Cyprus) needs to be revised to protect traditional copyright and be expanded to include digital copyright, especially for works produced through AI. On an international level, emphasising the need to revise international agreements to include regulations for works produced through AI or to create a new agreement based on the importance of this issue.

Prevalence and patterns of echocardiographic abnormalities among people living with HIV on anti-retroviral therapy in Kumasi, Ghana.

BACKGROUND: Echocardiography can be used to screen, confirm, and assist in the management of some cardiovascular diseases in people living with human immunodeficiency virus (HIV) (PLWH). Thus, complications from subclinical cardiovascular conditions or more apparent conditions, such as massive pericardial effusion with tamponade, can be promptly identified and managed to minimize cardiovascular morbidity and mortality associated with HIV infection. Since the introduction of antiretroviral therapy (ART) in Ghana approximately two decades ago, studies on the prevalence and patterns of echocardiographic abnormalities among PLWH on ART have been limited. This study was designed to assess the prevalence and patterns of echocardiographic abnormalities among PLWH on ART. METHODS: This was a cross-sectional study. PLWH on ART (cases) attending the HIV clinic at Komfo Anokye Teaching Hospital (KATH) and HIV-negative blood donors (controls) were consecutively recruited and enrolled in this study. The interviews were performed via a standardized questionnaire. After a clinical examination was performed, all patients underwent two-dimensional (2D) and Doppler transthoracic echocardiograms. The prevalence and patterns of echocardiographic abnormalities were characterized. RESULTS: There were 117 patients in each arm of the study. There were more females than males among both the cases (92 (78.6%) and controls (80 (68.4%)); however, the sex distribution was similar between the two groups (p = 0.075). For clinical characteristics such as age, weight, height and blood pressure, there were no statistically significant differences between the cases and controls. Echocardiographic abnormalities were more frequently observed and demonstrated a statistically significant difference between cases and controls, with an overall prevalence of 35.0% among cases and 19.7% among controls (p = 0.008). The echocardiographic abnormalities that demonstrated significant differences between the cases and controls were left ventricular (LV) diastolic dysfunction (28.2% versus 8.6%; p = 0.000) and LV hypertrophy (7% versus 0.9%; p = 0.017). CONCLUSION: Nearly 1 in 3 PLWH on ART had an echocardiographic abnormality in this Ghanaian study. Echocardiograms are recommended as helpful screening modalities for diagnosing cardiac abnormalities among PLWH on ART.

Field Exploration for Colony Selection: Evaluating Hygienic Behavior in Apis cerana indica Colonies.

Hygienic behavior (HB) emerges as a pivotal trait, impacting colony resistance to diseases. This study aimed to understand the behavioral traits of Apis cerana indica colonies, with a focus on HB and other key characteristics crucial for colony health, and to screen and identify colonies with superior hygienic behavior and better performance to combat prevailing diseases and pests. This research spans a comprehensive field analysis with different seasons and locations, encompassing the distinct environmental and management factors that influence honey bee behavior. The inclusion of A. cerana indica colonies from various locations provides a novel perspective, offering valuable insights regarding the hygienic behavior of A. cerana indica. Several statistical analyses, including descriptive statistics, principal component analysis (PCA), and Aligned Rank Transformation-Analysis of Variance (ART-ANOVA) for repeated measures, shed light on the distribution of hive metrics, emphasizing the significance of considering seasonality and location-specific factors. PCA highlights unique characteristics in Tirupur and Coimbatore colonies, while correlation analyses uncover relationships among HB, honey, pollen, brood area, and adult population. Moreover, the study's nuanced findings gave the status of hygienic behavior of A. cerana indica colonies and identified colonies with better colony performance, which will be useful for future breeding programs with A. cerana indica.

What Do the General Public Know about Infertility and Its Treatment?

Rates of infertility are rising, and informed decision making is an essential part of reproductive life planning with the knowledge that ART success decreases dramatically while a woman's age increases and that high costs can often be incurred during fertility treatment. We aimed to determine the current knowledge of infertility and its treatments in the general public through an online survey. We received 360 complete responses. The average age of respondents was 35 years with most respondents being female (90%), heterosexual (88%), white (85%) and university educated (79%). Of the total, 49% had children and 23% had a condition that affects their fertility; 41% had concerns about future fertility and 78% knew someone who had had fertility treatment. Participants' understanding of basic reproductive biology and causes of infertility varied with correct responses to questions ranging from 44% to 93%. Understanding of IVF outcomes was poorer with only 32% to 55% of responses being correct, and 76% of respondents felt that their education in fertility was inadequate. This survey highlights the inconsistencies in the general public's understanding of infertility in this relatively educated population. With increasing demands on fertility services and limited public funds, better education is essential to ensure patients are fully informed with regard to their reproductive life planning.

Associations between Body Segment Mass and Punch, Front Kick, or Countermovement Jump Performance in Military Cadets.

Despite the recognized influence of body mass on combat techniques, the relationship between body segment mass (BSM) and combat moves remains unexplored. This study aimed to examine the relationship between the striking arm mass (SAM), kicking leg mass (KLM), and body mass (BM) and the dynamic forces of direct punch (DP), palm strike (PS), elbow strike (ES), front kick (FK), and countermovement jump (CMJ) performance. Sixteen male military cadets (22.3 ± 1.8 years, 181.4 ± 7.0 cm, 82.1 ± 8.5 kg) performed combat techniques, with their performance measured by using a force plate and their body segment mass assessed by dual-energy X-ray absorptiometry. Spearman's correlation analysis, the Wilcoxon test, and Cohen's d were applied. The results indicated the relationship between the KLM or BM and the FK impulse (r = 0.64, p = 0.01; r = 0.52, p = 0.04, respectively) and CMJ impact force (r = 0.80, p ≤ 0.01; r = 0.70, p ≤ 0.01, respectively). The FK peak and impact forces were moderately correlated with the CMJ jump height (r = 0.74, p ≤ 0.01; r = 0.77, p ≤ 0.01). Moreover, the FK peak force was significantly higher than that for DP, PS, and ES (p ≤ 0.01, d = 3.32; p ≤ 0.01, d = 1.6; and p = 0.013, d = 1.3, respectively). The highest relationship was found between the KLM and the FK impulse; however, the difference in variability explained by the KLM versus the body mass was only 12%. This suggests that knowledge of the BSM did not provide a significantly better estimate of the dynamic forces of the punches and FKs than the knowledge of the BM.

A thing about karate in physical culture.

This paper deals with karate activity in the areas of physical culture in the broad sense. It is a concise and clear approach to the topic, which aimed to conceptualise the inclusion of karate in areas of physical culture as a contemporarily attractive physical activity. Karate was described here as a combat sport, martial art, and self-defence system in the following areas of physical culture: physical education, physiotherapy, recreation, sports, and tourism. Reference here was made to physical activity focused on bunkai (circuit interpretation exercises), kata (circuit exercises), kihon (technical exercises), and kumite (combat exercises). It has been determined that practitioners' involvement in karate culture affects their level of sense of coherence. In addition, the conditioning for using karate in physical culture to the maintenance of health was mentioned. Here, reference was made to the perceptual perspective of the bodily and mental practice of karate for health. It has been established that this can be effective by adopting only the objectives of karate as martial art. Based on the above, it was concluded that practising karate is present in all areas of physical culture as combat sport, martial art, and self-defence system, but practising karate only as martial art provides opportunities for maintenance of health.

Acute care nurses' decisions to recognise and respond to patient improvement: A qualitative study.

AIM: To explore and describe acute care nurses' decisions to recognise and respond to improvement in patients' clinical states as they occurred in the real-world clinical environment. DESIGN: A descriptive study. METHODS: Nine medical and eleven surgical nurses in a large Australian metropolitan hospital were individually observed during nurse-patient interactions and followed up in interview to describe their reasoning and clinical judgements behind observed decisions. Verbal description of observations and interviews were recorded and transcribed. Reflexive thematic analysis was used to analyse the data. RESULTS: The three themes constructed from the data were as follows: nurses checking in; nurses reaching judgements about improvements; and nurses deciding on the best person to respond. Acute care nurses made targeted assessment decisions based on predicted safety risks related to improvement in clinical states. Subjective and objective cues were used to assess for and make judgements about patient improvement. Acute care nurses' judgment of patient safety and a desire to promote patient centred care guided their decisions to select the appropriate person to manage improvement. CONCLUSIONS: The outcomes of this research have demonstrated that the proven safety benefits of acute care nurses' decision making in response to deterioration extend to improvement in patients' clinical states. In response to improvement, acute care nurses' decisions protect patients from harm and promote recovery. IMPLICATIONS FOR PATIENT CARE: Early recognition and response to improvement enable acute care nurses to protect patients from risks of unnecessary treatment and promote recovery. IMPACT: This study makes explicit nurses' essential safety role in recognising and responding to improvement in patients' clinical states. Healthcare policy and education must reflect the equal importance of assessment for and management of deterioration and improvement to ensure patients are protected and provided with safe care.

Histopathologic characteristics of term placentas in singleton pregnancies in women with endometriosis-related infertility after ART treatment: case-control study.

OBJECTIVES: Endometriosis is one of the leading causes of infertility, due to negative impact on ovarian folliculogenesis and endometrial receptivity. Literature show that endometriosis could be associated with perinatal complications such as preterm birth (PTB) and preeclampsia (PE). Authors hypothesized that women with endometriosis-related infertility conceived by assisted reproductive technology (ART) treatment have higher frequency of placental disorders. Main outcome is the occurrence of histopathologic alterations of term placentas in singleton pregnancies of women with endometriosis conceived by ART treatment, compared to healthy women with infertility due to male factor (MF) conceived by ART and to healthy women with spontaneous pregnancies. Secondary outcome include the occurrence of perinatal complications and the relationship of endometriosis and placental histopathologic characteristics. METHODS: Single-center, case-control study of term placentas that were collected within Department of Obstetrics and Gynecology of University Hospital Center (UHC) Split and analyzed in the Pathology department of the same hospital, by one senior perinatal pathologist. Histopathologic analysis was reported using Amsterdam Placental Workshop Group Consensus. All the noted placental lesions were divided into following categories: anatomic, inflammatory, villous maturation and vascular malperfusion disorders. Required sample size was 80 placentas, and study results were reported with descriptives, and analyzed with chi-squared, Fisher's exact test and Kruskal-Wallis ANOVA. Multivariate regression analysis was carried with adjustment for confounding factors. Ethics approval: Class n. 520-03/24-01/83. RESULTS: Study included term placentas of 107 women, of which 36 were women with endometriosis conceived by ART, 31 were healthy women with MF infertility conceived by ART and 40 healthy women with spontaneous pregnancies. Endometriosis women were predominantly primiparas, with longer infertility duration. Endometriosis group had higher occurrence of early pregnancy bleeding and imminent preterm labor. Endometriosis and MF groups had higher occurrence of Cesarian delivery (CS), while endometriosis group had newborns with lowest birthweight. Endometriosis group had shorter placental cords (PC), higher rates of increased syncytial knotting and vascular malperfusion disorders (subchorionic and perivillous fibrin, intervillous thrombosis, high grade fetal vascular malperfusion). Finally, endometriosis is showed to be associated with increased syncytial knots' formation and PC hypercoiling, after adjustment for confounding factors in the multivariate regression analysis. CONCLUSIONS: Despite low rates of perinatal complications, we report endometriosis to have higher occurrence of increased syncytial knotting and vascular malperfusion placental disorders, compared to control groups. Endometriosis is also associated with increased syncytial knotting and PC hypercoiling. Further studies are needed to elucidate the endometriosis impact on endometrial receptivity and immunopathogenesis in placental disorders and perinatal complications.HighlightsEndometriosis women were predominantly primiparas, with longer infertility duration.Endometriosis group had higher occurrence of early pregnancy bleeding and imminent preterm labor. Moreover, endometriosis and MF groups had higher occurrence of Cesarian delivery, while endometriosis group had newborns with lowest birthweight.Endometriosis group had shorter placental cords, higher rates of increased syncytial knotting and vascular malperfusion lesions.Endometriosis is showed to be associated with increased syncytial knots formation and hypercoiling of placental cord, after adjustment for confounding factor.

The art, science and technology studies movement: An essay review.

This is a review essay based primarily on the 2021 Routledge Handbook of Art, Science, and Technology Studies, edited by Hannah Star Rogers, Megan K. Halpern, Dehlia Hannah, and Kathryn de Ridder-Vignone. It focuses particularly on the use of art for public engagement with science and technology and it also draws upon the following books: Dialogues Between Artistic Research and Science and Technology Studies (2023), edited by Henk Borgdorff, Peter Peters, and Trevor Pinch, Making Art Work: How Cold War Engineers and Artists Forged a New Creative Culture (2020) by Patrick McCray, and Art, Science, and the Politics of Knowledge (2022), by Hannah Star Rogers.

RGB Color Model: Effect of Color Change on a User in a VR Art Gallery Using Polygraph.

This paper presents computer and color vision research focusing on human color perception in VR environments. A VR art gallery with digital twins of original artworks is created for this experiment. In this research, the field of colorimetry and the application of the L*a*b* and RGB color models are applied. The inter-relationships of the two color models are applied to create a color modification of the VR art gallery environment using C# Script procedures. This color-edited VR environment works with a smooth change in color tone in a given time interval. At the same time, a sudden change in the color of the RGB environment is defined in this interval. This experiment aims to record a user's reaction embedded in a VR environment and the effect of color changes on human perception in a VR environment. This research uses lie detector sensors that record the physiological changes of the user embedded in VR. Five sensors are used to record the signal. An experiment on the influence of the user's color perception in a VR environment using lie detector sensors has never been conducted. This research defines the basic methodology for analyzing and evaluating the recorded signals from the lie detector. The presented text thus provides a basis for further research in the field of colors and human color vision in a VR environment and lays an objective basis for use in many scientific and commercial areas.

Individual characteristics in arts management careers: investigating the highly sensitive person scale on motivation to lead.

Research on personality in leadership indicates that self-selection to leadership careers and artistic careers correlates with diverging personality profiles. People in leadership careers traditionally display lower neuroticism and higher conscientiousness than artistic individuals. In between, there are individuals entering arts management careers. To study these individuals directly, we collected Norwegian data from 91 musical theater students and 102 arts management students and compared with 109 business management students. As expected, conscientiousness and neuroticism predicted artistic careers against business management careers, aligned with the "arts for arts' sake" myth of artists. Interestingly, arts management careers were not different from artistic careers. They weren't more motivated to take on leadership roles than performing artists either. However, the Highly Sensitive Person Scale indicated that narrower traits of sensitivity predicted higher levels of motivation to lead in many artists. Some arts and arts management students seem to bring unique talents into forms of leadership particularly useful for artistic organizations. Our findings are discussed in terms of how leadership characteristics operate in the field of art, and the effect of domain-specific characteristics in this setting.

Are Art-Based Interventions Effective in Improving Psychological Well-Being Among Informal Caregivers of Cancer Patients? A Systematic Review.

Objectives: To systematically synthesize the current evidence on the effects of art-based interventions on improving anxiety, depression, stress, sleep, and well-being of cancer caregivers. Design: A systematic review. Methods: We searched PubMed, EMBASE, Web of Science, CINAHL, PsycINFO, and Cochrane Central Register of Controlled Trials databases from their inception up to April 2024. Studies exploring the effects of art-based interventions on the psychological symptoms of cancer caregivers were included. We did not restrict the publication to the particular study designs, including randomized controlled trials, quasiexperimental studies, and qualitative studies. Results: Fifteen studies of 607 participants were identified in this systematic review. Overall, the existing studies provided preliminary evidence to suggest that art-based interventions may benefit cancer caregivers in improving anxiety, depression, stress, caregiver burden, and quality of life. However, the relatively low quality of the current evidence limits the efficacy of these findings. Conclusions: According to the existing evidence, the therapeutic benefits of using art-based interventions for improving the psychological well-being of cancer caregivers are uncertain. More high-quality and well-designed studies are still required to confirm the psychological effectiveness of art-based interventions for cancer caregivers in the future.

Trends and correlates in HIV viral load monitoring and viral suppression among adolescents and young adults in Dar es Salaam, Tanzania.

BACKGROUND: Adolescents and young adults (AYA) living with HIV have been shown to have lower rates of viral load testing and viral suppression as compared to older adults. We examined trends over time and predictors of HIV viral load monitoring and viral suppression among AYA in a large HIV treatment programme in Dar es Salaam, Tanzania. METHODS: We analysed longitudinal data of AYA aged 10-24 years initiated on antiretroviral therapy between January 2017 and October 2022. Trend models were used to assess changes in HIV viral load testing and viral suppression by calendar year. Generalised estimating equations were used to examine the relationship of sociodemographic and clinical factors with HIV viral load testing and viral suppression. RESULTS: Out of 15,759 AYA, the percentage of those who received a 6-month HIV viral load testing increased from 40.6% in 2017 to 64.7% in 2022 and, a notable annual increase of 5.6% (p < 0.001). A higher HIV viral load testing uptake was observed among 20- to 24-year-olds (87.7%) compared to 10- to 19-year-olds (80.2%) (p < 0.001). The likelihood of not receiving an HIV viral load test within 12 months of antiretroviral therapy initiation was higher among 10- to 19-year-olds (adjusted odds ratio [aOR] = 1.7; 95% confidence interval [CI] = 1.4-2.0), advanced HIV disease (aOR = 1.3; 95% CI = 1.12-1.53), normal nutrition status at enrolment aOR 2.6 (95% CI = 1.59-4.26) and initiation of non-nucleoside reverse transcriptase inhibitors regimen aOR 1.2 (95% CI = 1.08-1.34). The proportion of AYA with viral suppression increased from 83.0% in 2017 to 94.6% in 2022. Notably, the overall trend in viral suppression increased significantly at 2.4% annually. The risk of not achieving viral suppression was greater among 10- to 14-year-olds (aOR = 2; 95% CI = 1.75-2.43) and 15- to 19-year-olds (aOR = 1.4; 95% CI = 1.24-1.58) as compared to 20-24 years; being male (aOR = 1.16; 95% CI = 1.02-1.32); undernourished (aOR = 1.53; 95% CI = 1.17-1.99); in WHO Stage II (aOR = 1.16; 95% CI = 1.02-1.33) and III (aOR = 1.21; 95% CI = 1.03-1.42) and being on an non-nucleoside reverse transcriptase inhibitors regimen (aOR = 1.32; 95% CI = 1.18-1.48). CONCLUSION: HIV viral load testing uptake at 6 months of antiretroviral therapy initiation and viral suppression increased from 2017 to 2022; however, overall HIV viral load testing was suboptimal. Demographic and clinical characteristics can be used to identify AYA at greater risk for not having HIV viral load test and not achieving viral suppression.

Mental Healthcare in Pediatrics During the COVID-19 Pandemic: A Call for International Public Health Action.

Public health measures associated with coronavirus disease 2019 (COVID-19), such as lockdowns and quarantine of suspected cases, can negatively affect children's mental health status. Although the current crisis provides personal growth and family cohesion opportunities, pitfalls appear to outweigh the benefits. The magnitude and quality of its impact on children depend on several factors, including anxiety, lack of social contact, and a reduced opportunity for stress regulation, along with an increased risk for parental mental health issues, child maltreatment, and domestic violence. Children with special needs and social disadvantages like trauma experiences, disabilities, pre-existing mental illness, e.g., autism spectrum disorders and hyperactivity, and low socioeconomic status, may be at higher risk in this context. Here, the potentials social support can provide for pediatrics, both healthy children and children with special needs, are reviewed after an overview of quarantine's adverse effects on this special population during a pandemic. The most common psychological issues associated with the COVID-19 pandemic are sleep disorders, mood swings, depression, anxiety, decreased attention, stress, irritability, anger, and fear. Moreover, the impact of COVID-19 on children's physical health includes weight gain, reduced physical activity, immune dysregulation, and cardiometabolic disorders. All support systems, involving parents, teachers/school counselors, pediatricians, mental healthcare workers, and Health and Art (HEART) groups, need to enter the scene and make their share of children's mental health care.

Aesthetic valence: Psychophysical perspectives.

Comparisons of aesthetic valence and of sensory magnitude are subject to similar order effects, indicating an evolved mechanism that sharpens also aesthetic discrimination. As the foundation of pleasantness and aesthetic valence of an object, an optimal level of evoked arousal or, in more recent research, of information load, has been proposed. According to discrepancy theory, this evoked effect is modulated by the object's deviation from the current adaptation level (AL). The AL is built up and updated by pooling recent stimulation. A model based on these concepts is proposed here, and it is illustrated by results of empirical studies by the author's students. For everyday objects such as cars and ladies' clothes, rated beauty was related by a U-shaped function to rated modernity. Minimal beauty occurred for intermediate modernity. For ladies' clothes, this minimum was situated higher on the modernity scale for females and extraverts. As modernity can be seen as the amount of deviation from the AL which represents the usual, this shift could be explained by faster upward adjustment of the AL. In contrast, for paintings the relation between modernity and beauty was inversely U-shaped. This could be due to paintings intrinsically carrying more information than other objects, as indicated by ratings of hard-to-access, with which rated beauty had an inverse U-shaped relation. In a factor-analytic study of preference for 42 paintings four orthogonal factors were extracted, interpreted as High and Low modernity, and High and Low information content. This could yield a rudimentary empirical typology of art.

Embryonic aneuploidy - the true "last barrier in assisted reproductive technology"?

Human embryonic aneuploidy may represent one of the final frontiers in assisted reproductive technology (ART), primarily secondary to oocyte aneuploidy. Mammalian oocytes possess unique characteristics predisposing them to much higher rates of aneuploidy than sperm or most somatic cells. Some of these characteristics are age-independent, while others result from reproductive aging and environmental toxicity. A detailed understanding of these properties may lead to novel diagnostic and therapeutic tools designed to detect and prevent oocyte and embryonic aneuploidy, to overcome this ultimate barrier to success in ART.

Empowering Health and Identity: The Vital Role of Gender-affirming Care for Individuals With HIV.

Comprehensive healthcare for all includes gender-affirming hormone therapy for transgender and nonbinary individuals. It is the unique privilege of HIV providers, who take care of a disproportionate number of transgender people, to provide gender-affirming hormone therapy along with antiretroviral therapy. It could increase viral suppression rates, increase overall health outcomes, and decrease gender health disparities.

Validation of MLC leaf open time calculation methods for PSQA in adaptive radiotherapy with tomotherapy units.

BACKGROUND: Treatment delivery safety and accuracy are essential to control the disease and protect healthy tissues in radiation therapy. For usual treatment, a phantom-based patient specific quality assurance (PSQA) is performed to verify the delivery prior to the treatment. The emergence of adaptive radiation therapy (ART) adds new complexities to PSQA. In fact, organ at risks and target volume re-contouring as well as plan re-optimization and treatment delivery are performed with the patient immobilized on the treatment couch, making phantom-based pretreatment PSQA impractical. In this case, phantomless PSQA tools based on multileaf collimator (MLC) leaf open times (LOTs) verifications provide alternative approaches for the Radixact® treatment units. However, their validity is compromised by the lack of independent and reliable methods for calculating the LOT performed by the MLC during deliveries. PURPOSE: To provide independent and reliable methods of LOT calculation for the Radixact® treatment units. METHODS: Two methods for calculating the LOTs performed by the MLC during deliveries have been implemented. The first method uses the signal recorded by the build-in detector and the second method uses the signal recorded by optical sensors mounted on the MLC. To calibrate the methods to the ground truth, in-phantom ionization chamber LOT measurements have been conducted on a Radixact® treatment unit. The methods were validated by comparing LOT calculations with in-phantom ionization chamber LOT measurements performed on two Radixact® treatment units. RESULTS: The study shows a good agreement between the two LOT calculation methods and the in-phantom ionization chamber measurements. There are no notable differences between the two methods and the same results were observed on the different treatment units. CONCLUSIONS: The two implemented methods have the potential to be part of a PSQA solution for ART in tomotherapy.