Risk evaluation of secondary malignancies after radiotherapy of breast cancer in light of the continuous development of planning techniques.

Secondary cancer risk is a significant concern for women treated with breast radiation therapy due to improved long-term survival rates. We evaluated the potential of new advanced automated planning algorithms together with hybrid techniques to minimize the excess absolute risk (EAR) for secondary cancer in various organs after radiation treatment for early staged breast cancer. Using CT data set of 25 patients, we generated 4 different radiation treatment plans of different complexity, including 3-dimensional conformal radiotherapy (3D-CRT), field-in-field (FinF), hybrid-IMRT (HMRT) and automated hybrid-VMAT (HVMAT) techniques. The organ-equivalent dose (OED) was calculated from differential dose-volume histograms on the basis of the "linear-exponential," "plateau," and "full mechanistic" dose-response models and was used to evaluate the EAR for secondary cancer in the contralateral breast (CB), contralateral lung (CL), and ipsilateral lung (IL). Statistical comparisons of data were performed by a Kruskal-Wallis analysis of variance. The planning objectives were fulfilled with all the planning techniques for both target coverage and organs-at-risk sparing. The differences in EAR for CB, CL and IL secondary tumor induction were not significant among the 4 techniques. For the CB and CL, the mean absolute difference did not reach 1 case of 10000 patient-years. For the IL, the mean absolute difference was up to 5 cases of 10,000 patient-years. In conclusion, the automated HVMAT technique allows an EAR reduction at the level of well-consolidated tangential 3D-CRT or FinF techniques, keeping all the HVMAT dosimetric improvements unchanged. On the basis of this analysis, the adoption of the HVMAT technique poses no increase in EAR and could be considered safe also for younger patients.

Strategic Planning: Moving From Plan to Implementation.

Successful organizations depend on strategic thinkers who understand strategic planning and strategic management. These strategic leaders can proactively manage the constant environmental changes to position their organizations for a competitive advantage and avoid acting in a reactive and defensive manner. However, while organizations are often adept at developing extensive strategic plans, implementation of the plan is often poor or without a definitive strategy. This article addresses key strategies for successful implementation of changes to bring about sustainable cultural change in an organization to meet the organization's overall strategic goals, specifically through the use of implementation science.

As startups no contexto da organização capitalista financeira e as subjetividades empreendedoras / Startups in the context of financial capitalist organization and entrepreneurial subjectivities / Startups en el contexto de la organización capitalista financiera y subjetividades emprendedoras

As startups são empresas que apresentam modelos de negócios marcados pela inovação, rapidez, flexibilidade e alta capacidade de adaptação aos mercados. Atuando em diferentes setores socioeconômicos, elas prometem criar e transformar produtos e serviços. A emergência e disseminação dessas empresas ocorrem em um momento histórico de mudanças iniciadas a partir de 1970 e marcadas pelas crises geradas com o esgotamento do paradigma da sociedade urbano industrial. No Brasil, o número desse modelo de negócio apresentou uma expansão expressiva, alcançando a marca de 13.374 nos últimos cinco anos. Atento a esse cenário, o objetivo desta pesquisa consistiu em compreender como sujeitos, grupos e instituições atribuem sentidos à experiência de trabalho nas chamadas startups. Na parte teórica, as condições sociais e econômicas que possibilitaram a emergência e disseminação das startups são analisadas em uma perspectiva crítica. A parte empírica, por sua vez, apresenta depoimentos de empreendedores relatando o contexto geral de atuação nas startups. Ao final deste artigo, conclui-se que há uma instrumentalização capitalística de componentes subjetivos específicos selecionados e colocados em circulação para fortalecer o modo de produção capitalista financeirizado.(AU)

Startups are companies that have business models characterized by innovation, speed, flexibility, and a high capacity to adapt to markets. Operating in different socioeconomic sectors, they promise to create and transform products and services. The emergence and dissemination of these companies occur at a historical moment of changes that began from 1970 and are marked by the crises generated by the exhaustion of the paradigm of industrial urban society. In Brazil, the number of businesses in this model showed a significant expansion, reaching 13,374 companies in the last five years. Attentive to this scenario, the objective of this research was to understand how subjects, groups, and institutions attribute meanings to the work experience in so-called startups. In the theoretical part, the social and economic conditions that enabled the emergence and dissemination of startups are analyzed in a critical perspective. The empirical part presents entrepreneurs reporting the general context of action in startups. At the end of this article, it is concluded that there is a capitalistic instrumentalization of specific subjective components that are selected and put into circulation to strengthen the financed capitalist production.(AU)

Las startups son empresas que tienen modelos de negocio marcados por la innovación, la velocidad, la flexibilidad y una alta capacidad de adaptación a los mercados. Desde diferentes sectores socioeconómicos, las startups prometen crear y transformar productos y servicios. La aparición y difusión de estas empresas se produce en un momento histórico de cambios que comenzó a partir de 1970 y que está marcado por crisis generadas por el agotamiento del paradigma de la sociedad urbana industrial. En Brasil, estas empresas se expandieron significativamente alcanzando la marca de 13.374 empresas en los últimos cinco años. En este escenario, el objetivo de esta investigación fue entender cómo los sujetos, grupos e instituciones atribuyen significados a la experiencia laboral en las startups. En la parte teórica, se analizan las condiciones sociales y económicas que permitieron el surgimiento y la difusión de las startups en una perspectiva crítica. La parte empírica presenta testimonios de emprendedores que informan sobre el trabajo en startups. La investigación concluye que hay una instrumentalización capitalista de componentes subjetivos específicos que se seleccionan y ponen en circulación para fortalecer el modo de producción capitalista financiero.(AU)

Development and evaluation of a three-step automatic planning technique for lung SBRT based on performance examination of advanced settings in Pinnacle's auto-planning module.

The benefits of Pinnacle's auto-planning module on clinical practice have been well documented. However, little is known regarding the efficiency of its Advanced Settings and the practicality of incorporating this module into Stereotactic Body Radiation Therapy (SBRT), which is why this research was conducted. To characterize the impact of Advanced Settings on plan quality, a total of 25 previously delivered postoperative cervical cases were re-planned and evaluated. Then a three-step automatic planning technique was developed and tested on ten lung SBRT cases based on the investigation. The differences between plans with fine-tuned Advanced Settings and the default were compared using a Wilcoxon signed-rank test with a significance threshold of 5%. The same statistical analysis was implemented to examine the quality variations in manual and automatic SBRT planning. When the Tuning Balance, Dose Fall-Off Margin, and Hot-Spot Maximum Goal were set to 100%, 1 cm, and 250%, respectively, better organ-at-risk (OAR) sparing was reached, but target quality was compromised. The OAR dose reduction and target homogeneity deterioration showed a strong correlation. The three-step methodology improved high dose spillage while saving time, with statistically significant reductions of 66.7% in V105% of non-PTV and 58.1% in planning time to the human-driven strategy. Except for urgent requirements for sparing OARs or processing SBRT plans, keeping the default is appropriate for Advanced Settings. The three-step methodology automatically searches for the available solution with purposeful Advanced Settings adjustments, demonstrating its ability to produce high-quality plans in less time. For the inexperienced or under-resourced clinics, our procedure can be introduced as a robust and handy strategy in SBRT, notably for expedited quality planning.

Development and validation of a route planning methodology for vehicle-based remote measurements of methane and other emissions from oil and gas wells and facilities.

Multi-sensor vehicle systems have been implemented in large-scale field programs to detect, attribute, and estimate emissions rates of methane (CH4) and other compounds from oil and gas wells and facilities. Most vehicle systems use passive sensing; they must be positioned downwind of sources to detect emissions. A major deployment challenge is predicting the best measurement locations and driving routes to sample infrastructure. Here, we present and validate a methodology that incorporates high-resolution weather forecast and geospatial data to predict measurement locations and optimize driving routes. The methodology estimates the downwind road intersection point (DRIP) of theoretical CH4 plumes emitted from each well or facility. DRIPs serve as waypoints for Dijkstra's shortest path algorithm to determine the optimal driving route. We present a case study to demonstrate the methodology for planning and executing a vehicle-based concentration mapping survey of 50 oil and gas wells near Pecos, Texas. Validation was performed by comparing DRIPs with 174 CH4 plumes measured by vehicle surveys of oil and gas wells and facilities in Alberta, Canada. Results indicate median Manhattan distances of 145.8 m between DRIPs and plume midpoints and 160.3 m between DRIPs and peak plume enhancements. A total of 46 (26%) of the plume segments overlapped DRIPs. Locational errors of DRIPs are related to misattributions of emissions sources and discrepancies between modeled and instantaneous wind direction measured when the vehicle intersects plumes. Although the development of the methodology was motivated by CH4 emissions from oil and gas facilities, it should be applicable to other types of point source air emissions from known facilities.Implications: This paper presents and validates a method that addresses the challenge of measuring industrial emissions from public roads. The method can increase the effectiveness and efficiency of targeted vehicle-based emissions surveys where the locations of potential sources are known. We believe the method has broad application in addition to the upstream oil and gas context it was designed for.

Tackling communication and analytical problems in environmental planning: Expert assessment of key definitions and their relationships.

Inadequate definition of key terms and their relationships generates significant communication and analytical problems in environmental planning. In this work, we evaluate an ontological framework for environmental planning designed to combat these problems. After outlining the framework and issues addressed, we describe its evaluation by a group of experts representing a range of expertise and institutions. Experts rated their level of agreement with 12 propositions concerning the definitions and models underpinning the framework. These propositions, in turn, were used to assess three assumptions regarding the expected effectiveness of the framework and its contribution to addressing the abovementioned planning problems. In addition to point-based best estimates of their agreement with propositions, expert ratings were also captured on a continuous interval-valued scale. The use of intervals addresses the challenge of measuring and modelling uncertainty associated with complex assessments such as those provided by experts. Combined with written anonymous expert comments, these data provide multiple perspectives on the level of support for the approach. We conclude that the framework can complement existing planning approaches and strengthen key definitions and related models, thus helping avoid communication and analytical problems in environmental planning. Finally, experts highlighted areas that require further development, and we provide recommendations for improving the framework.

A semi-automatic planning technique for whole breast irradiation with tangential IMRT fields.

PURPOSE: To implement a semi-automatic planning technique for whole breast irradiation with two tangential IMRT fields and to test the produced dose distribution against clinical 3DCRT plans, for introducing the technique in clinical practice. METHODS: The Auto-Planning module of the Pinnacle3 (Philips) treatment planning system was used for generating a Treatment Technique on left-sided breast cancer patients treated in free breathing or in deep inspiration breath hold (DIBH) and to right-sided breast cancer patients. The technique was evaluated against 3DCRT clinical plans in terms of dosimetric plan parameters. Plan robustness toward patient displacements was assessed on a subset of patients by inducing shifts to the isocenter. RESULTS: A statistically significant improvement in target coverage and dose homogeneity was observed for autoIMRT. No statistically significant differences were observed for ipsilateral organs, except for the ipsilateral lung in left DIBH, where slightly lower Dmean and V18% are registered for autoIMRT. Slightly higher Dmean doses (although far below the constraints) to contralateral organs were observed for autoIMRT plans. AutoIMRT plans were shown to be as robust as 3DCRT plans toward isocenter shifts, with a maximum decrease in CTV coverage of -2.2% and -2.1% for autoIMRT and 3DCRT, respectively. Average planning times were 40 min for 3DCRT and 6 min for IMRT plans. CONCLUSIONS: The developed autoIMRT technique was proven to be advantageous for target coverage and homogeneity and sufficiently robust towards isocenter displacements. The use of automated planning consistently reduces the planning workload with improvements in plan quality.

Reading Warm-Up, Reading Skill, and Reading Prosody When Reading the My Grandfather Passage: An Exploratory Study Born Out of the Motor Planning Theory of Prosody and Reading Prosody Research.

PURPOSE: The Motor Planning Theory of Prosody and reading prosody research indicate that "out of the blue" oral reading, as practiced in clinical and research settings, invokes surface rather than covert prosody, particularly when readers are recorded, less skilled, and/or speech impaired. Warm-up is not considered in passage reading for motor-speech assessment. We report on a preliminary study aimed to investigate the effect of warm-up on reading prosody in two conditions: silent reading alone and reading "out of the blue" followed by silent reading. A secondary aim of the study was to examine the effect of reading skill on reading prosody. METHOD: Twenty-one monolingual, English-speaking volunteers were recorded reading the My Grandfather Passage (GP) while their eye movements were tracked. Participants were randomly assigned to one of two reading conditions: (a) silent-oral (SO) and (b) oral-silent-oral (OSO). In the SO condition, participants read the GP silently as a warm-up for the subsequent oral reading. In the OSO condition, participants first read the GP aloud ("out of the blue") and then read the same passage silently with the instruction to do this in preparation for a second oral reading. Reading skill was quantified using eye-voice span and Wide Range Achievement Test-Fourth Edition testing. Reading prosody was evaluated using pause indexes, the Acoustic Multidimensional Prosody Index, and speech rate. CONCLUSIONS: One oral reading before a silent reading but not a silent reading alone before oral reading was shown to affect reading prosody. In terms of reading skill, results indicate that predictive associations patterned differently in the reading conditions explored, suggesting different underlying skill sets.

Retrospective evaluation of a robust hybrid planning technique established for irradiation of breast cancer patients with included mammary internal lymph nodes.

BACKGROUND: The irradiation of breast cancer patients with included internal mammary lymph nodes challenges radiation planning with regard to robustness and protection of OARs. In this publication, a feasible hybrid radiation technique is presented with a retrospective dosimetric and radiobiological analysis of patient data of our institute from 2016 to 2020 and robustness analysis. METHODS: The proposed hybrid irradiation technique consists of two IMRT tangents and two partial VMAT fields. The retrospective dosimetric and radiobiological evaluation are made for 217 patient treatments (right- and left-sided). The robustness is evaluated regarding an artificial swelling from 0.4 to 1.5 cm for a random example patient and compared to a pure VMAT planning technique with use of a virtual bolus. The out of field stray dose is calculated for a selected patient plan and compared to alternative radiation techniques. RESULTS: The coverage D95% of the PTVEval (with breast swelling of 1.5 cm) changes for the hybrid plan from 96.1 to 92.1% of prescribed dose and for the pure VMAT plan from 94.3 to 87%. The retrospective dosimetric evaluation of patient irradiations reveals a Dmean for total lung 6.5 ± 0.9 Gy (NTCP[Semenenko 2008] 2.8 ± 0.5%), ipsilateral lung 10.9 ± 1.5 Gy, contralateral lung 2.2 ± 0.6 Gy, heart 2.1 ± 1.1 Gy (ERR[Schneider 2017] 0.02 ± 0.17%) and contralateral breast 1.7 ± 0.6 Gy. The scatter dose of the hybrid irradiation technique is higher than for pure VMAT and lower than for pure IMRT irradiation. CONCLUSIONS: The feasibility of the proposed planning technique is shown by treating many patients with this technique at our radiotherapy department. The hybrid radiation technique shows a good sparing of the OARs in the retrospective analysis and is robust with regards to a breast swelling of up to 1.5 cm. The slightly higher stray dose of the hybrid technique compared to a pure VMAT technique originates from higher number of MUs and lower conformity.

Interorganizational Communication at Mass Gatherings: Professionals' Perceptions during the Planning and Implementation Stage of Marathon Events.

INTRODUCTION: Mass gatherings (MGs) often bring together professionals and organizations that collaborate irregularly or have never engaged in joint working. They involve interaction and communication among multiple and diverse services, which can often prove challenging. Planning such an event is of paramount importance for its success, and interorganizational communication ranks among its most important aspects. Nonetheless, there is limited empirical evidence to support interagency communication in MGs. OBJECTIVE: This study used the 2017 Athens Marathon (Athens, Greece) as the empirical setting to examine how interorganizational communication was perceived among the multiple public health and safety professionals during the planning and implementation phase of the event. METHODS: Data comprised 15 semi-structured in-depth interviews with key informants, direct observations of meetings and the event itself, and documentary analysis. Open coding and thematic analysis were used to analyze the data. RESULTS: Findings indicated three key components of interorganizational communication in such an event: (1) shared situational awareness; (2) interorganizational understanding; and (3) implementing liaison officers. CONCLUSION: This study outlined the factors that influenced interorganizational communication before and during a MG. Practical implications arising from this study may inform the way organizers of marathons and other mass sporting events can engage in effective interorganizational communication.

Implementation of volumetric-modulated arc therapy for locally advanced breast cancer patients: Dosimetric comparison with deliverability consideration of planning techniques and predictions of patient-specific QA results via supervised machine learning.

PURPOSE: The aim of this study was to implement a clinically deliverable VMAT planning technique dedicated to advanced breast cancer, and to predict failed QA using a machine learning (ML) model to optimize the QA workload. METHODS: For three planning methods (2A: 2-partial arc, 2AS: 2-partial arc with splitting, 4A: 4-partial arc), dosimetric results were compared with patient-specific QA performed with the electronic portal imaging device of the linac. A dataset was built with the pass/fail status of the plans and complexity metrics. It was divided into training and testing sets. An ML metamodel combining predictions from six base classifiers was trained on the training set to predict plans as 'pass' or 'fail'. The predictive performances were evaluated using the unseen data of the testing set. RESULTS: The dosimetric comparison highlighted that 4A was the highest dosimetric performant method but also the poorest performant in the QA process. 2AS spared the best heart, but provided the highest dose to the contralateral breast and lowest node coverage. 2A provides a dosimetric compromise between organ at risk sparing and PTV coverage with satisfactory QA results. The metamodel had a median predictive sensitivity of 73% and a median specificity of 91%. CONCLUSIONS: The 2A method was selected to calculate clinically deliverable VMAT plans; however, the 2AS method was maintained when the heart was of particular importance and breath-hold techniques were not applicable. The metamodel provides promising predictive performance, and it is intended to be improved as a larger dataset becomes available.

Os primeiros passos para a implementação de um banco de dentes humanos na Faculdade de Odontologia UFF / The first steps to implement a human teeth bank at Faculty of Dentistry - UFF

O Banco de Dentes Humanos (BDH) é uma instituição sem fins lucrativos, vinculada a uma faculdade, universidade ou instituição com o propósito de suprir as necessidades acadêmicas, através do fornecimento de dentes humanos para estudo e treinamento laboratorial dos alunos dos cursos de graduação e pós-graduação. Assim, o presente trabalho teve como objetivo relatar os métodos utilizados para captação, tratamento, seleção, preservação, armazenamento e reutilização de dentes humanos extraídos, realizados por alunos da Faculdade de Odontologia (FO) da Universidade Federal Fluminense (UFF) através de dois projetos deferidos junto a PROAES-UFF. Para isso, foram realizadas campanhas de conscientização e programas de divulgação para a doação de dentes humanos extraídos permanentes e decíduos tanto para a comunidade científica odontológica como para a comunidade leiga. Após 24 meses, foram captados um total de 2.536 dentes, sendo 346 molares superiores, 279 molares inferiores, 262 pré-molares superiores, 418 pré-molares inferiores, 343 caninos, 296 incisivos superiores e 592 incisivos inferiores. As campanhas e ações dos projetos da PROAES-UFF foram eficientes para coletar dentes humanos, suprindo as atividades laboratoriais de diversas disciplinas na graduação e também servindo de estoque para a futura implementação do BDH da FO-UFF.

The Human Teeth Bank (HTB) is a non-profit institution, linked to a college, university or institution with the purpose of meeting academic needs, through the provision of human teeth for study and laboratory training of undergraduate and postgraduate students. Thus, this study aimed to report the methods of capture, treatment, selection, preservation, storage and reuse of extracted human teeth, carried out by students from the Faculty of Dentistry (FO) of Universidade Federal Fluminense (UFF) through two projects approved by PROAES-UFF. To this end, awareness campaigns and outreach programs were carried out for the donation of human teeth extracted, permanent and deciduous, both for the dental scientific community and for the lay community. After 24 months, a total of 2,536 teeth were captured, with 346 upper molars, 279 lower molars, 262 upper premolars, 418 lower premolars, 343 canines, 296 upper incisors and 592 lower incisors. The campaigns and actions of PROAES-UFF projects were efficient in collecting human teeth, supplying the laboratory activities of several disciplines during graduation and also serving as a stock for a future implementation of the HTB of FO-UFF.

A Novel Approach to Virtual Surgical Planning for Mandibular and Midfacial Reconstruction With a Fibula Free Flap.

BACKGROUND: The fibula free flap is a major workhorse in facial reconstruction. To decrease operative times, virtual surgical planning (VSP) has been implemented. Traditional VSP is costly and may delay operative planning. in this study, the authors present a novel algorithm using readily accessible software packages to perform VSP in a manner that is quick and cost-effective. METHODS: A 6-part survey was administered to physicians with prior training in facial reconstruction. Fourteen physicians participated regarding outcomes on 10 patients who underwent mandibular or midfacial fibula free flap reconstruction. Participants were asked to match the true postoperative and VSP models and rate the similarity of the models using the Likert scale (0-10). The goal was to determine whether the VSP models accurately depicted the actual reconstruction, and whether they would use VSP in future clinical practice. RESULTS: The physicians surveyed were able to match the models correctly 93.6% of the time. The mean score for the similarity between virtual and actual models ranged between 7.60 and 8.80. Most participants (90.9%) who answered stated they would use our VSP algorithm if they were trained in the protocol. CONCLUSIONS AND RELEVANCE: Virtual surgical planning models were created utilizing our novel algorithm. Participants matched the preoperative VSP plan with the postoperative model most of the time and rated the similarity well. Participants in our study are interested in learning more about physician performed VSP. The authors believe this model may be financially and clinically relevant and serve as an excellent educational tool.

Potential gains: Comparison of a mono-isocentric three-dimensional conformal radiotherapy (3D-CRT) planning technique to hybrid intensity-modulated radiotherapy (hIMRT) to the whole breast and supraclavicular fossa (SCF) region.

INTRODUCTION: Until late 2018, standard of practice at the Northern Sydney Cancer Centre (NSCC) for breast and nodal treatment was a conformal mono-isocentric technique. A planning study comparing an existing mono-isocentric three-dimensional conformal radiotherapy (3D-CRT) planning technique to a hybrid intensity-modulated radiotherapy (hIMRT) approach for the whole breast and supraclavicular fossa (SCF) region was undertaken with the aim to improve plan quality by improving dose conformity/homogeneity across target volumes and reducing hotspots outside the target. METHODS: A cohort of 17 patients was retrospectively planned using the proposed hIMRT technique, keeping the same planning constraints as the original treated breast and SCF 3D-CRT plan and normalising the 3D-CRT plans to achieve minimum breast/SCF target coverage to compare organs at risk (OARs). Normal tissue index (NTI) and homogeneity index (HI) were compared for plan quality as well as for evaluating OARs. RESULTS: The hIMRT technique showed statistically significant improvements in NTI and HI, as well as improvement in maximum brachial plexus and thyroid doses. There was a negligible increase in maximum oesophagus dose which could be improved if used in optimisation. Other OAR doses in the irradiated region were comparable to the 3D-CRT plans, however maximum doses were reduced overall. CONCLUSION: The hIMRT planning technique maintained clinically acceptable doses to OARs and reduced normal tissue dose while maintaining equivalent dose coverage to breast and SCF planning target volumes with improved conformity and homogeneity. The reduction in maximum doses promotes a favourable toxicity profile, with potential benefit of improved long-term cosmesis.

Virtual reality surgical planning for endoscopic endonasal approaches to the craniovertebral junction.

PURPOSE: To demonstrate the utility of virtual reality (VR) for preoperative surgical planning of endoscopic endonasal craniovertebral junction (CVJ) surgery. MATERIALS AND METHODS: Five patients who had undergone endoscopic endonasal surgery of the craniovertebral junction with preoperative virtual reality surgical planning were identified and described. RESULTS: The anterior approach to the CVJ has been traditionally accomplished transorally. However, recently the transnasal endoscopic approach to this location has been described. Multiple anatomical studies have been conducted using the nasopalatine, nasoaxial, and rhinopalatine lines (NPL, NAxL, RPL) in an attempt to preoperatively delineate the inferior limits of endoscopic dissection. The use of advanced surgical simulation using immersive virtual reality is an innovative approach for analyzing CVJ anatomy and developing a surgical plan. VR simulation through the use of interactive and highly accurate patient specific models allows for the creation of three-dimensional (3D) digital reconstructions via the fusion of CT and MRI studies. Incorporation of simulation technology has been shown to increase surgeon proficiency while simultaneously decreasing complication rates. The described case series demonstrates the novel utility of VR planning for designing the endoscopic surgical approach to the CVJ. CONCLUSIONS: VR technology allows for the creation of anatomically accurate 3D models that can be used for preoperative planning of endoscopic endonasal surgery. Such models help in the development of safe surgical plans by predicting inferior and lateral planes of dissection and assisting in the identification of critical structures.