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In 2015-2016, the Levine Museum of the New South in Charlotte, North Carolina, featured "¡Nuevolution! Latinx and the New South," an interactive exhibit that explored the bidirectional ways Latinx and the US South influence one another. To strengthen the exhibit's impact, LMNS launched a dialogue program aimed at enhancing attendees' cultural competence, as measured through relevant gains in knowledge, acceptance, appreciation, and skills. Sixty-six group dialogs took place with 863 individuals. Results demonstrate evidence of increased knowledge of Latinx in the US South, some appreciation of different cultures, yet fewer proficiencies further along the cultural competence spectrum. Data show a need for additional cultural competence skill building. We see great potential for museums and other cultural institutions to offer carefully constructed programming that pairs exhibits and community dialogue as a tool to build a foundation upon which deeper cultural awareness and competency can grow.

Using case study method, this study examines the impact of an inquiry-based learning program among a cohort of first-semester undergraduates (n = 104) at a large public university in the southeastern United States who are aspiring to become teachers. The Boyer Commission (1999) asserted that inquiry-based learning should be the foundation of higher education curricula. Even though inquiry pedagogies are emphasized in teacher education, many prospective teacher candidates have limited experience with inquiry as a constructivist practice from their K-12 settings. This study investigates the effects and first-semester undergraduates' perceptions of an inquiry-based learning project. The research is grounded in Knowledge Building Theory (Scardamalia & Bereiter, 2006), which posits that knowledge building is comprised of three components: 1) inquiry driven questions, 2) epistemic artifacts, and 3) collective spaces for collaboration. The study found that inquiry projects had positive effects on participants' understanding of: the complexity of educational issues; the overall inquiry process; and a future career in teaching. Using Knowledge Building Theory, the findings are discussed and analyzed to posit a conceptual model of the entire inquiry process, called the Inquiry Processing Cycle.

Undergraduate research (UR) experiences continue to proliferate across all higher education settings. Yet community-based research (CBR) experiences account for a small percentage of UR opportunities. This paper describes the pilot study results of a summer program that is intentionally expanding the paradigm for UR at a public research university to include CBR as an equally valued form of scholarship. Results indicate that CBR opportunities expand participation by underrepresented students in UR. Dedicated program administration by CBR faculty and unique recruitment, design, and programs contributed to program success.

Background and Objective: Approximately 16,000 new cases of lung cancer are diagnosed each year in Australia and Aotearoa New Zealand, and it is the leading cause of cancer death in the region. Unwarranted variation in lung cancer care and outcomes has been described for many years, although clinical quality indicators to facilitate benchmarking across Australasia have not been established. The purpose of this study was to establish clinical quality indicators applicable to lung and other thoracic cancers across Australia and Aotearoa New Zealand. Methods: Following a literature review, a modified three round eDelphi consensus process was completed between October 2022 and June 2023. Participants included clinicians from all relevant disciplines, patient advocates, researchers and other stakeholders, with representatives from all Australian states and territories and Aotearoa New Zealand. Consensus was set at a threshold of 70%, with the first two rounds conducted as online surveys, and the final round held as a hybrid in person and virtual consensus meeting. Results: The literature review identified 422 international thoracic oncology indicators, and a total of 71 indicators were evaluated over the course of the Delphi consensus. Ultimately, 27 clinical quality indicators reached consensus, covering the continuum of thoracic oncologic care from diagnosis to first line treatment. Indicators benchmarking supportive care were poorly represented. Attendant numeric quality standards were developed to facilitate benchmarking. Conclusion: Twenty‐seven clinical quality indicators relevant to thoracic oncology care in Australasia were developed. Real world implementation will now be explored utilizing a prospective dataset collected across Australia. A three‐round Delphi consensus process developed 27 contemporary clinical quality indicators, spanning the continuum of lung cancer care from diagnosis to treatment at the end of life. Systematic benchmarking utilizing these indicators will enable the identification of unwarranted variation and promote equitable access to best practice care. [ABSTRACT FROM AUTHOR]

In 2008, the University of North Carolina at Charlotte (UNC Charlotte) joined in a community initiative with the Urban Ministry Center to provide shelter to the homeless during the winter months. A student organization was formed to sustain university support. The author created a service-learning project as part of a Citizenship and Service Practicum course. Three semesters of end-of-course student evaluations indicate that the service-learning experience had an impact on the students in three ways. It raised awareness of homelessness; helped dispel negative stereotypes and foster more positive attitudes; and promoted positive civic attitudes and desire to "make a difference." (Contains 2 tables and 1 figure.)

Background and Objective: Unwarranted variations in lung cancer care have been well described in both Australia and Aotearoa New Zealand, with shortfalls in hospital‐based workforce and infrastructure previously demonstrated. A survey of lung cancer clinicians was performed to gain an updated understanding of current workforce and infrastructure. Methods: An online Qualtrics survey included questions on institutional demographics, estimated lung cancer case load, multidisciplinary team (MDT) characteristics including workforce and local infrastructure. We sought to obtain one response from every institution treating lung cancer in Australia and Aotearoa New Zealand. Results: Responses were received from 89 institutions, estimated to include 85% centres treating lung cancer in Australia and 100% of public hospitals in Aotearoa New Zealand. Lung cancer nurse specialist and Nuclear Medicine are poorly represented in multidisciplinary teams (MDTs) with just 34/88 (38%) institutions fulfilling recommended core workforce for MDT meetings. Case presentation is low with 32/88 (36%) regularly discussing all lung cancer patients at MDT. Metropolitan institutions appear to have a more comprehensive range of services on site, compared to non‐metropolitan institutions. Few (4/88) institutions have embedded smoking cessation services. Compared to the previous 2021 Landscape Survey, thoracic surgery representation and core MDT workforce have improved, with modest change in specialist nurse numbers. Conclusion: This wide‐reaching survey has identified persistent deficiencies and variations in lung cancer workforce and gaps in infrastructure. Multidisciplinary collaboration and care coordination are needed to ensure all patients can access timely and equitable lung cancer care. [ABSTRACT FROM AUTHOR]

Drawing on a theory of program coherence, the establishment of an educational third space, and intentional clinical experience, the authors created a unique entry point in a teacher education program. The authors developed the Onsite Secondary Education Project (OSSEP) to connect relevant educational theory and discipline-specific pedagogy through intentional clinical placements for first-semester preservice teachers. Results from this exploratory research demonstrate that program coherence and structured clinical experiences can help preservice teachers orient themselves to the teaching profession and connect educational theory and practice. However, unintentional experiences were identified, suggesting that increased exposure to the classroom helped shape participants' views toward the teaching profession. Findings offer evidence of a teacher education that balances the idealism of teacher education with the practicalities of the PK-12 classroom.

Introduction: Brain metastases commonly occur in patients with non-small cell lung cancer (NSCLC). Standard first-line treatment for NSCLC, without an EGFR, ALK or ROS1 mutation, is either chemoimmunotherapy or anti-PD-1 monotherapy. Traditionally, patients with symptomatic or untreated brain metastases were excluded from the pivotal clinical trials that established firstline treatment recommendations. The intracranial effectiveness of these treatment protocols has only recently been elucidated in small-scale prospective trials. Methods: Patients with NSCLC and brain metastases, treated with first-line chemoimmunotherapy or anti-PD-1 monotherapy were selected from the Australian Registry and biObank of thoracic cancers (AURORA) clinical database covering seven institutions. The primary outcome was a composite time-to-event (TTE) outcome, including extracranial and intracranial progression, death, or need for local intracranial therapy, which served as a surrogate for disease progression. The secondary outcome included overall survival (OS), intracranial objective response rate (iORR) and objective response rate (ORR). Results: 116 patients were included. 63% received combination chemoimmunotherapy and 37% received anti-PD-1 monotherapy. 69% of patients received upfront local therapy either with surgery, radiotherapy or both. The median TTE was 7.1 months (95% CI 5 - 9) with extracranial progression being the most common progression event. Neither type of systemic therapy or upfront local therapy were predictive of TTE in a multivariate analysis. The median OS was 17 months (95% CI 13-27). Treatment with chemoimmunotherapy was predictive of longer OS in multivariate analysis (HR 0.35; 95% CI 0.14 - 0.86; p=0.01). The iORR was 46.6%. The iORR was higher in patients treated with chemoimmunotherapy compared to immunotherapy (58% versus 31%, p=0.01). The use of chemoimmunotherapy being predictive of iORR in a multivariate analysis (OR 2.88; 95% CI 1.68 - 9.98; p=0.04). Conclusion: The results of this study of real-world data demonstrate the promising intracranial efficacy of chemoimmunotherapy in the first-line setting, potentially surpassing that of immunotherapy alone. No demonstrable difference in survival or TTE was seen between receipt of upfront local therapy. Prospective studies are required to assist clinical decision making regarding optimal sequencing of local and systemic therapies. [ABSTRACT FROM AUTHOR]

Moonlighting, an employment practice where individuals work outside of their primary job, is popular within the public education sector. Using data from the National Center for Education Statistics Schools and Staffing Survey, this study examined both the characteristics and motivations of public school teachers across moonlighting categories. Findings indicate that teacher characteristics, workplace perceptions, and professional outlook varied across moonlighting type. The likelihood of moonlighting outside of the education sector increased among single, male teachers with high reported burnout and lower salaries. Results have implications for how school leaders and policymakers should view moonlighting inside and outside the education sector.

Background: Wide variation exists globally in the treatment and outcomes of stage III patients with non–small cell lung cancer (NSCLC). We conducted an up-to-date patterns of care analysis in the state of Victoria, Australia, with a particular focus on the proportion of patients receiving treatment with radical intent, treatment trends over time, and survival. Materials and Methods: Stage III patients with NSCLC were identified in the Victorian Lung Cancer Registry and categorized by treatment received and treatment intent. Logistic regression was used to explore factors predictive of receipt of radical treatment and the treatment trends over time. Cox regression was used to explore variables associated with overall survival (OS). Covariates evaluated included age, sex, ECOG performance status, smoking status, year of diagnosis, Australian born, Aboriginal or Torres Strait Islander status, socioeconomic status, rurality, public/private status of notifying institution, and multidisciplinary meeting discussion. Results: A total of 1396 patients were diagnosed between 2012 and 2019 and received treatment with radical intent 67%, palliative intent 23%, unknown intent 5% and no treatment 5%. Radical intent treatment was less likely if patients were >75 years, ECOG ≥1, had T3-4 or N3 disease or resided rurally. Surgery use decreased over time, while concurrent chemoradiotherapy and immunotherapy use increased. Median OS was 38.0, 11.1, and 4.4 months following radical treatment, palliative treatment or no treatment, respectively. Conclusion: Almost a third of stage III patients with NSCLC still do not receive radical treatment. Strategies to facilitate radical treatment and better support decision making between increasing multimodality options are required. Variations exist in the treatment and outcomes for patients with stage III non–small cell lung cancer. This article reports an up-to-date patterns of care analysis focusing on the proportion of patients receiving treatment with radical intent, treatment trends over time, and survival. [ABSTRACT FROM AUTHOR]

Quality Indicators, based on clinical practice guidelines, have been used in medicine and within oncology to measure quality of care for over twenty years. However, radiation oncology quality indicators are sparse. This article describes the background to the development of current national and international, general and tumour site-specific radiation oncology quality indicators in use. We explore challenges and opportunities to expand their routine prospective collection and feedback to help drive improvements in the quality of care received by people undergoing radiation therapy. [ABSTRACT FROM AUTHOR]

Keywords: Respiratory tract neoplasms; Chemotherapy; Radiotherapy; Radiology EN Respiratory tract neoplasms Chemotherapy Radiotherapy Radiology 334 336 3 04/19/22 20220415 NES 220415 Lung cancer treatments and outcomes are changing, but survival remains a challenge Lung cancer is the second most common cancer in the world, accounting for 11.4% of all cancers, but with 18.0% of total cancer-related deaths, it is the leading cause of cancer death.1 In Australasia, the incidence of lung cancer varies between 19.1 and 42.1 per 100 000 population, with the strongest risk factors historically being increasing age and tobacco smoke exposure.2,3 However, the proportion of (predominantly) female never smokers with lung cancer is increasing in many countries, particularly across South-East Asia, together with an enlarging proportion of adenocarcinomas and molecular mutations, especially of the epidermal growth factor receptor ( I EGFR i ).2,4 Lung cancer in never smokers is increasingly being recognised as biologically distinct from smoking-related lung cancers, although there is overlap with other risk factors such as environmental and genetic interactions, biofuel and occupational exposures, and indoor and outdoor pollution.2,4 The incidence of lung cancer in several developed countries (eg, the United Kingdom and the United States) has started to fall. Screening for lung cancer in individuals who never smoked: an International Association for the Study of Lung Cancer Early Detection and Screening Committee Report. Modern radiation techniques, such as four-dimensional computed tomography planning and intensity-modulated and high precision image-guided radiation therapies, have enabled early stage lung cancers to be treated with much higher ablative doses.15,16 There have been further encouraging results observed for both adjuvant and neoadjuvant studies for resectable NSCLC. [Extracted from the article]

Background: Approximately 15%-20% of all non-small cell lung cancer (NSCLC) cases present with stage I disease. Surgical resection traditionally offers the best chance of a cure but some patients will not have this treatment due to older age, comorbidities or personal choice. Stereotactic ablative radiotherapy (SABR) has become an established curative intent treatment option for patients who are not selected for or do not choose surgery. The aim of this study is to compare survival at 90 days, 6 months, 1 year and 2 years for patients who received either lobectomy or SABR.Methods: We used data from the 2015 National Lung Cancer Audit database and linked with Hospital Episode Statistics and the radiotherapy dataset to identify patients with NSCLC stage IA-IB and performance status (PS) 0-2 who underwent surgery or SABR treatment. We assessed the likelihood of death at 90 days, 6 months, 1 year and 2 year after diagnosis and procedure date to observe survival between two patient groups.Results: We identified 2373 patients in our cohort, 476 of whom had SABR. The median difference between date of diagnosis and date of treatment for surgery patients was 17 days while for SABR patients it was 73 days. Increasing age and worsening PS were associated with having SABR rather than surgery. Survival between the two treatment modalities was similar early on but by 1-year people who had surgery did better than those who had SABR (adjusted ORs 2.12, 95% CI 1.35 to 2.31). This difference persisted at 2 years and when the analysis was restricted to patients aged <80 years and with PS 0 or 1 and stage IA only.Conclusion: Our analysis suggests that patients who have lobectomy have a better survival compared with SABR patients; however, we found considerable delays in patients receiving SABR which may contribute to poorer long-term outcomes with this treatment option. Reducing these delays should be a key focus in development and reorganisation of services. [ABSTRACT FROM AUTHOR]

Keywords: Clinical Quality Registry; healthcare services; lung cancer EN Clinical Quality Registry healthcare services lung cancer 1103 1105 3 11/19/21 20211201 NES 211201 Unwarranted variation in lung cancer management and outcomes reflects important clinical quality and equity issues. A centralized lung cancer CQR should be capable of linkage with health service utilization data and electronic medical records, with data capture from the time of diagnosis. [Extracted from the article]

Introduction: Data from the National Lung Cancer Audit (NLCA) often show variation in outcomes between lung cancer units which are not entirely explained by case mix. We explore the association between the organisation of services and patient outcome.Methods: Details of service provision were collected via an electronic survey in June 2017. An overall organisational score derived from eleven key service factors from national lung cancer commissioning guidance was calculated for each organisation. The results for each hospital were linked to their patient outcome results from the 2015 NLCA cases. Multivariate logistic regression analysis was used to link the organisational score to patient outcomes.Results: Lung cancer unit organisational audit scores varied from 0 to 11. Thirty-eight (29%) units had a score of 0-4, 64 (50%) had a score of 5-7 and 27 (21%) had a score of 8-11. Multivariate regression analysis revealed that, compared with an organisational score of 0-4, patients seen at units with a score of 8-11 had higher 1-year survival (adjusted OR (95% CI)=2.30 (1.04 to 5.08), p<0.001), higher curative-intent treatment rate (adjusted OR (95% CI)=1.62 (1.26 to 2.09), p<0.001) and greater likelihood of receiving treatment within 62 days (adjusted OR (95% CI)=1.49 (1.20 to 1.86), p<0.001).Conclusion: National variation in the provision of services and workforce remain. We provide evidence that adherence to the national lung commissioning guidance has the potential to improve patient outcomes within the current service structure. [ABSTRACT FROM AUTHOR]

In 2016, Levine Museum of the New South (LMNS) developed an innovative Sustained Dialogue program aimed at engaging and training a diverse group of Millennials in dialogue. University researchers partnered with museum staff in the program development, implementation, and evaluation. The program led to awareness and critical reflection at multiple scales: individual, group, and the broader community. Participants enhanced their cultural competence and their ability to facilitate conversations about difficult and pressing community issues. The program also helped participants identify solutions and actions to make their communities more inclusive. Participants realized the power of dialogue as a tool for introspection, interaction and social change. Millennials are attracted to programming that is informal, non-hierarchical, involves movement and (inter)activity, and builds skills and networks useful to everyday life. Millennials believe in grassroots efforts and incorporating technology as a way to share experiences, though face-to-face interactions are still viewed as meaningful. [ABSTRACT FROM AUTHOR]

Introduction Following growing evidence to support the safety, local control (LC) and potential improvement in overall survival (OS) in patients with oligometastatic nonsmall cell lung cancer (NSCLC) that have been treated with local ablative therapy such as stereotactic ablative radiotherapy (SABR) and stereotactic radiosurgery (SRS), we initiate the SARON trial to investigate the impact and feasibility of adding SABR/SRS and radical radiotherapy (RRT) following standard chemotherapy on OS. Methods and analysis SARON is a large, randomised controlled, multicentre, phase III trial for patients with oligometastatic EGFR, ALK and ROS1 mutation negative NSCLC (1-3 sites of synchronous metastatic disease, one of which must be extracranial). 340 patients will be recruited over 3 years from approximately 30 UK sites and randomised to receive either standard platinumdoublet chemotherapy only (control arm) or standard chemotherapy followed by RRT/SABR to their primary tumour and then SABR/SRS to all other metastatic sites (investigational arm). The primary endpoint is OS; the study is powered to detect an improvement in median survival from 9.9 months in the control arm to 14.3 months in the investigational arm with 85% power and two-sided 5% significance level. The secondary endpoints are LC, progression-free survival, new distant metastasisfree survival, toxicity and quality of life. An early feasibility review will take place after 50 randomised patients. Patients requiring both conventional thoracic RT to the primary and SABR to a thoracic metastasis will be included in a thoracic SABR safety substudy to assess toxicity and planning issues in this subgroup of patients more thoroughly. Ethics and dissemination All participants are given a SARON patient information sheet and required to give written informed consent. Results will be submitted for presentation at local and international conferences and expected to be published in a peer-reviewed journal. [ABSTRACT FROM AUTHOR]

Purpose The sensitivity of the magnetization transfer ratio (MTR) and apparent diffusion coefficient (ADC) for early detection of brain metastases was investigated in mice and humans. Methods Mice underwent MRI twice weekly for up to 31 d following intracardiac injection of the brain-homing breast cancer cell line MDA-MB231-BR. Patients with small cell lung cancer underwent quarterly MRI for 1 year. MTR and ADC were measured in regions of metastasis and matched contralateral tissue at the final time point and in registered regions at earlier time points. Texture analysis and linear discriminant analysis were performed to detect metastasis-containing slices. Results Compared with contralateral tissue, mouse metastases had significantly lower MTR and higher ADC at the final time point. Some lesions were visible at earlier time points on the MTR and ADC maps: 24% of these were not visible on corresponding T2-weighted images. Texture analysis using the MTR maps showed 100% specificity and 98% sensitivity for metastasis at the final time point, with 77% sensitivity 2-4 d earlier and 46% 5-8 d earlier. Only 2 of 16 patients developed metastases, and their penultimate scans were normal. Conclusions Some brain metastases may be detected earlier on MTR than conventional T2; however, the small gain is unlikely to justify 'predictive' MRI. Magn Reson Med 77:1987-1995, 2017. © 2016 The Authors Magnetic Resonance in Medicine published by Wiley Periodicals, Inc. on behalf of International Society for Magnetic Resonance in Medicine. This is an open access article under the terms of the License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. [ABSTRACT FROM AUTHOR]

Introduction: The majority of stage III patients with non-small cell lung cancer (NSCLC) are unsuitable for concurrent chemoradiotherapy, the non-surgical gold standard of care. As the alternative treatment options of sequential chemoradiotherapy and radiotherapy alone are associated with high local failure rates, various intensification strategies have been employed. There is evidence to suggest that altered fractionation using hyperfractionation, acceleration, dose escalation, and individualisation may be of benefit. The MAASTRO group have pioneered the concept of 'isotoxic' radiotherapy allowing for individualised dose escalation using hyperfractionated accelerated radiotherapy based on predefined normal tissue constraints. This study aims to evaluate whether delivering isotoxic radiotherapy using intensity modulated radiotherapy (IMRT) is achievable. Methods and analysis: Isotoxic IMRT is a multicentre feasibility study. From June 2014, a total of 35 patients from 7 UK centres, with a proven histological or cytological diagnosis of inoperable NSCLC, unsuitable for concurrent chemoradiotherapy will be recruited. A minimum of 2 cycles of induction chemotherapy is mandated before starting isotoxic radiotherapy. The dose of radiation will be increased until one or more of the organs at risk tolerance or the maximum dose of 79.2 Gy is reached. The primary end point is feasibility, with accrual rates, local control and overall survival our secondary end points. Patients will be followed up for 5 years. Ethics and dissemination: The study has received ethical approval (REC reference: 13/NW/0480) from the National Research Ethics Service (NRES) Committee North West--Greater Manchester South. The trial is conducted in accordance with the Declaration of Helsinki and Good Clinical Practice (GCP). The trial results will be published in a peer-reviewed journal and presented internationally. Trial registration number: NCT01836692; Pre-results. [ABSTRACT FROM AUTHOR]

What is the role of teacher education classrooms in mediating educational controversy? In this paper, the authors argue schools of education approach educational controversies such as ability grouping and resegregation from a perspective that equates sublimation of controversy with progress. Although schools of education serve as conduits for educational policy, the pre-service teacher education curriculum often overlooks controversy and focuses exclusively on the technical and methodological aspects of teaching. Consequently, students rarely reflect on the existential consequences of educational policies and the role teachers play in both defining and helping students achieve a better life. The authors conclude teacher education classrooms should follow a more Kierkegaardian model towards controversy in which reflection and criticism of the dominant educational ideology are emphasized. [ABSTRACT FROM AUTHOR]

To what degree can a museum impact cultural change in a community? Drawing from an evaluation of Levine Museum of the New South's Speaking of Change program, this article - which is the outcome of a community engaged partnership between museum staff, urban social geographers, and urban education scholars - describes one museum's community practice in shaping receptivity toward newcomers in a new immigrant gateway. Specifically, we demonstrate how through its exhibit and dialogue programming, the museum deepened understanding of immigration in ways that led to a warmer welcome and proactive inclusion. This research illuminates the critical role of museums in guiding community receptivity towards immigrants in a way that provides counterbalance to reactive or hostile responses. [ABSTRACT FROM AUTHOR]

The emergence and recognition of outreach and engagement staff and non-tenure track faculty in higher education literature as key figures in the success of university outreach and community engagement are welcome developments for these practitioners. This article describes the perceptions of outreach and engagement staff at large, public research universities with decentralized engagement initiatives. The authors describe efforts to organize outreach and community engagement staff to create supportive networks, improve practice, provide professional development opportunities, and advocate for practitioner interests and needs. Community-of-practice theory offers a model for connecting, organizing, and sustaining outreach and engagement staff practitioners and their emerging professional identity. [ABSTRACT FROM AUTHOR]

Purpose: Dose differences from those planned can occur due to the respiratory interplay effect on helical tomotherapy. The authors present a technique to calculate single-fraction doses in threedimensions resulting from craniocaudal motion applied to a patient CT set. The technique is applied to phantom and patient plans using patient respiratory traces. An additional purpose of the work is to determine the contribution toward the interplay effect of different components of the respiratory trace. Methods: MATLAB code used to calculate doses to a CT dataset from a helical tomotherapy plan has been modified to permit craniocaudal motion and improved temporal resolution. Real patient traces from seven patients were applied to ten phantom plans of differing field width, modulation factor, pitch and fraction dose, and simulations made with peak-to-peak amplitudes ranging from 0 to 2.5 cm. PTV voxels near the superior or inferior limits of the PTV are excluded from the analysis. The maximum dose discrepancy compared with the static case recorded along with the proportion of voxels receiving more than 10% and 20% different from prescription dose. The analysis was repeated with the baseline variation of the respiratory trace removed, leaving the cyclic component of motion only. Radiochromic film was used on one plan-trace combination and compared with the software simulation. For one case, filtered traces were generated and used in simulations which consisted only of frequencies near to particular characteristic frequencies of the treatment delivery. Intraslice standard deviation of dose differences was used to identify potentialMLC interplay, which was confirmed using nonmodulated simulations. Software calculations were also conducted for four realistic patient plans and modeling movement of a patient CT set with amplitudes informed by the observed motion of the GTV on 4DCT. Results: The maximum magnitude of dose difference to a PTV voxel due to the interplay effect within a particular plan-trace combination for peak-to-peak amplitudes of up to 2.5 cm ranged from 4.5% to 51.6% (mean: 23.8%) of the dose delivered in the absence of respiratory motion. For cyclic motion only, the maximum dose differences in each combination ranged from 2.1% to 26.2% (mean: 9.2%). There is reasonable correspondence between an example of the phantom plan simulations and radiochromic film measurement. The filtered trace simulations revealed that frequencies close to the characteristic frequency of the jaw motion across the target were found to generate greater interplay effect than frequencies close to the gantry frequency orMLC motion. There was evidence of interplay between respiratory motion and MLC modulation, but this is small compared with the interplay between respiratory motion and jaw motion. For patient-plan simulations, dose discrepancies are seen of up to 9.0% for a patient with 0.3 cm peak-to-peak respiratory amplitude and up to 17.7% for a patient with 0.9 cm peak-to-peak amplitude. These values reduced to 1.3% and 6.5%, respectively, when only cyclic motion was considered. Conclusions: Software has been developed to simulate craniocaudal respiratory motion in phantom and patient plans using real patient respiratory traces. Decomposition of the traces into baseline and cyclic components reveals that the large majority of the interplay effect seen with the full trace is due to baseline variation during treatment [ABSTRACT FROM AUTHOR]

The UK has the highest incidence of mesothelioma in the world, but services vary across the country partly due to uneven geographical distribution of cases. The Mesothelioma UK-funded national organisational audit has highlighted challenges in accessing diagnostic procedures such as thoracoscopy, as well as identifying examples of best practice, including access to clinical trials and specialist therapeutic procedures. To ensure equitable and optimal patient care, cancer alliances should have established referral pathways to specialist multidisciplinary team (MDT) services for discussion of all mesothelioma patients. [ABSTRACT FROM AUTHOR]