Search

BackgroundWhile early reports highlight the benefits of tablet computing in hospitals, introducing any new technology can result in inflated expectations. ObjectiveThe aim of the study is to compare anticipated expectations of Apple iPad use and perceptions after deployment among residents. Methods115 internal medicine residents received Apple iPads in October 2010. Residents completed matched surveys on anticipated usage and perceptions after distribution 1 month prior and 4 months after deployment. ResultsIn total, 99% (114/115) of residents responded. Prior to deployment, most residents believed that the iPad would improve patient care and efficiency on the wards; however, fewer residents “strongly agreed” after deployment (34% vs 15% for patient care, P

PurposeUrgent indications for palliative radiation therapy (RT) include malignant spinal cord compression, symptomatic brain metastases, pain, airway obstruction, and bleeding. Data on the timing of palliative RT in the inpatient setting are limited. We report our experience with inpatient palliative RT at a tertiary academic center and evaluate the effect of a dedicated inpatient palliative RT nurse practitioner (NP) on treatment timelines.Methods and materialsWe performed a retrospective, single-institution review of 219 inpatients consulted for RT to sites of metastatic disease between May 2012 and May 2018. We compared time-to-treatment intervals before and after integrating an NP for palliative RT in August 2017.ResultsThe median age of the 219 patients receiving RT was 61 years (interquartile range [IQR], 51-69 years). The most frequent indications were symptomatic brain metastases (73 patients [33%]), pain (61 patients [28%]), and cord/cauda compression (48 patients [22%]). The median time from consultation request to consult was 1 day (IQR, 0-2 days), and the median time from consultation request to first RT fraction was 3 days (IQR, 2-6 days). The median time from consultation request to RT was shorter for cord compression (2 [IQR, 1-4] days) than for pain (5 [IQR, 2-7] days) (P = .001) or symptomatic brain metastases (3 [IQR, 1-6] days; P = .037). With an NP, patients were more likely to undergo same-day consultation and simulation (75% vs 60%; P = .045), which was associated with shorter median duration from consultation to initiation of RT (1 [IQR, 0-3] days vs 4 [IQR, 2-7] days; P

BackgroundOptimal techniques and patient selection for salvage reirradiation of high-grade glioma (HGG) are unclear. In this study, we identify prognostic factors for freedom from progression (FFP) and overall survival (OS) after reirradiation, risk factors for high-grade toxicity, and validate clinical prognostic scores.MethodsA total of 116 patients evaluated between 2000 and 2018 received reirradiation for HGG (99 WHO grade IV, 17 WHO grade III). Median time to first progression after initial therapy was 10.6 months. Salvage therapies before reirradiation included surgery (31%) and systemic therapy (41%). Sixty-five patients (56%) received single-fraction stereotactic radiosurgery (SRS) as reirradiation. The median biologically effective dose (BED) was 47.25 Gy, and the median planning target volume (PTV) was 4.8 cc for SRS and 95.0 cc for non-SRS treatments. Systemic therapy was given concurrently to 52% and adjuvantly to 74% of patients.ResultsMedian FFP was 4.9 months, and median OS was 11.0 months. Significant multivariable prognostic factors for FFP were performance status, time to initial progression, and BED; for OS they were age, time to initial progression, and PTV volume at recurrence. High-grade toxicity was correlated to PTV size at recurrence. Three-level prognostic scores were generated for FFP and OS, with cross-validated receiver operating characteristic area under the curve (AUC) of 0.640 and 0.687, respectively.ConclusionsClinical variables at the time of reirradiation for HGG can be used to prognosticate FFP and OS.

In recent years school-to-school collaboration in the English context has been promoted by a myriad of policy initiatives. Many of these initiatives have been directed at structural reforms seeking to facilitate a 'self-improving system' in which schools support one another to raise standards of teaching and learning and address educational inequality. Yet, at the same time, the English school system remains a deeply marketised and competitive arena while there are debates concerning the extent to which collaboration between schools can meaningfully facilitate educational improvement and equity. Taking these issues as a starting point, this paper reports on findings from a configurative review of the empirical evidence on school-to-school collaboration in England. Drawing on 46 peer-reviewed empirical studies from 2000 onwards, the paper provides insight into the reasons why schools enter into collaborative arrangements and the conditions and factors that can facilitate and hinder such activity, as well as the possible benefits that can result from collaboration between schools. A number of weaknesses within the field are also identified. For example, there is a need for more conceptual and terminological clarity and a stronger theoretical basis for research in this area. We also argue that the field is deficient in respect of critical perspective and interpretation (of collaborative practice). Furthermore, research into school-to-school collaboration is lagging behind policy and practice, presenting a formidable challenge for a system increasingly underpinned by an expectation that schools will work in partnership with one another.

ABSTRACT For over 15 years the Japanese government has promoted a national campaign on child abuse awareness and tasked authorities with addressing rising child abuse reports. With an orange ribbon as its symbol, a key aspect of this campaign, alongside casework, is the creation and circulation of visual‐discursive representations of abused children. Drawing on 18 months of ethnographic fieldwork on child protection practice, this paper contextualises the social construction of child abuse by critiquing the cultural and technical logics of abuse and protection discourse. Appeals to vulnerability, rights and duty bridge public and expert fields and position an image of pity as a call to action that drives child abuse prevalence as well as enduring dispositions by the state towards intrafamily normativity and a minimalist welfare state. [ABSTRACT FROM AUTHOR]

Purpose: The literature highlights the disconnection between university-based teacher education and field experiences as a significant barrier to student teacher preparation. To address this gap, the Research Teams (RTs) programme promotes a Networked Learning System (NLS), focusing on boundary-crossing work, inquiry and critical reflection to generate knowledge. This paper examines the emergence of relational and collective agency within this collaboration, linking school and university knowledge to enhance professional learning and drive teaching innovation. Design/methodology/approach: Employing an exploratory qualitative design, data collection includes advising team notes, reflective session materials, interviews and focus groups. Qualitative content and discourse analysis were utilised. Findings: Findings reveal how RTs promote relational agency among university tutors, school staff and preservice teachers and collective agency in the context of collaborative research. The pandemic presents both social interaction opportunities and challenges. Originality/value: The relevance of this study lies in the necessity to advance knowledge regarding the development of collaborative learning systems that encourage cross-institutional relationships, allowing for the creation and flow of knowledge. It highlights the role and development of collective and relational agency in fostering the development of a NLS. It also raises questions about the challenges and investments needed to sustain and scale collaborative research models that cross professional and institutional values and beliefs within schools and universities. [ABSTRACT FROM AUTHOR]

There is evidence from histopathological studies that glioma tumor cells migrate preferentially along large white matter bundles. If the peritumoral white matter structures can be used to predict the likely trajectory of migrating tumor cells outside of the surgical margin, then this information could be used to inform the delineation of radiation therapy (RT) targets. In theory, an anisotropic expansion that takes large white matter bundle anatomy into account may maximize the chances of treating migrating cancer cells and minimize the amount of brain tissue exposed to high doses of ionizing radiation. Diffusion-weighted MRI (DW-MRI) can be used in combination with fiber tracking algorithms to model the trajectory of large white matter pathways using the direction and magnitude of water movement in tissue. The method presented here is a tool for translating a DW-MRI fiber tracking (tractography) dataset into a white matter path length (WMPL) map that assigns each voxel the shortest distance along a streamline back to a specified region of interest (ROI). We present an open-source WMPL tool, implemented in the package Diffusion Imaging in Python (DIPY), and code to convert the resulting WMPL map to anisotropic contours for RT in a commercial treatment planning system. This proof-of-concept lays the groundwork for future studies to evaluate the clinical value of incorporating tractography modeling into treatment planning.

Abstract PURPOSE/OBJECTIVE(S): Identify prognostic factors for progression-free survival (PFS) and overall survival (OS) after reirradiation (re-RT) for recurrent high grade glioma (HGG). MATERIALS/ METHODS Patients with HGG received re-RT from 2010 to present. PFS and OS prognostic variables were examined using Cox models. Receiver operative curve (ROC) analysis identified predictive thresholds for continuous variables. RESULTS 58 patients received surgery and adjuvant radiation for HGG (51 grade IV, 7 grade III). The median time to first progression after initial radiation was 11 months. 36% received single fraction stereotactic re-RT (SRS) (median 18 Gy) and 64% received fractionated re-RT (median 35 Gy in 10 fractions). The median planning target volume (PTV) was 16.8 mL. The median biologically effective dose (BED10) of re-RT was 47 Gy (range 15–72). 50% received chemotherapy and 36% received bevacizumab concurrent to re-RT. Toxicity ≥ grade 3 was 7%. The median PFS after re-RT was 4.7 months and the median OS was 11 months. Lower PFS was significantly associated with shorter time to first progression, lower KPS, and lower re-RT dose. Lower OS was associated with shorter time to first progression, lower KPS, and larger PTV. Other factors were not significantly associated with PFS or OS. ROC analysis of time to first progression and re-RT dose showed best predictive thresholds at time > 12 months and BED10 > 42 Gy. CONCLUSIONS: Reirradiation was tolerated with infrequent high grade toxicity. PFS and OS after re-RT were both predicted by time to progression after initial radiation. Published prognostic scores have used total time from first to second radiation courses; however in our series the period from initial progression to re-RT did not add prognostic information. There was evidence for a dose threshold irrespective of radiotherapy technique. Use of chemotherapy and bevacizumab with re-RT were not associated with improved outcomes.

Purpose/objectivesFor lung stereotactic body radiation therapy (SBRT), real-time tumor tracking (RTT) allows for less radiation to normal lung compared to the internal target volume (ITV) method of respiratory motion management. To quantify the advantage of RTT, we examined the difference in radiation pneumonitis risk between these two techniques using a normal tissue complication probability (NTCP) model.Materials/method20 lung SBRT treatment plans using RTT were replanned with the ITV method using respiratory motion information from a 4D-CT image acquired at the original simulation. Risk of symptomatic radiation pneumonitis was calculated for both plans using a previously derived NTCP model. Features available before treatment planning that identified significant increase in NTCP with ITV versus RTT plans were identified.ResultsPrescription dose to the planning target volume (PTV) ranged from 22 to 60 Gy in 1-5 fractions. The median tumor diameter was 3.5 cm (range 2.1-5.5 cm) with a median volume of 14.5 mL (range 3.6-59.9 mL). The median increase in PTV volume from RTT to ITV plans was 17.1 mL (range 3.5-72.4 mL), and the median increase in PTV/lung volume ratio was 0.46% (range 0.13-1.98%). Mean lung dose and percentage dose-volumes were significantly higher in ITV plans at all levels tested. The median NTCP was 5.1% for RTT plans and 8.9% for ITV plans, with a median difference of 1.9% (range 0.4-25.5%, pairwise P < 0.001). Increases in NTCP between plans were best predicted by increases in PTV volume and PTV/lung volume ratio.ConclusionsThe use of RTT decreased the risk of radiation pneumonitis in all plans. However, for most patients the risk reduction was minimal. Differences in plan PTV volume and PTV/lung volume ratio may identify patients who would benefit from RTT technique before completing treatment planning.

PurposeRadiation dose escalation for prostate cancer improves biochemical control but is limited by toxicity. Magnetic resonance spectroscopic imaging (MRSI) can define dominant intraprostatic lesions (DIL). This phase I study evaluated dose escalation to MRSI-defined DIL using high-dose-rate (HDR) brachytherapy.Material and methodsEnrollment was closed early due to low accrual. Ten patients with prostate cancer (T2a-3b, Gleason 6-9, PSA < 20) underwent pre-treatment MRSI, and eight patients had one to three DIL identified. The eight enrolled patients received external beam radiation therapy to 45 Gy and HDR brachytherapy boost to the prostate of 19 Gy in 2 fractions. MRSI images were registered to planning CT images and DIL dose-escalated up to 150% of prescription dose while maintaining normal tissue constraints. The primary endpoint was genitourinary (GU) toxicity.ResultsThe median total DIL volume was 1.31 ml (range, 0.67-6.33 ml). Median DIL boost was 130% of prescription dose (range, 110-150%). Median urethra V120 was 0.15 ml (range, 0-0.4 ml) and median rectum V75 was 0.74 ml (range, 0.1-1.0 ml). Three patients had acute grade 2 GU toxicity, and two patients had late grade 2 GU toxicity. No patients had grade 2 or higher gastrointestinal toxicity, and no grade 3 or higher toxicities were noted. There were no biochemical failures with median follow-up of 4.9 years (range, 2-8.5 years).ConclusionsDose escalation to MRSI-defined DIL is feasible. Toxicity was low but incompletely assessed due to limited patients' enrollment.