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OBJECTIVES Guidelines for appropriate use of telemetry recommend monitoring for specific patient populations; however, many hospitalized patients receive telemetry monitoring without an indication. Clinical data and outcomes associated with nonindicated monitoring are not well studied. The objectives of our study were to evaluate the impact of an education and an order entry intervention on telemetry overuse and to identify the diagnoses and telemetry-related outcomes of patients who receive telemetry monitoring without guidelines indication. METHODS A retrospective cohort study of hospitalized patients on internal medicine (IM) wards between 2015 and 2018 examining the effects of educational and order entry interventions at an academic urban medical center. A baseline cohort examining telemetry use was established. This was followed by the delivery of IM resident educational sessions regarding telemetry guidelines. In a subsequent intervention, the telemetry order entry system was modified with a constraint to require American Heart Association guidelines justification. RESULTS Across all of the cohorts, 51% (n = 141) of patients lacked a guidelines-specified indication. These patients had variable diagnoses. The educational intervention alone did not result in significant differences in telemetry use by IM residents. The order entry intervention resulted in a significant increase in the proportion of guidelines-indicated patients and a decrease in nonindicated patients on telemetry. No safety events were noted in any group. CONCLUSIONS A telemetry order entry system modification implemented following an educational intervention is more likely to reduce telemetry use than an educational intervention alone in IM resident practice. A variety of patients are monitored without evidence of need; therefore, the clinical impact of telemetry reduction is unlikely to be harmful.

The incorporation of leadership concepts is at the forefront of agendas to advance the quality of patient care and innovation in many healthcare professions. In this Commentary, the authors draw upon evidence from the literature to discuss the theoretical perspectives of leadership and potential value in radiation therapy practice. For the patients to be provided with safe and high-quality treatment, continuous change and improvement are necessary. Leadership has the potential to influence behaviour change for practitioners and core organisational culture. Several leadership styles such as the transformational leadership can be applied to achieve a higher level of patient care and improve the likelihood of enhancing quality and efficiency in healthcare. These are also paramount to the success of radiation therapy practice. Hence, a higher priority should be placed on developing leadership in the Radiation Therapist (RT) workforce and educating new graduates of the potential benefits.

Image‐guided radiation therapy (IGRT) technologies are routinely used by radiation therapists (RTs) in clinical departments. However, there is limited literature on the acquisition and assessment of IGRT image‐matching competencies in undergraduate educational environments. This commentary paper aims to share the authors’ experiences in the development of teaching IGRT and image‐matching concepts in an undergraduate radiation therapy programme. It outlines how MOSAIQ oncology information systems (OIS) have enabled the university to embed hands‐on IGRT image matching on a range of clinical cases. The hands‐on exposure to case‐based planar and volumetric kilovoltage (kV) image matching has resulted in improved teaching and better preparation of students for clinical IGRT encounters. Students are likely to benefit from critical image assessment and decision‐making as well as the improved engagement in teaching and learning., The aim of this commentary paper is to share the authors’ experiences in the optimisation of teaching image‐guided radiation therapy (IGRT) and image‐matching concepts in an undergraduate radiation therapy programme. It outlines how MOSAIQ oncology information systems (OIS) enabled the university to embed in undergraduate teaching, hands‐on IGRT image matching on a range of clinical cases. The hands‐on exposure to case‐based planar kilovoltage (kV) and cone‐beam computed tomography (CBCT) image matching and resulted in improved teaching and better preparation of students for clinical learning.

The use of simulation to enhance the quality of preclinical teaching and learning in radiation therapy is increasing. This article discusses the use of the Virtual Environment for Radiotherapy Training (VERT) in supporting teaching on image-guided radiation therapy (IGRT) and image matching concepts. The authors review the capabilities of VERT and discuss how it is currently applied in undergraduate radiation therapy teaching. The integration of IGRT theory with hands-on image matching practice using VERT simulation in educational environments has many potential benefits. These include the potential to strengthen the students' knowledge and skills in online-image acquisition and review of planar two-dimensional images and cone beam computed tomography images. It is anticipated that learner engagement will improve as well as refine analytical skills and confident practice in critical assessment of IGRT images. The authors encourage the utilization of technology that provides students with hands-on skills so they are better prepared for clinical environments.

Artificial intelligence (AI) and machine learning (ML) approaches have caught the attention of many in health care. Current literature suggests there are many potential benefits that could transform future clinical workflows and decision making. Embedding AI and ML concepts in radiation therapy education could be a fundamental step in equipping radiation therapists (RTs) to engage in competent and safe practice as they utilise clinical technologies. In this discussion paper, the authors provide a brief review of some applications of AI and ML in radiation therapy and discuss pertinent considerations for radiation therapy curriculum enhancement. As the current literature suggests, AI and ML approaches will impose changes to routine clinical radiation therapy tasks. The emphasis in RT education could be on critical evaluation of AI and ML application in routine clinical workflows and gaining an understanding of the impact on quality assurance, provision of quality of care and safety in radiation therapy as well as research. It is also imperative RTs have a broader understanding of AI/ML impact on health care, including ethical and legal considerations. The paper concludes with recommendations and suggestions to deliberately embed AI and ML aspects in RT education to empower future RT practitioners.

Nearly two-thirds of fossil fuel-fired electricity generation capacity in the United States is expected to reach its typical end of life by 2035. While the closure of fossil fuel-fired power plants will help advance decarbonization goals, the cessation of water use for fossil fuel-fired power plant cooling -the largest water user in the US -will also impact the nation's water resources. We assess when, where, and how much water will be made available upon the expected retirement of the nation's nearly one thousand fossil fuel-fired power plants by combining a lifespan-based model of fossil fuel-fired generator retirements for the US fossil fuel-fired electricity generation fleet with a national-scale hydrologic model. We show that annual water withdrawals and consumption of fossil fuel-fired power generators will be significantly curtailed (85 % and 68 % reduction, respectively) by 2035 if these generators follow their typical retirement timeline. Most rivers with fossil fuel-fired power plants diverting and/or discharging water will have a net increase in annual streamflow after plant retirement (maximum decrease of 2 %, maximum increase of 57 % by 2050), with the most pronounced increases occurring in the summer months. The retirement of fossil fuel-fired power plants will lead to a large relative change (>5%) in streamflow at least one month per year by 2050 in 31 subbasins. The retirement of power generators was shown to produce noticeable streamflow impacts up to hundreds of kilometers downstream. By the retirement of the last US fossil fuel-fired power generator, 2.6 billion m3 of water that was once consumed by these power plants could be made available for other uses. In addition to the global benefits of reduced greenhouse gas emissions, the notable increases in streamflow and water availability in many US rivers due to the retirement of fossil fuel-fired power plants could benefit local water users and ecosystems. National Science Foundation [CBET-2144169, G20AP00002] Published version L.T.M. acknowledges support from the National Science Foundation Grant No. CBET-2144169 ('CAREER: Advancing Water Sustainability and Economic Resilience through Research and Education: An Integrated Systems Approach') and the U.S. Geological Survey Grant/Cooperative Agreement No. G20AP00002 ("Mapping and modeling of interbasin water transfers within the United States"). Any opinions, findings, and conclusions or recommendations expressed in this material are those of the author(s) and do not necessarily reflect the views of the National Science Foundation or the U.S. Geological Survey.

The concept of deliberate practice (DP) has been extensively applied to the development of skill and expert performance in many domains of professional practice. Although it has been widely reviewed in other health professions, there is a lack of evidence on its application in radiation therapy practice. This article aims to explore the concept of DP and how it can be applied to radiation therapy practice. The authors define DP, why it is essential, and how it can be implemented in radiation therapy. Evidence from the DP literature in the health professions was used to clarify the guiding principles for successful DP implementation within both the clinical and educational contexts. While the authors encourage radiation therapy practitioners to engage in DP approaches, every profession utilizing DP will develop strategies unique to the individual discipline. Hence, rather than imitating other professions, it is essential that radiation therapists engage evidence-based approaches that will generate empirical evidence to model radiation therapy-specific DP approaches.

We screened African wild dogs (Lycaon pictus) in Kruger National Park, South Africa, for Mycobacterium bovis infection using an interferon-gamma release assay. We detected M. bovis sensitization in 20 of 21 packs; overall apparent infection prevalence was 83%. These animals experience high infection pressure, which may affect long-term survival and conservation strategies.

Malignant melanomas tend to be locally destructive, aggressive tumours commonly associated with recurrence and/or metastasis. In this report, a 13-year-old captive white African lioness (Panthera leo), with a recent history of intermittent bouts of lethargy and inappetence, presented with a distended abdomen (due to ascites) and a small, round crusty lesion on the ear. An abdominal ultrasound showed the presence of masses on the liver and an exploratory laparotomy revealed multiple pale lesions on the liver and omentum. Histopathology revealed sheets of pleomorphic neoplastic cells compressing the non-neoplastic liver tissue. Similar neoplastic cells had multifocally expanded and effaced omentum adipose tissue, as well as formed a well-circumscribed mass in the ear sample, extending from close to the epidermis to the lateral and deep margins of the section. All three tissue samples had a high mitotic index (15 per 10 HPF), and critically, in the ear sample, there were rafts of neoplastic cells in the lymphatics, indicating lymphovascular invasion. Immunohistochemistry for the melanoma marker, PNL-2, showed strong positivity in all three tissue samples. Thus, the diagnosis was of malignant melanoma with metastasis to the liver and omentum. This is the first report of metastatic cutaneous melanoma in a lion.

PurposeRadiation oncology information systems (OIS) play a crucial role in radiation therapy by ensuring accurate and safe delivery of treatment. A MOSAIQ OIS system is currently used to support undergraduate radiation therapist training at Queensland University of Technology. This review addresses the rationale for implementation and integration in teaching environments and explores the pedagogical benefits supported by educational theory.DiscussionA review of MOSAIQ functionality shows potential to transform learning through the development of authentic and engaging learning tasks. It provides students with an opportunity to learn two-dimensional image matching through the use of digitally reconstructed radiographs and electronic portal images as well as three-dimensional image matching using computed tomography (CBCT) data in a safe learning environment without clinical time pressures. In addition, this provides the students with knowledge of quality assurance (QA) checks through the verification of treatment parameters and the transfer of information from the planning system to the treatment units. However, there are several potential challenges and practical considerations that need to be overcome.ConclusionThe application of MOSAIQ OIS could potentially transform teaching and learning strategies for student radiation therapists. Increased knowledge and hands-on skills at undergraduate levels in areas such as image matching and QA can be powerful tools to drive the standards of practice a step further.

Climate simulation with more accurate process-level representation at finer resolutions is a pressing need in order to provide actionable information to policy-makers regarding extreme events in a changing climate. Computational limitation is a major obstacle for building, and running high-resolution (HR, here 0.25° average grid spacing at the equator) models (HRM). A more affordable path to HRM is to use a global regionally refined model (RRM), which only simulates a portion of the globe at HR while the remaining is at low-resolution (LR, 1°). In this study, we compare the Energy Exascale Earth System Model (E3SM) atmosphere model version 1 (EAMv1) RRM with the HR mesh over the contiguous United States (CONUS) to its corresponding globally uniform LR and HR configurations, as well as to observations and reanalysis data. The RRM has a significantly reduced computational cost (roughly proportional to the HR mesh size) relative to the globally uniform HRM. Over the CONUS, we evaluate the simulation of important dynamical and physical quantities as well as various precipitation measures. Differences between the RRM and HRM over the HR region are predominantly small, demonstrating that the RRM reproduces both well- and poorly simulated behaviours of the HRM over the CONUS. Further analysis based on RRM simulations with the LR vs. HR model parameters reveals that RRM performance is greatly influenced by the different parameter choices used in the LR and HR EAMv1. This is a result of the poor scale-aware behaviour of physical parameterizations, especially for variables influencing sub-grid scale physical processes. RRM can serve as a useful framework to test physics schemes across a range of scales, leading to improved consistency in future E3SM versions. Applying nudging-to-observations techniques within the RRM framework also demonstrates significant advantages over a free-running configuration for use as a testbed, and as such represents an efficient and more robust physics testbed capability. Our results provide additional confirmatory evidence that the RRM is an efficient and effective approach for HRM development and hydrologic research.

In South Africa, the largest proportion of the African wild dog (

Aim The involvement of undergraduate students in assessment design is not a new concept. However, there is a paucity of evidence on radiation therapy students' participation in the design of teaching and learning activities. This article reports the development and initial evaluation of alternative approaches to assessing treatment planning skills and knowledge in undergraduate radiation therapy education. Methods A group of undergraduate radiation therapy students participated in a series of semistructured focus group meetings. The students nominated a practical examination and an oral plan critique assessment approach. The lecturers embedded two formative tasks to test the approaches in a second-year treatment planning subject. Two surveys assessed the experiences of the students, authenticity, engagement, and the practicality of the tasks in the treatment planning subject. Results The responses show that 92% of participants perceived the practical treatment planning examination as an authentic or real-world assessment approach. Moreover, 96% of the participants supported the notion of incorporating the tasks into the treatment planning subject. Most students (96%) perceived an oral critique of a treatment plan as an authentic approach and also supported the notion of incorporating oral critiques as an assessment task. Student engagement was high in both the practical and oral critique tasks, suggesting that lecturers could also include such tasks as formative activities to enhance learning. Conclusion Involving student voices in pedagogic assessment design positively influenced the development of new assessments for the treatment planning subject. The oral critiques and practical-based approaches nominated are likely to enhance authenticity to students' learning experiences and provide opportunities for students to develop desirable professional capabilities.

Understanding and quantitatively evaluating the regional impacts of climate change and variability (e.g., droughts) on forest ecosystem functions (i.e., water yield, evapotranspiration, and productivity) and services (e.g., fresh water supply and carbon sequestration) is of great importance for developing climate change adaptation strategies for National Forests and Grasslands (NFs) in the United States. However, few reliable continental-scale modeling tools are available to account for both water and carbon dynamics. The objective of this study was to test a monthly water and carbon balance model, the Water Supply Stress Index (WaSSI) model, for potential application in addressing the influences of drought on NFs ecosystem services across the conterminous United States (CONUS). The performance of the WaSSI model was comprehensively assessed with measured streamflow (Q) at 72 U.S. Geological Survey (USGS) gauging stations, and satellite-based estimates of watershed evapotranspiration (ET) and gross primary productivity (GPP) for 170 National Forest and Grassland (NFs). Across the 72 USGS watersheds, the WaSSI model generally captured the spatial variability of multi-year mean annual and monthly Q and annual ET as evaluated by Correlation Coefficient (R = 0.71–1.0), Nash–Sutcliffe Efficiency (NS = 0.31–1.00), and normalized Root Mean Squared Error (0.06–0.48). The modeled ET and GPP by WaSSI agreed well with the remote sensing-based estimates for multi-year annual and monthly means for all the NFs. However, there were systemic discrepancies in GPP between our simulations and the satellite-based estimates on a yearly and monthly scale, suggesting uncertainties in GPP estimates in all methods (i.e., remote sensing and modeling). Overall, our assessments suggested that the WaSSI model had the capability to reconstruct the long-term forest watershed water and carbon balances at a broad scale. This model evaluation study provides a foundation for model applications in understanding the impacts of climate change and variability (e.g., droughts) on NFs ecosystem service functions.