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The containment building Kori Unit 1 may require sequential steps for full decommissioning. This study assumes that the containment building is to be used as an auxiliary building that handles nuclear power systems and materials during decommissioning before conversion into a greenfield. Through the derivation of guidelines and dose evaluation, it was confirmed whether the radiation workers were satisfied with the ALARA decision. The specific modeling of the external radiation exposure was performed based on the facility investigation procedures. The external radiation specific derived concentration guideline levels (DCGLs) for radiation workers in containment building were obtained using the RESRAD-BUILD code and were applied to the VISIPLAN 3D ALARA Planning Tool code to calculate the working dose and check worker safety. The derivation of site-specific and realistic DCGLs and dose evaluation via 3D modeling can contribute to the scenario development for the decommission and remediation of containment building.

The literature on service quality recommends one to find an efficient direction for revising service quality with a combination analysis of a measurement model of service quality (SERVQUAL or SERVP...

BACKGROUND Up to 15% of previously irradiated metastatic spine tumors will progress. Re-irradiation of these tumors poses a significant risk of exceeding the radiation tolerance to the spinal cord. High-dose rate (HDR) brachytherapy is a treatment alternative. OBJECTIVE To develop a novel HDR spine brachytherapy technique using an intraoperative computed tomography-guided navigation (iCT navigation). METHODS Patients with progressive metastatic spine tumors were included in the study. HDR brachytherapy catheters were placed under iCT navigation. CT-based planning with magnetic resonance imaging fusion was performed to ensure conformal dose delivery to the target while sparing normal tissue, including the spinal cord. Patients received single fraction radiation treatment. RESULTS Five patients with thoracolumbar tumors were treated with HDR brachytherapy. Four patients previously received radiotherapy to the same spinal level. Preimplant plans demonstrated median clinical target volume (CTV) D90 of 116.5% (110.8%-147.7%), V100 of 95.7% (95.5%-99.6%), and Dmax of 8.08 Gy (7.65-9.8 Gy) to the spinal cord/cauda equina. Postimplant plans provided median CTV D90 of 113.8% (93.6%-120.1%), V100 of 95.9% (87%-99%), and Dmax of 9.48 Gy (6.5-10.3 Gy) to cord/cauda equina. Patients who presented with back pain (n = 3) noted symptomatic improvement at a median follow-up of 22 d after treatment. Four patients demonstrated local tumor control of spinal metastatic tumor at a median follow-up of 92 d after treatment. One patient demonstrated radiographic evidence of local tumor progression 2.7 mo after treatment. CONCLUSION HDR spine brachytherapy with iCT navigation is a promising treatment alternative to induce local tumor control and reduce pain symptoms associated with metastatic spine disease.

Previous research has analysed service quality mainly with single- and two-predictor models. The single-predictor models indicate the disconfirmation-only model and the performance-only model, wher...

A safety assessment was performed on the second-phase disposal facility of the Gyeongju low – and intermediate-level radioactive waste repository using the RESRAD-OFFSITE code. On the basis of the ...

A safety assessment of radioactive waste repositories is a mandatory requirement process because there are possible radiological hazards owing to radionuclide migration from radioactive waste to the biosphere. For a reliable safety assessment, it is important to establish a parameter database that reflects the site-specific characteristics of the disposal facility and repository site. From this perspective, solubility, a major geochemical parameter, has been chosen as an important parameter for modeling the migration behavior of radionuclides. The solubilities were derived for Am, Ni, Tc, and U, which were major radionuclides in this study, and on-site groundwater data reflecting the operational conditions of the Gyeongju low and intermediate level radioactive waste (LILW) repository were applied to reflect the site-specific characteristics. The radiation dose was derived by applying the solubility and radionuclide inventory data to the RESRAD-OFFSITE code, and sensitivity analysis of the dose according to the solubility variation was performed. As a result, owing to the low amount of radionuclide inventory, the dose variation was insignificant. The derived solubility can be used as the main input data for the safety assessment of the Gyeongju LILW repository in the future.

Site characterization for decommissioning Kori Unit 1 is ongoing in South Korea after 40 years of successful operation. Kori Unit 1’s containment building is assumed to be mostly radioactively contaminated, and therefore radiation exposure management and detailed contamination investigation are required for decommissioning and dismantling it safely. In this study, site-specific Derived Concentration Guideline Levels (DCGLs) were derived using the residual radioactivity risk evaluation tool, RESRAD-BUILD code. A conceptual model of containment building for Kori Unit 1 was set up and limited occupational worker building inspection scenario was applied. Depending on the source location, the maximum contribution source and exposure pathway of each radionuclide were analyzed. The contribution of radionuclides to dose and exposure pathways, by source location, is expected to serve as basic data in the assessment criteria of survey areas and classification of impact areas during further decommissioning and decontamination of sites.

The Kori Unit 1 will be decommissioned after a permanent shutdown in June 2017. South Korea has a 0.1 mSv/yr exposure limit standard for limited or unlimited site release. This is South Korea's first commercial NPP; therefore, if the containment building is reused as a memorial hall, it will contribute to the improvement of public understanding and enhance the public's acceptance of NPPs. Also, existing Kori Unit 1 nuclear power plant manpower resources can be reused after decommissioning and resident staff and memorial hall visitors can activate nearby commercial areas. Therefore, such a reuse scenario may also prevent an economic recession. The exposure dose was calculated using the following scenarios: worker in the containment building, visitor in the containment building, and worker in buildings other than the containment building. The exposure dose in the buildings was calculated by the RESRAD-BUILD developed by the Argonne National Laboratory (ANL). The preliminary exposure dose and derived concentration guideline level (DCGL) were derived.

In order to demonstrate capabilities of brachytherapy in skin cancer treatment, we reviewed clinical outcomes of patients with non-melanoma skin cancer (NMSC) treated with high-dose-rate brachytherapy (HDR-BT) at a single-institution.A surface custom mold (SC), interstitial (IS), or a combination of IS and SC applicator (IS + SC) was used for treatment based on depth of tumor invasion. Contoured growth tumor volume plus a 0.5 cm margin for basal cell carcinomas (BCC) and a 1-1.5 cm margin for squamous cell carcinomas (SCC) was considered a target. A prescription dose of 41.6 Gy in 8 fractions was delivered to BCC, and 46.8 Gy in 9 fractions to SCC.From 2013 to 2018, a total of 751 NMSC patients (534 BCCs and 217 SCCs) were treated with HDR-BT (518 with IS, 225 with SC, and 8 with IS + SC technique). Thirty patients (4%) partially responded to treatment, and 721 patients (96%) had complete responses. Only 3 patients (0.4%) displayed local recurrences. Grade 1, 2, and 3 acute toxicities were observed in 28.0%, 46.7%, and 1.2% of patients, respectively. Grade 1, 2, and 3 late toxicities were observed in 3.3%, 1.3%, and 0.1% of cases. Cosmetic results were excellent in 79.9%, good in 17.8%, fair in 1.7%, and poor in 0.5% of patients.HDR-BT using SC, IS, or IS + SC is an effective treatment for NMSC with good outcomes and cosmetic results in both BCC and SCC.

A RESRAD-OFFISTE computational code for the safety assessment model of a radioactive waste repository was utilized to evaluate the influence of the updated OECD/NEA thermodynamic database on the safety assessment model in terms of exposure dose. The solubility data as the input parameter for the RESRAD-OFFSITE code obtained with two different sets of chemical thermodynamic databases such as JAEA-TDB and amended JAEA-TDB reflecting the updates of the OECD/NEA thermodynamic database were calculated and compared with each other. As a result, almost identical exposure doses were obtained due to the remarkable similarity between the solubility data of various radionuclides for both chemical thermodynamic databases. In contrast, dramatic changes in exposure dose were observed with varying distribution coefficients. Thermodynamic calculations indicated that the aqueous species distribution can be significantly changed by the selection of a chemical thermodynamic database and thus the relevant distribution coefficient can also be influenced as a consequence. Accordingly, the result obtained in the present work indicated that (i) the impact of the updated chemical thermodynamic data was somewhat minor from the viewpoint of the solubility and (ii) the distribution coefficient, which can be sensitively influenced by the predominant chemical species, produced a remarkable change in the exposure dose. This work provided an insight into the precise exposure dose calculation in terms of the reliable estimation of the distribution coefficient by means of a surface complexation model, which can predict the distribution coefficient as a function of groundwater composition coupled with a chemical speciation calculation based on up to date chemical thermodynamic data.

Preliminary surface soil Derived Concentration Guideline Levels (DCGLs) were derived conforming to the Multi-Agency Radiation Site Survey and Investigation Manual (MARSSIM) procedure for the site release and reuse of Kori Unit 1 in Korea. Based on the decommissioning experiences of the U.S. nuclear power plants, a suite of residual radionuclides was determined, and uncertainties contributed to the resultant dose by the input parameters were quantified via the sensitivity analysis of parameters. The peak of the mean dose was obtained via the probabilistic analysis of the RESRAD (RESidual RADioactivity)-ONSITE code. Consequently, DCGLw of Kori Unit 1 in accordance with two scenarios, industrial worker and residential farmer scenario, were derived and the results were compared respectively with other NPPs. It could be used as a basic guideline for establishing regulatory standards for reuse planning, designing the site characterization surveys and implementing final status survey (FSS).

The purpose of this paper is to analytically and empirically show that the dimensions of SERVQUAL are not stable across service industries and even in the same service industry, because customers’ ...

This paper shows that an individual’s probability perception on risk occurrence incidence may be affected by situational factors and personal factors. To this end, it reviews previous research on the value function proposed by the prospect theory, and it reviews previous research on possible situational factors and individual factors that may affect the probability perception on the risk occurrence incidence. Then it empirically analyzes the effects of five variables as the situational factors (loss size from risky event, amount of information on risky event, temporal distance, social distance, and hypothetical distance) and the effects of three variables as the individual factors (perceived risk, involvement, and gender) with two experimental studies. According to the empirical studies, the probability perception on risk occurrence incidence varies depending on hypothetical distance (as a situational factor) and perceived risk, involvement, and gender (as individual factors).

대한민국 첫 상업원전인 고리1호기는 40년간의 성공적인 운전을 끝내고 2017년 6월 18일 영구정지 되었다. 고리1호기는 본격적인 해체에 앞서 터빈건물에 폐기물처리시설 건설을 계획하고 있다. 각종 방사성폐기물은 폐기물처리시설에서 제염, 해체, 절단, 용융되어 자체처분 되거나 방사성폐기물 처분장으로 보내 진다. 해...

Extracellular vesicles (EVs) are mediators of intercellular communication by transporting cargo containing proteins, lipids, mRNA, and miRNA. There is increasing evidence that EVs have various roles in regulating migration, invasion, stemness, survival, and immune functions. Previously, we have found that EVs from Kaposi's sarcoma-associated herpesvirus (KSHV)-infected human endothelial cells have the potential to activate the complement system. Although many studies have shown that the physical properties of EVs can be changed by their storage condition, there have been few studies for the stability of biological activity of EVs in various storage conditions. In this study, we investigated various conditions to identify the best conditions to store EVs with functional stability for 25 d. Furthermore, the correlation between the function and other characteristics of EVs, including the expression of EV markers, size distribution, and particle number, were also analyzed. Our results demonstrated that storage temperature is an important factor to maintain the activity of EVs and would be useful information for basic research and clinical application using EVs.

There is increasing evidence that the complement system is activated in various cancer tissues. Besides being involved in innate immunity against pathogens, the complement system also participates in inflammation and the modulation of tumor microenvironment. Recent studies suggest that complement activation promotes tumor progression in various ways. Among some cancer cell lines, we found that human bone osteosarcoma epithelial cells (U2-OS) can activate the alternative pathway of the complement system by pooled normal human serum. Interestingly, U2-OS cells showed less expression of complement regulatory proteins, compared to other cancer cell lines. Furthermore, the activated complement system enhanced the production of growth factors, which promoted angiogenesis of human endothelial cells. Our results demonstrated a direct linkage between the complement system and angiogenesis using the in vitro model, which suggest the complement system and related mechanisms might be potential targets for cancer treatment.

Background As high-dose-rate (HDR) brachytherapy can preferentially spare normal anatomic structures surrounding the radiation target, we report on our experience using this technique in head and neck cancer reirradiation. Methods Twenty patients received HDR brachytherapy reirradiation with curative or palliative intent from 2010-2015. Clinical and toxicity outcomes were recorded. Actuarial outcomes were calculated using Kaplan-Meier analysis. Results For curative treatment, actuarial 2-year rates of local control and overall survival (OS) were 73% and 56%, respectively. Palliatively, a 6-month local control rate of 65% was seen. Age >70 years was associated with poorer OS (P = .042). Prior salvage resection showed a trend toward improved local control and OS (P = .069 and P = .063, respectively). Thirty-three percent had grade 3 to 4 late toxicities. Conclusion Curative-intent HDR brachytherapy reirradiation can provide excellent local control and encouraging OS. Given the late toxicity rates, patient selection is essential, with particular utility for younger patients or those treated with salvage resection.

Purpose Given the limited data using an interstitial approach with 3D-based planning for definitive cervical cancer utilizing the GEC-ESTRO defined high-risk clinical target volume (HR-CTV), we reviewed our institutional experience of cervical cancer patients with HR-CTVs ≥ 30 cc to determine whether our clinical and toxicity outcomes are acceptable. Methods A retrospective review of 37 cervical cancer patients with high-risk clinical target volumes (HR-CTVs) ≥30 cc treated with interstitial image-guided brachytherapy (IS IGBT) was performed. All patients received external beam radiotherapy to a median dose of 45 Gy, followed by IS IGBT delivered in a single implant to a median dose of 6 Gy × 5 fractions. Median HR-CTV was 59 cc. A median HR-CTV D90 of 87.44 Gy was achieved. Kaplan–Meier method was used to evaluate local control (LC), distant control, and overall survival (OS), with stratification by overall treatment time (OTT) ≤ 7 or >7 weeks. Results Median followup was 17 months. The estimated 2-year LC, distant control, and OS were 77.6% (confidence interval [CI]: 63.8–94.5%), 56.8% (CI: 41.3–78.1%), and 54.4% (CI: 39.4–75%), respectively. The 2-year LC for OTT ≤7 weeks and >7 weeks were 100% and 58.3%, respectively (p = 0.026). The 2-year OS for OTT ≤7 weeks and >7 weeks were 77.8% and 38%, respectively (p = 0.021). Discussions IS IGBT can achieve a high D90 to the HR-CTV even in the setting of large-volume disease and results in a favorable LC and toxicity profile. OTT > 7 weeks is associated with significant decrease in LC and OS. Conclusions Efforts should be made to complete whole treatment within 7 weeks as this is associated with improved clinical outcomes.

A consumer may not be affected by all positive recommenders due to limitations of cognitive capacity. This limitation (of cognitive capacity) results in two different response functions for the size of positive recommenders: One is an S-shaped function which assumes that the second and third sources (recommenders) have greater additional impact than the first source, and the other is a concave-shaped function which assumes that the first source (recommender) is more influential than the second and the third sources. In this paper we operationalize volume of Word-of-Mouth as the total number of positive Word-of-Mouth senders and using two conjoint studies empirically investigate whether the relationship between the volume of Word-of-Mouth and its impact follows a concave-shaped function or an S-shaped function. The two conjoint studies support the concave-shaped response for the volume of Word-of-Mouth.

PURPOSE/OBJECTIVE(S) To evaluate the clinical and patient-reported outcomes and toxicities in prostate cancer patients undergoing HDR brachytherapy after TURP. MATERIALS/METHODS Data was prospectively collected for patients undergoing HDR brachytherapy from October 1991 to March 2016. Patients were classified according to NCCN risk criteria. Implants were performed under ultrasound-guidance with CT based planning. Goal dosimetric constraints included V100 Prostate > 95%, D1cc Urethra < 105%, D1cc Bladder < 75%, and D1cc Rectum < 75%. Multivariate cox analysis (MVA) was performed and adjusted for age, T stage, Gleason score, initial PSA, and androgen deprivation therapy (ADT) use. Sexual health inventory for men (SHIM) score, International Prostate Symptom Score (IPSS), and CTCAE v5.0 graded toxicity were recorded. RESULTS 2266 patients underwent HDR brachytherapy. 228 underwent a prior TURP. The median follow-up was 61.1 months (range 3 - 257.4 mos). The median time from TURP to HDR was 52.5 months (range 0.17 - 392 mos). A total of 641, 431, 617, and 577 patients were low-, favorable intermediate-, unfavorable intermediate-, and high-risk, respectively, of which 41, 49, 53, and 85 patients with TURP were low-, favorable intermediate-, unfavorable intermediate-, and high-risk, respectively. Patients with a prior history of TURP were more advanced in age and had a higher incidence of high-risk disease (P < 0.001). Of the patients with history of prior TURP, 49 (22%) and 54 (24%) patients experienced Gr 1 and 2 GU toxicity. 8 patients (3.5%) experienced grade 3 GU toxicity with a median time to occurrence of 16 mo (0.2 - 57.7 mo), and 3 of the Grade 3 toxicities resolved. No grade ≥4 GU toxicity and significant differences in toxicity were observed between the cohorts (P = 0.108). Patient-reported SHIM scores were found to not be statistically significant between prior TURP and non-TURP patients, with average decreases in SHIM no greater than 5 points at all time points in the TURP cohort. No significant differences were observed in biochemical free survival, distant metastases free survival, and prostate cancer specific survival at 4 and 8 years between patients who did and did not receive a prior TURP (8-yr BCFS 84.7% (95% CI: 78.2%-91.8%) vs. 89.1% (95% CI: 87.3-91.0%), respectively; P = 0.16). The TURP cohort was found to have lower overall survival (8-yr OS 72.0% (95% CI 64.8%-79.9%) vs. 81.9% (95% CI: 80.0% - 84.1%) respectively; P = 0.041), and may be attributed to the older age of the TURP cohort (P < 0.001). CONCLUSION HDR brachytherapy is a safe and effective treatment modality with low toxicity for prostate cancer patients after a prior TURP.

Although mega-watt class onshore and offshore wind power systems are used to generate power due to their cost-effectiveness, small wind power systems are important for household usages. Researchers have focused on aerodynamic characteristics as a conceptual design from their previous studies on Archimedes spiral wind turbines. Here, we verified the design of a small wind turbine AWM-750D (100 W capacity) via both numerical simulation and experimentation. We used commercial code ANSYS CFX for numerical simulation and compared turbulence models and surface roughness for determining the performance. To obtain reliable and robust blades, we analyzed the effective manufacturing method with Moldflow. Through a test with an open-suction type atmospheric boundary layer wind tunnel, we varied wind speed from 4.0 m/s to the rated value of 12.5 m/s and obtained 106 W, equivalent to a power coefficient of 0.205. In addition, we compared the numerical and experimental power vs. rotational speed and found the former is 6.5% lower than the latter. In this study, we proved that numerical simulations can act as design verification methods to predict wind turbine performances and reliable manufacturing. Through our research, we provided the prototype of a small wind turbine with 100 W to act as an efficient electric power supplier for households and also the stable manufacturing process for complex spiral blades using injection molding.

Performance–expectation measures and performance-only measures of service quality have been widely used in the literature. However, either of the two measures is not sufficient to explain customers’ evaluation of service quality and satisfaction. Their assumptions are too restrictive to explain the evaluation processes. From an analytic perspective, this paper derives a composite measure integrating both measures for service quality. The previous measures are nested in the composite measure. Due to this feature, the composite measure is more flexible than the previous measures. It can account for conflicting theories and empirical findings supporting each of the two measures. Furthermore, the composite measure allows us to interpret the link between service quality and customer satisfaction more intuitively.

Introduction To identify differences in acute urinary and sexual toxicity between a 6-fraction and 2-fraction high-dose-rate brachytherapy monotherapy regimen and correlate dosimetric constraints to short-term toxicity. Methods A single institution retrospective study of 116 men with prostate cancer treated with HDR monotherapy from 2010 to 2015 was conducted. Eighty-one men had 7.25 Gy × 6-fractions and 35 men had 13.5 Gy × 2-fractions. Patients had two CT-planned implants spaced 1–2 weeks apart. Patient baseline characteristics, International Prostate Symptom Scores (IPSS) and Sexual Health Inventory for Men (SHIM) scores were collected pre-treatment and 3, 6 and 12 months post-implantation. Mixed effect modelling was undertaken to compare baseline, 1–6 month and 7–12 month scores between groups. Poisson regression analysis was performed to correlate dosimetric constraints with acute toxicity. Results There was no difference between baseline and post-implantation IPSS scores between 6-fraction and 2-fraction groups. SHIM scores for men treated with 6-fractions had a steeper decline at 1–6 months, but resolved at 7–12 months. Pre-treatment alpha-blocker use correlated with worse short-term acute urinary toxicity. Worsened SHIM score correlated with increasing age, diabetes mellitus and androgen-deprivation therapy. In a dosimetric analysis of outcomes, prostate V150 dose and bladder wall (D01.cc, D1cc, D2cc) dose correlated with increased IPSS score. Conclusion No increased acute genitourinary or sexual dysfunction has been observed in men when transitioning from 6-fraction to 2-fraction HDR monotherapy. A dosimetric correlation was found between the V150 and bladder wall doses for acute urinary toxicity. Future research should continue to standardize and validate dose constraints for prostate HDR monotherapy patients.

Purpose Outcomes using high-dose-rate (HDR) brachytherapy monotherapy (without androgen deprivation therapy or external beam radiation therapy) for National Comprehensive Cancer Network–defined intermediate-risk (IR) patients are limited. We report our long-term data using HDR monotherapy for this patient population. Methods and Materials One-hundred ninety IR prostate cancer patients were treated 1996–2013 with HDR monotherapy. Biochemical prostate-specific antigen (PSA) failure was per the Phoenix definition. Acute and late genitourinary and gastrointestinal toxicities were graded according to Common Toxicity Criteria of Adverse Events, version 4. Kaplan–Meier (KM) biochemical progression-free survival (BPFS), cause-specific survival, and overall survival rates were calculated. Univariate analyses were performed to determine relationships with BPFS. The median patient age was 66 years (43–90), and the median initial PSA was 7.4 ng/mL. The Gleason score was ≤6 in 26%, 3 + 4 in 62%, and 4 + 3 in 12%. The median treatment BED 1.5 was 254 Gy; 83% of patients were treated with a dose of 7.25 Gy × six fractions delivered in two separate implants. Results With a median follow-up of 6.2 years, KM BPFS at 5/8 years was 97%/90%, cause-specific survival at 8 years was 100%, and overall survival at 5/8 years was 93%/88%. Late genitourinary toxicities were 36.3% Grade 1, 18.9% Grade 2, and 3.7% Grade 3. Late gastrointestinal toxicities were 6.3% Grade 1, 1.1% Grade 2, and no Grade ≥3. Of the patients with no sexual dysfunction before treatment, 68% maintained potency. Age, initial PSA, T stage, Gleason score, prostate volume, and percent positive cores did not correlate with BPFS. Stratifying by favorable vs. unfavorable IR groups did not affect BPFS. Conclusions HDR brachytherapy monotherapy represents a safe and highly effective treatment for IR prostate cancer patients with long-term follow-up.

There is a long debate over the superiority of performance-only measures vs. performance-expectation measures of service quality. This paper analytically derives the superiority conditions of the measures in predicting customer satisfaction. The conditions show that the superiority of the measures is determined by two factors. One is the strengths of linkages between the constructs (expectation, performance, and customer satisfaction) in the customer satisfaction formation process, and the other is customer heterogeneity in the evaluation of constructs in the process. The source of customer heterogeneity implies that the superiority is affected by the procedure for measuring service quality because the degree of customer heterogeneity in the evaluation of perceived and expected service quality may vary according to the measurement procedure.

Purpose Cost estimates through traditional hospital accounting systems are often arbitrary and ambiguous. We used time-driven activity-based costing (TDABC) to determine the true cost of low-dose-rate (LDR) and high-dose-rate (HDR) brachytherapy for prostate cancer and demonstrate opportunities for cost containment at an academic referral center. Methods and Materials We implemented TDABC for patients treated with I-125, preplanned LDR and computed tomography based HDR brachytherapy with two implants from initial consultation through 12-month followup. We constructed detailed process maps for provision of both HDR and LDR. Personnel, space, equipment, and material costs of each step were identified and used to derive capacity cost rates, defined as price per minute. Each capacity cost rate was then multiplied by the relevant process time and products were summed to determine total cost of care. Results The calculated cost to deliver HDR was greater than LDR by $2,668.86 ($9,538 vs. $6,869). The first and second HDR treatment day cost $3,999.67 and $3,955.67, whereas LDR was delivered on one treatment day and cost $3,887.55. The greatest overall cost driver for both LDR and HDR was personnel at 65.6% ($4,506.82) and 67.0% ($6,387.27) of the total cost. After personnel costs, disposable materials contributed the second most for LDR ($1,920.66, 28.0%) and for HDR ($2,295.94, 24.0%). Conclusions With TDABC, the true costs to deliver LDR and HDR from the health system perspective were derived. Analysis by physicians and hospital administrators regarding the cost of care afforded redesign opportunities including delivering HDR as one implant. Our work underscores the need to assess clinical outcomes to understand the true difference in value between these modalities.

Kaposi's Sarcoma-associated herpesvirus (KSHV) is the etiologic agent of Kaposi's sarcoma, which is the most common cancer in acquired immune deficiency syndrome patients. KSHV contains a variety of immunoregulatory proteins. There have been many studies on the modulation of antiviral response by these immunoregulatory proteins of KSHV. However, the antiviral effects of extracellular vesicles (EVs) during de novo KSHV infection have not been investigated to our best knowledge. In this study, we showed that KSHV-infected cells induce interferon-stimulated genes (ISGs) response but not type I interferon in uninfected bystander cells using EVs. mRNA microarray analysis showed that ISGs and IRF-activating genes were prominently activated in EVs from KSHV-infected cells (KSHV EVs)-treated human endothelial cells, which were validated by RT-qPCR and western blot analysis. We also found that this response was not associated with cell death or apoptosis by virus infection. Mechanistically, the cGAS-STING pathway was linked with these KSHV EVs-mediated ISGs expressions, and mitochondrial DNA on the surface of KSHV EVs was one of the causative factors. Besides, KSHV EVs-treated cells showed lower infectivity for KSHV and viral replication activity than mock EVs-treated cells. Our results indicate that EVs from KSHV-infected cells could be an initiating factor for the innate immune response against viral infection, which may be critical to understanding the microenvironment of virus-infected cells.