PURPOSE Our objective was to demonstrate the efficacy of a telehealth training course on high-dose-rate (HDR) brachytherapy for gynecologic cancer treatment for clinicians in low- and middle-income countries (LMICs) METHODS A 12-week course consisting of 16 live video sessions was offered to 10 cancer centers in the Middle East, Africa, and Nepal. A total of 46 participants joined the course, and 22 participants, on average, attended each session. Radiation oncologists and medical physicists from 11 US and international institutions prepared and provided lectures for each topic covered in the course. Confidence surveys of 15 practical competencies were administered to participants before and after the course. Competencies focused on HDR commissioning, shielding, treatment planning, radiobiology, and applicators. Pre- and post-program surveys of provider confidence, measured by 5-point Likert scale, were administered and compared. RESULTS Forty-six participants, including seven chief medical physicists, 16 senior medical physicists, five radiation oncologists, and three dosimetrists, representing nine countries attended education sessions. Reported confidence scores, both aggregate and paired, demonstrated increases in confidence in all 15 competencies. Post-curriculum score improvement was statistically significant ( P < .05) for paired respondents in 11 of 15 domains. Absolute improvements were largest for confidence in applicator commissioning (2.3 to 3.8, P = .009), treatment planning system commissioning (2.2 to 3.9, P = .0055), and commissioning an HDR machine (2.2 to 4.0, P = .0031). Overall confidence in providing HDR brachytherapy services safely and teaching other providers increased from 3.1 to 3.8 and 3.0 to 3.5, respectively. CONCLUSION A 12-week, low-cost telehealth training program on HDR brachytherapy improved confidence in treatment delivery and teaching for clinicians in 10 participating LMICs.
Background We aim to analyse the safety and feasibility of the DaVinci Single Port (SP) platform in general surgery. Methods A prospective series of robotic SP transabdominal pre‐peritoneal inguinal hernia repairs (SP‐TAPP) and cholecystectomies (SP‐C) (off‐label) were analysed. Primary endpoints were safety and feasibility defined by the need for conversion and incidence of perioperative complications. Results A total of 225 SP procedures were performed; 84 (37.3%) SP‐TAPP (70 unilateral, 7 bilateral), and 141 (62.7%) SP‐C. There were no conversions or additional ports placed. Mean console time was 17.6, 31.9, and 54 min for SP‐C, unilateral, and bilateral SP‐TAPP, respectively. There was no mortality, intraoperative or major postoperative complications. Mean LOS was 2.7 h for elective SP‐TAPP and 2.3 h for SP‐C. Conclusion Robotic SP surgery is safe and feasible for two of the most performed general surgery operations. Further experience might allow expanding the applications of robotic single‐incision surgery for other procedures.
In this paper, a method for the non-linear dynamic analysis of rectangular plates that undergo large rigid body motions and small elastic deformations is presented. The large rigid body displacement of the plate is defined by the translation and rotation of a selected plate reference. The small elastic deformation of the midplane is defined in the plate co-ordinate system using the assumptions of the classical theories of plates. Non-linear terms that represent the dynamic coupling between the rigid body displacement and the elastic deformation are presented in a closed form in terms of a set of time-invariant scalars and matrices that depend on the assumed displacement field of the plate. In this paper, the case of simple two-parameter screw displacement, where the rigid body translation and rotation of the plate reference are, respectively, along and about an axis fixed in space, is first considered. The non-linear dynamic equations that govern the most general and arbitrary motion of the plate are also presented and both lumped and consistent mass formulations are discussed. The non-linear dynamic formulation presented in this paper can be used to develop a total Lagrangian finite element formulation for plates in multibody systems consisting of interconnected structural elements.
Rationale-Cannabinoid type 1 receptors (CB1Rs) are widely expressed within the brain's reward circuits and are implicated in regulating drug induced behavioral adaptations. Understanding how CB1R signaling in discrete circuits and cell types contributes to drug-related behavior provides further insight into the pathology of substance use disorders.Objective and methods-We sought to determine how cell type-specific expression of CB1Rs within striatal circuits contributes to cocaine-induced behavioral plasticity, hypothesizing that CB1R function in distinct striatal neuron populations would differentially impact behavioral outcomes. We crossed conditional Cnr1 fl/fl mice and striatal output pathway cre lines (Drd1a -cre; D1, Adora2a -cre; A2a) to generate cell type-specific CB1R knockout mice and assessed their performance in cocaine locomotor and associative behavioral assays.Results-Both knockout lines retained typical locomotor activity at baseline. D1-Cre × Cnr1 fl/fl mice did not display hyperlocomotion in response to acute cocaine dosing, and both knockout lines exhibited blunted locomotor activity across repeated cocaine doses. A2a-cre Cnr1 fl/fl , mice did not express a preference for cocaine paired environments in a two-choice place preference task.Conclusions-This study aids in mapping CB1R-dependent cocaine-induced behavioral adaptations onto distinct striatal neuron subtypes.
In this investigation a nonlinear total Lagrangian finite element formulation is developed for the dynamic analysis of plates that undergo large rigid body displacements. In this formulation shape functions are required to include rigid body modes that describe only large translational displacements. This does not represent any limitation on the technique presented in this study, since most of commonly used shape functions satisfy this requirement. For each finite plate element an intermediate element coordinate system, whose axes are initially parallel to the axes of the element coordinate system, is introduced. This intermediate element coordinate system, which has an origin which is rigidly attached to the origin of the deformable body, is used for the convenience of describing the configuration of the element with respect to the deformable body coordinate system in the undeformed state. The nonlinear dynamic equations developed in this investigation for the large rigid body displacement and small elastic deformation analysis of the rectangular plates are expressed in terms of a unique set of time invariant element matrices that depend on the assumed displacement field. The invariants of motion of the deformable body discretized using the plate elements are obtained by assembling the invariants of its elements using a standard finite element procedure.
Problem High-quality training opportunities for providers in limited-resource settings are often scarce or nonexistent. This can lead to a dearth of boots-on-the-ground workers capable of translating knowledge into effective action. The tested telehealth education model of Project ECHO (Extension for Community Healthcare Outcomes) can help address this disparity. However, the planning and logistical coordination required can be limiting. Approach Medical student volunteers interested in health disparities and global health can be leveraged to reduce the costs of administration for Project ECHO programs. From mid-2018 to present (2020), student organizations have been formed at Vanderbilt University School of Medicine, University of California, San Francisco, School of Medicine, and Albert Einstein College of Medicine. These organizations have recruited and trained volunteers, who play an active role in assessing the needs of local clinics and providers, developing curricula, and coordinating the logistical aspects of programs. Outcomes In the first 4 student-coordinated Project ECHO cohorts (2019–2020), 25 clinics in 14 countries participated, with a potential impact on over 20,000 cancer patients annually. Satisfaction with the telehealth education programs was high among local clinicians and expert educators. Students’ perceived ability to conduct activities important to successfully orchestrating a telehealth education program was significantly greater among students who had coordinated one or more Project ECHO programs than among students who had yet to participate for 7 of 9 competencies. There also appears to be an additive effect of participating in additional Project ECHO programs on perceived confidence and career path intentions. Next Steps The student-led model of coordinating telehealth education programs described here can be readily expanded to medical schools across the nation and beyond. With continued expansion, efforts are needed to develop assessments that provide insights into participants’ learning, track changes in patient outcomes, and provide continuing medical education credits to local clinicians.
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