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Abstract Background Interprofessional communication is fundamental to the delivery of healthcare and can be taught in medical school and other health professional schools through interprofessional education (IPE) activities. Simulation centers have become a predominant location for simulation IPE activities with infrastructure able to support high fidelity activities in a controlled environment. In this secondary analysis of a scoping review conducted on simulation-based IPE, we describe the characteristics of previously reported simulation IPE activities involving undergraduate medical students in a simulation center focused on interprofessional communication. Methods Electronic searches of PubMed, CINAHL, and ERIC databases in accordance with PRISMA-ScR guidelines were conducted to isolate relevant articles from 2016–2020. In total, 165 peer-reviewed articles met inclusion criteria and data extraction linked to four research questions was applied by one individual and the accuracy was confirmed by a second individual. A secondary analysis was performed to describe what existing approaches for simulation IPE in simulation center settings have been used to explicitly achieve interprofessional communication competencies in undergraduate medical education. A sub-dataset was developed from the original scoping review and identified 21 studies describing simulation IPE activities that took place in dedicated simulation centers, targeted the IPEC interprofessional communication domain, and involved undergraduate medical students. Results Though diverse, the majority of simulation IPE activities described high-fidelity approaches involving standardized patients and utilized assessment tools with established validity evidence in IPE activities to measure learning outcomes. A minority of simulation IPE activities were described as hybrid and utilized more than one resource or equipment for the activity and only two were longitudinal in nature. Learning outcomes were focused predominantly on modification of attitudes/perceptions and few targeted higher levels of assessment. Conclusions Educators charged with developing simulation IPE activities for medical students focused on interprofessional communication should incorporate assessment tools that have validity evidence from similar activities, target higher level learning outcomes, and leverage hybrid models to develop longitudinal simulation IPE activities. Though an ideal environment to achieve higher level learning outcomes, simulation centers are not required for meaningful simulation IPE activities.

Anthropogenic activities can alter natural disturbance regimes in ecosystems, and thereby affect the structure and function of biological diversity. As many of the world’s ecosystems are degraded beyond natural recovery, well-defined restoration goals are necessary to maintain the ecological processes that provide valuable ecosystem services. Utilizing both taxonomic and functional approaches, we investigate the impacts of forest management practices in structuring predator communities in pine forest ecosystems under different forest management regimes. We focus on snakes as an indicator taxon, across pine forest systems in eastern Texas characterized by forest management practice frequency. Specifically, we investigate the responses of snake assemblages in the context of restoration efforts, comparing and contrasting these responses between high practice frequency (i.e., short burn intervals and thinning) and low practice frequency treatments (i.e., long burn intervals and no thinning). Taxonomic diversity was greater in the high-frequency treatment than in the low-frequency treatment, while functional diversity was similar between treatments. Functional redundancy was observed to increase with increasing forest management practice frequency, despite differences in taxonomic diversity and community-weighted means of traits between predator assemblages in each treatment. Consequently, increased frequency of prescribed fires and thinning operations may lead to greater stability and resilience in pine-forest ecosystems. Our study contributes to the understanding of how anthropogenic disturbances influence community organization in terrestrial ecosystems. Furthermore, this study reveals the importance of ecological restoration as a tool in disturbance prone ecosystems, and highlights importance of incorporating a multi-dimensional approach to meet desired restoration goals and ensure the health of forest ecosystems.

Purpose: Monaco treatment planning system (TPS) version 5.1 uses a Monte-Carlo (MC)-based dose calculation engine. The aim of this study is to verify and compare the Monaco-based dose calculations with both Pinnacle3 collapsed cone convolution superposition (CCCS) and Eclipse anisotropic analytical algorithm (AAA) calculations. Materials and Methods: For this study, 18 previously treated lung and head-and-neck (HN) cancer patients were chosen to compare the dose calculations between Pinnacle, Monaco, and Eclipse. Plans were chosen from those that had been treated using the Elekta VersaHD or a Novalis Tx linac. All of the treated volumetric-modulated arc therapy plans used 6 MV or 10 MV photon beams. The original plans calculated with CCCS or AAA along with the recalculated ones using MC from the three TPS were exported into Velocity software for intercomparison. Results: To compare the dose calculations, Planning target volume (PTV) heterogeneity indexes and conformity indexes were calculated from the dose volume histograms (DVH) of all plans. While mean lung dose (MLD), lung V5 and V20 values were recorded for lung plans, the computed dose to parotids, brainstem, and mandible were documented for HN plans. In plan evaluation, percent differences of the above dosimetric values in Monaco computation were compared against each of the other TPS computations. Conclusion: It could be concluded through this research that there can be differences in the calculation of dose across different TPSs. Although relatively small, these differences could become apparent when compared using DVH. These differences most likely arise from the different dose calculation algorithms used in each TPS. Monaco employs the MC allowing it to have much more detailed calculations that result in it being seen as the most accurate and the gold standard.

Introduction: Clinical evaluation of a two-dimensional (2D) liquid-filled ion chamber detector array used in the verification of highly modulated small beams of stereotactic body radiation therapy (SBRT) has been conducted. Materials and Methods: Measurements with the Octavius 1000 SRS (PTW, Freiburg, Germany) detector with 977 liquid-filled ion chambers were compared against EDR2 film and PTW Octavius Seven29. The performance of detector array has been evaluated on ten SBRT patient plans. Dose profiles of individual and composite fields' calculated using Pinnacle3 treatment planning system were compared against measurements with Octavius 1000 SRS detector array, EDR2 film, and Octavius Seven29 detector. Gamma index and profile comparison were used in the evaluation and assessment of the detector's performance. Results: The Gamma index measurements show agreement between Pinnacle3 computations and Octavius 1000 SRS array, PTW Octavius Seven29, and EDR2 film for >90% of the points using 2%, 2 mm tolerance criteria. Profiles obtained with the Octavius 1000 SRS were in agreement with the EDR2 film profiles, demonstrating the detector's superior sampling rate. Conclusions: The Octavius 1000 SRS is a dosimetrically accurate device to perform quality assurance checks in SBRT treatments. The broad range of measurements performed in this study quantified the dosimetric accuracy of Octavius 1000 SRS detector in the clinical setup of the small fields in radiotherapy.

Amphibians have seen large population declines, but the key drivers are hard to establish. Here, Miller et al. investigate trends of occupancy for 81 species of amphibians across North America and find greater sensitivity to water availability during breeding and winter conditions than mean climate.

ABSTRACT IMPACT: This work assesses clinical implementation of a surface guided imaging system to improve the accuracy radiation delivery for treatment of brain lesions using a patient CT derived head phantom. OBJECTIVES/GOALS: Advancements in radiotherapy design have made clinical demand for efficient and accurate methods to deliver stereotactic radiosurgery (SRS) for treatment of intracranial lesions. This study assesses the potential of using surface guided imaging for setup using a 3D patient specific head phantom. METHODS/STUDY POPULATION: A single isocenter, multiple metastases SRS plan was generated on a CT derived RTsafe Prime phantom made of tissue equivalent materials and a polymer gel insert. Five targets of varying diameters were treated with 8Gy of radiation using two different positioning techniques. The first gel insert was irradiated within the phantom according to internal alignment with standard orthogonal x-ray imaging while the second setup used surface guided imaging, based on external anatomy. 42 hours after irradiation, the phantom was scanned in a head coil using a 1.5T MRI. MR images were fused with the patient CT data and structure set to further evaluate calculated and measured dose distributions. RESULTS/ANTICIPATED RESULTS: Discrepancies in phantom setup according to standard orthogonal x-ray imaging compared to surface guided imaging demonstrated to be 94% (5%/2mm) and >87% (3%/2mm). Finally, 3 of 5 targets showed better 3D GI passing rates and less geometric offset for positioning with the surface guided imaging. DISCUSSION/SIGNIFICANCE OF FINDINGS: 3D spatial analysis of human like phantoms demonstrated that patient positioning according to external anatomy performed comparable to standard methods aligning to the internal anatomy, for a multiple met SRS treatment.

This study investigated the dosimetric differences in treatment plans from flattened and flattening filter-free (FFF) beams from the TrueBeam System. A total of 104 treatment plans with static (sliding window) intensity-modulated radiotherapy beams and volumetric-modulated arc therapy (VMAT) beams were generated for 15 patients involving three cancer sites. In general, the FFF beam provides similar target coverage as the flattened beam with improved dose sparing to organ-at-risk (OAR). Among all three cancer sites, the head and neck showed more important differences between the flattened beam and FFF beam. The maximum reduction of the FFF beam in the mean dose reached up to 2.82 Gy for larynx in head and neck case. Compared to the 6 MV flattened beam, the 10 MV FFF beam provided improved dose sparing to certain OARs, especially for VMAT cases. Thus, 10 MV FFF beam could be used to improve the treatment plan.

Oorganismos que adotam estratégias anti-predação fenotipicamente plásticas durantes estágios larvais podem sofrer perdas de sucesso reprodutivo nas fases finais do desenvolvimento. Em muitas espécies tais custos são tipicamente difíceis de serem definidos. A dificuldade de identificar balanços ecológicos pode resultar de comparações experimentais que não refletem adequadamente relações predador-presa que ocorrem naturalmente. Para examinar isso, capturamos 61 Acris blanchardi recém-metamorfoseados em lagoas dominadas por peixes ou por invertebrados. Estes predadores são conhecidos por induzir respostas fenotípicas anti-predadores alternativas na fase larvária. Utilizamos o desempenho no salto como uma medida de sucesso reprodutivo pós-metamorfose e comparamos características morfológicas e capacidade de salto de indivíduos de lagoas com e sem peixes. Indivíduos de lagoas sem peixes podem saltar significativamente mais longe do que indivíduos de lagoas dominadas por peixes. Medidas morfológicas indicaram que o tamanho total do indivíduo determinou diferenças na capacidade saltatória, com comprimento da pata sendo o fator primário a explicar o desempenho no salto. Diferenças no comprimento da pata posterior foram positivamente correlacionadas com o tamanho total do corpo, que diferiu entre os dois tipos de lagoas e não resultou do crescimento alométrico entre a pata e o corpo. Diferenças no tamanho dos indivíduos presumivelmente estão relacionadas a diferenças na morfologia anti-predação durante o desenvolvimento das larvas.

Purpose. To achieve rapid automated delineation of gross target volume (GTV) and to quantify changes in volume/position of the target for radiotherapy planning using four-dimensional (4D) CT. Methods and Materials. Novel morphological processing and successive localization (MPSL) algorithms were designed and implemented for achieving autosegmentation. Contours automatically generated using MPSL method were compared with contours generated using state-of-the-art deformable registration methods (using Elastix© and MIMVista software). Metrics such as the Dice similarity coefficient, sensitivity, and positive predictive value (PPV) were analyzed. The target motion tracked using the centroid of the GTV estimated using MPSL method was compared with motion tracked using deformable registration methods. Results. MPSL algorithm segmented the GTV in 4DCT images in 27.0±11.1 seconds per phase (512×512 resolution) as compared to 142.3±11.3 seconds per phase for deformable registration based methods in 9 cases. Dice coefficients between MPSL generated GTV contours and manual contours (considered as ground-truth) were 0.865±0.037. In comparison, the Dice coefficients between ground-truth and contours generated using deformable registration based methods were 0.909 ± 0.051. Conclusions. The MPSL method achieved similar segmentation accuracy as compared to state-of-the-art deformable registration based segmentation methods, but with significant reduction in time required for GTV segmentation.

La superficie que actualmente ocupa el encinar en la Comunidad de Madrid es pequeña: alrededor del 14% de la superficie que de forma potencial podría ocupar. Esta escasa representación del encinar se encuentra, además, en diversos estados de conservación. En este artículo se presenta un intento de elaboración de una tipología de los encinares mediante el análisis multivariable de algunos datos de estructura y las especies botánicas que aparecen en ellos. [fr] Á présent lachênaie occupe le 14% de sa surface potentielle dans la Communauté de Madrid. Cette peu abondante representation a, en plus, plusieurs états de conservation. Dans cet article nous essayons d'elaborer une typologie des chênaies au moyen de l'analyse multivariable des données de la structure et le leur cortége botanique.

Abstract Photodynamic therapy (PDT) is an anticancer treatment involving administration of a tumour-localizing photosensitizer, followed by activation by light of a suitable wavelength. In previous work, we showed that the natural anthraquinone (AQ) Parietin (PTN), was a promising photosensitizer for photodynamic therapy of leukemic cells in vitro. The present work aimed to analyze the photosensitizing ability of PTN in the mammary carcinoma LM2 cells in vitro and in vivo in a model of subcutaneously implanted tumours. Photodynamic therapy mediated by parietin (PTN-PDT) (PTN 30 µM, 1 h and 1.78 J/cm2 of blue light) impaired cell growth and migration of LM2 cells in vitro. PTN per se induced a significant decrease in cell migration, and it was even more marked after illumination (migration index was 0.65 for PTN and 0.30 for PTN-PDT, *p

Abstract Background Photodynamic therapy (PDT) is an anticancer treatment that utilizes the interaction of light and a photosensitiser (PS), promoting tumour cell death mediated by generation of reactive oxygen species. In this study, we evaluated the in vitro photoactivity of four meso-substituted porphyrins and a porphyrin coupled to a fullerene. Methods The cell line employed was the LM3 mammary adenocarcinoma, and the PS with the best photokilling activity was administered to mice bearing the LM3 subcutaneously implanted adenocarcinoma. The TEMCP4+ porphyrin and its analogue TEMCC4+ chlorine contain four identical carbazoyl substituents at the meso positions of the tetrapyrrolic macrocycle and have A4 symmetry. The TAPP derivative also has A4 symmetry, and it is substituted at the meso positions by aminopropoxy groups. The DAPP molecule has ABAB symmetry with aminopropoxy and the trifluoromethyl substituents in trans positions. The TCP-C60 4+ dyad is formed by a porphyrin unit covalently attached to the fullerene C60. Results The PSs are taken up by the cells with the following efficiency: TAPP> TEMCP4+ = TEMCC4+ > DAPP >TCP-C60 4+, and the amount of intracellular PS correlates fairly with the photodamage degree, but also the quantum yields of singlet oxygen influence the PDT outcome. TAPP, DAPP, TEMCC4+ and TEMCP4+ exhibit high photoactivity against LM3 mammary carcinoma cells, being TAPP the most active. After topical application of TAPP on the skin of mice bearing LM3 tumours, the molecule is localized mainly in the stratum corneum, and at a lower extent in hair follicles and sebaceous glands. Systemic administration of TAPP produces a tumour: normal skin ratio of 31.4, and high accumulation in intestine and lung. Conclusion The results suggest a potential use of topical TAPP for the treatment of actinic keratosis and skin adnexal neoplasms. In addition, selectivity for tumour tissue after systemic administration highlights the selectivity of and potentiality of TAPP as a new PS.

Photodynamic therapy (PDT) is a treatment modality for tumours and other accessible lesions based on the combination of light and a photosensitizer (PS) accumulated in the target tissue. The main disadvantage of PDT is PS retention after treatment during long time periods that conduces to cutaneous damage. It is believed that singlet oxygen is responsible for that skin photosensitization. The aim of this work was to evaluate the photoprotective activity of the methanolic extract of the Argentinian plant Collaea argentina against PDT under several treatments and employing different PSs. C. argentina exhibited photoprotective activity against aminolevulinic acid- (ALA-) PDT in the LM2 murine adenocarcinoma cell line. The photoprotection was dependant on the extract concentration and the incubation time, being detectable from 40 μg/mL onwards and at least after 3 h exposure of the cells. C. argentina extract protects these mammalian tumor cells against PDT effects, and it interferes with the oxygen singlet production from PSs during PDT treatment. We propose that it will be a promising agent to protect cells against PDT-induced skin sensitivity.

CONTEXT: Tuberculosis of the prostate has mainly been described in immunocompromised patients. However, it can exceptionally be found as an isolated lesion in immunocompetent patients. CASE REPORT: We report a case of prostatic tuberculosis in a young, healthy and immunocompetent patient with unremarkable findings from intravenous urographic examination. Computed tomography showed an abscess in the prostate and Mycobacterium tuberculosis was isolated in a urine culture. Treatment with isoniazid, rifampin and pyrazinamide was successful.