To prospectively evaluate cognitive function and intracranial failure patterns after hippocampal-sparing prophylactic cranial irradiation (PCI) for limited-stage small cell lung cancer (SCLC).
Adults ...with limited-stage SCLC, achieving a complete response to chemoradiotherapy and no brain metastases, were eligible. Patients received PCI 25 Gy/10 fractions, with a mean hippocampal dose limited to <8 Gy and ≥90% of the brain receiving 90% of the prescription. A diverse battery of neuropsychological testing was performed at baseline and 6 and 12 months after PCI. Brain MRI scans were performed at baseline and 6, 12, 18, and 24 months. The primary endpoint was memory measured by the Hopkins Verbal Learning Test-Revised Delayed Recall at 6 months after PCI. The 25-Gy arm of Radiation Therapy Oncology Group protocol 0212 was used as a reference of potential efficacy. Development of intracranial metastases was recorded. Overall survival and progression-free survival were estimated using the Kaplan-Meier method.
Eight men and 12 women with a median age of 61 years enrolled. Two-year overall survival was 88% (95% confidence interval 68%-100%). There was no significant decline in performance between baseline and 6 or 12 months for any of the tests. The association between baseline intelligence quotient and change in performance on testing was not significant. Magnetic resonance imaging revealed asymptomatic brain metastases at a cumulative rate of 20%, with no concurrent extracranial progression. Two patients developed a metastasis in the under-dosed region. Neither involved the dentate gyrus, but 1 involved the avoidance region. Both patients concurrently developed additional metastasis in fully treated brain regions. There were 2 neurologic deaths.
This prospective study suggests a potential benefit of hippocampal sparing in limiting the neuropsychological sequelae of brain radiation, but with a risk of failures in the spared region. These data strongly support continued enrollment on ongoing cooperative group randomized trials. Clinical Trials registration number: NCT01797159.
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GEOZS, IJS, NUK, OILJ, UL, UM, UPUK
Functional endoscopic sinus surgery (FESS) is one of the most common outpatient surgical procedures performed in the head and neck region. It is used to treat chronic sinusitis, a disease ...characterized by inflammation in the nose and surrounding paranasal sinuses, affecting about 15% of the adult population. During FESS, the nasal cavity is visualized using an endoscope, and instruments are used to remove tissues that are often within a millimeter of critical anatomical structures, such as the optic nerve, carotid arteries, and nasolacrimal ducts. To maintain orientation and to minimize the risk of damage to these structures, surgeons use surgical navigation systems to visualize the 3-D position of their tools on patients' preoperative Computed Tomographies (CTs). This paper presents an image-based method for enhanced endoscopic navigation. The main contributions are: (1) a system that enables a surgeon to asynchronously register a sequence of endoscopic images to a CT scan with higher accuracy than other reported solutions using no additional hardware; (2) the ability to report the robustness of the registration; and (3) evaluation on in vivo human data. The system also enables the overlay of anatomical structures, visible, or occluded, on top of video images. The methods are validated on four different data sets using multiple evaluation metrics. First, for experiments on synthetic data, we observe a mean absolute position error of 0.21mm and a mean absolute orientation error of 2.8° compared with ground truth. Second, for phantom data, we observe a mean absolute position error of 0.97mm and a mean absolute orientation error of 3.6° compared with the same motion tracked by an electromagnetic tracker. Third, for cadaver data, we use fiducial landmarks and observe an average reprojection distance error of 0.82mm. Finally, for in vivo clinical data, we report an average ICP residual error of 0.88mm in areas that are not composed of erectile tissue and an average ICP residual error of 1.09mm in areas that are composed of erectile tissue.
Community teaching physicians (i.e., community preceptors) have assumed an important role in medical education. More than half of medical schools use community settings to train medical students. ...Whether community preceptors are well prepared for their teaching responsibilities is unknown. In addition, best practice for faculty development (FD) of this population of preceptors has not been defined. The authors conducted a narrative review of the literature to describe FD programs for community preceptors that may be helpful to medical schools for future planning. Many databases were searched from their establishment to May 2022. Studies that described FD programs for community preceptors were included. Data were organized according to program aim, duration, setting, participants, content, and outcomes. The
Communities of Practice
theoretical framework was used to present findings. From a total of 6308 articles, 326 were eligible for full review, 21 met inclusion criteria. Sixty-seven percent (14/21) conducted a needs assessment; 57% (12/21) were developed by the medical school; 81% (17/21) included only community preceptors. Number of participants ranged from six to 1728. Workshops were often (24%, 5/21) used and supplemented by role-play, online modules, or instructional videos. Few programs offered opportunities to practice with standardized learners. Content focused primarily on teaching skills. Five programs offered CME credits as an incentive for engagement. Participant surveys were most often used for program evaluation. Learner evaluations and focus groups were used less often. Participants reported satisfaction and improvement in teaching skills after attending the program. Faculty development for community preceptors is primarily delivered through workshops and online materials, although direct observations of teaching with feedback from FD faculty and learners may be more helpful for training. Future studies need to focus on the long-term impact of FD on community preceptors’ teaching skills, identity formation as medical educators, and student learning.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
We present a description of the ModelE2 version of the Goddard Institute for Space Studies (GISS) General Circulation Model (GCM) and the configurations used in the simulations performed for the ...Coupled Model Intercomparison Project Phase 5 (CMIP5). We use six variations related to the treatment of the atmospheric composition, the calculation of aerosol indirect effects, and ocean model component. Specifically, we test the difference between atmospheric models that have noninteractive composition, where radiatively important aerosols and ozone are prescribed from precomputed decadal averages, and interactive versions where atmospheric chemistry and aerosols are calculated given decadally varying emissions. The impact of the first aerosol indirect effect on clouds is either specified using a simple tuning, or parameterized using a cloud microphysics scheme. We also use two dynamic ocean components: the Russell and HYbrid Coordinate Ocean Model (HYCOM) which differ significantly in their basic formulations and grid. Results are presented for the climatological means over the satellite era (1980–2004) taken from transient simulations starting from the preindustrial (1850) driven by estimates of appropriate forcings over the 20th Century. Differences in base climate and variability related to the choice of ocean model are large, indicating an important structural uncertainty. The impact of interactive atmospheric composition on the climatology is relatively small except in regions such as the lower stratosphere, where ozone plays an important role, and the tropics, where aerosol changes affect the hydrological cycle and cloud cover. While key improvements over previous versions of the model are evident, these are not uniform across all metrics.
Key Points
Description of the GISS ModelE2 contribution to CMIP5
Impact on evaluation of structural changes in composition and ocean treatment
Ocean model choice is an important structural uncertainty
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DOBA, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, SIK, UILJ, UKNU, UL, UM, UPUK
We examine trends in climate variables and their interrelationships over the Tibetan Plateau using global climate model simulations to elucidate the mechanisms for the pattern of warming observed ...over the plateau during the latter half of the twentieth century and to investigate the warming trend during the twenty-first century under the SRES A1B scenario. Our analysis suggests a 4°C warming over the plateau between 1950 and 2100. The largest warming rates occur during winter and spring. For the 1961-2000 period, the simulated warming is similar to the observed trend over the plateau. Moreover, the largest warming occurs at the highest elevation sites between 1950 and 2100. We find that increases in (1) downward longwave radiation (DLR) influenced by increases in surface specific humidity (q), and (2) absorbed solar radiation (ASR) influenced by decreases in snow cover extent are, in part, the reason for a large warming trend over the plateau, particularly during winter and spring. Furthermore, elevation-based increases in DLR (influenced by q) and ASR (influenced by snow cover and atmospheric aerosols) appear to affect the elevation dependent warming trend simulated in the model.
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DOBA, EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, IZUM, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, SIK, UILJ, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Purpose
Increasing challenges in recruiting and retaining community‐based teaching physicians (e.g., community preceptors) call for a better understanding of motivators and barriers community ...preceptors perceive in their teaching role. Given the importance of medical school partnerships with community‐based sites for student training, it is essential to understand the perspectives of community preceptors as teaching physicians in a context away from the medical school, such as rural, and the factors affecting their career choice to engage in teaching while practising medicine.
Methods
We conducted semi‐structured interviews with rural community preceptors and used open coding to conceptualise data and axial coding to connect codes into categories. We used the socio‐cognitive career theory framework to organise categories into themes.
Results
Eleven rural community preceptors from two medical schools participated. Specialties included family medicine, internal medicine and paediatrics; clinical practice and teaching experience ranged from 3–36 and 2–29 years, respectively. Readiness for teaching (‘self‐efficacy’) was pivotal in community preceptors' decision to teach and derived largely from vicarious learning from teaching attendings in medical school or residency; social persuasion and encouragement from clinical partners; and their accomplishments as practising physicians. However, limited faculty development, incomplete knowledge of expectations, disengagement from the medical school and lack of current mentors hindered their self‐confidence. Teaching fulfilled their aspirations (‘outcome expectations’) to give back to the profession, but they felt undervalued and disconnected from other clinician educators. Teaching increased job satisfaction, but clinical workload, and financial impact impeded their goals for achieving excellence (‘performance’).
Conclusions
Self‐efficacy was a pivotal motivator in rural community preceptors' decision to teach. Role models from early training inspired them to teach. Internal awards sustained teaching efforts. Future research should explore structural barriers influencing rural community preceptors' teaching experiences to better support their career choice to become medical educators.
Understanding rural community preceptors' motivations and barriers in teaching medical students is crucial for training. This study explores the role of self‐efficacy, giving back to the profession, and disengagement from medical schools. #MedEd #RuralHealth
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
7.
GISS‐E2.1: Configurations and Climatology Kelley, Maxwell; Schmidt, Gavin A; Nazarenko, Larissa ...
Journal of advances in modeling earth systems,
August 2020, Volume:
12, Issue:
8
Journal Article
Peer reviewed
Open access
This paper describes the GISS‐E2.1 contribution to the Coupled Model Intercomparison Project, Phase 6 (CMIP6). This model version differs from the predecessor model (GISS‐E2) chiefly due to ...parameterization improvements to the atmospheric and ocean model components, while keeping atmospheric resolution the same. Model skill when compared to modern era climatologies is significantly higher than in previous versions. Additionally, updates in forcings have a material impact on the results. In particular, there have been specific improvements in representations of modes of variability (such as the Madden‐Julian Oscillation and other modes in the Pacific) and significant improvements in the simulation of the climate of the Southern Oceans, including sea ice. The effective climate sensitivity to 2xCO2 is slightly higher than previously at 2.7‐‐3.1°C (depending on version), and is a result of lower CO2 radiative forcing and stronger positive feedbacks.
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DOBA, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, SIK, UILJ, UKNU, UL, UM, UPUK
The red algae, a remarkably diverse group of organisms, are difficult to identify using morphology alone. Following the proposal to use the mitochondrial cytochrome c oxidase subunit I (cox1) for DNA ...barcoding animals, we assessed the use of this gene in the identification of red algae using 48 samples plus 31 sequences obtained from GenBank. The data set spanned six orders of red algae: the Bangiales, Ceramiales, Corallinales, Gigartinales, Gracilariales and Rhodymeniales. The results indicated that species could be discriminated. Intraspecific variation was between 0 and 4 bp over 539 bp analyzed except in Mastocarpus stellatus (0-14 bp) and Gracilaria gracilis (0-11 bp). Cryptic diversity was found in Bangia fuscopurpurea, Corallina officinalis, G. gracilis, M. stellatus, Porphyra leucosticta and P. umbilicalis. Interspecific variation across all taxa was between 28 and 148 bp, except for G. gracilis and M. stellatus. A comparison of cox1 with the plastid Rubisco spacer for Porphyra species revealed that it was a more sensitive marker in revealing incipient speciation and cryptic diversity. The cox1 gene has the potential to be used for DNA barcoding of red algae, although a good taxonomic foundation coupled with extensive sampling of taxa is essential for the development of an effective identification system.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NMLJ, NUK, OILJ, PNG, SAZU, SBCE, SBMB, UL, UM, UPUK
A full description of the ModelE version of the Goddard Institute for Space Studies (GISS) atmospheric general circulation model (GCM) and results are presented for present-day climate simulations ...(ca. 1979). This version is a complete rewrite of previous models incorporating numerous improvements in basic physics, the stratospheric circulation, and forcing fields. Notable changes include the following: the model top is now above the stratopause, the number of vertical layers has increased, a new cloud microphysical scheme is used, vegetation biophysics now incorporates a sensitivity to humidity, atmospheric turbulence is calculated over the whole column, and new land snow and lake schemes are introduced. The performance of the model using three configurations with different horizontal and vertical resolutions is compared to quality-controlled in situ data, remotely sensed and reanalysis products. Overall, significant improvements over previous models are seen, particularly in upper-atmosphere temperatures and winds, cloud heights, precipitation, and sea level pressure. Data–model comparisons continue, however, to highlight persistent problems in the marine stratocumulus regions.
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