•Lowering the dose to organs at risk is a primary goal in mediastinal lymphoma radiotherapy.•We compared full arc and limited arc plans, with and without the use of breath-hold.•The effect of ...combining limited arc and DIBH is additive or complementary.
Radiotherapy is an effective treatment for mediastinal lymphoma but induces late effects including cardiac toxicity and secondary breast and lung cancer. Therefore reducing the dose to these organs is vital. We compared full arc volumetric modulated arc therapy (F-VMAT) against limited angle ‘Butterfly’ VMAT (B-VMAT) on free breathing (FB) and deep inspiration breath-hold (DIBH) computed tomography scans. The aim was to assess the benefits of B-VMAT over F-VMAT and to establish if the addition of DIBH results is a cumulative benefit.
F-VMAT and B-VMAT plans were calculated for 20 consecutive patients (15 females) with mediastinal lymphoma on both FB and DIBH scans. The planning target volume V95% was kept comparable between all plans while reducing organ doses as much as possible.
B-VMAT significantly reduced low lung doses (V5–10), while F-VMAT was better for higher lung doses (V20–30). DIBH further improved lung doses for both types of plans. DIBH B-VMAT produced the lowest mean lung dose. With FB, heart doses were slightly higher for B-VMAT but the maximum difference was small (0.8% for V20) and only statistically significant for V10-20. The mean heart dose increased by only 0.1 Gy. The addition of DIBH however significantly reduced heart doses. While DIBH F-VMAT had the lowest heart doses, the difference was small compared with DIBH B-VMAT. B-VMAT significantly reduced breast V4 while DIBH reduced the V10.
B-VMAT and DIBH are both effective in reducing organ doses and the dosimetric benefit is additive for some parameters and complementary for others.
Purpose - This article examines how certain historical forces - the scientific revolution and "scientific management" - have created a legacy of organizational "design DNA" that can create only ...organizational machines: good at execution, but poor at innovation and change. Next, it examines leadership and management practices that can overcome this legacy and create a climate of corporate creativity.Design methodology approach - The article traces the effect of the scientific revolution and "scientific management" on deeply-embedded cultural assumptions about the nature and purpose of organizations, leadership, and work. It argues that those assumptions drive an overwhelming organizational bias toward rationality, uniformity, stability, continuity, predictability and control, all of which militate against diversity, creativity, adaptation and change. Then the article describes a transformation in leadership and management practices that can overcome this historical legacy and create a culture of corporate creativity.Practical implications - The article calls on executives to: adopt an adult-to-adult (mutual partnering) relationship with the workforce, treating employees as independent, highly capable, unique adults; build social systems that maximize both social differentiation and social integration; build a culture that rewards creativity and creative (right-brained) people; build alignment on a mutually-shared "deep purpose"; and unite in community with the workforce. Originality value - This article argues that sustainable profound innovation is possible only if formal innovation processes are accompanied by a fundamentally new paradigm for leadership and management. Its goal is a workforce primed for sustainable performance and innovation excellence; its foundation is an ultra-high-engagement, ultra-high-inclusion culture based on an adult-to-adult, mutual partnering relationships.
This study constructed a model of individual and human systems development as an interpenetrating gestalt, which was used as the foundation for action research-based double-loop learning. The model's ...essence is well-captured by an ancient archetype: the Birth-Death-Rebirth Cycle. The model proposes that only two stances are possible toward life: we can either embrace it or resist it. Embracing the flow of life—and shepherding ourselves through cycles of ‘death and rebirth’—reinvigorates identity, unfolds latent potential, and expands capability, creativity and adaptability. Resistance—attempting to block or control the flow of life and defend the status quo—is a defensive strategy that lowers performance, creativity and flexibility, increases rigidity, stagnation and dysfunction, and may lead to early death. Action research was performed in a large government agency and in a small private company. Loop One focused on practical application of the model to build systemic resilience and address specific system concerns. Loop Two consisted of collective reflection on the model for the purpose of improving it. The results suggest that leaders and managers must: (1) Embrace—and build practical supports to—ongoing cycles of death and rebirth. (2) Build ‘safe containers’ for members to express authentic individuality— within the system. (3) Manage individual and human systems development as interdependent processes. (4) Support integration of ‘masculine’ and ‘feminine’ capabilities and attitudes at the system and individual levels. (5) Support dis-identification with the shared domain (the ‘organization’) as the sole basis for identity, acceptable meaning-making and action. The shared domain should become an object of reflection and co-construction by a community of differentiated individuals. (6) Build ‘whole-person’ commitment as the basis for gaining shared alignment with the shared purpose/task. (7) Gain shared alignment with the systemic purpose by building ‘whole-person’ commitment. (8) Root organizational purpose in genuine service to the world.
So you've made a short film, you think it's pretty good, and you want to get it out there. What now? Dean Robb goes over some of the options available to short filmmakers looking for an audience.
So you've made a short film, you think it's pretty good, and you want to get it out there. What now? Dean Robb goes over some of the options available to short filmmakers looking for an audience.
When studied from the right perspective, some real lessons can be gained from looking into the failures of AT&T and Enron. Enron saw itself as an entrepreneurial enterprise, but it collapsed. AT&T is ...a very old, bureaucratic company that has been struggling - with little success - to become more entrepreneurial ever since divestiture of its local operating companies in 1984. Both failures can be understood using a simple 'model' of societies and organizations developed by anthropologists and sociologists. The model is based on: 1. the degree to which members of a society or organization have a sense of group belonging and are interconnected; and 2. the degree of diversity, individuality and expression that's acceptable in that society. The entrepreneurial spirit is activated by constructively harnessing internal variety and differences as the raw fuel for continuous experimentation, innovation, learning and growth.
The COVID-19 pandemic represents a massive global health crisis. Because the crisis requires large-scale behaviour change and places significant psychological burdens on individuals, insights from ...the social and behavioural sciences can be used to help align human behaviour with the recommendations of epidemiologists and public health experts. Here we discuss evidence from a selection of research topics relevant to pandemics, including work on navigating threats, social and cultural influences on behaviour, science communication, moral decision-making, leadership, and stress and coping. In each section, we note the nature and quality of prior research, including uncertainty and unsettled issues. We identify several insights for effective response to the COVID-19 pandemic and highlight important gaps researchers should move quickly to fill in the coming weeks and months.
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