ABSTRACT
Treatment of primary and metastatic liver lesions with stereotactic body radiotherapy (SBRT) has made it essential to develop techniques to minimize target motion due to respiration. Common methods include inhibition with devices such as the Active Breathing Coordinator (ABC) system. However, the COVID-19 pandemic has made the use of some devices unfavorable given the theoretical risk of viral transmission. Another way to inhibit breathing motion is with faster, more shallow breathing. This retrospective study seeks to evaluate the effectiveness of a novel motion management technique using metronome-assisted shallow breathing (MASB). Consecutive patients treated between March, 2019 and July, 2021 for either primary or secondary liver tumors who were planned for SBRT and found to have ≥1cm motion on the 4DCT at the time of simulation. These patients then had a 4DCT with MASB with respiratory rates set between 24 and 29 breaths per minute via metronome guidance. To determine the effect of MASB on the radiation treatment volume we compared the average PTVs between MASB and FB groups using a paired t-test. To date, 17 of the 38 targets have been analyzed. Of the 17 targets, 9 targets (53%) had reduced PTVs with MASB 4DCT scans, the largest reduction was 19.6ccs. Of the 8 targets without decreased PTVs after MASB motion management, the largest difference was -8.89ccs. Overall, the average PTVs were smaller in the MASB group (58.32 ± 81.77) compared to the FB group (60.05 ± 85.22), a mean decrease of 1.74ccs (95% CI, -1.88 to 5.35), p-value = 0.32. Motion management with MASB did not show a statistically significant difference in PTV in this small sample, but will continue to serve as a useful technique for certain patients as it is easy and inexpensive to implement, provides higher 4DCT image quality, and offers a more comfortable experience compared to techniques such as ABC devices and abdominal compression. This is especially relevant in the era of COVID-19 when it is prudent to do the utmost to decrease the rate of viral transmission. Further analysis with a larger sample size is currently underway to determine which tumor location and patient population will most benefit from the MASB technique. [ FROM AUTHOR] Copyright of International Journal of Radiation Oncology, Biology, Physics is the property of Pergamon Press - An Imprint of Elsevier Science and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)
ABSTRACT
Purpose: Studies have shown adolescent and young adult (AYA) participation in voting and other forms of civic engagement is associated with future optimism, increased life satisfaction and decreased health-related risk behaviors. Yet, AYA aged 18-24 are the least represented demographic at voting polls across the US. Recognizing voting and civic engagement may be an important health intervention for this population, we sought to determine factors associated with future voting intention (planning to vote in the next election) among AYA attending an urban adolescent clinic during the COVID-19 pandemic. Methods: We added four voting-related questions (Do you plan to vote in the next election? Did you vote in the last election? Are you registered to vote? Do you want to know how to register to vote?) to our pre-visit questionnaire distributed to all adolescent clinic patients ages 13-26 years. Both before and after the November 2020 election (i.e., July 2020 to March 2021), we collected 634 patient questionnaires;77% (N=487) were from patients who were age eligible to vote on November 3, 2020. We limited the current analysis to questionnaires from age eligible patients with complete responses of yes or no to all four voting questions (N=258). Using bivariate and multivariable logistic regression we examined associations between voting intention and the following factors: age, gender, race, registration status, voting in last election, and weeks to/from November 2020 election. Age was dichotomized to 17-21 vs. 22-26 years based on Locally Weighted Scatterplot Smoothing and race to Black vs. non-Black. This project was approved by the Johns Hopkins IRB. Results: Mean age was 20.7 years (SD=2.1);63.2% were 17-21 years. Sixty-five percent were female, 88% were Black, 73% were registered to vote, 48% voted in last election, and 76% had future voting intention. Mean weeks to/from November election was -1.26 (SD=10.2). In the adjusted model, older patients were nearly 70% less likely to declare future voting intention than younger patients (aOR=0.32, 95% CI=0.14-0.76);males were half as likely as females (aOR=0.45, 95% CI=0.21-0.96). Voting in the last election (aOR=18.63, 95% CI=5.51-62.97) and being registered to vote (aOR=6.12, 95% CI=2.82-13.27) predicted future voting intention. Future voting intention was not associated with race or weeks to/from November election in either the unadjusted or adjusted models. Conclusions: Our findings from a clinic sample of urban AYA point to a subgroup of youth who may be more vulnerable to disenfranchisement. The COVID-19 pandemic introduced new challenges for AYA voting and this study highlighted how providers might harness the health care visit to promote AYA voting. Registration status, one of the variables most strongly associated with future voting intention, is modifiable and easily evaluated during a healthcare visit. Future qualitative investigation will explore the differences in future voting intention by age and gender to identify other factors that may also be modifiable or addressed by adolescent providers in clinical settings. Sources of Support: Thomas Wilson Foundation (PI:Fields), NICHD T32HD052459 (PI:Trent).
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Purpose/Objective(s): Medical student education in radiation oncology traditionally takes place in-person during 3rd or 4th year of medical school. Due to the COVID-19 pandemic, onsite clerkships were placed on hold, leading to virtual medical student clerkships in radiation oncology which incorporated didactics and hands-on learning. We sought to implement this virtual medical student clerkship in radiation oncology at multiple institutions and analyze the impact and utility of this platform. Materials/Methods: An IRB-approved virtual clerkship was created and implemented at 7 institutions. Students enrolled in home or away rotations. Clerkships offered general and disease subsite-specific oncology topics through recorded didactics geared towards medical students on www.radoncvirtual.com, as well as clinical vignettes, telehealth visits, chart rounds, contouring, and capstone presentations. Surveys were given pre- and post-clerkship to assess baseline comfort and knowledge. At the end of each clerkship, a course exam was given consisting of 48 questions. Clerkship directors were given a survey to assess comfort and ease of implementing the virtual clerkship. Surveys and course exams were analyzed using Wilcoxon Signed rank test and t-test, 2-sided. Results: Seventy-two (72) students enrolled at 7 institutions between 4/2020 and 2/2021. Survey response rates were 100% pre- and post-clerkship as well as from course directors. The majority of students were MS4 (57%) and MS3 (33%) with equal distribution in gender. Each institution's median number of total medical students doing an away rotation was 4 (range 3-9) and home rotation number of students 2 (range 0-36). The median length of each virtual rotation was 2.5 weeks (range: 1-4 week). 71% (n = 51) of medical students had never previously enrolled in a radiation oncology elective. Improvements in the overall knowledge of radiation oncology, as well as specific knowledge in the scope of radiation oncology, roles of radiation physicist, dosimetrist and therapist, contouring, treatment planning, and training path to the field (all P < 0.001). There was no significant difference in course final exam scores between students who had attended a radiation oncology elective before enrollment and those who had not (P = 0.27). Course directors reported spending an additional 5-10 hours per week with students. The survey revealed 100% were satisfied with content and delivery of this virtual elective, and 83% (n = 6) indicated they would utilize the material for future rotations. Conclusion: Implementation of a multi-institutional virtual radiation oncology elective was successful at improving knowledge for medical students at all levels, even those that had exposure previously. This virtual elective platform can be utilized to improve access to multiple institutions, resources, mentors, and networking opportunities. Resources in the virtual rotation platform can also be integrated into traditional educational paradigms to increase exposure in the field.
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Purpose/Objective(s): Radiation Oncology Virtual Education Rotation (ROVER) is a virtual education platform developed to support radiation oncology education for medical students during COVID19 when away and in-person rotations were suspended. Due to the positive reception of ROVER, we created ROVER2.0 tailored to radiation oncology residents. Materials/Methods: ROVER2.0 comprises monthly case-based discussions on various topics with radiation oncology faculty from across the country and is tailored to radiation oncology residents. Sessions are 1 hour in duration and hosted over Zoom. Sessions were advertised on social media (Twitter) and on ARRO, ACRO, and ADROP mailing lists. Pre- and post-session surveys were used to explore resident perspectives on virtual education and assess the utility of virtual education as a modern learning platform. Results: Five ROVER2.0 sessions have been held, led by 17 faculty from 16 institutions (3-4 faculty per session) with a total of 868 registrants (R), 445 attendees (A), and 152 post-survey respondents (P): gastrointestinal (R = 186, A = 103, P = 50), genitourinary (R = 159, A = 83, P = 29), central nervous system (R = 140, A = 58, P = 19), pediatrics (R = 177, A = 94, P = 27), and head and neck (R = 206, A = 107, P = 27). 43.5% of registrants were female, 6.1% were PGY-1, 37.3% were PGY-2/3, and 45% were PGY-4-5. Of all registrants, 82% signed up for ROVER2.0 for the "opportunity to hear from a diverse expert panel." At baseline, 73.5% reported that their home programs conducted mock oral exams and programs were reported to have a median of 5 hours/week of dedicated didactics. A third or fewer reported that COVID-19 negatively impacted residency didactics (22.8%), faculty engagement in teaching (30.8%), or access to faculty (33.9%). 24.2%, 37.3%, and 38.5% of respondents felt that virtual platforms are superior, equal, or inferior to in-person learning, respectively. 98.0% considered the sessions very valuable or valuable and that it was very easy or easy (94.1%) to learn through the virtual format. 83.6% strongly agreed or agreed that they felt more confident treating the disease site cancer as a result of the session. 84.2% reported that they had no difficulty attending sessions due to clinical responsibilities. Conclusion: ROVER2.0 case-based sessions can augment radiation oncology residency didactics by providing exposure to different practices across the country as an adjunct to in-person learning. Most respondents felt that COVID-19 did not negatively impact educational quality, and a rapid transition to virtual platforms likely served as an important buffer. ROVER2.0 was met with enthusiasm and considered an effective teaching tool by radiation oncology resident participants. This virtual and open-access resource can facilitate accessible and equitable education to those negatively impacted by in-person learning restrictions and allow broader dissemination of information about radiation oncology.
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Introduction: Global lockdowns implemented to reduce spread of the Coronavirus Disease 2019 (COVID-19) have offered unique insight into how sleep patterns change when typical social obligations are significantly reduced. Here, we aimed to replicate findings of sleep timing delays and reduced social jetlag during lockdown using a large, regionally-diverse sample of participants from the United States (US). Further, we conducted exploratory analyses to determine if observed sleep changes were associated with age and self-reported chronotype. Methods: A sample of 691 US adults (age 18-89) completed the Ultrashort Munich Chronotype Questionnaire twice during the same assessment: once querying retrospective memory for sleep patterns in the 6-weeks prior to February 1, 2020 (Pre-Lockdown) and a second time for sleep patterns in the 6-weeks prior to ∼May 20th (Peak-Lockdown in the US). Participants also completed the abbreviated Morningness- Eveningness Questionnaire to assess chronotype. We compared sleep duration (SDur), sleep onset time (SO), sleep end time (SEnd), social jetlag (SJL;difference between work-day and free-day sleep midpoint) and social sleep restriction (SSR;difference between work-day and freeday sleep duration) Pre- to Peak-Lockdown. We conducted exploratory analyses to determine whether Pre- to Peak-Lockdown changes in these sleep metrics were associated with age or chronotype. Main analyses were preregistered with Open Science Framework (https://osf.io/4a3fx). Results: During the Peak-Lockdown period, participants, on average, reported significantly later SO and SEnd times and significantly reduced SJL and SSR compared with the Pre-Lockdown period. Change in SJL and SSR Pre- to Peak-Lockdown was significantly positively associated with age and chronotype such that SJL and SSR decreased more during lockdown in younger participants and those with an evening chronotype. Conclusion: Our results support lockdown-associated sleep timing delays and reduced SJL and SSR. Younger age and evening chronotype were associated with greater reductions in SJL and SSR during lockdown. These findings suggest that individuals, particularly young individuals and those with an evening chronotype, experience greatest desynchrony between intrinsic and social sleep timing when conforming to typical pre-pandemic social schedules.
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During the coronavirus disease 2019 (COVID-19) pandemic, numerous existing chemicals have been screened for antiviral potential against the emerging coronavirus severe acute respiratory syndrome coronavirus 2. Chloroquine and hydroxychloroquine, after exhibiting potent in vitro efficacy, have gained tremendous attention. Both therapeutics are derivatives of natural alkaloid quinine and were first synthesized to treat malaria. Thereafter, the pharmaceutical applications of the agents have expanded to many new areas. In this article, the medicinal history and pharmacological activities of chloroquine and hydroxychloroquine are summarized. Antimalarial, anti-inflammatory, antitumor, antiviral properties, and therapeutic potential in the emerging viral infection COVID-19 are discussed. Pharmacokinetics, adverse effects, and toxicities are reviewed.
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Black/African American (Black thereafter) and Hispanic/Latino (Latinx thereafter) communities bear disproportionate burden of HIV infections in the U.S. These communities also tend to be disproportionately affected by social and structural determinants of health that hamper access to and engagement in HIV prevention and care services. Public health research efforts must advance HIV prevention and care through biomedical and structural interventions tailored to the needs of and culturally acceptable for the affected communities.The CDC Minority HIV Research Initiative (MARI) was established in 2003 to build capacity for HIV epidemiologic and prevention research in mostly Black and Latinx communities and among historically underrepresented early-career scientists working in highly affected communities. The MARI program supports the goal of promoting health equity and reducing HIV-related health disparities.From 2007–2020, 11 MARI investigators have developed HIV prevention interventions in highly affected communities. The interventions developed by seven MARI investigators will be discussed. Best practices about the recruitment and engagement of communities of color using evidence-based online recruitment campaigns, establishing community and scientific advisory boards, engaging community members in all stages of HIV research, and integration of mobile technologies to sustain HIV prevention and care interventions during the COVID-19 pandemic will be illustrated. We will also highlight the accomplishments of MARI investigators building successful partnerships with local health departments and community-based organizations to promote disseminations of findings and sustainability of interventions tailored to their communities. Lastly, we describe why initiatives like MARI that support the development of innovative and effective interventions to reduce HIV disparities in communities of color are essential to ending the HIV epidemic in the U.S.Ensuring the communities’ engagement in HIV policy changes and intervention development are crucial to intervention uptake and sustainability. As such, MARI research initiative is filling gaps in how we address HIV in racial/ethnic and sexual minority communities.