Association between Tumor Volume Change on MRI with Surgical Margin Status, Pathological Response, and Local Control Following Pre-Operative Radiation Therapy for Soft Tissue Sarcoma

PURPOSE/OBJECTIVE(S)

The clinical significance of radiographic progression during pre-operative radiation therapy (RT) for soft tissue sarcoma (STS) remains unclear. We sought to evaluate associations between radiographic change on T1 post-contrast (T1c) and T2 weighted magnetic resonance imaging (MRI) with percent pathological response (PR%), positive surgical margins (+SM), and local control (LC).

MATERIALS/METHODS

We retrospectively identified patients with STS undergoing neoadjuvant RT who had both pre- and post-RT MRI prior to surgical resection. Gross tumor volumes were contoured on pre- and post-RT T1c and T2 MRI sequences and relative change in volume from baseline was calculated. Radiographic classification was defined as response (>30% reduction), progression (>30% increase), or stable (≤30% reduction or ≤30% increase). Chi squared, Fishers Exact, and Kruskal Wallis (KW) tests were used to assess differences between groups. Linear and binary logistic regression models used to assess associations between MRI response and PR% and +SM, respectively. LC was modeled with Kaplan Meier methods and log rank tests.

RESULTS

A total of 68 STS patients were identified, with a median follow up of 49 months (range 7-229). With a median age of 60.5 years (25-88) and tumor size of 10.8cm (2.7-25.7), the most common histologies were undifferentiated pleomorphic sarcoma (UPS; 32.4%) and myxoid liposarcoma (ML; 16.2%), and were primarily grade 2-3 disease (89.7%). With a median RT dose of 50 Gy in 25 fractions (44-60Gy), the median radiographic volume change was 2% (-86.4 to 953.6%) and -2.1% (-89.6 to 962.5%) for T1c and T2, respectively. Radiographic classification of response/stable/progression was 25.4%/49.2%/25.4% and 27.9%/52.5%/19.7% for T1c and T2, respectively. Histology (ML vs. UPS) and grade (1 vs. 3) were predictors for radiographic response on both T1c (72.7% vs 18.8%, p = 0.03 and 71.4% vs. 10.4%, p = 0.03) and T2 (71.5% vs. 18.2%, p = 0.02 and 71.4% vs. 14.6%, p = 0.002), respectively. With 6 +SM (8.8%), the rate of +SM for response/stable/progression was 20%/10.3%/0% in T1c (p = 0.2) and 5.9%/12.5%/0% in T2 (p = 0.5). As a continuous variable, neither relative change on T1c (p = 0.2) or T2 (p = 0.4) were associated with +SM. With an overall median PR% of 64% (0-100%), the median PR% was significantly different for response/stable/progression for both T1c (95%/42%/73%, p = 0.02) and T2 (95%/50%/87.5%, p = 0.04). Radiographic change on neither T1c (p = 0.4) or T2 (p = 0.5) were associated with PR% on a continuous basis. With a total of 4 local recurrences, there was no significant difference in LC by radiographic classification on either T1c (p = 0.65) or T2 (p = 0.85).

CONCLUSION

While radiographic response may be correlated with pathological response, radiographic progression on either T1c or T2 following neoadjuvant RT was not associated with a detriment in surgical margins or local control. These findings suggest that STS radiographic "pseudoprogression" is not associated with worse outcome.

Teaching Trainees to be Effective Mentors: A Needs-Based Assessment in Radiation Oncology

PURPOSE/OBJECTIVE(S)

Mentorship plays a critical role in the training and career development of medical trainees. Teaching-the-teacher workshops for residents translate to higher long-term job satisfaction and improved patient communication skills. Further, near-peer mentorship has been associated with increased job satisfaction and patient care experience. Resident-as-mentors can add benefit to the mentorship networks of students, particularly in resource-limited environments, while benefiting residents' own mentorship relations and career satisfaction. We hypothesized that residents would desire to be a mentor, but would lack specific skills needed for effective mentoring of students in radiation oncology.

MATERIALS/METHODS

A multi-institution, cross-sectional study was conducted among residents in the Radiation Oncology Education Collaborative Study Group (ROECSG) Graduate Medical Education working group from 06/2022-10/2022. Participants completed the Mentorship Competency Assessment (MCA), a validated 26-item questionnaire, scored on a Likert scale from 0-7 (0: most unprepared with mentorship skill, 7: most prepared with mentorship skill). The primary endpoint was the average score in individual mentorship skills among participants. Kruskal-Wallis test assessed associations between total MCA score (range 0-182) and demographics.

RESULTS

A total of 36 of 39 participants (92% response rate) responded. A majority were male (58%), from a residency size >10 (75%), and P Gy-2/3 (52%). Most had no formal training in teaching (86%) or mentorship (89%). Many believed they would be a good mentor to students on a rotation (89%), but most felt they would benefit from a formal mentorship program (92%). From the MCA, the mentorship skills residents felt most unprepared for were: coordinating effectively with other mentors (3.4/7), helping mentees acquire resources (3.6/7), negotiating a path to professional independence with mentees (3.6/7), helping mentees network effectively (3.7/7), and working with mentees to set clear expectations of the mentoring relationship (3.9/7). The mentorship skills residents felt most prepared for were: acknowledging mentees' professional contributions (5.6/7), establishing a relationship based on trust (5.6/7), active listening (5.5/7), building mentees' confidence (4.9/7), and working effectively with mentees with personal backgrounds differing from one's own (4.8/7). Higher MCA scores were associated with former training in mentorship (p = 0.0143), and a trend for former training in teaching (p = 0.0525), but was not associated with sex (p = 0.5986), residency size (p = 0.1415), or P Gy-year (p = 0.9747).

CONCLUSION

Residents are interested in mentorship training and report unpreparedness in several important skills. Future work should focus on formal training and assessment of mentoring skills for residents.

Hypofractionated Accelerated Radiation Dose-Painting (HARD) vs. Standard Radiotherapy for Unresected Soft-Tissue Sarcoma

PURPOSE/OBJECTIVE(S)

Conventionally fractionated radiotherapy (CFRT) offers modest local control (LC) for unresected soft tissue sarcoma (STS). Although STS has a low α/β (∼2 - 6) that may benefit from a hypofractionated radiotherapy regimen, it is often limited due to the toxicity risk to surrounding organs. A simultaneous integrated boost to gross disease (2.5 - 3 Gy/fraction), with lower doses to the intermediate and low risk target volume, may offer a safe isotoxic dose escalation approach. We hypothesize that this hypofractionated accelerated radiotherapy dose-painting (HARD) will improve local control compared to CFRT.

MATERIALS/METHODS

We performed a single institution retrospective analysis of patients who received external beam radiotherapy with definitive intent (≥50 Gy) for unresected STS. CFRT was defined as 1.8 - 2 Gy/fraction (Gy/fx). HARD regimens consisted of 60 - 66 Gy at 3 Gy/fx or 70 Gy at 2.5 Gy/fx to gross disease, with 1.8 - 2.4 Gy/fx to intermediate and low risk regions. All anatomical sites and histologies were included. Local control (LC) was defined from date of current diagnosis, estimated by Kaplan-Meier methods via log-rank tests or Cox regression for univariate analysis (UVA), when appropriate. Cox regression multivariate analysis (MVA) included regimen, biological effective dose (α/β 6; BED6), lesion size, age, and grade.

RESULTS

We identified 77 patients with primary and metastatic STS treated with HARD (n = 40) or CFRT (n = 37) between 1990 and 2022, with a median follow up of 24 months in surviving patients. The mean dose for CFRT and HARD are 56.8 Gy (50 - 77.4 Gy) and 64.9 Gy (60 - 70 Gy), respectively. HARD was comprised of 65% for 3 Gy/fx and 35% for 2.5 Gy/fx regimens. At the time of RT, grade 3 (69%) and extremity (39%) tumors were the most common. Tumor histology was very heterogenous across both cohorts, with undifferentiated pleomorphic sarcoma being the most common for HARD (33%) and CFRT (19%). HARD was more often utilized in stage IV patients (55% vs. 19%, p = 0.001) and had a higher mean BED6 (96 vs. 74.2 Gy, p < 0.001) than CFRT, but without differences in age (67 vs. 59 years), tumor size (8 vs. 10 cm), concurrent chemotherapy (35% vs. 30%), Karnofsky performance status (86 vs. 85), follow-up (19 vs. 28 months), and grade (all p > 0.1). On UVA, there was a LC benefit associated with higher BED6 (HR 0.94, 95% CI 0.9 - 0.98, p = 0.002) and the HARD regimen (2-year LC 95% vs. 62%, p < 0.001). On MVA, only HARD (HR 0.07, 95% CI 0.006 - 0.729, p = 0.027) was independently associated with LC.

CONCLUSION

Although the HARD regimen and higher BED6 were both associated with significant improvement in LC, only the HARD regimen independently associated with a local control benefit for unresected STS. These results suggest biologic dose-intensification exploiting the low α/β of STS with an isotoxic hypofractionated regimen may be a favorable strategy for unresectable STS. Future prospective studies are necessary to validate these findings.

TEAMRO: TEAching Mentorship in Radiation Oncology, a Multicenter Prospective Phase 2 Intervention Study on Teaching Mentorship Skills to Residents Working with Medical Students

PURPOSE/OBJECTIVE(S)

While formal curriculum on resident teaching have been associated with improved career growth and sustained positive impact on patient care, mentorship skills are rarely taught in academic medicine. We hypothesized that a formalized resident mentorship curriculum coupled with a near-peer resident-medical student mentoring program would improve resident career growth.

MATERIALS/METHODS

A multi-institutional, prospective, phase 2 intervention study, approved by each participating center's institutional review board, was conducted from 4/2022-10/2022 among interested residents in the Radiation Oncology Education Collaborative Study Group Graduate Medical Education. Intervention included: 1) a 4-week mentorship curriculum (utilizing a Six Steps approach) composed of self-guided readings, didactic lecture, and 30-minute faculty check-in, and 2) a formalized 1:1 resident-medical student mentorship program during an existing radiation oncology sub-internship with weekly meetings. Resident participants completed the Mentorship Competency Assessment (MCA), a 26-item validated survey on mentorship skills in medicine scored from 0 (most unprepared) to 7 (most prepared) before and after the intervention. The primary endpoint was average change in MCA skill from pre- to post-intervention survey, with score ranges from -7 (a decrease in 7 points) to +7 (an increase of 7 points).

RESULTS

A total of 8 residents participated and all completed pre- and post-intervention surveys. Most residents were PGY-4/5 (75%), from programs with >10 residents (68%), and did not have prior training in teaching (88%) or mentorship (88%). Residents met students on average twice weekly (range 1-3) for an average of 2 hours a week (range 1-5). After the program, most residents felt confident in being a future mentor to students (100%), their overall well-being was positively impacted (63%), and their mentorship relationships were positively impacted (50%). All 26 mentorship skills increased on MCA after intervention (average +1.3/7 per skill). Skills that showed greatest improvement were helping mentees network effectively (+2.6/7), acquire resources (+2.1/7), negotiate a path to professional independence (+2.0/7), set career goals (+1.8/7), and balance work and personal life (+1.7/7). Skills that showed least improvement were establishing a relationship based on trust (+0.4/7), identifying and accommodating different communication styles (+0.6/7), providing constructive feedback (+0.7/7), and aligning mentor-mentee expectations (+0.8/7).

CONCLUSION

The formalized mentorship program improved mentorship skills among residents, translating to increased satisfaction in residents' own mentorship relations and overall well-being. Further studies are needed to assess the sustainability of these skills, as well as impact on career growth and satisfaction.

Effects of exogenous amylolytic or fibrolytic enzymes inclusion on in vitro fermentation of lactating dairy cow diets in a dual-flow continuous-culture system

The objective of this study was to determine the effects of including exogenous amylolytic or fibrolytic enzymes in a diet for high-producing dairy cows on in vitro ruminal fermentation. Eight dual-flow continuous-culture fermentors were used in a replicated 4 × 4 Latin square. The treatments were control (CON), a xylanase and glucanase mixture (T1), an α-amylase mixture (T2), or a xylanase, glucanase, and α-amylase mixture (T3). Treatments were included at a rate of 0.008% of diet dry matter (DM) for T1 and T2 and at 0.02% for T3. All treatments replaced the equivalent amount of soybean meal in the diet compared with CON. All diets were balanced to have the same nutrient composition [30.2% neutral detergent fiber (NDF), 16.1% crude protein (CP), and 30% starch; DM basis], and fermentors were fed 106 g/d divided into 2 feedings. At each feeding, T2 was pipetted into the respective fermentor and an equivalent amount of deionized water was added to each fermentor to eliminate potential variation. Experimental periods were 10 d (7 d for adaptation and 3 d for sample collection). Composite samples of daily effluent were collected and analyzed for volatile fatty acids (VFA), NH₃-N, and lactate concentrations, degradability of DM, organic matter, NDF, CP, and starch, and flow and metabolism of N. Samples of fermentor contents were collected from each fermentor at 0, 1, 2, 4, 6, and 8 h after feeding to determine kinetics of pH, NH₃-N, lactate, and VFA concentrations over time. All data were analyzed using PROC GLIMMIX of SAS (SAS Institute Inc.), and the repeated variable of time was included for kinetics measurements. Treatment did not affect mean pH, degradability, N flow and metabolism, or the concentrations of VFA, NH₃-N, or lactate in the effluent samples. Treatment did not affect pH, acetate:propionate ratio, or the concentrations of lactate, NH₃-N, total VFA, acetate, propionate, butyrate, isobutyrate, valerate, or caproate. However, the concentration of total VFA tended to change at each time point depending upon the treatment, and T2 tended to have a greater proportion of 2-methylbutyrate and isovalerate than CON, T1, or T3. As 2-methylbutyrate and isovalerate are branched-chain VFA that are synthesized from branched-chain amino acids, T2 may have an increased fermentation of branched-chain amino acids or decreased uptake by fibrolytic microorganisms. Although we did not observe changes in N metabolism due to the enzymes, there could be changes in microbial populations that utilize branched-chain VFA. Overall, the tested enzymes did not improve in vitro ruminal fermentation in the diet of high-producing dairy cows.

Evaluation of the BAX® System for Detection of Listeria monocytogenes in Foods: Collaborative Study

A multilaboratory study was conducted to compare the automated BAX® system and the standard cultural methods for detection of Listeria monocytogenes in foods. Six food types (frankfurters, soft cheese, smoked salmon, raw, ground beef, fresh radishes, and frozen peas) were analyzed by each method. For each food type, 3 inoculation levels were tested: high (average of 2 CFU/g), low (average of 0.2 CFU/g) and uninoculated controls. A total of 25 laboratories representing government and industry participated. Of the 2335 samples analyzed, 1109 were positive by the BAX system and 1115 were positive by the standard method. A Chi square analysis of each of the 6 food types, at the 3 inoculation levels tested, was performed. For all foods, except radishes, the BAX system performed as well as or better than the standard reference methods based on the Chi square results.

Abstract P4-08-15: Locoregional recurrence in invasive breast cancer and association with tumor infiltrating leukocyte (TIL) presence

Background:

The presence of TILs has been correlated with clinical outcomes and response to therapy in breast cancer. However, evaluation of TILs in breast cancer has largely been based on pathologic examination of tumor samples. Here, we report the relationship between invasive breast cancer locoregional recurrence (LRR) and the presence of TILs estimated by transcriptomic analysis with the deconvolution algorithm CIBERSORT.

Methods:

Patients were identified from an IRB-approved prospective tissue collection protocol at one academic institution and two community hospitals. 526 primary breast tumor samples were identified and gene expression profiling was assessed with high density Affymetrix microarray chips. Proportions of 22 different TIL types in samples were inferred based on the CIBERSORT algorithm, which uses gene expression data to estimate TIL presence. TIL presence was determined by dichotomization at the level of the first quartile among all samples (&gt;Q1=TIL presence). Patient characteristics and clinical outcomes were obtained by chart review. Time to event analysis was performed using Kaplan Meier (KM) estimates and the log-rank test. Associations between patient factors, tumor factors, TIL presence, and LRR were explored with univariable (UVA) and multivariable (MVA) analyses. Factors significant on UVA (p&lt;0.10) were included on MVA. P&lt;0.05 was considered statistically significant on MVA.

Results:

526 women with invasive breast cancer and available genomic profiling were retrospectively identified for analysis. Median age at diagnosis was 58 years. 70% of tumors were Stage I-II. 69% were luminal subtypes and 17% were triple negative. 37% received mastectomy, 25% received mastectomy + radiation, and 32% received breast conserving therapy. 64% received chemotherapy, and 62% received hormonal therapy. Median follow-up was 74.4 months. There were 61 LRRs. We found significant differences in time to LRR when comparing presence vs. no presence of resting memory CD4+ T-cells (RMCD4+) (p=0.01), activated natural killer cells (ANK) (p=0.003), and neutrophils (PMNs) (p=0.03). On UVA, factors associated with LRR were patient age at diagnosis (p=0.009), pathologic T stage (p=0.045), Estrogen receptor status (p=0.03), biologic subtype (p=0.01), lymphovascular invasion (LVI) (p=0.018), positive margins (p&lt;0.0001), receipt of hormonal therapy (0.014), and presence of tumor infiltrating RMCD4+ (p=0.012), ANK (p=0.0004), and PMNs (p=0.033). On MVA, factors remaining significant were LVI (HR 2.16 CI 1.13-4.13, p=0.011), positive margins (HR 4.36 CI 1.57-12.11, p=0.018), receipt of hormonal therapy (HR 0.31 CI 0.12-0.77, p=0.042), and presence of RMCD4+ (HR 0.48 CI 0.26-0.88, p=0.017), ANK (HR 0.43 CI 0.23-0.83, p=0.012), and PMNs (HR 2.15 CI 1.02-4.53, p=0.043).

Conclusion:

In this study of 526 women with invasive breast cancer, we identified that enrichment of certain TILs is associated with LRR. These results suggest genomic-based assays of TIL presence may be useful to predict LRR in invasive breast cancer.

Citation Format: Liveringhouse CL, Grass GD, Figura NB, Mills MN, Purcell JD, Rosensweig SR, Blumencranz PW, Allen KG, Ahmed KA, Harrison LB, Torres-Roca JF, Robinson TJ, Diaz R. Locoregional recurrence in invasive breast cancer and association with tumor infiltrating leukocyte (TIL) presence [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P4-08-15.

Critical care usage after major gastrointestinal and liver surgery: a prospective, multicentre observational study

BACKGROUND

Patient selection for critical care admission must balance patient safety with optimal resource allocation. This study aimed to determine the relationship between critical care admission, and postoperative mortality after abdominal surgery.

METHODS

This prespecified secondary analysis of a multicentre, prospective, observational study included consecutive patients enrolled in the DISCOVER study from UK and Republic of Ireland undergoing major gastrointestinal and liver surgery between October and December 2014. The primary outcome was 30-day mortality. Multivariate logistic regression was used to explore associations between critical care admission (planned and unplanned) and mortality, and inter-centre variation in critical care admission after emergency laparotomy.

RESULTS

Of 4529 patients included, 37.8% (n=1713) underwent planned critical care admissions from theatre. Some 3.1% (n=86/2816) admitted to ward-level care subsequently underwent unplanned critical care admission. Overall 30-day mortality was 2.9% (n=133/4519), and the risk-adjusted association between 30-day mortality and critical care admission was higher in unplanned [odds ratio (OR): 8.65, 95% confidence interval (CI): 3.51-19.97) than planned admissions (OR: 2.32, 95% CI: 1.43-3.85). Some 26.7% of patients (n=1210/4529) underwent emergency laparotomies. After adjustment, 49.3% (95% CI: 46.8-51.9%, P<0.001) were predicted to have planned critical care admissions, with 7% (n=10/145) of centres outside the 95% CI.

CONCLUSIONS

After risk adjustment, no 30-day survival benefit was identified for either planned or unplanned postoperative admissions to critical care within this cohort. This likely represents appropriate admission of the highest-risk patients. Planned admissions in selected, intermediate-risk patients may present a strategy to mitigate the risk of unplanned admission. Substantial inter-centre variation exists in planned critical care admissions after emergency laparotomies.

Evaluation of a Home Visiting and Befriending Scheme for Young Mothers: Newpin

Befriending schemes to support families with young children are now widespread in the United Kingdom. One such scheme, Newpin, which aims to prevent child abuse is described. Evaluation compared those recruited to befriend as well as those befriended. Assessments at baseline and 6 months' follow-up comprised interviews with mothers, developmental assessments of the children and observation of mother–child interaction using video tapes. All assessments were conducted in the home and similar measures were applied to a control sample in an area where a Newpin scheme was planned. Newpin recruits, whether befrienders or befriended had high rates of adverse early experiences, but depression was more common amongst those referred for befriending. Approximately a third did not sustain involvement in the scheme, but those that did were more likely to have had training as volunteers and mental health problems of more than 2 years' duration.

Mallards (Anas platyrhynchos) and wastewater ponds, Part II: Developmental, physiological, morphological and behavioural effects of ingestion of secondary clarified effluent water

Rather than migrating, mallard ducks may choose to overwinter in northern cities on open-water thermal refuges, such as municipal wastewater treatment ponds, which in Edmonton, Canada, stay ≥10°C during frigid winter months. Refuging mallards spend appreciable time daily on these ponds and hydrate using secondary clarified municipal wastewater (SCEW). We aimed to determine if SCEW ingestion affected mallard health. To this end, we gavaged newly hatched mallards (domesticated Pekin strain) over their first month with SCEW, as well as water representing negative and positive controls (municipal tap water, and the primary active ingredient from birth control pills, 17α-ethinyl estradiol (EE2), respectively). The gavage of SCEW did not affect mass of the body, liver, spleen or heart, but was associated with small increases in beak and wing chord length. In the positive control, EE2 gavage caused similar responses, but also increased tarsus and phallus length. The increases likely owed to the stimulatory effects of estrogenic substances on bone and phallus development. For the biotransformation enzyme CYP2H1, gene expression was numerically increased by both SCEW and EE2. In terms of behavior, SCEW and EE2 gavage reduced two infrequently detected behaviours, pecking and resting alone. Our results suggest that SCEW ingestion would be unlikely to cause any overt health effects in adults, but may evoke subtle, covert effects nevertheless.

The Role of Sulfur Dioxide in Stratospheric Aerosol Formation Evaluated Using In-Situ Measurements in the Tropical Lower Stratosphere

Stratospheric aerosols (SAs) are a variable component of the Earth's albedo that may be intentionally enhanced in the future to offset greenhouse gases (geoengineering). The role of tropospheric-sourced sulfur dioxide (SO₂) in maintaining background SAs has been debated for decades without in-situ measurements of SO₂ at the tropical tropopause to inform this issue. Here we clarify the role of SO₂ in maintaining SAs by using new in-situ SO₂ measurements to evaluate climate models and satellite retrievals. We then use the observed tropical tropopause SO₂ mixing ratios to estimate the global flux of SO₂ across the tropical tropopause. These analyses show that the tropopause background SO₂ is about 5 times smaller than reported by the average satellite observations that have been used recently to test atmospheric models. This shifts the view of SO₂ as a dominant source of SAs to a near-negligible one, possibly revealing a significant gap in the SA budget.

Interferon beta overexpression attenuates adipose tissue inflammation and high-fat diet-induced obesity and maintains glucose homeostasis

The worldwide prevalence of obesity is increasing, raising health concerns regarding obesity-related complications. Chronic inflammation has been characterized as a major contributor to the development of obesity and obesity-associated metabolic disorders. The purpose of the current study is to assess whether overexpression of interferon beta (IFNβ1), an immune-modulating cytokine, will attenuate high fat diet-induced adipose inflammation and protect animals against obesity development. Using hydrodynamic gene transfer to elevate and sustain blood concentration of IFNβ1 in mice fed a high fat diet, we showed that overexpression of Ifnβ1 gene markedly suppressed immune cell infiltration into adipose tissue, and attenuated production of pro-inflammatory cytokines. Systemically, IFNβ1 blocked adipose tissue expansion and body weight gain, independent of food intake. Possible browning of white adipose tissue might also contribute to blockade of weight gain. More importantly, IFNβ1 improved insulin sensitivity and glucose homeostasis. These results suggest that targeting inflammation represents a practical strategy to block the development of obesity and its related pathologies. In addition, IFNβ1-based therapies have promising potential for clinical applications for the prevention and treatment of various inflammation-driven pathologies.

Characterizing spatial uncertainty when integrating social data in conservation planning

Recent conservation planning studies have presented approaches for integrating spatially referenced social (SRS) data with a view to improving the feasibility of conservation action. We reviewed the growing conservation literature on SRS data, focusing on elicited or stated preferences derived through social survey methods such as choice experiments and public participation geographic information systems. Elicited SRS data includes the spatial distribution of willingness to sell, willingness to pay, willingness to act, and assessments of social and cultural values. We developed a typology for assessing elicited SRS data uncertainty which describes how social survey uncertainty propagates when projected spatially and the importance of accounting for spatial uncertainty such as scale effects and data quality. These uncertainties will propagate when elicited SRS data is integrated with biophysical data for conservation planning and may have important consequences for assessing the feasibility of conservation actions. To explore this issue further, we conducted a systematic review of the elicited SRS data literature. We found that social survey uncertainty was commonly tested for, but that these uncertainties were ignored when projected spatially. Based on these results we developed a framework which will help researchers and practitioners estimate social survey uncertainty and use these quantitative estimates to systematically address uncertainty within an analysis. This is important when using SRS data in conservation applications because decisions need to be made irrespective of data quality and well characterized uncertainty can be incorporated into decision theoretic approaches.

TU-F-213AB-01: Diagnostic Workforce and Manpower Survey

Since AAPM Report No. 33 on Diagnostic Radiology Physics staffing is more than 20 years old, the Diagnostic Work and Workforce Study Subcommittee (DWWSS) of the Professional Council was formed to conduct a new study and update the data. The intent of the DWWSS study has two goals. First, it wanted to assess the number of FTE diagnostic physicists needed to support the QC, acceptance tests, radiation safety and other clinical functions for various imaging modalities, such as: CT scanners, MRI units, angiography rooms, ultrasound units, nuclear medicine imagers and other equipment. For example, the preliminary results indicate that the median annual physics support for one CT scanner is 0.007 FTE or 12.6 hours per unit. Second, the study wanted to provide an estimate of the cost of these physics services in terms of a fraction of a dollar per patient examination performed. For example, the cost for physics support of CT would be $0.27 for each CT procedure. This information would be similar to the Abt study conducted in Radiation Oncology. Radiation therapy physicists have utilized the Abt studies to generate re-imbursement for physics services and to justify financially the cost of their work efforts. Appropriate recognition for physics efforts in Diagnostic Radiology has never been properly quantified nor appreciated. With all the current and future changes occurring in healthcare, the information from the DWWSS survey could be important to the future of diagnostic physicists. Although diagnostic physicists are involved with many other activities such as teaching of residents and research, information about the clinical equipment support effort could be used to assess diagnostic physics staffing needs. The goals of the DWWSS study and the preliminary findings will be presented.

OBJECTIVE

1. Present the goals of the DWWSS Diagnostic Physicist Survey.2. Present potential benefits to the AAPM members from this survey.3. Present findings from the preliminary analysis of the survey.

TU-G-211-01: New Member Symposium

As a new member of the AAPM, it's easy to feel overwhelmed by the size and complexity of the association and to be unaware of the benefits and opportunities available to members. At this year's AAPM national meeting in Charlotte, we will host a New Member Symposium, where you can learn more about the organization, member resources, opportunities to get involved, and about topics of particular interest to new professionals. We encourage you to take advantage of this great opportunity to learn valuable information and to grow your professional network. Following an introduction from Dr. Gary A. Ezzell, the AAPM President; Michael Woodward of the AAPM staff will provide a crash course on the AAPM structure and organization, as well as some pointers on navigating the website. Next will be Dr. Michael Mills presenting on the current state of the U.S. Medical Physics Workforce, Staffing, Supply & Demand, and Limited Residency slots. Registered attendees will receive a raffle ticket for entry in a drawing to win a complimentary registration for the 2013 Annual Meeting in Indianapolis. In addition, all new members who register for the Symposium will receive a drink ticket good for one complimentary beer served after the New Member Symposium during the social with committee chairs from 4 AAPM Councils: Science, Education, Professional, and Administrative.

Upper gastrointestinal bleeding: a Jamaican perspective

BACKGROUND

Upper gastrointestinal bleeding (UGIB) remains one of the most common clinical life-threatening emergencies which is associated with a high morbidity, mortality and medical care costs.

OBJECTIVES

This study reviews the clinical features, management and outcomes of patients with UGIB seen at the University Hospital of the West Indies (UHWI), Jamaica, between January 2006 and December 2008.

METHODS

Patients with UGIB admitted to the medical wards of the UHWI, Jamaica, between January 2006 and December 2008 were reviewed. Consecutive patients admitted with a confirmed diagnosis of UGIB were selected for analysis. Data collected included age, gender presenting complaints, risk factors, clinical features and management. Endoscopic findings, treatment and outcomes were also reviewed.

RESULTS

There were 104 patients, with a mean age of 55 years, admitted with UGIB. There were significantly more men than women (73 vs 31). Retching and vomiting were the most common presenting complaints followed by melaena and haemetemesis. Non-steroidal anti-inflammatory drug use was present in 28% of patients. Overall, 80% of patients had upper GI endoscopy (EGD) and 40% were done within 24 hours of admission. The median time for performing EGD was 24 hours (mean 46 hours). The leading causes of UGIB were duodenal ulcer (28%), erosive gastritis (20%) and gastric ulcer (13%). Proton pump inhibitors (PPI) were given to 95 (91%) patients intravenously. Blood transfusion was given to 40% of patients. The mortality was 5.7%, rebleeding occured in 4.8% of patients and 5% underwent surgery. The average duration of hospital stay was 6.6 days.

CONCLUSION

Upper gastrointestinal bleeding was more common in men of middle age in this study. Proton pump inhibitors were used in most patients. The overall mortality of 5.7% is similar to other series. Early EGD and use of endoscopic therapy may lead to a decrease in mortality in high risk patients.