Long-Term Outcomes of Multidisciplinary Radiation Oncology Equity and Inclusion Committee Programming at an Academic Health System

PURPOSE/OBJECTIVE(S)

Academic radiation oncology departments are increasingly implementing educational programs to promote diversity, equity, and inclusion, but data on their impact remains sparse. This study aimed to assess learning outcomes and perceived impact of the programming of a multidisciplinary radiation oncology equity and inclusion committee (EIC).

MATERIALS/METHODS

Since August 2020, a committee of radiation therapists (RTTs), physicians (MDs), nurses (RNs), and administrators (ADs) has led an alternate-monthly online EIC meeting open to all radiation oncology employees at one health system. Learning goals of EIC programming are (1) to understand disparities in healthcare practice and outcomes for marginalized populations, (2) to discuss current events relevant to marginalized groups, and (3) to identify and address personal bias. EIC has featured expert guest speakers, open discussion, cultural events, and individual storytelling. In February 2023, we conducted a department-wide survey evaluating participation in one or more EIC meetings. EIC participants also completed an evaluation focused on learning goal achievement and program strengths/weaknesses. Multiple choice responses and 5-point Likert scale survey items were descriptively analyzed; open responses were qualitatively coded and categorized into themes.

RESULTS

There were 84 survey respondents, corresponding to a department response rate of 53%. Of these, 37 (44%) indicated participation in at least one EIC meeting. Participants were 35% RTTs, 16% MDs, 14% ADs, 3% physicists/dosimetrists, 3% RNs, and 19% undisclosed profession; 46% identified as a racial, ethnic, sexual, and/or gender minority. 41% of participants attended 5 or more sessions. Participants reported high overall value of the EIC meeting (mean value 3.7 / 5, SD 1.2) and 89% would recommend participation. There was strong agreement with achievement of EIC learning goals (mean agreement [MA] 3.9 / 5, SD 0.91), and most participants reported improved capability to understand (61%, MA 3.72 / 5, SD 0.99) and address (61%, MA 3.75 / 5, SD 0.83) the specific needs of their patients from marginalized groups. The three most common themes of EIC strengths were educational value, speaker quality, and improved work relationships. Commonly requested improvements included more practice scenarios, increasing participation, and giving more equitable attention to all minority groups. Among EIC non-participants, 75% reported non-participation due to scheduling, 71% felt that having an EIC was valuable, and 59% reported a desire to attend an EIC meeting in the future.

CONCLUSION

Nearly 3 years since implementation, EIC programming is highly valued. The majority of participants report achievement of learning goals and perceive self-improvement in care for marginalized groups as a result of participation. Further research is needed to externally validate the impact of this programming on learning and patient care domains.

Migration of iodine-129 and iodine-127 in soils

To draw the balance of anthropogenic 129I input into European soils, the concentrations of 129I and 127I in seven soils from Lower Saxony were analyzed down to a depth of 250 cm. In comparison with pre-nuclear soils and Ukrainian soils, we detected a significant anthropogenic input of 129I. Considering the different time periods for the input of 129I and 127I it was possible to assess the dynamics of sorption processes which dominate migration and accumulation. Anthropogenic 129I was successfully used as a tracer for a clarification of the migration processes of trace elements in soils.

How do we fight COVID-19? Military medical actions in the war against the COVID-19 pandemic in France

'We are at war', French President Emmanuel Macron said in an address to the nation on 16 March 2020. As part of this national effort, the French Military Medical Service (FMMS) is committed to the fight against COVID-19. This original report aimed to describe and detail actions that the FMMS has carried out in the nationwide fight against the COVID-19 pandemic in France, as well as overseas. Experts in the field reported major actions conducted by the FMMS during the COVID-19 pandemic in France. In just few weeks, the FMMS developed ad hoc medical capabilities to support national health authorities. It additionally developed adaptive, collective en route care via aeromedical and naval units and deployed a military intensive care field hospital. A COVID-19 crisis cell coordinated the French Armed Forces health management. The French Military Centre for Epidemiology and Public Health provided all information needed to guide the decision-making process. Medical centres of the French Armed Forces organised the primary care for military patients, with the widespread use of telemedicine. The Paris Fire Brigade and the Marseille Navy Fire Battalion emergency departments ensured prehospital management of patients with COVID-19. The eight French military training hospitals cooperated with civilian regional health agencies. The French military medical supply chain supported all military medical treatment facilities in France as well as overseas, coping with a growing shortage of medical equipment. The French Armed Forces Biomedical Research Institute performed diagnostics, engaged in multiple research projects, updated the review of the scientific literature on COVID-19 daily and provided expert recommendations on biosafety. Finally, even students of the French military medical academy volunteered to participate in the fight against the COVID-19 pandemic. In conclusion, in an unprecedented medical crisis, the FMMS engaged multiple innovative and adaptive actions, which are still ongoing, in the fight against COVID-19. The collaboration between military and civilian healthcare systems reinforced the shared objective to achieve the goal of 'saving the greatest number'.

Tracking of Primary Human Hepatocytes with Clinical MRI: Initial Results with Tat-Peptide Modified Superparamagnetic Iron Oxide Particles

The transplantation of primary human hepatocytes is a promising approach in the treatment of specific liver diseases. However, little is known about the fate of the cells following application. Magnetic resonance imaging (MRI) could enable real-time tracking and long-term detection of transplanted hepatocytes. The use of superparamagnetic iron oxide particles as cellular contrast agents should allow for the non-invasive detection of labelled cells on high-resolution magnetic resonance images. Experiments were performed on primary human hepatocytes to transfer the method of detecting labelled cells via clinical MRI into human hepatocyte transplantation. For labelling, Tat-peptide modified nano-sized superparamagnetic MagForce particles were used. Cells were investigated via a clinical MR scanner at 3.0 Tesla and the particle uptake within single hepatocytes was estimated using microscopic examinations. The labelled primary human hepatocytes were clearly detectable by MRI, proving the feasibility of this new concept. Therefore, this method is a useful tool to investigate the effects of human hepatocyte transplantation and to improve safety aspects of this method.

Blazar spectral variability as explained by a twisted inhomogeneous jet

Blazars are active galactic nuclei, which are powerful sources of radiation whose central engine is located in the core of the host galaxy. Blazar emission is dominated by non-thermal radiation from a jet that moves relativistically towards us, and therefore undergoes Doppler beaming. This beaming causes flux enhancement and contraction of the variability timescales, so that most blazars appear as luminous sources characterized by noticeable and fast changes in brightness at all frequencies. The mechanism that produces this unpredictable variability is under debate, but proposed mechanisms include injection, acceleration and cooling of particles, with possible intervention of shock waves or turbulence. Changes in the viewing angle of the observed emitting knots or jet regions have also been suggested as an explanation of flaring events and can also explain specific properties of blazar emission, such as intra-day variability, quasi-periodicity and the delay of radio flux variations relative to optical changes. Such a geometric interpretation, however, is not universally accepted because alternative explanations based on changes in physical conditions-such as the size and speed of the emitting zone, the magnetic field, the number of emitting particles and their energy distribution-can explain snapshots of the spectral behaviour of blazars in many cases. Here we report the results of optical-to-radio-wavelength monitoring of the blazar CTA 102 and show that the observed long-term trends of the flux and spectral variability are best explained by an inhomogeneous, curved jet that undergoes changes in orientation over time. We propose that magnetohydrodynamic instabilities or rotation of the twisted jet cause different jet regions to change their orientation and hence their relative Doppler factors. In particular, the extreme optical outburst of 2016-2017 (brightness increase of six magnitudes) occurred when the corresponding emitting region had a small viewing angle. The agreement between observations and theoretical predictions can be seen as further validation of the relativistic beaming theory.

Challenging Investigation of a Norovirus Foodborne Disease Outbreak During a Military Deployment in Central African Republic

In January 2016, a large-scale outbreak of acute gastroenteritis was reported among French armed forces deployed in the Central African Republic. Challenging investigations, conducted from France, made it possible to identify a norovirus genogroup II in both stool and food samples, confirming a norovirus foodborne disease outbreak. Infected food handler management is discussed.

Analysis of the 148Gd and 154Dy Content in Proton-Irradiated Lead Targets

This work presents the determination of the ¹⁴⁸Gd and ¹⁵⁴Dy content in Pb targets irradiated by 220-2600 MeV protons. It includes the chemical separation of lanthanides, followed by the preparation of proper samples, by molecular plating technique, for α-spectrometry measurements. The experimental cross section results were compared with theoretical predictions, calculated with the INCL++-ABLA07 code. The comparisons showed a satisfactory agreement for ¹⁴⁸Gd (less than within a factor two), while measured ¹⁵⁴Dy cross sections are higher than the theoretical values.

INTERNATIONAL STANDARDS ON FOOD AND ENVIRONMENTAL RADIOACTIVITY MEASUREMENT FOR RADIOLOGICAL PROTECTION: STATUS AND PERSPECTIVES

Radiological protection is a matter of concern for members of the public and thus national authorities are more likely to trust the quality of radioactivity data provided by accredited laboratories using common standards. Normative approach based on international standards aims to ensure the accuracy or validity of the test result through calibrations and measurements traceable to the International System of Units. This approach guarantees that radioactivity test results on the same types of samples are comparable over time and space as well as between different testing laboratories. Today, testing laboratories involved in radioactivity measurement have a set of more than 150 international standards to help them perform their work. Most of them are published by the International Standardization Organization (ISO) and the International Electrotechnical Commission (IEC). This paper reviews the most essential ISO standards that give guidance to testing laboratories at different stages from sampling planning to the transmission of the test report to their customers, summarizes recent activities and achievements and present the perspectives on new standards under development by the ISO Working Groups dealing with radioactivity measurement in connection with radiological protection.

Iodine-129, Iodine-127 and Cesium-137 in seawater from the North Sea and the Baltic Sea

In this study, new data are presented for the iodine isotopes (¹²⁷I, ¹²⁹I and their isotopic ratios) and Cesium (¹³⁷Cs) in water samples of the North Sea and the Baltic Sea in 2005 and 2009. This study supplements and extends the study of Michel et al. (2012). Iodine isotopes were separated from their matrix by using an anion exchange method and were determined by applying ICP-MS and AMS. ¹³⁷Cs in seawater was determined after cesium ion exchange procedure enrichment by gamma-spectrometry. The concentrations of ¹²⁷I in seawater of the North and Baltic Sea are fairly constant in each Sea with averages of (44 ± 2) and (21 ± 1) ng g^-1, respectively, depending on the salinity. However, large variations of ¹²⁹I concentrations in these areas were detected, which decreased along the French, Belgian, Dutch, German, and Danish shores. ¹²⁹I/¹²⁷I isotope ratios in the Baltic Sea are about 10 times lower than in the North Sea in 2009. The highest isotopic ratios (2.7 × 10^-6) was detected in the English Channel east of the nuclear reprocessing plant at Cap de la Hague. The results confirm the result of our early study that the sources of ¹²⁹I in the North Sea are primarily the nuclear reprocessing facilities at Sellafield (UK) and La Hague (F), and that in the Baltic Sea the inflow of water from North Sea through the Danish Straits dominates the occurrence of ¹²⁹I. In 2009, the activity concentration of ¹³⁷Cs was at least 6 times higher in the Baltic Sea (37 Bq m^-3) than in the North Sea (5.9 Bq m^-3), due to release of ¹³⁷Cs from sediments in the Baltic Sea, which were contaminated by the Chernobyl accident and - to a minor degree - the atmospheric explosions of atomic bombs. The results are discussed by comparing the results of our previous work and the current study demonstrating the continuing disequilibrium of ¹²⁹I/¹²⁷I atomic ratio in the environmental compartments.

Introducing a Hydrogen-Bond Donor into a Weakly Nucleophilic Brønsted Base: Alkali Metal Hexamethyldisilazides (MHMDS, M=Li, Na, K, Rb and Cs) with Ammonia

Alkali metal 1,1,1,3,3,3-hexamethyldisilazide (MHMDSs) are one of the most utilised weakly nucleophilic Brønsted bases in synthetic chemistry and especially in natural product synthesis. Like lithium organics, they aggregate depending on the employed donor solvents. Thus, they show different reactivity and selectivity as a function of their aggregation and solvation state. To date, monomeric LiHMDS with monodentate donor bases was only characterised in solution. Since the first preparation of LiHMDS in 1959 by Wannagat and Niederprüm, all efforts to crystallise monomeric LiHMDS in the absence of chelating ligands failed. Herein, we present ammonia adducts of LiHMDS, NaHMDS, KHMDS, RbHMDS and CsHMDS with unprecedented aggregation motifs: 1) The hitherto missing monomeric key compound in the LiHMDS aggregation architectures. Monomeric crystal structures of trisolvated LiHMDS (1) and NaHMDS (2), showing unique intermolecular hydrogen bonds, 2) the unprecedented tetrasolvated KHMDS (3) and RbHMDS (4) dimers and 3) the disolvated CsHMDS (5) dimer with very close intermolecular Si-CH3 ⋅⋅⋅Cs s-block "agostic" interactions have been prepared and characterised by single-crystal X-ray structure analysis.

Retrospective dosimetry of Iodine-131 exposures using Iodine-129 and Caesium-137 inventories in soils--A critical evaluation of the consequences of the Chernobyl accident in parts of Northern Ukraine

The radiation exposure of thyroid glands due to (131)I as a consequence of the Chernobyl accident was investigated retrospectively based on (129)I and (137)Cs inventories in soils in Northern Ukraine. To this end, soil samples from 60 settlements were investigated for (129)I, (127)I, and (137)Cs by AMS, ICP-MS and gamma-spectrometry, respectively. Sampling was performed between 2004 und 2007. In those parts of Northern Ukraine investigated here the (129)I and (137)Cs inventories are well correlated, the variability of the individual (129)I/(137)Cs ratios being, however, high. Both the (129)I and (137)Cs inventories in the individual 5 samples for each settlement allowed estimating the uncertainties of the inventories due to the variability of the radionuclide deposition and consequently of the retrospective dosimetry. Thyroid equivalent doses were calculated from the (129)I and the (137)Cs inventories using aggregated dose coefficients for 5-year old and 10-year-old children as well as for adults. The highest thyroid equivalent doses (calculated from (129)I inventories) were calculated for Wladimirowka with 30 Gy for 5-years-old children and 7 Gy for adults. In 35 settlements of contamination zone II the geometric mean of the thyroid equivalent doses was 2.0 Gy for 5-years-old children with a geometric standard deviation (GSD) of 3.0. For adults the geometric mean was 0.47 Gy also with a GSD of 3.0. In more than 25 settlements of contamination zone III the geometric means were 0.82 Gy for 5-years old children with a GSD of 1.8 and 0.21 Gy for adults (GSD 1.8). For 45 settlements, the results of the retrospective dosimetry could be compared with thyroid equivalent doses calculated using time-integrated (131)I activities of thyroids which were measured in 1986. Thus, a critical evaluation of the results was possible which demonstrated the general feasibility of the method, but also the associated uncertainties and limitations.

Impact of former uranium mining activities on the floodplains of the Mulde River, Saxony, Germany

The Mulde River drains the former uranium mining areas in Saxony (Germany), which has led to a large-scale contamination of the river and the adjacent floodplain soils with radionuclides of the uranium decay series. The objective of the investigation is to quantify the long-term effect of former uranium mining activities on a river system. All of the investigated environmental compartments (water, sediment, soil) still reveal an impact from the former uranium mining and milling activities. The contamination of water has decreased considerably during the last 20 years due to the operation of water treatment facilities. The uranium content of the sediments decreased as well (on average by a factor of 5.6), most likely caused by displacement of contaminated material during flood events. Currently, the impact of the mining activities is most obvious in soils. For some of the plots activity concentrations of >200 Bq/kg of soil were detected for uranium-238. Alluvial soils used as grassland were found to be contaminated to a higher degree than those used as cropland.

Prevention of infectious diseases during military deployments: a review of the French armed forces strategy

Military personnel in operations have always paid a high toll to infections. In the 21st century some of these diseases still cause outbreaks with significant morbidity and impact on deployments. The new configuration of the French Armed Forces requires the permanent preparedness of deployable units. During deployments, soldiers are at least exposed to the infectious diseases that are observed in travellers, but with a potentially severe impact for the combatting strengths and a risk for cancelation or failure of the operational durability. The most common disabling infections during military deployments are faeco-oral transmitted diseases including diarrhoea. Preventing infectious diseases during deployments is of great concern and the French medical service has established a strategy based on different components; risk assessment and preparation, immunizations, protective measures and chemoprophylaxis, health education, health surveillance, outbreak investigations and medical tracking. In this review, the authors present the context of deployment of the French Armed Forces, the main health risks they are exposed to and develop the key points of the force health protection strategy, focused on infections related to military deployments.

Malaria control strategies in French armed forces

Each year, 40,000 French soldiers deploy or travel through malaria-endemic areas. Despite the effective control measures that were successively implemented, malaria remains a public health concern in French armed forces with several important outbreaks and one lethal case every two years. This article describes the malaria control strategy in French armed forces which is based on three combined strategies: i) Anopheles vector control to prevent infection with the implementation of personal protection against vectors (PPAV) adapted to the field living conditions of the troops. ii) Chemoprophylaxis (CP) to prevent the disease based on prescription of effective and well tolerated doxycycline. iii) Management of cases through early diagnosis and appropriate treatment to prevent death. In isolated conditions in endemic areas, rapid diagnosis tests (RDT) are used as first-line tests by military doctors. Treatment of uncomplicated Plasmodium falciparum (P. falciparum) malaria is based either on the piperaquine tetraphosphate-dihydroartemisinin association since 2013, or on the atovaquone-proguanil association. First-line treatment of severe P. falciparum malaria is based on IV artesunate. These measures are associated with constant education of the military, epidemiological surveillance of malaria cases and monitoring of parasite chemosensitivity.

Investigating the mechanism of phase transformations and migration in olivine at high temperature

A framework is presented to define the formation and migration mechanisms of oxides in olivine during their phase transformations at high temperature.

[Assessment of vaccination coverage among travelers to areas where yellow fever is endemic (Senegal)]

This prospective survey, conducted at the Dakar airport from August 18, 2011, to May 8, 2012, asked a sample of travelers living in France and returning there after a stay in Senegal to complete a questionnaire. The aim of the study was to assess the determinants of vaccination coverage against yellow fever. The study included 10 298 travelers, with a median age of 48 years (interquartile range: 27-58); 52% were tourists, and 22% were traveling for business purposes. The measured level of anti-yellow fever vaccination coverage was 39.3%. Vaccination coverage was influenced by the travelers' level of knowledge and their perception of the risk.

Radiological evaluation of mine water discharges from hard coal mining in the Fossa Eugeniana Area, Germany

Discharges of radium-carrying mine waters from hard coal mining in the area of the Fossa Eugeniana and the Rheinberger Altrhein in Germany have caused elevated radioactivity in sediments and soils. Extensive measurements of the ambient dose rate revealed some small area contaminations as well as a larger one in a nature protection area at the Rheinberger Altrhein. For the evaluation of the potential radiation exposure investigations of the activity concentrations of river sediments, soils, and biological materials were performed. The potential exposure of members of the public was modelled on the basis of the German Guidelines for the Calculation of Radiation Exposure due to Radioactivity from Mining Activities. In the assessment the present situation as well as its possible future development was considered.

Interface-engineered templates for molecular spin memory devices

The use of molecular spin state as a quantum of information for storage, sensing and computing has generated considerable interest in the context of next-generation data storage and communication devices, opening avenues for developing multifunctional molecular spintronics. Such ideas have been researched extensively, using single-molecule magnets and molecules with a metal ion or nitrogen vacancy as localized spin-carrying centres for storage and for realizing logic operations. However, the electronic coupling between the spin centres of these molecules is rather weak, which makes construction of quantum memory registers a challenging task. In this regard, delocalized carbon-based radical species with unpaired spin, such as phenalenyl, have shown promise. These phenalenyl moieties, which can be regarded as graphene fragments, are formed by the fusion of three benzene rings and belong to the class of open-shell systems. The spin structure of these molecules responds to external stimuli (such as light, and electric and magnetic fields), which provides novel schemes for performing spin memory and logic operations. Here we construct a molecular device using such molecules as templates to engineer interfacial spin transfer resulting from hybridization and magnetic exchange interaction with the surface of a ferromagnet; the device shows an unexpected interfacial magnetoresistance of more than 20 per cent near room temperature. Moreover, we successfully demonstrate the formation of a nanoscale magnetic molecule with a well-defined magnetic hysteresis on ferromagnetic surfaces. Owing to strong magnetic coupling with the ferromagnet, such independent switching of an adsorbed magnetic molecule has been unsuccessful with single-molecule magnets. Our findings suggest the use of chemically amenable phenalenyl-based molecules as a viable and scalable platform for building molecular-scale quantum spin memory and processors for technological development.

TLI in refractory chronic GVHD

Refractory chronic GVHD (cGVHD) remains a major cause of morbidity after transplantation. Many drugs are used but there is no consensus on the standard of care. We investigated the efficacy of TLI in corticosteroid-refractory cGVHD. We analyzed retrospectively 31 patients receiving one or more TLI session for refractory cGVHD from 2000 to 2007. The main objective was to evaluate the response rate after TLI. Decreased corticosteroid doses and/or discontinued immunosuppressive agents were considered to be surrogate markers of response. All but one patient presented with severe cGVHD at the time of TLI. The median number of previous immunosuppressive treatment lines was 3 (range: 2-4). Fourteen patients (45%) achieved an objective response after TLI and 8 (25%) were cGVHD free at long-term follow-up. In all, 5 (29%) of the 17 nonresponsive patients did not show the features of progressive cGVHD and could decrease the amount of immunosuppressive drugs taken. Response after TLI significantly improved 5-year GVHD-related mortality (14% vs 42%, P=0.038) but not OS (58%vs 64% P=0.27). Regarding the promising response rate in this heavily pretreated population, we reasoned that TLI could be an alternative treatment for corticosteroid-refractory cGVHD.

Iodine-129, iodine-127 and caesium-137 in the environment: soils from Germany and Chile

Soil profiles from Bavaria in southern Germany and from Chile were analysed for (129)I by accelerator mass spectrometry (AMS), for (127)I by inductively coupled plasma mass spectrometry (ICP-MS), and for (137)Cs by gamma-spectrometry. The mean deposition density of (137)Cs in soils from Bavaria was (41×1.5(±1)) kBq m(-2) (geometric mean and geometric standard deviation), originating mostly from the Chernobyl fall-out. The deposition density of (129)I in these soils was (109×1.5(±1)) mBq m(-2). The dominant sources of (129)I in Bavaria are, however, the reprocessing plants La Hague and Sellafield and not the Chernobyl fall-out. The (129)I/(127)I isotopic ratios of the Bavarian soils were between 10(-7) and 10(-10), i.e. 10(2)-10(5) times higher than the ratios observed for the samples from Chile. The (129)I integral deposition densities in Chile, Easter Island and Antarctica were between 0.3 mBq m(-2) and 2 mBq m(-2). In these soils, the observed (129)I/(127)I ratios were about 10(-12). The soils from Chile allow the determination of the (129)I fall-out from the atmospheric nuclear weapons explosions undisturbed from contaminations due to releases from reprocessing plants. An upper limit of the integral (129)I deposition density of the atmospheric nuclear weapons explosions on the Southern Hemisphere (27°S) is about 1 mBq m(-2). Finally, the dependence of the migration behaviour of (137)Cs, (127)I and of (129)I on the soil properties is discussed. It turns out that there is a distinctly different behaviour of (127)I, (129)I, and (137)Cs in the soils exhibiting different sorption mechanisms for old and recent iodine as well as for (137)Cs.