Comparison Of Plans Research Articles

한의학교육프로그램 평가에 CIPP 교육과정 평가 모형 적용 가능성 탐구: 한국한의학교육평가원 평가인증 편람을 바탕으로

Objectives The purpose of this study is to develop an evaluation plan by applying the CIPP model to the KAS2022 and then explore the possibilities that emerge when applied to the actual evaluation of education programs. Methods To solve the first research question, we collected evaluation criteria by providing an overview of the CIPP model, analyzing previous research related to the evaluation of the Korean medicine college educational program, and analyzing previous research related to the evaluation of medicine college education program applying the CIPP model. To solve the second research question, a draft evaluation plan applying the CIPP model to KAS2022 was developed and reviewed by two professors of Korean medicine and one professor of medicine. Afterward, limitations were examined by comparing the final draft of the evaluation plan with the evaluation criteria presented in eight previous studies. To solve the third research question, the computerized system for curriculum evaluation developed by S University were compared with the evaluation plan developed in this study. Results In this study, even though it is not presented in KAS2022, intermediate and final inspections criteria were developed on the activities planned for the educational program, and evaluation standards were developed to ensure the effectiveness of the educational program evaluation rather than just formality. Meanwhile, as a result of analyzing the improvements in the computer program dedicated to S University's curriculum evaluation through comparison of evaluation plans. Conclusions Based on the research results, this study is a follow-up study: first, a case study to apply this evaluation plan to the evaluation of an Korean medicine college education program and explore implications, second, an IPA research of the evaluation plan developed in this study, third, proposed a study on technical problems that may arise when adding menus to supplement the computer program dedicated to curriculum evaluation.

Dosimetric and radiobiological comparison of TomoTherapy and IMRT plans for prostate cancer

The purpose of this study was to investigate the dosimetric and radiobiological parameters of IMRT and TomoTherapy techniques to determine the best technique for the treatment of prostate cancer. Dynamic IMRT and Helical TomoTherapy (HT) radiotherapy techniques were used for the treatment planning of 10 patients with prostate cancer. Tumor Control Probability (TCP) and Normal Tissue Complication Probability (NTCP) based on Lyman-Kutcher-Burman (LKB) and Relative Seriality (RS) models as radiobiological parameters in addition to the multiple dosimetrics including Equivalent Uniform Dose (EUD), Heterogeneity Index (HI), and Conformity Index (CI) were evaluated. The mean NTCP value based on the LKB model for the IMRT method was higher than that for the HT method by approximately 4.62% for the bladder and 4.89% for the rectum, respectively. Similarly, in the RS model, the average NTCP values for IMRT were approximately 4.14% and 12.78% for the bladder and rectum, higher than the HT. The mean values of the HI and CI indices in IMRT were obtained as 0.06 ± 0.01 and 1.13 ± 0.08, respectively. With the HT technique, the index values were equal to 0.04 ± 0.01 and 1.09 ± 0.05, respectively. The mean doses to the rectum and right/left femoral heads were 13.19%, 11.32%, and 10.90% higher in IMRT than in HT, respectively. However, the mean dose to the bladder tissue was 17.13% higher in HT than in IMRT. Our study demonstrated that HT plans were superior to IMRT plans in terms of estimated NTCP using radiobiological models (LKB and RS) for healthily tissues. Except for the higher treatment duration, while having a desired and uniform dose distribution to the tumor, the TomoTherapy technique leads to preservation of healthy organs.

A dosimetric and robustness analysis of proton arc therapy with early energy layer and spot assignment for lung cancer versus conventional intensity modulated proton therapy.

Intensity Modulated Proton Therapy (IMPT) faces challenges in lung cancer treatment, like maintaining plan robustness for moving tumors against setup, range errors, and interplay effects. Proton Arc Therapy (PAT) is an alternative to maintain target coverage, potentially improving organ at risk (OAR) sparing, reducing beam delivery time (BDT), and enhancing patient experience. We aim to perform a systematic plan comparison study between IMPT and energy layer (EL) and spot assignment algorithm - Proton Arc Therapy (ELSA-PAT) to assess its potential for lung cancer treatment. A total of 14 Lung ELSA-PAT plans were compared retrospectively with IMPT plans. 4D worst-case minimax robust optimization was performed, including 84 scenarios (3%, 3 mm). Dosimetry assessment included target (clinical tumor volume [CTV]) and important OARs, on nominal and worst-case scenarios. Most relevant normal tissue complication probabilities (NTCP), target coverage robustness against interplay effect, and BDT were evaluated. CTV D95% and D98% showed no significant difference in comparison. PAT demonstrated better conformality by 66% (p = 0.00012) but delivered a higher heart mean dose (HMD, 23%). There was a 2% increase in NTCP 2-year mortality risk with PAT. Total BDT was comparable among techniques. IMPT was more robust than PAT against interplay effect, considering both D1% (1.0 ± 0.8 Gy vs 1.1 ± 1.4 Gy) and D98% bandwidths (0.9 ± 0.9 Gy vs 1.1 ± 1.3 Gy). Both techniques provide a similar level of dose coverage to the target volume. Although PAT improved dose conformality, higher HMD translated into increased heart toxicity, presumably due to chosen planning methodology and OAR proximity to target. Increased ELs and spots raised PAT BDT, although it could improve daily treatment workflow.

Medicare Part D beneficiaries' self-reported barriers to switching plans and making plan comparisons at all.

In the United States, individuals with disabilities and those aged ≥65 can supplement their Medicare with so-called stand-alone Medicare Part D prescription drug plans. Beneficiaries can switch their stand-alone prescription drug plans annually, but most do not. Indirect evidence has raised concerns that non-switchers do not even make plan comparisons (labeled "inattention"), but direct evidence is scarce. Therefore, we surveyed 439 beneficiaries of Medicare Part D plans from a nationally representative adult sample after the 2024 open-enrollment period. Overall, 53% self-reported making no comparisons. Of those who did not compare, 98% did not switch (vs 67% of those who did compare). Multinomial regressions revealed that beneficiaries who neither compared nor switched were more likely than switchers to report difficulties with comparing and switching, experiencing no plan-related discontinuation, changes, or dissatisfaction, not using advisors or the plan-finder website, and receiving potentially confusing mailings. Non-switchers who did compare were similar to switchers in reporting few difficulties and relying on advisors and the plan-finder website, but they were less likely than switchers to report plan-related changes, discontinuation, or dissatisfaction, while being more likely to report receiving mailings and having no college degree. We discuss insights for policy-making.

Evaluation and Improving Treatment Plans of Gated Radiotherapy in Left-Sided Breast Cancer Patients Using Respiratory Motion Management System for Deep Inspiration Breath-Hold (DIBH)

Background: One essential part of treating breast cancer is radiation therapy. Patients with breast cancer are more likely to develop cardiac problems and die if they accidentally expose their hearts to radiation. In order to minimize radiation exposure to the heart, the deep inspiration breath-hold technique (DIBH) has been implemented into clinical practice. This study aimed to assess the use of the Varian Respiratory Motion Management System (RGSC) for radiation application in DIBH, with a focus on dosimetric plan comparison and treatment planning during free breathing (FB) and DIBH Methods and Material: This prospective clinical trial comprised 100 patients with left-sided breast cancer who had undergone breast-conserving surgery. Gating control and the RGS system were employed for therapy application. Analytical anisotropic algorithm (AAA) was used to generate dual treatment plans after CT data were obtained in FB and DIBH. Using the Dose Volume Histogram (DVH), dosimetric output parameters of organs at risk were compared. Results: The RGSC is connected to the LINAC systems and enables con- tinuous, touchless respiratory motion tracking using a camera. After each patient underwent dual treatment planning, 50 patients received treatment in Intensity Modulated Radiotherapy (IMRT) using DIBH, while 50 more patients received treatment in IMRT using Free Breath (FB). The mean cardiac dose reduction for DIBH in these patients was 7.23 to 3.41 Gy when compared to FB. Conclusion: The current data demonstrate that RT could greatly lower mean doses to the heart and high-dose locations by implementing the DIBH approach.

The Australian paediatric brachytherapy experience: A pathway to a national programme.

Paediatric cancers are rare, and most children requiring radiation therapy receive external beam radiation (EBRT). Although EBRT may offer organ preservation compared to surgery, it can be associated with significant late effects. Image-guided brachytherapy is a highly specialised technique offering both organ preservation and dose conformity to minimise late toxicity. This is a retrospective mono-institutional review of paediatric brachytherapy in one of the largest paediatric centres in Australia. Outcomes and toxicities are presented as well as brachytherapy versus proton plan comparison in four patients. A total of 14 patients were treated with adjuvant brachytherapy between 2012 and 2022. The predominant histology was rhabdomyosarcoma, and all patients had pelvic tumours. High-dose rate (HDR) brachytherapy was given for 13 patients with one patient receiving low-dose rate (LDR) brachytherapy. Only one grade three late toxicity was reported and two patients developed metastatic disease within one year of completion of treatment. The brachytherapy plan was superior to protons in two of four patients and equivocal in one patient. This is the first Australian publication of a paediatric brachytherapy series from a single institution. This retrospective series demonstrates the feasibility and safety of brachytherapy in paediatric pelvic tumours. The initial work presented here demonstrates the value of a comprehensive radiation plan review in selecting the optimal modality for an individual paediatric patient.

Do citizens’ perspectives matter? A comparison of formal planning and local preferences for the deployment of renewable energies

ABSTRACT The aim of the study is to analyse the extent to which the spatial planning guidelines for renewable energies address the local people’s perception of a sustainable energy transition. Using the example of the municipality of Tettnang in southern Germany, the study focuses on GIS-based visualisations to investigate the spatial intensity to which the overarching formal specifications on land use have been imprinted on the local contexts and what options for alternative spatial concepts are left for the local population to promote the expansion of wind turbines and photovoltaics. In a further step, the methods of participatory mapping and supplementary interviews are used to analyse which spatial perceptions of a spatially balanced energy transition prevail at the local level. The study sample indicates that the specifications of higher-level spatial planning for renewable energies are not so far away from the spatial ideas of the local population as theoretical concepts assume. Rather, a high degree of criterial congruence was found between the interviewees informal and the overarching formal spatial concepts.

Health insurance plans from NCI-designated public and private cancer centers versus federal health insurance plans.

24 Background: Understanding health insurance plans is crucial for making informed financial decisions and ensuring equitable access to healthcare. While physicians are directly involved in healthcare, the plans available to them are poorly understood. This study compared plans offered at NCI-designated cancer centers with federal plans to better understand and further investigate the differences in beneficiary costs. Methods: We collected data on health plans from 65 cancer centers and federal plans from 5 major insurers by reviewing their websites from 11/2023 - 03/2024. We included up to 3 plans (regardless of insurer) per cancer center and up to 6 federal plans per insurer. We abstracted cost data on premium, deductible, co-pay for physician visits, out-of-pocket (OOP) maximum, and coinsurance for hospitalizations. We compared HMO and PPO plans between public and private cancer centers, as well as with federal plans. Results: We obtained data of 153 plans from 39 public and 26 private cancer centers to compare with 18 federal plans. In the comparison of plans offered at public and private cancer centers, private cancer centers had significantly higher deductible ($597.6 vs $225.9, p=0.03), specialist visit co-pays ($36.1 vs $27.1, p=0.01), and inpatient stay co-insurance ($1281.0 vs $582.9, p=0.02) in HMO plans compared to public cancer centers. For PPO plans, private cancer centers had higher inpatient stay co-insurance ($2,100.5 vs $1,526.3, p=0.03). The premiums of private cancer centers are lower than those in public centers for both HMO plans ($113.5 vs $139.5, p=0.43) and PPO plans ($140.8 vs $190.2, p=0.33), although these differences were not statistically significant. Compared to federal plans, cancer centers plans had significantly higher HMO deductibles ($387.8 vs $100, p=0.02), lower PPO specialist visit co-pays ($30.4 vs $40.5, p=0.05), and lower OOP maximum ($3,823.8 vs $6,554.6, p<0.001) (Table). Conclusions: Our research reveals differences in beneficiary costs between health plans offered by cancer centers and federal plans, as well as among different types of cancer centers. Notably, private cancer centers had higher average costs for deductible, specialist visit, and inpatient stays compared to public cancer centers, likely as a tradeoff to offer a lower premium. These findings underscore the complexities within health plans offered to physicians, emphasizing the necessity for a more comprehensive understanding. Comparison of health plans. Average costs ($) Cancer centers HMO Federal HMO p Cancer Centers PPO Federal PPO p Premium 133.6 425.1 0.1 176.8 259.3 0.1 Deductible 387.8 100 0.02* 906.2 768.2 0.52 Co-pay of PCP visit 20 21.7 0.52 19.7 18.8 0.78 Co-pay of specialist visit 29.4 36.7 0.14 30.4 40.5 0.05* Co-insurance for inpatient stay 955.2 1231.6 0.53 1712 1957.9 0.48 OOP Maximum 3300.2 4416.7 0.24 3823.8 6554.6 <0.001* *p-value < 0.05.

A culture of digital planning? An international comparison of culture, planning and technology

ABSTRACT Urban planning has become an increasingly digital practice in the last three decades and was accelerated by the COVID-19 pandemic. Discussions around the digitization of planning processes have focused on the platforms planners use, and the barriers to their use. Such literature does not adequately explain the variability in the use of planning-specific technologies among planning authorities with the same resources and time. We explore the degree to which workplace and professional culture influence the use of digital technologies in planning practice in Australia, Great Britain, and the United States of America. To study cultural attitudes, a mixture of interview data from 29 planners and document analysis from professional organizations were used. The study found cultural factors play a role in determining the diffusion of technology in planning practice. Our analysis demonstrates points of convergence and divergence across all three geographies of practice, with stark differences in the way that technology is discussed and espoused, as well as a broader lack of clear principles to guide the profession through digital transitions across scales.

Comprehensive Analysis and Development of Electric-Drive-Wheel with Idler Gear

This paper provides a comprehensive analysis of the electric-drive-wheel (EDW) with idler gear. From the perspective of automotive engineering, the EDW is an integrated execution unit that combines the function of powertrain and suspension. As a result, the research on EDW involves the intersection of multiple disciplines. The evolution of idler gear configuration requires some geometric constraints. Under this premise, the longitudinal and vertical dynamic characteristics of the system were studied, respectively. There are several factors that influence the system performance, such as the gear parameters, the position of the electric motor, and the suspension K&C value. The principles of each parameter on the output indicators were studied, with an optimized plan and simulation comparison to check the correctness of theory. In the end, the prototype was equipped with a test bench, covering a wide range of working operations to examine the expected performance of EDW design. The step response test of the EDW result showed a balanced performance in transmission smoothness and responsiveness agility.

348: Dosimetric comparison of helical tomotherapy plans in breast cancer patients with silicone implants

348: Dosimetric comparison of helical tomotherapy plans in breast cancer patients with silicone implants

1708: Automated proton IMPT treatment planning for plan comparison for breast cancer

1708: Automated proton IMPT treatment planning for plan comparison for breast cancer

An integrated urban flooding risk analysis framework leveraging machine learning models: A case study of Xi'an, China

As global climate change intensifies and urbanization progresses, the frequency and extent of urban flooding have been increasing. This trend poses a significant threat to the safety and property of urban residents and severely impedes the advancement of sustainable development goals (SDGs). This study proposed an integrated urban flooding risk analysis framework to provide an essential basis for developing effective adaptation and mitigation measures. The kernel density estimation was adopted to analyze the distribution characteristics of urban flooding hotspots. The maximum entropy (MaxEnt) model was adopted for urban flooding risk probability assessment based on multi-source data. This study conducted an in-depth analysis from three perspectives including spatial analysis, risk planning and model comparison. The MaxEnt model and multiple exploratory spatial data analysis methods were combined to reveal spatial distribution patterns at grid cell scale. The MaxEnt and Zonation models were coupled to generate an urban flooding risk map. Further, six traditional machine learning models were compared with the MaxEnt model. The results indicate that rapid urbanization and intense human activities have significantly increased the number of buildings, leading to loss of previously existing blue and green spaces. These urban characteristics increase the vulnerability of cities to extreme rainfall. Compared to traditional machine learning models, the MaxEnt model has significant advantages. In the field of urban flooding risk, the MaxEnt model demonstrates significant potential for practical application. In summary, the framework empowers urban managers to comprehensively evaluate flooding risk in planning, supporting urban design and risk prevention.

Research on gear whine evaluation method based on transmission error sensitivity

Abstract The issue of noise control for electric vehicles has gradually become prominent, and gear whine noise, as a key factor, is crucial for improving the overall performance and quality of vehicles. This paper discusses the transmission error, a key parameter leading to gear whine, and analyzes the influence of load and gear micro modification on the distribution of transmission error, to achieve comparison and optimization of different axle plans. In addition, by statistical analysis of the distribution of manufacturing errors, it is concluded that they accord with a normal distribution. Then, the weighted transmission error is obtained considering error probability distribution, which provides a new approach for evaluating the sensitivity of gear whine noise to manufacturing errors, in order to solve the issue of noise consistency in large-scale production.

Comparison of Urban Climate Change Adaptation Plans in Selected European Cities from a Legal and Spatial Perspective

The aim of this paper is to identify and compare the key institutional features of urban climate change adaptation plans in three geographically, systemically, and climatically distinct European countries (Greece, Spain, and Poland). The paper concentrates on the tool indicated and confirms the circumstances and potential outcomes of its usage in the selected countries. A case study of a particular city was chosen in each country and the applicability of the climate change adaptation plan there was confirmed. Analysis was also performed on the plans’ legal aspect, connection to national-level strategic planning, and spatial planning. The research questions formulated and addressed are as follows: how do urban climate change adaptation plans in the selected countries define key climate challenges? Is the content of the municipal climate change adaptation plans consistent with the content of the diagnosis of climate challenges at the supra-local level and in the scientific discussion? How are climate change adaptation plans translated into the implementation sphere? Τhe example of Spain and Greece confirms that plans can combine general climate change adaptation objectives with specific (evasive) guidelines for urban policies, while the example of Poland shows that the content of climate change adaptation plans can often be too vague and difficult to further integrate into urban policies. The research results obtained are relevant from the perspective of comparing institutional responses to climate challenges. The research proposes possible methods for making such comparisons.

Evaluation of an automated clinical decision system with deep learning dose prediction and NTCP model for prostate cancer proton therapy

Objective. To evaluate the feasibility of using a deep learning dose prediction approach to identify patients who could benefit most from proton therapy based on the normal tissue complication probability (NTCP) model. Approach. Two 3D UNets were established to predict photon and proton doses. A dataset of 95 patients with localized prostate cancer was randomly partitioned into 55, 10, and 30 for training, validation, and testing, respectively. We selected NTCP models for late rectum bleeding and acute urinary urgency of grade 2 or higher to quantify the benefit of proton therapy. Propagated uncertainties of predicted ΔNTCPs resulting from the dose prediction errors were calculated. Patient selection accuracies for a single endpoint and a composite evaluation were assessed under different ΔNTCP thresholds. Main results. Our deep learning-based dose prediction technique can reduce the time spent on plan comparison from approximately 2 days to as little as 5 seconds. The expanded uncertainty of predicted ΔNTCPs for rectum and bladder endpoints propagated from the dose prediction error were 0.0042 and 0.0016, respectively, which is less than one-third of the acceptable tolerance. The averaged selection accuracies for rectum bleeding, urinary urgency, and composite evaluation were 90%, 93.5%, and 93.5%, respectively. Significance. Our study demonstrates that deep learning dose prediction and NTCP evaluation scheme could distinguish the NTCP differences between photon and proton treatment modalities. In addition, the dose prediction uncertainty does not significantly influence the decision accuracy of NTCP-based patient selection for proton therapy. Therefore, automated deep learning dose prediction and NTCP evaluation schemes can potentially be used to screen large patient populations and to avoid unnecessary delays in the start of prostate cancer radiotherapy in the future.

Dosimetric comparison of HyperArc and InCise MLC-based CyberKnife plans in treating single and multiple brain metastases.

This study aimed to compare the dosimetric attributes of two multi-leaf collimator based techniques, HyperArc and Incise CyberKnife, in the treatment of brain metastases. 17 cases of brain metastases were selected including 6 patients of single lesion and 11 patients of multiple lesions. Treatment plans of HyperArc and CyberKnife were designed in Eclipse 15.5 and Precision 1.0, respectively, and transferred to Velocity 3.2 for comparison. HyperArc plans provided superior Conformity Index (0.91±0.06vs. 0.77±0.07, p<0.01) with reduced dose distribution in organs at risk (Dmax, p<0.05) and lower normal tissue exposure (V4Gy-V20Gy, p<0.05) in contrast to CyberKnife plans, although the Gradient Indexes were similar. CyberKnife plans showed higher Homogeneity Index (1.54±0.17vs. 1.39±0.09, p<0.05) and increased D2% and D50% in the target (p<0.05). Additionally, HyperArc plans had significantly fewer Monitor Units (MUs) and beam-on time (p<0.01). HyperArc plans demonstrated superior performance compared with MLC-based CyberKnife plans in terms of conformity and the sparing of critical organs and normal tissues, although no significant difference in GI outcomes was noted. Conversely, CyberKnife plans achieved a higher target dose and HI. The study suggests that HyperArc is more efficient and particularly suitable for treating larger lesions in brain metastases.

Comparison of different diet plans on patients with type 2 diabetes

Comparison of different diet plans on patients with type 2 diabetes

Clinical and Educational Aspects of Neuroimaging in Microsurgery of the Posterior Fossa: A Comprehensive Review.

The clinical and educational value of modern high-resolution magnetic resonance imaging (MRI) and image processing in neurovascular diseases of the posterior fossa with regard to preoperative planning and intraoperative comparison with the actual anatomical situation was consecutively evaluated. Patients with trigeminal neuralgia (TN), hemifacial spasm (HFS), glossopharyngeal neuralgia (GN) and arterial hypertension (HTN) were analyzed. The high-resolution MRI data was segmented and visualized three-dimensionally using computer graphics methods. New anatomical insights were gained, such as the classification of neurovascular compression (NVC) in HFS and GN. It was also possible to visualize the pathognomonic cerebrospinal fluid signal in patients with TN for the first time. Using the new imaging methods, pregnant hypertensive patients were examined and the existence of NVC was confirmed for the first time, and the findings were compared to other studies dealing with NVC syndromes. This review gives an overview on the established methods of neuroimaging and image processing of neurovascular structures in the posterior fossa with the focus on clinical and educational aspects.

Exclusion of non-Involved uterus from the target volume (EXIT-trial): An individualized treatment for locally advanced cervical cancer using modern radiotherapy and imaging techniques followed by completion surgery

Background and purposeChemoradiotherapy followed by brachytherapy is the standard of care for locally advanced cervical cancer (LACC). In this study, we postulate that omitting an iconographical unaffected uterus (+12 mm distance from the tumour) from the treatment volume is safe and that no tumour will be found in the non-targeted uterus (NTU) leading to reduction of high-dose volumes of surrounding organs at risk (OARs) Material and MethodsIn this single-arm phase 2 study, two sets of target volumes were delineated: one standard-volume (whole uterus) and an EXIT-volume (exclusion of non-tumour-bearing parts of the uterus with a minimum 12 mm margin from the tumour). All patients underwent chemoradiotherapy targeting the EXIT-volume, followed by completion hysterectomy. In 15 patients, a plan comparison between two treatment plans (PTV vs PTV_EXIT) was performed. The primary endpoint was the pathological absence of tumour involvement in the non-targeted uterus (NTU). Secondary endpoints included dosimetric impact of target volume reduction on OARs, acute and chronic toxicity, overall survival (OS), locoregional recurrence-free survival (LRFS), and progression-free survival (PFS). ResultsIn all 21 (FIGO stage I: 2; II: 14;III: 3; IV: 2) patients the NTU was pathologically negative. Ssignificant reductions in Dmean in bladder, sigmoid and rectum; V15Gy in sigmoid and rectum, V30Gy in bladder, sigmoid and rectum; V40Gy and V45Gy in bladder, bowel bag, sigmoid and rectum; V50Gy in rectum were achieved. Median follow-up was 54 months (range 7–79 months). Acute toxicity was mainly grade 2 and 5 % grade 3 urinary. The 3y- OS, PFS and LRFS were respectively 76,2%, 64,9% and 81 %. ConclusionMRI-based exclusion of the non-tumour-bearing parts of the uterus at a minimum distance of 12 mm from the tumour out of the target volume in LACC can be done without risk of residual disease in the NTU, leading to a significant reduction of the volume of surrounding OARS treated to high doses.