Planning Phase Research Articles

A novel approach to predict acute radiation dermatitis in patients with head and neck cancer using a model based on Bayesian probability

PurposeIn this study, we aimed to establish a method for predicting the probability of each acute radiation dermatitis (ARD) grade during the head and neck Volumetric Modulated Arc Therapy (VMAT) radiotherapy planning phase based on Bayesian probability. MethodsThe skin dose volume >50 Gy (V50), calculated using the treatment planning system, was used as a factor related to skin toxicity. The empirical distribution of each ARD grade relative to V50 was obtained from the ARD grades of 119 patients (55, 50, and 14 patients with G1, G2, and G3, respectively) determined by head and neck cancer specialists. Using Bayes’ theorem, the Bayesian probabilities of G1, G2, and G3 for each value of V50 were calculated with an empirical distribution. Conversely, V50 was obtained based on the Bayesian probabilities of G1, G2, and G3. ResultsThe empirical distribution for each graded patient group demonstrated a normal distribution. The method predicted ARD grades with 92.4 % accuracy and provided a V50 value for each grade. For example, using the graph, we could predict that V50 should be ≤24.5 cm3 to achieve G1 with 70 % probability. ConclusionsThe Bayesian probability-based ARD prediction method could predict the ARD grade at the treatment planning stage using limited patient diagnostic data that demonstrated a normal distribution. If the probability of an ARD grade is high, skin care can be initiated in advance. Furthermore, the V50 value during treatment planning can provide radiation oncologists with data for strategies to reduce ARD.

Can renewable energy work for rural societies? Exploring productive use, institutions, support systems, and trust for solar electricity in the Navajo Nation

Reliable electricity and water access remain major challenges in rural communities worldwide. Standalone renewable energy systems show promise in improving access, but successful long-term outcomes remain infrequent in practice. To achieve sustainable outcomes, planners and decision makers should place a greater emphasis on understanding community context to determine the technological and social appropriacy of renewable energy technology. This article investigates a case study of renewable energy systems in the Navajo Nation to develop an understanding of what technical and social considerations may be necessary. A qualitative exploratory data analysis approach is used to perform a comparative analysis of two programs that deployed solar home systems (SHS) and atmospheric water generation (AWG) systems to address electricity and water needs in the Nation, respectively. The findings reveal that renewable energy programs should critically evaluate four factors related to technological and procedural appropriacy. These four factors are (1) an understanding of the productive use of the technology in context, (2) the need to operate within extant institutional paradigms, (3) the capacity to develop and maintain a support network, and (4) the need for trust building. The findings indicate that productive use of renewable energy is determined by end-user application and its usefulness in the community’s rank order of priorities. It also demonstrates that social acceptance of renewable energy is affected by the willingness of programs to conform to existing institutional paradigms. This article refines and expands upon existing themes of social acceptance, making them more application oriented by focusing on the planning phase.

Regulating ecosystem services in a local forest: Navigating supply, trade-offs, and synergies

The management of ecosystem service supply in local forests is closely linked to the ecological well-being of residents. This study aimed to estimate the supply, tradeoffs, and synergies of local forest-regulating ecosystem services using a land cover classification map (LCCM) and a forest type map (FTM). Rigorous literature reviews and expert Delphi analyses were conducted to elicit a list of key regulating services and evaluate the potential of each ecosystem type and category of the 1:5,000 LCCM and FTM to provide the selected services. The Getis-Ord Gi* analysis was combined with the land-sue scoring method to propose a method for estimating the supply, trade-offs, and synergies of local forest ecosystem services. The results revealed that the ranking order (1st to 5th) of the supply of regulating ecosystem services was as follows: erosion prevention, air quality regulation, heat island mitigation, water quality regulation, and carbon storage. When analyzing the correlation between the defined services of the entire city, almost all services showed a synergistic effect. However, when analyzed locally, spatial tradeoffs (between heat island mitigation and air quality regulation; carbon storage and air quality regulation; water quality regulation and air quality regulation) were observed in the eastern and northwestern forest areas. This suggests the need to consider not only the synergies and trade-offs between specific ecosystem services at the regional level but also at the local level when managing regulating ecosystem services of local forests. The results of this study can serve as important baseline references for planners and policymakers during the planning phase of policies aimed at managing the supply of regulating ecosystem services for forests with restricted access. Moreover, the study results can help refine the estimation of the supply of regulating ecosystem services by integrating additional data sources.

Peningkatan Hasil Belajar Siswa Menggunakan Model Discovery Learning Berbantuan Media Audio Visual pada Pendidikan Agama Katolik di kelas IV SDN 08 Semidang

In Dusun Semidang, Desa Suka Maju, Kecamatan Sungai Betung, Kabupaten Bengkayang, West Kalimantan Province, education faces significant challenges. The majority of the population, engaged in farming and gardening, has a low level of education, especially after completing elementary school. The low educational attainment of parents can influence their understanding of the importance of education for their children. This research focuses on Catholic Religious Education at SDN 08 Semidang, with the aim of shaping students into individuals of faith. Students have low interest in learning, lack access to textbooks, and receive inadequate family support. In the fourth grade of SDN 08 Semidang, the Discovery Learning method with the assistance of audio-visual media is applied to address these issues.This study uses two action cycles based on the Kemmis and McTaggart model, consisting of planning, action, observation, and reflection phases. In the first cycle, student learning outcomes did not meet the target, but student reflection questionnaires indicated improvement. In the second cycle, the results were better, with student attitudes reaching 83% of the 80% target. Therefore, the second cycle is considered sufficient and concluded.The results show that the discovery learning model with audio-visual media is effective in improving the learning outcomes of Catholic Religious Education and Character Education in the fourth grade at SDN 08 Semidang. Several recommendations are proposed for further development, including designing more contextual learning materials, providing teacher training, continuous evaluation, active parental participation, and further research to assess the long-term impact of this learning model..

Be Well™ Acres Homes: a community-driven, evidence-based approach to reduce health inequities through sustained cross-sector partnership

PurposeBe Well Communities™ is MD Anderson’s signature place-based approach for cancer prevention and control, working with communities to promote wellness and address modifiable risk factors for cancer. The purpose of this paper is to describe implementation of the planning phase of the Be Well Communities model in Acres Homes which began in 2019.MethodsA community advisory group (Steering Committee) including residents, non-profit organizations, health care partners, city and county agencies, plus other stakeholders, was convened and aligned through a structured process to develop shared goals, foster multisector collaboration, as measured by a stakeholder survey administered twice, and enhance community capacity to improve health outcomes through development of a Community Action Plan.ResultsClear, achievable goals were developed, multisector collaboration was enhanced, and more than 400 h of capacity building support led to a Community Action Plan initially focused on healthy eating and active living, including 15 evidence-based interventions led by 18 organizations. The majority (93%) of the Steering Committee reports that this plan reflects community priorities and will reach the residents most in need.ConclusionBy listening and developing trust, the Be Well Communities team successfully worked with Acres Homes residents and organizations to enhance community capacity to address health inequities in one of Houston’s most diverse and historic communities.

Expediting Time to Market: Evaluating the Effects of Change Control Board Performance in Emerging Markets

This study aims to assess how the performance of Change Control Boards (CCBs) influences the relationship between requirements uncertainty and the Time to Market (TTM) of software projects in emerging markets. We collected data through a structured questionnaire, conducting surveys in project-based IT organizations across various cities in Pakistan. This research adopts a quantitative approach, employing software project houses as the unit of analysis. We selected 38 software projects out of 50 using a multi-stage sampling method and analyzed the data using Smart PLS 4.0 and SPSS 23. The results reveal that requirements uncertainty has a significant impact on Time to Market (TTM) conditions. Our study concludes that the presence and effective performance of CCBs can substantially reduce TTM. Additionally, higher CCB performance can expedite TTM, particularly when requirements lack precision initially. The study underscores the profound influence of requirements uncertainty on TTM in software projects. It provides organizations with insights into the critical role of CCBs, the consequences of uncontrolled changes in the absence or ineffectiveness of CCBs, and how requirements uncertainty affects software project development and timelines. This research contributes to software management and product development processes by highlighting the importance of requirement engineering during the planning phase to address uncertainty issues and enhance CCB performance.

Managing the KIR LIBA Program for Enhancing Writing Skills in State Madrasah Aliyah Students: A Case Study

This study focuses on assessing the administration of the KIR LIBA program's impact on enhancing students' writing abilities at MAN 1 Yogyakarta. It employs a qualitative research approach and data collection methods such as observation, interviews, and documentation. Data analysis involves data reduction and the presentation of findings in a narrative format. The research is framed within the context of the POAC management objectives theory. The research findings reveal the following aspects of the KIR LIBA program's management: (1) Planning: The KIR LIBA program initiates its planning phase by setting objectives and preparing program-related matters for the upcoming year. It includes creating work programs and budget estimates for the period; (2) Organizing: Organizational management structures are established to facilitate the division of responsibilities and tasks among different divisions, ensuring that each division fulfills its designated responsibilities and work programs; (3) Implementation: The program puts the prepared work programs into action for the year. KIR LIBA involves eight types of work programs and activities carried out throughout the year, with each program executed on a weekly, monthly, and yearly basis; (4) Monitoring and Evaluation: Continuous monitoring occurs during every activity, and an annual evaluation takes place during the handover process and the submission of management accountability reports. The madrasah head conducts the evaluation, the head of student affairs, and the KIR LIBA coaching staff. The management strategies employed by the KIR LIBA team have contributed to notable improvements in students' writing skills at MAN 1 Yogyakarta. This improvement is exemplified by the increased number of students successfully participating in international writing competitions during the study period. However, it is worth noting that this research provides a broad overview of program management without delving into specific details. Therefore, it is recommended that future researchers explore these aspects in more depth. It could include sharing specific examples of recent evaluation outcomes conducted by relevant institutions to further assist in achieving the program's implementation objectives.

Optimal Allocation and Energy Management of Units in Distribution Networks with Multiple Renewable Energy Sources and Battery Storage Based on Computational Intelligence

The paper deals with an optimization problem in an electricity distribution network with different types of distributed generation and a battery storage system in terms of a smart grid concept. The optimization problem considers two objectives, namely, the annual energy losses and the exchange of energy with the higher-level power grid. The decision variables of the problem are the allocation of the different distributed generation units and the battery storage system, the annual power profiles of the controllable distributed generation and the battery storage system, and the power factor profiles of the controllable and noncontrollable distributed generation. All decision variables are solved simultaneously in a single optimization problem. The variable load shapes of the grid consumers and the profiles of the photovoltaic and wind power systems are considered in the study. All data are observed at the annual level with hourly resolution. The problem solving method uses computational intelligence techniques, namely, metaheuristic optimization methods and artificial neural networks. The study proposes a framework for optimizing the decision variables in the planning phase of distributed generation and battery storage, and for controlling the variable power and power factor profiles based on an artificial neural network in the implementation phase. The optimization problem is solved with a power system simulation program and a metaheuristic optimizer in cosimulation synergy. The three cases of distributed generation and battery storage are considered simultaneously. The proposed method is applied to the test grid operator IEEE with 37 buses, and reductions in annual energy losses and energy exchange are obtained in the ranges 34–86% and 41–99%, respectively.

Subfluvial tunnel layout design: Mapping recent sediment fill in Bilbao Estuary using H/V spectral ratio

Mapping the soil-bedrock interface is crucial for tunnelling projects in engineering geology. This investigation demonstrates the effectiveness of a novel technique to calculate the horizontal-to-vertical (H/V) spectral ratio using ambient vibration measurements to characterize the unconsolidated sediment thickness and geometry of the top of the engineering bedrock in the city of Bilbao (northern Iberian Peninsula). Engineering bedrock is defined here as the consolidated rock layer underlying the Holocene sediments infill in the region. The non-invasive technique was integrated into the geophysical surveys conducted in 2019 for a subfluvial tunnel construction project beneath the Bilbao Estuary. We calculated the H/V transfer function at 37 sites using an AutoRegressive Moving Average (ARMA) model, which has been shown to be robust in extracting the ground fundamental resonant frequency with high spectral resolution. Lithological information from coincident stations and boreholes supports the empirical interpretation of the H/V spectral peaks in terms of peak impedance contrast depth. The estimated engineering bedrock exhibits morphological complexity with depths ranging from ∼10 m to ∼47 m below the surface. The obtained unconsolidated sediment thickness map is consistent with the geology known from the scattered historical borehole data and is supported by the results of the soil geotechnical characterization conducted in 2021 to advance the planning phase of the subfluvial tunnelling project. We show that the novel H/V approach used in this work is robust and yields somewhat higher resolution results than other commonly used H/V methods. The resolution of the method enables the use of H/V estimates to efficiently plan well campaigns and minimise costs, even for relatively shallow targets. We conclude that H/V mapping using this novel technique can help select layout alternatives in the early stages of tunnel construction planning, especially in heavily urbanized areas.

Regular cannabis use alters the neural dynamics serving complex motor control.

Cannabis is the most widely used recreational drug in the United States and regular use has been linked to deficits in attention and memory. However, the effects of regular use on motor control are less understood, with some studies showing deficits and others indicating normal performance. Eighteen users and 23 nonusers performed a motor sequencing task during high-density magnetoencephalography (MEG). The MEG data was transformed into the time-frequency domain and beta responses (16-24 Hz) during motor planning and execution phases were imaged separately using a beamformer approach. Whole-brain maps were examined for group (cannabis user/nonuser) and time window (planning/execution) effects. As expected, there were no group differences in task performance (e.g., reaction time, accuracy, etc.). Regular cannabis users exhibited stronger beta oscillations in the contralateral primary motor cortex compared to nonusers during the execution phase of the motor sequences, but not during the motor planning phase. Similar group-by-time window interactions were observed in the left superior parietal, right inferior frontal cortices, right posterior insular cortex, and the bilateral motor cortex. We observed differences in the neural dynamics serving motor control in regular cannabis users compared to nonusers, suggesting regular users may employ compensatory processing in both primary motor and higher-order motor cortices to maintain adequate task performance. Future studies will need to examine more complex motor control tasks to ascertain whether this putative compensatory activity eventually becomes exhausted and behavioral differences emerge.

The development of a novel decision support system for regional land use planning for brownfield land

Digital tools, particularly specialised decision support systems (DSSs), can be utilized to assist in the complex process of brownfield redevelopment. Existing brownfield DSSs typically focus on site-specific, late-stage applications, and socioeconomic factors are often overlooked. In this paper, we present a novel DSS aimed at providing support for early-stage, city region-scale brownfield land use planning and redevelopment. The proposed DSS is a prototype WebGIS application that enables land use planners and other brownfield regeneration professionals to examine a region and a set of sites during the initial planning phase for brownfield redevelopment. The DSS includes three bespoke modules comprising: (1) Land Use Potential (residential, commercial, and public open space), (2) risks posed by contamination and geotechnical hazards, (3) data pertinent to brownfield economic viability assessments. We outline a use case for this DSS, developed through comprehensive user-requirements gathering, and subsequently describe the techniques employed to construct the DSS modules and user interface. Finally, we present the results of user testing, wherein case-study stakeholders assessed the DSS. The feedback obtained during user testing aided in the identification of areas for improvement with regard to the functionality, usability, and effectiveness of the DSS in supporting decision-makers. The feedback was utilized to implement iterative improvements to the DSS and to plan future developments for the prototype DSS.

Vertidrome Airside Level of Service: Performance-Based Evaluation of Vertiport Airside Operations

This paper presents the Vertidrome Airside Level of Service (VALoS) framework, a novel performance metric designed to evaluate airside traffic flow operations at vertidromes in the context of Urban Air Mobility (UAM). As the UAM industry rapidly evolves, the need for a comprehensive evaluation framework becomes increasingly important. The VALoS framework provides a performance-based approach to evaluating vertidrome traffic flow performance, considering metrics like average passenger delay, air taxi in-flight delay, and vertidrome punctuality. Unlike existing Level of Service approaches, the VALoS framework unifies the requirements of various stakeholders, the passenger, the air taxi operator, and the vertidrome operator each with their own performance metric and target. It provides a multi-faceted approach covering airside air and ground traffic flows, arrivals and departures, and performance changes during strategic planning and tactical execution phases. The VALoS is evaluated at 15-min intervals while considering changing stakeholder performance targets and operational uncertainties. For the reference use case, the study demonstrates the significant impact of short-term disruptions, while stochastic deviations can be neglected. Higher traffic volumes due to changing demand/capacity ratios result in higher VALoS variability. The VALoS framework, together with a fast-time simulation, provides a versatile method for exploring future vertidrome traffic flows and supporting strategic vertidrome airside planning and integration. This integrated approach is essential for the evolving UAM vertidrome industry; aligning the interests of different stakeholders and promoting sustainable and efficient vertidrome planning and operation.

Integration of electro-anatomical maps in the planning phase of stereotactic arrhythmia radioablation for refractory ventricular tachycardia

Abstract Introduction Despite the efficacy of stereotactic arrhythmia radioablation (STAR) for the treatment of refractory ventricular tachycardia (VT), the planning phase to precisely delineate the arrhythmogenic substrate still suffers from limitations due to the incompatibility of data formats between 3D electro-anatomical mapping systems (EAM) and STAR planning software (CyberKnife). Purpose Within the STOPSTORM European consortium, we present a workflow to integrate all 3D EAM data (e.g. voltage, activation time, anatomical tags) into the STAR planning software using the open source software Slicer3D to improve targeting of the arrhythmogenic substrate. Method Two protocols were compared retrospectively. Protocol 1 (STAR gold-standard) comprised the manual contouring of the clinical target volume (CTV) on planning 4D-CAT SCAN drawn side-by-side using EAM (Carto3, Biosense Webster) screen-shots and diagnostic reports. Protocol 2 comprised semiautomatic segmentation of CTV on planning 4D-CAT SCAN using imported EAMs annotated with landmarks for VT target delimitation. The semiautomatic segmentation of CTVs included three steps: (1) semiautomatic segmentation of ventricular myocardium (VM), the blood-pool of the concerned ventricle and at least two additional cardiac cavities; (2) 3D alignment of EAM with the segmented cavities; and (3), 3D delineation of CTV identified as the transmural section of VM segment surrounding the EAM’s VT target delimited by the annotated landmarks. The volume overlap (Dice coefficient) and the absolute difference of the CTVs obtained with the two protocols were compared. Both measurements were expressed in percentage as follows: Dice coefficient 0% means no overlap and 100% complete overlap; absolute difference of volumes 0% means no difference and 100% means that one CTV was twice the size of the CTV generated by the other protocol. Results Both protocols were applied to four patients (65.5 ± 8.5 yo) with refractory VT successfully treated with STAR. Figure 1 shows an example (Patient 1) of the CTV contouring using the CARTO EAMs aligned with the CT images in Slicer3D. Figure 2 illustrates significant mismatch between the segmented CTVs of the two protocols. The median volume overlap of the CTVs was 44%, while the median volume absolute difference was 35%. Table 1 reports detailed results. Conclusion Our study reveals a high variability of CTV delineation for STAR using two different protocols. The intraprocedural assignment of anatomical landmarks for VT target delimitation on EAM appears promising to improve CTV delineation. Further research is needed to evaluate the correlation between STAR outcome and CTV delineation accuracy.

Prehospital emergency medicine research by additional teams on scene – Concepts and lessons learned

While the initial minutes of acute emergencies significantly influence clinical outcomes, prehospital research often receives inadequate attention due to several challenges. Retrospective chart reviews carry the risk of incomplete and inaccurate data. Furthermore, prehospital intervention trials frequently encounter difficulties related to extensive training requirements, even during the planning phase. Consequently, we have implemented prospective research concepts involving additional paramedics and physicians directly at the scene during major emergency calls. Three concepts were used: (I) Paramedic field supervisor units, (II) a paramedic + physician field supervisor unit, (III) a special physician-based research car. This paper provides insights into our historical perspective, the current situation, and the lessons learned while overcoming certain barriers and using existing and novel facilitators. Our objective is to support other research groups with our experiences in their planning of upcoming prehospital trials.

Configuration optimization of product-service system design requirements based on hesitant information axiom

Product-service system (PSS) has attracted attention of manufacturers to shift from product-providing to solution-providing, which is a marketable set of products and services. The existing researches emphasize the fulfillment of individualized customer requirements through different PSS configurations. The PSS planning phase is of high importance in generating conceptual schemes, which translates customer requirements (CRs) to design requirements (DRs). In this paper, a systematic decision-making approach based on QFD is put forward aiming to configure the PSS design requirements (DRs). To address the uncertainty and hesitancy in QFD modeling, a hesitant fuzzy linguistic term sets (HFLTSs) is applied to elicit the experts’ linguistic preferences in evaluating the importance of CRs and the relationships between CRs and DRs. To dealing with the group decision-making problems concerning the HFLTSs, the min-upper operator and the max-lower operator assemble the experts’ evaluation results into a linguistic interval, and then the numerical results can be obtained by using the 2-tuple linguistic representation model and the interval preference degree computation. A non-linear 0-1 programming model is proposed to select the target DRs’ specifications for maximizing customer satisfaction under cost constraint. In order to objectively determine the satisfaction degree of each optional specification of DR, the information axiom is introduced to construct the objective function via information content computation. To deal with the qualitative DRs, HFLTSs and information axiom are combined and hesitant information axiom (HIA) is proposed. Finally, a DRs optimization model is established using HIA and the imprecision method. A case study is carried out to demonstrate the effectiveness of the optimal PSS planning approach developed.

Study on the Maximum Outgoing Line Count of 750 kV Substations and Exploration of a Bus Short-circuit Current Suppression Method

With the development and construction of new power systems, the power grid structure is becoming increasingly interconnected, and the issue of short-circuiting currents in UHV systems will gradually manifest over the next five years. Existing measures for short-circuit current control typically involve using standby units, lines, and main transformers. However, conventional measures are gradually unable to meet the control requirements, necessitating strict control of the network topology during the planning phase and the exploration of new technologies and methods to keep pace with the evolving era. This paper studies the maximum outgoing line count of 750 kV substations, providing theoretical references applicable to practical operations for planning departments. A conceptual method based on fast-switching technology to suppress the current during a short circuit at the 750 kV voltage level is proposed, establishing the groundwork for the practical implementation of high-speed switching technology in the 750 kV voltage-level power grid.

Methods for Global Health Collaboration on Cardiovascular Disease: Vihiga 1.

Partnership building and understanding of context that addresses global health concerns is essential in global health research. However, limited knowledge is available on the practical experiences of building such relationships. The aim of this study was to provide a detailed description of the processes involved in establishing international collaboration, gain community involvement and cooperation with gatekeepers, and study populations of rural village areas in Western Kenya. Because of the limited information available in the published literature about the extremely important practical considerations, our experiences on the logistical aspects of planning and implementing global health research projects are presented. Understanding the local collaborators and their communities and allocating adequate resources in time and money during the planning phase is paramount in ensuring the successful completion of global health research studies.

Impact of model detail on daylighting metrics in residential buildings

Daylight metrics that shall guide performance-driven design must be applicable to models that reflect the limited knowledge at the time of planning decisions. In particular in residential buildings, the furnishing is beyond the control of such decisions and therefore unknown in the planning phase. The impact of model detail on illuminance- and luminance-based metrics is tested on a residential unit in Singapore. At two elevations, representing a work-plane and the eye level of a standing inhabitant, the metrics are computed from a) a detailed model incorporating furniture and shading devices, b) a model with only shading devices, and c) a minimalist model representing only the design decisions of the architect. As a potential approximation to the detailed model, d) a variant of the minimalist model with wall reflectance reduced to 0.20 is tested. The results for the three levels of detail are compared and indicate the significant impact of detail on all assessed daylight metrics.

An analysis of Plan, Do, Study, Act for a supportive care program for patients with metastatic breast cancer.

376 Background: Patients with metastatic cancer have unique survivorship needs. Recent studies show patients with advanced cancer have unmet needs in the following categories: health information (31%), psychosocial support (27%), symptom management and general wellness support (23%) (Hart, et al., 2022). The Living Well with Advanced Breast Cancer Clinic (LWABC) was established in 2017 to address these unmet needs. This multidisciplinary clinic provides the patient and caregiver(s) an individual visit with a medical oncologist, integrative medicine physician, palliative medicine physician, dietitian, and nurse navigator. The patient is provided in-depth education and personalized supportive care plans. Methods: Over recent years, clinic staff have utilized the Plan, Do, Study, Act (PDSA) (Taylor, et al., 2014 ) methodology to refine operations and improve patient care. In 2021, the plan phase was initiated with incorporation of a nurse navigator and program manager for the clinic. Nurse navigation services have been shown to improve patient and caregiver knowledge as well as quality of life and was deemed an important addition to the program (Oncology Nursing Society, 2018). At the beginning of calendar year 2022, in the “do” phase, the nurse navigator/program manager was hired and implemented pre-visit phone calls as well as navigation services for patients. These services include assessment of needs, patient education, provision of community resources, and assistance with scheduling referrals. At the beginning of calendar year 2023, use of the NCCN distress thermometer and problem list was initiated. The current phase, “study,” includes development of a dashboard for monitoring clinic operations. Review and assessment of distress thermometer data is ongoing. Results: When comparing calendar year 2021 to 2022, the clinic has seen increases in referrals (40 in 2021 to 65 in 2022), number of patients seen (31 in 2021 to 46 in 2022), and unique patient zip codes (28 in 2021 to 42 in 2022). There was also a reduction in late cancellation rates from 15.9% (2021) to 7.2% (2022). Late cancellation is defined as any appointment cancelled 24 hours or less prior to scheduled visit. Conclusions: Utilizing the PDSA cycle clinic staff have seen operational improvements over the last two years. Currently, this supportive care program remains in a “study” phase and will continue to evaluate progress and patient outcomes. Results from the act phase will be utilized to continue expansion of the clinic and services in the future. Further aiding this endeavor is an embedded patient advocate and ongoing outreach and collaboration with patient support organizations.

Proton Therapy Equipment Installation, Upgrades, and Building Design

This work aims at reviewing challenges and pitfalls in proton facility design related to equipment upgrade or replacement. Proton therapy was initially developed at research institutions in the 1950s which ushered in the use of hospital-based machines in 1990s. We are approaching an era where older commercial machines are reaching the end of their life and require replacement. The future widespread application of proton therapy depends on cost reduction; customized building design and installation are significant expenses. We take this opportunity to discuss how commercial proton machines have been installed and how buildings housing the equipment have been designed. Data on dimensions and weights of the larger components of proton systems (cyclotron main magnet and gantries) are presented and innovative, nongantry-based, patient positioning systems are discussed. We argue that careful consideration of the building design to include larger elevators, hoistways from above, wide corridors and access slopes to below grade installations, generic vault and treatment room layouts to accommodate multiple vendor's equipment, and modular system design can provide specific benefits during planning, installation, maintenance, and replacement phases of the project. Room temperature magnet coils can be constructed in a more modular manner: potential configurations are presented. There is scope for constructing gantries and magnet yokes from smaller modular sub-units. These considerations would allow a hospital to replace a commercial machine at its end of life in a manner similar to a linac.