Presentation Time Research Articles

Delayed care for STEMI and embolic stroke patients

Objective: The study sought to determine if the arrival of patients experiencing ST-segment elevation myocardial infarction (STEMI) or cerebrovascular accident to the emergency department (ED) was delayed due to fear of COVID-19, among other factors. Both these disease processes are time-dependent, and great efforts have been made to intervene in this pathology quickly to help improve patient-centered outcomes. Methods: A retrospective, case-control study was conducted using data from patient records from March to June 2019 and March to June 2020 from Spring Valley Hospital in Las Vegas, Nevada, USA. Chi-square analyses were performed to determine whether times to presentation for STEMIs and embolic strokes differed between 2019 and 2020 and between March and June using the times to present during the months following the U.S. COVID-19 emergency declaration on March 13th, 2020 (March, April, May, and June). The 432 STEMI and 183 stroke activations were reported during these months. Results: The results displayed an increase in presentation time for STEMI complaints (χ2 [3, N = 2289] = 109.8, p < 0.01) and for stroke complaints (χ2 [3, N = 1011] = 182.8, p < 0.01). The increase in times to presentation for STEMI and embolic stroke patients in the months following the emergency declaration compared to the year prior suggests that patients delayed presentation to the ED. Conclusion: During the pandemic, there was an increase in time to seek treatment for STEMI and embolic stroke patients from the onset of symptoms to their arrival at the ED. This was likely due to patients’ hesitancy to seek treatment due to fear of contracting COVID-19, scarce emergency medical services (EMS) resources, and the flux of new hospital-based virus screening. Data from stroke patients was more heterogenous, likely due to both patients and observers being able to activate the EMS system. These findings may support changes to future public health pandemic guidelines and health education.

Abstract WP190: Central Retinal Artery Occlusion: Do Patient Presentation Patterns Complicate Use Of Potential Treatments?

Introduction: For patients diagnosed with central retinal artery occlusion (CRAO), timely screening for underlying risk factors to prevent secondary stroke and other cardiovascular events is required. Given the profound impact on vision, there is also great interest in the potential to treat CRAO. Thrombolytic therapy is the current standard of care in acute ischemic cerebral stroke, but the window for administration is short. As part of a larger pilot to investigate the prospect of intravenous thrombolysis for patients presenting with acute CRAO in our institution, we set out to evaluate the specific presentation patterns of this population within our system. Methods: Retrospective study performed on 804 patients correctly diagnosed with CRAO from 2011-2020. From this cohort of patients, we identified 484 for whom we could accurately determine the time of first symptoms, the time of first contact with the healthcare system, and the time of evaluation by an ophthalmologist. Results: While 18.0% (87/484) of patients waited over 24 hours from time of vision loss to contact the health care system, 50.2% of patients did connect in under 4.5 hours (243/484). However, only 16.7% (81/484) of patients saw an ophthalmologist within that window, and 35.5% (172/484) did not have any ophthalmologic evaluation within 24 hours of vision loss. Conclusion: Half of CRAO patients within our institution connect with the health care system within a potential window for intravenous thrombolytic treatment, but the majority do not receive ophthalmic diagnosis within that time frame. In conclusion, public health education efforts to speed up presentation times and system-based strategies to decrease the time to ophthalmic diagnosis are needed if thrombolytic treatment either via compassionate use or within a clinical trial setting is to be more widely offered.

ISLPED 2022: An Experience of a Hybrid Conference in the Time of COVID-19

The International Symposium on Low Power Electronics and Design (ISLPED) 2022 conference was held as a hybrid conference on 1–2 August 2022, when travel restrictions associated with COVID-19 were easing slowly. The conference was conducted as an in-person meeting with the entire conference also streamed live on Zoom. We had separated live streams for keynote presentations, invited talks, and two parallel tracks for the technical papers. For presenters, the option was to come in person or send a prerecorded video for the normal presentation time. Authors had to be present in person for Q&A sessions at each of the technical sessions. The attendees were given access to both presentations through a box drive and papers in advance through the Association for Computing Machinery (ACM) library. We had 94 attendees at the conference from nine countries with the majority of the participants from the United States and Asia.

Pathophysiology of drug hypersensitivity.

Drug hypersensitivity reactions (DHRs) are type B adverse drug reactions (ADRs) traditionally defined as unpredictable, dose independent and not related to the drug pharmacology. DHRs, also called drug allergy if the immune system involvement is confirmed, represent around one-sixth of all ADRs and can cause major clinical problems due to their vague clinical presentation and irregular time course. Understanding the underlying pathophysiology of DHRs is very important for their diagnosis and management. Multiple layers of evidence exist pointing to the involvement of the immune system in DHRs. Recent data have led to a paradigm shift in our understanding of the exact pathophysiology of these reactions. Numerous hypotheses proposing explanation on how a low molecular weight drug molecule can elicit an immune reaction have been proposed. In addition to the classical "hapten" hypothesis, the reactive metabolite hypothesis, the pharmacological interaction with the immune system (p-i) concept, the danger/injury hypothesis and the altered peptide repertoire hypothesis have been proposed. We here introduce the inflammasome activation hypothesis and the cross-reactivity hypothesis as additional models explaining the pathophysiology of DHRs. Available data supporting these hypotheses are briefly summarized and discussed. We also introduced the cross-reactivity model, which may provide a platform to appreciate the potential role played by other factors leading to the activation of the immune system. We believe that although the drug in question could be the trigger of the reaction, the components of the immune system mediating the reaction do not act in isolation but rather are affected by the proinflammatory milieu occurring at the time of the reaction. This review attempts to summarize the available evidence to further illustrate the pathophysiology of DHRs.

Delayed Presentation and Referral Time from General Practitioners Contribute to Increased Complicated Appendicitis during the Initial COVID-19 Pandemic Period in Japan.

This study aims to investigate the impact of the coronavirus disease 2019 (COVID-19) pandemic on the situation of acute appendicitis (AA) with respect to patients' and general practitioners' behaviors in a general community hospital in Japan. The surgical outcomes and periods from symptom onset to medical presentation besides practitioners' referral time for consecutive AA patients were compared between the control (January 2016 to March 2020) and COVID-19 periods (April 2020 to April 2021). Eighty-three patients who underwent emergency surgery for AA were reviewed. Complicated appendicitis significantly increased in the COVID-19 period (63.6% vs. 31.2%, P = 0.023). In the COVID-19 period, the time from symptom onset to the medical presentation (2.2 vs. 0.9 days, P < 0.001) was significantly longer than in the control period. Among the patients who first presented to a general practitioner, the referral time from the practitioner to our hospital was significantly longer in the COVID-19 period (1.6 vs. 0.7 days, P = 0.017). Furthermore, among patients with a fever of higher than 38°C at medical presentation, the time from symptom onset to medical presentation was significantly longer in the COVID-19 period (3.0 vs. 0.7 days, P = 0.015). There was no difference in severe postoperative complications. Hesitation to seek surgical treatment for AA was seen in both the patients and practitioners in the COVID-19 period. The delay in surgical treatment presumably led to the increase in severe AA. In a pandemic era, timely care for emergent conditions is a crucial challenge.

The presence of irrelevant alternatives paradoxically increases confidence in perceptual decisions

Confidence in perceptual decisions is thought to reflect the probability of being correct. According to this view, confidence should be unaffected or minimally reduced by the presence of irrelevant alternatives. To test this prediction, we designed five experiments. In Experiment 1, participants had to identify the largest geometrical shape among two or three alternatives. In the three-alternative condition, one of the shapes was much smaller than the other two, being a clearly incorrect option. Counter-intuitively, confidence was higher when the irrelevant alternative was present, evidencing that confidence construction is more complex than previously thought. Four computational models were tested, only one of them accounting for the results. This model predicts that confidence increases monotonically with the number of irrelevant alternatives, a prediction we tested in Experiment 2. In Experiment 3, we evaluated whether this effect replicated in a categorical task, but we did not find supporting evidence. Experiments 4 and 5 allowed us to discard stimuli presentation time as a factor driving the effect. Our findings suggest that confidence models cannot ignore the effect of multiple, possibly irrelevant alternatives to build a thorough understanding of confidence.

Factors affecting the presentation time of patients with acute stroke to hospital and level of awareness of thrombolytic therapy

Introduction&#x0D; In this study, it was aimed to reveal the factors affecting the time of presentation of patients with acute stroke to the hospital, determine the rates of benefiting from thrombolytic therapy and assess the thrombolytic therapy awareness of patients.&#x0D; Materials and Methods&#x0D; 276 patients with acute stroke were included in our study. Standard structured questionnaire was administered to the patients. Patients were asked about the time of onset of stroke, age, place of residence, level of education, whether they received thrombolytic therapy, what was done as the first intervention, and whether they had information about thrombolytic therapy. Stroke severity was also evaluated by applying the National Institutes of Health Stroke Scale (NIHSS) to the patients.&#x0D; Results&#x0D; Of the patients included in the study, 218 (79%) had ischemic stroke, 26 (9.4%) had intracerebral hemorrhage and 32 (11.6%) had TIA. The mean NIHH score of the patients was 6.7±6.2. Stroke onset time was mainly between 18.00-24.00 with a rate of 28.3%. It was understood that 83.1% of the patients came to the emergency department by ambulance and 16.9% came by their own vehicle. When the groups of patients who received and did not receive thrombolytic therapy were compared, no significant difference was found between who the patient lived with at home and the groups of the level of education. Statistical significance was found with symptom onset time (p

Central Retinal Artery Occlusion: Time to Presentation and Diagnosis

To evaluate the presentation patterns of patients diagnosed with central retinal artery occlusion (CRAO) from 2011 to2020. Retrospective cohort study SUBJECTS: The present study was conducted in 484 patients presenting within 30 days of symptom onset with accurate documentation of time of symptom onset, time of presentation to the health care system, and time of presentation to an ophthalmologist. An independent chart review of patients with CRAO was conducted. Demographic information including age, sex, and race were collected. Presentation patterns such as time of first symptoms, time of first contact with the health care system, and time of evaluation by an ophthalmologist were analyzed. Additionally, information regarding the medical venue or specialty of initial patient contact was collected. A total of 247 (51%) patients contacted the health care system within 4.5 hours of system onset, whereas 86 (17.8%) patients waited over 24 hours. Only 81 (32.8%) of the 247 patients who presented within 4.5hours saw an ophthalmologist within that time frame, whereas 172 (35.5%) of the entire cohort of 484 did not present to an ophthalmologist within 24 hours of vision loss. There was significant variability with regards to medical specialty of initial patient contact, with 292 (60.3%) patients first presenting to an emergency department and 133 (27.5%) patients first presenting to an ophthalmologist. Black and Hispanic patients presented later than patients of White, Asian, or other racial backgrounds (40.4 ± 10.2 hours versus 23.0 ± 3.4 hours, P= 0.05). Although no level 1 evidence-based treatment is currently available for CRAO, thrombolytic therapy may be promising. Even though over half of patients with CRAO within our institution connected with the health care system within a potential window for thrombolytic therapy, most did not receive a definitive ophthalmic diagnosis within that time frame. Public health educational campaigns and infrastructure optimization must speed up presentation times, decrease the time to ophthalmic diagnosis, and target vulnerable populations to offer and research timely administration of thrombolytic therapy. The authors have no proprietary or commercial interest in any materials discussed in this article.

Decision-making from temporally accumulated conflicting evidence: The more the merrier.

How do humans evaluate temporally accumulated discrete pieces of evidence and arrive at a decision despite the presence of conflicting evidence? In the present study, we showed human participants a sequential presentation of objects drawn from two novel object categories and asked them to decide whether a given presentation contained more objects from one or the other category. We found that both a more disparate ratio and greater numerosity of objects improved both reaction time (RT) and accuracy. The effect of numerosity was separate from ratio, where with a fixed object ratio, sequences with more total objects had lower RT and lower error rates than those with fewer total objects. We replicated these results across three experiments. Additionally, even with the total presentation duration equated and with the motor response assignment varied from trial to trial, an effect of numerosity was still found in RT. The same RT benefit was also present when objects were shown simultaneously, rather than sequentially. Together, these results showed that, for comparative numerosity judgment involving sequential displays, there was a benefit of numerosity, such that showing more objects independent of the object ratio and the total presentation time led to faster decision performance.

Clinical Improvement Following Operative Management of Ankle Fractures Among Patients With and Without Moderate to High Depressive Symptoms: An Analysis Using PROMIS.

Understanding the recovery trajectory following operative management of ankle fractures can help surgeons guide patient expectations. Further, it is beneficial to consider the impact of mental health on the recovery trajectory. Our study aimed to address the paucity of literature focused on understanding the recovery trajectory following surgery for ankle fractures, including in patients with depressive symptoms. From February 2015 to March 2020, patients with isolated ankle fractures were asked to complete Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function (PF), Pain Interference (PI), and Depression questionnaires as part of routine care at presentation and follow-up time points. Linear mixed effects regression models were used to evaluate the patient recovery pattern, comparing the preoperative time point to <3 months, 3-6 months, and >6 months across all patients. Additional models that included the presence of depression symptoms as a covariate were then used. A total of 153 patients met inclusion criteria. By 3-6 months, PROMIS PF (β: 9.95, 95% CI: 7.97-11.94, P < .001), PI (β: -10.30, 95% CI: -11.87 to -8.72, P < .001), and Depression (β: -5.60, 95% CI: -7.01 to -4.20, P < .001) improved relative to the preoperative time point. This level of recovery was sustained thereafter. When incorporating depressive symptoms into our model as a covariate, the moderate to high depressive symptoms were associated with significantly and clinically important worse PROMIS PF (β: -4.00, 95% CI: -7.00 to -1.00, P = .01) and PI (β: 3.16, 95% CI: -0.55 to 5.76, P = .02) scores. Following ankle fracture surgery, all patients tend to clinically improve by 3-6 months postoperatively and then continue to appreciate this clinical improvement. Although patients with moderate to high depressive symptoms also clinically improve following the same trajectory, they tend to do so to a lesser level than those who have low depressive symptoms. Level III, case-control study.

Effects of Data Including Visual Presentation and Rest Time on Classification of Motor Imagery of Using Brain-Computer Interface Competition Datasets

Effects of Data Including Visual Presentation and Rest Time on Classification of Motor Imagery of Using Brain-Computer Interface Competition Datasets

BK virus nephropathy in renal transplantation and the effect of intravenous immunoglobulin: A prospective longitudinal single-center study in South Asia

Aims and Objectives: The aim was to assess the prevalence and treatment of BK virus nephropathy (BKVN) in patients who underwent renal transplantation at a single center in South India with a 1-year follow-up analysis. To assess the efficacy of treatment with intravenous immunoglobulin (IvIg) in cases of proven BKVN. Materials and Methods: Three hundred and seventy-one patients underwent renal transplantation from 2018 to 2020. All were screened for BKVN with quantitative serum polymerase chain reaction (PCR) every 3 months for 1 year after transplant. Patients with positive tests underwent renal allograft biopsy. In all patients, antimetabolite was stopped, tacrolimus dose was reduced, and leflunomide was started. All patients with biopsy-proven BKVN were administered IvIg 2 grams/kg over 5 days and had a 1-year follow-up. Results: Fourteen patients had BK viremia; 12 had biopsy-proven BKVN. All were male with a mean age of mean age: 45.3 years ± 14.8 standard deviation (SD). Induction: basiliximab (7) and antithymocyte globulin (ATG) (7). Maintenance immunosuppression: tacrolimus, enteric-coated mycophenolate mofetil, and prednisolone. The median presentation time was 12 months. Mean graft function: baseline S. Creatinine of 1.32 mg/dL changed to 2.01 mg/dL at diagnosis. The mean presenting BKV PCR (copies/ml) was 44912 ± 56285 SD. No significant differences were observed in time of presentation, severity, mean tacrolimus level, and graft failure between patients receiving basiliximab or ATG. There were two relapses; two grafts failed. Class I BKVN had a better prognosis. Graft survival at 1 year was 85.71%. Conclusions: This is the first South Asian follow-up study of BKVN in kidney transplant recipients treated with IvIg. BKVN was documented in the first 15 months after transplant. There was no increased prevalence of BKVN in patients with ATG. Histopathological class has prognostic relevance with Class I having a better prognosis. Multipronged treatment, including IvIg, leads to 1-year graft survival of 85.71%. Long-term outcomes need follow-up.

293 IMPACT OF FEMALE GENDER ON ACUTE AND MID-TERM MORTALITY IN PATIENTS WITH ST-SEGMENT ELEVATION MYOCARDIAL INFARCTION DURING THE PANDEMIC ERA

Abstract Background There is still much controversy concerning the impact of gender on mortality during ST-segment elevation myocardial infarction (STEMI). The COVID-19 pandemic deeply affected the clinical history of these patients, both in terms of presentation time and management. The aim of our study was to evaluate the impact of female gender on acute and mid-term mortality in STEMI patients hospitalized during the pandemic period. Materials and Methods Our study focuses on STEMI patients hospitalized during the darkest period of the pandemic. We retrospectively analyzed consecutive STEMI patients hospitalized from 15 March 2020 to 15 March 2021 in our Hub centre in Milan, Lombardy. All clinical, demographic, and procedural characteristics were collected in a dedicated database. Patient follow-up was carried out through clinical visits, telephone calls and remote monitoring through the “Lombardia Regional Registry”. Results From a total of 283 patients, women represented 26.8% of the population, with a mean age of 72 - 11.2 years vs. 64.7 - 12.6 years in men. Anterior STEMI was the most represented with a mildly reduced ejection fraction (EF 48.3 _ 11.8%) similar between genders. Coronary angiography showed more extensive disease in man, while women presented with a higher Killip class at admission and a more pronounced anemic status. In-hospital and 1-year mortality of the whole cohort were 11.4% and 7.5%, respectively, with no significant differences between genders (14.5% women vs. 10.6% men, p = ns; 9.2% women vs. 7% man, p = ns). EF resulted in being the only independent predictor of mortality in the short-term and at 1-year follow up in both genders. In the acute phase, the only other independent predictor of mortality was COVID-19 infection, secondary to the higher rate of respiratory omplications, without any difference in terms of major adverse cardiac events. The impact of COVID-19 infection on mortality was completely lost at 1-year follow up. Conclusions Our study has shown that female gender in STEMI patients does not represent an independent predictor of mortality both in the short- and in the mid-term follow up. Concomitant COVID-19 infection significantly influenced in-hospital mortality due to the higher rate of respiratory complications in both genders. The impact of COVID-19 on mortality was completely lost at follow-up, where age and a reduced EF remained the only independent predictors, regardless of gender.

No Meaningful Difference in Attentional Bias Between Daily and Non-Daily Smokers

Both daily and non-daily smokers find it difficult to quit smoking long-term. One factor associated with addictive behavior is attentional bias, but previous research in daily and non-daily smokers found inconsistent results and did not report the reliability of their cognitive tasks. Using an online sample, we compared daily (n = 106) and non-daily (n = 60) smokers in their attentional bias towards smoking pictures. Participants completed a visual probe task with two picture presentation times: 200ms and 500ms. In confirmatory analyses, there were no significant effects of interest, and in exploratory analyses, equivalence testing showed the effects were statistically equivalent to zero. The reliability of the visual probe task was poor, meaning it should not be used for repeated testing or investigating individual differences. The results can be interpreted in line with contemporary theories of attentional bias where there are unlikely to be stable trait-like differences between smoking groups. Future research in attentional bias should focus on state-level differences using more reliable measures than the visual probe task.

Inhibition of intentional binding by an additional sound presentation.

When a voluntary action is followed by an effect after a short delay, the time distance between the action and its effect is perceived to be shorter than the actual time distance. This phenomenon is known as intentional binding (IB). We investigated the influence of presentation of an additional effect on IB between the action and the target effect, and investigated the influence of the presentation timing of the additional effect. One sound (target sound) was constantly presented 250ms after the button was pressed, and the other sound (additional sound) was presented simultaneously when the button was pressed (Experiment 1) or at one of various timings that included moments both before and after the target sound (Experiment 2). The results showed that IB between the action and target sound was significantly inhibited only when the additional sound was presented prior to the target sound. This suggests that the prior effect has a greater advantage in connecting to the action compared to the posterior sound.

Robust Boundary Extension effects with different picture sets, set sizes, and presentation times

Robust Boundary Extension effects with different picture sets, set sizes, and presentation times

Spotting lesions in thorax X-rays at a glance: holistic processing in radiology

Radiologists often need only a glance to grasp the essence of complex medical images. Here, we use paradigms and manipulations from perceptual learning and expertise fields to elicit mechanisms and limits of holistic processing in radiological expertise. In the first experiment, radiologists were significantly better at categorizing thorax X-rays when they were presented for 200 ms in an upright orientation than when they were presented upside-down. Medical students, in contrast, were guessing in both situations. When the presentation time was increased to 500 ms, allowing for a couple more glances, the radiologists improved their performance on the upright stimuli, but remained at the same level on the inverted presentation. The second experiment circumvented the holistic processing by immediately cueing a tissue within the X-rays, which may or may not contain a nodule. Radiologists were again better than medical students at recognizing whether the cued tissue was a nodule, but this time neither the inverted presentation nor additional time affected their performance. Our study demonstrates that holistic processing is most likely a continuous recurring process which is just as susceptible to the inversion effect as in other expertise domains. More importantly, our study also indicates that holistic-like processing readily occurs in complex stimuli (e.g., whole thorax X-rays) but is more difficult to find in uniform single parts of such stimuli (e.g., nodules).

The Effects of Semantic and Syntactic Prediction on Reading Aloud

Semantic and syntactic prediction effects were investigated in a word naming task using semantic or syntactic contexts that varied between three and six words. Participants were asked to read the contexts silently and name a target word, which was indicated by a color change. Semantic contexts were composed of lists of semantically associated words without any syntactic information. Syntactic contexts were composed of semantically neutral sentences, in which the grammatical category but not the lexical identity of the final word was highly predictable. When the presentation time of the context words was long (1,200 ms), both semantically and syntactically related contexts facilitated reading aloud latencies of target words and syntactically related contexts produced larger priming effects than semantically related contexts in two out of three analyses. When the presentation time was short (200 ms), however, syntactic context effects disappeared, while semantic context effects remained significant. Across the three experiments, longer contexts produced faster response latencies, but longer contexts did not produce larger priming effects. The results are discussed in the context of the extant literature on semantic and syntactic priming and more recent evidence, suggesting that syntactic information constrains single word recognition.

HEMATOLOGIC MANIFESTATIONS OF SYSTEMIC LUPUS ERYTHEMATOSUS IN A TERTIARY CARE CENTRE

Background: Systemic lupus erythematosus (SLE) can present with hematologic manifestations alone or with features of systemic involvement. Diagnosis may be delayed or missed at presentation time, especially in those with hematologic abnormalities as the initial manifestation, with low index of clinical suspicion or inadequate follow-up. Aim And Objectives: To study the prevalence and the type of hematologic manifestations in SLE from pathologist's perspective. Setting And Design: Retrospective observational study. Material And Methods: Study was done in 63 SLE patients in a tertiary care hospital in Secunderabad for duration of one and half years, from January 2018 to June 2019. Hematological parameters of the same were retrieved. Results :It was observed that anemia was the most common hematologic nding with iron deciency anemia (IDA) being the commonest cause followed by hemolytic anemia. Leucopenia with predominant lymphopenia was the most common WBC abnormality and thrombocytopenia was seen in majority of the patients. Bi and pancytopenia was also observed. Raised erythrocyte sedimentation rate (ESR) was a common nding. Deranged coagulation prole was seen due to secondary anti-phospholipid antibody (APLA) syndrome, hemolysis and sepsis on anticoagulant. Bone marrow studies showed varied ndings including hypocellularity, dyspoiesis in the erythroid, myeloid and megakaryocytic series and abnormal localisation of immature precursors (ALIP) aggregates. Conclusion: This study was conducted to estimate the proportion of patients with hematological abnormalities as the manifestation of SLE and to study the nature of hematological problems, so that the empirical treatment can be started.

PHSOR09 Presentation Time: 1:10 PM: Establishing a Cs-131 Intraoperative Mesh Brachytherapy Program: Physics Perspective

<h3>Purpose</h3> Cs-131 has shown promise for the treatment of many cancers with its shorter half-life and more intense energy deposition compared to I-125. Cs-131 mesh has seeds embedded within a vicryl mesh, which keeps the seeds in place for about 30-35 days. Mesh applications have been limited to a few premier institutions. We present our process for the Intraoperative mesh brachytherapy program as a foundation for other new users to build upon. <h3>Methods and Materials</h3> A patient was selected after multidisciplinary tumor board discussion. Radiation Oncologist (RO) provided a written directive with the treatment site and prescription dose (60 Gy). TPS commissioning was carried out for Cs-131 (Cs-1, rev 2, IsoRay Medical Inc., Richland WA) utilizing half-life, source geometry, active source dimensions, dose rate constant, radial dose function, anisotropy function, air-kerma to activity conversion factor, etc. per TG43U1. Treatment planning CT with 1 mm slices was acquired. Target volume and nearby OARs were contoured. Pre-treatment plan was created in Varian Brachytherapy TPS v.15.6. Hand calculations and RadCalc were used to independently verify the TPS dose calculation. Planning CT was reconstructed with 1 cm slice thickness to match the mesh seed spacing. Seeds were modeled as line sources and placed within the target volume while modifying seed strength to achieve target coverage with the prescribed dose while sparing OARs. RO approved pre-plan. Mesh with optimal seed strength and number was ordered. 10% extra loose seeds plus 1 calibrated seed (same activity as determined per pre-plan) were ordered for strength verification. The mesh is received in sterile packaging. After a wipe test of the mesh container to ensure no radiation contamination, source strength for the loose seeds were verified using a well chamber (IVB1000 HO32871) calibrated for Cs-131.Vendor provided radiographs confirmed total seed number. A second independent physicist verified seed strength. Radiation safety training was completed with all personnel involved with the procedure. On implant day, MP and RO were both present. Mesh was taken to the OR after confirming the need for IORT per pathology. MP surveyed radiation levels throughout the procedure. RO and surgeon determined the mesh size to be implanted based on the at risk area. Once the implant was complete, the MP surveyed the OR room and accounted for total seed count. Numbers were verified by residual mesh radiography. Unused seeds were inventoried and stored in a lead container in the hot lab for decay. Post implant, radiation levels at 1 m were monitored periodically by the MP during the patient's hospital stay. Safety information was delivered to patient specific personnel by daily rounds, patient alerts and written instructions placed in the patient chart. MP provided verbal and written radiation safety recommendations to the patient and family members prior to discharge. A postoperative CT scan was acquired within 24 hours of the implant to review final implant dosimetry. <h3>Results</h3> The seed strength required per the pre-plan was 3.0 U. All loose seed strengths were within 2.3% of the vendor specified value. Post implant plan confirmed target coverage. Follow-up images acquired at 2 months confirmed nonsignificant seed migration. The exposure reading at 1 m from the patient was 1.0 mR/h immediately following the implant, and 0.5 mR/h at the day of discharge. The ring and collar badge readings for those directly handling the seed mesh were under regulatory limits. <h3>Conclusions</h3> An intraoperative mesh brachytherapy program has been safely established within our institution with the first patient successfully treated using the process described here.