Prior Plans Research Articles

A probabilistic evaluation of the Dutch robustness and model-based selection protocols for Head-and-Neck IMPT: A multi-institutional study

Background and purposeIn the Netherlands, 2 protocols have been standardized for PT among the 3 proton centers: a robustness evaluation (RE) to ensure adequate CTV dose and a model-based selection (MBS) approach for IMPT patient-selection. This multi-institutional study investigates (i) inter-patient and inter-center variation of target dose from the RE protocol and (ii) the robustness of the MBS protocol against treatment errors for a cohort of head-and-neck cancer (HNC) patients treated in the 3 Dutch proton centers. Materials and methodsClinical treatment plans of 100 HNC patients were evaluated. Polynomial Chaos Expansion (PCE) was used to perform a comprehensive robustness evaluation per plan, enabling the probabilistic evaluation of 100,000 complete fractionated treatments. PCE allowed to derive scenario distributions of clinically relevant dosimetric parameters to assess CTV dose (D99.8%/D0.2%, based on a prior photon plan calibration) and tumour control probabilities (TCP) as well as the evaluation of the dose to OARs and normal tissue complication probabilities (NTCP) per center. ResultsFor the CTV70.00, doses from the RE protocol were consistent with the clinical plan evaluation metrics used in the 3 centers. For the CTV54.25, D99.8% were consistent with the clinical plan evaluation metrics at center 1 and 2 while, for center 3, a reduction of 1 GyRBE was found on average. This difference did not impact modelled TCP at center 3. Differences between expected and nominal NTCP were below 0.3 percentage point for most patients. ConclusionThe standardization of the RE and MBS protocol lead to comparable results in terms of TCP and the NTCPs. Still, significant inter-patient and inter-center variation in dosimetric parameters remained due to clinical practice differences at each institution. The MBS approach is a robust protocol to qualify patients for PT.

BIPOC students' paths to genetic counseling: Results from a longitudinal qualitative study.

Despite diversity initiatives, the genetic counseling profession continues to exhibit limited racial and ethnic diversity, with relatively stagnant representation of Black, Indigenous, and People of Color (BIPOC) individuals. Prior research has found that BIPOC high school and college students are less likely to be aware of genetic counseling and learn about it later than their white peers. Financial barriers and familial discouragement based on a preference for medical school may disproportionately impact BIPOC applicants. Here, we report the first set of results from a longitudinal constructivist grounded theory study exploring the training experiences of BIPOC genetic counseling students. Through reflexive thematic analysis of semi-structured interviews conducted with 26 first-year BIPOC genetic counseling students, we identified five themes pertaining to participants' paths to enrolling in a genetic counseling program: (1) Deciding to pursue genetic counseling, (2) Family's reaction to genetic counseling, (3) Deciding where to submit applications, (4) Barriers during admissions, and (5) Ranking programs. Participants discovered genetic counseling later in their academic journey, often necessitating gap years to complete admissions requirements. Limited guidance from advisors was commonly cited as a barrier by first-generation college students. Family support seems to be a key factor in participants' successful pursuit of genetic counseling, but participants described challenges explaining the career, particularly to parents who did not speak English. In addition, some participants encountered resistance about changing prior plans to go to medical school. Finally, while participants prioritized cost and location in their initial decision about where to submit applications, their ranking of programs was heavily influenced by experiences during interviews, where they favored conversational interviews and evaluated if they would "fit in" at the program. These findings underscore the need for proactive measures, such as early exposure initiatives, mentorship programs, and resources to facilitate family support, to promote diversity in genetic counseling.

Understanding Experiences of Caregivers of Spouses With Dementia During Caregiver Health Care Emergencies.

Caregivers of persons with dementia are frequently spouses. Caregiver hospitalization causes disruption to caregiving. The goal of this research was to understand the preparedness and stress trajectory of peri-caregiver hospitalization. Mixed methods were used. Caregivers of spouses with dementia (n = 1,000) were surveyed to determine their perceived preparedness for their own hospitalization. Journey mapping interviews (n = 18) were used to map caregivers' experiences during 5 phases: (a) their spouse with dementia (SWD)'s dementia diagnosis; (b) their SWD's dementia progression; (c) their own health event; (d) their own hospitalization; and (e) their own return home from the hospital. Among the 452 (45%) eligible caregiver survey respondents, 75 (17%) had experienced hospitalization in the previous 12 months and 51 (68%) hospitalizations were unexpected. Twenty-three (31%) of hospitalized caregivers indicated they did not have prior plans in place for the care of the SWD. When asked about an unexpected hospitalization in the future, 233 (52%) felt somewhat prepared and 133 (29%) felt not at all prepared. Journey mapping revealed 3 groups of caregivers: Group 1 (n = 7) rated their stress lower during their hospitalization, Group 2 (n = 7) rated their stress highest during their hospitalization, and Group 3 (n = 4) were at a sustained high-stress level. Many caregivers are not prepared for their own hospitalization. The stress trajectory through important phases of dementia caregiving and a caregiver's own hospitalization is not universal. Meeting the needs of caregivers' peri-hospitalization should be tailored to the individual caregiver.

Online antecedents for young consumers’ impulse buying behavior

Acting on a sudden urge to purchase something without a prior intention or plan to do so and without considering its long-term effects is regarded as impulse buying behavior. The convenience and automatization of online and mobile shopping have made impulsive purchases increasingly easier. In addition, targeted online advertisements, and presence of brands on social media networks may tempt consumers to make hasty purchase decisions. Thus, there is a call for more research on how consumer-related factors and digital environment facilitate impulsive purchases. Based on a survey of 2318 respondents from 18- to 29-year-olds in Finland, we examined young adults’ impulse buying behavior from the perspective of self-control and persuasion in online environments. The findings suggest that low self-control not only directly enables impulsive purchasing, but also does so by fostering positive attitude toward targeted advertisements and the impulsiveness within social networks. Furthermore, a positive disposition towards targeted advertisements renders consumers more susceptible to the impulsiveness of social networks, encompassing the impact of recommendations and product displays on social media. Finally, we offer guidance on how the teaching of self-control and online media literacy can strengthen the resistance to persuasion in online environments and decrease the tendency to engage in impulse buying behavior.

Energy transition paradox: Solar and wind growth can hinder decarbonization

The decarbonization of energy systems requires the deployment of intermittent renewables (wind and solar) with increasingly low costs. The growth of these renewables impacts power prices, which may influence hydropower investments and the adoption of fossil-fuel options for baseload electricity. It thus remains unclear whether deploying more intermittent renewables would reduce the net carbon emissions across energy systems in the absence of well-designed policy. This study first developed a techno-economic optimization model to explore the impacts of future projections of intermittent renewables on long-run electricity prices and the subsequent hydropower investments, using Hubei Province of China as a case study. The carbon emissions associated with the change in hydropower investment were then quantified. Results indicate that the new policy-driven renewables deployment reduces the electricity prices by 36 % on average over 2021–2100, compared to the case with the policy specified in the prior (13th) National Five-Year Plan. Without intervention, the lower electricity price could result in a 42 % reduction in hydropower investments by 2050. With increased intermittent renewables and decreased investments in hydropower, the energy system is expected to deploy more backup fossil-fuel options, which could increase carbon emissions by 45 %. Therefore, deploying more renewable energy would depress the investments in hydropower plants and further hinder decarbonization unexpectedly, suggesting a possible paradox in the energy transition. This possible paradox calls for a new, and robust policy to ensure the benefits of decarbonization are realized regardless of potential changes electricity prices.

Planning and interaction: Teachers’ views on pre-primary read-alouds

Read-alouds are recurrent in early childhood education and care settings and there is an abundance of scholarly advice regarding the planning and implementation of these sessions. However, most studies concern read-alouds with younger children and there is little knowledge regarding read-alouds during the pre-primary year for Finnish six-year-olds. The present study therefore investigated teachers’ self-reported ways of organising and arguing for their ways of implementing read-alouds in Finnish pre-primary settings. The study focused on what teachers reported paying attention to when planning read-alouds and how they viewed interaction during the read-alouds. Data were collected through a questionnaire completed by 47 teachers and through group interviews with nine teachers. A qualitative content analysis showed that teachers mentioned paying attention to children’s needs, interests, prerequisites and the characteristics of the books in connection to planning. They also described practices that indicated that it is common for them not to be acquainted with the books beforehand or not to have a prior plan. According to the teachers, interaction during read-alouds is common and important. At the same time, some of them expressed that they felt expected to use read-alouds as tools for supporting children’s school readiness by calling for silence during the read-alouds.

원격대학 군인 성인학습자의 ‘유연한 온라인수업(On-Flex Teaching)’ 환경에서 학생참여 및 학업성취 분석

In this study, we designed a flexible online teaching environment (On-Flex Teaching) that allows military adult learners, who have greater difficulties in securing study time regularly than ordinary office workers, to participate in their studies on their own initiative. Their academic participation and academic performance were analyzed through analysis of variance and mediation model analysis. As a result of the analysis, in a flexible online learning environment, the group that implemented the pre-study plan performed more learning activities such as downloading lesson plans, answering class questions, and self-evaluation and had higher academic achievement scores than the group that did not follow the plan. Students who performed flexible, self-directed learning activities by flexibly changing the exam time to suit their own circumstances showed higher academic achievement scores through downloading lesson plans and self-evaluation than the group that followed a prior evaluation plan. In addition, as a result of analyzing the mediation model to determine whether the level of self-directed student participation influences the relationship between the degree of implementation of prior study plans and academic achievement, the results showed that establishing study plans increased self-evaluation scores (p<.001) and downloading lesson plans by increasing the number (p<.05), it was found to have a statistically significant positive effect on the total score. Through these results, this study shows that a self-directed, flexible online teaching environment that enables self-directed learning for military adult learners increases students' class participation behavior, As a result, the significance can be found in the fact that major factors that have a positive impact on academic achievement were identified.

Analysis of Noise Level Due to Heavy Vehicle Traffics in the Area of Cement Plant

Industrial areas which is built in remote village attracts peoples to live nearby and spontaneously develop clusters of settlements. As now prior plan for the new settlements, houses are built on roadsides in close distance, ignoring possible dangers of not enough end new The Poros Tonasa 2 road section is one of the primary collector roads that connect the PT Semen Tonasa (PT-ST) -the main cement manufacturing plant in the Eastern Indonesia region - and the Maros-Makassar junction (the main national road in the province). The main noise problem in the environment is caused by heavy vehicles belongs to PT-ST, which occupies 715 hectares of land in Biringere village, Bungoro district, Pangkep regency, about 68 kilometers from province capital, Makassar City. This research should determine the noise level due to heavy vehicles on the Poros Tonasa 2 road of PT-ST area road to Biringkassi port. The method used in this study is by using a Sound Level Meter (SLM). From the research results, it was found that the noise level coming from the sound of heavy vehicles on the road of Poros Tonasa 2 was equal to 85.42 dB(A), the Bungoro Intersection is 81.10 dB(A) and Pahlawan Laut road to Biringkassi port is 82.4 dB(A). The noises in the PT-ST area exceeds the noise threshold stipulated in the Minister of Environment decree No: KEP-48/MENLH/11/1996. The highest noise level at 85.42 dB(A) exceeds the permissible standard of 70 dB(A), which is 18% higher than the standard. This noise level is categorized as high noise which may jeopardize human's health that live in the surrounding environment of the cement plant area.

Repetition parallels in language and motor action: Evidence from tongue twisters and finger fumblers.

We investigated similarities in language and motor action plans by comparing errors in parallel speech and manual tasks. For the language domain, we adopted the "tongue twister" paradigm, while for the action domain, we developed an analogous key-pressing task, "finger fumblers." Our results show that both language and action plans benefit from reusing segments of prior plans: when onsets were repeated between adjacent units in a sequence, the error rates decreased. Our results also suggest that this facilitation is most effective when the planning scope is limited, that is, when participants plan ahead only to the next immediate units in the sequence. Alternatively, when the planning scope covers a wider range of the sequence, we observe more interference from the global structure of the sequence that requires changing the order of repeated units. We point to several factors that might affect this balance between facilitation and interference in plan reuse, for both language and action planning. Our findings support similar domain-general planning principles guiding both language production and motor action. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Universal Design for Learning and Direct Instruction in a Special Education Practicum

The Instructional Planning Project (IPP) assignment is set in an online practicum course for graduate students in a high incidence special education teacher preparation program. The IPP assignment is the culminating assignment in a sixteen-week long course. The course provides students with a lesson plan template, for a reading or math lesson, that integrates direct instruction and Universal Design for Learning. The template is used for the major IPP assignment as well as for prior lesson plan assignments. Detailed instructions and a rubric are provided on Canvas, the learning management system, for the IPP assignment, where practicum students infuse Universal Design for Learning principles into a direct instruction lesson.

Scorecards: Quantifying Dosimetric Plan Quality in Pancreatic Ductal Adenocarcinoma Stereotactic Body Radiation Therapy

A scoring mechanism called the scorecard that objectively quantifies the dosimetric plan quality of pancreas stereotactic body radiation therapy treatment plans is introduced. A retrospective analysis of patients with pancreatic ductal adenocarcinoma receiving stereotactic body radiation therapy at our institution between November 2019 and November 2020 was performed. Ten patients were identified. All patients were treated to 36 Gy in 5 fractions, and organs at risk (OARs) were constrained based on Alliance A021501. The scorecard awarded points for OAR doses lower than those cited in Alliance A021501. A team of 3 treatment planners and 2 radiation oncologists, including a physician resident without plan optimization experience, discussed the relative importance of the goals of the treatment plan and added additional metrics for OARs and plan quality indexes to create a more rigorous scoring mechanism. The scorecard for this study consisted of 42 metrics, each with a unique piecewise linear scoring function which is summed to calculate the total score (maximum possible score of 365). The scorecard-guided plan, the planning and optimization for which were done exclusively by the physician resident with no prior plan optimization experience, was compared with the clinical plan, the planning and optimization for which were done by expert dosimetrists, using the Sign test. Scorecard-guided plans had, on average, higher total scores than those clinically delivered for each patient, averaging 280.1 for plans clinically delivered and 311.7 for plans made using the scorecard (P=.003). Additionally, for most metrics, the average score of each metric across all 10 patients was higher for scorecard-guided plans than for clinically delivered plans. The scorecard guided the planner toward higher coverage, conformality, and OAR sparing. A scorecard tool can help clarify the goals of a treatment plan and provide an objective method for comparing the results of different plans. Our study suggests that a completely novice treatment planner can use a scorecard to create treatment plans with enhanced coverage, conformality, and improved OAR sparing, which may have significant effects on both tumor control and toxicity. These tools, including the scorecard used in this study, have been made freely available.

Cortically Evoked Movement in Humans Reflects History of Prior Executions, Not Plan for Upcoming Movement.

Human motor behavior involves planning and execution of actions, some more frequently. Manipulating probability distribution of a movement through intensive direction-specific repetition causes physiological bias toward that direction, which can be cortically evoked by transcranial magnetic stimulation (TMS). However, because evoked movement has not been used to distinguish movement execution and plan histories to date, it is unclear whether the bias is because of frequently executed movements or recent planning of movement. Here, in a cohort of 40 participants (22 female), we separately manipulate the recent history of movement plans and execution and probe the resulting effects on physiological biases using TMS and on the default plan for goal-directed actions using a timed-response task. Baseline physiological biases shared similar low-level kinematic properties (direction) to a default plan for upcoming movement. However, manipulation of recent execution history via repetitions toward a specific direction significantly affected physiological biases, but not plan-based goal-directed movement. To further determine whether physiological biases reflect ongoing motor planning, we biased plan history by increasing the likelihood of a specific target location and found a significant effect on the default plan for goal-directed movements. However, TMS-evoked movement during preparation did not become biased toward the most frequent plan. This suggests that physiological biases may either provide a readout of the default state of primary motor cortex population activity in the movement-related space, but not ongoing neural activation in the planning-related space, or that practice induces sensitization of neurons involved in the practiced movement, calling into question the relevance of cortically evoked physiological biases to voluntary movements.SIGNIFICANCE STATEMENT Human motor performance depends not only on ability to make movements relevant to the environment/body's current state, but also on recent action history. One emerging approach to study recent movement history effects on the brain is via physiological biases in cortically-evoked involuntary movements. However, because prior movement execution and plan histories were indistinguishable to date, to what extent physiological biases are due to pure execution-dependent history, or to prior planning of the most probable action, remains unclear. Here, we show that physiological biases are profoundly affected by recent movement execution history, but not ongoing movement planning. Evoked movement, therefore, provides a readout of the default state within the movement space, but not of ongoing activation related to voluntary movement planning.

Japan’s greenhouse gas reduction scenarios toward net zero by 2050 in the material cycles and waste management sector

The first draft scenario toward net zero greenhouse gas (GHG) emissions by 2050 for the material cycles and waste management sector was presented by the Ministry of the Environment, Japan in August 2021. The details of the future GHG emission estimation used to create the draft scenario are described in this document. For multiple scenarios where more aggressive measures, such as carbon capture, utilization, and storage (CCUS), were included in addition to business-as-usual and the current policy continuity scenario, future GHG emissions were estimated as the sum of the products of activities and emission factors indicating changes in measures between scenarios. The estimation outcomes demonstrated that future GHG emissions from the solid waste management sector could be anticipated to be zero or even negative when material conversion to biomass, primarily for plastics, recycling to raw materials, and installation of CCUS at incineration facilities are assumed. Extensions of prior plans are not enough to reach the goal of net zero emissions, according to the measures necessary and the volume and pace of their implementation suggested in this study. Stakeholders should collaborate with great ambition.

Cueing in Theatre: Timing and Temporal Variance in Rehearsals of Scene Transitions

This video-ethnographic study explores how professional actors and a director at the end of a theatrical rehearsal process coordinate transitions between rehearsed scenes. This is done through the development and use of cues, that is, ‘signals for action’. The aim is to understand how cues are developed and how timing in transitions is achieved by using the designed cues. Work on three different scene transitions is analysed using multimodal Conversation Analysis. The results show that cueing is a central tool for developing well-timed transitions, and how cues serve different purposes in the developing performance. There is no prior plan for how to achieve timely transitions. In all the analysed examples, it is an actor who must produce or act on the given cue who insists on its precise definition, followed by a negotiation on candidate cues, confirmation and specifying the cue. It is also actors who are primarily responsible for the timing of transitions, and the timing is solved through an interplay of clear-cut and embodied actions that allow for temporal variance. Cues are reflexively linked to actors’ observation and interpretation of other actors’ actions, which prevents a mechanical determination of timing in scene transition.

Maintenance Automation: Methods for Robotics Manipulation Planning and Execution

Automating complex tasks using robotic systems requires skills for planning, control and execution. This paper proposes a complete robotic system for maintenance automation, which can automate disassembly and assembly operations under environmental uncertainties (e.g. deviations between prior plan information). The cognition of the robotic system is based on a planning approach (using CAD and RGBD data) and includes a method to interpret a symbolic plan and transform it to a set of executable robot instructions. The complete system is experimentally evaluated using real-world applications. This work shows the first step to transfer these theoretical results into a practical robotic solution. Note to Practitioners—This paper is inspired by the actual deficit to automate maintenance tasks in manufacturing environments through robotic systems. The focus of this work is on providing a practical robotic solution which can automate maintenance tasks completely autonomously. For this, the different skills from manipulation planning to the control and execution are explained. One main aspect of this work is to show how to create elementary robot motion tasks from symbolic plans. The second important part is to explain the practical capabilities applied on real-world applications.

Management of Change and its Impact on Productivity: A Case in Point

Today change has turned out to be an essential element of everyone’s lives and for business existence as well. Most of the organizations with the necessity of change in their day-to-day operations have different ideas on change. The main focus of the paper is to understand the effect of change and its management in the achievement of business goals. Moreover, the study aims to throw light on the prime concepts & various applications of change management with the help of the various change models on employee’s productivity. The effort to bring about change may face retaliations so businesses should incorporate means to curtail the resistance level and promote an even shift of change. Top level management have huge role to play in executing the change and they serve as a role model to successfully handle the change. With respect to implement an unbeaten change initiative, management and businesses must make sure that any prior plan for change must be associated with the company’s objectives as witnessed by many literatures in this current study certifying the relationship between change, change management and the accomplishment of corporate objectives. This present paper has been designed to analyze and to assess the effect of change management on worker’s productivity and the adverse effect of resistance to change by examining the case study of Nokia. It also explores the range of models that the management could pertain to minimize resistance towards change. In the present case study of Nokia McKinsey’s 7s framework model fits well.

Deep learning-based prediction of deliverable adaptive plans for MR-guided adaptive radiotherapy: A feasibility study.

Fast and automated plan generation is desirable in radiation therapy (RT), in particular, for MR-guided online adaptive RT (MRgOART) or real-time (intrafractional) adaptive RT (MRgRART), to reduce replanning time. The purpose of this study is to investigate the feasibility of using deep learning to quickly predict deliverable adaptive plans based on a target dose distribution for MRgOART/MRgRART. A conditional generative adversarial network (cGAN) was trained to predict the MLC leaf sequence corresponding to a target dose distribution based on reference plan created prior to MRgOART using a 1.5T MR-Linac. The training dataset included 50 ground truth dose distributions and corresponding beam parameters (aperture shapes and weights) created during MRgOART for 10 pancreatic cancer patients (each with five fractions). The model input was the dose distribution from each individual beam and the output was the predicted corresponding field segments with specific shape and weight. Patient-based leave-one-out-cross-validation was employed and for each model trained, four (44 training beams) out of five fractionated plans of the left-out patient were set aside for testing purposes. We deliberately kept a single fractionated plan in the training dataset so that the model could learn to replan the patient based on a prior plan. The model performance was evaluated by calculating the gamma passing rate of the ground truth dose vs. the dose from the predicted adaptive plan and calculating max and mean dose metrics. The average gamma passing rate (95%, 3mm/3%) among 10 test cases was 88%. In general, we observed 95% of the prescription dose to PTV achieved with an average 7.6% increase of max and mean dose, respectively, to OARs for predicted replans. Complete adaptive plans were predicted in ≤20 s using a GTX 1660TI GPU. We have proposed and demonstrated a deep learning method to generate adaptive plans automatically and rapidly for MRgOART. With further developments using large datasets and the inclusion of patient contours, the method may be implemented to accelerate MRgOART process or even to facilitate MRgRART.

Meta Synthesis of Community Participation Model on Trans-Papua Road Development

The Trans Papua road infrastructure is not only for physical growth but also for social and economic improvement (social, cultural, and environmental relations). Trans Papua establishes a new economic development center that will boost the community's income but must also reduce social, cultural, and environmental issues. Increasing community and indigenous Papuan engagement reduces social disputes. Trans-development Papua raises environmental problems in addition to economic benefits. Environmental disputes are avoided by not disturbing Lorentz National Park, which has the most comprehensive biodiversity and environment in Asia and the Pacific. To achieve Indonesia's commitment to the Sustainable Development Goals, the policy model for future consequences must be examined (SDGs). This project intends to build a dispute resolution paradigm and cooperative implementation strategies for Trans Papua road development. It starts with bottom-up perception discussions, alternative possibilities, concept creation, and Trans Papua infrastructure execution plans. This initiative intends to maximize social-community capital to speed the building of functional and efficient infrastructure for the Papuan community. The predicted benefits help the government evaluate prior Trans Papua road construction plans and guide future decision-making to accelerate and reduce road conflicts. Doi: 10.28991/CEJ-2022-08-11-08 Full Text: PDF

A Prospective Evaluation of Individualized CONstraints for Radiation Therapy Planning in Prostate Cancer (ICON-P)

<h3>Purpose/Objective(s)</h3> Present planning practices for radiation therapy are based on generic dose-constraints for organs-at-risk (OAR) extrapolated from those defined in the QUANTEC guidance. We have developed a web-based dashboard to determine individualized dose constraints based on summary estimates of achieved doses in prior approved plans in prostate cancer. In this study, we prospectively evaluated the feasibility and improvements achieved in doses to OARs with this approach. <h3>Materials/Methods</h3> A set of 24 cases previously planned using generic constraints to a dose of 60 Gy in 20 fractions was de-identified and replanned using individualized constraints derived from summary statistics of a subset of cases with similar target, OAR and overlap volumes from a reference library of 94 approved plans on a web-based dashboard. From the similar case subset for each study patient, the 25th and 50th percentile of achieved V59 Gy, V56 Gy, V53 Gy, V47 Gy, V40 Gy for the rectum and bladder and V57 Gy for the planning target volume (PTV) were defined as the ideal and acceptable set of individualized dose-constraints. The goal was to assess the improvement in mean doses and the specified dose volumes. Planners were blinded to the prior achieved doses and penalties. Sample size estimation was based on an estimated 3 percentage point improvement in V53 Gy for rectum and bladder with a paired evaluation using Wilcoxon sign-rank test. Python v3.7 was used for creating the dashboard and statistical comparisons. <h3>Results</h3> The differences in reference and replanned cases using individualized dose constraints are charted in table 1. There was a numerically robust and statistically significant reduction of mean doses and percentage volumes of all the discrete dose points for both bladder and rectum, including a 4% and 6.8% reduction in the primary endpoint of V53 Gy. All the plans generated had a D95 of at least 95% for the PTV. <h3>Conclusion</h3> Treatment planning based on individualized dose constraints is feasible and leads to improvement at clinically important dose volumes in prostate cancer treatment planning.

한·일 자살형 무차별 살상범죄 사례연구

Since the 2000s, the so-called ‘don’t ask crime’, an indiscriminate murder against unspecified peoples, has been recognized as a serious social problem. In particular, social shock and ripple effect are great when the crime of “Don’t Ask” causes a large number of casualties. In this study, in order to achieve one’s purpose through suicide, the type of crime that kills a large amount of human life was defined as ‘suicide-type indiscriminate murder crime’, and the case of Korea and Japan was analyzed. As a result of the study, in the case of ‘suicide-type indiscriminate murder’, there were many cases of suicide attempts before committing the crime. the contents suggesting the crime and suicide were expressed on SNS and around. In addition, prior plans were made, such as selecting places that could cause massive casualties. In conclusion, suicide prevention and management of suicide prayers are necessary to prevent ‘suicide-type indiscriminate murder crimes’ that cause enormous casualties. In addition, it is necessary to monitor suicide and crime-related SNS, strengthen gun management, media reporting policy, pre-safety measures for crime-expected areas, and post-rescue system.