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  1. Establishing Partnerships and Developing Relevant Virtual Curriculum to Augment Contouring Education in Southeast Asia
    Warren B, Henson L, Thomas H, Baclay JR, Flores J, Tangco ED, et al.
    Int J Radiat Oncol Biol Phys, 2021 Nov 01;111(3S):e185.
    PMID: 34700867 DOI: 10.1016/j.ijrobp.2021.07.685
    PURPOSE/OBJECTIVE(S): While rapid innovations in radiation treatment improve tumor controls and minimize toxicity, there is a dearth of quality training in resource-limited settings globally to ensure all radiation oncologists keep pace with the latest advances. We aim to create a learning platform shared by centers in Southeast Asia and to deliver quality training to participants with a curated virtual curriculum. To produce a comprehensive curriculum for countries enrolling in a non-profit organization training program, a needs assessment was conducted for registered participants.

    MATERIALS/METHODS: Participants interested in a 12-week virtual training program completed a needs assessment survey via a data collection web application. The survey included demographics, practice characteristics, and interests in contouring and plan evaluation education and training. Herein we provide descriptive statistics of the reports from participant surveys.

    RESULTS: Across Thailand, Myanmar, Malaysia, Indonesia, and Nepal, 116 participants (82 attendings, 33 residents, 1 other) responded from 23 participating medical institutions (20 public, 3 private). The average number of radiation oncologists per medical institution was 6.81 (range 1-30) and radiation oncology residents was 17.50 (range 2-56). In the 7 centers with residency programs, 0 (0%) indicated that residents were solely involved in contouring, 5 (71.4%) that residents were jointly involved in contouring with attendings, and 2 (28.6%) that attendings contour without residents. Commonly cited obstacles to providing radiotherapy included: patient financial barriers (61.4%), inadequate training (51.8%), too many patients (48.2%), lack of modern equipment (40.4%), shortage of staff (39.5%), and malfunctioning equipment (36.8%). The most common, top-rated obstacle was inadequate training (24.8%). The most seen disease sites were head and neck (38.2%) and breast (30.3%). Respondent time spent contouring the target was greatest for head and neck, pediatric, and lymphoma disease sites with 66 (56.9%), 59 (50.8%), and 46 (29.3%) indicating more than 1 hour, respectively. Respondent time spent contouring the normal tissues was greatest for head and neck, pediatric, and CNS disease sites with 51 (44%), 46 (39.7%), and 30 (26.1%) indicating more than 1 hour. For head and neck cases, 34 (29.3%) respondents typically contour 6-10 Organs at Risk (OARs), 47 (40.5%) contour 11-15 OARs, 18 (15.5%) contour 16-20 OARs, and 15 (12.9%) contour > 20 OARs. 85 (76.3%) respondents believe their practice would most benefit from head and neck contouring education, while 114 (98.3%) were interested in receiving contouring and plan evaluation training.

    CONCLUSION: The biggest physician-reported obstacle to providing radiotherapy in Southeast Asian practices is inadequate training. There is both high need and interest for well-developed virtual training, particularly in head and neck contouring, which currently appears time-intensive and heterogeneous among practices.

  2. Fulltext Multi-proxy evidence for sea level fall at the onset of the Eocene-Oligocene transition
    De Lira Mota MA, Dunkley Jones T, Sulaiman N, Edgar KM, Yamaguchi T, Leng MJ, et al.
    Nat Commun, 2023 Aug 08;14(1):4748.
    PMID: 37553323 DOI: 10.1038/s41467-023-39806-6
    Continental-scale expansion of the East Antarctic Ice Sheet during the Eocene-Oligocene Transition (EOT) is one of the largest non-linear events in Earth's climate history. Declining atmospheric carbon dioxide concentrations and orbital variability triggered glacial expansion and strong feedbacks in the climate system. Prominent among these feedbacks was the repartitioning of biogeochemical cycles between the continental shelves and the deep ocean with falling sea level. Here we present multiple proxies from a shallow shelf location that identify a marked regression and an elevated flux of continental-derived organic matter at the earliest stage of the EOT, a time of deep ocean carbonate dissolution and the extinction of oligotrophic phytoplankton groups. We link these observations using an Earth System model, whereby this first regression delivers a pulse of organic carbon to the oceans that could drive the observed patterns of deep ocean dissolution and acts as a transient negative feedback to climate cooling.
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