Medicine and Health Sciences Commons^™

Therapeutic Effect Of Recombinant Echinococcus Granulosus Antigen B Subunit 2 Protein On Sepsis In A Mouse Model, Ya-Yun Qian, Fei-Fei Huang, Si-Yu Chen, Wei-Xiao Zhang, Yin Wang, Peng-Fei Du, Gen Li, Wen-Bo Ding, Lei Qian, Bin Zhan, Liang Chu, Dong-Hui Jiang, Xiao-Di Yang, Rui Zhou

Faculty, Staff and Students Publications

BACKGROUND: Sepsis is a potentially fatal systemic inflammatory response syndrome (SIRS) that threatens millions of lives worldwide. Echinococcus granulosus antigen B (EgAgB) is a protein released by the larvae of the tapeworm. This protein has been shown to play an important role in modulating host immune response. In this study we expressed EgAgB as soluble recombinant protein in E. coli (rEgAgB) and explored its protective effect on sepsis.

METHODS: The sepsis model was established by cecal ligation and puncture (CLP) procedure in BALB/c mice. The therapeutic effect of rEgAgB on sepsis was performed by interperitoneally injecting 5 µg rEgAgB in …

Sample Multiplexing For Retinal Single-Cell Rna Sequencing, Justin Ma, Ting-Kuan Chu, Maria Polo-Prieto, Yong H Park, Yumei Li, Rui Chen, Graeme Mardon, Benjamin J Frankfort, Nicholas M Tran

Faculty, Staff and Students Publications

Rare cell populations can be challenging to characterize using microfluidic single-cell RNA sequencing (scRNA-seq) platforms. Typically, the population of interest must be enriched and pooled from multiple biological specimens for efficient collection. However, these practices preclude the resolution of sample origin together with phenotypic data and are problematic in experiments in which biological or technical variation is expected to be high (e.g., disease models, genetic perturbation screens, or human samples). One solution is sample multiplexing whereby each sample is tagged with a unique sequence barcode that is resolved bioinformatically. We have established a scRNA-seq sample multiplexing pipeline for mouse retinal …

Lung Tissue Multilayer Network Analysis Uncovers The Molecular Heterogeneity Of Chronic Obstructive Pulmonary Disease, Nuria Olvera, Jon Sánchez-Valle, Iker Núñez-Carpintero, Joselyn Rojas-Quintero, Guillaume Noell, Sandra Casas-Recasens, Alen Faiz, Philip Hansbro, Angela Guirao, Rosalba Lepore, Davide Cirillo, Alvar Agustí, Francesca Polverino, Alfonso Valencia, Rosa Faner

Faculty, Staff and Students Publications

Rationale: Chronic obstructive pulmonary disease (COPD) is a heterogeneous condition. Objectives: We hypothesized that the unbiased integration of different COPD lung omics using a novel multilayer approach might unravel mechanisms associated with clinical characteristics.

Methods: We profiled mRNA, microRNA and methylome in lung tissue samples from 135 former smokers with COPD. For each omic (layer), we built a patient network on the basis of molecular similarity. The three networks were used to build a multilayer network, and optimization of multiplex modularity was used to identify patient communities across the three distinct layers. Uncovered communities were related to clinical features.

Measurements …

Children In Psychiatric Crises, Elizabeth Mcgarvey, Gabriella Demeo, Jasmine Clark, Carrie Ribbing, Paige Hameister, Sally Hannafon

Nursing Research and EBP Day 2024

Mental illness in children is on the rise and more children are becoming psychiatric boarders while awaiting treatment. Many hospitals lack a separate area to board children in psychiatric crisis who can’t be discharged to home which means that children are housed in the same unit as adult psychiatric patients. This EBP project sought to identify best practices for children experiencing a mental health crisis, but a more thorough review of the literature as well as an evidence synthesis needs to be completed before practice recommendations can be identified.

Decreasing Workplace Violence In Ambulatory Care, Jeanene Case, Christine Cook, Nicole Gemme, Rebecca Hass, Taylor Mikiewicz, Lynn Paladino, Erin Parkinson, Maydelin Reve Padilla, Amanda Thongsirimonghoun, Carolyn Vojtush

Nursing Research and EBP Day 2024

Workplace violence is recognized as a significant public health issue. Staff in ambulatory settings are at high risk for experiencing violence from patients or clinic visitors. Exposure to workplace violence may put staff at risk for depression, chronic fatigue, or poor job satisfaction. Developing a safety plan that incorporates organizational policy, staff training, environmental changes and debriefing may help reduce the risk of workplace violence.

Centralized Triage: Working Together To Improve Patient Safety, Quality And Satisfaction - A Focus On Improving Average Speed To Answer, Maria Larner, Tammy Palamitia, Nora Closser, Heather Waske

Nursing Research and EBP Day 2024

The speed in which triage calls are answered affects patient access to care. After addressing workflows and barriers through huddles and team meetings, this quality improvement project adjusted staff schedules, partnered with Access Coordinators, and utilized the Genesys team to streamline calls and monitor call volume, quality and safety.

Results from these initiatives substantially reduced the average speed to answer for both inbound and outbound queues. The team will continue to monitor the data and capture trends in volume to ensure we sustain the gains.

Improving Incidence Of Hospital Acquired Pressure Injuries, Dena Chapman, Melissa Combs, Heather Lewis, Amanda Spamer, Gracie Young, Hope Van Duyne, Brandon Sproul, Sarah Stripp, Bethany Surline

Nursing Research and EBP Day 2024

Pressure injuries remain a huge concern in both the acute and long term care settings worldwide. It is estimated that nearly 2.5 million people are affected each year by a pressure injury. They contribute to higher costs for care, decrease patient’s quality of life and can increase morbidity and mortality.

This project implemented the use of rounding by both skin care champions and nurse residents for high risk patients, while leadership utilized huddles to reinforce appropriate interventions. Turning and positioning every two hours was endorsed as was daily bathing for patients at high risk for developing pressure injuries.

Family Presence During Resuscitation Efforts, Gabrielle Gavin, Marissa Pecora, Gabrielle Narvaez, Kalpana Rai, Matthew Mendolera, Leanne Coon, Bailey Oldham, Olivia Pino

Nursing Research and EBP Day 2024

Family presence during resuscitation enables family members to be present during the resuscitation efforts of a loved one. The focus of this process is to provide support to the patient and their family, while also providing transparency and trust in the medical process and personnel.

The purpose of this project was to identify the impact on family members of witnessing life saving measures on their loved one.

Roadmap To Address Nursing Recruitment And Retention In Ambulatory Care, Susan Madison, Tiffany Smith

Nursing Research and EBP Day 2024

As hospital stays shorten, ambulatory care must expand to meet the increased patient acuity and need for care. Ambulatory care is the entry point for care delivery and the initiator of disease management and wellness (Ulrich, 2019). The ambulatory care system of Rochester Regional Health includes 400 registered nurses, and 600 licensed practical nurses with a nursing turnover rate of 18.75%.

By leveraging technology and innovation in program development, ambulatory-specific programs have been implemented to target nursing staff recruitment and retention, resulting in a 4% decrease in ambulatory nurse turnover rates.

Nurses Busting Burnout: How Self Care Programs Support Nurse Well-Being, Lenard Fernandez, Marguerite Loughrey, Andrea Cooley, Ashley Dilimone, Mariah Luce, Gabriella Rindell

Nursing Research and EBP Day 2024

Nurses working in acute care suffer from high levels of stress, burnout and turnover. Our question: For acute care nurses, what is the effect of self-care program versus no program on moral resilience? A literature review was conducted and results showed that when education on group-based wellness practices was provided, there was increased job satisfaction, moral resilience, and problem solving ability. There were decreases in feelings of burnout, and improved work/life balance. Some studies demonstrated an increase in patient satisfaction. Within Rochester Regional Health, it may not be too difficult to implement group based programs and coaching services.

12-Hour Shifts: Heaven Or Hell?, Amy Bontrager, Mary Caprio, Lakysha Grant, Seth Kibler, Savanah Wirth, Sarah Reynolds

Nursing Research and EBP Day 2024

In many hospital settings, the 12-hour shift is the standard. While it may be better for continuity of patient care, many studies have looked at the effect it has on nurses as well as patient safety. This project identified themes in the literature and while it couldn’t see a precise path forward, flexible scheduling may be looming just over the horizon.

Nurse Navigation Supports Implementation Of Guideline Based Care, Michelle Ferguson, Uzma Iqbal, Alyssa Pino

Nursing Research and EBP Day 2024

The European Society of Cardiology has developed guidelines aimed at identifying and mitigating risk for cardio-oncology events in oncology patients. Cardiovascular risk factors, cancer type and therapeutic regimen present unique treatment considerations requiring individualized risk assessment. Use of a nurse navigator to initiate triage with pre-visit testing and to coordinate care with the provider ensures patients receive timely treatment.

State Of Science Literature Review: The Effect Nutrition Has On Wound Healing, Alicia M. Grandy

Nursing Research and EBP Day 2024

Objectives:

• State the steps necessary to conduct a comprehensive review of the literature
• Utilize available resources/tools when conducting a literature search

The Effect Of Interruptions In Surgical Counts, Jaidin Degraw, Brooke Gisel

Nursing Research and EBP Day 2024

Retained surgical items can lead to patient frustration and prolonged hospital stays. They remain the top reason for reoperation despite the tools that are used to maintain accurate counts. Minimizing disruptions and distractions in the operating room may be one way to assist circulating nurses in obtaining correct and consistent counts.

Flexible Work Schedules To Promote Leader Wellbeing Ambulatory Care Nursing Leadership, Elizabeth Carreira, Rebecca Hall, Rebecca Dellafave

Nursing Research and EBP Day 2024

Nursing leaders in ambulatory care may experience high levels of work-related stress and dissatisfaction with the number of hours they were working, and this dissatisfaction may result in higher turnover among nursing leadership.

The purpose of this evidence-based practice project was to develop a flexible scheduling option for nursing leaders practicing in ambulatory care at Rochester Regional Health to promote leader wellbeing and role satisfaction.

Results indicated that leadership satisfaction with their role and the amount of time spent working with nursing staff increased. Perceptions of work-life balance improved as did their interprofessional relationships. A decrease in the average number …

Morale Wednesday, Sadie Bonetti, Christen Ballard, Desiree Dixon, Casey Legros, Danielle Pickney, Meghan Camp, Alyson Harp, Jonathan Ferrer, Catie Wood, Melissa Combs, Heather Lewis, Dena Chapman

Nursing Research and EBP Day 2024

Many factors lead to low nurse satisfaction and poor morale. Some of the factors identified in the literature include organizational culture, burnout, staff shortages, and lack of leadership support. Nurses who are not satisfied at work may become less engaged and may be more likely to leave the organization

This project implemented manager rounding, break buddies, staff snack sharing and encouraged intentional recognition of peers.

Teaching Sbirt To Nurses In A Mental Health Setting For Improved Assessment And Management Of Patients With Substance Use Disorders, Kifle Gashie Jikamo

Walden Dissertations and Doctoral Studies

Addressing the knowledge gap is essential in nursing practice, as RNs are the first point of contact for patients in mental health settings where substance use significantly influences overall health and recovery. This Doctor of Nursing Practice project focused on the need for staff education in an inpatient mental health unit regarding the assessment and triage of patients with substance use disorders (SUDs). The guiding question for this project was: “In nurses working within an inpatient mental health setting, does the implementation of Screening, Brief Intervention, and Referral to Treatment (SBIRT) training improve knowledge in assessing, managing, and providing care …

Optimization Processes Of Clinical Chelation-Based Radiopharmaceuticals For Pathway-Directed Targeted Radionuclide Therapy In Oncology, Katsumi Tomiyoshi, Lydia J. Wilson, Firas Mourtada, Jennifer Sims Mourtada, Yuta Namiki, Wataru Kamata, David J. Yang, Tomio Inoue

Department of Radiation Oncology Faculty Papers

Targeted radionuclide therapy (TRT) for internal pathway-directed treatment is a game changer for precision medicine. TRT improves tumor control while minimizing damage to healthy tissue and extends the survival for patients with cancer. The application of theranostic-paired TRT along with cellular phenotype and genotype correlative analysis has the potential for malignant disease management. Chelation chemistry is essential for the development of theranostic-paired radiopharmaceuticals for TRT. Among image-guided TRT,

Impact Of Quality Of Care On Outcomes In Survivors Of Stroke With Aphasia: A Linked Registry And Hospital Data Observational Study, Tharshanah Thayabaranathan, Sarah J. Wallace, Joosup Kim, Monique F. Kilkenny, Muideen T. Olaiya, Nadine E. Andrew, Emily Brogan, Caroline Baker, Erin Godecke, David A. Copland, Miranda L. Rose, Mulugeta M. Birhanu, Dominique A. Cadilhac

Research outputs 2022 to 2026

Background: The impact of hospital care quality on patient outcomes in post-stroke aphasia remains unclear. We investigated the impact of nationally-endorsed acute stroke treatments on outcomes post-stroke, by aphasia status. Methods: Patient-level data from the Australian Stroke Clinical Registry (2009–2013) linked to national deaths, hospital emergency presentations and admissions data were used. Aphasia was identified for the index stroke event (ICD-10 diagnosis code R47.0). Impact of receiving an optimal stroke care bundle (stroke unit care, antihypertensive medication at discharge and discharge care plan) and an acute ischemic stroke (AIS) care bundle (stroke unit care, intravenous thrombolysis and aspirin within 48 …

The Impact Of Diabetes Mellitus On Hiv Virologic Control: Results Of The Macs/Wihs Combined Cohort Study, Sarah C Mann, Weiqun Tong, Alison G Abraham, Frank Palella, Anjali Sharma, Phyllis C Tien, Margaret A Fischl, Samy I Mcfarlane, Cecile D Lahiri, Susan Koletar, Daniel Merenstein, Michelle Floris-Moore, Jordan E Lake, Elizabeth Daubert, Aubri Hickman, Todd T Brown, Jose Castillo-Mancilla

Faculty, Staff and Student Publications

Objective: Diabetes mellitus (DM) is associated with lower antiretroviral (ART) drug exposure among persons with HIV (PWH) compared to PWH without DM. The association between DM and virologic control in PWH, however, remains unknown.

Methods: We included participants in the Multicenter AIDS Cohort Study/Women's Interagency HIV Study Combined Cohort Study (MWCCS) who had initiated ART between 1999 and 2020 and had a suppressed HIV viral load (≤200 copies/ml) within 1 year of ART initiation. We compared the frequency of incident HIV viremia (HIV-1 RNA >200 copies/ml) between adult PWH with and without DM. Poisson regression was used to examine the …

The Use Of Real-World Evidence To Generate Cost Analysis Of Antibiotic Susceptibility Testing (Ast) In Patients With Elicobacter Pylori Treatment Failure In Thailand: A Large Population-Based Study, Natsuda Aumpan, Pornpen Gamnarai, Arti Wongcha-Um, Muhammad Miftahussurur, Yoshio Yamaoka, Ratha-Korn Vilaichone

Faculty, Staff and Students Publications

BACKGROUND:H. pylori eradication is effective for gastric cancer prevention. Treatment failure is caused by increased antibiotic resistance. This study aimed to determine eradication rates and perform cost analysis between susceptibility-guided therapy and empirical treatment in patients with H. pylori treatment failure.

METHODS: This retrospective cohort study included patients with dyspepsia undergoing gastroscopy at tertiary care center in Thailand from March 2014 to October 2021. Treatment failure was defined as persistent H. pylori infection after ≥1 regimen completion. Early AST was defined as AST performed shortly after first-line treatment failure. Demographic data, AST results, eradication regimens, and medication costs were …

Isolation, Discrimination, And Feeling “Constant Guilt”: A Mixed-Methods Analysis Of Female Physicians’ Experience With Fertility, Family Planning, And Oncology Careers, Sarah Marion, Shraddha M Dalwadi, Aleksandra Kuczmarska-Haas, Erin F Gillespie, Michelle S Ludwig, Emma B Holliday, Bridgette Thom, Fumiko Chino, Anna Lee

Faculty, Staff and Students Publications

Introduction: Family planning among female physicians is harmed by high risks of infertility, workload burden, poor family leave policies, and gender discrimination. Many women report feeling unsupported in the workplace, despite national policies to protect against unfair treatment.

Methods: This secondary analysis applied a modified version of the rigorous and accelerated data reduction technique to conduct a thematic analysis of comments to an open-ended prompt. Comments were coded by multiple trained researchers then grouped and merged into illustrative themes via qualitative techniques.

Results: Of 1004 responses to the quantitative survey, 162 physicians completed the open-ended prompt. Initial codes (n = …

Alternatively Spliced Map4 Isoforms Have Key Roles In Maintaining Microtubule Organization And Skeletal Muscle Function, Lathan Lucas, Larissa Nitschke, Brandon Nguyen, James A Loehr, George G Rodney, Thomas A Cooper

Faculty, Staff and Students Publications

Skeletal muscle cells (myofibers) are elongated non-mitotic, multinucleated syncytia that have adapted a microtubule lattice. Microtubule-associated proteins (MAPs) play roles in regulating microtubule architecture. The most abundant MAP in skeletal muscle is MAP4. MAP4 consists of a ubiquitous MAP4 isoform (uMAP4), expressed in most tissues, and a striated-muscle-specific alternatively spliced isoform (mMAP4) that includes a 3,180-nucleotide exon (exon 8). To determine the role of mMAP4 in skeletal muscle, we generated mice that lack mMAP4 and express only uMAP4 due to genomic deletion of exon 8. We demonstrate that loss of mMAP4 leads to disorganized microtubule architecture and intrinsic loss of …

Going Against The Family: Perturbation Of A Greenbeard Pathway Leads To Falsebeard Cheating, Peter Lehmann, Mariko Katoh-Kurasawa, Peter Kundert, Gad Shaulsky

Faculty, Staff and Students Publications

Greenbeards facilitate cooperation by encoding a perceptible signal, the ability to detect it, and a tendency to help others that display it. Falsebeards are hypothetical cheaters that display the signal without being altruistic. Despite many examples of greenbeards, evidence for falsebeards is scarce. The Dictyostelium discoideum tgrB1-tgrC1 allorecognition pathway encodes a greenbeard. It allows development, which yields fruiting bodies with altruistic stalks that increase spore dispersal. Here we show that cells lacking rapgapB, a tgrB1-tgrC1 signaling element, cheat by avoiding the stalk fate and generating more spores in chimeras than in pure populations. rapgapB– cells cheat only on …

Association Of Clonal Hematopoiesis And Mosaic Chromosomal Alterations With Solid Malignancy Incidence And Mortality, Pinkal Desai, Ying Zhou, Justin Grenet, Samuel K Handelman, Cynthia M Crispino, Laura N Tarbay, Eric A Whitsel, Gail Roboz, Ana Barac, Michael Honigberg, Alexander Bick, Garnet Anderson, Jean Wactawski-Wende, Yasminka A Jakubek Swartzlander, Jason Bacon, Justin Wong, Xiaolong Ma, Paul Scheet, Zichan Li, Pashtoon Kasi, Ross Prentice, Paul Auer, Joann E Manson, Alexander Reiner, Michael Simon

Faculty, Staff and Student Publications

Background: Understanding the impact of clonal hematopoiesis of indeterminate potential (CHIP) and mosaic chromosomal alterations (mCAs) on solid tumor risk and mortality can shed light on novel cancer pathways.

Methods: The authors analyzed whole genome sequencing data from the Trans-Omics for Precision Medicine Women's Health Initiative study (n = 10,866). They investigated the presence of CHIP and mCA and their association with the development and mortality of breast, lung, and colorectal cancers.

Results: CHIP was associated with higher risk of breast (hazard ratio [HR], 1.30; 95% confidence interval [CI], 1.03-1.64; p = .02) but not colorectal (p = .77) or …

Disease Site Specialization In The Academic Radiation Oncology Workforce: Evidence Of Gender Differences, Kelsey L Corrigan, Mikaela E Bankston, Emma B Holliday, Simona F Shaitelman, Anna Lee, Chelain R Goodman, C David Fuller, Fumiko L Chino, Charles R Thomas, Reshma Jagsi, Ethan B Ludmir

Faculty, Staff and Student Publications

Purpose: Because some stakeholders within medicine seek to diversify and attain greater workforce equity, it is critical to understand gender-based divisions within specialization. Radiation oncology (RO) has one of the smallest proportions of women representation of all specialties, and to our knowledge, no prior studies have investigated gender differences in all the disease site specializations within RO. Thus, we analyzed the relationship between gender and disease site(s) treated in academic RO (ARO).

Methods and materials: Faculty gender and disease site(s) treated by faculty from ARO departments were collected via publicly available department websites in January 2020. X2 analyses were conducted …

Outcomes Of Patients With Acute Myeloid Leukemia And Bone Marrow Fibrosis, Samuel Urrutia, Hagop M Kantarjian, Farhad Ravandi-Kashani, Carlos Bueso-Ramos, Rashmi Kanagal-Shamanna, Elias Jabbour, Guillermo Montalban-Bravo, Nicholas J Short, Naval Daver, Gautam Borthakur, Courtney D Dinardo, Tapan M Kadia, Lucia Masarova, Prithviraj Bose, Naveen Pemmaraju, Guillermo Garcia-Manero, Koji Sasaki

Faculty, Staff and Student Publications

The outcomes of patients with acute myeloid leukemia (AML) and bone marrow fibrosis (MF) are not well defined. The study objectives were to evaluate the degrees of MF in AML, and corresponding response rates and outcomes. We performed a retrospective review of 2302 patients with AML. We annotated the clinical and molecular characteristics, response to therapy, and survival outcomes of patients with bone marrow fibrosis. Overall, 492 patients (21.4%) had a reported microscopic evaluation of MF: 344 (69.9%) had MF grade 0-1 and 148 (30.1%) had MF grade 2-3. Patients with MF 2-3 had a higher proportion of complex cytogenetics …

Low-Molecular Weight Cyclin E Confers A Vulnerability To Pkmyt1 Inhibition In Triple-Negative Breast Cancer, Mi Li, Amriti R Lulla, Yan Wang, Spyros Tsavaschidis, Fuchenchu Wang, Cansu Karakas, Tuyen D T Nguyen, Tuyen N Bui, Marc A Pina, Mei-Kuang Chen, Sofia Mastoraki, Asha S Multani, Natalie W Fowlkes, Aysegul Sahin, C Gary Marshall, Kelly K Hunt, Khandan Keyomarsi

Faculty, Staff and Student Publications

Cyclin E is a regulatory subunit of CDK2 that mediates S phase entry and progression. The cleavage of full-length cyclin E (FL-cycE) to low-molecular weight isoforms (LMW-E) dramatically alters substrate specificity, promoting G1-S cell cycle transition and accelerating mitotic exit. Approximately 70% of triple-negative breast cancers (TNBC) express LMW-E, which correlates with poor prognosis. PKMYT1 also plays an important role in mitosis by inhibiting CDK1 to block premature mitotic entry, suggesting it could be a therapeutic target in TNBC expressing LMW-E. In this study, analysis of tumor samples of patients with TNBC revealed that coexpression of LMW-E and PKMYT1-catalyzed CDK1 …

What Do Cancer Genetic Providers Want Us To Know About Variant Reclassification And Recontact That We Are Not Asking? A Thematic Analysis Of Open-Ended Survey Responses, Kerri Brown, Marisel Ponton, Elenita Davidson, Banu Arun, Robert J Volk, Sanjay Shete, Susan K Peterson, Sukh Makhnoon

Faculty, Staff and Student Publications

BACKGROUND: Accurate variant classification and relaying reclassified results to patients is critical for hereditary cancer care delivery. Over a 5- to 10-year period, 6%-15% of variants undergo reclassification. As the frequency of reclassifications increases, the issue of whether, how, when, and which providers should recontact patients becomes important but remains contentious.

METHODS: The authors used inductive thematic analysis to analyze open-ended comments offered by oncologists and genetic counselors (GCs) from a large national survey.

RESULTS: Of the 634 oncologists and cancer GCs, 126 (20%) offered substantive free-text comments. Four thematic areas emerged: 1) ambiguity over professional responsibility to recontact, 2) …

Personalized Composite Dosimetric Score-Based Machine Learning Model Of Severe Radiation-Induced Lymphopenia Among Patients With Esophageal Cancer, Yan Chu, Cong Zhu, Brian P Hobbs, Yiqing Chen, Peter S N Van Rossum, Clemens Grassberger, Degui Zhi, Steven H Lin, Radhe Mohan

Faculty, Staff and Student Publications

Purpose: Radiation-induced lymphopenia (RIL) is common among patients undergoing radiation therapy (RT)' Severe RIL has been linked to adverse outcomes. The severity and risk of RIL can be predicted from baseline clinical characteristics and dosimetric parameters. However, dosimetric parameters, e.g. dose-volume (DV) indices, are highly correlated with one another and are only weakly associated with RIL. Here we introduce the novel concept of "composite dosimetric score" (CDS) as the index that condenses the dose distribution in immune tissues of interest to study the dosimetric dependence of RIL. We derived an improved multivariate classification scheme for risk of grade 4 RIL …