• Title/Summary/Keyword: radiation management

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A Study on Environmental Standards of School Building (교사환경기준에 관한 연구)

  • Hong, Seok-Pyo;Park, Young-Soo
    • The Journal of Korean Society for School & Community Health Education
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    • v.1 no.1
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    • pp.11-43
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    • 2000
  • The purpose of this study was, through analyzing the previous researches, to grasp the present status of environment of school building(ESB), research the sundry records of each element and, through comparative analysis of the standard of ESB in Korea, the United States, and Japan, select the normative standard of ESB, to clarify the point at issue presented in Regulation of Construction & facility Management for Elementary and and Secondary School in Korea, and to suggest an alternative preliminary standard of ESB. To carry out a research for this purpose, these were required: 1. to investigate the existing present status of ESB, 2. to make a comparative analysis of the standard of ESB in each country, 3. to suggest the normative standard of preliminary standard of ESB, 4. to analyze the controversial points of the standard of ESB in Korea, 5. to suggest an alternative preliminary standard of ESB. The conclusions were as follows: 1. Putting, through analyzing the previous researches, the existing present status of ESB together, it seemed that lighting environment, indoor air environment and noise environment were all in poor conditions. 2. In the result of a comparative analysis of the standard of ESB in Korea, Japan and the United States, in Korea the factors of each lighting and indoor air environment were not presented properly, in Japan, in lighting environment aspect, the standard on natural lighting and the factors on brightness were not presented., and in the USA the essential factors of each environment were throughly presented. In the comparison of the standards on each factor, Korea showed that the standard level presented was less properly prescribed than those of the USA and Japan but it also showed that the standard levels prescribed in the USA and in Japan were mostly similar to the standard levels in records investigated. 3. With the result of the normative standard selection on School Builiding environment factor of prescribed in this study, the controversial points of the standard of ESB in Korea were analyzed and the result was utilized to suggest new preliminary standard of ESB. 4. As the result of the analysis of the controversial points of the standard of ESB in Korea, it was found that the standard of ESB in Korea should be established on a basis of School Health Act and be concretely presented in School Health Regulation and School Health Rule. The factors of each environment was improperly presented in the existing standard of ESB in Korea. Moreover the standard of them was inferior to that of the records investigated and those of in the USA and in Japan and it also showed that the standard of it in Korea was improper to maintain Comfortable Learning Environment. 5. A suggested preliminary standard of ESB acquired through above study as follows: 1) In this study a new kind of preliminary standard of ESB is divided into lighting environment, indoor air environment, noise environment, odor environment and for above classification, reasonable factor and standard should be established and the controling way on each standard and countermeasures against it should be considered. 2) In lighting environment, the factors of natural lighting are divided into daylight rate, brightness, glare. In the standard on each factor, daylight rate should secure 5% of a mean daylight rate and 2% of a minimum daylight rate, brightness ratio of maximum illumination to minimum illumination should be under 10:1, and in glare there should not be an occurrence factor from a reflector outside of the classroom. And the factors of unnatural lighting are illumination, brightness, and glare. In the standard on each factor, illumination should be 750 lux or more, brightness ratio should be under 3 to 1, and glare should not occur. And Optimal reflection rate(%) of Colors and Facilities of Classroom which influences lighting environment should be considered. 3) In indoor air environment factors, thermal factors are divided into (1) room temperature, (2) relative humidity, (3) room air movement, (4) radiation heat, and harmful gases (5) CO, (6) $CO_2$ that are proceeded from using the heating fuel such as oval briquettes, firewood, charcoal being used in most of the classroom, and finally (7) dust. In the standard on each factor, the next are necessary; room temperature: $16^{\circ}C{\sim}26^{\circ}C$(summer : $E.T18.9{\sim}23.8^{\circ}C$, winter: $E.T16.7{\sim}21.7^{\circ}C$), relative humidity: $30{\sim}80%$, room air movement: under 0.5m/sec, radiation heat: under $5^{\circ}C$ gap between dry-bulb temperature and wet-bulb temperature, below 1000 ppm of ca and below 10ppm of $CO_2$, dust: below 0.10 $mg/m^3$ of Volume of dust in indoor air, and ventilation standard($CO_2$) for purification of indoor air : once/6 min.(about 7 times/40 min.) in an airtight classroom. 4) In the standard on noise environment, noise level should be under 40 dB(A) and the noise measuring way and the countermeasures against it should be considered. 5) In the standard on odor environment, odor level under Physical Method should be under 2 degrees, and the inspecting way and the countermeasures against it should be considered.

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External Beam Radiotherapy in the Management of Low Grade Astrocytoma of the Brain (뇌 성상세포종 환자의 외부 방사선치료)

  • Chun, Ha-Chung
    • Radiation Oncology Journal
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    • v.27 no.1
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    • pp.23-28
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    • 2009
  • Purpose: This study was designed to evaluate the effectiveness of postoperative radiotherapy for patients with low-grade astrocytomas and to define an optimal radiotherapeutic regimen and prognostic factors. Materials and Methods: A total of 69 patients with low-grade astrocytomas underwent surgery and postoperative radiotherapy immediately following surgery at our institution between October 1989 and September 2006. The median patient age was 36 years. Forty-one patients were 40 years or younger and 28 patients were 41 years or older. Fourteen patients underwent a biopsy alone and the remaining 55 patients underwent a subtotal resection. Thirty-nine patients had a Karnofsky performance status of less than 80% and 30 patients had a Karnofsky performance status greater than 80%. Two patients were treated with whole brain irradiation followed by a coned down boost field to the localized area. The remaining 67 patients were treated with a localized field with an appropriate margin. Most of the patients received a dose of $50\sim55$ Gy and majority of the patients were treated with a dose of 54 Gy. Results: The overall 5-year and 7-year survival rates for all of the 69 patients were 49% and 44%, respectively. Corresponding disease free survival rates were 45% and 40%, respectively. Patients who underwent a subtotal resection showed better survival than patients who underwent a biopsy alone. The overall 5-year survival rates for patients who underwent a subtotal resection and patients who underwent a biopsy alone were 57% and 38%, respectively (p<0.05). Forty-one patients who were 40 years or younger showed a better overall 5-year survival rate as compared with 28 patients who were 41 years or older (56% versus 40%, p<0.05). The overall 5-year survival rates for 30 patients with a Karnofsky performance status greater than 80% and 39 patients with a Karnofsky performance status less than 80% were 51% and 47%, respectively. This finding was not statistically significant. Although one patient was not able to complete the treatment because of neurological deterioration, there were no significant treatment related toxicities. Conclusion: Postoperative radiotherapy following surgery is a safe and effective treatment for patients with low-grade astrocytomas. The extent of surgery and age were noted as significant prognostic factors in this study. However, further effective treatment might be necessary in the future to improve long-term survival rates.

Efficacy of Neoadjuvant Chemotherapy and Radiotherapy for the Histology-confirmed Intracranial Germinoma - Preliminary Report (조직학적으로 확진된 두개내 배아종의 전보조화학요법 후 방사선치료의 성적 - 예비적 결과)

  • Noh, Young-Ju;Kim, Hak-Jae;Heo, Dae-Seog;Shin, Hee-Yung;Kim, Il-Han
    • Radiation Oncology Journal
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    • v.20 no.2
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    • pp.93-99
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    • 2002
  • Purpose : We intended to decrease late CNS reaction after radical radiotherapy for an intracranial germinoma by using combined neoadjuvant chemotherapy and involved-field radiotherapy. The efficacy in terms of its acute toxicity and short-term relapse patterns was analyzed. Materials and Methods : Eighteen patients were treated with combined neoadjuvant chemotherapy and radiotherapy between 1995 and 2001. The chemotherapy regimen used was the Children's Cancer Group (CCG) 9921A (cisplatin, cyclophosphamide, VP-16, vincristine) for 5 patients younger than 16 years, BEP (bleomycin, VP-16, cisplatin) for 12 patients, and EP (VP-16, cisplatin) for 1 patient. The radiotherapy covered the whole craniospinal axis for 5 patients, the whole brain for 1, and the partial brain (involved field) for 12. the primary lesion received tumour doses between 3,960 and 5,400 cGy. Results : The male to female ratio was 16:2 and the median age was 16 years old. The tumors were located in the pineal gland in 12 patients, in the suprasellar region in 1, in the basal ganglia In 1, in the thalamus in 1. Three patients had multiple lesions and ventricular seedings were shown at MRI. In 3 patients, tumor cells were detected in the cerebrospinal fluid and MRI detected a spinal seeding in 2 patients. The response to neoadjuvant chemotherapy was complete remission in 5 patients, partial remission in 12, and no response in 1. However, after radiotherapy, all except 1 patient experienced complete remission. The toxicity during or after chemotherapy greater than or equal to grade III was remarkable; hematologic toxicity was observed in 11 patients, liver toxicity in none, kidney toxicity in none, and gastrointestinal toxicity in one. One patient suffered from bleomycin-induced pneumonitis. Radiotherapy was therefore stopped and the patient eventually died of respiratory failure. The other 17 are alive without any evidence of disease or relapse during an average of 20 months follow-up. Conclusion : A high response rate and disease control was experienced, which was the same as observed other studies and the morbidity from chemotherapy-induced toxicity was similar. With these results, the results from adjuvant chemotherapy and involved-field radiotherapy cannot be concluded to be equal to those from extended-field radiotherapy. The long term follow-up study on later complications are required in order to draw definite conclusions on the optimal management with minimum side effects.

The Evaluation of Meteorological Inputs retrieved from MODIS for Estimation of Gross Primary Productivity in the US Corn Belt Region (MODIS 위성 영상 기반의 일차생산성 알고리즘 입력 기상 자료의 신뢰도 평가: 미국 Corn Belt 지역을 중심으로)

  • Lee, Ji-Hye;Kang, Sin-Kyu;Jang, Keun-Chang;Ko, Jong-Han;Hong, Suk-Young
    • Korean Journal of Remote Sensing
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    • v.27 no.4
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    • pp.481-494
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    • 2011
  • Investigation of the $CO_2$ exchange between biosphere and atmosphere at regional, continental, and global scales can be directed to combining remote sensing with carbon cycle process to estimate vegetation productivity. NASA Earth Observing System (EOS) currently produces a regular global estimate of gross primary productivity (GPP) and annual net primary productivity (NPP) of the entire terrestrial earth surface at 1 km spatial resolution. While the MODIS GPP algorithm uses meteorological data provided by the NASA Data Assimilation Office (DAO), the sub-pixel heterogeneity or complex terrain are generally reflected due to coarse spatial resolutions of the DAO data (a resolution of $1{\circ}\;{\times}\;1.25{\circ}$). In this study, we estimated inputs retrieved from MODIS products of the AQUA and TERRA satellites with 5 km spatial resolution for the purpose of finer GPP and/or NPP determinations. The derivatives included temperature, VPD, and solar radiation. Seven AmeriFlux data located in the Corn Belt region were obtained to use for evaluation of the input data from MODIS. MODIS-derived air temperature values showed a good agreement with ground-based observations. The mean error (ME) and coefficient of correlation (R) ranged from $-0.9^{\circ}C$ to $+5.2^{\circ}C$ and from 0.83 to 0.98, respectively. VPD somewhat coarsely agreed with tower observations (ME = -183.8 Pa ~ +382.1 Pa; R = 0.51 ~ 0.92). While MODIS-derived shortwave radiation showed a good correlation with observations, it was slightly overestimated (ME = -0.4 MJ $day^{-1}$ ~ +7.9 MJ $day^{-1}$; R = 0.67 ~ 0.97). Our results indicate that the use of inputs derived MODIS atmosphere and land products can provide a useful tool for estimating crop GPP.

Growth Performances of Seedlings of Daphniphyllum macropodum in Naejang National Park for Container Seeding Production (시설양묘에 적용을 위한 내장산 굴거리 나무 군락내 치수의 생장 특성)

  • Chung, Jin-Chul;Jeong, Ji-Young;Choi, Jeong-Ho;Jeon, Kyung-Soo;Bae, Jong-Hyang
    • Journal of Bio-Environment Control
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    • v.20 no.4
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    • pp.365-372
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    • 2011
  • This study aimed to examine foundational data for container seedling production with the subject of Daphniphyllum macropodum community in Mt. Naejang National Park. To achieve the goal, it investigated the growth characteristics of young tree seedlings growing in places with different light intensity environment. Regarding the growth environment of Daphniphyllum macropodum community, it was typical heavy rain summer climate, and the soil was silt loam with the organic content as 11.42~15.61%, total nitrogen as 0.50~0.76%, cation exchangeable capacity (C.E.C) as 18.92~23.32 cmol/kg, and pH as 4.85~5.58. About light intensity environment changed by research plots, relative transmittance of solar radiation was 71~76% in plot A, 37~42% in plot B, 65~70% in plot C, and 28~33% in plot D. The seedlings tended to be intensively distributed either under the crown of their mother tree or in the slope site, and plot A and C where light intensity environment is relatively more favorable showed 1,550 tree/ha and 1,250 tree/ha. Total biomass production of Daphniphyllum macropodum seedlings was 5.37 g in plot A and 5.29 g in plot C, so they were higher than 4.42~4.51 g in plot B and D with relatively less favorable light intensity environment. The T/R ratio was 1~2, leaf area rate was $139.71{\sim}183.50cm^2{\cdot}g^{-1}$, leaf area ratio was $39.68{\sim}60.66cm^2{\cdot}g^{-1}$, and leaf dry weight ratio grew higher in the range of $0.28{\sim}0.33cm^2{\cdot}g^{-1}$ as the intensity of radiation became less. It is thought that in the generation and growth of Daphniphyllum macropodum seedlings, the intensity of light has more effects than the organic content in soil. And it is also thought that in the application of container seedlings production, light environment management over 65~70% to full sun light intensity will affect significantly the initial growth of Daphniphyllum macropodum.

Comparison of Single vs Combined Modality Treatment in Locally Advanced Non-Small Cell Lung Cancer (국소 진행된 비소세포 폐암에서 복합요법과 단일요법의 비교)

  • Kim, Ae-Kyoung;Jeong, Seong-Su;Shin, Kyoung-Sang;Park, Sang-Gee;Jo, Hai-Jeong;Lee, Jong-Jin;Seo, Jee-Won;Kim, Ju-Ock;Kim, Sun-Young
    • Tuberculosis and Respiratory Diseases
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    • v.42 no.4
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    • pp.502-512
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    • 1995
  • Background: One quarter to one third of patients with NSCLC present with primary tumors that although confined to the thorax are too extensive for surgical resection. Until resently standard treatment for these patients had been thoracic radiation, which produces tumor regression in most patients but few cures and dismal 5-year survival rate. The fact that death for most patients with stage III tumors is caused by distant metastases has promped a reevaluation of combined modality treatment approaches that include systemic chemotherapy. Therefore, we report the results observed in a study to evaluate the effect of multimodality treatment in locally advanced non-small cell lung cancer from 1/91 to 8/93 in CNUH. Method: We grouped the patients according to the treatment modalities and evaluated response rate, median survival and the effect of prognostic variables. Among 67 patients evaluated, twenty seven patients classified with group A, received cisplatin and etoposide containing combination chemotherapy alone, eighteen patients, classified with group B, received chemotherapy and radiotherapy, fifteen patients, group C, received neoadjuvant or adjuvant chemotherapy and surgery with/without radiation therapy, seven patients, group D, received only supportive care. Result: The major response rate for group A and B was 37% and 61% respectively. There was no statistically significant difference in response rate between A and B groups(p=0.97). The analysis of prognostic factors showed that differences of age, sex, pathology, blood type, smoking year, stage and ECOG performance did not related to improvement in survival. Median survival time was 8.6 months for group A, 13.4 months for group B, 19.2 months for group C, and 5.4 months for group D, respectively and there was statistically significant difference(p=0.003), suggesting that multimodality therapy was associated with signigicant improvement in survival. Subset survival analysis showed a significant therapeutic effect for earlier stage and good performance state(p=0.007, 0.009, respectively). A possible survival advantages were observed for major response groups. Conclusion: It was suggested that multimodality therapy for the management of patients who had stage III disease, has yielded good median survival and long survival for seleted patients. But, it is necessory to validate above result with further investigation in large scale and in prospective randomized trials.

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Microbiological Safety Assessment of a Perilla Leaf Postharvest Facility for Application of a Good Agricultural Practices (GAP) System (농산물우수관리제도(GAP system) 적용을 위한 깻잎의 수확 후 관리시설(APC)에 대한 미생물학적 안전성 평가)

  • Kim, Kyeong-Yeol;Nam, Min-Ji;Lee, Hyo-Won;Shim, Won-Bo;Yoon, Yo-Han;Kim, Se-Ri;Kim, Doo-Ho;Ryu, Jae-Gee;Hong, Moo-Ki;You, Oh-Jong;Chung, Duck-Hwa
    • Korean Journal of Food Science and Technology
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    • v.41 no.4
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    • pp.392-398
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    • 2009
  • This study identified risk factors of cross-contamination of foodborne pathogens and established a good agricultural practice (GAP) system for an agricultural products processing center (APC) for perilla leaves. All samples were collected before and after a standard work shift at the APC, while perilla leaves were also collected after each step in the APC. In addition, the workers and their surroundings were sampled by swabbing. The total plate count (TPC) and coliform count in the water samples increased significantly (p<0.05) to 3.36 and 1.73 log CFU/mL after work, respectively. However, no Escherichia coli and Listeria monocytogenes were detected. The bacterial populations of the workers and their surroundings did not differ significantly (p${\geq}$0.05) before and after work. However, Staphylococcus aureus (<1.66 log CFU) was detected at a high rate (13-50%) in the basket, packing table, gloves and cloth. Although perilla leaves passed through the washing steps, the TPC and coliform bacterial populations on the final products were higher (p${\geq}$0.05) than those of unwashed perilla leaves, which indicates that the washing system was not functioning properly. Accordingly, a GAP system with a better washing system should be employed at this facility.

Study of Factors Controlling Exposure Dose and Image Quality of C-arm in Operation Room according to Detector Size of It (Mainly L-Spine AP Study) (수술 중 C-Arm Neutral AP 검사 시 조절인자에 따른 피폭선량 및 화질비교(L-Spine AP검사를 기준으로))

  • CHOI, Sung-Hyun;JO, Hwang-Woo;Dong, Kyung-Rae;Chung, Woon-Kwan;Choi, Eun-Jin;Song, Ha-jin
    • Journal of Radiation Industry
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    • v.9 no.2
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    • pp.85-90
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    • 2015
  • Purpose: Time of operation has been reduced and accuracy of operation has been improved since C-arm, which offer real-time image of patient, was introduced in operation room. However, because of the contamination of patient, C-arm could not be used more appropriately. Therefore, this study is to know factors of controlling exposure dose, image quality and the exposed dose of health professional in operation room. Materials and methods: Height of Wilson frame (bed for operation) was fixed at 130 cm. Then, Model 76-2 Phantom, which was set by assembling manual of Fluke Company, was set on the bed. Head/Spine Fluoroscopy AEC mode was set for exposure condition. According to detector size of C-arm, the absorbed dose per min was measured in the 7 steps OFD (cm) from 10 cm to 40 cm (10, 15, 20, 25, 30, 35, 40 cm). In each step of OFD, the absorbed dose per min of same diameter of collimation was measured. Moreover, using Nero MAX Model 8000, exposure dose per min was measured according to 3 step of distance from detector (20 cm, 60 cm, 100 cm). Finally, resolution was measured by CDRH Disc Phantom and magnification of each OFD was measured by aluminum stick bar. Result: According to detector size of C-arm, difference of absorbed dose shows that the dose of 20 cm OFD is 1.750 times higher than the dose of 40 cm OFD. It means that the C-arm, which has smaller size of detector, shows the bigger difference of absorbed dose per min (p<0.05). In the difference of absorbed dose in the same step of OFD (from 20 cm to 40 cm), the absorbed dose of 9 inch detect or C-arm was 1.370 times higher than 12 inch' s (p<0.05). When OFD was set to 20 cm OFD, the absorbed dose of non-collimation case was approximately 0.816 times lower than the absorbed dose of collimation cases (p<0.05). When the distance was 20 cm from detector, exposed does includes first-ray and scatter-ray. When the distance was 60 cm and 100 cm from detector, exposed does includes just scatter-ray. So, there was the 2.200 times difference of absorbed does. Finally, when OFD was increased, spatial resolution was 4 to 5 step was increased. However, low contrast resolution was not relative. Moreover, there was 1.363 times difference of magnification (p<0.05). Conclusion: When C-Arm is used, avoiding contamination of patient is more important factor than reducing exposed dose of health professional in operation room. Just controlling exposure time is just way to reduce the exposed does of workers. However, in the case, non-probability influence could be occurred. Therefore, this study proved that the exposed dose will be reduced if the factors such as using small detector size of C-arm, setting OFD from 20 cm to 25 cm and non-collimating. Moreover, dose management of C-arm in the non-interesting area will be considered additionally.

Effect of Irrigation Starting Point of Soil on Chlorophyll Fluorescence, Stem Sap Flux Relative Rate and Leaf Temperature of Cucumber in Greenhouse (시설 토양 오이재배에서 관수개시점 처리가 광합성 형광반응, 줄기수액흐름 및 엽온에 미치는 영향)

  • An, Jin Hee;Jeon, Sang Ho;Choi, Eun Yong;Kang, Ho Min;Na, Jong Kuk;Choi, Ki Young
    • Journal of Bio-Environment Control
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    • v.30 no.1
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    • pp.46-55
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    • 2021
  • This experiment was conducted to investigate the effect on chlorophyll fluorescence, stem sap flux relative rate (SFRR) and leaf temperature of cucumber when irrigation is controlled using a soil moisture tensiometer. Cucumber (Cucumis sativus L.) 'Chungchun' was irrigated of 10-10-20 kPa and 20-10-10 kPa by soil starting point of irrigation at each growth stage. At the 66 days after treatment (DAT) of 736 to 854 W·m-2 and above 32℃, chlorophyll fluorescence variables (Fo, Fm, Fv/Fm) values showed significantly different between treatments. The Fo and Fv/Fm value in the daytime (10:30 am to 6:00 pm) at 66 DAT was higher in 20-10-10 kPa treatment than in 10-10-20 kPa treatment. The Fv/Fm value decreased when the leaf temperature was increased. There was no difference in leaf growth (length, width and area) at 28 and 66 DAT, but the chlorophyll content (SPAD value) was significantly higher in 20-10-10kPa treatment. SFRR and leaf temperature increased with light intensity and temperature increased. In both treatments, the SFRR started to increase sharply between 8 am and 9 am when the solar radiation is 170 W·m-2 or higher. The soil temperature of the treatments decreased after irrigation, that showed 31.0℃ at 10-10-20kPa and 28.5℃ at 20-10-10kPa on July 5 (820W·m-2 at 1 pm). However, there was no difference in SFRR, leaf temperature, temperature difference (leaf temperature - air temperature) and VPD between treatments. SFRR was significantly positive correlate with the leaf temperature (p < 0.01, r = 0.770). The SFRR and leaf temperature showed positive significant correlation with solar radiation, temperature, soil temperature, soil moisture content and VPD. There was a negative significant correlation with relative humidity and temperature difference.

Necessity of Developing University Radiology Curriculum for Veterinary Hospital Radiological Technologists - D University Case Focusing - (동물병원 방사선사를 위한 대학 방사선학과 교육과정 개발 필요성 - D 대학 사례 중심으로 -)

  • Won-Jeong Lee
    • Journal of the Korean Society of Radiology
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    • v.18 no.3
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    • pp.203-212
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    • 2024
  • The purpose of this study was to survey by the veterinary hospital Specialists (VHSs) and radiology students (RSs) for radiology curriculum development veterinary hospital (VH), and for veterinary hospital radiological technologists (VHRTs). VHSs were surveyed to regarding the basic information and radiological examination training, radiological examination experience, anatomy physiology, radiation safety management training, radiation biology training. RSs were surveyed to regarding the basic information and career paths, VH awareness, and VH-related department environments. The survey results were quantitatively entered into Excel and then analyzed using the SPSS ver. 26.0. The students were aged by 22.6 years old, and out of 171 students, male and female were 92 and 79 espectively. In employment career paths, 62.6% of all subjects responded that employment prospects at medical institutions were good. Employment prospects outside of medical institutions, VH had the highest number of students. Of the 83 students who responded that they wanted to work at a VH, 64 students liked animals, and 47 students the high potential for advancement. Of the 159 students who responded that there is potential for development of VH, 96.2% responded that it was due to the increase in companion animals. In the VH-related department environment, 94.7% responded that there was no related equipment, and 72.5% responded that the department needed to open animal care courses and 82.5% anatomy and physiology courses. 76.6% responded that they would be willing to take animal-related courses if they were offered. Among the 20 VHSAs, 4 had no experience in radiological examination of animals, 2 VHRTs, and 2 others. There were 7 people who had not received training in animal radiography, and 2 VHRTs had not received training in animal care and animal anatomy and physiology. This study is expected to be helpful in developing a radiology curriculum for VHRTs in the future.