BackgroundA knowledge based planning tool has been developed and implemented for prostate VMAT radiotherapy plans providing a target average rectum dose value based on previously achievable values for similar rectum/PTV overlap. The purpose of this planning tool is to highlight sub-optimal clinical plans and to improve plan quality and consistency.MethodsA historical cohort of 97 VMAT prostate plans was interrogated using a RayStation script and used to develop a local model for predicting optimum average rectum dose based on individual anatomy. A preliminary validation study was performed whereby historical plans identified as “optimal” and “sub-optimal” by the local model were replanned in a blinded study by four experienced planners and compared to the original clinical plan to assess whether any improvement in rectum dose was observed. The predictive model was then incorporated into a RayStation script and used as part of the clinical planning process. Planners were asked to use the script during planning to provide a patient specific prediction for optimum average rectum dose and to optimise the plan accordingly.ResultsPlans identified as “sub-optimal” in the validation study observed a statistically significant improvement in average rectum dose compared to the clinical plan when replanned whereas plans that were identified as “optimal” observed no improvement when replanned. This provided confidence that the local model can identify plans that were suboptimal in terms of rectal sparing. Clinical implementation of the knowledge based planning tool reduced the population-averaged mean rectum dose by 5.6Gy. There was a small but statistically significant increase in total MU and femoral head dose and a reduction in conformity index. These did not affect the clinical acceptability of the plans and no significant changes to other plan quality metrics were observed.ConclusionsThe knowledge-based planning tool has enabled substantial reductions in population-averaged mean rectum dose for prostate VMAT patients. This suggests plans are improved when planners receive quantitative feedback on plan quality against historical data.

Background In 2018, USAID published a report based on Demographic and Health Surveys data on the relationship between men’s involvement and women and children’s health outcomes. Using a flawed operationalization of “men’s involvement,” USAID’s analysis implies that Senegalese men are not involved in women and children’s health. Methods The findings of this study come from 12 months of ethnographic research in Dakar, Senegal that examined the roles and responsibilities of expectant fathers. Research participants included 32 pregnant women and 27 expectant partners recruited from three maternity wards. Research methods included long-term, immersive participant observation and semi-structured interviews. Results Pregnant women in Senegal are surrounded by a kin-based network of care providers called the entourage who share responsibilities for support. Expectant fathers, as members of the entourage, are expected to provide financial and emotional support, while other members of the entourage are expected to undertake the responsibilities which USAID have designated as “men’s involvement.” Men typically do not undertake additional forms of care and support because they are considered “women’s business,” meaning that women actively discourage men from doing those things, in order to preserve women’s autonomy. Conclusion This research demonstrates that expectant fathers are involved in antenatal care in ways that USAID does not track through DHS. Further, I argue that USAID’s heterosexist, monogamous, and nuclear operationalization of “men’s involvement” aligns with a long history of Eurocentrism in development discourse which may be potentially harmful and obstructive to improving maternal and child health when the problem that is targeted is not a problem at all. This study is yet another case that demonstrates an urgent need of public and global health engagement with local stakeholders and ethnographic researchers.

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Dakar, Senegal is precarious. Precarity has been described as longing for the ordinary, for the normal, for release, for a once‐promised future (see Allison 2013); it is the frail bond with which affects and attachments hang together, are worlded, and threaten to unworld (Stewart 2012); it is the condition of an uncertain present and insecure future under which one waits (toog; Melly 2011), “kills time” (Ralph 2008), or “timepasses” (Jeffrey 2010) until an opportunity reveals itself. The men in Dakar with whom I have worked since 2013 await a common opportunity: to get married, to be fathers, to become heads‐of‐household (borom keur). But amidst economic instability, elevated rates of un(der)employment (which is higher among youth than the national population), and a housing crisis, men must put such plans on hold in order to gain a firmer footing for a more stable future. In the interim, new masculinities “emerge” (Inhorn and Wentzell 2011) while men long for the chance to fulfill their notions of social adulthood. Rethinking Tylor's (1865) concept of couvade – the practices and expectations that men adopt during pregnancy and after childbirth – this paper, from preliminary pre‐dissertation fieldwork in the Medina neighborhood, documents the ways in which men endure (muñ) precarity, how precarious or intermediate masculinities take shape, and how fatherhoods change in response to the conditions of waiting. After a brief review of the concept of couvade, I will push the boundaries of its quaint 19th and 20th century definitions to meet the needs of assessing young men who live immersed in the precarity of a 21st century postcolonial African metropolis. Ethnographically, I illustrate that what men do for their children, both before and after childbirth, is not simply for the purpose of constructing socio‐spiritual bonds, as Peter Rivière (1974) and others would have it, but also as a complex negotiation in an effort to secure a better future in the face of economic and social insecurities that endure just as strongly as they do.

In Dakar, Senegal, skilled tradesmen must navigate boom‐and‐bust cycles of the economy—tempos disproportionately influenced by the Islamic calendar, foreign investment, and an individual’s access to social capital. Anticipating these cycles, drawing on community networks for support, and learning to weather the bad times can mean the difference between providing for your family and having your masculinity questioned. Both Dakar and its builders are always under construction, ever in progress.