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Sample records for experience treating locally

  1. Experiences with treating immigrants

    DEFF Research Database (Denmark)

    Sandhu, Sima; Bjerre, Neele V; Dauvrin, Marie

    2012-01-01

    of human trafficking. Interviews were transcribed and analysed using thematic analysis. RESULTS: The interviews highlighted specific challenges to treating immigrants in mental health services across all 16 countries including complications with diagnosis, difficulty in developing trust and increased risk...

  2. Nociceptive Effects of Locally Treated Metoprolol

    Directory of Open Access Journals (Sweden)

    Nursima Cukadar

    2015-06-01

    Results: Metoprolol, an antagonist, significantly decreased the thermal latency and mechanical thresholds with dose and time dependent manner. However, dobutamine, an agonist, enhanced the latency and thresholds dose and time dependent. Conclusions: This results suggest that in contrast to dobutamine, locally treated metoprolol may cause hyperalgesic and allodynic actions. In addition, our results can demonstrate that peripheral beta-adrenergic receptors can play important roles in nociceptive process. [Cukurova Med J 2015; 40(2.000: 258-266

  3. Locally Advanced Malignant Myoepithelioma of the Parotid Gland Treated With Radiotherapy: A Case Study and Review of the BC Cancer Agency Experience.

    Science.gov (United States)

    Caon, Julianna; Alexander, Cheryl; Kader, Hosam A

    2017-06-01

    Malignant myoepithelioma of salivary glands is a rare neoplasm; most arise in the parotid gland and minor salivary glands of the palate. Surgery has been the mainstay of treatment. This is case report of a patient treated with primary radical radiotherapy and retrospective review of institutional experience. An 87-year-old man with locoregionally advanced malignant myoepithelioma of the parotid gland received radiotherapy alone with complete clinical response and sustained 39 months of posttreatment. Between 1981 and 2012, 15 cases of malignant myoepithelioma of the parotid were seen. Thirteen patients received surgical excision and adjuvant radiotherapy. At a median follow-up of 47 months, 12 patients were alive without recurrence, 2 died without recurrence, and 1 died with metastatic myoepithelioma. Durable locoregional disease control and disease-free-survival was achieved in the majority of patients. The case reported suggests radiation therapy may be an effective treatment option for inoperable cases.

  4. EXPERIENCES IN TREATING LAUGIER'S FRACTURES

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    Ivan Golubović

    2011-12-01

    Full Text Available Laugier's fractures are rare because they are located deep in the elbow joint and are thus protected from any direct trauma. This study shows two patients whose Laugier's fractures were surgically treated. Surgical interventions were performed using the Campbell surgical approach. The ulnar nerve was mobilised for a distance of 12 cm, and then a tenotomy of the triceps brachii muscle and a posterior capsulectomy of the elbow joint were performed. A temporary repositioning followed by a permanent fixation were undertaken using two 3.2mm screws. The screws were inserted from the back, through the posterolateral and posteromedial pillars of the humeral condyle, to the front and medially. The tip of the screw was kept subchondrally in the bone of the humeral capitellum or trochlea and did not go through the cartilage. The stitches of the wound were done by layers, and prior to that a transposition of the ulnar nerve was performed medially. A plaster cast was worn on the upper arm for three weeks, with mandatory prophylaxis of periarticular ossification by taking indomethacin, 25mg three times a day. Upon removing the plaster cast, the patients underwent outpatient physical therapy for two weeks followed by inpatient physical therapy with full weight-bearing. Laugier's fractures have been insufficiently described in the literature. Surgical treatment does not have an alternative, and timely diagnosis and surgical and physical therapy yield, according to the Mayo elbow performance index, good results.

  5. [Experience in treating mucoceles in Primary Care].

    Science.gov (United States)

    Sabando Carranza, J A; Cortés Martinez, M; Calvo Carrasco, D

    2016-03-01

    Several cases of mucocele have been treated in our Primary Health Care centre. These are benign lesions, relatively frequent (2.5/1000), which is caused by a retention of mucous from the minor salivary glands into the oral cavity, mainly at the level of the lower lip. The experience in their treatment in this centre is presented, along with a review of the literature to see if our treatment was correct. Copyright © 2015 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España, S.L.U. All rights reserved.

  6. Cooperative and heterogeneous indoor localization experiments

    OpenAIRE

    Denis, Benoit; Raulefs, Ronald; Fleury, Bernard; Uguen, Bernard; Amiot, Nicolas; Celis, L.; Dominguez,, J; Koldsgaard,, M.B; Laaraiedh, Mohamed; Noureddine,, H; Staudinger,, E; Steinboeck, Gerhard

    2013-01-01

    International audience; In this paper we present the results of real-life localization experiments performed in an unprecedented cooperative and heterogeneous wireless context. These measurements are based on ZigBee and orthogonal frequency division multiplexing (OFDM) devices, respectively endowed with received signal strength indicator (RSSI) and round trip delay (RTD) estimation capabilities. More particularly we emulate a multi-standard terminal, moving in a typical indoor environment, wh...

  7. Collection of european experiences in local investment

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2003-07-01

    This booklet is realized within the framework of the european project called PREDAC. This objective of this project are to promote citizen participation in the financing of renewable energies projects in Europe, to make organizations, investor clubs and local government to be aware of this way of implication into renewable energies development. The first part presents a collection of european experiences, as discussions and perspectives are proposed in the second part. The last part gives a comparative table between Germany and Denmark in term of renewable energies development. (A.L.B.)

  8. pattern and experience with cancers treated with the chinese ...

    African Journals Online (AJOL)

    hi-tech

    East African Medical Journal Vol. 77 No. 10 October 2000. PATTERN AND EXPERIENCE WITH CANCERS TREATED WITH THE CHINESE GWGP80 COBALT UNIT AT MULAGO HOSPITAL, KAMPALA. J. B. Kigula Mugambe, MBChB, MMed (Rad) MUK, MSc (Rad. Oncol.) Cairo, Department of Radiology, Makerere ...

  9. Prognostic impact of external beam radiation therapy in patients treated with and without extended surgery and intraoperative electrons for locally recurrent rectal cancer: 16-year experience in a single institution.

    Science.gov (United States)

    Calvo, Felipe A; Sole, Claudio V; Alvarez de Sierra, Pedro; Gómez-Espí, Marina; Blanco, Jose; Lozano, Miguel A; Del Valle, Emilio; Rodriguez, Marcos; Muñoz-Calero, Alberto; Turégano, Fernando; Herranz, Rafael; Gonzalez-Bayon, Luis; García-Sabrido, Jose Luis

    2013-08-01

    To analyze prognostic factors associated with survival in patients after intraoperative electrons containing resective surgical rescue of locally recurrent rectal cancer (LRRC). From January 1995 to December 2011, 60 patients with LRRC underwent extended surgery (n=38: multiorgan [43%], bone [28%], soft tissue [38%]) or nonextended (n=22) surgical resection, including a component of intraoperative electron-beam radiation therapy (IOERT) to the pelvic recurrence tumor bed. Twenty-eight (47%) of these patients also received external beam radiation therapy (EBRT) (range, 30.6-50.4 Gy). Survival outcomes were estimated by the Kaplan-Meier method, and risk factors were identified by univariate and multivariate analyses. The median follow-up time was 36 months (range, 2-189 months), and the 1-year, 3-year, and 5-year rates for locoregional control (LRC) and overall survival (OS) were 86%, 52%, and 44%; and 78%, 53%, 43%, respectively. On multivariate analysis, R1 resection, EBRT at the time of pelvic rerecurrence, no tumor fragmentation, and non-lymph node metastasis retained significance with regard to LRR. R1 resection and no tumor fragmentation showed a significant association with OS after adjustment for other covariates. EBRT treatment integrated for rescue, resection radicality, and not involved fragmented resection specimens are associated with improved LRC in patients with locally recurrent rectal cancer. Additionally, tumor fragmentation could be compensated by EBRT. Present results suggest that a significant group of patients with LRRC may benefit from EBRT treatment integrated with extended surgery and IOERT. Copyright © 2013 Elsevier Inc. All rights reserved.

  10. Lesotho's Democratic Local Government Experiment | Lebusa ...

    African Journals Online (AJOL)

    The residues of Lesotho's political past (party politics, inter-party confl ict and conflict over economic resources and their distribution) remain in force within Lesotho's local government process. Despite commitment to decentralise and the promises for enhanced democracy and poverty reduction, the local government ...

  11. Localized wave pulses in the keyport experiment

    Energy Technology Data Exchange (ETDEWEB)

    Chambers, D.H.; Lewis, D.K.

    1998-02-17

    Localized wave (LW) pulses were produced using a standard Navy array in the anechoic tank at Navy Underwater Weapons Center (NUWC) Keyport. The LW pulses used were the MPS pulse first derived by Ziolkowski, and a new type of pulse based on a superposition of Gaussian beam modes. This new type is motivated by a desire to make a comparison of the MPS pulse with another broad band pulse built from solutions to the wave equation. The superposed Gaussian pulse can be described by parameters which are analogous to those describing the MPS pulse. We compare the directivity patternsand the axial energy decay between the pulses. We find the behavior of the pulses to be similar so that the superposed Gaussian could be another candidate in the class of low diffractive pulses known as localized waves.

  12. Outcomes and predictors of localized or locally-advanced prostate cancer treated by radiotherapy in Indonesia

    Directory of Open Access Journals (Sweden)

    Wempy Supit

    2013-03-01

    Conclusions: RT is an effective treatment modality for localized or locally-advanced PCa in Indonesian patients, with outcomes and predictors consistent to that reported elsewhere. Predictors of poorer outcomes include high-risk group, higher pretreatment PSA, incidental detection by TUR-P, and lack of adjuvant HT. Adjuvant hormonal therapy significantly improve the survival of high risk patients.

  13. MR imaging predictors of local control of glottic squamous cell carcinoma treated with radiation alone

    NARCIS (Netherlands)

    Ljumanovic, Redina; Langendijk, Johannes A.; van Wattingen, Menno; Schenk, Barry; Knol, Dirk L.; Leemans, C. Rene; Castelijns, Jonas A.

    Purpose: To retrospectively evaluate the prognostic significance of magnetic resonance ( MR) imaging - determined tumor parameters, especially the presence of cartilage invasion, regarding local control of glottic squamous cell carcinoma treated with radiation therapy ( RT) alone. Materials and

  14. OUR EXPERIENCE IN TREATING SINUSITIS IN CHILDREN AND YOUTH

    Directory of Open Access Journals (Sweden)

    Emilija Zivkovic

    2001-09-01

    Full Text Available The experiences in treating sinusitis in 30 children and young men arepresented. The patients' age was within the range from 7 to 18. There were 16 boysand 14 girls. Ali the patients were examined in the clinic approach, that is, by the frontrhinoscopiy; the laboratory analyses were done as well as the biogram and the antibiogramof the nose beside x-raying of the paranasal cavities in the oxyphytomentalposition and sinusoscopy. The ophtalmological and the pediatrie examinations werealso carried out. Nine patients underwent the maxillary sinus trephination accordingto Caldwell-Luc; two patients underwent external ethmoidectomy while one patientunderwent the frontal sinus trephination according to Ruttemburg as well asendonasal back ethmoidectomy. The conservative treatment was given to 18 patients.A surgical intervention was done on 12 patients. Ali the patients were successfullytreated.

  15. Experience of Percutaneous Trigger Finger Release under Local ...

    African Journals Online (AJOL)

    the results of percutaneous trigger finger release under local anesthesia. Subjects and Methods. This prospective study was carried out at Orthopedics department of M. M. Medical College from July 2005 to July 2010. It. Experience of Percutaneous Trigger Finger Release under Local Anesthesia in the Medical College of.

  16. Experience of Percutaneous Trigger Finger Release under Local ...

    African Journals Online (AJOL)

    Background: Trigger finger is a common disorder of upper extremity. Majority of the patients can be treated conservatively but some resistant cases eventually need surgery. Aim: The aim of this study is to evaluate the results of percutaneous trigger finger release under local anesthesia. Subjects and Methods: This is a ...

  17. Local smoke-free policy experiences in Appalachian communities.

    Science.gov (United States)

    Klein, Elizabeth G; Liber, Alex C; Kauffman, Ross M; Berman, Micah; Ferketich, Amy K

    2014-02-01

    In Appalachian areas, strong tobacco control policies are not in place, so residents are not adequately protected from secondhand smoke exposure. This area is predominantly rural, and residents experience a high burden of tobacco-related illnesses. There has been limited examination of elements that hinder smoke-free policy adoption in these vulnerable communities. Key informant interviews were conducted with individuals identified as being knowledgeable about local tobacco control policy activities within a random selection of Appalachian communities within 6 states with (n = 15) and without (n = 12) local smoke-free policies. Five key themes emerged from the qualitative interviews: (1) opposition to tobacco control, (2) need for local involvement, (3) role of community coalitions, (4) leveraging outside advocates, and (5) working with decision makers. In Appalachian communities, the local context and locally-based coalitions were critical to promote the adoption of smoke-free policies.

  18. Clinical experience of surgically treating giant neurofibromatosis-1.

    Science.gov (United States)

    Chen, Baoguo; Xu, Minghuo; Song, Huifeng; Gao, Quanwen

    2017-02-01

    The surgical treatment for giant neurofibromatosis-1 (NF-1) requires comprehensive measures. Presently, there is no systematic description of surgical treatment. Because of its high level of risk, we want to share our clinical experience. From 2011 to 2014, patients (n = 8, 5 female and 3 male patients, aging from 31 to 45 years-old) were included in the study. The tumours were located on the trunk (n = 5) or face (n = 3). In addition to routine examination, blood storage was also prepared. Preoperative consultation from related departments was critical at first. Related artery embolisation was also carried out. In the operation, we checked thromboelastography, based on which reasonable blood component transfusion was implemented. Autologous blood transfusion was also ready. An instrument of copper needle or ring ligation was used to reduce haemorrhage before the surgery. Protruding or drooping portions of the tumours were excised. A pressurised bandage was applied when the surgery was completed. After the surgery, besides the routine monitoring of vital signs, re-haemorrhage should be detected in time. Then, we should decide whether blood transfusion or surgery was required again. Expanders were implanted in one female patient with facial injuries before removing the tumour. Then, expanded flaps were applied to repair the secondary wound. According to the above clinical route, after an average of 1-year follow-up, no patients died, and other unforeseen events did not occur. Wounds healed well in all patients. The tumor was excised as much as possible. No facial nerve paralysis occurred in the facial sites. Expanded flaps necrosis WAS not encountered. It is essential to design the educational clinical route for treating NF-1 when a giant protruding tumour is advised to be excised, which can minimise the risk of surgery and assure us of the maximum range of resection. © 2016 Medicalhelplines.com Inc and John Wiley & Sons Ltd.

  19. LOCAL BUDGETS UNDER CURRENT DECENTRALIZATION: UKRAINE AND FOREIGN EXPERIENCE

    Directory of Open Access Journals (Sweden)

    O. Cheberyako

    2016-04-01

    Full Text Available The article is devoted to the major trends and issues of development of local budgets in Ukraine. A study of the essence of fiscal decentralization as one of the components of the management, aimed at reducing the dependence of local governments from the central government with regard to foreign experience. Particular attention is paid to local budgets under decentralization of own and delegated financial powers. The theoretical principles of fiscal decentralization and its proven impact on the socio-economic development. Studied the European countries model of local budgets. The features of formation of revenues of local budgets under decentralization. The role in shaping tax revenues of local budgets in foreign countries and Ukraine. The analysis of state policy of financial support for regional development in Ukraine. The structure of tax revenue in the context of changes in the budget and tax legislation in a decentralized tax powers. Systematized features of fiscal decentralization in Ukraine. Problems and grounded main ways of optimizing the formation of local budgets in a decentralized tax powers. Formed selection of areas targeted as ways to increase economic and financial independence of regions of Ukraine.

  20. Merkel cell tumor of the skin treated with localized radiotherapy: are widely negative margins required?

    Directory of Open Access Journals (Sweden)

    David Parda

    2011-03-01

    Full Text Available Merkel’s cell carcinoma is a rare cutaneous tumor that can affect a wide variety of sites throughout the body. Commonly, it affects the skin alone and the management of limited disease can be confusing since the natural history of the disease involves distant metastasis. Traditional management has required wide local excision with negative margins of resection. We describe a case treated with local therapy alone and review the literature to suggest that complete microscopic excision may not be required if adjuvant radiotherapy is used.

  1. Pattern and experience with cancers treated with the chinese ...

    African Journals Online (AJOL)

    Conclusion: The Chinese GWGP80 Cobalt unit has effectively treated a large number of cancer patients but the failures of the “force back system” of its radioactive source compromise its radiation safety and ideally would require a change in the engineering design to decrease on the associated radiation hazards.

  2. Radiotherapy for locally recurrent rectal cancer treated with surgery alone as the initial treatment

    Energy Technology Data Exchange (ETDEWEB)

    Tanaka, Hidekazu; Yamaguchi, Takahiro; Hachiya, Kae; Okada, Sunaho; Kitahara, Masashi; Matsuyama, Katsuya; Matsuo, Masayuki [Gifu University, Gifu (Japan)

    2017-03-15

    Although the technical developments of radiotherapy have been remarkable, there are currently few reports on the treatment results of radiotherapy for local recurrence of rectal cancer treated with surgery alone as initial treatment in this three-dimensional conformal radiotherapy era. Thus, we retrospectively evaluated the treatment results of radiotherapy for local recurrence of rectal cancer treated with surgery alone as the initial treatment. Thirty-two patients who underwent radiotherapy were enrolled in this study. The dose per fraction was 2.0–3.5 Gy. Because the treatment schedule was variable, the biological effective dose (BED) was calculated. Local control (LC) and overall survival (OS) rates from the completion of radiotherapy were calculated. The 1-, 2-, 3-, 4-, and 5-year LC rates were 51.5%, 24.5%, 19.6%, 19.6%, and 13.1%, respectively. LC rates were significantly higher for the high BED group (≥75 Gy10) than for the lower BED group (<75 Gy10). All patients who reported pain achieved pain relief. The duration of pain relief was significantly higher for the high BED group than for the lower BED group. The 1-, 2-, 3-, 4-, and 5-year OS rates were 82.6%, 56.5%, 45.2%, 38.7%, and 23.2%, respectively. There was a trend toward higher OS rates in with higher BED group compared to lower BED group. For patients with unresectable locally recurrent rectal cancer treated with surgery alone, radiotherapy is effective treatment. The prescribed BED should be more than 75 Gy10, if the dose to the organ at risk is within acceptable levels.

  3. Leukocytosis and neutrophilia predict outcome in locally advanced esophageal cancer treated with definitive chemoradiation

    Science.gov (United States)

    Schernberg, Antoine; Moureau-Zabotto, Laurence; Del Campo, Eleonor Rivin; Escande, Alexandre; Ducreux, Michel; Nguyen, France; Goere, Diane; Chargari, Cyrus; Deutsch, Eric

    2017-01-01

    Purpose To investigate the prognostic value of leukocyte and neutrophil count as biomarkers in patients with locally advanced esophageal squamous cell carcinoma (SCC) undergoing exclusive chemoradiation. Results A total of 126 patients were identified. Respectively, 33% and 35% displayed baseline leukocytosis and neutrophilia. Estimated 3-year OS and PFS from chemoradiation completion were 31% and 25%, respectively. In univariate analysis, both leukocytosis and neutrophilia were associated with worse OS, PFS, and LRC (p < 0.01). In multivariate analysis, leukocytosis remained an independent risk factor associated with poorer OS, PFS and LRC (p < 0.05), independently from tumor stage and length, with higher prognostic value for OS compared with patients’ performance status (PS). Materials and Methods Bi-institutional clinical records from consecutive non-operable patients treated between 2003 and 2015 with definitive chemoradiation for locally advanced esophageal carcinoma were reviewed. Leukocytosis and neutrophilia were defined as a leukocyte or neutrophil count over 10 G/L and 7 G/L, respectively. These parameters were studied for their potential correlation with overall survival (OS), progression free survival (PFS), locoregional control (LRC) and distant metastases control (DMC). Conclusions Leukocytosis and neutrophilia were independent prognostic factors of poor OS, PFS, and LRC in this bi-institutional series of locally advanced esophageal SCC treated with definitive chemoradiation. Although prospective confirmation is warranted, it is suggested that the leukocyte and neutrophil count parameters might be clinically relevant biomarkers to be considered for further clinical investigations. PMID:28086222

  4. Local resonance bandgaps in periodic media: theory and experiment.

    Science.gov (United States)

    Raghavan, L; Phani, A Srikantha

    2013-09-01

    Periodic composites such as acoustic metamaterials use local resonance phenomenon in designing low frequency sub-Bragg bandgaps. These bandgaps emerge from a resonant scattering interaction between a propagating wave and periodically arranged resonators. This paper develops a receptance coupling technique to combine the dynamics of the resonator with the unit cell dynamics of the background medium to analyze flexural wave transmission in a periodic structure, involving a single degree of freedom coupling between the medium and the resonator. Receptance techniques allow for a straightforward extension to higher dimensional systems with multiple degrees of freedom coupling and for easier experimental measurements. Closed-form expressions for the location and width of sub-Bragg bandgaps are obtained. Rigid body modes of the unit cell of the background medium are shown to set the bounding frequencies for local resonance bandgaps. Results from the receptance analysis compare well with Bloch wave analysis and experiments performed on a finite structural beam with periodic masses and resonators. Stronger coupling and inertia of the resonator increase the local resonance bandgap width. Two-fold periodicity widens the Bragg bandgap, narrowed by local resonators, thus expanding the design space and highlighting the advantages of hierarchical periodicity.

  5. Patients' subjective visual experiences during vitreous surgery under local anesthesia.

    Science.gov (United States)

    Yu, Ji-Feng; Liang, Li; Wen, Yu-Qin; Liu, Li; Huang, Yi-Fei

    2011-01-01

    To investigate patient's visual experience during vitreous surgery under local anesthesia. A prospective and randomized study of 76 patients that underwent vitreous surgeries in our hospital between July 2010 and December 2010 was designed. All patients were interviewed half an hour before and within 1 hour after the surgery using a standardized questionnaire. Basic characteristics of patients and their intraoperative visual experiences like light, color, moving object, pain, fear, and the desire for general anesthesia before and after the surgery were recorded. Sixty patients (78.9%) perceived at least light perception, and 16 patients (21.1%) got no light perception throughout the entire duration of the operation. Forty one patients (53.9%) perceived only light, while 19 patients (25%) experienced moving objects. Thirty nine patients (51.3%) were frightened during their intraoperative visual experiences. Patients with better preoperative best-corrected visual acuity (BCVA) were more likely to be frightened (p=0.002). The frightened experience was affected notably by the different perceptions during operation, moving object (p=0.024), light (p=0.071), and color (p=0.071). Patients below 50 years old, especially from 20 to 30, were more likely to choose general anesthesia after the vitreous surgery. Most patients (78.9%) experienced at least light perception during the vitreous surgery under local anesthesia. There were no significant differences between the various visual experiences and their basic characteristics. Patients with better preoperative BCVA, perceived moving objects in their visual sensations seemed more likely to be frightened.

  6. Localization and activity of lipoxygenase in Cd-treated seedlings of Phaseolus coccineus

    Directory of Open Access Journals (Sweden)

    Ewa Skórzyńska-Polit

    2011-01-01

    Full Text Available Lipoxygenase was localized in the primary leaves of Phaseolus coccineus (L., seedlings treated with 25 µM Cd and in control plants using the immunogold method. The enzyme was localized mainly in the peripheral parts of protoplast of control plant cells. It was found in the cell wall, along the ER elements, at plastid lamellae and inside the mitochondria. In Cd-treated seedlings the elements of parenchyma cells showed an atypical inner structure. The immunolabelling of LOX was less intensive in comparison with control. The enzyme was found in the cytoplasm, at the cell wall area, vacuoles and in the plastid stroma as single gold particles. LOX activity optima were determined at pH 7.0 and 8.0 for both linoleic and linolenic acid used as substrates. After 2 days of seedlings exposure to Cd the activity of LOX decreased at pH 7.0 and 8.0 when linoleic acid was used as substrate, and strongly declined at pH 7.0 after 4 days of the metal treatment. When linolenic acid was the substrate LOX activity slightly increased after 2 days of the plants exposure to Cd, but after 4 days it rapidly decreased at pH 7.0. The changes in LOX activity are discussed.

  7. Brachytherapy should not be omitted when treating locally advanced neuroendocrine cervical cancer with definitive chemoradiation therapy.

    Science.gov (United States)

    Robin, Tyler P; Amini, Arya; Schefter, Tracey E; Behbakht, Kian; Fisher, Christine M

    Neuroendocrine cervical cancer is a rare malignancy with a poor prognosis, yet there is a paucity of data to guide treatment decisions when managing patients with this diagnosis. Specifically, there are little data to aid practitioners in deciding if there is added value to brachytherapy given the additional time, cost, discomfort, and toxicity to patients. We used the National Cancer Data Base to identify women with locally advanced neuroendocrine cervical cancer treated with definitive chemoradiotherapy to determine if the addition of brachytherapy improves outcomes in this disease. We also assessed outcomes based on chemotherapy timing in this cohort. We identified 100 patients with locally advanced nonmetastatic neuroendocrine cervical cancer that were treated with definitive chemoradiotherapy between 2004 and 2012. There was a substantial improvement in overall survival when brachytherapy was administered in addition to external beam radiotherapy. In multivariate analysis, the addition of brachytherapy, compared with external beam radiotherapy alone, was associated with an improved median survival of 48.6 vs. 21.6 months (hazard ratio (HR), 0.475; 95% CI, 0.255-0.883; p = 0.019). We observed no difference in overall survival for patients treated with neoadjuvant chemotherapy compared with the group who received chemotherapy started concurrently with radiation (HR, 0.851; 95% CI, 0.483-1.500; p = 0.578). Brachytherapy should be considered an essential component of definitive chemoradiotherapy for the treatment of neuroendocrine cervical cancer. Chemotherapy timing, however, does not impact outcome. Copyright © 2016 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.

  8. [Acute pyelonephritis treated under "home hospitalization." Ten years' experience].

    Science.gov (United States)

    Regalado, José; Mendoza, Humberto; Aizpuru, Felipe; Altuna, Elena; Gómez, Montserrat; Cía, Juan M

    2006-12-01

    We present the experience of the Vitoria-Gasteiz Hospital at Home Unit in the treatment of acute pyelonephritis, including an analysis of potential predictors of failure. A total of 369 episodes of acute pyelonephritis without septic shock or renoureteral obstruction are described. After initiating intravenous antibiotic therapy in the hospital emergency department, all patients were referred to the HH. We analyzed the characteristics of the cases and the relationship between several clinical factors and failure of HH care, defined as the need to readmit the patient to conventional hospitalization. During the study period, 280 women and 89 men (age 16-88 years) met the inclusion criteria. Mean length of HH stay was 5 days and duration of intravenous therapy was 3 days. Sixteen of the 369 cases (4%) had to be readmitted to the hospital because of hypotension, vomiting, pain, fever, or signs of obstruction on ultrasound or because they requested it (four patients). Patients who were readmitted had a higher maximum temperature (mean 39.4 vs. 38.7 degrees C; p = 0.006) than those who remained at the HH. There were no differences between the groups with respect to the other clinical variables studied. The evolution of all 16 hospitalized patients was favorable; only one required a urological intervention. Hospital at home care was an effective alternative for managing acute pyelonephritis without shock in 96% of cases referred by the emergency department, and obviated conventional hospital admission, which is usually indicated for this disease.

  9. [Treating bulimia nervosa: a nurse's experience using cognitive behavior therapy].

    Science.gov (United States)

    Huang, Chiu-Min; Hsieh, Chia-Jung

    2010-04-01

    This paper focused on the experience of the authors in providing nursing care to a patient with bulimia nervosa who sought psychiatric assistance upon her first episode. The nursing period spanned a period from April 21, 2008 to June 16, 2008. After primary diagnosis, relevant data was collected by observation, interview, and a review of medical records. The patient's disease was assessed from five dimensions. Care problems faced for this patient included: altered nutrition profile, abnormal eating patterns, ineffective individual coping, and body image disturbance. The authors adopted a three-stage nursing intervention based on cognitive behavior theory (CBT). First, a caring attitude was employed to establish a good nurse-patient relationship, after which the patient was instructed to maintain a diet diary, which could be used to help identify the underlying causes of her bulimia nervosa condition. Secondly, we assisted the patient to express her emotions and feelings in order to help her disentangle herself from unhealthy perceptions regarding body image and weight. Thirdly, we assisted the patient to develop critical problem-solving abilities and coping skills that would help avoid symptom recurrence. We followed up on patient progress by telephone for one month after treatment. The treatment had successfully stabilized her emotions and bulimia nervosa did not recur. Her body weight was kept within a satisfactory range. Furthermore, she applied cognitive behavior skills in daily life continuously, and she did exercise and kept company with an individual who helped reinforce appropriate behavior. It is hoped that this report can help nurses better understand bulimia nervosa and be used as a reference in clinical care.

  10. Acute esophagitis for patients with Local-regional Advanced NSCLC treated with concurrent chemoradiotherapy

    DEFF Research Database (Denmark)

    Pan, Y.; Brink, C.; Knap, M.

    2015-01-01

    Purpose/Objective: Esophagitis are one of the acute treatment related toxicities to definitive radiotherapy for NSCLC. Most current researches about the risk factors for acute esophagitis are based on 3DCRT. The purpose of this study was to estimate the dose-effect relationship between esophagitis...... and clinical and dosimetric parameters in the patients with local advanced NSCLC receiving IMRT and concomitant chemotherapy (CCT). Materials and Methods: Between 2009 and 2013, 117 patients with stages IIB-IIIB NSCLC enrolled in the multi institution clinical trial NARLAL. All patients were treated with 2...... cycles of induction chemotherapy followed by IMRT and CCT (fixed dose of vinorelbine 50 mg three times per week). The maximal esophagitis grade was prospectively scored using the Common Toxicity Criteria 3.0. Clinical and dosimetric variables were analyzed for the correlation with grade >2 esophagitis...

  11. Outcome of Locally Advanced Esophageal Cancer Treated with Concurrent Chemo-radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Jang, Hyun Soo; Kang, Seung Hee; Jo, Sun Mi; Oh, Young Taek; Chun, Mi Son; Choi, Jin Hyuk; Kang, Seok Yun [Ajou University School of Medicine, Suwon (Korea, Republic of); Lee, Sun Young [Gonyang University School of Medicine, Daejeon (Korea, Republic of)

    2009-06-15

    We investigated the outcome and the prognostic factors of patients with locally advanced esophageal cancer who were treated with concurrent chemo-radiotherapy. Two hundred forty six patients with esophageal cancer that were treated by radiotherapy between January 1994 and July 2007. Of these, 78 patients who received radiotherapy of {>=}45 Gy with concurrent chemotherapy were retrospectively enrolled in this study. We included patients stages IIA, IIB, III, IVA, and IVB with supraclavicular metastasis in the middle/lower esophageal cancer or celiac node metastasis in cervical or upper/middle thoracic esophageal cancer. The median radiation dose was 54 Gy and the combination chemotherapy with 5-FU and cisplatin (FP chemotherapy) was given concurrently with radiotherapy in most patients (88%). The follow-up period ranged from 2 to 117 months (median 14 months). The treatment response of the 54 patients could be evaluated by computerized tomography or endoscopy. A complete response (CR) was observed in 17 patients, whereas a partial response was observed in 18 patients. In patients with a CR, the median recurrence time was 20 months and the first relapse sites constituted a locoregional failure in 3 patients and a distant failure in 7 patients. The 1-, 2-, and 5-year overall survival (OS) rates were 58.9%, 21.7%, and 12.2%, respectively. The median survival period was 14 months. A univariate analysis indicated that the treatment response and cycles of FP chemotherapy were significant prognostic factors for OS. Daily or weekly administration of cisplatin as a radiosensitizer showed a better treatment response than FP chemotherapy. This study has shown that results of concurrent chemo-radiotherapy in patients with locally advanced esophageal cancer is comparable to those of other studies. Daily or weekly cisplatin administration may be considered as an alternative treatment in patients that are medically unfit for FP chemotherapy.

  12. Toxicity outcome in patients treated with modulated arc radiotherapy for localized prostate cancer

    Science.gov (United States)

    Lengua, Rafael E.; Gonzalez, Maria F.; Barahona, Kaory; Ixquiac, Milton E.; Lucero, Juan F.; Montenegro, Erick; Lopez Guerra, Jose L.; Jaén, Javier; Linares, Luis A.

    2013-01-01

    Aim This study evaluates the acute toxicity outcome in patients treated with RapidArc for localized prostate cancer. Background Modern technologies allow the delivery of high doses to the prostate while lowering the dose to the neighbouring organs at risk. Whether this dosimetric advantage translates into clinical benefit is not well known. Materials and methods Between December 2009 and May 2012, 45 patients with primary prostate adenocarcinoma were treated using RapidArc. All patients received 1.8 Gy per fraction, the median dose to the prostate gland, seminal vesicles, pelvic lymph nodes and surgical bed was 80 Gy (range, 77.4–81 Gy), 50.4 Gy, 50.4 Gy and 77.4 Gy (range, 75.6–79.2 Gy), respectively. Results The time between the last session and the last treatment follow up was a median of 10 months (range, 3–24 months). The incidence of grade 3 acute gastrointestinal (GI) and genitourinary (GU) toxicity was 2.2% and 15.5%, respectively. Grade 2 acute GI and GU toxicity occurred in 30% and 27% of patients, respectively. No grade 4 acute GI and GU toxicity were observed. Older patients (>median) or patients with V60 higher than 35% had significantly higher rates of grade ≥2 acute GI toxicity compared with the younger ones. Conclusions RapidArc in the treatment of localized prostate cancer is tolerated well with no Grade >3 GI and GU toxicities. Older patients or patients with higher V60 had significantly higher rates of grade ≥2 acute GI toxicity. Further research is necessary to assess definitive late toxicity and tumour control outcome. PMID:25061516

  13. Immunostimulatory sutures that treat local disease recurrence following primary tumor resection

    Energy Technology Data Exchange (ETDEWEB)

    Intra, Janjira; Zhang Xueqing; Salem, Aliasger K [Division of Pharmaceutics, College of Pharmacy, University of Iowa, Iowa City, IA 52242 (United States); Williams, Robin L; Zhu Xiaoyan [Department of Surgery, Roy J and Lucille Carver College of Medicine, University of Iowa, Iowa City, IA 52242 (United States); Sandler, Anthony D, E-mail: aliasger-salem@uiowa.edu [Department of Surgery and Center for Cancer and Immunology Research, Children' s National Medical Center, Washington DC 20010 (United States)

    2011-02-15

    Neuroblastoma is a common childhood cancer that often results in progressive minimal residual disease after primary tumor resection. Cytosine-phosphorothioate-guanine oligonucleotides (CpG ODN) have been reported to induce potent anti-tumor immune responses. In this communication, we report on the development of a CpG ODN-loaded suture that can close up the wound following tumor excision and provide sustained localized delivery of CpG ODN to treat local disease recurrence. The suture was prepared by melt extruding a mixture of polylactic acid-co-glycolic acid (PLGA 75:25 0.47 dL g{sup -1}) pellets and CpG ODN 1826. Scanning electron microscopy images showed that the sutures were free of defects and cracks. UV spectrophotometry measurements at 260 nm showed that sutures provide sustained release of CpG ODN over 35 days. Syngeneic female A/J mice were inoculated subcutaneously with 1 x 10{sup 6} Neuro-2a murine neuroblastoma wild-type cells and tumors were grown between 5 to 10 mm before the tumors were excised. Wounds from the tumor resection were closed using CpG ODN-loaded sutures and/or polyglycolic acid Vicryl suture. Suppression of neuroblastoma recurrence and mouse survival were significantly higher in mice where wounds were closed using the CpG ODN-loaded sutures relative to all other groups. (communication)

  14. Cleft lip repair under local anaesthesia: experience in two tertiary ...

    African Journals Online (AJOL)

    ) under local anaesthesia. Some patients refuse surgery for fear of general anaesthesia. Indeed local anaesthesia is preferred over general anaesthesia where practicable, but lip repair is commonly done under general anaesthesia.

  15. [Local public health networks. Apropos of an experience].

    Science.gov (United States)

    Guix, Joan; Bocio, Ana; Ferràs, Joaquim; Margalef, Jordi; Osanz, Anna C; Serrano, Mónica; Sentenà, Anna

    2013-01-01

    Public health action on a territory is complex and requires the involvement of multiple actors, who do not always act coordinately. Networks of organizations structures including the whole of the local actors facilitate the generation of synergies and enable greater effectiveness and efficiency of the joint action from the different actors on a same landscape. We present 3 years experience of four Public Health Committees in a region of Catalonia (Spain), composed by the main actors in public health planning. Each of the committees is organized on a plenary and working groups on issues arising from the regional health diagnosis, and coincident with the Health Plan of the Region. Coordination in no case implies the loss or dilution of the firm of the actor generator of intervention initiative in public health, but their empowerment and collaboration by the other actors. In conclusion welcomes the creation of a culture of collaboration and synergies between the different organizations concerned. Lack of specificity is observed in establishing operational objectives, and the need for greater coordination and involvement of the components of the various working groups. Copyright © 2012 SESPAS. Published by Elsevier Espana. All rights reserved.

  16. Localized Epidermal Cysts as a Radiation Recall Phenomenon in a Melanoma Patient Treated with Radiotherapy and the BRAF Inhibitor Vemurafenib

    Directory of Open Access Journals (Sweden)

    Carine Houriet

    2014-09-01

    Full Text Available BRAF inhibitors are broadly used for metastatic melanoma with BRAF mutations. Their use results in various cutaneous side effects, such as the development of keratoacanthomas and squamous cell carcinomas. We report a patient with metastatic melanoma treated with vemurafenib who developed dozens of histologically confirmed epidermal cysts within 2 months after initiation of vemurafenib administration. The cystic lesions were observed only in the localized area where a large exophytic melanoma tumor mass had been previously irradiated. Localized epidermal cysts may constitute an unusual radiation recall reaction in patients treated with BRAF inhibitors.

  17. Thyroidectomy under local anaesthesia: experience with giant goitres

    African Journals Online (AJOL)

    Adele

    Saxe AW, Brown E, Hamburger SW. Thyroid and parthyroid surgery performed with patient under regional anaesthesia. Surgery 1988;. 103:415-20. 7. Ajao OG. Thyroidectomy under local anaesthesia. Tropical Doctor. 1979;. 9:73-75. TABLE 1: SUBTOTAL THYROIDECTOMY DONE UNDER LOCAL ANAESTHESIA:.

  18. Population Engagement and Consultation at the Local Level: Thailand Experience.

    Science.gov (United States)

    Putthasri, Weerasak; Mathurapote, Nanoot; Srisookwattana, Orapan

    2017-01-01

    The World Health Organization handbook on Strategizing National Health in the 21st Century has emphasized the importance of the process of population consultation on needs and expectations. According to Thailand National Health Act 2007, three innovative social tools for participatory healthy public policy process were proposed, i.e., health assembly, health impact assessment and health system statute (charter). In practice, population consultation process is required in the process of the tools implementation. Therefore, this paper aims to illustrate how local health statute implementation supports population participation and consultation at the local level. The first local health statute owned by Cha-lae sub-district in Songkla Province had been introduced in 2009. So far, there are above 500 sub-districts or "Tambon" having their own health system statutes. Tambon Administrative Organization (TAO), health and non-health sectors, community leaders and civil society seemed to be key actors or a mechanism for the local health statute. This demonstrated three crucial elements or sectors for policy development, i.e., policy maker, evidence support and society. Contents of the local health statute are wide ranged, including social determinants, risks and diseases, life style, health services, health fund, to mental and social health in regard to the local problem and context. Therefore, it needs the process of discussion and consultation to seek their common interest and expectation. Local health statute in Thailand is an example of engagement and consultation of the population for health policy. This confirmed the process of population consultation on their needs and expectation that can be implemented both at national and local levels. This is also the strategy to improve the accountability of policy makers for health impacts at all levels of policy making. The challenges of local health statute include the mechanism to maintain and ensure the engagement and

  19. Tumor control outcomes of patients treated with trimodality therapy for locally advanced prostate cancer.

    Science.gov (United States)

    Copp, Hillary; Bissonette, Eric A; Theodorescu, Dan

    2005-06-01

    To evaluate, in a pilot study, the tumor control outcomes of our approach and define the pretreatment characteristics that predict a response to therapy. Patients with advanced clinically localized prostate cancer have a high likelihood of prostate-specific antigen (PSA) failure 3 to 5 years after initial treatment. We adopted trimodality therapy (neoadjuvant and adjuvant androgen ablation, external beam radiotherapy [RT], and a brachytherapy boost) to augment biochemical disease-free survival in this patient population. From 1997 to 2000, 93 patients with clinical Stage T2b or greater, or PSA level greater than 10 ng/mL, or Gleason score 7 or greater were treated with external beam RT followed by palladium-103 brachytherapy. Two to three months before external beam RT, an 8 to 9-month regimen of leuprolide and an oral antiandrogen was initiated. Patients were followed up at 3 to 4-month intervals with PSA determination and digital rectal examination. Perineural invasion, the percentage of cancer in biopsy cores, pretreatment PSA level, clinical T stage, and Gleason score were analyzed as prognostic factors for biochemical failure defined by both the American Society for Therapeutic Radiology and Oncology (ASTRO) criteria and PSA level greater than 0.2 ng/mL. The median length of follow-up was 45 months. The overall probability of biochemical failure using a PSA level greater than 0.2 ng/mL at 4 years was 79% (95% confidence interval 69% to 89%). With the ASTRO criteria, the overall failure rate at the same point was 77% (95% confidence interval 68% to 87%). Gleason score (P = 0.07) showed a trend toward predicting biochemical failure using the PSA level greater than 0.2 ng/mL criterion. Trimodality RT offers excellent tumor control in patients with poor prognosis who often relapse early. Longer follow-up will be important to determine whether these results are durable over time.

  20. Localized Ocular Adnexal Mucosa-Associated Lymphoid Tissue Lymphoma Treated With Radiation Therapy: A Long-Term Outcome in 86 Patients With 104 Treated Eyes

    Energy Technology Data Exchange (ETDEWEB)

    Harada, Ken, E-mail: keharada@ncc.go.jp [Department of Radiation Oncology, National Cancer Center Hospital, Tokyo (Japan); Murakami, Naoya; Kitaguchi, Mayuka; Sekii, Shuhei; Takahashi, Kana; Yoshio, Kotaro; Inaba, Koji; Morota, Madoka; Ito, Yoshinori; Sumi, Minako [Department of Radiation Oncology, National Cancer Center Hospital, Tokyo (Japan); Suzuki, Shigenobu [Department of Ophthalmic Oncology, National Cancer Center Hospital, Tokyo (Japan); Tobinai, Kensei [Department of Hematologic Oncology, National Cancer Center Hospital, Tokyo (Japan); Uno, Takashi [Department of Radiology, Chiba University School of Medicine, Chiba (Japan); Itami, Jun [Department of Radiation Oncology, National Cancer Center Hospital, Tokyo (Japan)

    2014-03-01

    Purpose: To evaluate the natural history, behavior of progression, prognostic factors, and treatment-related adverse effects of primary ocular adnexal mucosa-associated lymphoid tissue (MALT) lymphoma (POAML). Methods and Materials: Eighty-six patients with histologically proven stage I POAML treated with radiation therapy at National Cancer Center Hospital, Tokyo between 1990 and 2010 were retrospectively reviewed. The median age was 56 years (range, 18-85 years). The median dose administered was 30 Gy (range, 30-46 Gy). Seventy-seven patients (90%) were treated by radiation therapy alone. Results: The median follow-up duration was 9 years (range, 0.9-22 years). The 5- and 10-year overall survival (OS) rates were 97.6% and 93.5%, respectively, and no patients died of lymphoma. Patients with tumor sizes ≥4 cm showed a greater risk of contralateral relapse (P=.012). Six patients with contralateral relapse were seen and treated by radiation therapy alone, and all the lesions were controlled well, with follow-up times of 3 to 12 years. There was 1 case of local relapse after radiation therapy alone, and 3 cases of relapse occurred in a distant site. Cataracts developed in 36 of the 65 eyes treated without lens shielding and in 12 of the 39 patients with lens shielding (P=.037). Conclusions: The majority of patients with POAML showed behavior consistent with that of localized, indolent diseases. Thirty gray of local irradiation seems to be quite effective. The initial bilateral involvement and contralateral orbital relapses can be also controlled with radiation therapy alone. Lens shielding reduces the risk of cataract.

  1. Lipid rescue: the use of lipid emulsions to treat local anaesthetic ...

    African Journals Online (AJOL)

    Despite increasing safety of regional anaesthesia, the growth in the popularity therof implies that local anaesthetic toxicity will occur occasionally. Local anaesthetic cardiotoxicity, even when using “safer” modern local anaesthetics, is notoriously resistant to standard resuscitation. The aim of this paper is to review current ...

  2. Solving local problems through local involvement? Experiences from Danish Urban Regeneration

    DEFF Research Database (Denmark)

    Jensen, Jesper Ole

    Over the last decades, the Danish Urban Regeneration Program has – in line with public well-fare politics in general - increasingly turned towards efforts to generate more local involvement in solving local urban problems. Whereas former periods of urban regeneration have been mainly based on top...... agenda, and what can be learned from the development so far. Although ‘local involvement’ is a commonly used term in various urban regeneration programs, it can have many different meanings and implications. Therefore, the paper will discuss local involvement in the urban regeneration based on four...

  3. Comparative Analysis of Experiment Treating Benzene and CEES by Pulse Corona Plasma

    Science.gov (United States)

    Yan, Xuefeng; Hu, Zhen

    2005-08-01

    Based on an experiment treating benzene and 2-chloroethyl ethyl sulfide (CEES) by pulse corona induced-plasma, the similarities and differences found in the experimental data and analytical results are analyzed in a comparative manner in this paper. The theory applied is also discussed.

  4. CCA transport in soil from treated-timber posts: pattern dynamics from the local to regional scale

    Science.gov (United States)

    Clothier, B. E.; Green, S. R.; Vogeler, I.; Greven, M. M.; Agnew, R.; van den Dijssel, C. W.; Neal, S.; Robinson, B. H.; Davidson, P.

    2006-08-01

    Winegrape growing in many parts of the world, including Marlborough, New Zealand, uses treated-timber posts to act as supports for the grapevine's canopy. At a density of 580 posts per hectare, the H4-process treated supports result in an areal loading of CCA of: Copper (12 kg-Cu ha-1), Chromium (21 kg-Cr ha-1) and Arsenic (17 kg-As ha-1). Arsenic is the most mobile and toxic of the CCA-treatment cocktail. We describe experiments which indicate that about 4-6 mg-As month-1 post-1 is released from the subterranean part of the post. We have used SPASMO (Soil Plant Atmosphere System Model) to predict post-to-soil leakage, as well as the pattern dynamics of leaching and exchange around the post. Locally the pattern dynamics of transport and fate are controlled by the soil's chemical characteristics and the prevailing weather. Over its 20-year lifetime, the concentration of arsenic, both that adsorbed on the soil and in the soil solution, exceeds guideline values for soils (100 mg-As kg-1) and drinking water (10 μg-As L-1). Under a regime of 5% annual replacement of posts, the spatially averaged concentration of arsenic leaching through the soil is predicted to rise to 1.25 to 1.7 times the drinking water standard, depending only slightly on the soil type. The steady value is primarily controlled by the arsenic-release rate from the post. These steady values were used in a simple hydrogeological model of the major Marlborough aquifer systems to determine whether the subterranean flow of water could dilute the descending plumes of arsenic coming from above. Except for the sluggish aquifers of the southern valleys in Marlborough, most of the aquifer systems seem capable of diluting the leachate to between one tenth and one twentieth of the drinking water standard. The upscaling of our modelling of the local pattern dynamics spanned six orders of spatial magnitude, and four orders of time dimension.

  5. Dynamic contrast-enhanced MR imaging predicts local control in oropharyngeal or hypopharyngeal squamous cell carcinoma treated with chemoradiotherapy.

    Directory of Open Access Journals (Sweden)

    Shu-Hang Ng

    Full Text Available The role of pretreatment dynamic contrast-enhanced perfusion MR imaging (DCE-PWI and diffusion-weighted MR imaging (DWI in predicting the treatment response of oropharyngeal or hypopharyngeal squamous cell carcinoma (OHSCC to chemoradiation remains unclear. We prospectively investigated the ability of pharmacokinetic parameters derived from pretreatment DCE-PWI and DWI to predict the local control of OHSCC patients treated with chemoradiation. Between August, 2010 and March, 2012, patients with untreated OHSCC scheduled for chemoradiation were eligible for this prospective study. DCE-PWI and DWI were performed in addition to conventional MRI. The relationship of local control with the following clinical and imaging variables was analyzed: the hemoglobin level, T-stage, tumor location, gross tumor volume, maximum standardized uptake value, metabolic tumor volume and total lesion glycolysis on FDG PET/CT, transfer constant (K (trans , volume of blood plasma and volume of extracellular extravascular space on DCE-PWI, and apparent diffusion coefficient on DWI of the primary tumor. The patients were also divided into a local control group and a local failure group, and their clinical and imaging parameters were compared. There were 58 patients (29 with oropharynx squamous cell carcinoma [SCC] and 29 with hypopharynx SCC with successful pretreatment DCE-PWI and DWI available for analysis. After a median follow-up of 18.2 months, 17 (29.3% participants had local failure, whereas the remaining 41 patients achieved local control. Univariate analysis revealed that only the K (trans value was significantly associated with local control (P = 0.03. When the local control and local failure groups were compared, significant differences were observed in K (trans and the tumor location (P = 0.01 and P = 0.04, respectively. In the multivariable analysis, only K (trans was statistically significant (P = 0.04. Our results suggest that pretreatment K (trans may help

  6. Experiment Needs and Facilities Study Appendix A Transient Reactor Test Facility (TREAT) Upgrade

    Energy Technology Data Exchange (ETDEWEB)

    None

    1976-09-01

    The TREAT Upgrade effort is designed to provide significant new capabilities to satisfy experiment requirements associated with key LMFBR Safety Issues. The upgrade consists of reactor-core modifications to supply the physics performance needed for the new experiments, an Advanced TREAT loop with size and thermal-hydraulics capabilities needed for the experiments, associated interface equipment for loop operations and handling, and facility modifications necessary to accommodate operations with the Loop. The costs and schedules of the tasks to be accomplished under the TREAT Upgrade project are summarized. Cost, including contingency, is about 10 million dollars (1976 dollars). A schedule for execution of 36 months has been established to provide the new capabilities in order to provide timely support of the LMFBR national effort. A key requirement for the facility modifications is that the reactor availability will not be interrupted for more than 12 weeks during the upgrade. The Advanced TREAT loop is the prototype for the STF small-bundle package loop. Modified TREAT fuel elements contain segments of graphite-matrix fuel with graded uranium loadings similar to those of STF. In addition, the TREAT upgrade provides for use of STF-like stainless steel-UO{sub 2} TREAT fuel for tests of fully enriched fuel bundles. This report will introduce the Upgrade study by presenting a brief description of the scope, performance capability, safety considerations, cost schedule, and development requirements. This work is followed by a "Design Description". Because greatly upgraded loop performance is central to the upgrade, a description is given of Advanced TREAT loop requirements prior to description of the loop concept. Performance requirements of the upgraded reactor system are given. An extensive discussion of the reactor physics calculations performed for the Upgrade concept study is provided. Adequate physics performance is essential for performance of experiments with

  7. Sustainable Local Development and Environmental Governance: A Strategic Planning Experience

    Directory of Open Access Journals (Sweden)

    Giuseppe Ioppolo

    2016-02-01

    Full Text Available The emphasis on learning and adaptation among different actors at various political administrative levels and on various geographic scales has become a precondition for the emergence of sustainable development. It is possible to find the essential form of collaborative management by using a Strategic Plan, designed to determine a local model of sustainable competitiveness in economic, social and environmental terms. The adoption of a Strategic Plan stimulates a process of shared knowledge, through which it is possible to generate a new environmental governance (EG that is truly representative of a local system. This paper presents, as a case study representative of the Italian context, the Strategic Plan of the Nebrodi area (SP, and assesses the structure of a new form of public and private environmental governance focused on sustainable concern. Finally, the SP could be considered a guideline for managing the local territorial and environmental system from a long-term perspective.

  8. Endoscopic variceal band ligation: a local experience | Jani | East ...

    African Journals Online (AJOL)

    Objective: To evaluate the results of endoscopic variceal band ligation (EVBL) in the local set-up. Design: Retrospective analysis of data of all patients who had EVBL. Setting: Patients having EVBL at the office endoscopy suite. The Nairobi Hospital, the Aga Khan Hospital and M.P Shah Hospital. Methods: The varices were ...

  9. Local Experiences in Decentralization in West and Central Africa ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    Civil society (associations, private sector) has an essential role to play in the implementation of development activities that fall to local communities. But to what extent do current processes of decentralization allow the integration of actors favorable to equitable development in basic social services (water, health, education)? ...

  10. Pharmacovigilance in Calabria (Italy): Local experiences resonate international relevance

    OpenAIRE

    Giuseppe Pimpinella; Loriana Tartaglia

    2013-01-01

    The new European Union (EU) regulations on pharmacovigilance require that the national systems are strengthened in order to fit the new requirements. The Italian Pharmacovigilance System, coordinated by the Italian Medicines Agency (AIFA), is made by local and regional structures. In 2007, a program for funding active pharmacovigilance projects in the Italian Regions was established by the National law. The AIFA is responsible for the preparation of guidelines aimed at the identification of r...

  11. Local stationarity of graph signals: insights and experiments

    OpenAIRE

    Girault, Benjamin; Narayanan, Shrikanth; Ortega, Antonio

    2017-01-01

    International audience; In this paper, we look at one of the most crucial ingredient to graph signal processing: the graph. By taking a step back on the conventional approach using Gaussian weights, we are able to obtain a better spectral representation of a stochastic graph signal. Our approach focuses on learning the weights of the graphs, thus enabling better richness in the structure by incorporating both the distance and the local structure into the weights. Our results show that the gra...

  12. Local investment in renewable energies - European experiences; Investissement local dans les energies renouvelables - recueil d'experiences europeennes

    Energy Technology Data Exchange (ETDEWEB)

    Quantin, J.; Grepmeier, K.; Larsen, J.; Manolakaki, E.; Smith, M

    2004-01-01

    This booklet is realized within the framework of the european commission called PREDAC. This document have been conceived by a working group specialized on the local investment into renewable energies thematic. The objectives of this project are: to promote citizen participation in the financing of renewable energies projects in Europe; to make organizations, investor clubs and local government to be aware of this way of implication into renewable energies development; to examine more especially three renewable energy sources: biomass, photovoltaic and wind in Denmark, France, Germany, Greece and United Kingdom. (author)

  13. Acute esophagitis for patients with local-regional advanced non small cell lung cancer treated with concurrent chemoradiotherapy

    DEFF Research Database (Denmark)

    Pan, Yi; Brink, Carsten; Knap, Marianne

    2016-01-01

    PURPOSE: Esophagitis is common in patients treated with definitive radiotherapy for local-regional advanced non small cell lung cancer (NSCLC). The purpose of this study was to estimate the dose-effect relationship using clinical and dosimetric parameters in patients receiving intensity modulated...... radiotherapy (IMRT) and concomitant chemotherapy (CCT). METHODS: Between 2009 and 2013, 117 patients with stages IIB-IIIB NSCLC were treated in a multicenter randomized phase II trial with 2 cycles of induction chemotherapy followed by IMRT and CCT. The esophagitis was prospectively scored using the Common...

  14. International Students' Views on Local Culture: Turkish Experience

    Science.gov (United States)

    Çetin, Yakup; Bahar, Mustafa; Griffiths, Carol

    2017-01-01

    The number of international students in Turkey has steadily increased in recent years. As they come from different geographical locations, their successful adaptation to a medium sized country in-between three continents is of great interest. This study was conducted to investigate international students' perceptions of their Turkish experience.…

  15. Life experiences in active addiction and in recovery among treated and untreated persons: a national study.

    Science.gov (United States)

    Laudet, Alexandre; Hill, Thomas

    2015-01-01

    Addiction treatment can be effective but fewer than 50% of addiction affected persons are ever treated. Little is known about the addiction and recovery experience of this large subgroup. A national sample of persons in recovery (N = 3,176, 29.5% untreated) was used to begin addressing these questions to inform strategies to encourage help-seeking and to contribute to the small knowledge base on untreated individuals. Study domains were finances, family, social and civic functioning, health, criminal justice involvement, and employment. Treated persons reported significantly greater levels of negative-and fewer positive-experiences in all areas during active addiction than did the untreated group. This gap was significantly narrowed in recovery.

  16. Very Late Local Relapse of Ewing's Sarcoma of the Head and Neck treated with Aggressive Multimodal Therapy

    Directory of Open Access Journals (Sweden)

    J. Thariat

    2008-01-01

    Full Text Available Ewing's sarcoma's relapse rarely occurs more than two years after the initial diagnosis. We report the case of a 26-year-old man with a history of Ewing's sarcoma of the left maxillary sinus at the age of 10 who presented with a very late local relapse, 16 years after the first occurrence of disease. Ultimate control was achieved after multimodal therapy including surgery, high-dose chemotherapy, and radiotherapy. This report indicates that local relapses of Ewing's sarcoma can be treated with curative intent in selected cases.

  17. AB29. The experience in diagnosising and treating rare types of erectile dysfunction

    OpenAIRE

    Chen, Jun; Zhang, Yan; Qi, Tao; Wang, Bo; Zang, Zhijun; Jiang, Manbo; Zhang, Bin

    2014-01-01

    Objective To introduce our experience in diagnosising and treating two types of rare erectile dysfunction (ED). Subjects and methods Type 1: three patients of 20 years old, complicated ED due to instability of the penile base. Physical examination explored slim penile base and penis. Nocturnal penile tumescence (NPT) showed several erectile episodes with the hardness reaching 80-100%. Intracavernous injection (ICI) induced 3-4 grade erectile hardness, but the penis could not keep stable and l...

  18. Experience and needs of family members of patients treated with extracorporeal membrane oxygenation.

    Science.gov (United States)

    Tramm, Ralph; Ilic, Dragan; Murphy, Kerry; Sheldrake, Jayne; Pellegrino, Vincent; Hodgson, Carol

    2017-06-01

    To explore the experiences of family members of patients treated with extracorporeal membrane oxygenation. Sudden onset of an unexpected and severe illness is associated with an increased stress experience of family members. Only one study to date has explored the experience of family members of patients who are at high risk of dying and treated with extracorporeal membrane oxygenation. A qualitative descriptive research design was used. A total of 10 family members of patients treated with extracorporeal membrane oxygenation were recruited through a convenient sampling approach. Data were collected using open-ended semi-structured interviews. A six-step process was applied to analyse the data thematically. Four criteria were employed to evaluate methodological rigour. Family members of extracorporeal membrane oxygenation patients experienced psychological distress and strain during and after admission. Five main themes (Going Downhill, Intensive Care Unit Stress and Stressors, Carousel of Roles, Today and Advice) were identified. These themes were explored from the four roles of the Carousel of Roles theme (decision-maker, carer, manager and recorder) that participants experienced. Nurses and other staff involved in the care of extracorporeal membrane oxygenation patients must pay attention to individual needs of the family and activate all available support systems to help them cope with stress and strain. An information and recommendation guide for families and staff caring for extracorporeal membrane oxygenation patients was developed and needs to be applied cautiously to the individual clinical setting. © 2016 John Wiley & Sons Ltd.

  19. Preliminary results of column experiments simulating nutrients transport in artificial recharge by treated wastewater

    Science.gov (United States)

    Leal, María; Meffe, Raffaella; Lillo, Javier

    2013-04-01

    Nutrients (phosphates, nitrates, nitrites and ammonium) are very often present in treated wastewater as consequence of the inefficient removal capability during wastewater treatments. Such compounds represent an environmental concern since they are responsible for contamination and/or eutrophication problems when reaching the water bodies (groundwater, river, streams…). Therefore, when wastewater reclamation activities such as artificial recharge are planned, special attention should be paid to these compounds to avoid groundwater deterioration. In this context, we proposed the installation of a Horizontal Permeable Reactive Barrier (H-PRB) made of different reactive materials, among them zeolite and palygorskite, to remove nutrients or at least to decrease their concentrations. The overall aim of this research is to evaluate if the application of a H-PRB could represent a feasible solution for the attenuation of nutrients when unconventional water resources (i.e. treated wastewater) are used for recharge activities. Specifically, this study is intended to identify the transport processes affecting nitrates, nitrites, ammonium and phosphates when treated wastewater is infiltrated through the reactive materials of the H-PRB. Column experiments are generally suitable to examine the interactions between reactive materials and treated wastewater that affect the transport behavior of nutrients. For example, processes such as adsorption can be identified and quantified. Thus, laboratory column experiments were carried out using zeolite or palygorskite as column infilling material and synthetic treated wastewater as column influent. The experiments are closely connected to an experimental field study in Carrión de los Céspedes (Seville-Spain) where a pilot H-PRB is currently under evaluation. The columns were operated under saturated conditions applying a constant flow rate of 1.2 mL/min equivalent to the infiltration rate estimated through infiltration experiments at

  20. Outcomes and patterns of care of patients with locally advanced oropharyngeal carcinoma treated in the early 21st century.

    Science.gov (United States)

    Garden, Adam S; Kies, Merrill S; Morrison, William H; Weber, Randal S; Frank, Steven J; Glisson, Bonnie S; Gunn, Gary B; Beadle, Beth M; Ang, K Kian; Rosenthal, David I; Sturgis, Erich M

    2013-01-29

    We performed this study to assess outcomes of patients with oropharyngeal cancer treated with modern therapy approaches. Demographics, treatments and outcomes of patients diagnosed with Stage 3- 4B squamous carcinoma of the oropharynx, between 2000-2007 were tabulated and analyzed. The cohort consisted of 1046 patients. The 5-year actuarial overall survival, recurrence-free survival and local-regional control rates for the entire cohort were 78%, 77% and 87% respectively. More advanced disease, increasing T-stage and smoking were associated with higher rates of local-regional recurrence and poorer survival. Patients with locally advanced oropharyngeal cancer have a relatively high survival rate. Patients' demographics and primary tumor volume were very influential on these favorable outcomes. In particular, patients with small primary tumors did very well even when treatment was not intensified with the addition of chemotherapy.

  1. Outcomes and patterns of care of patients with locally advanced oropharyngeal carcinoma treated in the early 21st century

    Directory of Open Access Journals (Sweden)

    Garden Adam S

    2013-01-01

    Full Text Available Abstract Background We performed this study to assess outcomes of patients with oropharyngeal cancer treated with modern therapy approaches. Methods Demographics, treatments and outcomes of patients diagnosed with Stage 3- 4B squamous carcinoma of the oropharynx, between 2000 – 2007 were tabulated and analyzed. Results The cohort consisted of 1046 patients. The 5- year actuarial overall survival, recurrence-free survival and local-regional control rates for the entire cohort were 78%, 77% and 87% respectively. More advanced disease, increasing T-stage and smoking were associated with higher rates of local-regional recurrence and poorer survival. Conclusions Patients with locally advanced oropharyngeal cancer have a relatively high survival rate. Patients’ demographics and primary tumor volume were very influential on these favorable outcomes. In particular, patients with small primary tumors did very well even when treatment was not intensified with the addition of chemotherapy.

  2. Survival of localized NSCLC patients without active treatment or treated with SBRT

    DEFF Research Database (Denmark)

    Jeppesen, S S; Hansen, N C G; Schytte, T

    2018-01-01

    BACKGROUND: Little information on the natural history of patients with localized NSCLC is available since many of the studies covering the subject lack information on pathological confirmation, staging procedures and comorbidity. No randomized studies have compared SBRT with no treatment for pati...

  3. Parenteral Nutrition for Patients Treated for Locally Advanced Inoperable Tumors of the Head and Neck

    Science.gov (United States)

    2017-09-08

    Squamous Cell Carcinoma of the Hypopharynx Stage III; Squamous Cell Carcinoma of the Hypopharynx Stage IV; Laryngeal Squamous Cell Carcinoma Stage III; Laryngeal Squamous Cell Carcinoma Stage IV; Oropharyngeal Squamous Cell Carcinoma Stage III; Oropharyngeal Squamous Cell Carcinoma Stage IV; Squamous Cell Carcinoma of the Oral Cavity Stage III; Squamous Cell Carcinoma of the Oral Cavity Stage IV; Locally Advanced Malignant Neoplasm

  4. Atypical localizations of hydatid disease: Experience from a single institute

    Directory of Open Access Journals (Sweden)

    Majid Mushtaque

    2012-01-01

    Full Text Available Introduction: The hydatid disease most often involves the liver and the lungs. The disease can involve any part of the body except the hair, teeth and nails. Primary extrahepatico-pulmonary hydatid cysts are rare and only a few sporadic cases have been reported. Materials and Methods: Two hundred and forty-four patients with hydatid cysts managed surgically from January 2005 to December 2009 were evaluated retrospectively. Fourteen (5.7% patients had isolated involvement of the atypical sites, while six (2.4% also had a primary involvement of liver. Results: The cysts were present in gall bladder (0.4%, peritoneum (1.6%, spleen (1.6%, ovary (0.4%, subcutaneous (0.8%, seminal vesicle (0.4%, spinal (0.4%, pancreas (0.4%, kidney (0.4%, mediastinal (0.4%, muscle (0.4%, and brain (0.8%. Discussion and Conclusions: Involvement of sites other than liver and lungs by hydatid disease is rare. Symptoms are related to size, location or possible complication of the cyst. It should be strongly suspected in differential diagnosis of all abdominal cysts especially in an endemic area. Proper surgical and medical management to avoid any recurrences, and a regular follow-up, are of utmost importance to detect any late complications such as local recurrence of the disease and development of hydatidosis at the primary sites.

  5. Stimulus dependence of local field potential spectra: experiment versus theory.

    Science.gov (United States)

    Barbieri, Francesca; Mazzoni, Alberto; Logothetis, Nikos K; Panzeri, Stefano; Brunel, Nicolas

    2014-10-29

    The local field potential (LFP) captures different neural processes, including integrative synaptic dynamics that cannot be observed by measuring only the spiking activity of small populations. Therefore, investigating how LFP power is modulated by external stimuli can offer important insights into sensory neural representations. However, gaining such insight requires developing data-driven computational models that can identify and disambiguate the neural contributions to the LFP. Here, we investigated how networks of excitatory and inhibitory integrate-and-fire neurons responding to time-dependent inputs can be used to interpret sensory modulations of LFP spectra. We computed analytically from such models the LFP spectra and the information that they convey about input and used these analytical expressions to fit the model to LFPs recorded in V1 of anesthetized macaques (Macaca mulatta) during the presentation of color movies. Our expressions explain 60%-98% of the variance of the LFP spectrum shape and its dependency upon movie scenes and we achieved this with realistic values for the best-fit parameters. In particular, synaptic best-fit parameters were compatible with experimental measurements and the predictions of firing rates, based only on the fit of LFP data, correlated with the multiunit spike rate recorded from the same location. Moreover, the parameters characterizing the input to the network across different movie scenes correlated with cross-scene changes of several image features. Our findings suggest that analytical descriptions of spiking neuron networks may become a crucial tool for the interpretation of field recordings. Copyright © 2014 the authors 0270-6474/14/3414589-17$15.00/0.

  6. Localized type Volkmann's contracture treated with tendon transfer and tension-reduced early mobilization

    Science.gov (United States)

    Kaji, Yoshio; Nakamura, Osamu; Yamaguchi, Konosuke; Tobiume, Sachiko; Yamamoto, Tetsuji

    2017-01-01

    Abstract Rationale: For localized type Volkmann's contracture, in which degeneration of the flexor digitorum profundus (FDP) muscle to one or two fingers and restriction of finger extension occur, dissection or excision of the affected muscle is usually recommended. However, these surgical procedures need relatively wide exposure of the muscle, because the FDP muscle is in the deep portion of the forearm. Patient concerns: In this report, the case of a 35-year-old woman with localized type Volkmann's contracture is presented. Her left forearm had been compressed with an industrial roller 4 months earlier, and severe flexion contracture of the long finger and mild flexion contracture of the ring finger developed gradually. Diagnoses: localized type Volkmann's contracture. Intervention: Five months after the injury, transection of the FDP tendon to the long finger and transfer of the transected tendon to the FDP tendon to the index finger was performed after adjusting the tonus of these two tendons using a small skin incision. This procedure was followed by a tension-reduced early mobilization technique in which a tension-reduced position of the tendon suture site was maintained by taping the long finger to the volar side of the index finger, and then immediate active range of motion (ROM) exercise was started. Outcomes: Within 9 weeks after surgery, full ROM had been regained. Lessons: Using the treatment procedure presented in this case report, a good clinical result was obtained in a minimally invasive manner. PMID:28072735

  7. Emergency Psychiatry Experience, Resident Burnout, and Future Plans to Treat Publicly Funded Patients.

    Science.gov (United States)

    Dennis, Nora M; Swartz, Marvin S

    2015-08-01

    This study examined psychiatry resident burnout in emergency departments and its association with residents' posttraining plans to care for Medicaid patients and others publicly insured. Between November and December 2013, psychiatry residents in North Carolina were recruited for a cross-sectional, Internet-based survey concerning emergency department experiences, attitudes about their roles, feelings of burnout, and posttraining intentions to treat Medicaid patients. The completion rate was 51% (N=91). In bivariate analyses (N=82 with an emergency psychiatry rotation), burnout was positively associated with frequent exhaustion (pburnout scores (pemergency department indicated decreased likelihood of treating publicly insured patients after training (Medicaid, odds ratio=.09, pemergency department during psychiatry residency appear to be linked to professional burnout and threaten to shape long-term plans regarding care for publicly insured patients.

  8. Treating patients with traumatic life experiences: providing trauma-informed care.

    Science.gov (United States)

    Raja, Sheela; Hoersch, Michelle; Rajagopalan, Chelsea F; Chang, Priscilla

    2014-03-01

    and Overview Dentists frequently treat patients who have a history of traumatic events. These traumatic events (including childhood sexual abuse, domestic violence, elder abuse and combat history) may influence how patients experience oral health care and may interfere with patients' engagement in preventive care. The purpose of this article is to provide a framework for how dentists can interact sensitively with patients who have survived traumatic events. The authors propose the trauma-informed care pyramid to help engage traumatized patients in oral health care. Evidence indicates that all of the following play an important role in treating traumatized patients: demonstrating strong behavioral and communication skills, understanding the health effects of trauma, engaging in interprofessional collaboration, understanding the provider's own trauma-related experiences and understanding when trauma screening should be used in oral health practice. Dental patients with a history of traumatic experiences are more likely to engage in negative health habits and to display fear of routine dental care. Although not all patients disclose a trauma history to their dentists, some patients might. The trauma-informed care pyramid provides a framework to guide dental care providers in interactions with many types of traumatized patients, including those who choose not to disclose their trauma history in the context of oral health care.

  9. Carers' experiences of dysphagia in people treated for head and neck cancer: a qualitative study.

    Science.gov (United States)

    Nund, Rebecca L; Ward, Elizabeth C; Scarinci, Nerina A; Cartmill, Bena; Kuipers, Pim; Porceddu, Sandro V

    2014-08-01

    The implication of dysphagia for people treated nonsurgically for head and neck cancer (HNC) and its detrimental effects on functioning and quality of life has been well documented. To date, however, there has been a paucity of research on the effects of dysphagia following HNC on carers, independent of the consequences of a gastrostomy. The objective of this qualitative study was to report on the experiences of carers of people with dysphagia (non-gastrostomy dependent) following nonsurgical treatment for HNC and to identify the support needs of this group. A purposive, maximum-variation sampling technique was adopted to recruit 12 carers of people treated curatively for HNC since 2007. Each participated in an in-depth interview, detailing their experience of caring for someone with dysphagia and the associated impact on their life. Thematic analysis was adopted to search the transcripts for key phases and themes that emerged from the discussions. Analysis of the transcripts revealed four themes: (1) dysphagia disrupts daily life, (2) carers make adjustments to adapt to their partner's dysphagia, (3) the disconnect between carers' expectations and the reality of dysphagia, and (4) experiences of dysphagia-related services and informal supports. Carers generally felt ill-prepared for their role in dysphagia management. The qualitative methodology successfully described the impact of dysphagia on the everyday lives of carers, particularly in regard to meal preparation, social events, and family lifestyle. Clinicians should provide adequate and timely training and support to carers and view carers as copartners in dysphagia management.

  10. [Bilateral deep venous thrombosis and vena cava aplasia treated with local thrombolysis

    DEFF Research Database (Denmark)

    Pelta, A.M.; Jørgensen, Maja; Just, Sven Richardt Lundgren

    2008-01-01

    In this case report the treatment of a young man with bilateral iliaco-femoral DVT and vena cava aplasia is presented. The patient was treated with catheter-directed thrombolysis; the catheters were introduced in the thrombus of both legs via v. popliteae. The treatment led to almost complete thr...... thrombus resolution and no valvular incompetence at three months follow-up. In our opinion this treatment should be offered even in complex cases of acute proximal deep venous thrombosis Udgivelsesdato: 2008/5/19...

  11. Analgesic Effect of Botulinum Toxin A in Myofascial Pain Syndrome Patients Previously Treated with Local Infiltration of Anesthetic and Steroids.

    Science.gov (United States)

    Cartagena-Sevilla, Joaquín; García-Fernández, María R; Vicente-Villena, Juan P

    2016-12-01

    The purpose of this study was to evaluate the analgesic effect of botulinum toxin A (BoNTA) injections in patients with myofascial pain syndrome (MPS) who were previously treated with the local infiltration of anesthetic and steroids (LIAS). The study included a retrospective phase and a longitudinal open-label prospective phase, which were conducted on consecutive patients with MPS previously treated with the local infiltration of anesthetic (levobupivacaíne 0.25%) and steroids (triamcinolone 40 mg). Eligible patients were treated with a single intramuscular injection of BoNTA (Botox; Allergan, Inc., Irvine, CA). The treatment efficacy was determined according to the degree of pain relief obtained. Eighty-two patients met the inclusion/exclusion criteria and were included in the study. Successful results were obtained for 32 (39.0%) and 30 (36.6%) patients, during treatment with BoNTA and LIAS, respectively. The mean (standard deviation) length of the analgesic effect was significantly longer with BoNTA (29.6 [SD = 17.7] weeks) than with LIAS (8.5 [SD = 6.4] weeks), P pain for a relatively long time.

  12. [JIN Bohua's experience of peripheral facial paralysis diagnosed and treated by Yifeng (TE 17)].

    Science.gov (United States)

    Zhao, Xinyu; Li, Jing; Wang, Junxia; Zhang, Pengxiang; Huang, Yi

    2017-01-12

    To introduce famous TCM doctor JIN Bohua's experience of peripheral facial paralysis diagnosed and treated by Yifeng (TE 17). Based on holism concept of TCM, Doctor JIN refers to modern medicine and takes Yifeng (TE 17) as the main acupoint for its diagnosis, treatment and prognosis. She determines severe degree according to the pressing pain of Yifeng (TE 17) and the significance of positive substances. She inserts the needle at the acupoint to pharynx and larynx, with 60°~80° from skin. The inserting method is to ensure quick qi arrival and safety. Besides, the manipulations are various according to different stage principles.

  13. Incidence, Causative Mechanisms, and Anatomic Localization of Stroke in Pituitary Adenoma Patients Treated With Postoperative Radiation Therapy Versus Surgery Alone

    Energy Technology Data Exchange (ETDEWEB)

    Sattler, Margriet G.A., E-mail: g.a.sattler@umcg.nl [Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen (Netherlands); Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON (Canada); Vroomen, Patrick C. [Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen (Netherlands); Sluiter, Wim J. [Department of Endocrinology and Metabolic Diseases, University of Groningen, University Medical Center Groningen, Groningen (Netherlands); Schers, Henk J. [Department of Primary and Community Care, Radboud University Nijmegen Medical Centre (Netherlands); Berg, Gerrit van den [Department of Endocrinology and Metabolic Diseases, University of Groningen, University Medical Center Groningen, Groningen (Netherlands); Langendijk, Johannes A. [Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen (Netherlands); Wolffenbuttel, Bruce H.R. [Department of Endocrinology and Metabolic Diseases, University of Groningen, University Medical Center Groningen, Groningen (Netherlands); Bergh, Alphons C.M. van den [Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen (Netherlands); Beek, André P. van [Department of Endocrinology and Metabolic Diseases, University of Groningen, University Medical Center Groningen, Groningen (Netherlands)

    2013-09-01

    Purpose: To assess and compare the incidence of stroke and stroke subtype in pituitary adenoma patients treated with postoperative radiation therapy (RT) and surgery alone. Methods and Materials: A cohort of 462 pituitary adenoma patients treated between 1959 and 2008 at the University Medical Center Groningen in The Netherlands was studied. Radiation therapy was administered in 236 patients. The TOAST (Trial of ORG 10172 in Acute Stroke Treatment) and the Oxfordshire Community Stroke Project classification methods were used to determine causative mechanism and anatomic localization of stroke. Stroke incidences in patients treated with RT were compared with that observed after surgery alone. Risk factors for stroke incidence were studied by log–rank test, without and with stratification for other significant risk factors. In addition, the stroke incidence was compared with the incidence rate in the general Dutch population. Results: Thirteen RT patients were diagnosed with stroke, compared with 12 surgery-alone patients. The relative risk (RR) for stroke in patients treated with postoperative RT was not significantly different compared with surgery-alone patients (univariate RR 0.62, 95% confidence interval [CI] 0.28-1.35, P=.23). Stroke risk factors were coronary or peripheral artery disease (univariate and multivariate RR 10.4, 95% CI 4.7-22.8, P<.001) and hypertension (univariate RR 3.9, 95% CI 1.6-9.8, P=.002). There was no difference in TOAST and Oxfordshire classification of stroke. In this pituitary adenoma cohort 25 strokes were observed, compared with 16.91 expected (standard incidence ratio 1.48, 95% CI 1.00-1.96, P=.049). Conclusions: In pituitary adenoma patients, an increased incidence of stroke was observed compared with the general population. However, postoperative RT was not associated with an increased incidence of stroke or differences in causative mechanism or anatomic localization of stroke compared with surgery alone. The primary stroke risk

  14. Inhibition of sodium currents by local anesthetics in chloramine-T- treated squid axons. The role of channel activation

    Science.gov (United States)

    1987-01-01

    In order to test the requirement of Na channel inactivation for the action of local anesthetics, we investigated the inhibitory effects of quaternary and tertiary amine anesthetics on normally inactivating and noninactivating Na currents in squid axons under voltage clamp. Either the enzymatic mixture pronase, or chloramine-T (CT), a noncleaving, oxidizing reagent, was used to abolish Na channel inactivation. We found that both the local anesthetics QX-314 and etidocaine, when perfused internally at 1 mM, elicited a "tonic" (resting) block of Na currents, a "time-dependent" block that increased during single depolarizations, and a "use-dependent" (phasic) block that accumulated as a result of repetitive depolarizations. All three effects occurred in both control and CT-treated axons. As in previous reports, little time-dependent or phasic block by QX-314 appeared in pronase-treated axons, although tonic block remained. Time-dependent block was greatest and fastest at large depolarizations (Em greater than +60 mV) for both the control and CT-treated axons. The recovery kinetics from phasic block were the same in control and CT-modified axons. The voltage dependence of the steady state phasic block in CT-treated axons differed from that in the controls; an 8-10% reduction of the maximum phasic block and a steepening and shift of the voltage dependence in the hyperpolarizing direction resulted from CT treatment. The results show that these anesthetics can bind rapidly to open Na channels in a voltage-dependent manner, with no requirement for fast inactivation. We propose that the rapid phasic blocking reactions in nerve are consequences primarily of channel activation, mediated by binding of anesthetics to open channels, and that the voltage dependence of phasic block arises directly from that of channel activation. PMID:2438374

  15. Clinical experiences in using cognitive-behavior therapy to treat panic disorder.

    Science.gov (United States)

    Wolf, Abraham W; Goldfried, Marvin R

    2014-01-01

    Although there is a growing body of research to support the use of psychological treatments for specific disorders, there has been no way for practitioners to provide feedback to researchers on the barriers they encounter in implementing these treatments in their day-to-day clinical work. In order to provide practitioners a means to give researchers information about their clinical experience, the Society of Clinical Psychology and the Division of Psychotherapy of the American Psychological Association collaborated on an initiative to build a two-way bridge between practice and research. A questionnaire was developed on the therapist, patient, and contextual variables that undermine the effective use of CBT in reducing the symptoms of panic disorder, a clinical problem that occurs frequently in clinical practice and has an extensive research base. An Internet-based survey was advertised internationally in listservs and professional newsletters, asking clinicians to indicate all aspects of CBT that they used in treating panic disorder, and to respond to a series of questions with variables that presumably limited successful symptom reduction in clinical work using CBT to treat panic disorder. The final database included responses from 338 participants who varied in experience in applying CBT to the treatment of panic disorders. Participants identified a wide range of patient factors that were barriers to symptom reduction, including symptoms related to panic, motivation, social system, and the psychotherapy relationship, in addition to specific problems with implementing CBT for the treatment of panic disorder. © 2013.

  16. Early Toxicity in Patients Treated With Postoperative Proton Therapy for Locally Advanced Breast Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Cuaron, John J. [Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Chon, Brian; Tsai, Henry; Goenka, Anuj; DeBlois, David [Procure Proton Therapy Center, Somerset, New Jersey (United States); Ho, Alice; Powell, Simon [Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Hug, Eugen [Procure Proton Therapy Center, Somerset, New Jersey (United States); Cahlon, Oren, E-mail: cahlono@mskcc.org [Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Procure Proton Therapy Center, Somerset, New Jersey (United States)

    2015-06-01

    Purpose: To report dosimetry and early toxicity data in breast cancer patients treated with postoperative proton radiation therapy. Methods and Materials: From March 2013 to April 2014, 30 patients with nonmetastatic breast cancer and no history of prior radiation were treated with proton therapy at a single proton center. Patient characteristics and dosimetry were obtained through chart review. Patients were seen weekly while on treatment, at 1 month after radiation therapy completion, and at 3- to 6-month intervals thereafter. Toxicity was scored using Common Terminology Criteria for Adverse Events version 4.0. Frequencies of toxicities were tabulated. Results: Median dose delivered was 50.4 Gy (relative biological equivalent [RBE]) in 5 weeks. Target volumes included the breast/chest wall and regional lymph nodes including the internal mammary lymph nodes (in 93%). No patients required a treatment break. Among patients with >3 months of follow-up (n=28), grade 2 dermatitis occurred in 20 patients (71.4%), with 8 (28.6%) experiencing moist desquamation. Grade 2 esophagitis occurred in 8 patients (28.6%). Grade 3 reconstructive complications occurred in 1 patient. The median planning target volume V95 was 96.43% (range, 79.39%-99.60%). The median mean heart dose was 0.88 Gy (RBE) [range, 0.01-3.20 Gy (RBE)] for all patients, and 1.00 Gy (RBE) among patients with left-sided tumors. The median V20 of the ipsilateral lung was 16.50% (range, 6.1%-30.3%). The median contralateral lung V5 was 0.34% (range, 0%-5.30%). The median maximal point dose to the esophagus was 45.65 Gy (RBE) [range, 0-65.4 Gy (RBE)]. The median contralateral breast mean dose was 0.29 Gy (RBE) [range, 0.03-3.50 Gy (RBE)]. Conclusions: Postoperative proton therapy is well tolerated, with acceptable rates of skin toxicity. Proton therapy favorably spares normal tissue without compromising target coverage. Further follow-up is necessary to assess for clinical outcomes and cardiopulmonary

  17. Experiences with treating immigrants: a qualitative study in mental health services across 16 European countries.

    Science.gov (United States)

    Sandhu, Sima; Bjerre, Neele V; Dauvrin, Marie; Dias, Sónia; Gaddini, Andrea; Greacen, Tim; Ioannidis, Elisabeth; Kluge, Ulrike; Jensen, Natasja K; Lamkaddem, Majda; Puigpinós i Riera, Rosa; Kósa, Zsigmond; Wihlman, Ulla; Stankunas, Mindaugas; Straßmayr, Christa; Wahlbeck, Kristian; Welbel, Marta; Priebe, Stefan

    2013-01-01

    While there has been systematic research on the experiences of immigrant patients in mental health services within certain European countries, little research has explored the experiences of mental health professionals in the delivery of services to immigrants across Europe. This study sought to explore professionals' experiences of delivering care to immigrants in districts densely populated with immigrants across Europe. Forty-eight semi-structured interviews were conducted with mental health care professionals working in 16 European countries. Professionals in each country were recruited from three areas with the highest proportion of immigrants. For the purpose of this study, immigrants were defined as first-generation immigrants born outside the country of current residence, including regular immigrants, irregular immigrants, asylum seekers, refugees and victims of human trafficking. Interviews were transcribed and analysed using thematic analysis. The interviews highlighted specific challenges to treating immigrants in mental health services across all 16 countries including complications with diagnosis, difficulty in developing trust and increased risk of marginalisation. Although mental health service delivery varies between and within European countries, consistent challenges exist in the experiences of mental health professionals delivering services in communities with high proportions of immigrants. Improvements to practice should include training in reaching appropriate diagnoses, a focus on building trusting relationships and measures to counter marginalisation.

  18. Experiences of teenagers and young adults treated for cancer in Sweden.

    Science.gov (United States)

    Olsson, Maria; Jarfelt, Marianne; Pergert, Pernilla; Enskär, Karin

    2015-10-01

    Approximately 600 teenagers and young adults, TYAs (ages 15-29), are newly diagnosed with cancer in Sweden every year and treated in many different units. The knowledge about TYAs is limited and there might be a need for a new approach in the care for this particular age group. The purpose of this study was to identify requirements TYAs in Sweden acknowledge as important to them. 44 participants aged 15-29 who were treated at either pediatric or adult cancer units in Sweden, participated in focus group interviews. They were interviewed in groups based on whether they were treated in pediatric (14-18 years old) or adult units (18-29). The focus group interviews were recorded, transcribed, and analyzed using qualitative content analysis. Results of the study can be summarized into four categories: personal professional interaction, knowledge and participation, age-appropriate environment, and support. Important TYA care needs vary over time due to individual situations. The time line of the cancer experience can be described as a continuum; at diagnosis, during treatment, and in life-after cancer treatment. TYAs treated in Sweden have special needs that are not being satisfied, whether at pediatric or adult units. Areas that need closer attention are: close relatives' participation in the care, information on sex and fertility, age-appropriate social physical environments during treatment, and psychosocial support after treatment. In Sweden, there is a demand for increased knowledge on the special needs for TYAs in clinical practice. Copyright © 2015 Elsevier Ltd. All rights reserved.

  19. Clinical implications of local field potentials for understanding and treating movement disorders.

    Science.gov (United States)

    Thompson, John A; Lanctin, David; Ince, Nuri Firat; Abosch, Aviva

    2014-01-01

    Deep brain stimulation (DBS) for the treatment of movement disorders has provided researchers with an opportunity to record electrical oscillatory activity from electrodes implanted in deep brain structures. Extracellular activity recorded from a population of neurons, termed local field potentials (LFPs), has shed light on the pathophysiology of movement disorders and holds the potential to lead to refinement in existing treatments. This paper reviews the clinical significance of LFPs recorded from macroelectrodes implanted in basal ganglia and thalamic targets for the treatment of Parkinson's disease, essential tremor and dystonia. Neural population dynamics and subthreshold events, which are undetectable by single-unit recordings, can be examined with frequency band analysis of LFPs (frequency range: 1-250 Hz). Of clinical relevance, reliable correlations between motor symptoms and components of the LFP power spectrum suggest that LFPs may serve as a biomarker for movement disorders. In particular, Parkinson's rigidity has been shown to correlate with the power of beta oscillations (13-30 Hz), and essential tremor coheres with oscillations of 8-27 Hz. Furthermore, evidence indicates that the optimal contacts for DBS programming can be predicted from the anatomic location of beta and gamma bands (48-200 Hz). LFP analysis has implications for improved electrode targeting and the development of a real-time, individualized, 'closed-loop' stimulation system. 2014 S. Karger AG, Basel.

  20. Keratoacanthoma centrifugum marginatum: unresponsive to oral retinoid and successfully treated with wide local excision.

    Directory of Open Access Journals (Sweden)

    Kapildev Das

    2010-01-01

    Full Text Available We describe a case of a 65-year-old male presenting with a large plaque with a rolled-out interrupted margin, atrophic center, and island of normal skin over the left arm. It grew peripherally with central healing, and there was a history of recurrence after inadequate excision. Investigations ruled out other clin­ical mimickers; namely, squamous cell carcinoma, lupus vulgaris, botryomycosis, and blastomycosis-like pyoderma. Histopathological sections showed irregularly shaped craters filled with keratin and epithelial pearl but no evidence of granuloma or cellular atypia. Clinico­pathological correlation proved the lesion to be keratoacanthoma centrifugum marginatum (KCM, a rare variant of keratoacanthoma, which spreads centrifugally, attains a huge size, and never involutes spontaneously. Treatment of KCM has been a problem always and, in our case, systemic retinoid (acitretin for three months proved ineffective. The patient also had a history of recurrence following surgical intervention previously, necessitating wide excision to achieve complete clearance of tumor cells. Hence, after failure of retinoid therapy, the decision of excision with a 1-centimeter margin was taken and the large defect was closed by a split thickness skin graft. The graft uptake was satisfactory, and the patient is being followed-up presently and shows no signs of recurrence after six months, highlighting wide local excision as a useful treatment option.

  1. An Experiment on Enforcement Strategies for Managing a Local Environment Resource

    Science.gov (United States)

    Murphy, James J.; Cardenas, Juan-Camilo

    2004-01-01

    Managing local environmental resources with moderately enforced government regulations can often be counterproductive, whereas nonbinding communications can be remarkably effective. The authors describe a classroom experiment that illustrates these points. The experiment is rich in its institutional settings and highlights the challenges that…

  2. Systematic approach to treat chronic osteomyelitis through localized drug delivery system: Bench to bed side

    Energy Technology Data Exchange (ETDEWEB)

    Bhattacharya, Rupnarayan [Department of Plastic Surgery, R. G. Kar Medical College and Hospital (RGKMCH), Kolkata 700004 (India); Kundu, Biswanath, E-mail: biswa_kundu@rediffmail.com [Biocermics and Coating Division, CSIR — Central Glass and Ceramic Research Institute (CSIR-CGCRI), Kolkata 700032 (India); Nandi, Samit Kumar, E-mail: samitnandi1967@gmail.com [Department of Veterinary Surgery and Radiology, West Bengal University of Animal and Fishery Sciences (WBUAFS), Kolkata 700037 (India); Basu, Debabrata [Biocermics and Coating Division, CSIR — Central Glass and Ceramic Research Institute (CSIR-CGCRI), Kolkata 700032 (India)

    2013-10-15

    Chronic osteomyelitis is a challenging setback to the orthopedic surgeons in deciding an optimal therapeutic strategy. Conversely, patients feel frustrated of the therapeutic outcomes and development of adverse drug effects, if any. Present investigation deals with extensive approach incorporating in vivo animal experimentation and human application to treat chronic osteomyelitis, using antibiotic loaded porous hydroxyapatite scaffolds. Micro- to macro-porous hydroxyapatite scaffolds impregnated with antibiotic ceftriaxone–sulbactam sodium (CFS) were fabricated and subsequently evaluated by in vivo animal model after developing osteomyelitis in rabbit tibia. Finally 10 nos. of human osteomyelitis patients involving long bone and mandible were studied for histopathology, radiology, pus culture, 3D CT etc. up to 8–18 months post-operatively. It was established up to animal trial stage that 50N50H samples [with 50–55% porosity, average pore size 110 μm, higher interconnectivity (10–100 μm), and moderately high drug adsorption efficiency (50%)] showed efficient drug release up to 42 days than parenteral group based on infection eradication and new bone formation. In vivo human bone showed gradual evidence of new bone formation and fracture union with organized callus without recurrence of infection even after 8 months. This may be a new, alternative, cost effective and ideal therapeutic strategy for chronic osteomyelitis treatment in human patients. - Highlights: • Chronic osteomyelitis is challenging setback to decide optimal therapeutic strategy. • Micro- to macro-porous antibiotic CFS impregnated HAp scaffolds were fabricated. • Complete in vivo animal trial done after developing osteomyelitis in rabbit tibia. • Clinical trial showed fracture union without recurrence of infection after 8 months. • This may be a new, alternative, cost effective and ideal therapeutic strategy.

  3. BRAF Mutation is Associated with Improved Local Control of Melanoma Brain Metastases Treated with Gamma Knife Radiosurgery

    Directory of Open Access Journals (Sweden)

    Ian S Gallaher

    2016-05-01

    Full Text Available Objectives: Evidence has implicated a possible role of tumor mutation status on local control (LC with radiotherapy. BRAF is a proto-oncogene that is mutated in approximately 50% of patients with melanoma. We sought to analyze the influence of BRAF status on LC of melanoma brain metastases following Gamma Knife radiosurgery (GK. Methods: Among 125 patients treated with GK for melanoma brain metastases at our institution between 2006 and 2015, we identified 19 patients with 69 evaluable metastases whose BRAF mutation status was known and follow-up imaging was available. LC of individual metastases was compared based on BRAF mutation status using statistical techniques to control for measurements of multiple metastases within each patient. CNS progression was defined as either local failure or development of new lesions. Results: Of the 69 metastases, BRAF was mutated in 30, and wild-type in 39. With a median follow-up of 30 months for all patients and a median follow-up of 5.5 months for treated lesions, one-year LC was significantly better among metastases with mutated vs. wild-type BRAF (69% vs. 34%, RR = 0.3, 95% CI = 0.1-0.7, p = 0.01. BRAF mutation was found to be a significant predictor of LC after SRS in both univariate (RR=0.3, [95% CI 0.1-0.7, p = 0.01] and multivariate (RR=0.2, [95% CI 0.1-0.7, p = 0.01] analyses. There was also a trend towards improved CNS progression free survival (PFS at one year (26% vs. 0%, p=0.06, favoring BRAF-mutated patients. Conclusions: In this retrospective study, melanoma brain metastases treated with GK had significantly improved local control for patients with BRAF mutation vs. wild-type. Our data suggest that BRAF mutation may sensitize tumors to radiosurgery, and that BRAF wild-type tumors may be more radioresistant. Results: Of the 69 metastases, BRAF was mutated in 30, and wild-type in 39. With a median follow-up of 30 months for all patients and a median follow-up of 5.5 months for treated lesions

  4. Colorectal Histology Is Associated With an Increased Risk of Local Failure in Lung Metastases Treated With Stereotactic Ablative Radiation Therapy

    Energy Technology Data Exchange (ETDEWEB)

    Binkley, Michael S. [Department of Radiation Oncology and Cancer Institute, Stanford University School of Medicine, Stanford, California (United States); Trakul, Nicholas [Department of Radiation Oncology, University of Southern California Keck School of Medicine, Los Angeles, California (United States); Jacobs, Lisa Rose; Eyben, Rie von; Le, Quynh-Thu; Maxim, Peter G.; Loo, Billy W. [Department of Radiation Oncology and Cancer Institute, Stanford University School of Medicine, Stanford, California (United States); Shultz, David Benjamin, E-mail: DavidS4@Stanford.edu [Department of Radiation Oncology and Cancer Institute, Stanford University School of Medicine, Stanford, California (United States); Diehn, Maximilian, E-mail: Diehn@Stanford.edu [Department of Radiation Oncology and Cancer Institute, Stanford University School of Medicine, Stanford, California (United States); Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, California (United States)

    2015-08-01

    Purpose: Stereotactic ablative radiation therapy (SABR) is increasingly used to treat lung oligometastases. We set out to determine the safety and efficacy of this approach and to identify factors associated with outcomes. Methods and Materials: We conducted a retrospective study of patients treated with SABR for metastatic lung tumors at our institution from 2003 to 2014. We assessed the association between various patient and treatment factors with local failure (LF), progression, subsequent treatment, systemic treatment, and overall survival (OS), using univariate and multivariate analyses. Results: We identified 122 tumors in 77 patients meeting inclusion criteria for this study. Median follow-up was 22 months. The 12- and 24-month cumulative incidence rates of LF were 8.7% and 16.2%, respectively; the 24-month cumulative incidence rates of progression, subsequent treatment, and subsequent systemic treatment were 75.2%, 64.5%, and 35.1%, respectively. Twenty-four-month OS was 74.6%, and median OS was 36 months. Colorectal metastases had a significantly higher cumulative incidence of LF at 12 and 24 months (25.5% and 42.2%, respectively), than all other histologies (4.4% and 9.9%, respectively; P<.0004). The 24-month cumulative incidences of LF for colorectal metastases treated with a biologically effective dose at α/β = 10 (BED{sub 10}) of <100 Gy versus BED{sub 10} of ≥100 Gy were 62.5% and 16.7%, respectively (P=.08). Toxicity was minimal, with only a single grade 3 or higher event observed. Conclusions: SABR for metastatic lung tumors appears to be safe and effective with excellent local control, treatment-free intervals, and OS. An exception is metastases from colorectal cancer, which have a high LF rate consistent with a radioresistant phenotype, suggesting a potential role for dose escalation.

  5. Clinical nursing leaders', team members' and service managers' experiences of implementing evidence at a local level.

    Science.gov (United States)

    Kitson, Alison; Silverston, Heidi; Wiechula, Rick; Zeitz, Kathryn; Marcoionni, Danni; Page, Tammy

    2011-05-01

    To describe the experiences of 14 clinical nursing leaders introducing a knowledge translation (KT) project into one metropolitan acute care hospital in South Australia. The study also explored team members' and service managers' experiences. KT strategies assume that local (nursing) clinical leaders have the capacity and capability to champion innovation combining positional leadership roles (ward leader) with a project lead role. There is limited evidence to support these assumptions. Semi-structured interviews of clinical nursing leaders and managers were undertaken at month 4 and 12 of the project. Data were also collected from the interdisciplinary team members (n = 28). Clinical nursing leaders identified risks and anxieties associated with taking on an additional leadership role, whereas managers acknowledged the multiple pressures on the system and the need for local level innovation. Team members generally reported positive experiences. With support, clinical nursing leaders can effectively embrace KT project leadership roles that complement their positional leadership roles. Clinical nursing leaders' experiences differed from nursing and medical managers' experiences.   Managers need to be more attuned to the personal risks local leaders experience, providing support for leaders to experiment and innovate. Managers need to integrate local priorities with broader system wide agendas. © 2011 The Authors. Journal compilation © 2011 Blackwell Publishing Ltd.

  6. Radiological response and survival in locally advanced non-small-cell lung cancer patients treated with three-drug induction chemotherapy followed by radical local treatment

    Science.gov (United States)

    Bonanno, Laura; Zago, Giulia; Marulli, Giuseppe; Del Bianco, Paola; Schiavon, Marco; Pasello, Giulia; Polo, Valentina; Canova, Fabio; Tonetto, Fabrizio; Loreggian, Lucio; Rea, Federico; Conte, PierFranco; Favaretto, Adolfo

    2016-01-01

    Objectives If concurrent chemoradiotherapy cannot be performed, induction chemotherapy followed by radical-intent surgical treatment is an acceptable option for non primarily resectable non-small-cell lung cancers (NSCLCs). No markers are available to predict which patients may benefit from local treatment after induction. This exploratory study aims to assess the feasibility and the activity of multimodality treatment, including triple-agent chemotherapy followed by radical surgery and/or radiotherapy in locally advanced NSCLCs. Methods We retrospectively collected data from locally advanced NSCLCs treated with induction chemotherapy with carboplatin (area under the curve 6, d [day]1), paclitaxel (200 mg/m2, d1), and gemcitabine (1,000 mg/m2 d1, 8) for three to four courses, followed by radical surgery and/or radiotherapy. We analyzed radiological response and toxicity. Estimated progression-free survival (PFS) and overall survival (OS) were correlated to response, surgery, and clinical features. Results In all, 58 NSCLCs were included in the study: 40 staged as IIIA, 18 as IIIB (according to TNM Classification of Malignant Tumors–7th edition staging system). A total of 36 (62%) patients achieved partial response (PR), and six (10%) progressions were recorded. Grade 3–4 hematological toxicity was observed in 36 (62%) cases. After chemotherapy, 37 (64%) patients underwent surgery followed by adjuvant radiotherapy, and two patients received radical-intent radiotherapy. The median PFS and OS were 11 months and 23 months, respectively. Both PFS and OS were significantly correlated to objective response (P<0.0001) and surgery (P<0.0001 and P=0.002). Patients obtaining PR and receiving local treatment achieved a median PFS and OS of 35 and 48 months, respectively. Median PFS and OS of patients not achieving PR or not receiving local treatment were 5–7 and 11–15 months, respectively. The extension of surgery did not affect the outcome. Conclusion The

  7. Thermal-Hydraulic Performance of the TREAT Multi-SERTTA for Reactivity Initiated Accident Experiments

    Energy Technology Data Exchange (ETDEWEB)

    Jensen, Colby B.; Folsom, Charles P.; Davis, Cliff B.; Woolstenhulme, Nicolas E.; Bess, John D.; O' Brien, Robert C.; Ban, Heng; Wachs, Daniel M.

    2016-08-01

    Experimental testing in the Multi-Static Environment Rodlet Transient Test Apparatus (SERTTA) will lead the rebirth of transient fuel testing in the United States as part of the Accident Tolerant Fuels (ATF) progam. The Multi-SERTTA is comprised of four isolated pressurized environments capable of a wide variety of working fluids and thermal conditions. Ultimately, the TREAT reactor as well as the Multi-SERTTA test vehicle serve the purpose of providing desired thermal-hydraulic boundary conditions to the test specimen. The initial ATF testing in TREAT will focus on reactivity insertion accident (RIA) events using both gas and water environments including typical PWR operating pressures and temperatures. For the water test environment, a test configuration is envisioned using the expansion tank as part of the gas-filled expansion volume seen by the test to provide additional pressure relief. The heat transfer conditions during the high energy power pulses of RIA events remains a subject of large uncertainty and great importance for fuel performance predictions. To support transient experiments, the Multi-SERTTA vehicle has been modeled using RELAP5 with a baseline test specimen composed of UO2 fuel in zircaloy cladding. The modeling results show the influence of the designs of the specimen, vehicle, and transient power pulses. The primary purpose of this work is to provide input and boundary conditions to fuel performance code BISON. Therefore, studies of parameters having influence on specimen performance during RIA transients are presented including cladding oxidation, power pulse magnitude and width, cladding-to-coolant heat fluxes, fuel-to-cladding gap, transient boiling effects (modified CHF values), etc. The results show the great flexibility and capacity of the TREAT Multi-SERTTA test vehicle to provide testing under a wide range of prototypic thermal-hydraulic conditions as never done before.

  8. Managed aquifer recharge: the fate of pharmaceuticals from infiltrated treated wastewater investigated through soil column experiments

    Science.gov (United States)

    Silver, Matthew; Selke, Stephanie; Balsaa, Peter; Wefer-Roehl, Annette; Kübeck, Christine; Schüth, Christoph

    2017-04-01

    The EU FP7 project MARSOL addresses water scarcity challenges in arid regions, where managed aquifer recharge (MAR) is an upcoming technology to recharge depleted aquifers using alternative water sources. Within this framework, column experiments were conducted to investigate the fate of pharmaceuticals when secondary treated wastewater (TWW) is infiltrated through a natural soil (organic matter content 6.8%) being considered for MAR. Three parallel experiments were run under conditions of continuous infiltration (one column) and wetting-drying cycles (two columns, with different analytes) over a 16 month time period. The pharmaceuticals diclofenac, ibuprofen, carbamazepine, naproxen, gemfibrozil, and fenoprofen, as well as the antibiotics doxycycline, sulfadimidine, and sulfamethoxazole, are commonly present in treated wastewater in varying concentrations. For the experiments, concentration variability was reduced by spiking the column inflow water with these compounds. Concentrations were periodically analyzed at different depths in each column and the mass passing each depth over the duration of the experiment was calculated. At the end of the experiments, sorbed pharmaceuticals were extracted from soil samples collected from different depths. A pressurized liquid extraction method was developed and resulted in recoveries from spiked post-experiment soil samples ranging from 64% (gemfibrozil) to 82% (carbamazepine) for the six non-antibiotic compounds. Scaling results by these recovery rates, the total mass of pharmaceuticals sorbed to the soil in the columns was calculated and compared to the calculated attenuated mass (i.e. mass that left the water phase). The difference between the attenuated mass and the sorbed mass is considered to be mass that degraded. Results for continuous infiltration conditions indicate that for carbamazepine and diclofenac, sorption is the primary attenuation mechanism, with missing (i.e. degraded) mass lying within the propagated

  9. Experience in treating combat burns in Afghanistan by using silver-nylon dressing.

    Science.gov (United States)

    Pozza, Moreno; Matthew, Pflipsen; Lunardi, Federico

    2014-01-01

    On the battlefield, insidious and devastating weapons like the improvised explosive device (IED) rapidly emit extreme heat (thousands of degrees), create a shock wave (overpressure) that can hurl bodies long distances (inducing secondary fall lesions), and deliver thousands of pieces of shrapnel over hundreds of meters. Very often, Soldiers injured by an IED blast are inside their vehicle. Subsequently, they are exposed to the thermal effects of the blast. Frequently, these patients have complex wounds that consist of extensive burn areas, bone fractures, and internal organ lesions. The use of silver-nylon burn wrap dressing is widely documented for its bactericidal properties. Silverlon® Burn Dressings is an elastic bandage made of nylon and plated with pure metallic silver. In summer 2008, in a U.S. advanced Role 2 facility, two U.S. Soldiers with extensive second- and third-degree burn injuries were successfully treated with the use of Silverlon Burn Dressings and Silverlon® Burn Gloves. From this experience emerged the ease of use silver-nylon dressing in treating badly burned Soldiers on the battlefield. 2014.

  10. [Gradient elevation of temperature startup experiment of thermophilic ASBR treating thermal-hydrolyzed sewage sludge].

    Science.gov (United States)

    Ouyang, Er-Ming; Wang, Wei; Long, Neng; Li, Huai

    2009-04-15

    Startup experiment was conducted for thermophilic anaerobic sequencing batch reactor (ASBR) treating thermal-hydrolyzed sewage sludge using the strategy of the step-wise temperature increment: 35 degrees C-->40 degrees C-->47 degrees C-->53 degrees C. The results showed that the first step-increase (from 35 degrees C to 40 degrees C) and final step-increase (from 47 degrees C to 53 degrees C) had only a slight effect on the digestion process. The second step-increase (from 40 degrees C to 47 degrees C) resulted in a severe disturbance: the biogas production, methane content, CODeffluent and microorganism all have strong disturbance. At the steady stage of thermophilic ASBR treating thermal-hydrolyzed sewage sludge, the average daily gas production, methane content, specific methane production (CH4/CODinfluent), TCOD removal rate and SCOD removal rate were 2.038 L/d, 72.0%, 188.8 mL/g, 63.8%, 83.3% respectively. The results of SEM and DGGE indicated that the dominant species are obviously different at early stage and steady stage.

  11. The Experience of Patients with Schizophrenia Treated with Repetitive Transcranial Magnetic Stimulation for Auditory Hallucinations

    Directory of Open Access Journals (Sweden)

    Priya Subramanian

    2013-01-01

    Full Text Available Introduction. Auditory hallucinations are a common symptom experience of individuals with psychotic disorders and are often experienced as persistent, distressing, and disruptive. This case series examined the lived experiences of four individuals treated (successfully or unsuccessfully with low-frequency (1 Hz rTMS for auditory hallucinations. Methods. A phenomenological approach was used and modified to involve some predetermined data structuring to accommodate for expected cognitive impairments of participants and the impact of rTMS on auditory hallucinations. Data on thoughts and feelings in relation to the helpful, unhelpful, and other effects of rTMS on auditory hallucinations, on well-being, functioning, and the immediate environment were collected using semistructured interviews. Results. All four participants noted some improvements in their well-being following treatment and none reported a worsening of their symptoms. Only two participants noted an improvement in the auditory hallucinations and only one of them reported an improvement that was sustained after treatment completion. Conclusion. We suggest that there are useful findings in the study worth further exploration, specifically in relation to the role of an individual’s acceptance and ownership of the illness process in relation to this biomedical intervention. More mixed methods research is required to examine rTMS for auditory hallucinations.

  12. Local agenda 21. The French experience; Agendas 21 locaux. L'experience francaise

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2002-07-01

    In keeping with the Rio Declaration on Environment and Development, and with the ''Agenda 21'' Action program for the 21 Century, the French Minister of the Environment, in January 1993, and again on 11 May 1994, set up new mechanisms, entitled ''Urban Ecology Charters'' or ''Environmental Charters'', also described as ''Partnership Programmes for Sustainable Development''. Their purpose is to implement a new economic approach which, in the Rio spirit, encourages a sustainable form of development, characterized by the integration of environmental costs. Since 1999, a broad new legal text, the ''Act on Spatial Planning and Sustainable Development Policy'' encourages urban and rural local government to define and run development projects that refer to Chapter 28 of the Action 21 program of Rio. The development of Agenda 21 is now supported by contracts between the State and local authorities of various character, such as the large ''Regions'' (of which there are only 21 in France), local institutions responsible for managing urban agglomerations, smaller ad-hoc rural areas called ''Pays'', and some of the regional natural parks or reserves. Such development projects are required broadly to call upon the participation of, and partnership with concerned private and public stakeholders. They must support modes of production and consumption that are thrifty in resources (energy, water, soil, air, biodiversity), and also socially responsible towards populations of other countries and future generations. (author)

  13. Association of p53 protein expression with responses and survival of patients with locally advanced esophageal carcinoma treated with chemoradiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Muro, Kei; Ohtsu, Atsushi; Boku, Narikazu; Chin, Keisho; Oda, Yasushi; Fujii, Takahiro; Hosokawa, Koichi; Yoshida, Shigeaki [National Cancer Center Hospital East, Kashiwa, Chiba (Japan); Hasebe, Takahiro

    1996-04-01

    Immunohistochemical analysis was performed to determine the clinical role of p53 mutations in patients with locally advanced esophageal carcinomas treated with concurrent chemoradiotherapy. The subjects of this study were 20 patients with previously untreated esophageal carcinomas with evidence of T4 disease and/or distant node metastases. Treatment comprised protracted 5-fluorouracil and 2-h cisplatinum infusions along with radiation treatment with a total radiation dose of 60 Gy. Tumor specimens from 18 of the 20 patients were analyzed immunohistochemically. Mutant p53 protein expression in the biopsy materials from the primary tumors was analyzed by immunohistochemical staining using a polyclonal antibody, RSP53. Expression of p53 was detected immunohistochemically in 10 (56%) of the 18 esophageal tumors, the cancer cell nuclei of which were diffusely stained. There were no significant differences between the patient backgrounds of the p53-`positive` and `negative` groups. Four (40%) of the 10 patients with p53 expression achieved overall complete remissions (CRs) and 7 (70%) of these 10 achieved CRs of their primary tumors. In contrast, none of the 8 p53-negative patients achieved overall CRs and two (25%) achieved CRs of their primary tumors. The CR rates overall and of primary tumors tended to be higher in the p53-positive than negative group, but the differences were not significant. The survival rate for the 10 patients with p53 expression was better than that for the 8 negative ones (P>0.01): their median survival times were 12 and 4.5 months, respectively. Expression of p53 protein may be an indicator of a favorable prognosis in patients with locally advanced esophageal carcinomas treated with concurrent chemoradiotherapy. (author).

  14. Treating Localized Prostate Cancer

    Science.gov (United States)

    ... No. 146. (Prepared by the ECRI Institute–Penn Medicine Evidence-based Practice Center under Contract No. 290-2007-10063.) AHRQ Publication No. 15-EHC004-EF. Rockville, MD: Agency for Healthcare Research ... Library of Medicine and the National Institutes of Health. This summary ...

  15. Injectable hydrogel based on quaternized chitosan, gelatin and dopamine as localized drug delivery system to treat Parkinson's disease.

    Science.gov (United States)

    Ren, Yizhuo; Zhao, Xin; Liang, Xiaofeng; Ma, Peter X; Guo, Baolin

    2017-12-01

    There is still an enormous demand for designing materials to the treatment of Parkinson's disease, and dopamine-based injectable polysaccharide hydrogels as localized drug delivery system have huge potential. Here, we developed a facile approach to prepare dopamine-based and polydopamine crosslinked injectable hydrogels by simply oxidizing a mixture of quaternized chitosan, gelatin and dopamine under physiological conditions. These injectable hydrogels showed stable mechanical strength by rheometer and exhibited good degradability evaluated by in vitro degradation test. The chemical structure and morphology of the hydrogels were characterized by FT-IR and SEM. Dopamine as a drug for treating Parkinson's disease and metronidazole as an anti-inflammatory drug were encapsulated in the hydrogel. The release profiles indicated that the injectable hydrogels have great capacity as a carrier for long-term localized release system for dopamine and metronidazole. Furthermore, the cytocompatibility of the hydrogels was confirmed by cell viability and proliferation assays using mouse L929 fibroblast cells. This work provides a new and facile approach to prepare dopamine-based injectable materials which can be used as long-term injectable sustained release system for dopamine as well as anti-inflammatory drug for Parkinson's treatment. Copyright © 2017 Elsevier B.V. All rights reserved.

  16. Local tumor control and toxicity in HIV-associated anal carcinoma treated with radiotherapy in the era of antiretroviral therapy

    Directory of Open Access Journals (Sweden)

    Lütolf Urs M

    2006-08-01

    Full Text Available Abstract Purpose To investigate the outcome of HIV-seropositive patients under highly active antiretroviral treatment (HAART with anal cancer treated with radiotherapy (RT alone or in combination with standard chemotherapy (CT. Patients and methods Clinical outcome of 81 HIV-seronegative patients (1988 – 2003 and 10 consecutive HIV-seropositive patients under HAART (1997 – 2003 that were treated with 3-D conformal RT of 59.4 Gy and standard 5-fluorouracil and mitomycin-C were retrospectively analysed. 10 TNM-stage and age matched HIV-seronegative patients (1992 – 2003 were compared with the 10 HIV-seropositive patients. Pattern of care, local disease control (LC, overall survival (OS, cancer-specific survival (CSS, and toxicity were assessed. Results RT with or without CT resulted in complete response in 100 % of HIV-seropositive patients. LC was impaired compared to matched HIV-seronegative patients after a median follow-up of 44 months (p = 0.03. OS at 5 years was 70 % in HIV-seropositive patients receiving HAART and 69 % in the matched controls. Colostomy-free survival was 70 % (HIV+ and 100 % (matched HIV- and 78 % (all HIV-. No HIV-seropositive patient received an interstitial brachytherapy boost compared to 42 % of all HIV-seronegative patients and adherence to chemotherapy seemed to be difficult in HIV-seropositive patients. Acute hematological toxicity reaching 50 % was high in HIV-seropositive patients receiving MMC compared with 0 % in matched HIV-seronegative patients (p = 0.05 or 12 % in all HIV-seronegative patients. The rate of long-term side effects was low in HIV-seropositive patients. Conclusion Despite high response rates to organ preserving treatment with RT with or without CT, local tumor failure seems to be high in HIV-positive patients receiving HAART. HIV-seropositive patients are subject to treatment bias, being less likely treated with interstitial brachytherapy boost probably due to HIV-infection, and they are at

  17. Predictors of Severe Acute and Late Toxicities in Patients With Localized Head-and-Neck Cancer Treated With Radiation Therapy

    Energy Technology Data Exchange (ETDEWEB)

    Meyer, Francois, E-mail: francois.meyer@chuq.qc.ca [Laval University Cancer Research Center, Centre hospitalier universitaire de Quebec - L' Hotel-Dieu de Quebec, Quebec (Canada); Fortin, Andre; Wang, Chang Shu [Radiation Therapy Department, Centre hospitalier universitaire de Quebec - L' Hotel-Dieu de Quebec, Quebec (Canada); Liu, Geoffrey [Applied Molecular Oncology, Ontario Cancer Institute/Princess Margaret Hospital, Toronto (Canada); Bairati, Isabelle [Laval University Cancer Research Center, Centre hospitalier universitaire de Quebec - L' Hotel-Dieu de Quebec, Quebec (Canada)

    2012-03-15

    Purpose: Radiation therapy (RT) causes acute and late toxicities that affect various organs and functions. In a large cohort of patients treated with RT for localized head and neck cancer (HNC), we prospectively assessed the occurrence of RT-induced acute and late toxicities and identified characteristics that predicted these toxicities. Methods and Materials: We conducted a randomized trial among 540 patients treated with RT for localized HNC to assess whether vitamin E supplementation could improve disease outcomes. Adverse effects of RT were assessed using the Radiation Therapy Oncology Group Acute Radiation Morbidity Criteria during RT and one month after RT, and the Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer Late Radiation Morbidity Scoring Scheme at six and 12 months after RT. The most severe adverse effect among the organs/tissues was selected as an overall measure of either acute or late toxicity. Grade 3 and 4 toxicities were considered as severe. Stepwise multivariate logistic regression models were used to identify all independent predictors (p < 0.05) of acute or late toxicity and to estimate odds ratios (OR) for severe toxicity with their 95% confidence intervals (CI). Results: Grade 3 or 4 toxicity was observed in 23% and 4% of patients, respectively, for acute and late toxicity. Four independent predictors of severe acute toxicity were identified: sex (female vs. male: OR = 1.72, 95% confidence interval [CI]: 1.06-2.80), Karnofsky Performance Status (OR = 0.67 for a 10-point increment, 95% CI: 0.52-0.88), body mass index (above 25 vs. below: OR = 1.88, 95% CI: 1.22-2.90), TNM stage (Stage II vs. I: OR = 1.91, 95% CI: 1.25-2.92). Two independent predictors were found for severe late toxicity: female sex (OR = 3.96, 95% CI: 1.41-11.08) and weight loss during RT (OR = 1.26 for a 1 kg increment, 95% CI: 1.12-1.41). Conclusions: Knowledge of these predictors easily collected in a clinical setting could help

  18. Cost and appropriateness of treating asthma with fixed-combination drugs in local health care units in Italy

    Science.gov (United States)

    Ruggeri, Isabella; Bragato, Donatello; Colombo, Giorgio L; Valla, Emanuela; Di Matteo, Sergio

    2012-01-01

    Background Bronchial asthma is a chronic airways disease and is considered to be one of the major health problems in the Western world. During the last decade, a significant increase in the use of β2-agonists in combination with inhaled corticosteroids has been observed. The aim of this study was to assess the appropriateness of expenditure on these agents in an asthmatic population treated in a real practice setting. Methods This study used data for a resident population of 635,906 citizens in the integrated patient database (Banca Dati Assistito) of a local health care unit (Milano 2 Azienda Sanitaria Locale) in the Lombardy region over 3 years (2007–2009). The sample included 3787–4808 patients selected from all citizens aged ≥ 18 years entitled to social security benefits, having a prescription for a corticosteroid + β2-agonist combination, and an ATC code corresponding to R03AK, divided into three groups, ie, pressurized (spray) drugs, inhaled powders, and extrafine formulations. Patients with chronic obstructive lung disease were excluded. Indicators of appropriateness were 1–3 packs per year (underdosed, inappropriate), 4–12 packs per year (presumably appropriate), and ≥13 packs per year (overtreatment, inappropriate). Results The corticosteroid + β2-agonist combination per treated asthmatic patient increased from 37% in 2007 to 45% in 2009 for the total of prescribed antiasthma drugs, and 28%–32% of patients used the drugs in an appropriate manner (4–12 packs per years). The cost of inappropriately used packs increased combination drug expenditure by about 40%, leading to inefficient use of health care resources. This trend improved during the 3-year observation period. The mean annual cost per patient was higher for powders (€223.95) and sprays (€224.83) than for extrafine formulation (€142.71). Conclusion Based on this analysis, we suggest implementation of better health care planning and more appropriate prescription practices

  19. Radiological response and survival in locally advanced non-small-cell lung cancer patients treated with three-drug induction chemotherapy followed by radical local treatment

    Directory of Open Access Journals (Sweden)

    Bonanno L

    2016-06-01

    Full Text Available Laura Bonanno,1 Giulia Zago,1 Giuseppe Marulli,2 Paola Del Bianco,3 Marco Schiavon,2 Giulia Pasello,1 Valentina Polo,1,4 Fabio Canova,1 Fabrizio Tonetto,5 Lucio Loreggian,5 Federico Rea,2 PierFranco Conte,1,4 Adolfo Favaretto1 1Medical Oncology Unit 2, Veneto Institute of Oncology IOV-IRCCS, 2Thoracic Surgery Department, University of Padova, 3Clinical Trials and Biostatistics Unit, Veneto Institute of Oncology IOV-IRCCS, 4Department of Surgery, Oncology and Gastroenterology, University of Padova, 5Radiotherapy Unit, Veneto Institute of Oncology IOV-IRCCS, Padova, Italy Objectives: If concurrent chemoradiotherapy cannot be performed, induction chemotherapy followed by radical-intent surgical treatment is an acceptable option for non primarily resectable non-small-cell lung cancers (NSCLCs. No markers are available to predict which patients may benefit from local treatment after induction. This exploratory study aims to assess the feasibility and the activity of multimodality treatment, including triple-agent chemotherapy followed by radical surgery and/or radiotherapy in locally advanced NSCLCs. Methods: We retrospectively collected data from locally advanced NSCLCs treated with induction chemotherapy with carboplatin (area under the curve 6, d [day]1, paclitaxel (200 mg/m2, d1, and gemcitabine (1,000 mg/m2 d1, 8 for three to four courses, followed by radical surgery and/or radiotherapy. We analyzed radiological response and toxicity. Estimated progression-free survival (PFS and overall survival (OS were correlated to response, surgery, and clinical features. Results: In all, 58 NSCLCs were included in the study: 40 staged as IIIA, 18 as IIIB (according to TNM Classification of Malignant Tumors–7th edition staging system. A total of 36 (62% patients achieved partial response (PR, and six (10% progressions were recorded. Grade 3–4 hematological toxicity was observed in 36 (62% cases. After chemotherapy, 37 (64% patients underwent surgery

  20. Functional Opportunities of the School Administration in Municipalities with Local Agencies and Free Municipality Experiments.

    Science.gov (United States)

    Stromberg, Lars

    1987-01-01

    Efforts to achieve greater decentralization, deregulation, and management by objectives in the public sector have left an indelible mark on the school sector in Sweden during the 1980s. The experimental scheme of local agencies and free municipalities illustrates two such reforms. Under the free municipality experiment, a number of municipalities…

  1. Developing Evidence for Action on the Postgraduate Experience: An Effective Local Instrument to Move beyond Benchmarking

    Science.gov (United States)

    Sampson, K. A.; Johnston, L.; Comer, K.; Brogt, E.

    2016-01-01

    Summative and benchmarking surveys to measure the postgraduate student research experience are well reported in the literature. While useful, we argue that local instruments that provide formative resources with an academic development focus are also required. If higher education institutions are to move beyond the identification of issues and…

  2. [Professor Ling Changquan's experience in treating primary liver cancer: an analysis of herbal medication].

    Science.gov (United States)

    Sun, Zhen; Su, Yong-hua; Yue, Xiao-qiang

    2008-12-01

    On the basis of outpatients' medical records concerning primary liver cancer (PLC), data of 552 patients (with 2020 effective prescriptions) from the Outpatient Department of Changhai Hospital treated by Professor Ling Changquan were collected. The nature, flavor and meridian distribution of the herbs used in the prescriptions were summarized by frequency method, and the features of the herbs used according to syndrome differentiation were analyzed by logistic regression. The couple herbs used were analyzed by cluster analysis. All the data were analyzed in combination with the experience of the specialist. It showed that most of the frequently used herbs were herbs for invigorating the spleen to promote appetite, removing toxic materials to inhibit tumor growth, and activating blood circulation to dissipate blood stasis. These herbs are mostly of plain or cool nature, and mainly of sweet, bitter, or acrid taste. It also showed that the most frequently used herbs for qi deficiency were Astragalus membranaceus, Atractylodes macrocephala, and Pseudostellariae; Caulis Spatholobi and Chinese jujube for blood asthenia; Fructus Corni and Ophiopogon japonicus for yin deficiency; Agastache rugosa, Semen Plantaginis and Poria for water-dampness; cape jasmine fruit and baikal skullcap root for heat excess; peach seed and Radix Paeoniae Rubra for blood stasis; Curcuma wenyujin, Akebia trifoliata and Bupleurum chinese for qi stagnation. A total of 19 pairs of couple herbs were summarized by the cluster analysis.

  3. Local experience-dependent changes in the wake EEG after prolonged wakefulness.

    Science.gov (United States)

    Hung, Ching-Sui; Sarasso, Simone; Ferrarelli, Fabio; Riedner, Brady; Ghilardi, M Felice; Cirelli, Chiara; Tononi, Giulio

    2013-01-01

    Prolonged wakefulness leads to a progressive increase in sleep pressure, reflected in a global increase in slow wave activity (SWA, 0.5-4.5 Hz) in the sleep electroencephalogram (EEG). A global increase in wake theta activity (5-9 Hz) also occurs. Recently, it was shown that prolonged wakefulness in rodents leads to signs of "local sleep" in an otherwise awake brain, accompanied by a slow/theta wave (2-6 Hz) in the local EEG that occurs at different times in different cortical areas. Compelling evidence in animals and humans also indicates that sleep is locally regulated by the amount of experience-dependent plasticity. Here, we asked whether the extended practice of tasks that involve specific brain circuits results in increased occurrence of local intermittent theta waves in the human EEG, above and beyond the global EEG changes previously described. Participants recorded with high-density EEG completed 2 experiments during which they stayed awake ≥ 24 h practicing a language task (audiobook listening [AB]) or a visuomotor task (driving simulator [DS]). Sleep laboratory. 16 healthy participants (7 females). Two extended wake periods. Both conditions resulted in global increases in resting wake EEG theta power at the end of 24 h of wake, accompanied by increased sleepiness. Moreover, wake theta power as well as the occurrence and amplitude of theta waves showed regional, task-dependent changes, increasing more over left frontal derivations in AB, and over posterior parietal regions in DS. These local changes in wake theta power correlated with similar local changes in sleep low frequencies including SWA. Extended experience-dependent plasticity of specific circuits results in a local increase of the wake theta EEG power in those regions, followed by more intense sleep, as reflected by SWA, over the same areas.

  4. Community cooperatives and insecticide-treated materials for malaria control: a new experience in Latin America.

    Science.gov (United States)

    Kroeger, Axel; Aviñna, Ana; Ordoñnez-Gonzalez, José; Escandon, Celia

    2002-11-15

    Insecticide-treated materials (ITMs) are effective in substantially reducing the burden of malaria and other vector-borne diseases; but how can high coverage rates of ITMs be achieved and maintained? In south Mexico and on the Pacific and Atlantic coasts of Colombia 14 community-based cooperatives offering three different kinds of ITM services (sale of impregnation services; sale of impregnated nets; production of nets and sale of impregnated nets) were formed and supervised by a national health service (IMSS-SOLIDARIDAD, Mexico) and by an academic institution (the Colombian Institute of Tropical Medicine) along with local district health services. The objectives of this research were to analyse the processes and results of this approach and to identify the favourable and limiting factors. The methods used for data collection and analysis were group discussions, individual and semi-structured interviews with users and non-users of ITMs, individual in-depth interviews with cooperative members and supervisors, checks of sales book and observation of impregnation services. Coverage with unimpregnated nets was above 50% in all study areas. The fastest increase of ITM coverage was achieved through the exclusive sale of impregnation services. Low-cost social marketing techniques were used to increase demand. The large-scale production of nets in two cooperatives was only possible with the aid of an international NGO which ordered impregnated bednets for their target group. A number of favourable and limiting factors relating to the success of ITM cooperatives were identified. Of particular importance for the more successful Mexican cooperatives were: a) support by health services, b) smaller size, c) lesser desire for quick returns and d) lower ITM unit costs. ITM community cooperatives supported and supervised by the health services have good potential in the Latin American context for achieving and maintaining high impregnation rates.

  5. Community cooperatives and insecticide-treated materials for malaria control: a new experience in Latin America

    Directory of Open Access Journals (Sweden)

    Ordoñnez-Gonzalez José

    2002-11-01

    Full Text Available Abstract Background and objectives Insecticide-treated materials (ITMs are effective in substantially reducing the burden of malaria and other vector-borne diseases; but how can high coverage rates of ITMs be achieved and maintained? In south Mexico and on the Pacific and Atlantic coasts of Colombia 14 community-based cooperatives offering three different kinds of ITM services (sale of impregnation services; sale of impregnated nets; production of nets and sale of impregnated nets were formed and supervised by a national health service (IMSS-SOLIDARIDAD, Mexico and by an academic institution (the Colombian Institute of Tropical Medicine along with local district health services. The objectives of this research were to analyse the processes and results of this approach and to identify the favourable and limiting factors. Methods The methods used for data collection and analysis were group discussions, individual and semi-structured interviews with users and non-users of ITMs, individual in-depth interviews with cooperative members and supervisors, checks of sales book and observation of impregnation services. Results Coverage with unimpregnated nets was above 50% in all study areas. The fastest increase of ITM coverage was achieved through the exclusive sale of impregnation services. Low-cost social marketing techniques were used to increase demand. The large-scale production of nets in two cooperatives was only possible with the aid of an international NGO which ordered impregnated bednets for their target group. A number of favourable and limiting factors relating to the success of ITM cooperatives were identified. Of particular importance for the more successful Mexican cooperatives were: a support by health services, b smaller size, c lesser desire for quick returns and d lower ITM unit costs. Conclusions ITM community cooperatives supported and supervised by the health services have good potential in the Latin American context for achieving

  6. Use of 5% lidocaine medicated plaster to treat localized neuropathic pain secondary to traumatic injury of peripheral nerves

    Directory of Open Access Journals (Sweden)

    Correa-Illanes G

    2012-07-01

    Full Text Available Gerardo Correa-Illanes,1 Ricardo Roa,2 José Luis Piñeros,2 Wilfredo Calderón31Rehabilitation Department, 2Burns and Plastic Surgery Department, Hospital del Trabajador, 3Plastic Surgery Department, Hospital del Salvador, Santiago, ChileObjective: The efficacy of 5% lidocaine medicated plaster (LMP has previously been demonstrated in post-traumatic localized neuropathic pain. This study evaluated the use of LMP in localized neuropathic pain secondary to traumatic peripheral nerve injury.Patients and methods: This prospective observational study enrolled patients with traumatic injuries to peripheral nerves that were accompanied by localized neuropathic pain of more than 3 months duration. Demographic variables, pain intensity (measured using the numeric rating scale; NRS, answers to the Douleur Neuropathique 4 (DN4 questionnaire, and the size of the painful area were recorded.Results: Nineteen patients were included, aged (mean ± standard deviation 41.4 ± 15.7 years. Nerve injuries affected the upper (eight patients or lower (11 patients limbs. The mean duration of pain before starting treatment with LMP was 22.6 ± 43.5 months (median 8 months. Mean baseline values included: NRS 6.7 ± 1.6, painful area 17.8 ± 10.4 cm2 (median 18 cm2, and DN4 score 6.7 ± 1.4. The mean duration of treatment with LMP was 19.5 ± 10.0 weeks (median 17.4 weeks. Mean values after treatment were: NRS 2.8 ± 1.5 (≥3 point reduction in 79% of patients, ≥50% reduction in 57.9% of patients and painful area 2.1 ± 2.3 cm2 (median 1 cm2, ≥50% reduction in 94.7% of patients. Functional improvement after treatment was observed in 14/19 patients (73.7%.Conclusion: LMP effectively treated traumatic injuries of peripheral nerves which presented with chronic localized neuropathic pain, reducing both pain intensity and the size of the painful area.Keywords: chronic post-surgical pain, chronic post-traumatic pain, 5% lidocaine medicated plaster, neuropathic pain

  7. Modeling the Test-Retest Statistics of a Localization Experiment in the Full Horizontal Plane.

    Science.gov (United States)

    Morsnowski, André; Maune, Steffen

    2016-10-01

    Two approaches to model the test-retest statistics of a localization experiment basing on Gaussian distribution and on surrogate data are introduced. Their efficiency is investigated using different measures describing directional hearing ability. A localization experiment in the full horizontal plane is a challenging task for hearing impaired patients. In clinical routine, we use this experiment to evaluate the progress of our cochlear implant (CI) recipients. Listening and time effort limit the reproducibility. The localization experiment consists of a 12 loudspeaker circle, placed in an anechoic room, a "camera silens". In darkness, HSM sentences are presented at 65 dB pseudo-erratically from all 12 directions with five repetitions. This experiment is modeled by a set of Gaussian distributions with different standard deviations added to a perfect estimator, as well as by surrogate data. Five repetitions per direction are used to produce surrogate data distributions for the sensation directions. To investigate the statistics, we retrospectively use the data of 33 CI patients with 92 pairs of test-retest-measurements from the same day. The first model does not take inversions into account, (i.e., permutations of the direction from back to front and vice versa are not considered), although they are common for hearing impaired persons particularly in the rear hemisphere. The second model considers these inversions but does not work with all measures. The introduced models successfully describe test-retest statistics of directional hearing. However, since their applications on the investigated measures perform differently no general recommendation can be provided. The presented test-retest statistics enable pair test comparisons for localization experiments.

  8. The Exposure Experience: Ohio River Valley Residents Respond to Local Perfluorooctanoic Acid (PFOA) Contamination.

    Science.gov (United States)

    Judge, J Matthew; Brown, Phil; Brody, Julia Green; Ryan, Serena

    2016-09-01

    This article explores the "exposure experience" of participants who received their personal results in a biomonitoring study for perfluorooctanoic acid. Exposure experience is the process of identifying, understanding, and responding to chemical contamination. When biomonitoring studies report results to participants, those participants generate an exposure experience that identifies hidden contaminants and helps level informational imbalances between polluters and affected communities. Participants welcomed the opportunity to learn their exposure results, reporting no psychological harm following report-back. They wove health, economic, and political considerations into their interpretation of results and their present views of past impact. Participants framed their experiences by a half-century of dependence on the chemical industry's economic benefits, leading them to considerable acceptance of chemical exposure as a tradeoff for jobs and the local economy. Our findings show that the exposure experience is an ongoing process that influences social action, with new activism being generated by exposure and health studies. © American Sociological Association 2016.

  9. Prognostic Factors for Survival and Resection in Patients With Initial Nonresectable Locally Advanced Pancreatic Cancer Treated With Chemoradiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Bjerregaard, Jon K., E-mail: jon.bjerregaard@ouh.regionsyddanmark.dk [Department of Oncology, Odense University Hospital, Odense (Denmark); Institute of Clinical Research, University of Southern Denmark, Odense (Denmark); Mortensen, Michael B. [Department of Surgery, Odense University Hospital, Odense (Denmark); Jensen, Helle A.; Nielsen, Morten [Department of Oncology, Odense University Hospital, Odense (Denmark); Pfeiffer, Per [Department of Oncology, Odense University Hospital, Odense (Denmark); Institute of Clinical Research, University of Southern Denmark, Odense (Denmark)

    2012-07-01

    Background and Purpose: Controversies regarding the optimal therapy for patients with locally advanced pancreatic cancer (LAPC) exist. Although the prognosis as a whole remains dismal, subgroups are known to benefit from intensive therapy, including chemoradiotherapy (CRT). We describe the results in 178 patients treated from 2001 to 2010 and have developed a prognostic model for both survival and the possibility of a subsequent resection in these patients. Methods and Materials: From 2001 until 2010, 178 consecutive patients with LAPC were treated and included in the present study, with CRT consisting of 50 Gy in 27 fractions combined with tegafur-uracil(UFT)/folinic acid(FA). Results: The median survival from diagnosis was 11.5 months. Adverse events of Grade 3 or above were seen in 36% of the patients. Ninety-three percent of the patients completed all fractions. A Cox regression model for survival demonstrated resection (hazard ratio [HR] 0.12; 95% confidence interval [CI], 0.1-0.3) and pre-CRT gemcitabine-based therapy (HR 0.57; 95% CI, 0.4-0.9) as being associated with a favorable outcome, increasing gross tumor volume (HR 1.14; 95% CI, 1.0-1.3) was associated with shorter survival. A logistic regression model showed Stage III disease (odds ratio [OR] 0.16; 95% CI, 0.0-1.1) and abnormal hemoglobin (OR 0.26; 95% CI, 0.0-1.2) as being associated with lower odds of resection. Conclusion: This study confirms the favorable prognosis for patients receiving gemcitabine therapy before CRT and the poor prognosis associated with increasing tumor volume. In addition, CRT in patients with abnormal hemoglobin and Stage III disease rarely induced tumor shrinkage allowing subsequent resection.

  10. Prognostic value of p53 mutations in patients with locally advanced esophageal carcinoma treated with definitive chemoradiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Ito, Tomohiro; Kaneko, Kazuhiro; Makino, Reiko; Ito, Hiroaki; Konishi, Kazuo; Kurahashi, Toshinori; Kitahara, Tadashi; Mitamura, Keiji [Showa Univ., Tokyo (Japan). School of Medicine

    2001-05-01

    A significant correlation has been found between p53 mutation and response to chemotherapy or radiotherapy. To determine the prognostic value of p53 mutation in patients with locally advanced esophageal carcinoma treated with definitive chemoradiotherapy, p53 mutation was analyzed using the biopsied specimens taken for diagnosis. Concurrent chemoradiotherapy was performed for 40 patients with severe dysphagia caused by esophageal squamous cell carcinoma associated with T3 or T4 disease. Chemotherapy consisted of protracted infusion of 5-fluorouracil, combined with an infusion of cisplatinum. Radiation treatment of the mediastinum was administered concomitantly with chemotherapy. The p53 gene mutation was detected by fluorescence-based polymerase chain reaction single-strand conformation polymorphism (PCR-SSCP) methods. DNA sequences were determined for DNA fragments with shifted peaks by SSCP methods. Of the 40 patients, 15 had T3 disease and 25 had T4 disease; 11 patients had M1 lymph node (LYM) disease. Of the 40 patients, 13 (33%) achieved a complete response. The median survival time was 14 months, and the 2-year survival rate was 20%. Among the 40 tumor samples, p53 mutation was detected in 24 tumors (60%). The survival rate in the 24 patients with p53 mutation did not differ significantly from that in the 16 patients without p53 mutation. In contrast, the 15 patients with T3 disease survived longer than the 25 patients with T4 disease (P=0.016); however, the survival rate in the 11 patients with M1 LYM disease did not differ significantly from that in the 29 patients without M1 LYM disease. Concurrent chemoradiotherapy is potentially curative for locally advanced esophageal carcinoma, but p53 genetic abnormality has no impact on prognosis. (author)

  11. Localized fast neutron flux enhancement for damage experiments in a research reactor; Accroissement local du flux rapide pour des experiences de dommages dans un reacteur de recherche

    Energy Technology Data Exchange (ETDEWEB)

    Malouch, F

    2003-06-01

    In irradiation experiments on materials in the core of the Osiris reactor (CEA-Saclay) we seek to increase damage in irradiated samples and to reduce the duration of their stay in the core. Damage is essentially caused by fast neutrons (E {>=} 1 MeV); we have therefore pursued the possibility of a localized increase of their level in an irradiation experiment by using a flux converter device made up of fissile material arranged according to a suitable geometry that allows the converter to receive experiments. We have studied several parameters that are influential in the increase of fast neutron flux within the converter. We have also considered the problem of the converter's cooling in the core and its effect on the operation of the reactor. We have carried out a specific neutron calculation scheme based on the modular 2D-transport code APOLLO2 using a two-level transport method. Experimental validation of the flux calculation scheme was carried out in the ISIS reactor, the mock-up of OSIRIS, by optimizing the loading of fuel elements in the core. The experimental results show that the neutron calculation scheme computes the fluxes in close agreement with the measurements especially the fast flux. This study allows us to master the essential physical parameters needed for the design of a flux converter in an MTR reactor. (author)

  12. Factors Constraining Local Food Crop Production in Indonesia: Experiences from Kulon Progo Regency, Yogyakarta Special Province

    Directory of Open Access Journals (Sweden)

    RADEN RIJANTA

    2013-01-01

    Full Text Available Local food crops are believed to be important alternatives in facing the problems of continuously growing price of food stuff worldwide. There has been a strong bias in national agricultural development policy towards the production of rice as staple food in Indonesia. Local food crops have been neglected in the agricultural development policy in the last 50 years, leading to the dependency on imported commodities and creating a vulnerability in the national food security. This paper aims at assessing the factors constraining local food production in Indonesia based on empirical experiences drawn from a research in Kulon Progo Regency, Yogyakarta Province. The government of Kulon Progo Regency has declared its commitment in the development of local food commodities as a part of its agricultural development policy, as it is mentioned in the long-term and medium-term development planning documents. There is also a head regency decree mandating the use of local food commodities in any official events organized by the government organisations. The research shows that there are at least six policy-related problems and nine technical factors constraining local food crops production in the regency. Some of the policy-related and structural factors hampering the production of local food crops consist of (1 long-term policy biases towards rice, (2 strong biases on rice diet in the community, (3 difficulties in linking policy to practices, (4 lack of information on availability of local food crops across the regency and (5 external threat from the readily available instant food on local market and (6 past contra-productive policy to the production of local food crops. The technical factors constraining local food production comprises (1 inferiority of the food stuff versus the instantly prepared food, (2 difficulty in preparation and risk of contagion of some crops, lack of technology for processing, (3 continuity of supply (some crops are seasonally

  13. Local Experience-Dependent Changes in the Wake EEG after Prolonged Wakefulness

    Science.gov (United States)

    Hung, Ching-Sui; Sarasso, Simone; Ferrarelli, Fabio; Riedner, Brady; Ghilardi, M. Felice; Cirelli, Chiara; Tononi, Giulio

    2013-01-01

    Study Objectives: Prolonged wakefulness leads to a progressive increase in sleep pressure, reflected in a global increase in slow wave activity (SWA, 0.5-4.5 Hz) in the sleep electroencephalogram (EEG). A global increase in wake theta activity (5-9 Hz) also occurs. Recently, it was shown that prolonged wakefulness in rodents leads to signs of “local sleep” in an otherwise awake brain, accompanied by a slow/theta wave (2-6 Hz) in the local EEG that occurs at different times in different cortical areas. Compelling evidence in animals and humans also indicates that sleep is locally regulated by the amount of experience-dependent plasticity. Here, we asked whether the extended practice of tasks that involve specific brain circuits results in increased occurrence of local intermittent theta waves in the human EEG, above and beyond the global EEG changes previously described. Design: Participants recorded with high-density EEG completed 2 experiments during which they stayed awake ≥ 24 h practicing a language task (audiobook listening [AB]) or a visuomotor task (driving simulator [DS]). Setting: Sleep laboratory. Patients or Participants: 16 healthy participants (7 females). Interventions: Two extended wake periods. Measurements and Results: Both conditions resulted in global increases in resting wake EEG theta power at the end of 24 h of wake, accompanied by increased sleepiness. Moreover, wake theta power as well as the occurrence and amplitude of theta waves showed regional, task-dependent changes, increasing more over left frontal derivations in AB, and over posterior parietal regions in DS. These local changes in wake theta power correlated with similar local changes in sleep low frequencies including SWA. Conclusions: Extended experience-dependent plasticity of specific circuits results in a local increase of the wake theta EEG power in those regions, followed by more intense sleep, as reflected by SWA, over the same areas. Citation: Hung CS; Sarasso S

  14. The model of localized business community economic development under limited financial resources: computer model and experiment

    Directory of Open Access Journals (Sweden)

    Berg Dmitry

    2016-01-01

    Full Text Available Globalization processes now affect and are affected by most of organizations, different type resources, and the natural environment. One of the main restrictions initiated by these processes is the financial one: money turnover in global markets leads to its concentration in the certain financial centers, and local business communities suffer from the money lack. This work discusses the advantages of complementary currency introduction into a local economics. By the computer simulation with the engineered program model and the real economic experiment it was proved that the complementary currency does not compete with the traditional currency, furthermore, it acts in compliance with it, providing conditions for the sustainable business community development.

  15. A 10-year experience of outcome in chemotherapy-treated hereditary retinoblastoma.

    Science.gov (United States)

    Bartuma, Katarina; Pal, Niklas; Kosek, Sonja; Holm, Stefan; All-Ericsson, Charlotta

    2014-08-01

    The aim is to report the 10-year retrospective experience of systemic chemotherapy for a population-based group of patients with hereditary retinoblastoma at a national referral centre. The outcomes include control rates, treatment side-effects, adjuvant therapy, failure rate, survival, secondary cancers and visual acuity. All patients (n = 24, 46 eyes) diagnosed with retinoblastoma and treated with systemic chemotherapy at a national referral centre during 2001-2011 were included. Data were extracted from medical records. The patients were followed for a mean of 60 months (range 13-144). Four-six cycles of VEC was administered to all newly diagnosed group B/C/D/E eyes with bilateral disease and 83% (38 of 46) responded to the treatment. None of the patients discontinued chemotherapy because of adverse reactions. Altogether 26% (12 of 46) of the eyes received second-line therapy (other than thermotherapy, cryotherapy and chemotherapy). The failure rate was 35% (16 of 46) and mortality rate 0%. None of the patients developed CNS manifestations (metastases or trilateral retinoblastoma). One of the patients developed a second primary tumour (osteosarcoma) 4 years following retinoblastoma diagnosis. Altogether 17% (4 of 24) patients received radiation therapy, 28% (13 of 46) of the eyes had to be enucleated, and one patient underwent bilateral enucleation. The age-correlated visual acuity was mean of 73% of expected visual acuity. Group A/B retinoblastomas have a distinct chemotherapy response, while group C/D/E tumours do not respond as well. The success rate was 65%; while patients have a good prognosis for life, approximately one-third of all hereditary cases received radiation therapy or underwent enucleation. © 2013 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

  16. Patients’ survival in lung malignancies treated by microwave ablation: our experience on 56 patients

    Energy Technology Data Exchange (ETDEWEB)

    Belfiore, G.; Ronza, F. [Department of Diagnostic Imaging, “S. Anna-S. Sebastiano” Hospital, Via F. Palasciano, 81100 Caserta (Italy); Belfiore, M.P., E-mail: mariapaola.belfiore@virgilio.it [Institute of Radiology, Second University of Naples, Piazza Miraglia, 80138 Naples (Italy); Serao, N.; Di Ronza, G. [Department of Diagnostic Imaging, “S. Anna-S. Sebastiano” Hospital, Via F. Palasciano, 81100 Caserta (Italy); Grassi, R.; Rotondo, A. [Institute of Radiology, Second University of Naples, Piazza Miraglia, 80138 Naples (Italy)

    2013-01-15

    Objectives: We retrospectively evaluated percutaneous CT-guided microwave (MW) ablation safety and efficacy in unresectable lung malignancies focusing on patients’ survival. Materials and methods: All procedures were approved by the hospital ethical committee. From 2008 to 2012 we treated 69 unresectable lesions (44 lung cancer, 25 lung metastases) in 56 patients (35 men/21 women; mean age: 61.5 years). Treatment was performed under CT guidance using 14 G needles with a 3 cm active tip and a 55 W MW generator (Vivawave Microwave Coagulation System; Valley Lab). Treatment was performed at 45 W for 6–10 min. Patients were scheduled for a 3 and 6 month CT follow-up to evaluate lesion diameter and enhancement. Survival rate was evaluated by Kaplan–Meier analysis. Results: Ablation procedures were completed according to protocol in all patients. Pneumothorax occurred in 18 patients and 8 required chest tube. Four lesions (all >4.3 cm) were retreated 20 days after the ablation because of peripheral focal areas of residual tumor. Follow-up CT evaluation showed a decrease in maximum diameter in 44/69 lesions (64%) and in 42/59 lesions (71%) at 3 and 6 months, respectively. In all cases no pathologic enhancement was observed. Cancer-specific mortality yielded a survival rate of 69% at 12 months, 54% at 24 months and 49% at 36 months, respectively. An estimate mean for survival time was 27.8 months with a standard error of 2.8 months (95% confidence interval: 22.4–33.2 months). Conclusion: Based on our experience, MW ablation seems to represent a potential safe and effective percutaneous technique in the treatment of lung malignancies. MW ablation may improve survival in patients not suitable to surgery.

  17. Percutaneous vertebroplasty under local anaesthesia: feasibility regarding patients' experience

    Energy Technology Data Exchange (ETDEWEB)

    Bonnard, Eric; Foti, Pauline; Amoretti, Nicolas [Nice University Hospital, Diagnostic and Interventional Radiology Unit, Nice (France); Kastler, Adrian [Grenoble University Hospital, Neuroradiology and MRI Unit, CLUNI, Grenoble (France)

    2017-04-15

    Evaluate patients' intraoperative experience of percutaneous vertebroplasty (PV) performed without general anaesthesia in order to assess the feasibility of local anaesthesia and simple analgesic medication as pain control protocol. Ninety-five patients who underwent single-site PV were consecutively included in the study between 2011 and 2013. Each procedure was achieved under local anaesthesia and perfusion of paracetamol, tramadol and dolasetron, with combined CT and fluoroscopy guidance. Numeric pain scale (NPS) was collected before, during and after intervention. After intervention, patients were asked to evaluate their experience as ''very bad'', ''bad'', ''fair'', ''good'' or ''very good'', independently of the pain. Indications for vertebroplasty were osteopenic fractures (78 %), aggressive angiomas (13 %) and somatic tumours (9 %). In 76 % of cases, patients' experience was described as ''very good'' (44 %) or ''good'' (32 %), whereas 19 % described it as ''fair'' and 5 % as ''very bad''. Mean operative NPS was 5.5. After intervention, NPS was significantly lower with a decrease of 4.5 points. No differences were found according to the localization, type of lesion, age or sex either in terms of experience or NPS. Percutaneous vertebroplasty is feasible under local anaesthesia alone, with a very good or good experience in 76 % of the patients. (orig.)

  18. MR and CT imaging characteristics and ablation zone volumetry of locally advanced pancreatic cancer treated with irreversible electroporation.

    Science.gov (United States)

    Vroomen, Laurien G P H; Scheffer, Hester J; Melenhorst, Marleen C A M; de Jong, Marcus C; van den Bergh, Janneke E; van Kuijk, Cornelis; van Delft, Foke; Kazemier, Geert; Meijerink, Martijn R

    2017-06-01

    To assess specific imaging characteristics after irreversible electroporation (IRE) for locally advanced pancreatic carcinoma (LAPC) with contrast-enhanced (ce)MRI and ceCT, and to explore the correlation of these characteristics with the development of recurrence. Qualitative and quantitative analyses of imaging data were performed on 25 patients treated with percutaneous IRE for LAPC. Imaging characteristics of the ablation zone on ceCT and ceMRI were assessed over a 6-month follow-up period. Contrast ratio scores between pre- and post-treatment were compared. To detect early imaging markers for treatment failure, attenuation characteristics at 6 weeks were linked to the area of recurrence within 6 months. Post-IRE, diffusion-weighted imaging (DWI)-b800 signal intensities decreased in all cases (p characteristics may be useful to establish technical success and predict treatment outcome. • This study describes imaging characteristics after irreversible electroporation (IRE) for pancreatic adenocarcinoma. • Familiarity with typical post-IRE imaging characteristics helps to interpret ablation zones. • Post-IRE, no central and variable rim enhancement are visible on contrast-enhanced imaging. • DWI-b800 may prove useful to predict early tumour recurrence. • Post-IRE examinations reveal an initial volume increase followed by a decrease.

  19. MR and CT imaging characteristics and ablation zone volumetry of locally advanced pancreatic cancer treated with irreversible electroporation

    Energy Technology Data Exchange (ETDEWEB)

    Vroomen, Laurien G.P.H.; Scheffer, Hester J.; Melenhorst, Marleen C.A.M.; Jong, Marcus C. de; Bergh, Janneke E. van den; Kuijk, Cornelis van; Meijerink, Martijn R. [VU University Medical Center, Department of Radiology and Nuclear Medicine, Amsterdam (Netherlands); Delft, Foke van [VU University Medical Center, Department of Gastroenterology and Hepatology, Amsterdam (Netherlands); Kazemier, Geert [VU University Medical Center, Department of Surgery, Amsterdam (Netherlands)

    2017-06-15

    To assess specific imaging characteristics after irreversible electroporation (IRE) for locally advanced pancreatic carcinoma (LAPC) with contrast-enhanced (ce)MRI and ceCT, and to explore the correlation of these characteristics with the development of recurrence. Qualitative and quantitative analyses of imaging data were performed on 25 patients treated with percutaneous IRE for LAPC. Imaging characteristics of the ablation zone on ceCT and ceMRI were assessed over a 6-month follow-up period. Contrast ratio scores between pre- and post-treatment were compared. To detect early imaging markers for treatment failure, attenuation characteristics at 6 weeks were linked to the area of recurrence within 6 months. Post-IRE, diffusion-weighted imaging (DWI)-b800 signal intensities decreased in all cases (p < 0.05). Both ceMRI and ceCT revealed absent or decreased contrast enhancement, with a hyperintense rim on ceMRI. Ablation zone volume increase was noted on both modalities in the first 6 weeks, followed by a decrease (p < 0.05). In the patients developing tumour recurrence (5/25), a focal DWI-b800 hyperintense spot at 6 weeks predated unequivocal recurrence on CT. The most remarkable signal alterations after pancreatic IRE were shown by DWI-b800 and ceMRI. These early imaging characteristics may be useful to establish technical success and predict treatment outcome. (orig.)

  20. The Prognostic Value of Baseline Lymphocyte, Neutrophil, and Monocyte Counts in Locally Advanced Cervical Carcinoma Treated with Radiation

    Directory of Open Access Journals (Sweden)

    Sareena Singh

    2017-01-01

    Full Text Available Background. To determine the prognostic significance of pretreatment levels of circulating lymphocyte (CLC, neutrophil (CNC, and monocyte (CMC counts in patients with locally advanced cervical carcinoma (CC treated with definitive radiation. Methods. A retrospective, dual-institution review of patients with Stage IB2-IVA CC from 2005 to 2015. Progression-free (PFS and Overall Survival (OS were determined for high and low CLC, CNC, and CMC groups. Multivariate analysis was used to confirm prognostic value of baseline leukocyte counts. Results. 181 patients were included. Median follow-up time was 26 (3–89 months. CNC had no effect on PFS or OS. PFS was similar between CMC groups; however, OS was significantly improved for patients with low CMC (62.5 versus 45.3 months, p=0.016. High CLC was associated with improved PFS (48.5 versus 27.8 months, p=0.048 and OS (58.4 versus 34.9 months, p=0.048. On multivariate analysis, high CNC was associated with increased relapse risk (HR 1.12, p=0.006 and low CLC was associated with increased mortality risk (HR 0.67, p=0.027. Conclusion. This study demonstrates that leukocyte values can provide prognostic information in CC. These hypothesis-generating findings warrant further prospective investigations.

  1. Local construction of small wind turbines : the EOLSenegal Project experience; Vers la construction locale de petits aerogenerateurs : l'experience du projet EOLSenegal

    Energy Technology Data Exchange (ETDEWEB)

    Joulain, C.; Kebe, C.M.F. [Centre International de Formation et de Recherche en Energie Solaire (Senegal); Zambeaux, N. [Agence de l' Environnement et de la Maitrise de l' Energie, Paris (France); Galy, S. [La Fondation Nicola Hulot pour la Nature et l' Homme (France)

    2008-04-15

    The Centre International de Formation et de Recherche en Energie Solaire (CIFRES) is working to set-up a local branch of manufacturers and maintenance staff for small wind turbines destined for producing electricity in Senegal. The EOLSenegal Project stipulates that a minimum of 95 per cent of local materials must be used to manufacture the wind turbines and that all production and maintenance must occur in Senegal. The purpose of the project is to demonstrate the feasibility of rural electrification projects while determining which technology among wind power, solar photovoltaic or biofuel is best suited for contributing to energy independence and the industrial development of the country through job creation. There are multiple applications for wind energy, including domestic lighting; electrification of community buildings; electrification of district housing; pumping for drinking water; the transformation and conservation of agricultural products; driving force for local crafts such as woodworking, metals, sewing, and hairdressing; and, battery recharging for small food appliances. Wind power and solar energy were touted as being the best solution for meeting the electricity needs of rural populations. The first phase of the EOLSenegal Project involves a feasibility study and site selection followed by phase 2 in which the equipment will be installed. The last industrial phase of the project will be based on the experience gained during the first 2 phases with a market study and financial estimate to draw investors. It was concluded that while small wind turbines may solve some of Senegal's electricity needs, they cannot meet the needs alone and should be used in conjunction with other forms of energy such as solar, thermal, biomass or biogas. 4 figs.

  2. Local treatment in unresectable hepatic metastases of carcinoid tumors: Experiences with hepatic artery embolization and radiofrequency ablation

    Directory of Open Access Journals (Sweden)

    van Coevorden Frits

    2005-11-01

    Full Text Available Abstract Background Hepatic metastases of carcinoid tumors cause incapacitating symptoms, but are usually diffuse and therefore unresectable. In this article we evaluate our experiences with local treatment techniques in the management of carcinoid patients with hepatic metastases and failing systemic treatment. Methods Fifteen consecutive carcinoid patients (11 men and 4 women; median age 60 years; range 45–71 years were treated with either hepatic artery embolization (HAE with Ivalon particles or radiofrequency ablation (RFA (percutaneously or intra-operatively. Follow-up evaluation was performed by CT scan and 24-hours urinary 5-HIAA excretions. Results A total of 18 HAE's was performed in 13 patients, while 10 lesions in 3 patients were treated with RFA. Median follow-up was 12.5 months (2 – 25 months. Median duration of symptoms was 22 months (8 – 193 months. Median overall decrease of 5-HIAA excretion 2 months after HAE was 32% with tumor regression on CT-scan in 4 patients (30% and improvement of symptoms with a median duration of 15 months in 3 of them (23%. Embolization led to fatal hepatic failure in one patient. The 3 patients treated with RFA showed a decrease of urinary 5-HIAA values of 34, 81 and 93% respectively, with tumor regression in all of them. Improvement of symptoms was reported in 2 patients up to 25 months. Conclusion Liver embolization performed late in the clinical course had limited effect on symptoms and biochemical and radiological parameters. First experiences with RFA are favorable and might encourage to apply RFA more widely in metastatic carcinoid.

  3. Development of Science and Mathematics Education System Including Teaching Experience of Students in Local Area

    Science.gov (United States)

    Kage, Hiroyuki

    New reformation project on engineering education, which is supported from 2005 to 2008FY by Support Program for Contemporary Educational Needs of Ministry of Education, Culture, Sports, Science and Technology, started in Kyushu Institute of Technology. In this project, teaching experience of students is introduced into the curriculum of Faculty of Engineering. In the curriculum students try to prepare teaching materials and to teach local school pupils with them by themselves. Teaching experience is remarkably effective for them to strengthen their self-dependence and learning motivation. Science Education Center, Science Laboratory and Super Teachers College were also organized to promote the area cooperation on the education of science and mathematics.

  4. Experiences of using a participatory action research approach to strengthen district local capacity in Eastern Uganda

    Science.gov (United States)

    Tetui, Moses; Coe, Anna-Britt; Hurtig, Anna-Karin; Ekirapa-Kiracho, Elizabeth; Kiwanuka, Suzanne N.

    2017-01-01

    ABSTRACT Background: To achieve a sustained improvement in health outcomes, the way health interventions are designed and implemented is critical. A participatory action research approach is applauded for building local capacity such as health management. Thereby increasing the chances of sustaining health interventions. Objective: This study explored stakeholder experiences of using PAR to implement an intervention meant to strengthen the local district capacity. Methods: This was a qualitative study featuring 18 informant interviews and a focus group discussion. Respondents included politicians, administrators, health managers and external researchers in three rural districts of eastern Uganda where PAR was used. Qualitative content analysis was used to explore stakeholders’ experiences. Results: ‘Being awakened’ emerged as an overarching category capturing stakeholder experiences of using PAR. This was described in four interrelated and sequential categories, which included: stakeholder involvement, being invigorated, the risk of wide stakeholder engagement and balancing the risk of wide stakeholder engagement. In terms of involvement, the stakeholders felt engaged, a sense of ownership, felt valued and responsible during the implementation of the project. Being invigorated meant being awakened, inspired and supported. On the other hand, risks such as conflict, stress and uncertainty were reported, and finally these risks were balanced through tolerance, risk-awareness and collaboration. Conclusions: The PAR approach was desirable because it created opportunities for building local capacity and enhancing continuity of interventions. Stakeholders were awakened by the approach, as it made them more responsive to systems challenges and possible local solutions. Nonetheless, the use of PAR should be considered in full knowledge of the undesirable and complex experiences, such as uncertainty, conflict and stress. This will enable adequate preparation and

  5. NASA Cold Land Processes Experiment (CLPX 2002/03): Local scale observation site

    Science.gov (United States)

    Janet Hardy; Robert Davis; Yeohoon Koh; Don Cline; Kelly Elder; Richard Armstrong; Hans-Peter Marshall; Thomas Painter; Gilles Castres Saint-Martin; Roger DeRoo; Kamal Sarabandi; Tobias Graf; Toshio Koike; Kyle McDonald

    2008-01-01

    The local scale observation site (LSOS) is the smallest study site (0.8 ha) of the 2002/03 Cold Land Processes Experiment (CLPX) and is located within the Fraser mesocell study area. It was the most intensively measured site of the CLPX, and measurements here had the greatest temporal component of all CLPX sites. Measurements made at the LSOS were designed to produce a...

  6. Local mechanical properties of LFT injection molded parts: Numerical simulations versus experiments

    Science.gov (United States)

    Desplentere, F.; Soete, K.; Bonte, H.; Debrabandere, E.

    2014-05-01

    In predictive engineering for polymer processes, the proper prediction of material microstructure from known processing conditions and constituent material properties is a critical step forward properly predicting bulk properties in the finished composite. Operating within the context of long-fiber thermoplastics (LFT, length Moldflow Insight 2014 software has been used. In this software, a fiber breakage algorithm for the polymer flow inside the mold is available. Using well known micro mechanic formulas allow to combine the local fiber length with the local orientation into local mechanical properties. Different experiments were performed using a commercially available glass fiber filled compound to compare the measured data with the numerical simulation results. In this investigation, tensile tests and 3 point bending tests are considered. To characterize the fiber length distribution of the polymer melt entering the mold (necessary for the numerical simulations), air shots were performed. For those air shots, similar homogenization conditions were used as during the injection molding tests. The fiber length distribution is characterized using automated optical method on samples for which the matrix material is burned away. Using the appropriate settings for the different experiments, good predictions of the local mechanical properties are obtained.

  7. Local content: worldwide trends and the Brazilian experience in the oil and gas sector; Conteudo local: tendencias mundiais e a experiencia brasileira no setor de oleo e gas

    Energy Technology Data Exchange (ETDEWEB)

    Pedrosa Junior, Oswaldo A.; Guimaraes, Paulo Buarque [Associacao Brasileira dos Produtores Independentes de Petroleo e Gas - ABPIP, Rio de Janeiro, RJ (Brazil); Fernandez y Fernandez, Eloi [Organizacao Nacional da Industria do Petroleo, Rio de Janeiro, RJ (Brazil)

    2008-07-01

    In recent years a trend on increasing requirements for local investments has been observed worldwide in the petroleum industry. Host countries expect to have increasing social and economical benefits from the development of the oil and gas industry. This expectation drives at a more comprehensive concept of local content to include commitment with social, industrial, and technological development. The Brazilian experience has shown a lot of emphasis on local industry development. Initiatives from governmental authorities and the private sector have been implemented to increase the local industry participation in the oil and gas projects. The current regulation focus on the full and fair opportunities for the local suppliers and the local content commitment established in the E and P concession agreements. A key issue on promoting local content initiatives is to assure that the competitiveness of the indigenous industry will be developed and preserved. The constraints on building up the local industry competitiveness will be addressed, focusing on the taxation overburden, lack of adequate local financing, and internal structural aspects affecting industrial productivity. In addition to this, the experiences on measuring local content for offshore construction and drilling are highlighted. Technology development and technical capability have been addressed by incentive programs for the O and G sector. Finally, the technology learning process and the regulatory requirements to invest in R and D programs conducted by Brazilian technological institutions are discussed. (author)

  8. School closures during the 2009 influenza pandemic: national and local experiences

    Science.gov (United States)

    2014-01-01

    Background School closure is a non-pharmaceutical intervention that was considered in many national pandemic plans developed prior to the start of the influenza A(H1N1)pdm09 pandemic, and received considerable attention during the event. Here, we retrospectively review and compare national and local experiences with school closures in several countries during the A(H1N1)pdm09 pandemic. Our intention is not to make a systematic review of country experiences; rather, it is to present the diversity of school closure experiences and provide examples from national and local perspectives. Methods Data were gathered during and following a meeting, organized by the European Centres for Disease Control, on school closures held in October 2010 in Stockholm, Sweden. A standard data collection form was developed and sent to all participants. The twelve participating countries and administrative regions (Bulgaria, China, France, Hong Kong Special Administrative Region (SAR), Italy, Japan, New Zealand, Serbia, South Africa, Thailand, United Kingdom, and United States) provided data. Results Our review highlights the very diverse national and local experiences on school closures during the A(H1N1)pdm09 pandemic. The processes including who was in charge of making recommendations and who was in charge of making the decision to close, the school-based control strategies, the extent of school closures, the public health tradition of responses and expectations on school closure varied greatly between countries. Our review also discusses the many challenges associated with the implementation of this intervention and makes recommendations for further practical work in this area. Conclusions The single most important factor to explain differences observed between countries may have been the different public health practises and public expectations concerning school closures and influenza in the selected countries. PMID:24739814

  9. Collection and Integration of Local Knowledge and Experience through a Collective Spatial Analysis

    Directory of Open Access Journals (Sweden)

    Juan Daniel Castillo-Rosas

    2017-01-01

    Full Text Available This article discusses the convenience of adopting an approach of Collective Spatial Analysis in the P/PGIS processes, with the aim of improving the collection and integration of knowledge and local expertise in decision-making, mainly in the fields of planning and adopting territorial policies. Based on empirical evidence, as a result of the review of scientific articles from the Web of Science database, in which it is displayed how the knowledge and experience of people involved in decision-making supported by P/PGIS are collected and used, a prototype of a WEB-GSDSS application has been developed. This prototype allows a group of people to participate anonymously, in an asynchronous and distributed way, in a decision-making process to locate goods, services, or events through the convergence of their views. Via this application, two case studies for planning services in districts of Ecuador and Italy were carried out. Early results suggest that in P/PGIS local and external actors contribute their knowledge and experience to generate information that afterwards is integrated and analysed in the decision-making process. On the other hand, in a Collective Spatial Analysis, these actors analyse and generate information in conjunction with their knowledge and experience during the process of decision-making. We conclude that, although the Collective Spatial Analysis approach presented is in a subjective and initial stage, it does drive improvements in the collection and integration of knowledge and local experience, foremost among them is an interdisciplinary geo-consensus.

  10. The impact of age on local control in women with pT1 breast cancer treated with conservative surgery and radiation therapy

    NARCIS (Netherlands)

    Jobsen, J.J.; van der Palen, Jacobus Adrianus Maria; Meerwaldt, J.H.

    2001-01-01

    The aim of the study was to evaluate the importance of young age with regard to local control in a prospective cohort of 1085 women with pathological T1 tumours treated with breast conservative treatment (BCT). Patients were divided into two age groups: 40 years or younger, 7.8%, and older than 40

  11. Molluscum contagiosum: to treat or not to treat? Experience with 170 children in an outpatient clinic setting in the northeastern United States.

    Science.gov (United States)

    Basdag, Hatice; Rainer, Barbara M; Cohen, Bernard A

    2015-01-01

    Despite the high prevalence of molluscum contagiosum (MC) in children, epidemiologic data on this common self-limited viral infection is limited. In this report we review our experience with the demographic characteristics, clinical characteristics, management, and time to resolution of MC in 170 children. A retrospective medical chart review and telephone survey were conducted on children younger than 16 years of age evaluated for MC in the Division of Pediatric Dermatology at the Johns Hopkins Children's Center, Baltimore, Maryland, from January 1, 2008, to December 31, 2011. Of 170 children with MC, 51.8% were female and 77.1% were Caucasian. The median age at diagnosis was 5 years and 46.5% had a history of atopic dermatitis (AD). Children with AD had significantly more MC lesions than those without (p children did not receive any treatment. MC lesions completely cleared within 12 months in 45.6% of treated and 48.4% of untreated children and within 18 months in 69.5% of treated and 72.6% of untreated children. Treatment (if any), sex, race, diagnosing physician, number of lesions at diagnosis, number of anatomic locations, or history of AD did not predict time to resolution of MC lesions. MC lesions completely resolved in approximately 50% of children within 12 months and in 70% within 18 months. Treatment did not shorten the time to resolution. © 2015 Wiley Periodicals, Inc.

  12. Local perception of infrequent, extreme upland flash flooding: prisoners of experience?

    Science.gov (United States)

    Hopkins, Jonathan; Warburton, Jeff

    2015-07-01

    The United Kingdom has experienced several exceptional summer flash floods in recent years and there is growing concern about the frequency of such events and the preparedness of the population. This paper uses a case study of the upper Ryedale flash flood (2005) and questionnaire and interview data to assess local perceptions of upland flash flooding. Experience of a major flash flood may not be associated with increased flood risk perception. Despite local residents' awareness of a trend towards wetter summers and more frequent heavy rainfall, the poor maintenance of rivers was more frequently thought to be a more significant factor influencing local flood risk than climate change. Such findings have important implications for the potential success of contemporary national flood policies, which have put greater emphasis on public responsibility for responding to flooding. This study recommends, therefore, the use of fresh participatory approaches to redistribute and raise awareness of locally-held flood knowledge. © 2015 The Author(s). Disasters © Overseas Development Institute, 2015.

  13. Downsizing Chemotherapy for Initially Unresectable Locally Advanced Biliary Tract Cancer Patients Treated with Gemcitabine Plus Cisplatin Combination Therapy Followed by Radical Surgery.

    Science.gov (United States)

    Kato, Atsushi; Shimizu, Hiroaki; Ohtsuka, Masayuki; Yoshitomi, Hideyuki; Furukawa, Katsunori; Takayashiki, Tsukasa; Nakadai, Eri; Kishimoto, Takashi; Nakatani, Yukio; Yoshidome, Hiroyuki; Miyazaki, Masaru

    2015-12-01

    We have treated patients with initially unresectable locally advanced biliary tract cancer (BTC) by administering gemcitabine and have found that surgical resection became feasible in some downsized patients. The aim of this study was to investigate the usefulness of downsizing combination chemotherapy using gemcitabine plus cisplatin to treat initially unresectable locally advanced BTC. The subjects of the study were 150 consecutive patients who were treated for BTC between October 2011 and April 2014. Downsizing chemotherapy was carried out for 39 patients (26.0 %) whose lesions were unresectable because of locally advanced BTC. Reduction in tumor size with downsizing chemotherapy was seen in 18 patients, and surgical resection was performed in 10 of 39 patients (25.6 %). Median survival time in patients with surgical resection following downsizing chemotherapy and those with chemotherapy alone was 17.9 and 12.4 months, respectively (p = 0.0378). According to the historical comparison between gemcitabine and gemcitabine plus cisplatin chemotherapy, there is no significant difference in overall survival. However, there was a significant difference for the pathologic response rate (≥Grade III) to be higher in patients with gemcitabine plus cisplatin chemotherapy compared with gemcitabine monotherapy. Preoperative downsizing chemotherapy with gemcitabine plus cisplatin provides longer survival by the conversion to the surgical resection in patients with initially unresectable locally advanced BTC. It may have the potential for disease eradication as a new multidisciplinary approach for initially unresectable locally advanced BTC.

  14. Histologic and systemic prognosticators for local control and survival in margin-negative transoral laser microsurgery treated oral cavity squamous cell carcinoma.

    Science.gov (United States)

    Sinha, Parul; Mehrad, Mitra; Chernock, Rebecca D; Lewis, James S; El-Mofty, Samir K; Wu, Ningying; Nussenbaum, Brian; Haughey, Bruce H

    2015-01-01

    Appreciable local recurrence rates observed in patients with margin-negative, transoral laser microsurgery (TLM)-treated oral cavity squamous cell carcinoma (SCC) necessitate identification of new prognosticators for local control and survival. A histopathologic index (Brandwein-Gensler score [BGS]) and intrinsic/iatrogenic/chronic conditions causing immune compromise are investigated. From a prospectively assembled database of TLM-treated oral cavity SCC, specimens for 60 patients with a minimum of 2-years follow-up could undergo BGS assignment. Local control, disease-specific survival (DSS), and overall survival (OS) were study endpoints. "Low-BGS" was recorded in 28 patients (47%) and "high-BGS" in 32 patients (53%), whereas immune compromise was observed in 18%. In multivariate analyses, immune compromise was the only predictor for local control. T classification and immune compromise were prognostic for DSS and OS. "High-BGS" was prognostic only for OS. "High-BGS" was associated with recurrences but immune compromise was the most significant predictor of local control and survival in margin-negative, TLM-treated oral cavity SCC. Strategies that maintain/restore tumor-specific immune responses in immune compromised oral cavity SCC hosts need to be developed. © 2014 Wiley Periodicals, Inc.

  15. Treating internet addiction with cognitive-behavioral therapy: a thematic analysis of the experiences of therapists.

    NARCIS (Netherlands)

    Rooij, A.J. van; Zinn, M.F.; Schoenmakers, T.M.; Mheen, D. van de

    2012-01-01

    In 2009, one of the major Dutch addiction care organizations initiated a pilot program to explore the possibility of using an existing Cognitive Behavioral Therapy and Motivational Interviewing based treatment program (‘Lifestyle Training’) to treat internet addiction. The current study evaluates

  16. Closed mallet thumb injury: Our experience of 10 patients treated with surgery and a systematic review.

    Science.gov (United States)

    Abe, Yoshihiro; Rokkaku, Tomoyuki; Tokunaga, Susumu; Yamada, Toshiyuki; Okamoto, Seiji

    2016-06-01

    This retrospective study reports 10 patients with closed mallet thumb injury treated with surgery and compares the clinical outcomes achieved with those of previously described patients who were treated with either conservative therapy or surgery. We report the outcomes of a series of 10 patients who received surgical treatment at our institutions. Due to the rarity of closed mallet thumb, a systematic review was conducted, and the results of a literature search were compared with our case series to strengthen our conclusions. The previously described patients were categorized into two groups: the surgically treated group (16 patients) and the conservatively treated group (10 patients). The following patient and injury characteristics were documented: age, gender, injured side, time from injury to treatment, mechanism of injury, extension lag at first visit, postoperative range of motion (ROM) of the interphalangeal joint, immobilization period, and follow-up period. Statistical analyses showed no significant differences in the clinical results, except for shorter immobilization periods between our series and the previously described patients involving conservative treatment (4.9 ± 0.9 vs. 9.5 ± 2.3 weeks, respectively; P = 0.0053). This study suggests that surgery may result in more rapid recovery. Copyright © 2016 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  17. Treating Internet Addiction with Cognitive-Behavioral Therapy: A Thematic Analysis of the Experiences of Therapists

    Science.gov (United States)

    van Rooij, Antonius J.; Zinn, Mieke F.; Schoenmakers, Tim M.; van de Mheen, Dike

    2012-01-01

    In 2009, one of the major Dutch addiction care organizations initiated a pilot program to explore the possibility of using an existing Cognitive Behavioral Therapy and Motivational Interviewing based treatment program ("Lifestyle Training") to treat internet addiction. The current study evaluates this pilot treatment program by providing…

  18. [Experiment study on ultrashort wave for treating vascular crisis after rat tail replantation].

    Science.gov (United States)

    Tan, Long; Gao, Wenshan; Xi, Ali; Wang, Cong; Chen, Shouying; Zhao, Yanyan; Di, Keqian; Yang, Xincai; Weng, Shengbin

    2012-10-01

    To explore the effect and mechanism of ultrashort wave (USW) for prevention and treatment of vascular crisis after rat tail replantation. Eighty 3-month old female Sprague Dawley rats (weighing 232.8-289.6 g) were randomly divided into 5 groups. In each group, based on the caudal vein and the coccyx was retained, the tail was cut off. The tail artery was ligated in group A; the tail artery was anastomosed in groups B, C, D, and E to establish the tail replantation model. After surgery, the rats of group B were given normal management; the rats of group C were immediately given intraperitoneal injection (3.125 mL/kg) of diluted papaverine hydrochloride injection (1 mg/mL); the rats of groups D and E were immediately given the local USW treatment (once a day) at anastomotic site for 5 days at the dosage of 3 files and 50 mA for 20 minutes (group D) and 2 files and 28 mA for 20 minutes (group E). The survival rate of the rat tails was observed for 10 days after the tail replantation. The tail skin temperature difference between proximal and distal anastomosis was measured at pre- and post-operation; the change between postoperative and preoperative temperature difference was calculated. The blood plasma specimens were collected from the inner canthus before operation and from the tip of the tail at 8 hours after operation to measure the content of nitric oxide (NO). The survival rates of the rat tails were 0 (0/14), 36.4% (8/22), 57.1% (8/14), 22.2% (4/18), and 75.0% (9/12) in groups A, B, C, D, and E, respectively, showing significant overall differences among 5 groups (chi2 = 19.935, P = 0.001); the survival rate of group E was significantly higher than that of group B at 7 days (P 0.05). At preoperation, there was no significant difference in tail skin temperature difference among 5 groups (P > 0.05); at 8 hours, 5 days, 6 days, and 7 days after operation, significant overall difference was found in the change of the skin temperature difference among groups (P

  19. The role of FDG PET/CT in patients treated with neoadjuvant chemotherapy for localized bone sarcomas

    Energy Technology Data Exchange (ETDEWEB)

    Palmerini, Emanuela; Marchesi, Emanuela; Paioli, Anna; Ferrari, Stefano [Istituto Ortopedico Rizzoli, Chemotherapy, Bologna (Italy); Colangeli, Marco; Donati, Davide; Cevolani, Luca; De Paolis, Massimiliano [Istituto Ortopedico Rizzoli, Orthopaedic Surgery, Bologna (Italy); Nanni, Cristina; Fanti, Stefano; Cambioli, Silvia [Sant' Orsola Hospital, Nuclear Medicine, Bologna (Italy); Picci, Piero [Istituto Ortopedico Rizzoli, Research Laboratory, Bologna (Italy); Gambarotti, Marco [Istituto Ortopedico Rizzoli, Surgical Pathology, Bologna (Italy); Istituto Ortopedico Rizzoli, Radiology, Musculoskeletal Oncology Department, Bologna (Italy)

    2017-02-15

    The histological response to neoadjuvant chemotherapy is an important prognostic factor in patients with osteosarcoma (OS) and Ewing sarcoma (EWS). The aim of this study was to assess baseline primary tumour FDG uptake on PET/CT, and serum values of alkaline phosphatase (ALP) and lactate dehydrogenase (LDH), to establish whether these factors are correlated with tumour necrosis and prognosis. Patients treated between 2009 and 2014 for localized EWS and OS, who underwent FDG PET/CT as part of their staging work-up, were included. The relationships between primary tumour SUVmax at baseline (SUV1), SUVmax after induction chemotherapy (SUV2), metabolic response calculated as [(SUV1 - SUV2)/(SUV1)] x 100, LDH and ALP and tumour response/survival were analysed. A good response (GR) was defined as tumour necrosis >90 % in patients with OS, and grade II-III Picci necrosis (persistence of microscopic foci only or no viable tumor) in patients with Ewing sarcoma. The study included 77 patients, 45 with EWS and 32 with OS. A good histological response was achieved in 53 % of EWS patients, and 41 % of OS patients. The 3-year event-free survival (EFS) was 57 % in EWS patients and 48 % OS patients. The median SUV1 was 5.6 (range 0 - 17) in EWS patients and 7.9 (range 0 - 24) in OS patients (p = 0.006). In EWS patients the GR rate was 30 % in those with a high SUV1 (≥6) and 72 % in those with a lower SUV1 (p = 0.0004), and in OS patients the GR rate was 29 % in those with SUV1 ≥6 and 64 % in those with a lower SUV1 (p = 0.05). In the univariate analysis the 3-year EFS was significantly better in patients with a low ALP level (59 %) than in those with a high ALP level (22 %, p = 0.02) and in patients with a low LDH level (62 %) than in those with a high LDH level (37 %, p = 0.004). In EWS patients the 3-year EFS was 37 % in those with a high SUV1 and 75 % in those with a low SUV1 (p = 0.004), and in OS patients the 3-year EFS was 32 % in those with a high SUV1 and 66 % in those

  20. Comparison of weight changes in patients treated with different antidepressants: clinical experiences in Taiwanese patients.

    Science.gov (United States)

    Su, Jian-An; Tsang, Hin-Yeung

    2006-01-01

    Psychiatric patients are more likely to gain weight when prescribed antipsychotics or antidepressants. Studies on these issues in Taiwan are scarce. This study compared weight changes in patients treated with NaSSA (Noradrenergic and Specific Serotonergic Antidepressant) and SSRIs (Selective Serotonin Reuptake Inhibitors), and investigated possible associated factors. An observational, non-randomized study was conducted on all patients diagnosed with depression attending the out-patient's clinic at a general hospital. Patients treated with NaSSA or SSRIs were monitored for 24 weeks. Forty-Seven patients (27 patients on NaSSA and 20 on SSRIs) completed the study. Patients taking NaSSA gained an average of 1.87 kg (SD: 4.14, median: 1.0, range: -3.5 to 11.0) at the end of the study, compared to 1.83 kg (SD: 3.78; median: 1.5, range: -7.0 to 8.0) for the SSRIs group. No statistically significant difference existed between the two groups. However, patients who had never previously been treated with either SSRIs or NaSSA exhibited significantly greater weight gain (4.84 kg, SD: 3.20, median: 4.75, range: 0 to 11.0) than those who had previously been treated (-0.78 kg, SD: 2.36, median: -0.5, range: -7.0 to 3.5). Low initial body mass index and concomitant medications also seemed to be linked to weight gain. Significant weight gain occurred in those patients who had not been previously treated with NaSSA or SSRIs. Patients should be informed of this possibility before initiating treatment, especially those with low body mass index and those prescribed co-medications. Furthermore, the treatment program should include weight monitoring, nutritional assessment and counseling.

  1. Incidence, causative mechanisms, and anatomic localization of stroke in pituitary adenoma patients treated with postoperative radiation therapy versus surgery alone

    NARCIS (Netherlands)

    Sattler, Margriet; Vroomen, Patrick; Sluiter, Wim J.; Schers, Henk J.; van den Berg, Gerrit; Langendijk, Johannes A.; Wolffenbuttel, Bruce H. R.; van den Bergh, Alphons C. M.; van Beek, Andre P.

    2013-01-01

    PURPOSE: To assess and compare the incidence of stroke and stroke subtype in pituitary adenoma patients treated with postoperative radiation therapy (RT) and surgery alone. METHODS AND MATERIALS: A cohort of 462 pituitary adenoma patients treated between 1959 and 2008 at the University Medical

  2. [Traditional Chinese medicine inheritance system analysis of professor Ding Yuanqing in treating tic disorder medication based on experience].

    Science.gov (United States)

    Sun, Lu-yan; Li, Qing-peng; Zhao, Li-li; Ding, Yuan-qing

    2015-08-01

    In recent years, the incidence of tic disorders has increased, and it is not uncommon for the patients to treat the disease. The pathogenesis and pathogenesis of Western medicine are not yet clear, the clinical commonly used western medicine has many adverse reactions, traditional Chinese medicine (TCM) research is increasingly valued. Based on the software of TCM inheritance assistant system, this paper discusses Ding Yuanqing's experience in treating tic disorder with Professor. Collect yuan Qing Ding professor in treating tic disorder of medical records by association rules Apriori algorithm, complex system entropy clustering without supervision and data mining method, carries on the analysis to the selected 800 prescriptions, to determine the frequency of use of prescription drugs, the association rules between the drug and digging out the 12 core combination and the first six new prescription, medication transferred to the liver and extinguish wind, cooling blood and relieving convulsion, Qingxin soothe the nerves, with the card cut, flexible application, strict compatibility.

  3. Mycorrhizal symbiosis and local adaptation in Aster amellus: a field transplant experiment.

    Science.gov (United States)

    Pánková, Hana; Raabová, Jana; Münzbergová, Zuzana

    2014-01-01

    Many plant populations have adapted to local soil conditions. However, the role of arbuscular mycorrhizal fungi is often overlooked in this context. Only a few studies have used reciprocal transplant experiments to study the relationships between soil conditions, mycorrhizal colonisation and plant growth. Furthermore, most of the studies were conducted under controlled greenhouse conditions. However, long-term field experiments can provide more realistic insights into this issue. We conducted a five-year field reciprocal transplant experiment to study the relationships between soil conditions, arbuscular mycorrhizal fungi and plant growth in the obligate mycotrophic herb Aster amellus. We conducted this study in two regions in the Czech Republic that differ significantly in their soil nutrient content, namely Czech Karst (region K) and Ceske Stredohori (region S). Plants that originated from region S had significantly higher mycorrhizal colonisation than plants from region K, indicating that the percentage of mycorrhizal colonisation has a genetic basis. We found no evidence of local adaptation in Aster amellus. Instead, plants from region S outperformed the plants from region K in both target regions. Similarly, plants from region S showed more mycorrhizal colonisation in all cases, which was likely driven by the lower nutrient content in the soil from that region. Thus, plant aboveground biomass and mycorrhizal colonisation exhibited corresponding differences between the two target regions and regions of origin. Higher mycorrhizal colonisation in the plants from region with lower soil nutrient content (region S) in both target regions indicates that mycorrhizal colonisation is an adaptive trait. However, lower aboveground biomass in the plants with lower mycorrhizal colonisation suggests that the plants from region K are in fact maladapted by their low inherent mycorrhizal colonization. We conclude that including mycorrhizal symbiosis in local adaptation studies

  4. Mycorrhizal symbiosis and local adaptation in Aster amellus: a field transplant experiment.

    Directory of Open Access Journals (Sweden)

    Hana Pánková

    Full Text Available Many plant populations have adapted to local soil conditions. However, the role of arbuscular mycorrhizal fungi is often overlooked in this context. Only a few studies have used reciprocal transplant experiments to study the relationships between soil conditions, mycorrhizal colonisation and plant growth. Furthermore, most of the studies were conducted under controlled greenhouse conditions. However, long-term field experiments can provide more realistic insights into this issue. We conducted a five-year field reciprocal transplant experiment to study the relationships between soil conditions, arbuscular mycorrhizal fungi and plant growth in the obligate mycotrophic herb Aster amellus. We conducted this study in two regions in the Czech Republic that differ significantly in their soil nutrient content, namely Czech Karst (region K and Ceske Stredohori (region S. Plants that originated from region S had significantly higher mycorrhizal colonisation than plants from region K, indicating that the percentage of mycorrhizal colonisation has a genetic basis. We found no evidence of local adaptation in Aster amellus. Instead, plants from region S outperformed the plants from region K in both target regions. Similarly, plants from region S showed more mycorrhizal colonisation in all cases, which was likely driven by the lower nutrient content in the soil from that region. Thus, plant aboveground biomass and mycorrhizal colonisation exhibited corresponding differences between the two target regions and regions of origin. Higher mycorrhizal colonisation in the plants from region with lower soil nutrient content (region S in both target regions indicates that mycorrhizal colonisation is an adaptive trait. However, lower aboveground biomass in the plants with lower mycorrhizal colonisation suggests that the plants from region K are in fact maladapted by their low inherent mycorrhizal colonization. We conclude that including mycorrhizal symbiosis in local

  5. Inter-organizational collaboration at the local level—models and experiences

    Science.gov (United States)

    Axelsson, Runo

    2012-01-01

    Integration and collaboration has been an important strategy for development of the health and welfare system in Sweden since the 1960s. This development has been intensified during the 1990s and the first decade of the 2000s. This key note speech will focus on the development of interorganizational collaboration between health care, social service and other welfare services on the local level of the Swedish society. There will be examples from care of the elderly, social psychiatric care and vocational rehabilitation. Different organizational models will be presented and experiences of barriers as well as facilitating factors will be discussed.

  6. Theory of non-local point transformations - Part 2: General form and Gedanken experiment

    CERN Document Server

    Tessarotto, Massimo

    2016-01-01

    The problem is posed of further extending the axiomatic construction proposed in Part 1 for non-local point transformations mapping in each other different curved space times. The new transformations apply to curved space times when expressed in arbitrary coordinate systems. It is shown that the solution permits to achieve an ideal (Gedanken) experiment realizing a suitable kind of phase-space transformation on point-particle classical dynamical systems. Applications of the theory are discussed both for diagonal and non-diagonal metric tensors.

  7. Large loop excision of the transformation zone for treating cervical intraepithelial neoplasia: a 12-year experience.

    Science.gov (United States)

    Paraskevaidis, E; Koliopoulos, G; Malamou-Mitsi, V; Zikopoulos, K; Paschopoulos, M; Pappa, L; Agnantis, N J; Loli, D E

    2001-01-01

    Although the existing evidence suggests that there is no obviously superior conservative method for treating cervical intraepithelial neoplasia (CIN), one of the most widely used is the large loop excision of the transformation zone (LLETZ). A total of 897 women who were treated with LLETZ at our colposcopy clinic from 1989 to 2000 were retrospectively studied. Forty women did not have significant cervical pathology (4.5% over-treatment rate). Clear margins of excision were obtained in 748 (88.5%) of the 845 cases of CIN or microinvasive cancers. Treatment failure rates were 4.7% for clear margins and 26.8% for involved or uncertain. LLETZ is a fast and reliable method of treating CIN and microinvasive carcinoma. Generalized cauterization of the resulting crater should be avoided and satellite HPV lesions ablated. Involved margins have a higher treatmentfailure rate, therefore a larger excision is recommended as cervical craters regenerate. Treatment in pregnant women can be delayed until postpartum provided they have adequate surveillance during pregnancy.

  8. Subjective experience and dopamine D2 receptor occupancy in patients treated with antipsychotics: clinical implications

    NARCIS (Netherlands)

    de Haan, Lieuwe; Lavalaye, Jules; van Bruggen, Marion; van Nimwegen, Lonneke; Booij, Jan; van Amelsvoort, Therese; Linszen, Don

    2004-01-01

    OBJECTIVES: This paper gives an overview of studies on the association between dopaminergic neurotransmission and the subjective experience of patients with schizophrenia. METHODS: We undertook a review of the literature. RESULTS: Dopaminergic neurotransmission may be relevant for subjective

  9. Subjective experiences of illness recovery in individuals treated for first-episode psychosis.

    Science.gov (United States)

    Windell, Deborah L; Norman, Ross; Lal, Shalini; Malla, Ashok

    2015-07-01

    Individuals with psychotic disorders identify several parallel dimensions of recovery as being important, including illness related, personal and social domains. Learning how patients deal with the experience of psychosis and recovery early in the course of illness may provide insights for improvement of early intervention services. The primary aim of the present research is to explore experiences related to recovery for individuals receiving services following a first episode of psychosis (FEP) in a specialized early intervention (SEI) program and to examine key turning points that shape such recovery. Semi-structured interviews were carried out with 30 individuals in early recovery following an FEP. Interpretative phenomenological analysis (IPA) was used to examine the subjectively identified important processes and turning points in relation to the illness domain of recovery. Participants described several early recovery processes including symptom recovery; reconciling the meaning of the illness experience; regaining control over the experience; and negotiation and acceptance of treatment. Of particular relevance were the various turning points associated with the recovery processes that were described. Differences in illness acceptance trajectories and the turning points within such trajectories have important implications for understanding psychological adjustment to the experience of psychosis, its diagnosis and treatment. These findings underline the importance of assisting individuals with the construction of meaning following the initial illness experience.

  10. Contemporary risks of local and regional recurrence and contralateral breast cancer in patients treated for primary breast cancer

    NARCIS (Netherlands)

    Aalders, K. C.; Van Bommel, A. C M; Van Dalen, T.; Sonke, G. S.; Van Diest, P. J.; Boersma, L. J.; Van Der Heiden-Van Der Loo, M.

    2016-01-01

    Introduction Breast cancer treatment has evolved extensively over the past two decades with a shift towards less invasive local treatment and increased systemic treatment. The present study aimed to investigate the rates of local (LR) and regional (RR) recurrence and contralateral breast cancer

  11. The localization of 10% of the pathologic glands in secondary hyperparathyroidism depends on the surgeon experience

    Directory of Open Access Journals (Sweden)

    José Luis D’Addino

    2015-07-01

    Full Text Available Methods for preoperative localization of parathyroidin secondary hyperparathyroidism are controversial in the literature and have different and dissimilar sensitivity. With the objective to determine the correlation between preoperative ultrasound, scintigraphy MIBI and intraoperative findings in secondary hyperparathyroidism we review our 10 years statistic.Between2004-2014, 100 patients underwent parathyroidectomy due to secondary hyperparathyroidism. Data obtained from medical records included: preoperative serum parathormona, ultrasound, scintigraphy. Positive predictive value and negative predictive value were analyzed in correlation with intraoperative findings.The method of calculation of ROC curves and area under the curve and other screening values (confidence index, index of validity and likelihood ratio were used. 68% were women; mean age was 52,7 years. Mean PTH value was 1486 pg/ml. The specificity and sensitivity of preoperative ultrasound were 94,44% and 30,14%, respectively. PPV was 93,62% and NPV was 33,33%. For scintigraphy, the sensitivity was 25,34%, specificity 98,15%, PPV was 97,37% and NPV was 32,72%. The ultrasound diagnosed 94 glands among a possibility of 400, the scintigraphy showed 76 and the surgery founded 292. Recurrence, 22%. Ultrasound and scintigraphy allow the localization of pathological parathyroid; however, in 10% of cases,glands could not be detected preoperatively, making surgeons experience fundamental in gland localization

  12. Understanding the local context for the application of global mental health: a rural South African experience.

    Science.gov (United States)

    Braathen, Stine Hellum; Vergunst, Richard; Mji, Gubela; Mannan, Hasheem; Swartz, Leslie

    2013-03-01

    The global mental health movement has supplied ample evidence of treatment gaps for mental health care in low and middle-income countries. It is also clear that substantial progress has been made in developing an evidence base for innovative treatments which have been shown to work. It is only through rich and detailed understandings of local contexts and individual experiences that the challenges global mental health faces can be fully appreciated. In this article, we use a single, qualitative case study from one context and of one family affected by mental disorder. This is to elucidate core issues which we regard as key to further developments in the global mental health agenda. Core issues are poor mental health literacy, transport and lack of outreach, limitations of formal health care, challenges at the interface with indigenous health care and lack of follow-up and rehabilitation. We propose shifting the focus of mental health care from cure to promotion and prevention, using an interdisciplinary team of lay and trained health workers from the professional, folk and popular sectors. The challenges are complex, as this small study shows, but it is only by looking closely at local conditions that it is possible to develop interventions which are contextually appropriate and make optimal use of local resources.

  13. A single centre experience with sequential and concomitant chemoradiotherapy in locally advanced stage IV tonsillar cancer

    Directory of Open Access Journals (Sweden)

    Coyle Catherine

    2010-12-01

    Full Text Available Abstract Background Chemo-radiotherapy offers an alternative to primary surgery and adjuvant therapy for the management of locally advanced stage IV squamous cell carcinomas of the tonsil. Methods A retrospective analysis was performed of the outcomes of 41 patients with locoregionally advanced squamous cell carcinoma of the tonsil treated non-surgically at the Yorkshire Cancer Centre between January 2004 and December 2005. Due to long radiotherapy waiting times, patients received induction chemotherapy with cisplatin and 5-fluorouracil followed by either cisplatin concurrent chemoradiotherapy or radiotherapy alone. Results Median age was 55 years (range 34-76 years and 28 (68% patients were male. 35/41 patients (85% received 2 or more cycles of induction chemotherapy. Following induction chemotherapy, 32/41 patients (78% had a clinical response. Concomitant chemotherapy was given to 30/41 (73%. All patients received the planned radiotherapy dose with no delays. There were no treatment related deaths. Six (15% patients had gastrostomy tubes placed before treatment, and 22 (54% required nasogastric tube placement during or after treatment for nutritional support. 17 patients required unplanned admissions during treatment for supportive care. At 4 months post treatment assessment 35 out of 41 (85% patients achieved complete clinical and radiographic response. Median follow-up is 38 months (8-61 months. Local and regional control rate in complete responders at 3 years was 91%. Distant metastases have been found in 4 (9.8% patients. Three year progression-free survival rate in all patients is 75%. The 3-year cause specific survival and overall survival are 75% and 66% respectively. Conclusion Cisplatin-based induction and concurrent chemoradiotherapy provides excellent tumour control with acceptable toxicity for patients with locally advanced tonsillar cancer.

  14. The humbling experience of treating obesity: Should we persist or desist?

    Science.gov (United States)

    Brownell, Kelly D

    2010-08-01

    Obesity has humbled one research group after another. Some of the field's brightest scientists have attempted to subdue obesity by treating it, but now, after decades of work, treatment gains remain small, maintenance is poor, and the field produces effects far below what patients want or expect. This can be explained by strong biological and environmental forces that oppose weight loss and foster regain. Attempts to improve treatment must continue, but with recognition that treatment is a clinical measure and will not affect prevalence (because treatments are too expensive to be used broadly). Policy change and prevention will be necessary to improve public health. Copyright 2010. Published by Elsevier Ltd.

  15. Streptococcus bovis infectious endocarditis and occult gastrointestinal neoplasia: experience with 25 consecutive patients treated surgically.

    Science.gov (United States)

    Alozie, Anthony; Köller, Kerstin; Pose, Lumi; Raftis, Maximilian; Steinhoff, Gustav; Westphal, Bernd; Lamprecht, Georg; Podbielski, Andreas

    2015-01-01

    To assess the prevalence of gastrointestinal neoplasia in patients with Streptococcus bovis infectious endocarditis we performed a retrospective cohort analysis of all episodes of S. bovis infectious endocarditis treated at our institution between January 2000 through December 2014. Twenty-five patients were identified for this purpose. 12/25 patients received colonoscopy and 1/25 of the patients was assessed with CT colonography. Of the 13 who underwent colonic assessment, 11 were diagnosed with colonic neoplasms at different stages of development. In the absence of any strong contraindication, gastroenteroscopic evaluation in all patients diagnosed with S. bovis infectious endocarditis should be pursued.

  16. A qualitative exploration of the experiences of living with and being treated for fibromyalgia

    Directory of Open Access Journals (Sweden)

    Simon C Ashe

    2017-08-01

    Full Text Available This study explores the life and treatment experience of people in the United Kingdom with fibromyalgia in order to inform the development of treatments which are both effective and acceptable to users. Qualitative interviews were conducted with 14 participants with interpretative phenomenological analysis used as the theoretical framework and analytical method. The themes identified were as follows: Inauthenticity of fibromyalgia, An Unconventional healthcare experience, Re-creating support networks, Challenging the working identity, Threatening the family dynamic and Fighting, accepting or accommodating? The biopsychosocial impacts of fibromyalgia disrupted the identity, lifestyle, roles and relationships of our participants with such challenges further exacerbated by the contested nature of the illness.

  17. Our experience with Van Nes Rotationplasty for locally advanced lower extremity tumours.

    Science.gov (United States)

    Askari, Raza; Umer, Masood

    2014-12-01

    To present an early experience with the time-tested technique of Van Ness Rotationplasty to save distal lmbs. Van Nes Rotationplasty for locally advanced lower extremity tumours. A reterorespective audit was conducted at Aga Khan University Hospital, Karachi, and comprised cases of bone and soft tissue sarcoma who underwent Van Ness Rotationplasty over seven years from January 2005 to December 2011. Demographic data, family history, past history, co-morbids, date since diagnosis, duration of symptoms, type of tumour, metastasis, pre-op and post-op functional status, recurrence and survival were collected. Of the 351 cases of bone and soft tissue sarcoma, 9 (2.6%) underwent Van Ness Rotationplasty and were included in the study. The mean duration of symptoms was 7±3SD months (range: 8-41 months). All except 1(11.1%) were osteogenic sarcomas. All except 1(11.1%) involved distal femur. Overall, 7(77.8%) had localised Enneking stage IIB disease. Two (22.2%) patients expired due to metastatic disease, but none had local recurrence. Complete excision of tumour was achieved in all (100%) patients. Longest follow-up was of 34 months while the shortest was of 6 months. No local recurrences were noted. Functional recovery was good. Two (22.2%) patients had simultaneous sciatic nerve repair as part of the primary procedure. Both of them had good motor function at the time of final follow-up. Mean Musculoskeletal Tumour Societyscore was 23.88±2SD. Van Nes Rotationplasty was found to be a successful alternative to amputation in cases of locally advanced tumours of distal femur or proximal tibia.

  18. Treatment and outcome in cancer cervix patients treated between 1979 and 1994: A single institutional experience

    Directory of Open Access Journals (Sweden)

    Shyamkishore Shrivastava

    2013-01-01

    Materials and Methods: This is a retrospective study of 6234 patients with carcinoma of the cervix treated with radical intent between 1979 and 1994. All the work-up, staging investigations, treatment details, radiation protocols, outcomes, and toxicities were noted, compiled, and analyzed. Results: With a mean age of 46 years (range: 18-90 years; median: 45 years, 669 (11% patients were in stage Ib, 284 (5% were in stage IIa, 1891 (30% were in stage IIb, 69 (1% were in stage IIIa, and 3321 (53% were in stage IIIb. With a median follow-up of 68 months (57-79 months for the entire group, there was no significant difference in the outcome of 953 patients with international federation of gynecology and obstetrics (FIGO Ib-IIa treated after radical surgery, pre-operative radiation therapy (pre-op RT + Sx or after radical radiation; their disease-free survival (DFS was 60-62% at 8 years. In our series of 1891 patients with stage IIb and 3321 with stage IIIb, a respective DFS of 56% and 40% was achieved at 8 years. Conclusion: Over the last two decades, with the acquisition of newer facilities and inception of Joint Clinics, there has been a significant refinement in the treatment protocols and outcome. Improving radiation strategies to improve therapeutic ratio is the key to success.

  19. How Much Clinical and Functional Impairment do Children Treated With Knee Rotationplasty Experience in Adulthood?

    Science.gov (United States)

    Benedetti, Maria Grazia; Okita, Yusuke; Recubini, Elena; Mariani, Elisabetta; Leardini, Alberto; Manfrini, Marco

    2016-04-01

    Rotationplasty may be indicated for some children with osteosarcoma in the distal femur or proximal tibia; in properly selected patients, it may offer functional advantages over transfemoral amputation and more durable results than a prosthesis. The clinical and functional outcomes reported for this procedure generally have been limited to studies with a mean followup of approximately 8 years in terms of Musculoskeletal Tumor Society Score (MSTS), physical examination, and gait analysis. However, the effects of residual thigh-shank length on gait have not been explored to our knowledge. We asked: (1) Do differences in the length of the surgically treated residual thigh-shank relative to the contralateral thigh result in altered gait patterns? (2) What were the clinical and functional impairments and radiographic findings of patients who underwent rotationplasty and who survived to adulthood? (3) Do gait analysis findings in adults differ from previously reported findings in children in terms of relevant gait parameters such as maximal ground reaction forces and sagittal knee angles? From January 1986 to December 2009, 254 children (age range, 3-14 years) affected by high-grade bone sarcomas located in the distal half of the femur were surgically treated at our institute. Forty-two of these patients (16.5%) underwent rotationplasty. During this period, three adolescents older than 15 years were treated by rotationplasty owing to the tumor volume and extracompartmental involvement. In total, 45 patients underwent rotationplasty. From January 1986 to December 2000, rotationplasty generally was the preferred treatment for patients younger than 9 years with a high-grade bone sarcoma calling for an intra- or extraarticular resection of the distal femur, as long as the sciatic nerve could be spared. From January 2001, the procedure was not used as often. Of the 45 patients who underwent a rotationplasty, 14 died of disease at a mean of 37 months (31%); 31 patients (69

  20. Baseline DCE-MRI and PET-CT as a predictor of pathologic response in patients treated with neodjuvant chemotherapy (NAC) for locally advanced breast cancer

    OpenAIRE

    colleter, Loïc

    2015-01-01

    Purpose: To evaluate DCE-MRI and PET-CT at baseline for prediction of pathological response to neoadjuvant chemotherapy (NAC) in patients with locally advanced breast cancer. Materials and methods: 88 patients with locally advanced breast cancer treated with NAC followed in DCE-MRI at 1.5T and PET-CT were included in this retrospective study. Perfusion parameters (Ktrans, kep, ve) and SUVmax were measured at baseline of the NAC. Imaging datas were compared with tumoral and nodal pathologic re...

  1. Localization of gamma-glutamyl transpeptidase in hamster buccal pouch epithelium treated with 7,12-dimethylbenz(a)anthracene

    Energy Technology Data Exchange (ETDEWEB)

    Solt, D.B.

    1981-07-01

    The utility of gamma-glutamyl transpeptidase (GGT) was explored as a histochemical marker for chemical carcinogenesis in hamster buccal pouch mucosa. One or both buccal pouches of 18 noninbred male Syrian golden hamsters were treated topically with 0.5% 7,12-dimethylbenz(a)anthracene (DMBA) in mineral oil over 16 weeks to produce numerous epithelial lesions at various stages of neoplastic development. Both buccal pouches of 4 control animals were similarly treated with mineral oil alone. GGT activity was not detectable in untreated pouches or pouches treated with mineral oil alone. With this technique, multiple discrete GGT-stained areas were visible in wholemounts prepared at 1 and 6 weeks after the final application of DMBA. The experimental results were consistent with the hypothesis that the early GGT-stained cell populations are preneoplastic in nature.

  2. 铜绿色月经的辨治体会%Experience for treating aeruginous menstruation

    Institute of Scientific and Technical Information of China (English)

    王新昌

    2014-01-01

    Irregular menstruation is a common gynecological disease, but aeruginous menstruation is relatively rare. In this article, clinical manifestations character of this disease in TCM was collected. Differentiation analysis showed that aeruginous menstruation was caused by Daxu and Dahan, and Wuji Wan can be used to treat this disease.%月经不调为妇科常见病,但月经见铜绿色者较为罕见。本文对此症的中医临床表现特点加以整理。进行辨证分析,认为此症由大虚大寒所致,宜用乌鸡丸加减治疗。

  3. Toxicity of oiled sediments treated with bioremediation agents: A shoreline experiment in Delaware, USA

    Energy Technology Data Exchange (ETDEWEB)

    Mearna, A. [National Oceanic and Atmospheric Administration, Seattle, WA (United States); Doe, K. [Environment Canada, Dartmouth, Nova Scotia (Canada); Fisher, W. [Environmental Protection Agency, Gulf Breeze, FL (United States); Lee, K. [Department of Fisheries and Oceans, Mont-Joli, Quebec (Canada); Mueller, C. [SAIC, Inc., Narragansett, RI (United States)

    1995-12-31

    Using a randomized complete block design, a battery of five pore water and sediment bioassays were used to monitor and compare toxicity among un-oiled, oiled (light Nigerian crude) and nutrient and bacteria-treated shoreline plots on a sandy beach. Tests included sea urchin fertilization, water and modified-solid phase microtox, 10-day amphipod survival and grass shrimp embryo bioassays. During the 13-week study, bioremediation treatment with nutrients and/or bacteria did not decrease toxicity relative to that in untreated plots. Results from at least one bioassay suggested that, relative to no treatment, treatment may have increased toxicity for several weeks. The least and most sensitive tests were sea urchin fertilization (pore water) and 10-day amphipod test, respectively. Coupled with chemical monitoring, the study produced a large data-base for evaluating toxic concentrations of petroleum hydrocarbons in sandy sediments.

  4. Real-life experience using trabectedin plus pegylated liposomal doxorubicin combination to treat patients with relapsed ovarian cancer

    Directory of Open Access Journals (Sweden)

    Saad Tahir

    2014-12-01

    Full Text Available The goal of recurrent ovarian cancer (ROC treatment is no longer just palliation, but prolonging survival. This is usually through administering a new line of chemotherapy at each relapse. A novel treatment sequencing strategy to achieve this is through the intercalation of an effective non-platinum alternative, in between platinum-based therapies. Trabectedin in combination with pegylated liposomal doxorubicin (PLD has been fully available privately in the UK since 2009 for treating patients with ROC. A single institution's experience with the trabectedin + PLD combination, as a non-platinum/non-taxane alternative, to intercalate between platinum-based therapies is reported here. To date 6 patients have been successfully treated with trabectedin + PLD at Broomfield Hospital, Chelmsford, Essex. Here we describe a new, practice-changing treatment approach in a real-life case study of a heavily-treated patient with advanced ROC treated with trabectedin + PLD at fourth-line and then subsequently rechallenged at seventh-line; with treatment continuing until disease progression.

  5. Evaluation of Public Service Advertising Messages with Local and Non-Local Source Attribution: A Controlled Laboratory Experiment.

    Science.gov (United States)

    Lynn, Jerry R.; Gagnard, Alice

    A study was conducted to examine message evaluations of selected public service advertisements (PSAs) by a young adult population and to test whether local and nonlocal source attribution would influence those evaluations. In addition, the study investigated the extent to which audience characteristics such as fatalism (the degree to which a…

  6. Attachment of polymer chains on plasma-treated surfaces: experiments and modeling

    Energy Technology Data Exchange (ETDEWEB)

    Riccardi, C [Dipartimento di Fisica, Universita di Milano-Bicocca, Piazza della Scienza 3, 20126 Milano (Italy); Roman, H E [Max Planck Institute for the Physics of Complex Systems, Noethnitzer Str. 38, 01187 Dresden (Germany); Ziano, R, E-mail: roman@pks.mpg.d [Dipartimento di Medicina Sperimentale, Universita di Milano-Bicocca, Via Cadore 48, 20052 Monza (Italy)

    2010-07-15

    Deposition of linear polymers, such as polyethylene glycol (PEG), on a plasma-treated surface has been studied experimentally and theoretically by means of Monte Carlo (MC) simulations. Acrylic acid is deposited on a silicon wafer in the presence of argon at a pressure of 10 Pa by applying 30 W external power. Active carboxyl sites are obtained having a surface number density of {approx}2 sites nm{sup -2}. A homogeneous PEG solution is brought into contact with the treated surface (over 24 h) and a thin film of attached PEG chains is formed. Two different PEGs having molecular weights of 3000 and 5000 g mol{sup -1}, respectively, are considered. The corresponding thin film widths, W, are measured, yielding W(3000)=4.3{+-}3.1 nm and W(5000)=8.8{+-}1.8 nm. For the MC simulations, the linear polymers are modeled as an ensemble of self-avoiding walks of length N (number of monomers) on a simple cubic lattice, executing worm-like or reptation dynamics, which can become attached at an active carboxyl site on the surface. The numerical results for the film widths are in good agreement with the experimental findings. We find that less than 20% of active sites are effectively occupied by attached chains, corresponding to less than 5% of the total available surface sites. Scaling arguments predict universal power-law dependences of the film density, {rho}(N), as a function of polymer length, i.e. {rho}(N){approx}c/N{sup {nu}}, with c{approx_equal}5 g cm{sup -3} and {nu}{approx_equal}0.6. The model also predicts a dependence of the prefactor c on the density of carboxyl active sites.

  7. The use of lipofilling to treat congenital hypoplastic breast anomalies: preliminary experiences.

    Science.gov (United States)

    Derder, Mohamed; Whitaker, Iain S; Boudana, David; Marchac, Alexandre; Hivelin, Mikael; Mattar, Nadia; Lepage, Christophe; Claude, Olivier; Benjoar, Marc-David; Bosc, Romain; Lantieri, Laurent

    2014-10-01

    Treatment options for congenital hypoplastic breast anomalies are often open, including radial scoring, parenchymal flaps, and insertion of expanders and implants. Drawbacks of open techniques involve scarring, the use of drains, and inpatient stays. The use of lipofilling to treat breast deformities is increasing, as more research is completed in this area. We report a retrospective study of 10 patients below the age of 20 following autologous fat transfer between January 1, 2003 and January 1, 2004. (2 Poland syndrome, 3 bilateral tuberous breast, and 5 unilateral micromastia). Age, cup size, the number of sessions, time interval between each session, volumes injected, and complications were recorded. Postoperative mammography, ultrasonography, and MRI were assessed by a specialized radiologist. Patients answered a questionnaire 1 year after the procedure. Mean follow-up was 68 months (60-77 months) and mean age was 17.5 years (15-20 years). Mean number of fat injection sessions was 2 (1-4) and mean volume injected 285 mL per breast (200-500 mL). The time interval between each session was 5 months (3-6 months). Cup size remained unchanged after at least 5 years of follow-up. One case underwent a contralateral breast reduction. The cosmetic results considered satisfactory in almost all the patients after 1 year of follow-up. None of our patients complained of scars or defects at the donor site. All breasts imaging were normal except 1 patient with oil cysts. Our preliminary results using lipofilling to treat young patients with breast hypoplasia with lipofilling are very encouraging. The authors believe it is an alternative of choice for the correction of the young woman's breast deformities if the avoidance of scarring is preferred.

  8. Modified components separation technique: experience treating large, complex ventral hernias at a University Hospital.

    Science.gov (United States)

    Torregrosa-Gallud, A; Sancho Muriel, J; Bueno-Lledó, J; García Pastor, P; Iserte-Hernandez, J; Bonafé-Diana, S; Carreño-Sáenz, O; Carbonell-Tatay, F

    2017-08-01

    An increasing number of patients have large or complex abdominal wall defects. Component separation technique (CST) is a very effective method for reconstructing complex midline abdominal wall defects in a manner that restores innervated muscle function without excessive tension. Our goal is to show our results by a modified CST for treating large ventral hernias. A total of 351 patients with complex ventral hernias have been treated over a 10-year period. Pre- and postoperative CT scans were performed in all patients. All ventral hernias were W3, according to the EHS classification 1. We analyzed demographic variables, co-morbidities, hernia characteristics, operative, and postoperative variables. One hundred and seventy patients (48.4%) were men; the average age of the study population was 51.6 ± 23.2 years with an average BMI of 32.3 ± 1.3. The hernia was located in the midline in 321 cases (91.5%) versus the flank in 30 (8.5%). In 45 patients, preoperative botulinum toxin (BT) and progressive pneumoperitoneum (PPP) were needed due to giant hernia defects when the VIH/VAC ratio was >20%. Postoperative complications related to the surgical site were seroma (35.1%), hematoma (9.1%), infection (7.2%), and wound necrosis (8.8%). Complications related to the repair were evisceration in 3 patients (1.1%), small bowel fistula in 4 patients (1.5%), 11 cases of mesh infection (2.9%), and abdominal compartment syndrome (ACS) in 2 patients. There were 29 hernia recurrences (8.2%) with a mean follow-up of 31.6 ± 8.1 months. The modified CST is an effective strategy for managing complex ventral hernias that enables primary fascial closure with low rates of morbidity and hernia recurrence.

  9. Experiments with central-limit properties of spatial samples from locally covariant random fields

    Science.gov (United States)

    Barringer, T.H.; Smith, T.E.

    1992-01-01

    When spatial samples are statistically dependent, the classical estimator of sample-mean standard deviation is well known to be inconsistent. For locally dependent samples, however, consistent estimators of sample-mean standard deviation can be constructed. The present paper investigates the sampling properties of one such estimator, designated as the tau estimator of sample-mean standard deviation. In particular, the asymptotic normality properties of standardized sample means based on tau estimators are studied in terms of computer experiments with simulated sample-mean distributions. The effects of both sample size and dependency levels among samples are examined for various value of tau (denoting the size of the spatial kernel for the estimator). The results suggest that even for small degrees of spatial dependency, the tau estimator exhibits significantly stronger normality properties than does the classical estimator of standardized sample means. ?? 1992.

  10. Treating acute promyelocytic leukaemia in Latin America: lessons from the International Consortium on Acute Leukaemia experience.

    Science.gov (United States)

    Corrêa de Araujo Koury, Luisa; Ganser, Arnold; Berliner, Nancy; Rego, Eduardo M

    2017-06-01

    The Latin Americas and Caribbean are regions where social exclusion and inequality persist as the main obstacles to human development and improvement of health conditions, despite economic growth and social development. These countries need to establish international collaborations with the goal of improving health conditions. In this scenario Acute Promyelocytic Leukaemia (APL), a disease with a high cure rate in developed countries and high prevalence in young patients, offers an ideal opportunity to implement measures with educational and cooperative scope. We discuss the experience of Latin America and the Caribbean through a common network, the International Consortium on Acute Promyelocytic Leukaemia (IC-APL). © 2017 John Wiley & Sons Ltd.

  11. Las Cumbres Observatory Partners With Local Museums In “Experience The Eclipse” Community Program

    Science.gov (United States)

    Greenstreet, Sarah; Seale, Sandy; Rivera, Javier; Skinner, Ron

    2017-10-01

    Las Cumbres Observatory (LCO) in Goleta, California, together with the Santa Barbara Museum of Natural History (SBMNH) and the Wolf Museum of Exploration & Innovation (MOXI) put together a community program called “Experience the Eclipse” for the month of August.The greater Santa Barbara community includes over 200,000 people and the city is known for its vibrant cultural life. Events featuring science, physics, and astronomy are very popular. In 2016, Javier Rivera, the Astronomy Program Manager of the SBMNH, and Ron Skinner, the Director of Education at MOXI, met with LCO to discuss planning a month of activities to educate the public about the Great American Eclipse. The vision was to capitalize on the strength of each organization and to share information and events.The events included daily planetarium shows and open houses at the observatory of the SBMNH. All three organizations gave parties at public venues with presentations by astronomers. Together the group purchased 6,000 pairs of eclipse viewer glasses and they shared the responsibility of distributing these to local schools and community groups. A master calendar of the events was published in local press outlets and a document describing the eclipse and safe viewing practices was distributed widely. Preparation of these materials was a joint effort among the three institutions.“Experience the Eclipse” was a great success. The open houses at SBMNH were well attended and all public events sold out very quickly. On August 21, the SBMNH presented a live feed of the eclipse taken from their own observatory.We will present photos and videos from these events, along with data on the attendance and quotes from enthusiastic participants.

  12. Evolution patterns and parameter regimes in edge localized modes on the National Spherical Torus Experiment

    Science.gov (United States)

    Smith, D. R.; Fonck, R. J.; McKee, G. R.; Diallo, A.; Kaye, S. M.; LeBlanc, B. P.; Sabbagh, S. A.

    2016-04-01

    We implement unsupervised machine learning techniques to identify characteristic evolution patterns and associated parameter regimes in edge localized mode (ELM) events observed on the National Spherical Torus Experiment. Multi-channel, localized measurements spanning the pedestal region capture the complex evolution patterns of ELM events on Alfvén timescales. Some ELM events are active for less than 100 μs, but others persist for up to 1 ms. Also, some ELM events exhibit a single dominant perturbation, but others are oscillatory. Clustering calculations with time-series similarity metrics indicate the ELM database contains at least two and possibly three groups of ELMs with similar evolution patterns. The identified ELM groups trigger similar stored energy loss, but the groups occupy distinct parameter regimes for ELM-relevant quantities like plasma current, triangularity, and pedestal height. Notably, the pedestal electron pressure gradient is not an effective parameter for distinguishing the ELM groups, but the ELM groups segregate in terms of electron density gradient and electron temperature gradient. The ELM evolution patterns and corresponding parameter regimes can shape the formulation or validation of nonlinear ELM models. Finally, the techniques and results demonstrate an application of unsupervised machine learning at a data-rich fusion facility.

  13. Analysis of surgically treated gastric cancers: a tertiary hospital experience in Turkey

    Science.gov (United States)

    Alimoglu, Orhan; Sisik, Abdullah; Eren, Tunc; Aktas, Suat; Basak, Fatih; Leblebici, Metin; Bas, Gurhan

    2015-01-01

    OBJECTIVE: Gastric cancer (GC) is the fifth most common cancer worldwide, and in Turkey, GC is placed among the 10 most frequently seen cancers. However, analyzing the epidemiology of cancers and improving screening programs for cancers are not still the top priorities for healthcare professionals. This study aims to show distribution of GC based on stages in a tertiary hospital of Istanbul, Turkey. METHODS: All surgically treated GC cases in the General Surgery Department, between January 2009 and January 2014 were retrospectively reviewed. Data including the operation year, the demographic, clinical and histopathological parameters were recorded and statistically analyzed. RESULTS: The study group consisted of 111 patients. Seventy-four (66.66%) patients were men, and 37 (33.33%) patients were women with a mean age of 63.49±11.83 years. Stage 3 and 4 were the most frequently observed stages with 62 and 18 cases, respectively. Stage 3 was the most common stage found during the study period (p<0.05). During 5 years of the study period, GC was less frequently located on the cardia (n=31) when compared with other locations (n=75) for GC (p<0.05). CONCLUSION: Turkey’s population has generally advanced stage GC disease. New strategies are needed for achievement of early diagnosis and better outcomes. PMID:28058349

  14. Bortezomib in Treating Patients With Unresectable Locally Advanced or Metastatic Adenocarcinoma of the Bile Duct or Gallbladder

    Science.gov (United States)

    2017-06-13

    Adenocarcinoma of the Extrahepatic Bile Duct; Adenocarcinoma of the Gallbladder; Advanced Adult Primary Liver Cancer; Gastrointestinal Cancer; Localized Unresectable Adult Primary Liver Cancer; Recurrent Adult Primary Liver Cancer; Recurrent Extrahepatic Bile Duct Cancer; Recurrent Gallbladder Cancer; Unresectable Extrahepatic Bile Duct Cancer; Unresectable Gallbladder Cancer

  15. Complications after treating esophageal strictures with prostheses and stents – 20 years’ experience

    Directory of Open Access Journals (Sweden)

    Mariusz P. Łochowski

    2016-12-01

    Full Text Available Introduction : Over 80% of patients with esophageal cancer are qualified only for palliative treatment. The main goal of the therapy is to eliminate symptoms of dysphagia. Aim: To analyze complications after insertion of prostheses and stents in patients with inoperable cancer of the esophagus/cardia. Material and methods : From 1996 to 2015 prostheses of the esophagus were implanted in 1309 patients. In the strictures of the lower part of the esophagus, Barbin-Mousseau prostheses (102 cases and Häring prostheses (324 cases were placed. In the strictures of the upper and middle part of the esophagus, Wilson-Cook prostheses (65 cases and Sumi prostheses (51 cases were implanted using rigid oesophagoscopy. Since 2001, 867 esophageal stents have been implanted. Results: Complications occurred in 146 (11% patients, including 7 (0.6% cases of death. The most common complication was the recurrence of swallowing disorders (74 patients. In 51 patients, tumor overgrowth over the stent/prosthesis was responsible for that symptom, and in 23 patients its clogging. A fistula (22 cases and the passage of the prosthesis/stent (25 cases were the second most common group of complications. Compression of the trachea, bleeding, and dehiscence of wounds occurred in a total of 18 patients. Complications were mostly treated through the repositioning of the prosthesis/stent or the insertion of an additional one. Conclusions : The most common complications after esophageal prosthetics are the recurrence of dysphagia, a fistula and the displacement of the prosthesis/stent. The basic treatment of complications is the repositioning or insertion of an additional prosthesis.

  16. Long term irrigation with treated wastewater and soil structure stability - the Israeli experience

    Science.gov (United States)

    Levy, G. J.

    2009-04-01

    With the increased necessity to use treated waste water (TWW) for irrigation, especially in arid and semi-arid regions, farmers are faced with unique and unfamiliar problems among which is the possible degradation in soil structure and stability. Probable risks for adverse changes in the structural stability of soils and its hydraulic properties, following irrigation with TWW, may stem from the higher levels of organic matter, suspended solids, sodium adsorption ratio (SAR) and salinity in the TWW compared with its fresh water of origin. Laboratory studies with specimen clays have indicated that irrigation with TWW can lead to conditions in the soil that enhance clay swelling and dispersion. These phenomena can, in turn, initiate and/or increase clay depletion from the upper soil layer, deterioration in aggregate stability, a decrease in soil hydraulic conductivity and an increase in soil susceptibility to seal formation and soil erosion. These possible scenarios are expected to take place mostly during winter when the soil is exposed to rain water (i.e., water without electrolytes), which thus increase the sensitivity of the soil clays to swelling and dispersion. The current presentation has limited itself to Israeli studies from the past ten years because in studies prior to that period most of the TWW used for irrigation were of extremely poor quality. The impact of irrigation with TWW on clay movement and illuviation at deeper soil layers, aggregate stability, saturated hydraulic conductivity, and runoff and soil loss production, is presented. Results from the examined studies suggested that the effects of irrigation with TWW were inconsistent and complex. The results seemed to depend, beyond variation in the quality of the TWW, on soil properties (e.g., texture, lime content) and conditions prevailing in the field (e.g., type of tillage, rate of wetting, etc). It is therefore recommended that caution is exercised when TWW is used for irrigation and that

  17. Treating body, treating mind: The experiences of people with psychotic disorders and their general practitioners - Findings from the Australian National Survey of High Impact Psychosis.

    Science.gov (United States)

    Waterreus, Anna; Morgan, Vera A

    2017-09-01

    To describe from the perspective of people living with psychotic illness their use of general practitioner services over a 12-month period and the experiences, attitudes and challenges general practitioners face providing health care to this population. A two-phase design was used. Phase 1, screening for psychosis, occurred in public specialised mental health services and non-government organisations within seven catchment sites across Australia. In Phase 2, 1825 people who were screened positive for psychosis were randomly selected for interview which included questions about frequency and reason for general practitioner contact in the 12 months prior to interview. General practitioners (1473) of consenting participants were also surveyed. Almost all (90.3%) survey participants had consulted a general practitioner in the 12-month period, on average 8.9 times, and 28.8% of attenders had consulted 12 times or more. The majority (83.5%) attended one general practitioner practice. Most (77.6%) general practitioners wanted to be involved in the mental health care of their patient. Although 69.1% said the management of their patient was not problematic for their practice, one in five general practitioners reported issues related to patient non-compliance with treatment and non-attendance at scheduled appointments; time constraints; and lack of feedback from treating mental health services. People with psychotic disorders consult general practitioners, some very frequently. Most Australian general practitioners believe they have a responsibility to review the physical and mental health of their patients. Improved communication between general practitioners and mental health services, and easier access to mental health support, may help general practitioners manage the complex mental, physical and social problems of their patients.

  18. Experiments and improvements of ear recognition based on local texture descriptors

    Science.gov (United States)

    Benzaoui, Amir; Adjabi, Insaf; Boukrouche, Abdelhani

    2017-04-01

    The morphology of the human ear presents rich and stable information embedded on the curved 3-D surface and has as a result attracted considerable attention from forensic scientists and engineers as a biometric recognition modality. However, recognizing a person's identity from the morphology of the human ear in unconstrained environments, with insufficient and incomplete training data, strong person-specificity, and high within-range variance, can be very challenging. Following our previous work on ear recognition based on local texture descriptors, we propose to use anatomical and embryological information about the human ear in order to find the autonomous components and the locations where large interindividual variations can be detected. Embryology is particularly relevant to our approach as it provides information on the possible changes that can be observed in the external structure of the ear. We experimented with three publicly available databases, namely: IIT Delhi-1, IIT Delhi-2, and USTB-1, consisting of several ear benchmarks acquired under varying conditions and imaging qualities. The experiments show excellent results, beyond the state of the art.

  19. Education and patient preferences for treating type 2 diabetes: a stratified discrete-choice experiment

    Directory of Open Access Journals (Sweden)

    Janssen EM

    2017-10-01

    Full Text Available Ellen M Janssen,1 Daniel R Longo,2 Joan K Bardsley,3 John FP Bridges1 1Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 2Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, VA, 3MedStar Health Research Institute and MedStar Nursing, Hyattsville, MD, USA Purpose: Diabetes is a chronic condition that is more prevalent among people with lower educational attainment. This study assessed the treatment preferences of patients with type 2 diabetes by educational attainment. Methods: Patients with type 2 diabetes were recruited from a national online panel in the US. Treatment preferences were assessed using a discrete-choice experiment. Participants completed 16 choice tasks in which they compared pairs of treatment profiles composed of six attributes: A1c decrease, stable blood glucose, low blood glucose, nausea, treatment burden, and out-of-pocket cost. Choice models and willingness-to-pay (WTP estimates were estimated using a conditional logit model and were stratified by educational status. Results: A total of 231 participants with a high school diploma or less education, 156 participants with some college education, and 165 participants with a college degree or more completed the survey. Participants with a college degree or more education were willing to pay more for A1c decreases ($58.84, standard error [SE]: 10.6 than participants who had completed some college ($28.47, SE: 5.53 or high school or less ($17.56, SE: 3.55 (p≤0.01. People with a college education were willing to pay more than people with high school or less to avoid nausea, low blood glucose events during the day/night, or two pills per day. Conclusion: WTP for aspects of diabetes medication differed for people with a college education or more and a high school education or less. Advanced statistical methods might overcome limitations of stratification and advance understanding

  20. Self-reported experience in patients treated with Hepatitis C direct acting antivirals

    Directory of Open Access Journals (Sweden)

    Irene Cañamares Orbis

    2016-12-01

    Full Text Available Background and objective: To learn about and analyze the self-reported treatment experience of HCV patients who started treatment with direct acting antivirals agents (DAA, at a real-time, proactive and integrated into the pharmaceutical care healthcare process, using a prospective questionnaire completed by patients as clinical tool. Material and methods: Observational and cross-sectional study conducted between April (start of the National Strategic Plan and December 2015 in the Outpatient Pharmacy Service. The questionnaire includes variables related to health related quality of life (HRQOL, adherence, adverse effects (AEs, satisfaction, and usefulness of the Pharmacy Service implemented training program. A descriptive analysis of all variables included in the study was conducted and the influence of different variables analyzed in the degree of adherence and HRQOL. The analysis of the differences was performed using chi-square test and simple logistic regresión model for calculation of OR. We use SPSS version 20 program and statistical significance for values of p < 0.05 was considered. Results: 155 of the 226 surveys returned, with a response rate of 68.6%. Referring to the HRQOL (evaluation of physical and emotional state, 38.7% of patients reports that their physical and emotional state is much better from the start of treatment. The presence of EA and worse global information of their disease was associated with worse physical and emotional state (p < 0.05. Reported adherence was 84.5% and the treatment was evaluated as very good or good by 87% of patients. 52.9% had no adverse effects related to the medication and the training process performed by the specialist pharmacist at the first visit 96.7% of patients assessed as very good or good. Conclusions: Self-reported experience acquired through direct and constant contact with patients provides information on important aspects of treatment. We believe that these tools should be

  1. Laparoscopic versus open nephroureterectomy to treat localized and/or locally advanced upper tract urothelial carcinoma: oncological outcomes from a multicenter study.

    Science.gov (United States)

    Liu, Jian-Ye; Dai, Ying-Bo; Zhou, Fang-Jian; Long, Zhi; Li, Yong-Hong; Xie, Dan; Liu, Bin; Tang, Jin; Tan, Jing; Yao, Kun; He, Le-Ye

    2017-01-17

    Many studies have reported the oncological outcomes between open radical nephroureterectomy (ONU) and laparoscopic radical nephroureterectomy (LNU) of upper tract urothelial carcinoma (UTUC). However, few data have focused on the oncological outcomes of LNU in the subgroup of localized and/or locally advanced UTUC (T1-4/N0-X). The purpose of this study was to compare the oncological outcomes of LNU vs. ONU for the treatment in patients with T1-4/N0-X UTUC. We collected and analyzed the data and clinical outcomes retrospectively for 265 patients who underwent radical nephroureterectomy for T1-4/N0-X UTUC between April 2000 and April 2013 at two Chinese tertiary hospitals. Survival was estimated using the Kaplan-Meier method. Cox's proportional hazards model was used for univariate and multivariate analysis. The mean patient age was 62.0 years and the median follow-up was 60.0 months. Of the 265 patients, 213 (80.4%) underwent conventional ONU, and 52 (19.6%) patients underwent LNU. The groups differed significantly in their presence of previous hydronephrosis, presence of previous bladder urothelial carcinoma, and management of distal ureter (P ONU and LNU groups. Multivariable Cox proportional regression analysis showed that surgical approach was not significantly associated with intravesical RFS (odds ratio [OR] 1.23, 95% confidence interval [CI] 0.46-3.65, P = 0.622), Overall RFS (OR 0.99, 95% CI 0.54-1.83, P = 0.974), CSS (OR 1.38, 95% CI 0.616-3.13, P = 0.444), or OS (OR 1.61, 95% CI 0.81-3.17, P = 0.17). The results of this retrospective study showed no statistically significant differences in intravesical RFS, overall RFS, CSS, or OS between the laparoscopy and the open groups. Thus, LNU can be an alternative to the open procedure for T1-4/N0-X UTUC. Further studies, including a multi-institutional, prospective study are required to confirm these findings.

  2. Communicating with mismatch and tension: treatment provision experiences of primary care doctors treating patients with overactive bladder in Hong Kong.

    Science.gov (United States)

    Siu, Judy Yuen-Man

    2015-10-30

    Overactive bladder (OAB) is a common chronic bladder dysfunction worldwide. As the first contact point of health care, primary health care providers are often consulted by patients seeking initial consultation for OAB. The relatively short history of the existence of OAB in medicine and low public awareness of OAB in Hong Kong, however, often serve as a challenge to primary health care providers in treating patients with OAB. The experiences of patients and health care providers are often influenced by the interaction between these two groups, hence both health care providers and patients are key determinants of the entire treatment experience, and the perspectives of health care providers should not be overlooked. However, patient experiences have been the main focus of related studies, few of which have examined the treatment provision experiences and perspectives of health care providers. This research gap is notable considering that the satisfaction and morale of health care providers can influence treatment outcome. This study adopted a qualitative research approach by conducting semistructured individual interviews with 30 private practice primary care doctors in Hong Kong between November 2013 and May 2014. Lacking confidence in treating OAB patients, encountering mismatch with patients in treatment expectations and communication style, and feeling embarrassed when communicating with OAB patients were the experiences reported by the sampled doctors. The sampled doctors' treatment provision experiences revealed a general lack of knowledge about OAB among primary care doctors in Hong Kong. Furthermore, the negative stereotype of and lack of trust in private practice doctors created tension between the doctors and patients. This lack of mutual trust was particularly unfavourable for the doctors to provide long-term treatment and support to patients with OAB. The embedded distrust of private practice doctors also affected the prescribing behaviour of the doctors

  3. Sequential Pattern Mining of Electronic Healthcare Reimbursement Claims: Experiences and Challenges in Uncovering How Patients are Treated by Physicians

    Energy Technology Data Exchange (ETDEWEB)

    Pullum, Laura L [ORNL; Ramanathan, Arvind [ORNL; Hobson, Tanner C [ORNL

    2015-01-01

    We examine the use of electronic healthcare reimbursement claims (EHRC) for analyzing healthcare delivery and practice patterns across the United States (US). We show that EHRCs are correlated with disease incidence estimates published by the Centers for Disease Control. Further, by analyzing over 1 billion EHRCs, we track patterns of clinical procedures administered to patients with autism spectrum disorder (ASD), heart disease (HD) and breast cancer (BC) using sequential pattern mining algorithms. Our analyses reveal that in contrast to treating HD and BC, clinical procedures for ASD diagnoses are highly varied leading up to and after the ASD diagnoses. The discovered clinical procedure sequences also reveal significant differences in the overall costs incurred across different parts of the US, indicating a lack of consensus amongst practitioners in treating ASD patients. We show that a data-driven approach to understand clinical trajectories using EHRC can provide quantitative insights into how to better manage and treat patients. Based on our experience, we also discuss emerging challenges in using EHRC datasets for gaining insights into the state of contemporary healthcare delivery and practice in the US.

  4. Local Blockade of CCL21 and CXCL13 Signaling as a New Strategy to Prevent and Treat Osteoarthritis

    Science.gov (United States)

    2016-09-01

    PRINCIPAL INVESTIGATOR: Bouchra Edderkaoui., Ph.D. CONTRACTING ORGANIZATION: Loma Linda Veterans Association for Research and Education Redlands, CA...8. PERFORMING ORGANIZATION REPORT NUMBER Loma Linda Veterans Association for Research and Education 710 Brookside Ave. STE 2 Redlands, CA...planned experimental approach was to compare the development of OA after surgery between the animals that received local injection of CCl21 or CXCL13

  5. Treating gynecological pain: the experiences of bachelor students in physiotherapy performing somatocognitive therapy.

    Science.gov (United States)

    Fougner, Marit; Haugstad, Gro Killi

    2015-07-01

    Longstanding gynecological pain affects large numbers of women in the Western world. In recently published studies, we have found that a hybrid of physiotherapy and cognitive psychotherapy called somatocognitive therapy (SCT) ameliorates physical symptoms and psychological distress. In this paper, we report on the experiences of undergraduate physiotherapy students performing the therapy to patients with provoked vestibulodynia (PVD). The study aimed to investigate the nature of the collaborative interaction between female physiotherapy students and patients with PVD, focusing on critical factors for the students' learning of professional skills through SCT applied on patients suffering from an especially demanding pain condition. In a qualitative study design, data were collected from two group interviews with four female students in pairs, and subjected to a thematic analysis. We found that students perceive the patient encounter as critical incidents in the sense of strong emotional encounters. From the data material, there emerged a four-step process ranging from distance to proximity, highlighting factors that influence the development of professional skills. The four steps are defined respectively as: (1) the students' prejudices; (2) identification and empathy; (3) senses of responsibility in the therapeutic relationship and (4) collaborative engagement for change. Contrary to expectations, the students experienced the application of this combined approach (SCT) as an interesting and rewarding way of working with patients, and that they had achieved skills and a sufficient set of tools to cope with the challenges that patients with longstanding gynecological pain represent.

  6. How we treat our own: the experiences and characteristics of psychology trainees with disabilities.

    Science.gov (United States)

    Lund, Emily M; Andrews, Erin E; Holt, Judith M

    2014-11-01

    To better understand the characteristics and experiences of psychologists and trainees with disabilities. An invitation to participate in a survey of psychologists and psychology trainees with disabilities was sent to professional listservs related to psychology and/or disability. Fifty-six trainees and psychologists with doctoral training in clinical, counseling, school, or rehabilitation psychology completed the survey. Over half (57.1%) were practicing psychologists and 42.9% were current trainees. The most commonly reported disabilities were physical, sensory, and chronic health. The majority of the participants reported experiencing disability-related discrimination during their training, and less than one third had received mentorship from psychologists with disabilities. Less than half of respondents disclosed their disability to a university disability services office, and many relied on informal accommodations alone. Most participants did not disclose their disability during the graduate school, internship, or postdoctoral application processes. Professional psychology programs and training sites should work to remove barriers and provide support for trainees with disabilities, especially during preinternship doctoral training. Programs should not expect disability services offices to provide all support for students with disabilities, especially support related to clinical training. (PsycINFO Database Record (c) 2014 APA, all rights reserved).

  7. 'Why, why did you have me treated?': the psychotic experience in a literary narrative.

    Science.gov (United States)

    Kaptein, A A; Koopman, J J E; Weinman, J A; Gosselink, M J

    2011-12-01

    In this paper, the authors suggest an approach that may be helpful in teaching medical humanities to medical students. In the context of an honours class on medicine and literature, students (1) read a novel on an illness, (2) interviewed a patient with the medical condition described in the novel and (3) wrote an essay on the biomedical, narrative and literary aspects of these sources of information. The authors compared the story of Chekhov's literary protagonist Kovrin in The Black Monk with the personal story of patient H., who was diagnosed with schizophrenia. The narratives of the two patients were compared, based on Chekhov's literary narrative and the narrative of the patient. Both patients appeared to somehow regret losing their symptoms, following various psychiatric treatments. Both narratives show the ambivalence between the gain and loss that adequate psychiatric treatment may bring. Studying novels and other literary sources may help in understanding the story of the patient better, with associated improvements in various aspects of medical outcome. Reading literary fiction may help to increase an understanding of patients' emotions, experiences, cognitions and perspectives. It may also reduce the emotional distance between the self and the patient. The educational approach that was explored in the authors' honours class may be helpful to others when developing methods for teaching medical humanities to (medical) students.

  8. A qualitative study to explore health professionals' experience of treating gout: understanding perceived barriers to effective gout management.

    Science.gov (United States)

    Humphrey, Chloe; Hulme, Richard; Dalbeth, Nicola; Gow, Peter; Arroll, Bruce; Lindsay, Karen

    2016-06-01

    INTRODUCTION The management of gout is challenging and mainly occurs in primary care. This study aims to explore the experience of treating gout among primary care clinicians and understand the perceived barriers to effective therapy. METHODS Fourteen health professionals from primary care practices in South Auckland were recruited. Each participated in a semi-structured interview exploring their experience of treating and managing gout patients were analysed thematically. FINDINGS Participants described the large burden of gout in their communities and the importance of the clinician-patient relationship in gout management. Four themes summarise the perceived barriers to effective urate lowering therapy (ULT); unique gout factors, eg its intermittent nature and potential for stigmatisation; systemic barriers to optimal treatment, or barriers that emerge from working within a certain organisation; uncertainty about ownership, or who should carry responsibility for overcoming barriers to optimal treatment; and cultural barriers to optimal treatment. CONCLUSION Clinicians in primary practice perceive gout management to be mainly acute rather than preventive care. Patients may be stigmatised and management difficult particularly when diet is emphasised over ULT. Practice nurses are a group potentially available and willing to assist in educating patients. These findings may be helpful in planning for and improving healthcare in gout. KEYWORDS Gout; general practice; uric acid; primary health care; allopurinol; primary prevention.

  9. Subjective stimulant and sedative effects of alcohol during early drinking experiences predict alcohol involvement in treated adolescents.

    Science.gov (United States)

    Chung, Tammy; Martin, Christopher S

    2009-09-01

    Research on low subjective response to alcohol has focused primarily on alcohol's sedative effects during early drinking experiences. This study examined subjective response to both stimulant and sedative effects of alcohol during initial drinking experiences as predictors of treated adolescents' severity of alcohol involvement before treatment and over 1-year follow-up. Adolescents (N = 169) recruited from addictions treatment reported on the number of drinks needed to obtain stimulant and sedative effects of alcohol for early and heavy drinking periods. The number of drinks needed to obtain stimulant and sedative effects, as well as the degree of stimulant and sedative effect obtained, were examined as predictors of adolescents' alcohol involvement at baseline (before treatment) and 1-year follow-up. During early drinking experiences, females reported a greater degree of sedative effect compared with males; there was no gender difference in degree of stimulant effect reported during early drinking experiences. Both early subjective stimulant and sedative effects of alcohol predicted the usual number of drinks needed to become intoxicated and the maximum drinking quantity per day before treatment. However, at 1-year follow-up, only early sedative effects predicted 1-year outcomes. Study findings suggest potentially important roles for both early subjective stimulant and sedative effects of alcohol in relation to adolescent alcohol involvement.

  10. Education and patient preferences for treating type 2 diabetes: a stratified discrete-choice experiment.

    Science.gov (United States)

    Janssen, Ellen M; Longo, Daniel R; Bardsley, Joan K; Bridges, John Fp

    2017-01-01

    Diabetes is a chronic condition that is more prevalent among people with lower educational attainment. This study assessed the treatment preferences of patients with type 2 diabetes by educational attainment. Patients with type 2 diabetes were recruited from a national online panel in the US. Treatment preferences were assessed using a discrete-choice experiment. Participants completed 16 choice tasks in which they compared pairs of treatment profiles composed of six attributes: A1c decrease, stable blood glucose, low blood glucose, nausea, treatment burden, and out-of-pocket cost. Choice models and willingness-to-pay (WTP) estimates were estimated using a conditional logit model and were stratified by educational status. A total of 231 participants with a high school diploma or less education, 156 participants with some college education, and 165 participants with a college degree or more completed the survey. Participants with a college degree or more education were willing to pay more for A1c decreases ($58.84, standard error [SE]: 10.6) than participants who had completed some college ($28.47, SE: 5.53) or high school or less ($17.56, SE: 3.55) (p≤0.01). People with a college education were willing to pay more than people with high school or less to avoid nausea, low blood glucose events during the day/night, or two pills per day. WTP for aspects of diabetes medication differed for people with a college education or more and a high school education or less. Advanced statistical methods might overcome limitations of stratification and advance understanding of preference heterogeneity for use in patient-centered benefit-risk assessments and personalized care approaches.

  11. INTERSTITIAL BRACHYTHERAPY USING TEMPLATE FOR LOCALLY ADVANCED GYNAECOLOGICAL MALIGNANCIES- REVISITING THE FORGOTTEN CLASSICAL ART- A SINGLE INSTITUTE EXPERIENCE

    Directory of Open Access Journals (Sweden)

    Chatharaju Swarna Kumari

    2017-10-01

    Full Text Available BACKGROUND Brachytherapy is an important therapeutic strategy for the treatment of locally advanced gynaecologic (GYN cancers despite evolution of different newer radiotherapy techniques like high-dose-rate and image-guided BT. Despite being used in the management of advanced gynaecological cancer, currently there is a scarcity of studies and data on interstitial BT in Indian context. This is a retrospective analysis on 71 patients with locally advanced gynaecological malignancies treated in the period of 2010 to 2016 to assess the local tumour control, survival, and complications with the template (Syed-Neblett guided interstitial technique. MATERIALS AND METHODS The patients with a median age of 51 years treated from July 2010 to May 2016 were retrospectively reviewed. This study included previously unirradiated 71 patients with advance stage of gynaecological malignancies, not suitable for intracavitary brachytherapy due to distorted anatomy or extensive disease stage. Histologically all patients had squamous cell carcinoma (cervix= 56, vault= 9, vagina= 6 and treated by whole pelvis external beam radiation therapy (EBRT up to a total dose of 50 Gy in 25 fractions. These patients were further treated by high-dose-rate interstitial brachytherapy using SyedNeblett dedicated vaginal plastic template. During treatment all these patients were re-optimised and a dose of 15-21 Gy was delivered in 3 fractions with a minimum gap of 6 hours between fractions using Varisource iX HDR unit. RESULTS Out of 71 patients 5 were lost to followup during study period and they were excluded from the final analysis. The average followup duration ranged between 6-71 months and median followup was 20 months. This study included parameters like local disease control, acute/late complications and distant metastasis. Out of 66 patients, local disease control was seen in 54 (81.81% patients, whereas local recurrence was observed in 12 patients (18.18%. Distant

  12. Thirty-day outcomes in patients treated with en bloc colectomy and pancreatectomy for locally advanced carcinoma of the colon.

    Science.gov (United States)

    Paquette, Ian M; Swenson, Brian R; Kwaan, Mary R; Mellgren, Anders F; Madoff, Robert D

    2012-03-01

    The aim of this was to define 30-day outcomes of patients treated with colectomy and en bloc pancreatectomy for invasive colon cancer. ACS NSQIP was used to identify patients who underwent colectomy and pancreatectomy concomitantly (n = 65) for colon carcinoma. Patients with en bloc pancreatectomy were compared to a propensity score-matched control group for 30-day outcomes. Sixteen patients underwent a pancreaticoduodenectomy with colectomy and 49 patients underwent a distal pancreatectomy with colectomy. There were 195 matched control patients. En bloc pancreatectomy (Whipple vs. distal pancreatectomy vs. control) patients had longer OR times (390 vs. 265 vs.137 min) and length of postoperative stay (12 vs. 10 vs. 6 days). The frequency of pulmonary complications (31.3% vs. 36.7% vs. 3.6%), blood transfusions (2.9 vs. 1.7 vs. 0.3 U), wound dehiscence, (18.8% vs. 6.12% vs.0.5%) and surgical site infection (43.5% vs. 34.7% vs.14.9%) were substantially higher in the pancreatectomy group (p < 0.05). There were no statistically significant differences in 30-day mortality between the pancreatectomy group and the control group (6.3% vs. 0% vs. 1.5% p = 0.25) Perioperative outcomes with en bloc pancreatectomy and colectomy include increased pulmonary complications, blood transfusions, wound complications, and length of stay compared to patients treated with colectomy alone for colon cancer.

  13. Local experience with extracorporeal membrane oxygenation in children with acute fulminant myocarditis.

    Directory of Open Access Journals (Sweden)

    Botao Ning

    Full Text Available To analyze the clinical effect of extracorporeal membrane oxygenation (ECMO in children with acute fulminant myocarditis, we retrospectively analyzed the data of five children with acute fulminant myocarditis in the intensive care unit (ICU at the Affiliated Children's Hospital, Zhejiang University from February 2009 to November 2012. The study group included two boys and three girls ranging in age from 9 to 13 years (median 10 years. Body weight ranged from 25 to 33 kg (mean 29.6 kg. They underwent extracorporeal membrane oxygenation (ECMO through a venous-arterial ECMO model with an average ECMO supporting time of 89.8 h (40-142 h. Extracorporeal circulation was established in all five children. After treatment with ECMO, the heart rate, blood pressure, and oxygen saturation were greatly improved in the four children who survived. These four children were successfully weaned from ECMO and discharged from hospital machine-free, for a survival rate of 80% (4/5. One child died still dependent on the machine. Cause of death was irrecoverable cardiac function and multiple organ failure. Complications during ECMO included three cases of suture bleeding, one case of acute hemolytic renal failure and suture bleeding, and one case of hyperglycemia. During the follow-up period of 4-50 months, the four surviving children recovered with normal cardiac function and no abnormal functions of other organs. The application of ECMO in acute fulminant myocarditis, even in local centers that experience low incidence of this disease, remains an effective approach. Larger studies to determine optimal timing of placement on ECMO to guide local centers are warranted.

  14. Academic performance and personal experience of local, international, and collaborative exchange students enrolled in an Australian pharmacy program.

    Science.gov (United States)

    Davey, Andrew K; Grant, Gary D; Anoopkumar-Dukie, Shailendra

    2013-09-12

    To assess the academic performance and experiences of local, international, and collaborative exchange students enrolled in a 4-year Australian bachelor of pharmacy degree program. Survey instruments exploring the demographics, background, and academic and cultural experiences of students during the program were administered in 2005 to students in all 4 years. Additionally, grades from each semester of the program for students (406 local, 70 international, 155 exchange) who graduated between 2002 and 2006 were analyzed retrospectively. The main differences found in the survey responses among the 3 groups were in students' motivations for choosing the degree program and school, with international and collaborative exchange students having put more thought into these decisions than local students. The average grades over the duration of the program were similar in all 3 demographic groups. However, local students slightly outperformed international students, particularly at the start of the year, whereas collaborative exchange students' grades mirrored those of local students during the 2 years prior to leaving their home country of Malaysia but more closely mirrored those of international students in the final 2 years after arriving on campus in Australia. Despite differences in academic backgrounds and culture, international and exchange students can perform well compared to local students in a bachelor of pharmacy program and were actually more satisfied than local students with the overall experience. Studying in a foreign country can negatively influence academic grades to a small extent and this is probably related to adjusting to the new environment.

  15. Locally advanced head and neck cancer treated with accelerated radiotherapy, the hypoxic modifier nimorazole and weekly cisplatin

    DEFF Research Database (Denmark)

    Bentzen, Jens; Toustrup, Kasper; Eriksen, Jesper Grau

    2015-01-01

    , and 149 patients (66%) received the full dose of nimorazole. The five-year actuarial LRC, EFS and OS rates were 80%, 67% and 72%, respectively. The LRC rates according to site were: oropharynx: 88%, larynx: 77%, hypopharynx 72% and oral cavity 49%, respectively. HPV/p16 staining was obtained in 141......%. CONCLUSION: The treatment was tolerable in this cohort of locally advanced HNSCC patients. Acute and late toxicity was comparable to similar studies of chemoradiotherapy, and the outcome superior to the data reported in the literature. This strongly indicates that RT of a...

  16. Measuring New Public Management at the Local Level: Experiences from EU Cities

    Directory of Open Access Journals (Sweden)

    Irena BAČLIJA

    2012-10-01

    Full Text Available Economic globalization, growingly differentiated and unstable markets, fiscal crises in light of increasing public expenditure are the elements of an uncertain future for local communities. Local communities are captured between the local service provision demands and the global market of local communities that compete for investors. In the context of this ever demanding environment the functions of local administration should be reformed. The article presents the specifics of local management and alongside its reform process under the principles of new public management. The empirical part of the article explains the findings of an extensive study of local administrations in the European Union and their reforms with implications that show the effects of reformed local administration on the economic performance of the local community.

  17. Demographics and Outcomes of Stage I-II Merkel Cell Carcinoma Treated with Mohs Micrographic Surgery Compared with Wide Local Excision in the National Cancer Data Base.

    Science.gov (United States)

    Singh, Babu; Qureshi, Muhammad M; Truong, Minh Tam; Sahni, Debjani

    2018-02-03

    The optimal surgical approach (wide local excision (WLE) vs. Mohs micrographic surgery (MOHS)) for treating Merkel cell carcinoma (MCC) is yet to be determined. To compare survival outcomes in patients with early stage MCC treated with MOHS versus WLE. A retrospective review of all cases in the National Cancer Data Base (NCDB) of MCC of clinical Stage I-II MCC treated with WLE or MOHS was performed. 1,795 cases of Stage I-II MCC were identified who underwent WLE (N=1,685) or MOHS (N=110). There was no difference in residual tumor on surgical margins between the two treatment groups (p=0.588). On multivariate analysis, there was no difference in overall survival between the treatment modalities (adjusted HR 1.02; 95% CI 0.72-1.45, p=0.897). There was no difference in overall survival between the two groups on propensity score matched analysis. Disease specific survival was not reported as this data in not available in the NCDB. MOHS appears to be as effective as WLE in treating early stage MCC. Copyright © 2018. Published by Elsevier Inc.

  18. ITALIAN LOCAL PUBLIC SERVICES: SOME GOVERNANCE HIGHLIGHTS FROM THE LARGER CITIES’ EXPERIENCE

    Directory of Open Access Journals (Sweden)

    DE MATTEIS Fabio

    2013-06-01

    Full Text Available Entrusting most local public services to local government entities has led to proliferation of public groups and, consistently, to greater complexity of the governance dynamics of local authorities. Differently from Anglo-Saxon countries, the Italian local public services provision has been characterized by a hybrid externalization process where local entities are legally autonomous but owned by the local government. This leads to a peculiar governance complexity source represented by the dual role (stakeholder and customer assumed by the local authority. Considering these elements (hybrid externalization and governance structure, this work tries to investigate some governance issues of public groups, basing on the two most populous Italian municipalities. The empirical findings highlight a gap between the presence of the conditions for defining a group governance structure and the adoption of a group approach by the parent local government. The authors try to suggest how to bridge this gap.

  19. High-accuracy local positioning network for the alignment of the Mu2e experiment.

    Energy Technology Data Exchange (ETDEWEB)

    Hejdukova, Jana B. [Czech Technical Univ., Prague (Czech Republic)

    2017-06-01

    This Diploma thesis describes the establishment of a high-precision local positioning network and accelerator alignment for the Mu2e physics experiment. The process of establishing new network consists of few steps: design of the network, pre-analysis, installation works, measurements of the network and making adjustments. Adjustments were performed using two approaches. First is a geodetic approach of taking into account the Earth’s curvature and the metrological approach of a pure 3D Cartesian system on the other side. The comparison of those two approaches is performed and evaluated in the results and compared with expected differences. The effect of the Earth’s curvature was found to be significant for this kind of network and should not be neglected. The measurements were obtained with Absolute Tracker AT401, leveling instrument Leica DNA03 and gyrotheodolite DMT Gyromat 2000. The coordinates of the points of the reference network were determined by the Least Square Meth od and the overall view is attached as Annexes.

  20. A (S)TEM Gas Cell Holder with Localized Laser Heating for In Situ Experiments

    Energy Technology Data Exchange (ETDEWEB)

    Mehraeen, Shareghe [Univ. of California, Davis, CA (United States). Dept. of Molecular and Cellular Biology; McKeown, Joseph T. [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States). Condensed Matter and Materials Division; Deshmukh, Pushkarraj V. [E.A. Fischione Instruments, Inc., Export, PA (United States); Evans, James E. [Univ. of California, Davis, CA (United States). Dept. of Molecular and Cellular Biology; Pacific Northwest National Lab. (PNNL), Richland, WA (United States). Chemical and Materials Science Division; Abellan, Patricia [Pacific Northwest National Lab. (PNNL), Richland, WA (United States). Chemical and Materials Science Division; Xu, Pinghong [Univ. of California, Davis, CA (United States). Dept. of Chemical Engineering and Materials Science; Reed, Bryan W. [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States). Condensed Matter and Materials Division; Taheri, Mitra L. [Drexel Univ., Philadelphia, PA (United States). Dept. of Materials Science & Engineering; Fischione, Paul E. [E.A. Fischione Instruments, Inc., Export, PA (United States); Browning, Nigel D. [Univ. of California, Davis, CA (United States). Dept. of Molecular and Cellular Biology; Pacific Northwest National Lab. (PNNL), Richland, WA (United States). Chemical and Materials Science Division; Univ. of California, Davis, CA (United States). Dept. of Chemical Engineering and Materials Science

    2013-03-04

    We report that the advent of aberration correction for transmission electron microscopy has transformed atomic resolution imaging into a nearly routine technique for structural analysis. Now an emerging frontier in electron microscopy is the development of in situ capabilities to observe reactions at atomic resolution in real time and within realistic environments. Here we present a new in situ gas cell holder that is designed for compatibility with a wide variety of sample type (i.e., dimpled 3-mm discs, standard mesh grids, various types of focused ion beam lamellae attached to half grids). Its capabilities include localized heating and precise control of the gas pressure and composition while simultaneously allowing atomic resolution imaging at ambient pressure. The results show that 0.25-nm lattice fringes are directly visible for nanoparticles imaged at ambient pressure with gas path lengths up to 20 μm. Additionally, we quantitatively demonstrate that while the attainable contrast and resolution decrease with increasing pressure and gas path length, resolutions better than 0.2 nm should be accessible at ambient pressure with gas path lengths less than the 15 μm utilized for these experiments.

  1. Limberg flap in management of pilonidal sinus disease: systematic review and a local experience.

    Science.gov (United States)

    Boshnaq, Mohamed; Phan, Yih Chyn; Martini, Iana; Harilingam, Mohanraj; Akhtar, Mansoor; Tsavellas, George

    2018-02-01

    To review published evidence of Limberg flap (LF) use in pilonidal sinus disease (PSD). We also included our local experience of LF. Medline and Embase database were searched for the words 'pilonidal, sinus, Limberg, flap'. Non-English articles and those not-related to our scope of search were omitted. We included a retrospective study of patients underwent LF in our district hospital. Data including length of hospital stay, post-operative complications and recurrence were collected. Literature review revealed 68 studies (22 case series, 35 comparative studies, nine RCTs and two meta-analyses). Recurrence rate was 0-7.4% in case series. Recurrence rate in comparative studies was 0-8.3%, compared to 4-37.7% for primary closure and 0-11% for Karydakis flap. RCTs showed that LF or its modification is superior to primary closure, with comparable results to Karydakis flap. About 26 patients included in the cohort study (16 male, average age 27 years). Six patients presented with recurrent disease. Post-operative length of hospital stay was four to seven days. Post-operative complication rate was 11.5% - [two partial wound dehiscence, one wound infection]. Recurrence rate was 7.7%. Average follow-up was 18 months. Limberg flap presents a safe and effective method that can be offered for patients with primary or recurrent PSD.

  2. Clinical Outcome and Characterization of Local Field Potentials in Holmes Tremor Treated with Pallidal Deep Brain Stimulation.

    Science.gov (United States)

    Ramirez-Zamora, Adolfo; Kaszuba, Brian C; Gee, Lucy; Prusik, Julia; Danisi, Fabio; Shin, Damian; Pilitsis, Julie G

    2016-01-01

    Holmes tremor (HT) is an irregular, low-frequency rest tremor associated with prominent action and postural tremors. Currently, the most effective stereotactic target and neurophysiologic characterization of HT, specifically local field potentials (LFPs) are uncertain. We present the outcome, intraoperative neurophysiologic analysis with characterization of LFPs in a patient managed with left globus pallidus interna deep brain stimulation (Gpi DBS). A 24-year-old male underwent left Gpi DBS for medically refractory HT. LFPs demonstrated highest powers in the delta range in Gpi. At the 6-month follow-up, a 90% reduction in tremor was observed. Pallidal DBS should be considered as an alternative target for management of refractory HT. LFP demonstrated neuronal activity associated with higher power in the delta region, similarly seen in patients with generalized dystonia.

  3. Stability and Wash Resistance of Local Made Mosquito Bednets and Detergents Treated with Pyrethroids against Anopheles stephensi

    Directory of Open Access Journals (Sweden)

    H Vatandoost

    2009-07-01

    Full Text Available Abstract Background: We aimed to evaluate different fibres of bednets impregnated with various pyrethroids. The stability of insecticide on the bednet was measured using different methods of washings as well as local made detergents."nMethods: The entire test was carried out according to the WHO-recommended methods. In addition, the impact of the numbers of washes on the stability of the insecticides was determined. Permethrin 10% (EC, deltamethrin 10% (SC, lambdacyhalothrin 2.5% (CS and cyfluthrin 5% (EW were used at the recommended dosages. Three different lo­cal detergents were used. Two kinds of washing methods (shaking, no shaking were used and in each method four kinds of washings, i.e. no wash, one wash, two washes and three washes was done. The main malaria vectors, Anophe­les stephensi, which is susceptible to all insecticides (BEECH strain, was tested with impregnated bednets in 3 minutes exposure time and the mortality was measured after 24 hours recovery period. Knock-down was measured as well using appropriate statistical methods."nResults: Lambdacyhalothrin has saved its insecticidal impact after being washed, whereas, deltamethrin has lost its activ­ity faster than other insecticides. Tow other insecticides had moderate effect. Golnar soap detergent has least ef­fect on the durability of insecticides, but the Shoma had the most. Whit increasing  the times of washing, insecticidal ef­fects was decreased , but shaking had no influence on the decreasing  of the quality of insecticidal impact."nConclusion: Results will be useful for local people who wish to use pyrethroid-impregnated bednets with their own lo­cal made detergent and bednets. 

  4. Stability and Wash Resistance of Local Made Mosquito Bednets and Detergents Treated with Pyrethroids against Anopheles stephensi

    Directory of Open Access Journals (Sweden)

    H Vatandoost

    2009-06-01

    Full Text Available Background: We aimed to evaluate different fibres of bednets impregnated with various pyrethroids. The stability of insecticide on the bednet was measured using different methods of washings as well as local made detergents.Methods: The entire test was carried out according to the WHO-recommended methods. In addition, the impact of the numbers of washes on the stability of the insecticides was determined. Permethrin 10% (EC, deltamethrin 10% (SC, lambdacyhalothrin 2.5% (CS and cyfluthrin 5% (EW were used at the recommended dosages. Three different lo­cal detergents were used. Two kinds of washing methods (shaking, no shaking were used and in each method four kinds of washings, i.e. no wash, one wash, two washes and three washes was done. The main malaria vectors, Anophe­les stephensi, which is susceptible to all insecticides (BEECH strain, was tested with impregnated bednets in 3 minutes exposure time and the mortality was measured after 24 hours recovery period. Knock-down was measured as well using appropriate statistical methods.Results: Lambdacyhalothrin has saved its insecticidal impact after being washed, whereas, deltamethrin has lost its activ­ity faster than other insecticides. Tow other insecticides had moderate effect. Golnar soap detergent has least ef­fect on the durability of insecticides, but the Shoma had the most. Whit increasing  the times of washing, insecticidal ef­fects was decreased , but shaking had no influence on the decreasing  of the quality of insecticidal impact.Conclusion: Results will be useful for local people who wish to use pyrethroid-impregnated bednets with their own lo­cal made detergent and bednets. 

  5. MR-targeted TRUS prostate biopsy using local reference augmentation: initial experience

    NARCIS (Netherlands)

    Ven, W.J.M. van de; Venderink, W.; Sedelaar, J.P.M.; Veltman, J.; Barentsz, J.O.; Futterer, J.J.; Cornel, E.B.; Huisman, H.J.

    2016-01-01

    PURPOSE: To evaluate MR-targeted TRUS prostate biopsy using a novel local reference augmentation method. PATIENTS AND METHODS: Tracker-based MR-TRUS fusion was applied using local reference augmentation. In contrast to conventional whole gland fusion, local reference augmentation focuses the highest

  6. Between grassroots and governments: Civil society experiences with the PRSPs. A study of local civil society response to the PRSPs

    OpenAIRE

    Possing, Susanne

    2003-01-01

    The report focuses on civil society experience with locally identified priorities for poverty eradication, an area little examined and less discussed in the international debate on PRSP to date. In the three N/S PRSP Programme countries, Honduras, Nicaragua and Zambia, civil society organisations have been involved in efforts to identify national as well as local priorities for poverty eradication. Taking the point of departure in involvement of CS with PRSP planning and monitoring at both le...

  7. Systemic versus local responses in melanoma patients treated with talimogene laherparepvec from a multi-institutional phase II study.

    Science.gov (United States)

    Kaufman, Howard L; Amatruda, Thomas; Reid, Tony; Gonzalez, Rene; Glaspy, John; Whitman, Eric; Harrington, Kevin; Nemunaitis, John; Zloza, Andrew; Wolf, Michael; Senzer, Neil N

    2016-01-01

    We previously reported that talimogene laherparepvec, an oncolytic herpes virus encoding granulocyte-macrophage colony-stimulating factor (GM-CSF), resulted in an objective response rate of 26 % in patients with advanced melanoma in a phase II clinical trial. The response of individual lesions, however, was not reported. Since talimogene laherparepvec is thought to mediate anti-tumor activity through both direct tumor cytolysis and induction of systemic tumor-specific immunity, we sought to determine the independent response rate in virus-injected and non-injected lesions. Fifty patients with stage IIIC or IV melanoma were treated with talimogene laherparepvec in a multi-institutional single-arm open-label phase II clinical trial. In this study patients were treated until a complete response was achieved, all accessible tumors disappeared, clinically significant disease progression, or unacceptable toxicity. This report is a post hoc analysis of the systemic effects of talimogene laherparepvec in injected lesions and two types of uninjected lesions-non-visceral lesions and visceral lesions. Eleven of 23 patients (47.8 %) had a ≥ 30 % reduction in the total burden of uninjected non-visceral lesions, and 2 of 12 patients (16.7 %) had a ≥ 30 % reduction in the total burden of visceral lesions. Among 128 evaluable lesions directly injected with talimogene laherparepvec, 86 (67.2 %) decreased in size by ≥ 30 % and 59 (46.1 %) completely resolved. Of 146 uninjected non-visceral lesions, 60 (41.1 %) decreased in size by ≥ 30 %, the majority of which (44 [30.1 %]) completely resolved. Of 32 visceral lesions, 4 (12.5 %) decreased in size by ≥ 30 %, and 3 (9.4 %) completely resolved. The median time to lesion response was shortest for lesions that were directly injected (18.4 weeks), followed by uninjected non-visceral lesions (23.1 weeks) and visceral lesions (51.3 weeks), consistent with initiation of a delayed regional and

  8. Intensity modulated radiotherapy as neoadjuvant chemoradiation for the treatment of patients with locally advanced pancreatic cancer. Outcome analysis and comparison with a 3D-treated patient cohort

    Energy Technology Data Exchange (ETDEWEB)

    Combs, S.E.; Habermehl, D.; Kessel, K.; Brecht, I. [Univ. Hospital of Heidelberg (Germany). Dept. of Radiation Oncology; Bergmann, F.; Schirmacher, P. [Univ. Hospital of Heidelberg (Germany). Dept. of Pathology; Werner, J.; Buechler, M.W. [Univ. Hospital of Heidelberg (Germany). Dept. of Surgery; Jaeger, D. [National Center for Tumor Diseases (NCT), Heidelberg (Germany); Debus, J. [Univ. Hospital of Heidelberg (Germany). Dept. of Radiation Oncology; Deutsches Krebsforschungszentrum (DKFZ), Heidelberg (Germany). Clinical Cooperation Unit Radiation Oncology

    2013-09-15

    Background: To evaluate outcome after intensity modulated radiotherapy (IMRT) compared to 3D conformal radiotherapy (3D-RT) as neoadjuvant treatment in patients with locally advanced pancreatic cancer (LAPC). Materials and methods: In total, 57 patients with LAPC were treated with IMRT and chemotherapy. A median total dose of 45 Gy to the PTV {sub baseplan} and 54 Gy to the PTV {sub boost} in single doses of 1.8 Gy for the PTV {sub baseplan} and median single doses of 2.2 Gy in the PTV {sub boost} were applied. Outcomes were evaluated and compared to a large cohort of patients treated with 3D-RT. Results: Overall treatment was well tolerated in all patients and IMRT could be completed without interruptions. Median overall survival was 11 months (range 5-37.5 months). Actuarial overall survival at 12 and 24 months was 36 % and 8 %, respectively. A significant impact on overall survival could only be observed for a decrease in CA 19-9 during treatment, patients with less pre-treatment CA 19-9 than the median, as well as weight loss during treatment. Local progression-free survival was 79 % after 6 months, 39 % after 12 months, and 13 % after 24 months. No factors significantly influencing local progression-free survival could be identified. There was no difference in overall and progression-free survival between 3D-RT and IMRT. Secondary resectability was similar in both groups (26 % vs. 28 %). Toxicity was comparable and consisted mainly of hematological toxicity due to chemotherapy. Conclusion: IMRT leads to a comparable outcome compared to 3D-RT in patients with LAPC. In the future, the improved dose distribution, as well as advances in image-guided radiotherapy (IGRT) techniques, may improve the use of IMRT in local dose escalation strategies to potentially improve outcome. (orig.)

  9. Good quality locally procured drugs can be as effective as internationally quality assured drugs in treating multi-drug resistant tuberculosis.

    Science.gov (United States)

    Qadeer, Ejaz; Fatima, Razia; Fielding, Katherine; Qazi, Fahad; Moore, David; Khan, Mishal S

    2015-01-01

    Owing toGiven the high costs of drugs to treat multi-drug resistant tuberculosis (MDR-TB), the Green Light Committee (GLC) initiative enables TB programs to procure quality-assured drugs at reduced prices. Despite price reductions, internationally quality assured (IQA) drugs can be more expensive than locally procured drugs. There is little evidence to inform decision-makers about whether IQA drugs are more effective than local drugs. This is the first study to compare outcomes between MDR-TB patients treated using IQA, and locally procured drugs in the same hospitals during the same time period. A retrospective cohort study was conducted in three hospitals across Pakistan. Data on baseline characteristics and treatment outcomes during the first six months of treatment were extracted from hospital records of adult culture-positive pulmonary MDR-TB patients starting treatment between January 2011 and June 2012. Two cohorts were defined: patients receiving IQA drugs, and patients receiving locally procured non-IQA drugs. Data were analysed using Kaplan-Meier curves and Cox proportional hazards regression. The primary outcome compared between cohorts was time to culture conversion. Of 231 patients, 90 were in the IQA and 141 in the non-IQA cohorts. Baseline characteristics were similar except for higher frequency of quinolone resistance in the IQA cohort. Overall, 193 patients (84%) culture converted. Culture conversion was not faster in the IQA cohort; the median time was 81 and 68 days in the IQA and non-IQA cohorts, respectively. Unadjusted and adjusted hazard ratios for culture conversion in IQA verses non-IQA cohorts were 0.82 (95%-CI, 0.62-1.10) and 0.95 (95%-CI, 0.66-1.36) respectively. Use of good quality, locally procured drugs can be effective in treating MDR-TB, may involve lower costs than using IQA drugs and could strengthen developing country drug quality assurance systems. This may be a suitable alternative in lieu of or whilst awaiting arrival of

  10. PADF RF localization experiments with multi-agent caged-MAV platforms

    Science.gov (United States)

    Barber, Christopher; Gates, Miguel; Selmic, Rastko; Al-Issa, Huthaifa; Ordonez, Raul; Mitra, Atindra

    2011-06-01

    This paper provides a summary of preliminary RF direction finding results generated within an AFOSR funded testbed facility recently developed at Louisiana Tech University. This facility, denoted as the Louisiana Tech University Micro- Aerial Vehicle/Wireless Sensor Network (MAVSeN) Laboratory, has recently acquired a number of state-of-the-art MAV platforms that enable us to analyze, design, and test some of our recent results in the area of multiplatform position-adaptive direction finding (PADF) [1] [2] for localization of RF emitters in challenging embedded multipath environments. Discussions within the segmented sections of this paper include a description of the MAVSeN Laboratory and the preliminary results from the implementation of mobile platforms with the PADF algorithm. This novel approach to multi-platform RF direction finding is based on the investigation of iterative path-loss based (i.e. path loss exponent) metrics estimates that are measured across multiple platforms in order to develop a control law that robotically/intelligently positionally adapt (i.e. self-adjust) the location of each distributed/cooperative platform. The body of this paper provides a summary of our recent results on PADF and includes a discussion on state-of-the-art Sensor Mote Technologies as applied towards the development of sensor-integrated caged-MAV platform for PADF applications. Also, a discussion of recent experimental results that incorporate sample approaches to real-time singleplatform data pruning is included as part of a discussion on potential approaches to refining a basic PADF technique in order to integrate and perform distributed self-sensitivity and self-consistency analysis as part of a PADF technique with distributed robotic/intelligent features. These techniques are extracted in analytical form from a parallel study denoted as "PADF RF Localization Criteria for Multi-Model Scattering Environments". The focus here is on developing and reporting specific

  11. Enhancing Local Community’s Involvement and Empowerment through Practicing Cittaslow: Experiences from Goolwa, South Australia

    Directory of Open Access Journals (Sweden)

    Park Eerang

    2014-01-01

    Full Text Available This study attempted to investigate how and the extent to which Cittaslow philosophy and practice enhanced local community’s involvement and empowerment in relation to tourism development from the sustainability’s perspective. As an empirical study, a series of in-depth interviews with key stakeholders including local government, local business, and local community’s members were conducted in Goolwa, the first Australian accredited Cittaslow town since 2007, located in South Australia. The results indicated that to a greater extent the accreditation and practice of Cittaslow philosophy in Goolwa increased a stronger and more effective collaboration amongst local community, business and residents as an essential element for achieving sustainability in tourism development. Not only did it encourage the local community’s participation in decision making process from the beginning of tourism development, but also revitalised the locality and sense of place of Goolwa through promoting local specialities and produces, in particular food and wine products. The results also suggested that psychological and social aspects of local community’s empowerment have been significantly enhanced after the establishment of Cittaslow. Yet, the economic empowerment of the local community was less experienced.

  12. Perineural infiltration as a prognostic factor in surgically treated gallbladder cancer: a single center experience and literature review.

    Science.gov (United States)

    Feo, Claudio Francesco; Cossu, Maria Laura; Ginesu, Giorgio Carlo; Fancellu, Alessandro; Scanu, Antonio Mario; Piras, Nadia; Cherchi, Giuseppe; Cossu, Antonio; Sotgiu, Giovanni; Pazzona, Marco; Porcu, Alberto

    2017-10-04

    Gallbladder cancer (GBC) is the most incident cancer of the biliary tract with only 5-13% of the sufferers surviving for five years. The aim of this study was to evaluate the prognostic role of perineural invasion (PNI) and its association with several clinicopathological variables in a cohort of surgically treated patients, and through a comprehensive review of the scientific literature. Twenty-five consecutive patients submitted to curative surgery for GBC from 2008 through 2016 were enrolled. Demographic, clinical and pathological data were retrieved from medical files, and specimens were re-examined by two experienced pathologists. The Pubmed database was searched for articles reporting on perineural infiltration on gallbladder cancer. Perineural invasion was observed in 14 (56%) cases, and it was more frequent in higher pathological stages. A statistically significant association was found with high preoperative serum Ca 19-9 levels. Fourteen (56%) patients died during the follow-up; survival was lower in patients with perineural invasion in comparison to those without, but not statistically significant. Twelve English-language articles reporting on PNI were retrieved and discussed. Perineural invasion is associated with higher stage and poorer survival in surgically treated GBC patients. In patients with locally advanced GBC resection of the extrahepatic biliary duct and frozen section examination of the distal stump must be taken into consideration, especially in cases of tumor arising from the hepatic side of the gallbladder. In cases without residual disease but with pathological evidence of PNI, a careful follow-up is suggested to early detect recurrences. Adenocarcinoma, Cancer, Gallbladder, Perineural infiltration, Surgery.

  13. Methodological challenges for the large N study of local participatory experiences. Combining methods and databases

    Directory of Open Access Journals (Sweden)

    Galais, Carolina

    2012-12-01

    Full Text Available In this article we analyse the effects of different data collection strategies in the study of local participatory experiences in a region of Spain (Andalusia. We examine the divergences and similarities between the data collected using different methods, as well as the implications for the reliability of the data. We have collected participatory experiences through two parallel processes: a survey of municipalities and web content mining. The survey of municipalities used two complementary strategies: an online questionnaire and a CATI follow-up for those municipalities that had not answered our first online contact attempt. Both processes (survey and data mining were applied to the same sample of municipalities, but provided significantly different images of the characteristics of Andalusia’s participatory landscape. The goal of this work is to discuss the different types of biases introduced by each data collection procedure and their implications for substantive analyses.

    En este artículo analizamos los efectos de diferentes estrategias para la recolección de datos en el estudio de las experiencias participativas andaluzas. Examinamos para ello las diferencias y similitudes entre los datos recogidos mediante diferentes métodos, así como las implicaciones para la fiabilidad de los datos. Para ello, hemos utilizado dos procedimientos paralelos. En primer lugar, una encuesta a municipios y la minería de datos en Internet. La encuesta se realizó utilizando dos modos de administración diferentes, un cuestionario online y un cuestionario telefónico de seguimiento a los municipios que no respondieron al primer intento de contacto vía correo electrónico. Tanto la encuesta como la minería de datos fueron aplicados a la misma muestra de municipios, aunque arrojaron diferencias significativas en cuanto a las características del panorama participativo en Andalucía. El objetivo de este trabajo es discutir los diferentes tipos

  14. Veff Scaling of Te and ne Measurements During Local Helicity Injection on the Pegasus Toroidal Experiment

    Science.gov (United States)

    Bodner, G. M.; Bongard, M. W.; Fonck, R. J.; Perry, J. M.; Reusch, J. A.; Rodriguez Sanchez, C.

    2017-10-01

    Understanding the electron confinement of local helicity injection (LHI) is critical in order to evaluate its scalability as a startup technique to MA-class devices. Electron confinement in the Pegasus Toroidal Experiment is investigated using multi-point Thomson scattering (TS). The Pegasus TS system utilizes a set of high-throughput transmission gratings and intensified CCDs to measure Te and ne profiles. Previous TS measurements indicated peaked Te profiles 120 eV in outboard injector discharges characterized by strong inductive drive and low LHI drive. Injectors designed to have dominant non-inductive drive have recently been installed in the divertor region of Pegasus to understand the relationship between effective drive voltage, Veff, and plasma performance. At low Veff and reduced plasma current, Ip 60 kA, TS measurements reveal a flat Te profile 50 eV, with a peaked ne profile 1 ×1019 m-3, resulting in a slightly peaked pe profile. As current drive is increased, the Te profiles become hollow with a core Te 50 eV and an edge Te 120 -150 eV. These hollow profiles appear after the start of the Ip flattop and are sustained until the discharge terminates. The ne profiles drop in magnitude to < 1 ×1019 m-3 but remain somewhat peaked. Initial results suggest a weak scaling between input power and core Te. Additional studies are planned to identify the mechanisms behind the anomalous profile features. Work supported by US DOE Grant DE-FG02-96ER54375.

  15. LPEseq: Local-Pooled-Error Test for RNA Sequencing Experiments with a Small Number of Replicates.

    Science.gov (United States)

    Gim, Jungsoo; Won, Sungho; Park, Taesung

    2016-01-01

    RNA-Sequencing (RNA-Seq) provides valuable information for characterizing the molecular nature of the cells, in particular, identification of differentially expressed transcripts on a genome-wide scale. Unfortunately, cost and limited specimen availability often lead to studies with small sample sizes, and hypothesis testing on differential expression between classes with a small number of samples is generally limited. The problem is especially challenging when only one sample per each class exists. In this case, only a few methods among many that have been developed are applicable for identifying differentially expressed transcripts. Thus, the aim of this study was to develop a method able to accurately test differential expression with a limited number of samples, in particular non-replicated samples. We propose a local-pooled-error method for RNA-Seq data (LPEseq) to account for non-replicated samples in the analysis of differential expression. Our LPEseq method extends the existing LPE method, which was proposed for microarray data, to allow examination of non-replicated RNA-Seq experiments. We demonstrated the validity of the LPEseq method using both real and simulated datasets. By comparing the results obtained using the LPEseq method with those obtained from other methods, we found that the LPEseq method outperformed the others for non-replicated datasets, and showed a similar performance with replicated samples; LPEseq consistently showed high true discovery rate while not increasing the rate of false positives regardless of the number of samples. Our proposed LPEseq method can be effectively used to conduct differential expression analysis as a preliminary design step or for investigation of a rare specimen, for which a limited number of samples is available.

  16. Impact and relationship of anterior commissure and time-dose factor on the local control of T1N0 glottic cancer treated by 6 MV photons

    Directory of Open Access Journals (Sweden)

    Fu Yiu-Tung

    2011-05-01

    Full Text Available Abstract Background To evaluate prognostic factors that may influence local control (LC of T1N0 glottic cancer treated by primary radiotherapy (RT with 6 MV photons. Methods We retrospectively reviewed the medical records of 433 consecutive patients with T1N0 glottic cancer treated between 1983 and 2005 by RT in our institution. All patients were treated with 6 MV photons. One hundred and seventy seven (41% patients received 52.5 Gy in 23 fractions with 2.5 Gy/fraction, and 256 (59% patients received 66 Gy in 33 fractions with 2 Gy/fraction. Results The median follow-up time was 10.5 years. The 10-year LC rates were 91% and 87% for T1a and T1b respectively. Multivariate analysis showed LC rate was adversely affected by poorly differentiated histology (Hazard Ratio [HR]: 7.5, p = 0.035; involvement of anterior commissure (HR: 2.34, p = 0.011; fraction size of 2.0 Gy (HR: 2.17, p = 0.035 and tumor biologically effective dose (BED 15 (HR: 3.38, p = 0.017. Conclusions The negative impact of anterior commissure involvement could be overcome by delivering a higher tumor BED through using fraction size of > 2.0 Gy. We recommend that fraction size > 2.0 Gy should be utilized, for radiation schedules with five daily fractions each week.

  17. Olivocochlear Efferent Control in Sound Localization and Experience-Dependent Learning

    Science.gov (United States)

    Irving, Samuel; Moore, David R.; Liberman, M. Charles; Sumner, Christian J.

    2012-01-01

    Efferent auditory pathways have been implicated in sound localization and its plasticity. We examined the role of the olivocochlear system (OC) in horizontal sound localization by the ferret and in localization learning following unilateral earplugging. Under anesthesia, adult ferrets underwent olivocochlear bundle section at the floor of the fourth ventricle, either at the midline or laterally (left). Lesioned and control animals were trained to localize 1 s and 40ms amplitude-roved broadband noise stimuli from one of 12 loudspeakers. Neither type of lesion affected normal localization accuracy. All ferrets then received a left earplug and were tested and trained over 10 d. The plug profoundly disrupted localization. Ferrets in the control and lateral lesion groups improved significantly during subsequent training on the 1 s stimulus. No improvement (learning) occurred in the midline lesion group. Markedly poorer performance and failure to learn was observed with the 40 ms stimulus in all groups. Plug removal resulted in a rapid resumption of normal localization in all animals. Insertion of a subsequent plug in the right ear produced similar results to left earplugging. Learning in the lateral lesion group was independent of the side of the lesion relative to the earplug. Lesions in all reported cases were verified histologically. The results suggest the OC system is not needed for accurate localization, but that it is involved in relearning localization during unilateral conductive hearing loss. PMID:21325517

  18. [Experience with mobile units of Disaster Medicine Service of the Russian Defense Ministry in local wars and armed conflicts].

    Science.gov (United States)

    Korniushko, I G; Iakovlev, S V; Vladimirov, E V

    2011-09-01

    The article describes the experience of using of mobile medical units for medical support of combat operations in the armed conflicts in the North Caucasus. The factors affecting the operation of medical services in local wars and armed conflicts are analyzed. Suggestions for the optimization of organizational structure and principles of the use of mobile units service Emergency Medicine are formulated.

  19. Treatment outcomes and morbidity following definitive brachytherapy with or without external beam radiation for the treatment of localized prostate cancer: 20-year experience at Mount Sinai Medical Center.

    Science.gov (United States)

    Marshall, Richard A; Buckstein, Michael; Stone, Nelson N; Stock, Richard

    2014-01-01

    To present our treatment algorithm and 20-year experience in treating prostate cancer with brachytherapy since 1990, with focus on cancer-control outcomes and treatment-related morbidity. We selected patients treated for localized prostate cancer with brachytherapy, combination therapy with external beam radiotherapy, and adjuvant androgen deprivation therapy as prescribed by our Mount Sinai risk stratification and treatment algorithm. Outcomes were analyzed with respect to biochemical failure, distant metastases, prostate cancer-specific survival, and overall survival. Morbidity was assessed with respect to urinary, sexual, and rectal outcomes. In total, 2,495 patients met inclusion criteria. The 12-year actuarial freedom from biochemical failure was 83% (low risk: 90%, intermediate risk: 84%, and high risk: 64%); freedom from distant metastasis was 95%; prostate cancer-specific survival was 95%; and overall survival was 70%. On multivariate analysis, significant associations were found between cancer control and risk group, total biologically effective dose, and androgen deprivation therapy. With regard to morbidity, potency was preserved in 61%, and urinary symptoms improved in 35%. The 12-year actuarial freedom from urinary retention events was 90% and from severe rectal bleed was 93%. Brachytherapy, as administered via the Mount Sinai algorithm, remains an efficacious and benign treatment option for patients with localized prostate cancer of all risk groups. Copyright © 2014 Elsevier Inc. All rights reserved.

  20. Local expert experiences and perceptions of environmentally induced migration from Bangladesh to India

    NARCIS (Netherlands)

    Stojanov, Robert; Boas, Ingrid; Kelman, Ilan; Duží, Barbora

    2017-01-01

    This study investigates local expert perceptions of the role of environmental factors, especially in terms of contemporary climate change, in population movements from Bangladesh to India. The aim is to delve into locally held understandings of the phenomenon and to gain a better understanding of

  1. Generic Regional Development Strategies from Local Stakeholders' Scenarios - an Alpine Village Experience

    Directory of Open Access Journals (Sweden)

    Wolfgang Loibl

    2010-09-01

    Full Text Available The article discusses the participatory elaboration of strategies for sustainable regional development in an Alpine tourist region in Austria to cope with global change effects evolving locally, considering climate change, economic change as well as (local societal change. Local stakeholders in an Alpine village in the Montafon region contributed in workshops to achieve the final results: participant teams conducted system analyses of the regional system to explore key elements of the region. Narrative scenarios described possible positive and negative development trends and indicated the critical issues controlling future development; 3D-images of landscape transition simulations show the consequences of certain development directions. Alternative development directions supported the local stakeholders to elaborate regional development strategies. In the end, the scientist team derived generic strategies for Alpine regions based on the locally developed strategy bundle. The article presents the intention, progress and outcome of the participatory approach and elaborates the potential to derive generic strategies from local ones and discusses the possibly occurring conflicts regarding cross-scale transfers of these local strategies. Overall, tourism was seen as a key element for future regional development, which can on the one hand derogate Alpine regions and is on the other hand threatened by climate change and diminution of landscape attractiveness. The suggested development strategies will help to cope with global change issues mitigating the negative consequences on the local society and environment.

  2. How health professionals perceive and experience treating people on social assistance: a qualitative study among dentists in Montreal, Canada

    Science.gov (United States)

    2013-01-01

    Background In Canada, the prevalence of oral diseases is very high among people on social assistance. Despite great need for dental treatment, many are reluctant to consult dental professionals, arguing that dentists do not welcome or value poor patients. The objective of this research was thus to better understand how dentists perceived and experienced treating people on social assistance. Methods This descriptive qualitative research was based on in-depth semi-structured interviews with 33 dentists practicing in Montreal, Canada. Generally organized in dentists’ offices, the interviews lasted 60 to 120 minutes; they were digitally recorded and later transcribed verbatim. The interview transcripts were coded with NVivo software, and data was displayed in analytic matrices. Three members of the research team interpreted the data displayed and wrote the results of this study. Results Dentists express high levels of frustration with people on social assistance as a consequence of negative experiences that fall into 3 categories: 1) Organizational issues (people on social assistance ostensibly make the organization of appointments and scheduling difficult); 2) Biomedical issues (dentists feel unable to provide them with adequate treatment and fail to improve their oral health); 3) Financial issues (they are not lucrative patients). To explain their stance, dentists blame people on social assistance for neglecting themselves, and the health care system for not providing adequate coverage and fees. Despite dentists’ willingness to treat all members of society, an accumulation of frustration leads to feelings of powerlessness and discouragement. Conclusions The current situation is unacceptable; we urge public health planners and governmental health agencies to ally themselves with the dental profession in order to implement concrete solutions. PMID:24192504

  3. Local anaesthesia and conscious sedation for cochlear implantation: experience with 20 patients.

    Science.gov (United States)

    Pateron, B; Bakhos, D; LeLouarn, A; Bordure, P; Bozorg Grayeli, A; Godey, B; Lescanne, E

    2016-02-01

    Cochlear implantation is mostly performed under general anaesthesia. This study aimed to evaluate cochlear implantation performed under local anaesthesia and sedation. Twenty patients had a cochlear implant fitted under combined local anaesthesia (local anaesthesia group) and 41 patients had one fitted under general anaesthesia (general anaesthesia group) for bilateral profound hearing loss, from 2011 to 2014. Surgical duration, period of post-operative hospitalisation and early post-operative symptoms were compared. In the local anaesthesia group, operative symptoms reported during the surgery and by questionnaire were analysed. Mean surgical duration was significantly shorter in the local anaesthesia group: 87 versus 122 minutes (p anaesthesia and general anaesthesia groups regarding mean post-operative hospitalisation and early post-operative symptoms. Under local anaesthesia, patients had no particular symptoms in 60 per cent of cases. The remaining patients in this group experienced vertigo (10 per cent), pain (20 per cent) and pain-related movement (10 per cent) during the intervention. These symptoms can be controlled with symptomatic treatment. Combined local anaesthesia for cochlear implantation is a good alternative to general anaesthesia for co-operating patients.

  4. Experiential Learning in Rodents: Past Experience Enables Rapid Learning and Localized Encoding in Hippocampus

    Science.gov (United States)

    Cox, Conor D.; Palmer, Linda C.; Pham, Danielle T.; Trieu, Brian H.; Gall, Christine M.; Lynch, Gary

    2017-01-01

    Humans routinely use past experience with complexity to deal with novel, challenging circumstances. This fundamental aspect of real-world behavior has received surprisingly little attention in animal studies, and the underlying brain mechanisms are unknown. The present experiments tested for transfer from past experience in rats and then used…

  5. Percutaneous Image-Guided Screw Fixation of Bone Lesions in Cancer Patients: Double-Centre Analysis of Outcomes including Local Evolution of the Treated Focus

    Energy Technology Data Exchange (ETDEWEB)

    Cazzato, Roberto Luigi, E-mail: gigicazzato@hotmail.it; Koch, Guillaume, E-mail: guillaume.koch@chru-strasbourg.fr [Hôpitaux Universitaires de Strasbourg, HUS, Department of Interventional Radiology, Nouvel Hôpital Civil (France); Buy, Xavier, E-mail: x.buy@bordeaux.unicancer.fr [Institut Bergonié, Department of Radiology (France); Ramamurthy, Nitin, E-mail: nitin-ramamurthy@hotmail.com [Norfolk and Norwich University Hospital, Department of Radiology (United Kingdom); Tsoumakidou, Georgia, E-mail: georgia.tsoumakidou@chru-strasbourg.fr; Caudrelier, Jean, E-mail: jean.caudrelier@chru-strasbourg.fr [Hôpitaux Universitaires de Strasbourg, HUS, Department of Interventional Radiology, Nouvel Hôpital Civil (France); Catena, Vittorio, E-mail: v.catena@bordeaux.unicancer.fr [Institut Bergonié, Department of Radiology (France); Garnon, Julien, E-mail: juleiengarnon@gmail.com [Hôpitaux Universitaires de Strasbourg, HUS, Department of Interventional Radiology, Nouvel Hôpital Civil (France); Palussiere, Jean, E-mail: j.palussiere@bordeaux.unicancer.fr [Institut Bergonié, Department of Radiology (France); Gangi, Afshin, E-mail: gangi@unistra.fr [Hôpitaux Universitaires de Strasbourg, HUS, Department of Interventional Radiology, Nouvel Hôpital Civil (France)

    2016-10-15

    AimTo review outcomes and local evolution of treated lesions following percutaneous image-guided screw fixation (PIGSF) of pathological/insufficiency fractures (PF/InF) and impeding fractures (ImF) in cancer patients at two tertiary centres.Materials and methodsThirty-two consecutive patients (mean age 67.5 years; range 33–86 years) with a range of tumours and prognoses underwent PIGSF for non/minimally displaced PF/InF and ImF. Screws were placed under CT/fluoroscopy or cone-beam CT guidance, with or without cementoplasty. Clinical outcomes were assessed using a simple 4-point scale (1 = worse; 2 = stable; 3 = improved; 4 = significantly improved). Local evolution was reviewed on most recent follow-up imaging. Technical success, complications, and overall survival were evaluated.ResultsThirty-six lesions were treated with 74 screws mainly in the pelvis and femoral neck (58.2 %); including 47.2 % PF, 13.9 % InF, and 38.9 % ImF. Cementoplasty was performed in 63.9 % of the cases. Technical success was 91.6 %. Hospital stay was ≤3 days; 87.1 % of lesions were improved at 1-month follow-up; three major complications (early screw-impingement radiculopathy; accelerated coxarthrosis; late coxofemoral septic arthritis) and one minor complication were observed. Unfavourable local evolution at imaging occurred in 3/24 lesions (12.5 %) at mean 8.7-month follow-up, including poor consolidation (one case) and screw loosening (two cases, at least 1 symptomatic). There were no cases of secondary fractures.ConclusionsPIGSF is feasible for a wide range of oncologic patients, offering good short-term efficacy, acceptable complication rates, and rapid recovery. Unfavourable local evolution at imaging may be relatively frequent, and requires close clinico-radiological surveillance.

  6. SU-D-204-07: Retrospective Correlation of Dose Accuracy with Regions of Local Failure for Early Stage Lung Cancer Patients Treated with Stereotactic Body Radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Devpura, S; Li, H; Liu, C; Fraser, C; Ajlouni, M; Movsas, B; Chetty, I [Henry Ford Health System, Detroit, MI (United States)

    2016-06-15

    Purpose: To correlate dose distributions computed using six algorithms for recurrent early stage non-small cell lung cancer (NSCLC) patients treated with stereotactic body radiotherapy (SBRT), with outcome (local failure). Methods: Of 270 NSCLC patients treated with 12Gyx4, 20 were found to have local recurrence prior to the 2-year time point. These patients were originally planned with 1-D pencil beam (1-D PB) algorithm. 4D imaging was performed to manage tumor motion. Regions of local failures were determined from follow-up PET-CT scans. Follow-up CT images were rigidly fused to the planning CT (pCT), and recurrent tumor volumes (Vrecur) were mapped to the pCT. Dose was recomputed, retrospectively, using five algorithms: 3-D PB, collapsed cone convolution (CCC), anisotropic analytical algorithm (AAA), AcurosXB, and Monte Carlo (MC). Tumor control probability (TCP) was computed using the Marsden model (1,2). Patterns of failure were classified as central, in-field, marginal, and distant for Vrecur ≥95% of prescribed dose, 95–80%, 80–20%, and ≤20%, respectively (3). Results: Average PTV D95 (dose covering 95% of the PTV) for 3-D PB, CCC, AAA, AcurosXB, and MC relative to 1-D PB were 95.3±2.1%, 84.1±7.5%, 84.9±5.7%, 86.3±6.0%, and 85.1±7.0%, respectively. TCP values for 1-D PB, 3-D PB, CCC, AAA, AcurosXB, and MC were 98.5±1.2%, 95.7±3.0, 79.6±16.1%, 79.7±16.5%, 81.1±17.5%, and 78.1±20%, respectively. Patterns of local failures were similar for 1-D and 3D PB plans, which predicted that the majority of failures occur in centraldistal regions, with only ∼15% occurring distantly. However, with convolution/superposition and MC type algorithms, the majority of failures (65%) were predicted to be distant, consistent with the literature. Conclusion: Based on MC and convolution/superposition type algorithms, average PTV D95 and TCP were ∼15% lower than the planned 1-D PB dose calculation. Patterns of failure results suggest that MC and convolution

  7. Evaluation of the pain and local tenderness in bone metastasis treated with magnetic resonance-guided focused ultrasound surgery (MRgFUS)

    Science.gov (United States)

    Namba, Hirofumi; Kawasaki, Motohiro; Kato, Tomonari; Tani, Toshikazu; Ushida, Takahiro; Koizumi, Norihiro

    2017-03-01

    It has been reported that MRgFUS has pain palliative effects on the local pain in patients with bone metastasis. In general, a severity of pain has been evaluated using only subjective method with numerical rating scale (NRS) or visual analogue scale (VAS). It is important to evaluate local pain-palliative effects of MRgFUS treatment with objective and quantitative method. The aim of this study is to investigate changes in the severity of local pain of bone metastasis before and after MRgFUS treatments, measuring pressure pain threshold (PPT) using pressure algometer, and pain intensity using electrical stimulation device (the Pain Vision system) at most painful site of bone metastasis. We have conducted MRgFUS for pain palliation of bone metastasis for 8 patients, and evaluated the local tenderness quantitatively for 8 patients, and evaluated local pain intensity for 7 patients. Before the treatments, PPTs were 106.3kPa [40.0-431.5] at metastatic site and 344.8 kPa [206.0-667.0] at normal control site, which showed a significant difference. The PPTs at metastatic site shows a significant increase from 106.3 kPa [40.0-431.5] at the baseline to 270.5 kPa [93.5-533.5] at 3 months after the treatment. The NRS score shows a significant decrease from 6.0 [4-8] at baseline to 1 [0-3] at 3 months after the treatment. Similarly, the pain intensity shows a significant decrease 245 [96.3-888.7] at baseline to 55.9 [2.8-292] at 3 months after the treatment. The results of our study illustrate the pain-relieving effects of MRgFUS for the treatment of painful bone metastasis. PPT might be a useful parameter not only for assessing a treatment's effect, but also for the decision of the painful area to treat with MRgFUS. Pain Vision seems to be useful for quantitative and objective evaluation of local pain of painful bone metastasis.

  8. Range-based underwater vehicle localization in the presence of unknown ocean currents: Theory and experiments

    Digital Repository Service at National Institute of Oceanography (India)

    Bayat, M.; Crasta, N.; Aguiar, A.P.; Pascoal, A.M.

    This paper addresses the problem of range-based autonomous underwater vehicle (AUV) localization in the presence of unknown ocean currents. In the setup adopted, the AUV is equipped with an attitude and heading reference system, a depth sensor...

  9. Building local human resources to implement SLMTA with limited donor funding: The Ghana experience

    Directory of Open Access Journals (Sweden)

    Bernard Nkrumah

    2014-11-01

    Full Text Available Background: In 2009, Ghana adopted the Strengthening Laboratory Management Toward Accreditation (SLMTA programme in order to improve laboratory quality. The programme was implemented successfully with limited donor funding and local human resources. Objectives: To demonstrate how Ghana, which received very limited PEPFAR funding, was able to achieve marked quality improvement using local human resources. Method: Local partners led the SLMTA implementation and local mentors were embedded in each laboratory. An in-country training-of-trainers workshop was conducted in order to increase the pool of local SLMTA implementers. Three laboratory cohorts were enrolled in SLMTA in 2011, 2012 and 2013. Participants from each cohort attended in a series of three workshops interspersed with improvement projects and mentorship. Supplemental trainingon internal audit was provided. Baseline, exit and follow-up audits were conducted using the Stepwise Laboratory Quality Improvement Process Towards Accreditation (SLIPTA checklist. In November 2013, four laboratories underwent official SLIPTA audits by the African Society for Laboratory Medicine (ASLM. Results: The local SLMTA team successfully implemented three cohorts of SLMTA in 15 laboratories. Seven out of the nine laboratories that underwent follow-up audits have reached at least one star. Three out of the four laboratories that underwent official ASLM audits were awarded four stars. Patient satisfaction increased from 25% to 70% and sample rejection rates decreased from 32% to 10%. On average, $40 000 was spent per laboratory to cover mentors’salaries, SLMTA training and improvement project support. Conclusion: Building in-country capacity through local partners is a sustainable model for improving service quality in resource-constrained countries such as Ghana. Such modelspromote country ownership, capacity building and the use of local human resources for the expansion of SLMTA.

  10. Building local human resources to implement SLMTA with limited donor funding: The Ghana experience

    Directory of Open Access Journals (Sweden)

    Bernard Nkrumah

    2014-09-01

    Full Text Available Background: In 2009, Ghana adopted the Strengthening Laboratory Management Toward Accreditation (SLMTA programme in order to improve laboratory quality. The programme was implemented successfully with limited donor funding and local human resources.Objectives: To demonstrate how Ghana, which received very limited PEPFAR funding, was able to achieve marked quality improvement using local human resources.Method: Local partners led the SLMTA implementation and local mentors were embedded in each laboratory. An in-country training-of-trainers workshop was conducted in order to increase the pool of local SLMTA implementers. Three laboratory cohorts were enrolled in SLMTA in 2011, 2012 and 2013. Participants from each cohort attended in a series of three workshops interspersed with improvement projects and mentorship. Supplemental trainingon internal audit was provided. Baseline, exit and follow-up audits were conducted using the Stepwise Laboratory Quality Improvement Process Towards Accreditation (SLIPTA checklist. In November 2013, four laboratories underwent official SLIPTA audits by the African Society for Laboratory Medicine (ASLM.Results: The local SLMTA team successfully implemented three cohorts of SLMTA in 15 laboratories. Seven out of the nine laboratories that underwent follow-up audits have reached at least one star. Three out of the four laboratories that underwent official ASLM audits were awarded four stars. Patient satisfaction increased from 25% to 70% and sample rejection rates decreased from 32% to 10%. On average, $40 000 was spent per laboratory to cover mentors’salaries, SLMTA training and improvement project support.Conclusion: Building in-country capacity through local partners is a sustainable model for improving service quality in resource-constrained countries such as Ghana. Such modelspromote country ownership, capacity building and the use of local human resources for the expansion of SLMTA.

  11. Accounting for local adaptation in ectomycorrhizas: a call to track geographical origin of plants, fungi, and soils in experiments.

    Science.gov (United States)

    Rúa, Megan A; Lamit, Louis J; Gehring, Catherine; Antunes, Pedro M; Hoeksema, Jason D; Zabinski, Cathy; Karst, Justine; Burns, Cole; Woods, Michaela J

    2018-02-01

    Local adaptation, the differential success of genotypes in their native versus foreign environments, can influence ecological and evolutionary processes, yet its importance is difficult to estimate because it has not been widely studied, particularly in the context of interspecific interactions. Interactions between ectomycorrhizal (EM) fungi and their host plants could serve as model system for investigations of local adaptation because they are widespread and affect plant responses to both biotic and abiotic selection pressures. Furthermore, because EM fungi cycle nutrients and mediate energy flow into food webs, their local adaptation may be critical in sustaining ecological function. Despite their ecological importance and an extensive literature on their relationships with plants, the vast majority of experiments on EM symbioses fail to report critical information needed to assess local adaptation: the geographic origin of the plant, fungal inocula, and soil substrate used in the experiment. These omissions limit the utility of such studies and restrict our understanding of EM ecology and evolution. Here, we illustrate the potential importance of local adaptation in EM relationships and call for consistent reporting of the geographic origin of plant, soil, and fungi as an important step towards a better understanding of the ecology and evolution of EM symbioses.

  12. Radio-guided localization of clinically occult breast lesions (ROLL): a DGH experience.

    Science.gov (United States)

    Thind, C R; Desmond, S; Harris, O; Nadeem, R; Chagla, L S; Audisio, R A

    2005-06-01

    Wire-guided localization (WGL) of clinically occult breast lesions is a well established technique. The aim of this study was to evaluate radio-guided localization (ROLL) within the breast screening service of a district general hospital. The study group comprised 70 women who underwent ROLL under US and stereotaxis. This required an injection of Technetium-labelled colloidal albumen into the impalpable breast lesion. The women then proceeded to theatre, where localization was achieved with the use of a gamma probe. The lesion was identified by the presence of a high signal, caused by the injected isotope. The results of 70 consecutive cases in which a breast lesion was localized using ROLL were compared with the results of the latest 70 WGLs. All 140 lesions were successfully localized. However, the change in technique from WGL to ROLL offered significant benefits to patients. Our study demonstrated that ROLL is a practical and reliable localization technique. It can be implemented in hospital units without using valuable gamma camera time. The cost compares well with WGL. There is an improved cosmetic outcome for patients, and the very small quantity of radioactivity used is safe for both patients and staff.

  13. Radio-guided localization of clinically occult breast lesions (ROLL): a DGH experience

    Energy Technology Data Exchange (ETDEWEB)

    Thind, C.R. [St Helens and Knowsley Hospitals, Prescot (United Kingdom)]. E-mail: thindr@aol.com; Desmond, S. [St Helens and Knowsley Hospitals, Prescot (United Kingdom); Harris, O. [St Helens and Knowsley Hospitals, Prescot (United Kingdom); Nadeem, R. [St Helens and Knowsley Hospitals, Prescot (United Kingdom); Chagla, L.S. [St Helens and Knowsley Hospitals, Prescot (United Kingdom); Audisio, R.A. [St Helens and Knowsley Hospitals, Prescot (United Kingdom)

    2005-06-01

    AIM: Wire-guided localization (WGL) of clinically occult breast lesions is a well established technique. The aim of this study was to evaluate radio-guided localization (ROLL) within the breast screening service of a district general hospital. METHOD: The study group comprised 70 women who underwent ROLL under US and stereotaxis. This required an injection of Technetium-labelled colloidal albumen into the impalpable breast lesion. The women then proceeded to theatre, where localization was achieved with the use of a gamma probe. The lesion was identified by the presence of a high signal, caused by the injected isotope. The results of 70 consecutive cases in which a breast lesion was localized using ROLL were compared with the results of the latest 70 WGLs. RESULTS: All 140 lesions were successfully localized. However, the change in technique from WGL to ROLL offered significant benefits to patients. CONCLUSION: Our study demonstrated that ROLL is a practical and reliable localization technique. It can be implemented in hospital units without using valuable gamma camera time. The cost compares well with WGL. There is an improved cosmetic outcome for patients, and the very small quantity of radioactivity used is safe for both patients and staff.

  14. The Feasibility of Using Large-Scale Text Mining to Detect Adverse Childhood Experiences in a VA-Treated Population.

    Science.gov (United States)

    Hammond, Kenric W; Ben-Ari, Alon Y; Laundry, Ryan J; Boyko, Edward J; Samore, Matthew H

    2015-12-01

    Free text in electronic health records resists large-scale analysis. Text records facts of interest not found in encoded data, and text mining enables their retrieval and quantification. The U.S. Department of Veterans Affairs (VA) clinical data repository affords an opportunity to apply text-mining methodology to study clinical questions in large populations. To assess the feasibility of text mining, investigation of the relationship between exposure to adverse childhood experiences (ACEs) and recorded diagnoses was conducted among all VA-treated Gulf war veterans, utilizing all progress notes recorded from 2000-2011. Text processing extracted ACE exposures recorded among 44.7 million clinical notes belonging to 243,973 veterans. The relationship of ACE exposure to adult illnesses was analyzed using logistic regression. Bias considerations were assessed. ACE score was strongly associated with suicide attempts and serious mental disorders (ORs = 1.84 to 1.97), and less so with behaviorally mediated and somatic conditions (ORs = 1.02 to 1.36) per unit. Bias adjustments did not remove persistent associations between ACE score and most illnesses. Text mining to detect ACE exposure in a large population was feasible. Analysis of the relationship between ACE score and adult health conditions yielded patterns of association consistent with prior research. Copyright © 2015 International Society for Traumatic Stress Studies.

  15. Temporal variation of nitrogen balance within constructed wetlands treating slightly polluted water using a stable nitrogen isotope experiment.

    Science.gov (United States)

    Zhang, Wanguang; Lei, Qiongye; Li, Zhengkui; Han, Huayang

    2016-02-01

    Slightly polluted water has become one of the main sources of nitrogen contaminants in recent years, for which constructed wetlands (CW) is a typical and efficient treatment. However, the knowledge about contribution of individual nitrogen removal pathways and nitrogen balance in constructed wetlands is still limited. In this study, a stable-isotope-addition experiment was performed in laboratory-scale constructed wetlands treating slightly polluted water to determine quantitative contribution of different pathways and temporal variation of nitrogen balance using Na(15)NO3 as tracer. Microbial conversion and substrate retention were found to be the dominant pathways in nitrogen removal contributing 24.4-79.9 and 8.9-70.7 %, respectively, while plant contributed only 4.6-11.1 % through direct assimilation but promoted the efficiency of other pathways. In addition, microbial conversion became the major way to remove N whereas nitrogen retained in substrate at first was gradually released to be utilized by microbes and plants over time. The findings indicated that N2 emission representing microbial conversion was not only the major but also permanent nitrogen removal process, thus keeping a high efficiency of microbial conversion is important for stable and efficient nitrogen removal in constructed wetlands.

  16. Phase Ib study of the mitochondrial inhibitor ME-344 plus topotecan in patients with previously treated, locally advanced or metastatic small cell lung, ovarian and cervical cancers.

    Science.gov (United States)

    Diamond, Jennifer R; Goff, Barbara; Forster, Martin D; Bendell, Johanna C; Britten, Carolyn D; Gordon, Michael S; Gabra, Hani; Waterhouse, David M; Poole, Mark; Ross Camidge, D; Hamilton, Erika; Moore, Kathleen M

    2017-10-01

    Background This multicenter, open-label, phase Ib study was designed to assess the safety, pharmacokinetics and preliminary efficacy of ME-344, a mitochondrial inhibitor, administered in combination with the topoisomerase I inhibitor, topotecan, in patients with previously treated, locally advanced or metastatic small cell lung (SCLC), ovarian and cervical cancers. Patients and methods In Part 1, patients received ME-344 10 mg/kg intravenously weekly on days 1, 8, 15 and 22 in combination with topotecan 4 mg/m2 on days 1, 8, and 15 of a 28 day cycle. Cycles were repeated until disease progression or unacceptable toxicity. Patients were evaluated for dose-limiting toxicity (DLT) in cycle 1 and ME-344 pharmacokinetic samples were obtained. In Part 2, patients with locally advanced or metastatic SCLC and ovarian cancer were enrolled in expansion cohorts treated at the recommended phase II dose (RP2D) determined in Part 1. Results Fourteen patients were enrolled in Part 1 and no DLTs were observed. The RP2D of ME-344 in combination with topotecan was established as 10 mg/kg. In Part 2, 32 patients were enrolled. The most common treatment-emergent all-grade and grade 3/4 toxicities included fatigue (65.2%, 6.5%), neutropenia (56.5%, 43.5%) and thrombocytopenia (50%, 23.9%). One patient with recurrent ovarian cancer experienced a partial response by RECIST 1.1 and 21 patients achieved stable disease as best response. Conclusions The combination of ME-344 10 mg/kg weekly and topotecan 4 mg/m2 was tolerable, however, the degree of anti-cancer activity does not support further investigation of the combination in unselected patients with SCLC, ovarian and cervical cancers.

  17. Simultaneous Integrated Boost Using Intensity-Modulated Radiotherapy Compared With Conventional Radiotherapy in Patients Treated With Concurrent Carboplatin and 5-Fluorouracil for Locally Advanced Oropharyngeal Carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Clavel, Sebastien, E-mail: sebastien.clavel@umontreal.ca [Department of Radiation Oncology, Centre Hospitalier de l' Universite de Montreal, Montreal, QC (Canada); Nguyen, David H.A.; Fortin, Bernard [Department of Radiation Oncology, Hopital Maisonneuve-Rosemont, Montreal, QC (Canada); Despres, Philippe [Department of Radiation Oncology, Centre Hospitalier de l' Universite de Montreal, Montreal, QC (Canada); Khaouam, Nader [Department of Radiation Oncology, Hopital Maisonneuve-Rosemont, Montreal, QC (Canada); Donath, David [Department of Radiation Oncology, Centre Hospitalier de l' Universite de Montreal, Montreal, QC (Canada); Soulieres, Denis [Department of Medical Oncology, Centre Hospitalier de l' Universite de Montreal, Montreal, QC (Canada); Guertin, Louis [Department of Head and Neck Surgery, Centre Hospitalier de l' Universite de Montreal, Montreal, QC (Canada); Nguyen-Tan, Phuc Felix [Department of Radiation Oncology, Hopital Maisonneuve-Rosemont, Montreal, QC (Canada)

    2012-02-01

    Purpose: To compare, in a retrospective study, the toxicity and efficacy of simultaneous integrated boost using intensity-modulated radiotherapy (IMRT) vs. conventional radiotherapy (CRT) in patients treated with concomitant carboplatin and 5-fluorouracil for locally advanced oropharyngeal cancer. Methods and Materials: Between January 2000 and December 2007, 249 patients were treated with definitive chemoradiation. One hundred patients had 70 Gy in 33 fractions using IMRT, and 149 received CRT at 70 Gy in 35 fractions. Overall survival, disease-free survival, and locoregional control were estimated using the Kaplan-Meier method. Results: Median follow-up was 42 months. Three-year actuarial rates for locoregional control, disease-free survival, and overall survival were 95.1% vs. 84.4% (p = 0.005), 85.3% vs. 69.3% (p = 0.001), and 92.1% vs. 75.2% (p < 0.001) for IMRT and CRT, respectively. The benefit of the radiotherapy regimen on outcomes was also observed with a Cox multivariate analysis. Intensity-modulated radiotherapy was associated with less acute dermatitis and less xerostomia at 6, 12, 24, and 36 months. Conclusions: This study suggests that simultaneous integrated boost using IMRT is associated with favorable locoregional control and survival rates with less xerostomia and acute dermatitis than CRT when both are given concurrently with chemotherapy.

  18. Current problems of constitutional regulation of the status of local communities in Ukraine in the context of international experience

    Directory of Open Access Journals (Sweden)

    O. V. Batanov

    2016-03-01

    Full Text Available In the article, taking into account foreign experience of development of modern systems of municipal management and practice application of the provisions of new legislation on decentralization highlights the conceptual problems of reforming local government and territorial organization of power in modern Ukraine. Describes the characteristics of the legal status of the territorial community as the primary subject of the municipal authorities in Ukraine and foreign countries. Analyzed the current state of the legal status of the territorial community, the basic of the modern constitutional project initiatives in part on local self-government in Ukraine from the position of the principles of classical muncipalism. We separately consider the possible risks with the possibility of introduction in Ukraine of Institute of the prefects and new mechanism of control over activity of local governments, draws attention to the shortcomings of legal support of process of formation of territorial basis of local government - the creation of local communities who owned the resource base necessary to ensure compliance with the tasks and powers transferred to local government during the decentralization. Proposed separate proposals to prevent possible conflicts of laws and organizational conflicts that can arise in the application of the provisions of the law of Ukraine «On Association of territorial communities».

  19. Wave localization of linear gravity waves in shallow water: Global measurements and agreement between random matrix theory and experiments

    Science.gov (United States)

    Schmessane, Andrea; Laboratory of matter out equilibrium Team

    2012-11-01

    Wave localization explains how a perturbation is trapped by the randomness present in a propagation medium. As it propagates, the localized wave amplitude decreases strongly by multiple internal reflections with randomly positioned scatterers, effectively trapping the perturbation inside the random region. The characteristic length where a localized wave is propagated before being extinguish by randomness is called localization length. We carried experiments in a quasi-onedimensional channel with random bottom in a shallow water regime for surface gravity water waves, using a Perfilometry Fourier Transform method, which enables us to obtain global surface measurements. We discuss keys aspects of the control of variables, the experimental setup and the implementation of the measurement method. Thus, we can control, measure and evaluate fundamental variables present in the localization phenomenon such as the type of randomness, scattering intensity and sample length, which allows us to characterize wave localization. We use the scattering matrix method to compare the experimental measurements with theoretical and numerical predictions, using the Lyapunov exponent of the scattering matrix, and discuss their agreement. Conicyt

  20. Adult education for local community development: A cross-border experience of study circles

    Directory of Open Access Journals (Sweden)

    Giovanna Del Gobbo

    2014-04-01

    Full Text Available The relationship between adult education and local community development is emphasised by the contextualisation of study circles in the cross-border area along the border between Italy and Slovenia. The system of crossborder study circles development is described on the basis of local challenges framed in the theory of human and social capital. The educational model of study circles, well developed in Slovenia, is implemented. New dimensions development and empirical data are provided by the EU project. Monitoring evidence stimulated educational demands of the local community on various levels of activity (training programmes for mentors, study circles, stakeholders round tables and at the same time stimulated offers as well. The project described demonstrates the possibility of building a local system of study circles linked to local development in the border area via a multi-level approach and the direct involvement of the various stakeholders. The final discussion highlights the importance of vertical and horizontal integration, typical for long-term bottom-up development. The diversity of learning devices and the role of the intermediary level provide a greater degree of creativity and initiative than the formal educational system, but only when it is recognised and empowered by top-down decision making.

  1. Perceived stress mediates the effects of social support on health-related quality of life among men treated for localized prostate cancer.

    Science.gov (United States)

    Zhou, Eric S; Penedo, Frank J; Lewis, John E; Rasheed, Mikal; Traeger, Lara; Lechner, Suzanne; Soloway, Mark; Kava, Bruce R; Antoni, Michael H

    2010-12-01

    To examine the longitudinal effect of social support on general health-related quality of life (HRQOL) in men treated for localized prostate cancer, and to evaluate the role of perceived stress as a potential mediator of that relationship, in an ethnically and demographically diverse sample. Psychosocial assessments were administered to a sample of 175 men at baseline, and 2 years later. Hierarchical regression analyses were conducted to investigate the relationships between social support, perceived stress and HRQOL, while controlling for possible covariates that may affect HRQOL (e.g., age, time since diagnosis, medical comorbidities, etc.). Higher levels of social support at baseline predicted higher levels of HRQOL at 2-year follow-up after controlling for relevant covariates and baseline levels of HRQOL. This relationship was partially mediated by level of perceived stress at baseline. Furthermore, men perceiving high levels of social support reported significantly higher HRQOL compared with men perceiving low levels of social support. Results indicate positive social relationships contribute to improved HRQOL in patients who have undergone treatment for localized prostate cancer. One pathway through which social support can benefit HRQOL is through lower perceptions of stress. Enhancing or maintaining social support and reducing perceived stress may be potential targets for future psychosocial interventions aimed at improving HRQOL. Published by Elsevier Inc.

  2. Long-term Survival and Toxicity in Patients Treated With High-Dose Intensity Modulated Radiation Therapy for Localized Prostate Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Spratt, Daniel E.; Pei, Xin; Yamada, Josh; Kollmeier, Marisa A.; Cox, Brett [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Zelefsky, Michael J., E-mail: zelefskm@mskcc.org [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York (United States)

    2013-03-01

    Purpose: To report long-term survival and toxicity outcomes with the use of high-dose intensity modulated radiation therapy (IMRT) to 86.4 Gy for patients with localized prostate cancer. Methods and Materials: Between August 1997 and December 2008, 1002 patients were treated to a dose of 86.4 Gy using a 5-7 field IMRT technique. Patients were stratified by prognostic risk group based on National Comprehensive Cancer Network risk classification criteria. A total of 587 patients (59%) were treated with neoadjuvant and concurrent androgen deprivation therapy. The median follow-up for the entire cohort was 5.5 years (range, 1-14 years). Results: For low-, intermediate-, and high-risk groups, 7-year biochemical relapse-free survival outcomes were 98.8%, 85.6%, and 67.9%, respectively (P<.001), and distant metastasis-free survival rates were 99.4%, 94.1%, and 82.0% (P<.001), respectively. On multivariate analysis, T stage (P<.001), Gleason score (P<.001), and >50% of initial biopsy positive core (P=.001) were predictive for distant mestastases. No prostate cancer-related deaths were observed in the low-risk group. The 7-year prostate cancer-specific mortality (PCSM) rates, using competing risk analysis for intermediate- and high-risk groups, were 3.3% and 8.1%, respectively (P=.008). On multivariate analysis, Gleason score (P=.004), percentage of biopsy core positivity (P=.003), and T-stage (P=.033) were predictive for PCSM. Actuarial 7-year grade 2 or higher late gastrointestinal and genitourinary toxicities were 4.4% and 21.1%, respectively. Late grade 3 gastrointestinal and genitourinary toxicity was experienced by 7 patients (0.7%) and 22 patients (2.2%), respectively. Of the 427 men with full potency at baseline, 317 men (74%) retained sexual function at time of last follow-up. Conclusions: This study represents the largest cohort of patients treated with high-dose radiation to 86.4 Gy, using IMRT for localized prostate cancer, with the longest follow-up to date

  3. Experience in local Glyciphon chemotherapy of basal cell carcinoma of the problem face areas

    Directory of Open Access Journals (Sweden)

    S. O. Podvyaznikov

    2017-01-01

    Full Text Available Basal cell carcinoma (BCC is the most common type of malignant skin tumors, characterized by selective localization on the head and neck. Currently there is a variety of treatment methods for this disease, but some of them are not feasible due to patients’ age, cancer localization, morphological type, size, or number of tumor lesions. In that respect, local chemotherapy of BCC, especially for the problem face areas, can serve as a good alternative. Clinical and experimental trials have shown a high treatment effect for 30 % Glyciphon ointment in patients with BCC. In this article we present successful examples of treatment of patients with BCC on the problem face areas using Glyciphon.

  4. High-Intensity Focused Ultrasound (HIFU) Using Sonablate-500 for the Treatment of Localized Prostate Cancer: 6-year experience

    Science.gov (United States)

    Uchida, Toyoaki; Shoji, Sunao; Nagata, Yoshihiro

    2006-05-01

    We evaluated 281 patients of localized prostate cancer treated with high-intensity focused ultrasound (HIFU) for biochemical disease-free rate, safety, morbidity and predictors of biochemical outcome. A total of 281 patients underwent HIFU with the use of Sonablate-500 and with at least 12 months of follow-up. Biochemical failure was defined according to the criteria recommended by the American Society for Therapeutic Radiology and Oncology Consensus Panel. The biochemical disease-free rates at 1, 3 and 5 years in all patients were 78%, 74% and 72%, respectively. The biochemical disease-free rates at 5 years for patients with pretreatment PSA less than 10 ng/ml, 10.01 to 20.0 ng/ml and more than 20.0 ng/ml were 88%, 70% and 17%, respectively (ppatients with localized prostate cancer, especially those with a pretreatment PSA level less than 20 ng/ml.

  5. Building local competences to meet mining activities – strategies based on experiences from Greenland and Island

    DEFF Research Database (Denmark)

    Jørgensen, Ulrik; Gjedssø Bertelsen, Rasmus; Hendriksen, Kåre

    Mineral extraction in the Arctic is seen as a key to overcome future shortages of raw materials and local economic challenges in northern regions. Governmental strategies aim at building competence in governance and a local workforce that can be employed in mining industries and related businesses......, operation as well as closing down of mines. These impact assessments are embedded in wider socio-technical regimes framing the conditions for operation and the ways mining is integrated into the development of knowledge, skills, economy and social living conditions and practices. EIA and SIA have...

  6. Social media, FOAMed in medical education and knowledge sharing: Local experiences with international perspective.

    Science.gov (United States)

    Cevik, Arif Alper; Aksel, Gokhan; Akoglu, Haldun; Eroglu, Serkan Emre; Dogan, Nurettin Ozgur; Altunci, Yusuf Ali

    2016-09-01

    Social media, through the Internet and other web-based technologies, have become a means of communication and knowledge-sharing. In this article, we provide details about the social media traffic of various scientific activities, the organizations of which we have played an active role in. We also provide information in our native language through our FOAMed website, which has been published for about 30 months, with us acting as editors. We are comparing these local and limited ventures with examples from the world and aim to remind that social media sources play a very important role in sharing knowledge in medical training and encouraging local initiatives, like ours, with limited resources.

  7. Improving the Estimation of Local Welfare Costs of Conservation in Low-Income Countries Using Choice Experiments

    DEFF Research Database (Denmark)

    Rakotonarivo, Onjamirindra Sarobidy

    the validity of DCE in estimating the costs of conservation restrictions ex-ante. I found that experience of forest protection matters; households who have been exposed to forest protection for a comparatively longer period had significantly higher welfare costs for restricting forest clearance than those who...... techniques. It also has major implications for how forest conservation policy may be devised in low-income countries, including devolution of secure forestland tenure to local people and genuinely negotiating conservation with forest users....

  8. I saw the sign: the new federal menu-labeling law and lessons from local experience.

    Science.gov (United States)

    Banker, Michelle I

    2010-01-01

    Following the lead of several state and local governments, Congress recently imposed menu-labeling requirements on chain restaurants as part of the federal health care reform bill signed into law in March 2010. Section 4205 of the Patient Protection and Affordable Care Act requires restaurant chains with 20 or more locations nationwide to display calorie information for standard menu items on menus, menu boards, and drive-thru displays. This paper examines the new federal law in light of existing state and local regulations and considers the arguments for and against mandatory calorie labeling at restaurants as a federal tool for preventing obesity. Specifically, this paper examines the provisions of the new federal law, highlights how it differs from the municipal and state menu-labeling laws already in effect, reviews early studies of the effectiveness of these state and local laws, and considers the propriety of requiring restaurants to disclose calorie information on menus by discussing arguments for and against menu labeling generally and calorie labeling in particular. This paper finds that based on initial studies of state and local menu-labeling regulations, the efficacy of compulsory menu labeling as a tool to combat obesity remains uncertain. Finally, this paper raises practical considerations associated with the new federal law, including implementation issues, potential collateral effects of the law, a survey of legal challenges that may arise, and a discussion of the Food and Drug Administration's competence to enforce a menu-labeling requirement against restaurants.

  9. High resolution modelling of aerosol dispersion regimes during the CAPITOUL field experiment: from regional to local scale interactions

    Directory of Open Access Journals (Sweden)

    B. Aouizerats

    2011-08-01

    Full Text Available High resolution simulation of complex aerosol particle evolution and gaseous chemistry over an atmospheric urban area is of great interest for understanding air quality and processes. In this context, the CAPITOUL (Canopy and Aerosol Particle Interactions in the Toulouse Urban Layer field experiment aims at a better understanding of the interactions between the urban dynamics and the aerosol plumes. During a two-day Intensive Observational Period, a numerical model experiment was set up to reproduce the spatial distribution of specific particle pollutants, from the regional scales and the interactions between different cities, to the local scales with specific turbulent structures. Observations show that local dynamics depends on the day-regime, and may lead to different mesoscale dynamical structures. This study focuses on reproducing these fine scale dynamical structures, and investigate the impact on the aerosol plume dispersion. The 500-m resolution simulation manages to reproduce convective rolls at local scale, which concentrate most of the aerosol particles and can locally affect the pollutant dispersion and air quality.

  10. Our experience of breast conservative therapy in the treatment of localized breast cancer

    Energy Technology Data Exchange (ETDEWEB)

    Kataoka, Takeshi; Okamoto, Taro; Gotoh, Takahiko (Hiroshima Univ. (Japan). School of Medicine) (and others)

    1992-06-01

    In the recent two years, twenty-three patients with usually Stage I breast cancers were treated with breast conservative therapy (BCT). At the time of the analysis, the median follow-up was about 8 months (range 1 to 23 months). There was a 52.2% intraductal spread, and one third of them fatty tissue or vessel infiltration were observed. In our study, 73.9% of patients treated with BCT had a good or excellent cosmetic results, subjectively. The contraversy of patient selection for BCT has to be continued to generate consideration in our country until the long-term results of BCT can be assessed for each patient, and the pathological or biological predictors for recurrence can be clarified. (author).

  11. Experiences of pain: a longitudinal, qualitative study of patients with head and neck cancer recently treated with radiotherapy.

    Science.gov (United States)

    Schaller, Anne; Larsson, Britt; Lindblad, Mona; Liedberg, Gunilla M

    2015-06-01

    It is not unusual for patients with head and neck cancer (HNC) to suffer from both tumor- and treatment-related pain that is difficult to alleviate despite individualized pain management. The aim of this qualitative study was to describe how HNC patients experience pain and how pain influences those who are treated with radiotherapy (RT). Qualitative semistructured interviews were performed 1 and 6 months after patients completed RT. The interviews addressed symptoms, moods, and suffering. The study included 26 patients with HNC who had recently completed RT. The interviews were analyzed using manifest content analysis. The main category was: HNC patients did not report that their severe physical pain influenced their psychological suffering, but it did influence their social lives. Furthermore, four categories were revealed: pain in the head and neck region, overwhelming fatigue, altered mood and preoccupied mind, and decreased participation and changed relationships. Physical pain, psychological distress, and social withdrawal were prominent at both interviews and consequently their situation can be considered as chronic. Remarkably, patients did not express a clear relationship between pain and psychological load. This may imply a biomedical view of pain or may reflect the difficult situation patients were in (i.e., facing a possibly life-threatening cancer). Thus, their situation might require a prioritization and might negatively affect the possibility of identifying the interaction between the different pain dimensions. The biopsychosocial model of chronic pain aims to understand the interaction between pain and psychosocial factors. Interventions aiming to teach patients with HNC how to internalize the biopsychosocial model framework to manage pain could be useful and should be evaluated in future research. Copyright © 2015 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

  12. Connecting transport, agriculture and rural development: Experiences from Mhlontlo local municipality integrated infrastructure atlas

    CSIR Research Space (South Africa)

    Chakwizira, J

    2010-08-01

    Full Text Available This paper establishes the connection between transport, agriculture and rural development. The paper achieves this purpose by drawing from the experiences of the Mhlontlo municipality integrated infrastructure atlas project. The connection between...

  13. A qualitative national focus group study of the experience of living with lymphoedema and accessing local multiprofessional lymphoedema clinics.

    Science.gov (United States)

    Watts, Tessa E; Davies, Ruth E

    2016-12-01

    The aim of this study was to explore people's experiences of living with lymphoedema and to assess the impact of access to local lymphoedema clinics on their condition and thus their lives. A chronic condition caused by reduced lymphatic function, lymphoedema leads to swelling, pain and mobility problems and can adversely affect quality-of-life. It is of international concern as its prevalence is rising. Yet lymphoedema awareness is limited, diagnostic delay common and access to specialist treatment restricted. The concept of local lymphoedema clinics is gaining support and in 2011 the All Wales Lymphoedema Service was founded. However, empirical investigation of local lymphoedema services remains limited. A qualitative exploratory study consisting of focus group interviews in every Welsh lymphoedema clinic (n = 8). A convenience sample of adults living with lymphoedema in Wales was recruited. Data were collected in digitally recorded focus groups during July and August 2013. Interviews were fully transcribed and analysed using a qualitative content approach. Fifty-nine people participated in eight focus groups. Analysis revealed three themes: Living with lymphoedema is a battle; delays in obtaining a correct diagnosis and the positive impact of lymphoedema clinics on participants' lives. Locally accessible clinics made meaningful differences to peoples' lymphoedema, engendered positive outcomes and improved engagement with and adherence to lymphoedema self-management. Local specialist lymphoedema clinics can make a positive difference. They may be cost-effective and further investigation, including economic evaluation is necessary. © 2016 John Wiley & Sons Ltd.

  14. Pain Experience and Behavior Management in Pediatric Dentistry: A Comparison between Traditional Local Anesthesia and the Wand Computerized Delivery System.

    Science.gov (United States)

    Garret-Bernardin, Annelyse; Cantile, Tiziana; D'Antò, Vincenzo; Galanakis, Alexandros; Fauxpoint, Gabriel; Ferrazzano, Gianmaria Fabrizio; De Rosa, Sara; Vallogini, Giulia; Romeo, Umberto; Galeotti, Angela

    2017-01-01

    Aim. To evaluate the pain experience and behavior during dental injection, using the Wand computerized delivery system versus conventional local anesthesia in children and adolescents. Methods. An observational crossover split mouth study was performed on 67 patients (aged 7 to 15 years), requiring local anesthesia for dental treatments in both sides of the dental arch. Patients received both types of injections in two separate appointments, one with the use of a Computer Delivery System (the Wand STA system) and one with the traditional syringe. The following data were recorded: pain rating; changes in heart rate; level of collaboration; patient satisfaction. The data were analyzed using ANOVA for quantitative outcomes and nonparametric analysis (Kruskal-Wallis) for qualitative parameters. Results. The use of the Wand system determined significantly lower pain ratings and lower increase of heart rate than the traditional syringe. During injection, the number of patients showing a relaxed behavior was higher with the Wand than with the traditional local anesthesia. The patient level of satisfaction was higher with the Wand compared to the conventional local anesthesia. Conclusions. The Wand system may provide a less painful injection when compared to the conventional local anesthesia and it seemed to be better tolerated with respect to a traditional syringe.

  15. Pain Experience and Behavior Management in Pediatric Dentistry: A Comparison between Traditional Local Anesthesia and the Wand Computerized Delivery System

    Directory of Open Access Journals (Sweden)

    Annelyse Garret-Bernardin

    2017-01-01

    Full Text Available Aim. To evaluate the pain experience and behavior during dental injection, using the Wand computerized delivery system versus conventional local anesthesia in children and adolescents. Methods. An observational crossover split mouth study was performed on 67 patients (aged 7 to 15 years, requiring local anesthesia for dental treatments in both sides of the dental arch. Patients received both types of injections in two separate appointments, one with the use of a Computer Delivery System (the Wand STA system and one with the traditional syringe. The following data were recorded: pain rating; changes in heart rate; level of collaboration; patient satisfaction. The data were analyzed using ANOVA for quantitative outcomes and nonparametric analysis (Kruskal–Wallis for qualitative parameters. Results. The use of the Wand system determined significantly lower pain ratings and lower increase of heart rate than the traditional syringe. During injection, the number of patients showing a relaxed behavior was higher with the Wand than with the traditional local anesthesia. The patient level of satisfaction was higher with the Wand compared to the conventional local anesthesia. Conclusions. The Wand system may provide a less painful injection when compared to the conventional local anesthesia and it seemed to be better tolerated with respect to a traditional syringe.

  16. Social media, FOAMed in medical education and knowledge sharing: Local experiences with international perspective

    Directory of Open Access Journals (Sweden)

    Arif Alper Cevik

    2016-09-01

    Full Text Available Social media, through the Internet and other web-based technologies, have become a means of communication and knowledge-sharing. In this article, we provide details about the social media traffic of various scientific activities, the organizations of which we have played an active role in. We also provide information in our native language through our FOAMed website, which has been published for about 30 months, with us acting as editors. We are comparing these local and limited ventures with examples from the world and aim to remind that social media sources play a very important role in sharing knowledge in medical training and encouraging local initiatives, like ours, with limited resources. Keywords: Medical education, Social media, FOAMed, Knowledge sharing

  17. Simplified Surgical Placement of Tenckhoff Catheter under Local Anesthesia: The Dammam Central Hospital Experience

    Directory of Open Access Journals (Sweden)

    Youmbissi T

    2001-01-01

    Full Text Available Many methods are used for the placement of Tenckhoff catheters. Eighteen consecutive Tenckhoff catheters were placed under local anesthesia through a mini laparotomy with a reduced operating team. There were only three total catheter failures. Complications were infrequent and operating time was less than one hour on average. This simple procedure should be a part of the training program of all junior surgeons and nephrologists.

  18. Reinterpretation of Matter-Wave Interference Experiments Based on the Local-Ether Wave Equation

    OpenAIRE

    Su, Ching-Chuan

    2002-01-01

    Based on the local-ether wave equation for free particle, the dispersion of matter wave is examined. From the dispersion relation, the angular frequency and wavelength of matter wave are derived. These formulas look like the postulates of de Broglie in conjunction with the Lorentz mass-variation law. However, the fundamental difference is that for terrestrial particles their speeds are referred specifically to a geocentric inertial frame and hence incorporate the speed due to earth's rotation...

  19. Breast Conserving Surgery and Sentinel Lymph Node Biopsy in Locally Advanced Breast Cancer: Single Center Experience

    Directory of Open Access Journals (Sweden)

    Atakan Sezer

    2011-06-01

    Full Text Available Objective: Patients with locally advanced breast cancer may undergo breast conserving surgery after neoadjuvant chemotherapy. The aim of the study is to evaluate the results of locally advanced breast cancer patients who underwent breast conserving surgery, axillary dissection and sentinel lymph node biopsy in a single center. Material and Methods: 12 patients with locally advanced breast cancer stage IIIA/IIIB were included in the study between 2002-2009. The patients were given anthracycline-based regimen before surgery. Patients underwent breast conserving surgery, axillary dissection, and sentinel lymph node biopsy followed by radiotherapy. Results: There were five patients in stage IIIA, six in stage IIIB, and one in stage IIIC. Patients had received 3-6 regimen of FAC/FEC. Eight had partial and four had complete response. Five positive axilla were detected. The median value of the lymph nodes was 12 (n:8-19. Five patients underwent sentinel lymph node biopsy. The biopsy has failed in one patient and the median value of dissected sentinel node was 3.5 (n:3-4. Locoregional recurrence was not observed in any patients. The mean follow-up of the patients was 29.8 months and median time was 16 (n:2-80 months.Of the 12 patients 10 are alive and 2 were deceased. Conclusion: In selected locally advanced patients, breast conserving surgery and sentinel lymph node biopsy may be applied by a multidisciplinary approach, and excellent success may be achieved in those patients as in early breast cancer patients.

  20. Is green economy achievable through championing green growth? A local government experience from Zambia

    Directory of Open Access Journals (Sweden)

    Phiri Rodgers

    2016-03-01

    Full Text Available The need to enhance environmental sustainability, sustainable development and growth that takes into account the well-being of the people and nature because of the increased production and consumption of goods and services is the major driver to the introduction of green economy in Zambia and countries in southern Africa. This article examines the extent to which local government in Zambia has embraced green growth and green economy and critically analyses the concept of green economy and green growth. This study is based on a review of planning and policy documents, a household questionnaire survey and interviews with various institutions, planners and rural development organisations. A number of policies implemented at the local government level were analysed and reflected upon irrespective of whether they contain the components of green growth and green economy and the extent to which they contribute to attaining green economy. The article argues that the need for economic diversification is important as far as green economy is concerned. The article recommends the need to invest in research and development in order to find more carbon-free economic activities. The conclusion is that local government is key to achieving green growth and green economy, because it is involved at all levels, from policy formulation to implementation.

  1. GNSS-based train positioning experiments with local and wide area augmentation

    Energy Technology Data Exchange (ETDEWEB)

    Gu, X.; Schmidt, M.; Winter, J. [DaimlerChrysler Rail Systems (Signals) GmbH, Ulm (Germany)

    1999-07-01

    Within the frame of the MAGNET Project ('Multimodal Approach for GNSS 1 in European Transport') of the Telematics Applications programme of the 4{sup th} Research Framework of the European Community (1994-1998), a GNSS-based Train Positioning Platform (TPP) has been developed and tested with the wide area augmentation system pre-EGNOS and a local differential GNSS system using a reference station. This paper presents the principle and the system architecture of the developed GNSS-based train positioning system and highlights the system performance achieved in field tests. The TPP consists of a GNSS core module with an EGNOS (European Geostationary Navigation Overlay Service) decoding function, a GSM (Global System for Mobile Communication) data link for local GPS and GLONASS differential corrections, a digital route map and an interface to odometer. The first step to calculate the train position is to select either wide area or local area differential corrections depending on which are available. The position and velocity are then calculated and matched to the track by using the digital route map. Finally, the GNSS position and velocity data is integrated with odometer data in a sensor data fusion model. The integrated solution avoids the masking problem of GNSS signals and reduces odometer errors like drift and braking slip, so that a continuous positioning availability can be reached and the positioning accuracy can be improved to meter level. The achieved performance is being exploited for industrial applications. (orig.)

  2. Local media monitoring in process evaluation. Experiences from the Stockholm Diabetes Prevention Programme.

    Science.gov (United States)

    Andersson, Camilla Maria; Bjärås, Gunilla; Tillgren, Per; Ostenson, Claes-Göran

    2007-01-01

    We present a rationale and approach for longitudinal analyses of media coverage and content, and illustrate how media monitoring can be used in process evaluations. Within a community-based diabetes prevention project, the Stockholm Diabetes Prevention Program, we analyzed the frequency, prominence, and framing of physical activity in local newspapers of three intervention and two control municipalities. In total, 2,128 stories and advertisements related to physical activity were identified between the years 1997 and 2002. Although stories about physical activity were relatively few (n = 224), they were prominently located in all five local newspapers. Physical activity was framed rather similarly in the municipalities. Health aspects, however, were expressed to a greater extent in stories in two of the intervention municipalities. A limited portion (14%) of the articles could be linked directly to the program. It is not possible to assess to what extent the program has had a disseminating effect on the newspapers' health-related content in general, due to weaknesses of the process tracking system and limitations of the study design. Implications for the design is that an evaluative framework should be preplanned and include data collection about media relationships, media's interest in public health, media coverage prior to the program and coverage in other media for comparisons of general trends in the reporting. The material and the current database, however, provide a good basis for quantitative content analysis and qualitative discourse analysis to yield information on the type, frequency, and content of health reporting in local newspapers.

  3. Combined radiotherapy and local external hyperthermia in advanced cancer. Animal experiment and clinical study

    Energy Technology Data Exchange (ETDEWEB)

    Terashima, Hiromi; Ishino, Yohichi; Nakata, Hajime; Norimura, Toshiyuki; Tsuchiya, Takehiko

    1987-06-01

    The response of a mouse's foot to heat was studied. Transplanted syngeneic tumor, C3H mouse mammary carcinoma, was treated with irradiation and hyperthermia in a waterbath. The tumor did not disappear in any of the mice treated with radiotherapy with a dose of 20 Gy alone, but disappearance of the tumor was observed in 11 of 15 and 6 of 8 of the mice treated with combined therapy of irradiation and hyperthermia. There was a significant difference between these two groups. Synergistic effect was confirmed (P < 0.001, P < 0.005). Hyperthermia using Thermotron RF-8 was performed on 19 patients (5 bladder cancers, 3 uterine cancers, 3 rectal cancers, 4 soft tissue tumors, 2 oral cancers, 1 biliary tract cancer, 1 renal cancer) between April, 1986 and December, 1986. They were irradiated with a daily dose of 1.5 - 2.0 Gy, 5 times a week and hyperthermia was performed within 30 minutes after each irradiation once or twice a week. Intratumoral temperature was kept at 43 deg C - 45 deg C. Temperature over 41 deg C was maintained in most patients. Clinical response was assessed by tumor regression rates. Partial response a (PRa), defined as 80 % or more regression in tumor volume, was obtained in 1 bladder cancer patient and PRb, defined as 50 % to less than 80 % regression, was obtained in another 5 patients. Side effects were observed in all patients including mild skin burn, nausea and diarrhea. Rectovaginal fistula developed in 1 patient. Combined radiotherapy and hyperthermia seems to be useful in advanced cancer patients.

  4. Change in carbohydrate antigen 19-9 level as a prognostic marker of overall survival in locally advanced pancreatic cancer treated with concurrent chemoradiotherapy.

    Science.gov (United States)

    Kim, Yi-Jun; Koh, Hyeon Kang; Chie, Eui Kyu; Oh, Do-Youn; Bang, Yung-Jue; Nam, Eun Mi; Kim, Kyubo

    2017-12-01

    To investigate the significance of carbohydrate antigen 19-9 (CA19-9) levels for survival in locally advanced pancreatic cancer (LAPC) treated with concurrent chemoradiotherapy (CCRT). We retrospectively reviewed data from 97 LAPC patients treated with CCRT between 2000 and 2013. CA19-9 levels (initial and post-CCRT) and their changes [{(post-CCRT CA19-9 level - initial CA19-9 level)/(initial CA19-9 level)} × 100] were analyzed for overall survival. A cut-off point of 37 U/mL was used to analyze initial and post-CCRT CA19-9 levels. In order to define an optimal cut-off point for change in CA19-9 level, the maxstat package of R was applied. Median overall survival was 14.7 months (95% CI 13.4-16.0), and the 2-year survival rate was 16.5%. The estimated optimal cut-off point of CA19-9 level change was 94.4%. On univariate analyses, CA19-9 level change between initial and post-CCRT was significantly correlated with overall survival (median survival time 9.7 vs 16.3 months, p 94.4% might serve as a surrogate marker for poor survival in patients with LAPC undergoing CCRT, and the prognostic power surpassed other CA19-9 variables including initial and post-CCRT values.

  5. Exploring how to improve patients' experience in hospital at both national and local levels.

    Science.gov (United States)

    Cornwell, Jocelyn

    At The King's Fund's Point of Care programme, we wanted to discover which types of intervention were most likely to achieve positive results and why. Where should staff and hospital senior leaders with an interest in improving patients' experience focus their effort? Should it be on the front line, with staff in direct contact with patients? On the board, with the non-executive and executive directors? Or in the middle, with matrons and business managers? Who is best placed to lead the improvement efforts and what support do these people need in order to be effective? Before we could answer these questions, we needed to frame the factors that shaped patients' experience in hospital and to review the lessons learnt from the limited research available on interventions designed to improve patients' experiences.

  6. c-Met Expression Is a Marker of Poor Prognosis in Patients With Locally Advanced Head and Neck Squamous Cell Carcinoma Treated With Chemoradiation

    Energy Technology Data Exchange (ETDEWEB)

    Baschnagel, Andrew M. [Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, Michigan (United States); Williams, Lindsay [Department of Pathology, William Beaumont Hospital, Royal Oak, Michigan (United States); Hanna, Alaa; Chen, Peter Y.; Krauss, Daniel J. [Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, Michigan (United States); Pruetz, Barbara L. [Beaumont BioBank, William Beaumont Hospital, Royal Oak, Michigan (United States); Akervall, Jan [Beaumont BioBank, William Beaumont Hospital, Royal Oak, Michigan (United States); Department of Otolaryngology, William Beaumont Hospital, Royal Oak, Michigan (United States); Wilson, George D., E-mail: George.Wilson@Beaumont.edu [Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, Michigan (United States); Beaumont BioBank, William Beaumont Hospital, Royal Oak, Michigan (United States)

    2014-03-01

    Purpose: To examine the prognostic significance of c-Met expression in relation to p16 and epidermal growth factor receptor (EGFR) in patients with locally advanced head and neck squamous cell carcinoma (HNSCC) treated with definitive concurrent chemoradiation. Methods and Materials: Archival tissue from 107 HNSCC patients treated with chemoradiation was retrieved, and a tissue microarray was assembled. Immunohistochemical staining of c-Met, p16, and EGFR was performed. c-Met expression was correlated with p16, EGFR, clinical characteristics, and clinical endpoints including locoregional control (LRC), distant metastasis (DM), disease-free survival (DFS), and overall survival (OS). Results: Fifty-one percent of patients were positive for p16, and 53% were positive for EGFR. Both p16-negative (P≤.001) and EGFR-positive (P=.019) status predicted for worse DFS. Ninety-three percent of patients stained positive for c-Met. Patients were divided into low (0, 1, or 2+ intensity) or high (3+ intensity) c-Met expression. On univariate analysis, high c-Met expression predicted for worse LRC (hazard ratio [HR] 2.27; 95% CI, 1.08-4.77; P=.031), DM (HR 4.41; 95% CI, 1.56-12.45; P=.005), DFS (HR 3.00; 95% CI, 1.68-5.38; P<.001), and OS (HR 4.35; 95% CI, 2.13-8.88; P<.001). On multivariate analysis, after adjustment for site, T stage, smoking history, and EGFR status, only high c-Met expression (P=.011) and negative p16 status (P=.003) predicted for worse DFS. High c-Met expression was predictive of worse DFS in both EGFR-positive (P=.032) and -negative (P=.008) patients. In the p16-negative patients, those with high c-Met expression had worse DFS (P=.036) than did those with low c-Met expression. c-Met expression was not associated with any outcome in the p16-positive patients. Conclusions: c-Met is expressed in the majority of locally advanced HNSCC cases, and high c-Met expression predicts for worse clinical outcomes. High c-Met expression predicted for worse DFS in p16

  7. Explosion localization via infrasound.

    Science.gov (United States)

    Szuberla, Curt A L; Olson, John V; Arnoult, Kenneth M

    2009-11-01

    Two acoustic source localization techniques were applied to infrasonic data and their relative performance was assessed. The standard approach for low-frequency localization uses an ensemble of small arrays to separately estimate far-field source bearings, resulting in a solution from the various back azimuths. This method was compared to one developed by the authors that treats the smaller subarrays as a single, meta-array. In numerical simulation and a field experiment, the latter technique was found to provide improved localization precision everywhere in the vicinity of a 3-km-aperture meta-array, often by an order of magnitude.

  8. Significance of Magnetic Resonance Imaging-Assessed Tumor Response for Locally Advanced Rectal Cancer Treated With Preoperative Long-Course Chemoradiation.

    Science.gov (United States)

    Fayaz, Mohamed Salah; Demian, Gerges Attia; Fathallah, Wael Moftah; Eissa, Heba El-Sayed; El-Sherify, Mustafa Shawki; Abozlouf, Sadeq; George, Thomas; Samir, Suzanne Mona

    2016-08-01

    To study the predictive and prognostic value of magnetic resonance imaging (MRI)-assessed tumor response after long-course neoadjuvant therapy for locally advanced rectal cancer. This study included 79 patients who had T3 or T4 and/or N+ rectal cancer treated with long-course neoadjuvant chemoradiation. MRI-assessed tumor regression grade (mrTRG) was assessed in 64 patients. MRIs were reviewed by the study radiologist. Surgical and pathologic reports for those who underwent surgery were reviewed. Disease-free survival (DFS) was estimated. Progression during therapy, local relapse, metastasis, and death resulting from the tumor were classified as events. Statistical significance was calculated. In 11 patients, the tumor completely disappeared on MRI; that is, it had an mrTRG of 1. All but one patient, who chose deferred surgery, had a complete pathologic response (pCR), with a positive predictive value of nearly 100%. Of the 20 patients who had an mrTRG of 2 on MRI, six had a pCR. mrTRG 3, mrTRG 4, and mrTRG 5 were detected in 24, six, and three patients, respectively, of whom only one patient had a pCR. The 2-year DFS was 77%. The mrTRG was significant for DFS. The 2-year DFS was 88% for patients with a good response versus 66% for those with a poor response (P = .046). MRI-assessed complete tumor response was strongly correlated with pCR and, therefore, can be used as a surrogate marker to predict absence of viable tumor cells. Our results can be used to implement use of mrTRGs in larger prospective correlative studies as a tool to select patients for whom deferred surgery may be appropriate. Also, those with a poor response may be offered further treatment options before definitive surgery.

  9. Significance of Magnetic Resonance Imaging–Assessed Tumor Response for Locally Advanced Rectal Cancer Treated With Preoperative Long-Course Chemoradiation

    Science.gov (United States)

    Fayaz, Mohamed Salah; Demian, Gerges Attia; Fathallah, Wael Moftah; Eissa, Heba El-Sayed; Abozlouf, Sadeq; George, Thomas; Samir, Suzanne Mona

    2016-01-01

    Purpose To study the predictive and prognostic value of magnetic resonance imaging (MRI)–assessed tumor response after long-course neoadjuvant therapy for locally advanced rectal cancer. Methods This study included 79 patients who had T3 or T4 and/or N+ rectal cancer treated with long-course neoadjuvant chemoradiation. MRI-assessed tumor regression grade (mrTRG) was assessed in 64 patients. MRIs were reviewed by the study radiologist. Surgical and pathologic reports for those who underwent surgery were reviewed. Disease-free survival (DFS) was estimated. Progression during therapy, local relapse, metastasis, and death resulting from the tumor were classified as events. Statistical significance was calculated. Results In 11 patients, the tumor completely disappeared on MRI; that is, it had an mrTRG of 1. All but one patient, who chose deferred surgery, had a complete pathologic response (pCR), with a positive predictive value of nearly 100%. Of the 20 patients who had an mrTRG of 2 on MRI, six had a pCR. mrTRG 3, mrTRG 4, and mrTRG 5 were detected in 24, six, and three patients, respectively, of whom only one patient had a pCR. The 2-year DFS was 77%. The mrTRG was significant for DFS. The 2-year DFS was 88% for patients with a good response versus 66% for those with a poor response (P = .046). Conclusion MRI-assessed complete tumor response was strongly correlated with pCR and, therefore, can be used as a surrogate marker to predict absence of viable tumor cells. Our results can be used to implement use of mrTRGs in larger prospective correlative studies as a tool to select patients for whom deferred surgery may be appropriate. Also, those with a poor response may be offered further treatment options before definitive surgery. PMID:28717704

  10. The Predictive Value of Pretreatment (18)-F-FDG-PET-CT in Locally Advanced Nasopharyngeal Cancer Patients Treated Definitively with Induction Chemotherapy Followed by Concurrent Chemo-Radiotherapy.

    Science.gov (United States)

    Zaghloul, Hala A; Khedr, Gehan A; Rostom, Yousri; Refaat, Tamer

    2014-05-01

    This study aimed to evaluate the role of pretreatment 18F-Fluorodeoxyglucose positron emission tomography ((18)F-FDG-PET-CT) as a predictor of disease-free survival (DFS), and overall survival (OS) in locally advanced nasopharyngeal carcinoma (LANPC) patients treated definitively with docetaxel-based induction chemotherapy followed by concurrent chemoradiation (CRT). This is a retrospective study approved by the institutional review board and included LANC patients treated definitively and consecutively between January 2008 and December 2012 with induction chemotherapy; docetaxel, cisplatin, and 5-flurouracil (TPF) followed by CRT utilizing weekly cisplatin. All patients had baseline pretreatment (18)F-FDG-PET-CT. We studied the association between the baseline primary tumor maximum standardized uptake value (SUVmax) and the treatment outcomes; OS and DFS. The study included 70 eligible LANPC patients. The 4-year OS and DFS rates were 86.7% and 78.6%, respectively. The median OS and DFS intervals were not reached. On a univariate analysis, the 4-years DFS was significantly higher in patients with pretreatment SUVmax <8 compared versus ≥ 8 (95% vs 57.7%, P=0.002). Furthermore, DFS was significantly correlated with pretreatment T stage (P=0.01), N stage (P=0.02), treatment response (P<0.001) and treatment breaks (P<0.001). On a multivariate analysis, the SUVmax category was the only factor correlated with 4-year DFS (Hazard ratio=10.2, 95% C I 1.3-116.8, P=0.035) but not OS (P=0.085). There is no actual or potential conflict of interest with the production and publication of this work. No author has a direct or indirect commercial financial incentive associated with the publication of this article. This study shows that the pretreatment primary tumor (18)F-FDG-PET-CT SUVmax is a potential independent prognostic predictor of clinical outcomes in patients with LANC treated definitively with TPF induction chemotherapy followed by CRT. Further controlled clinical

  11. Low p53 Binding Protein 1 (53BP1) Expression Is Associated With Increased Local Recurrence in Breast Cancer Patients Treated With Breast-Conserving Surgery and Radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Neboori, Hanmanth J.R. [Department of Radiation Oncology, Cancer Institute of New Jersey and University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick, NJ (United States); Haffty, Bruce G., E-mail: hafftybg@umdnj.edu [Department of Radiation Oncology, The Cancer Institute of New Jersey and University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick, NJ (United States); Wu Hao [Department of Radiation Oncology, Cancer Institute of New Jersey and University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick, NJ (United States); Yang Qifeng [Department of Breast Surgery, Qilu Hospital, Shandong University, Ji' nan (China); Aly, Amal [Division of Medical Oncology, The Cancer Institute of New Jersey and University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick, NJ (United States); Goyal, Sharad; Schiff, Devora [Department of Radiation Oncology, Cancer Institute of New Jersey and University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick, NJ (United States); Moran, Meena S. [Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT (United States); Golhar, Ryan [Department of Radiation Oncology, Cancer Institute of New Jersey and University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick, NJ (United States); Chen Chunxia; Moore, Dirk [Department of Biostatistics, The Cancer Institute of New Jersey and University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick, NJ (United States); and others

    2012-08-01

    Purpose: To investigate whether the expression of p53 binding protein 1 (53BP1) has prognostic significance in a cohort of early-stage breast cancer patients treated with breast-conserving surgery and radiotherapy (BCS+RT). Methods and Materials: A tissue microarray of early-stage breast cancer treated with BCS+RT from a cohort of 514 women was assayed for 53BP1, estrogen receptor, progesterone receptor, and HER2 expression by immunohistochemistry. Through log-rank tests and univariate and multivariate models, the staining profile of each tumor was correlated with clinical endpoints, including ipsilateral breast recurrence-free survival (IBRFS), distant metastasis-free survival (DMFS), cause-specific survival (CSS), recurrence-free survival (RFS), and overall survival (OS). Results: Of the 477 (93%) evaluable tumors, 63 (13%) were scored as low. Low expression of 53BP1 was associated with worse outcomes for all endpoints studied, including 10-year IBRFS (76.8% vs. 90.5%; P=.01), OS (66.4% vs. 81.7%; P=.02), CSS (66.0% vs. 87.4%; P<.01), DMFS (55.9% vs. 87.0%; P<.01), and RFS (45.2% vs. 80.6%; P<.01). Multivariate analysis incorporating various clinico-pathologic markers and 53BP1 expression found that 53BP1 expression was again an independent predictor of all endpoints (IBRFS: P=.0254; OS: P=.0094; CSS: P=.0033; DMFS: P=.0006; RFS: P=.0002). Low 53BP1 expression was also found to correlate with triple-negative (TN) phenotype (P<.01). Furthermore, in subset analysis of all TN breast cancer, negative 53BP1 expression trended for lower IBRFS (72.3% vs. 93.9%; P=.0361) and was significant for worse DMFS (48.2% vs. 86.8%; P=.0035) and RFS (37.8% vs. 83.7%; P=.0014). Conclusion: Our data indicate that low 53BP1 expression is an independent prognostic indicator for local relapse among other endpoints in early-stage breast cancer and TN breast cancer patients treated with BCS+RT. These results should be verified in larger cohorts of patients to validate their clinical

  12. Democracy Promotion at a Local Level : Experiences, Perspectives and Policy of Swiss International Cooperation

    Directory of Open Access Journals (Sweden)

    Martin Dahinden

    2014-09-01

    Full Text Available I would like to thank Andrea Iff and Marco Pfister from swisspeace, who were asked by the SDC’s Analysis and Policy Division to write a discussion paper on the SDC’s democracy promotion. The project further received advice and drew extensively from dlgn’s (SDC Decentralisation and Local Governance Network work. The results of dlgn’s work are accessible in full detail on the dlgn website, http://www.sdc-decentralization.net.What is democracy promotion? Today, we are witnessing a new wave of i...

  13. [First experience with intrasurgical brachytherapy in the combined treatment for locally advanced laryngeal cancer].

    Science.gov (United States)

    Vasil'chenko, I L; Vinogradov, V M; Pastushenko, D A; Samsonova, N N; Iudin, A L

    2011-01-01

    Results of combined radiosurgical treatment with larynx preservation, and pre- and postoperative distant external irradiation, were evaluated. Forty-eight patients with locally advanced laryngeal cancer received single-step individually-tailored tissue application, followed by high-dose brachytherapy. Discriminative function of the larynx was restored in all patients within 2 days involving swallowing disturbances in 8%. Breathing function was restored in 98% within 2 days to 6 months after completion of treatment. Three-year relapse-free survival was 95.8%.

  14. Efficacy of qualitative response assessment interpretation criteria at 18F-FDG PET-CT for predicting outcome in locally advanced cervical carcinoma treated with chemoradiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Scarsbrook, Andrew [Leeds Teaching Hospitals NHS Trust, Department of Radiology, Leeds (United Kingdom); Leeds Teaching Hospitals NHS Trust, Department of Nuclear Medicine, Level 1, Bexley Wing, St James' s University Hospital, Leeds (United Kingdom); University of Leeds, Leeds Institute of Cancer and Pathology, Leeds (United Kingdom); Vaidyanathan, Sriram; Chowdhury, Fahmid; Patel, Chirag [Leeds Teaching Hospitals NHS Trust, Department of Radiology, Leeds (United Kingdom); Leeds Teaching Hospitals NHS Trust, Department of Nuclear Medicine, Level 1, Bexley Wing, St James' s University Hospital, Leeds (United Kingdom); Swift, Sarah [Leeds Teaching Hospitals NHS Trust, Department of Radiology, Leeds (United Kingdom); Cooper, Rachel [Leeds Teaching Hospitals NHS Trust, Department of Clinical Oncology, Leeds (United Kingdom)

    2017-04-15

    To evaluate the utility of a standardized qualitative scoring system for treatment response assessment at 18F-FDG PET-CT in patients undergoing chemoradiotherapy for locally advanced cervical carcinoma and correlate this with subsequent patient outcome. Ninety-six consecutive patients with locally advanced cervical carcinoma treated with radical chemoradiotherapy (CRT) in a single centre between 2011 and 2014 underwent 18F-FDG PET-CT approximately 3 months post-treatment. Tumour metabolic response was assessed qualitatively using a 5-point scale ranging from background level activity only through to progressive metabolic disease. Clinical and radiological (MRI pelvis) follow-up was performed in all patients. Progression-free (PFS) and overall survival (OS) was calculated using the Kaplan-Meier method (Mantel-Cox log-rank) and correlated with qualitative score using Chi-squared test. Forty patients (41.7 %) demonstrated complete metabolic response (CMR) on post-treatment PET-CT (Score 1/2) with 38 patients (95.0 %) remaining disease free after a minimum follow-up period of 18 months. Twenty-four patients (25.0 %) had indeterminate residual uptake (ID, Score 3) at primary or nodal sites after treatment, of these eight patients (33.3 %) relapsed on follow-up, including all patients with residual nodal uptake (n = 4). 11 of 17 patients (64.7 %) with significant residual uptake (partial metabolic response, PMR, Score 4) subsequently relapsed. In 15 patients (15.6 %) PET-CT demonstrated progressive disease (PD, Score 5) following treatment. Kaplan-Meier analysis showed a highly statistically significant difference in PFS and OS between patients with CMR, indeterminate uptake, PMR and PD (Log-rank, P < 0.0001). Chi-squared test demonstrated a highly statistically significant association between increasing qualitative score and risk of recurrence or death (P < 0.001). Use of a 5-point qualitative scoring system to assess metabolic response to CRT in locally advanced

  15. Perspectives of Complexity in Water Governance: Local Experiences of Global Trends

    Directory of Open Access Journals (Sweden)

    Michele-Lee Moore

    2013-10-01

    Full Text Available Those responsible for water governance face great complexity. However, the conceptualisations of what comprises that complexity have been broad and inconsistent. When efforts are made to address the complexity in water governance, it is unclear whether the problems and the related solutions will be understood across the actors and institutions involved. This paper provides a review of the literature focused on global water governance to discern core themes that commonly characterise discussions of complexity. It then considers how the consequences of these issues are manifested at the local scale through an examination of empirical research of the Murray-Darling Basin Authority and the Prachinburi River Basin Committee. The results demonstrate that a history of a technical, depoliticised discourse is often perceived to contribute to complexity. The consequence is that when a severe ecological disturbance occurs within a river basin with poorly understood causes, few tools are available to support river basin organisations to address the political nature of these challenges. Additionally, a lack of clear authority structures has been recognised globally, but locally this can contribute to conflict amongst the 'governors' of water. Finally, a range of contested definitions and governance frameworks exists that contributes to complexity, but confronting the diversity of perspectives can lead to ethical dilemmas given that the decisions will affect the health and livelihoods of basin communities.

  16. Review of Proximal Nail Antirotation (PFNA and PFNA-2 – Our Local Experience

    Directory of Open Access Journals (Sweden)

    WL Loo

    2011-07-01

    Full Text Available The proximal femoral nail antirotation (PFNA device was recently introduced as an option for intramedullary management of pertrochanteric hip fractures. We report here local results with this relatively new implant. Sixty-two patients with pertrochanteric or subtrochanteric fractures underwent intramedullary fixation with PFNA devices in our centre during the 14 month period from September 2008 to October 2009. Data for this report were retrieved from clinical case records and operative notes. We recorded the age, gender, length of stay and operative time, preoperative ambulatory status and days required to regain mobility. Fractures were classified using the AO classification (A1, A2 and A3. Complications were also identified.There were 15 male and 47 female patients and the mean age was 74.3 years. The mean surgical duration was 76.1min and the average length of hospitalisation was 14.5 days. Five cases were noted to have femoral shaft fracture and no occurrences of screw cutout. We found that 83.9% of the patients were able to regain preoperative mobility status by 6 months following surgery. We conclude that the PFNA is an effective implant for stabilisation of proximal hip fractures and that the local complication rate is similar to reports from other centres.

  17. Is age a prognostic biomarker for survival among women with locally advanced cervical cancer treated with chemoradiation? An NRG Oncology/Gynecologic Oncology Group ancillary data analysis.

    Science.gov (United States)

    Moore, Kathleen N; Java, James J; Slaughter, Katrina N; Rose, Peter G; Lanciano, Rachelle; DiSilvestro, Paul A; Thigpen, J Tate; Lee, Yi-Chun; Tewari, Krishnansu S; Chino, Junzo; Seward, Shelly M; Miller, David S; Salani, Ritu; Moore, David H; Stehman, Frederick B

    2016-11-01

    To determine the effect of age on completion of and toxicities following treatment of local regionally advanced cervical cancer (LACC) on Gynecologic Oncology Group (GOG) Phase I-III trials. An ancillary data analysis of GOG protocols 113, 120, 165, 219 data was performed. Wilcoxon, Pearson, and Kruskal-Wallis tests were used for univariate and multivariate analysis. Log rank tests were used to compare survival lengths. One-thousand-three-hundred-nineteen women were included; 60.7% were Caucasian, 15% were age 60-70years and an additional 5% were >70; 87% had squamous histology, 55% had stage IIB disease and 34% had IIIB disease. Performance status declined with age (p=0.006). Histology and tumor stage did not significantly differ. Number of cycles of chemotherapy received, radiation treatment time, nor dose modifications varied with age. Notably, radiation protocol deviations and failure to complete brachytherapy (BT) did increase with age (p=0.022 and p50 for all-cause mortality (HR 1.02; 95% CI, 1.01-1.04) was found, but no association between age and disease specific mortality was found. This represents a large analysis of patients treated for LACC with chemo/radiation, approximately 20% of whom were >60years of age. Older patients, had higher rates of incomplete brachytherapy which is not explained by collected toxicity data. Age did not adversely impact completion of chemotherapy and radiation or toxicities. Copyright © 2016. Published by Elsevier Inc.

  18. The broad-spectrum antiviral compound ST-669 restricts chlamydial inclusion development and bacterial growth and localizes to host cell lipid droplets within treated cells.

    Science.gov (United States)

    Sandoz, Kelsi M; Valiant, William G; Eriksen, Steven G; Hruby, Dennis E; Allen, Robert D; Rockey, Daniel D

    2014-07-01

    Novel broad-spectrum antimicrobials are a critical component of a strategy for combating antibiotic-resistant pathogens. In this study, we explored the activity of the broad-spectrum antiviral compound ST-669 for activity against different intracellular bacteria and began a characterization of its mechanism of antimicrobial action. ST-669 inhibits the growth of three different species of chlamydia and the intracellular bacterium Coxiella burnetii in Vero and HeLa cells but not in McCoy (murine) cells. The antichlamydial and anti-C. burnetii activity spectrum was consistent with those observed for tested viruses, suggesting a common mechanism of action. Cycloheximide treatment in the presence of ST-669 abrogated the inhibitory effect, demonstrating that eukaryotic protein synthesis is required for tested activity. Immunofluorescence microscopy demonstrated that different chlamydiae grow atypically in the presence of ST-669, in a manner that suggests the compound affects inclusion formation and organization. Microscopic analysis of cells treated with a fluorescent derivative of ST-669 demonstrated that the compound localized to host cell lipid droplets but not to other organelles or the host cytosol. These results demonstrate that ST-669 affects intracellular growth in a host-cell-dependent manner and interrupts proper development of chlamydial inclusions, possibly through a lipid droplet-dependent process. Copyright © 2014, American Society for Microbiology. All Rights Reserved.

  19. Development and Optimization of Polymeric Self-Emulsifying Nanocapsules for Localized Drug Delivery: Design of Experiment Approach

    Directory of Open Access Journals (Sweden)

    Jyoti Wadhwa

    2014-01-01

    Full Text Available The purpose of the present study was to formulate polymeric self-emulsifying curcumin nanocapsules with high encapsulation efficiency, good emulsification ability, and optimal globule size for localized targeting in the colon. Formulations were prepared using modified quasiemulsion solvent diffusion method. Concentration of formulation variables, namely, X1 (oil, X2 (polymeric emulsifier, and X3 (adsorbent, was optimized by design of experiments using Box-Behnken design, for its impact on mean globule size (Y1 and encapsulation efficiency (Y2 of the formulation. Polymeric nanocapsules with an average diameter of 100–180 nm and an encapsulation efficiency of 64.85 ± 0.12% were obtained. In vitro studies revealed that formulations released the drug after 5 h lag time corresponding to the time to reach the colonic region. Pronounced localized action was inferred from the plasma concentration profile (Cmax 200 ng/mL that depicts limited systemic absorption. Roentgenography study confirms the localized presence of carrier (0–2 h in upper GIT; 2–4 h in small intestine; and 4–24 h in the lower intestine. Optimized formulation showed significantly higher cytotoxicity (IC50 value 20.32 μM in HT 29 colonic cancer cell line. The present study demonstrates systematic development of polymeric self-emulsifying nanocapsule formulation of curcumin for localized targeting in colon.

  20. Secret Shopping is an Effective Tool for Identifyings in Library User Experience Local Pattern

    Directory of Open Access Journals (Sweden)

    Kelley Wadson

    2016-12-01

    Full Text Available A Review of: Boyce, C. M. (2015. Secret shopping as user experience assessment tool. Public Services Quarterly, 11(4, 237-253. doi:10.1080/15228959.2015.1084903 Objective – To assess library user experience (UX at two entry-level service desks to determine the need for, and inform the aspects in which to improve, services and staff training. Design – Observational study using secret shopping. Setting – A small, private university in Illinois, United States of America. Subjects – Library employees, comprised primarily of student assistants; and 11 secret shoppers, comprised of 5 faculty members, 4 staff members, and 2 first-year students from the university.

  1. Youth media consumption within cosmopolitan experiences: between global entertainment and local practices

    OpenAIRE

    Bekesas, Wilson Roberto; Riegel, Viviane; Mader, Renato Vercesi

    2016-01-01

    This article presents as a proposal a discussion about the connection between youth media consumption and cosmopolitan experiences. This is a part of the research project “Youth cosmopolitanisms. Brazilian project. Step 1: Conceptions and cosmopolitan practices in Brazilian university students”, hosted by ESPM-SP, linked to the international project “Youth cultural cosmopolitanism”. The focus emphasized is anchored on a reflexive base on (1) media consumption and the reality of global enterta...

  2. Neoadjuvant Chemotherapy and Surgical Options for Locally-advanced Breast Cancer: A Single Institution Experience

    Directory of Open Access Journals (Sweden)

    Mohamed Abo Elmagd Salem

    2017-07-01

    Full Text Available Background: Neoadjuvant chemotherapy can downstage the size of the tumor, thus allowing some patients with advanced disease with the option of conservative breast surgery. Our study aims to investigate the effectiveness of neoadjuvant chemotherapy in patients with locally advanced breast cancer. Methods: Fifty-six patients had locally advanced breast cancer. Ten patients (18% were stage IIB, 32 (57% were stage IIIA, 9 (16% were stage IIIB, and 5 (9% were stage IIIC. Patients received neoadjuvant chemotherapy comprised of cyclophosphamide, doxorubicin, and fluorouracil followed by surgery (15 patients with breast conservative surgery,11 with skin sparing mastectomy and latesmus dorsi reconstruction, and 30 patients who underwent modified radical mastectomy and then followed by radiotherapy, 50 Gy with conventional fractionation. Results: Clinical down staging was obtained in 49 (87.5% patients: 5 (9% had complete clinical response, 44 (78.5% had partial response, 6 (10.7% had stable disease, and 1 (1.8% had progressive disease. The primary tumor could not be palpated after chemotherapy in 7 (12.5% of 56 patients who presented with a palpable mass. Median follow-up was 47.5 months. The factors that correlated positively with locoregional recurrence on univariate analysis included hormonal receptor status and surgical margin status. On multivariate analysis, surgical margin status was the only independent significant factor for locoregional recurrence-free survival. In univariate analysis for distant relapse free survival, factors that correlated positively included disease stage and hormonal receptor status. Multivariate analysis showed that tumor stage and hormonal receptor status were independent significant factors that correlated with distant relapse-free survival. Conclusion: Neoadjuvant chemotherapy was effective in clinical down staging and should be considered for patients with advanced breast cancer. It improved operability and enhanced

  3. Experience of wireless local area network in a radiation oncology department.

    Science.gov (United States)

    Mandal, Abhijit; Asthana, Anupam Kumar; Aggarwal, Lalit Mohan

    2010-01-01

    The aim of this work is to develop a wireless local area network (LAN) between different types of users (Radiation Oncologists, Radiological Physicists, Radiation Technologists, etc) for efficient patient data management and to made easy the availability of information (chair side) to improve the quality of patient care in Radiation Oncology department. We have used mobile workstations (Laptops) and stationary workstations, all equipped with wireless-fidelity (Wi-Fi) access. Wireless standard 802.11g (as recommended by Institute of Electrical and Electronic Engineers (IEEE, Piscataway, NJ) has been used. The wireless networking was configured with the Service Set Identifier (SSID), Media Access Control (MAC) address filtering, and Wired Equivalent Privacy (WEP) network securities. We are successfully using this wireless network in sharing the indigenously developed patient information management software. The proper selection of the hardware and the software combined with a secure wireless LAN setup will lead to a more efficient and productive radiation oncology department.

  4. Local Human Development in contexts of permanent crisis: Women’s experiences in the Western Sahara

    Directory of Open Access Journals (Sweden)

    María López Belloso

    2009-04-01

    Full Text Available Sahrawi women are active agents in the social dynamics of the refugee camps, in which they have developeda number of coping strategies to overcome the hardships of a deteriorating humanitarian situation. Since the outbreak of the con#ict and the forced settlement in Tindouf, Algeria, women have been responsible for the entire management of refugee camps, assuming leadership roles in many sectors of society.This paper highlights the Sahrawi women’s contribution to the process of local human development in a context of protracted refuge such as the one in the Western Sahara. In addition to the enlargement of the refugee population’s capacities in relation to material and physical assets, social and organizational abilities, and motivational strengths, one of the major achievements of Sahrawi women has been their own individual and collective process of empowerment within the camp life.

  5. Experience of wireless local area network in a radiation oncology department

    Directory of Open Access Journals (Sweden)

    Mandal Abhijit

    2010-01-01

    Full Text Available The aim of this work is to develop a wireless local area network (LAN between different types of users (Radiation Oncologists, Radiological Physicists, Radiation Technologists, etc for efficient patient data management and to made easy the availability of information (chair side to improve the quality of patient care in Radiation Oncology department. We have used mobile workstations (Laptops and stationary workstations, all equipped with wireless-fidelity (Wi-Fi access. Wireless standard 802.11g (as recommended by Institute of Electrical and Electronic Engineers (IEEE, Piscataway, NJ has been used. The wireless networking was configured with the Service Set Identifier (SSID, Media Access Control (MAC address filtering, and Wired Equivalent Privacy (WEP network securities. We are successfully using this wireless network in sharing the indigenously developed patient information management software. The proper selection of the hardware and the software combined with a secure wireless LAN setup will lead to a more efficient and productive radiation oncology department.

  6. Vortex self-imaging experiments on aberration insensitive localization of micro-objects

    Science.gov (United States)

    Baránek, M.; Bouchal, P.; Bouchal, Z.

    2016-12-01

    In recent years, optical microscopy has been enriched by a wide range of modern techniques enabling exploration of volume samples. One of the preferred ways for reaching a depth estimation required in three-dimensional (3D) imaging is based on utilization of optical systems working with a point spread function (PSF) that rotates under defocusing. Here, the method of axial localization of microparticles is examined that is based on the evaluation of the PSF rotation caused by interference of the vortex nondiffracting beams (VNBs). For generation of the VNBs, a special complex mask is used, modulating both amplitude and phase of the spatial spectrum of the specimen. The main attention is focused on examination of the optical performance of the method and analysis of the effects that occur, when the mask is implemented using a spatial light modulator (SLM).

  7. Edge localized mode control experiments on MAST using resonant magnetic perturbations from in-vessel coils

    Science.gov (United States)

    Nardon, E.; Kirk, A.; Akers, R.; Bécoulet, M.; Cahyna, P.; De Temmerman, G.; Dudson, B.; Hnat, B.; Liu, Y. Q.; Martin, R.; Meyer, H.; Tamain, P.; Taylor, D.; Temple, D.; MAST Team

    2009-12-01

    Edge localized mode (ELM) control has been investigated on MAST with a set of in-vessel coils producing n = 3 perturbations. In spite of a broad enough region where the Chirikov parameter is above 1, according to the criterion employed for the design of the ITER ELM control coils, no effect was seen on type I ELMs. The behaviour on MAST is different from that in DIII-D in this respect. The coils do have an effect, however, on Ohmic L-mode plasmas and plasmas just above the L-H transition. In the former, they induce a density pump-out, modify the turbulence characteristics and edge radial electric field and produce a strike point splitting, while in the latter they can trigger ELMs in ELM-free plasmas.

  8. Edge localized mode control experiments on MAST using resonant magnetic perturbations from in-vessel coils

    Energy Technology Data Exchange (ETDEWEB)

    Nardon, E; Kirk, A; Akers, R; De Temmerman, G; Liu, Y Q; Martin, R; Meyer, H; Tamain, P; Taylor, D; Temple, D [EURATOM/UKAEA Fusion Association, Culham Science Centre, Abingdon, Oxon OX14 3DB (United Kingdom); Becoulet, M [Association Euratom/CEA, CEA Cadarache, F-13108, St. Paul-lez-Durance (France); Cahyna, P [Institute of Plasma Physics AS CR v.v.i., Association EURATOM/IPP.CR, Prague (Czech Republic); Dudson, B [University of York, Heslington, York YO10 5DD (United Kingdom); Hnat, B, E-mail: eric.nardon@ukaea.org.u [Centre for Fusion, Space and Astrophysics, Warwick University, Coventry CV4 7AL (United Kingdom)

    2009-12-15

    Edge localized mode (ELM) control has been investigated on MAST with a set of in-vessel coils producing n = 3 perturbations. In spite of a broad enough region where the Chirikov parameter is above 1, according to the criterion employed for the design of the ITER ELM control coils, no effect was seen on type I ELMs. The behaviour on MAST is different from that in DIII-D in this respect. The coils do have an effect, however, on Ohmic L-mode plasmas and plasmas just above the L-H transition. In the former, they induce a density pump-out, modify the turbulence characteristics and edge radial electric field and produce a strike point splitting, while in the latter they can trigger ELMs in ELM-free plasmas.

  9. Poster - Thurs Eve-31: Clinical implementation and experience with EPID-based precision isocentre localization.

    Science.gov (United States)

    Heaton, R; Smale, J; Norrlinger, B; Wang, Y; van Prooijen, M; Islam, M

    2008-07-01

    Modern linear accelerators contain multiple isocentres, defined by the mechanical motions of gantry, collimator and table. Isocentre localization for these motions has been performed using film and manual evaluations which have difficulty in relating the individual motions. To address these limitations, we have developed an EPID based technique to measure the isocentre position for each of the treatment unit motions. This technique uses the projected position of a radio-opaque marker at the isocentre in a series of MV images to determine the motion of the isocentre. This analytical procedure has been implemented in the clinic using a MatLab code to automatically analyze images and determine both the isocentre position and motion about the mean for each of gantry, collimator and table. Results of isocentre measurements for 18 machines from 2 different vendors at 2 separate clinics are reported. These measurements show that while the position of the mean isocentres are contained within a 2mm sphere, combinations of gantry, table and collimator rotations can be found that result in treatment isocentres more than 2mm apart. Results for a treatment unit, which underwent a recent equipment upgrade, are also presented that show a small change in the location of the gantry relative to the table isocentre. The implementation of this of isocentre localization technique has provided important clinical information which can be efficiently completed in less than an hour. This information is an important consideration in monitoring the changes and in assessing the treatment precision that can be obtained. © 2008 American Association of Physicists in Medicine.

  10. Quantifying emerging local anthropogenic emissions in the Arctic region: the ACCESS aircraft campaign experiment

    Science.gov (United States)

    Roiger, Anke; Thomas, Jennie L.; Schlager, Hans; Law, Kathy; Kim, Jin; Reiter, Anja; Schäfler, Andreas; Weinzierl, Bernadett; Rose, Maximilian; Raut, Jean-Christophe; Marelle, Louis

    2014-05-01

    Arctic change has opened the region to new industrial activities, most notably transit shipping and resource extraction. The impacts that Arctic industrialization will have on pollutants and Arctic climate are not well understood. In order to understand how shipping and offshore oil/gas extraction impact on Arctic tropospheric chemistry and composition, we conducted the ACCESS (Arctic Climate Change, Economy, and Society, a European Union Seventh Framework Programme project) aircraft campaign. The campaign was conducted in July 2012 using the DLR Falcon research aircraft, based in Andenes, Norway. The Falcon was equipped with a suite of trace gas and aerosol instruments (black carbon, ozone, as well as other trace species) to characterize these emissions and their atmospheric chemistry. The Falcon performed nine scientific flights to study emissions from different ships (e.g. cargo, passenger, and fishing vessels) and a variety of offshore extraction facilities (e.g. drilling rigs, production and storage platforms) off the Norwegian Coast. Distinct differences in chemical and aerosol composition were found in emissions from these increasing pollution sources. We also studied the composition of biomass burning plumes imported from Siberian wildfires to put the emerging local pollution within a broader context. In addition to our measurements, we used a regional chemical transport model to study the influence of emerging pollution sources on gas and aerosol concentrations in the region. We will present an overview on the measured trace gas and aerosol properties of the different emission sources and discuss the impact of future local anthropogenic activities on the Arctic air composition by combining measurements with model simulations.

  11. Quantifying emerging local anthropogenic emissions in the Arctic region: the ACCESS aircraft campaign experiment (Invited)

    Science.gov (United States)

    Roiger, A.; Thomas, J. L.; Schlager, H.; Law, K.; Kim, J.; Reiter, A.; Schaefler, A.; Weinzierl, B.; Rose, M.; Raut, J.; Marelle, L.

    2013-12-01

    Arctic sea ice has decreased dramatically in the past few decades, which has opened the Arctic Ocean to transit shipping and hydrocarbon extraction. These anthropogenic activities are expected to increase emissions of air pollutants and climate forcers (e.g. aerosols, ozone) in the Arctic troposphere significantly in the future. However, large knowledge gaps exist how these emissions influence regional air pollution and Arctic climate. Here we present an overview on the ACCESS (Arctic Climate Change, Economy, and Society, a European Union Seventh Framework Programme project) aircraft campaign, which primarily focused on studying emissions from emerging Arctic pollution sources. During the ACCESS campaign in July 2012, the DLR Falcon was based in Andenes, Norway, and was equipped with a suite of trace gas and aerosol instruments (black carbon, ozone, as well as other trace species). During nine scientific flights, emissions from different ship types (e.g. cargo, passenger, and fishing vessels) and a variety of offshore extraction facilities (e.g. drilling rigs, production and storage platforms) were probed off the Norwegian Coast. The emissions from these increasing pollution sources showed distinct differences in chemical and aerosol composition. To put the emerging local pollution within a broader context, we also measured sulfur-rich emissions originating from industrial activities on the Kola Peninsula and black carbon containing biomass burning plumes imported from Siberian wildfires. We will present an overview on the trace gas and aerosol properties of the different emission sources, and discuss the influence of future local anthropogenic activities on the Arctic air composition by combining measurements with model simulations.

  12. High-Performing Local Health Departments Relate Their Experiences at Community Engagement in Emergency Preparedness.

    Science.gov (United States)

    Schoch-Spana, Monica; Ravi, Sanjana; Meyer, Diane; Biesiadecki, Laura; Mwaungulu, Geoffrey

    2017-10-27

    Local health departments (LHDs) are implementing a national mandate to engage community partners, including individuals, businesses, and community- and faith-based organizations in the larger public health emergency preparedness (PHEP) enterprise. Investigate how LHDs of varying size and resource levels successfully engage the community in PHEP to help uncover "best practices" that aspiring agencies can replicate, particularly in low-resource environments. In-depth, semistructured qualitative interviews with practitioners from 9 highly performing LHDs. Participating agencies comprised equal amounts of small (serving 500 000 residents) LHDs and were diverse in terms of geographic region, rural-urban environment, and governance structure. A cross section of LHD staff (n = 34) including agency leaders, preparedness coordinators, public information officers, and health educators/promoters. Local health department performance at community engagement as determined by top scores in 2 national LHD surveys (2012, 2015) regarding community engagement in PHEP. Based on key informant accounts, high-performing LHDs show a holistic, organization-wide commitment to, rather than discrete focus on, community engagement. Best practices clustered around 5 domains: administration (eg, top executive who models collaborative behavior), organizational culture (eg, solicitous rather than prescriptive posture regarding community needs), social capital (eg, mining preexisting community connections held by other LHD programs), workforce skills (eg, cultural competence), and methods/tactics (eg, visibility in community events unrelated to PHEP). For LHDs that wish to enhance their performance at community engagement in PHEP, change will entail adoption of evidence-based interventions (the technical "what") as well as evidence-based administrative approaches (the managerial "how"). Smaller, rural LHDs should be encouraged that, in the case of PHEP community engagement, they have unique social

  13. On Local Coupling of Electron Transport and ATP-Synthesis System in Mitochondria. Theory and Experiment.

    Science.gov (United States)

    Eremeev, S A; Yaguzhinsky, L S

    2015-05-01

    A brief description of the principal directions for searching and investigating the model of local coupling between respiration and phosphorylation proposed by R. Williams is given in this paper. We found conditions where it was possible to reveal typical functional special features of the mitochondrial phosphorylating system. According to the theory, such special features should be observed experimentally if the mitochondrial phosphorylating system operated in the state of a supercomplex. It was proved that the phosphorylating system is able to operate in two states: P. Mitchell state and R. Williams state. It was demonstrated that in the ATP synthesis reaction, ATP-synthase (F1F0) was able to use thermodynamic potential of Bronsted acids as a source of energy. It was shown using a double-inhibitor titration technique that when the phosphorylating system operated in the supercomplex state, the electron transfer system and ATP-synthesis system were docked rigidly. A model system of chemical synthesis of membrane-bound proton fraction (Bronsted acids), carrying a free energy excess, was developed on the model of bilayer lipid membrane. Catalysts selectively accelerating proton detachment of this fraction were also found. The formation of a Bronsted acids fraction carrying free energy excess was recorded during the operation of proton pumps on mitochondrial and mitoplastic membranes. In the experimental part of the work, a brief description is given of studies on new uncouplers that transfer the phosphorylation system from the local coupling state to the state of transmembrane proton transfer. Thus, they accelerated the respiration of mitochondria and decreased the ADP/O parameter.

  14. COMMUNITY BASED TOURISM AND LOCAL EXPERIENCES. CASE STUDY OF THE INDIGENOUS COMMUNITY MARAVILLA, TENEJAPA, CHIAPAS

    Directory of Open Access Journals (Sweden)

    Julio César Sánchez Morales

    2014-01-01

    Full Text Available This article discusses the experiences of the residents of Ejido Las Nubes, municipality of Maravilla Tenejapa in an ecotourism project called Green Causes. The results show the no easy effort they make from years ago, with little relevance to the financial aspect, but strength in decision-making, from the organizational innovations in agency capacity for the permanence of the project and conservation of natural resources. Decisions on the project involve a position not only instrumental, but normative, with participatory and consensus. Nothing strange is that this process has generated social learning among This research was conducted from a qualitative and quantitative approach.

  15. Localization and physical properties experiments conducted by Spirit at Gusev Crater

    Science.gov (United States)

    Arvidson, R. E.; Anderson, R. C.; Bartlett, P.; Bell, J. F., III; Blaney, D.; Christensen, P. R.; Chu, P.; Crumpler, L.; Davis, K.; Ehlmann, B. L.; hide

    2004-01-01

    The precise location and relative elevation of Spirit during its traverses from the Columbia Memorial station to Bonneville crater were determined with bundle-adjusted retrievals from rover wheel turns, suspension and tilt angles, and overlapping images. Physical properties experiments show a decrease of 0.2% per Mars solar day in solar cell output resulting from deposition of airborne dust, cohesive soil-like deposits in plains and hollows, bright and dark rock coatings, and relatively weak volcanic rocks of basaltic composition. Volcanic, impact, aeolian, and water-related processes produced the encountered landforms and materials.

  16. Physical experiments of land subsidence within a maar crater: insights for porosity variations and fracture localization

    Directory of Open Access Journals (Sweden)

    M. Cerca

    2015-11-01

    Full Text Available We present the results of a series of physical models aiming to reproduce rapid subsidence (at least 25 m in 30 years observed in the sediments of a maar crater caused by extraction of groundwater in the interconnected adjacent aquifer. The model considered plausible variations in the geometry of the crater basement and the measured rate of groundwater extraction (1 m per year in the time interval from 2005 to 2011 in 15 wells located around the structure. The experiments were built within a rigid plastic bowl in which the sediments and rocks of the maar sequence were modeled using different materials: (a plasticine for the rigid country rock, (b gravel for the fractured country rock forming the diatreme fill and, (c water saturated hollow glass microbeads for the lacustrine sedimentary fill of the crater. Water table was maintained initially at the surface of the sediments and then was allowed to flow through a hole made at the base of the rigid bowl. Water extraction provoked a sequence of gentle deformation, fracturing, and faulting of the surface in all the experiments. Vertical as well as lateral displacements were observed in the surface of the experiments. We discuss the results of 2 representative models. The model results reproduced the main geometry of the ring faults affecting the crater sediments and helps to explain the diversity of structures observed in relation with the diatreme geometry. The surface of the models was monitored continuously with an optical interferometric technique called structured light projection. Images collected at nearly constant time intervals were analyzed using the ZEBRA software and the obtained interferometric pairs permitted to analyze the full field subsidence in the model (submilimetric vertical displacements. The experiments were conducted at a continuous flow rate extraction and show a also a linear subsidence rate. Comparison among the results of the physical models and the fault system

  17. Local experience with thrombotic thrombocytopenic purpura from the western part of Turkey.

    Science.gov (United States)

    Vural, Filiz; Donmez, Ayhan; Cagirgan, Seçkin; Tombuloglu, Murat

    2006-04-01

    Thrombotic thrombocytopenic purpura (TTP) is a fatal disorder if left untreated. Therapeutic plasma exchange (PE) has resulted in excellent remission and survival rates in these patients but there is a need for alternative immuno-modulatory treatments in unresponsive patients. We present a descriptive, retrospective study of 25 (14 female, 11 male) adult patients admitted to our hematology unit with TTP. The patients' median age was 32 years. The patients were treated with immediate PE and a standard dose of corticosteroid therapy. Twenty percent of the patients obtained a complete response after the addition of Intravenous immuno-globulin (IVIg). Improvement of clinical status, platelet counts and serum LDH levels were seen after a median 13, 14 and 3.5 PE sessions, respectively. The mortality rate was 12%. One patient has a chronic relapsing form of TTP and two patients have relapsed. All the other patients are still in complete remission after a median of 7 years of follow-up. Although PE therapy is life-saving and the application of early corticosteroid treatment could obtain early and durable responses, addition of other immuno-modulatory treatments are needed in unresponsive patients. The use of IVIg could result in a dramatic response.

  18. Local food:

    DEFF Research Database (Denmark)

    Sundbo, Donna Isabella Caroline

    2013-01-01

    Recently there has been more focus on food in general and local food in particular. But what is local food? And what are the perceptions of this concept according to theory and to providers and consumers of local food? This article first summarises and compares three different theoretical perspec...... the providers and consumers studied on what local food is. However, this may change in time.......Recently there has been more focus on food in general and local food in particular. But what is local food? And what are the perceptions of this concept according to theory and to providers and consumers of local food? This article first summarises and compares three different theoretical...... perspectives on local food, namely experience economy, local food systems and what is termed pro-industrialism. These have differing and sometimes opposite conceptualisations and aims for the concept of local food. Using the perspective of experience economy as theoretical background, the concept of local food...

  19. Survival and local control rates of triple-negative breast cancer patients treated with boost-IOERT during breast-conserving surgery

    Energy Technology Data Exchange (ETDEWEB)

    Fastner, Gerd; Zehentmayr, Franz; Kopp, Peter; Fussl, Christoph; Sedlmayer, Felix [Landeskrankenhaus, Paracelsus Medical University, Department of Radiotherapy and Radio-Oncology, Salzburg (Austria); Hauser-Kronberger, Cornelia [Landeskrankenhaus, Paracelsus Medical University, Department of Pathology, Salzburg (Austria); Moder, Angelika [Landeskrankenhaus, Paracelsus Medical University, Institute of Inborn Errors in Metabolism, Salzburg (Austria); Reitsamer, Roland; Fischer, Thorsten [Landeskrankenhaus, Paracelsus Medical University, Department of Special Gynecology, Salzburg (Austria); Landeskrankenhaus, Paracelsus Medical University, Department of Gynecology, Salzburg (Austria); Deutschmann, Heinrich [Landeskrankenhaus, Paracelsus Medical University, Department of Radiotherapy and Radio-Oncology, Salzburg (Austria); Paracelsus Medical University, Institute for Research and Development of Advanced Radiation Technologies (radART), Salzburg (Austria)

    2016-01-15

    The purpose of this work was to retrospectively evaluate survival and local control rates of triple-negative breast cancer subtypes classified as five marker negative (5NP) and core basal (CB), respectively, after breast-conserving surgery and intraoperative boost radiotherapy with electrons (IOERT) followed by whole breast irradiation. A total of 71 patients with triple-negative breast cancer were enrolled, who were treated with lumpectomy, axillary lymph node dissection, and IOERT with 9.6 Gy (median D{sub max}) followed by normofractionated whole breast irradiation to median total doses of 54 Gy. Chemotherapy was applied in a neoadjuvant (12 %), adjuvant (75 %), or combinational setting (7 %). After a median follow-up of 97 months (range 4-170 months), 5 in-breast recurrences were detected (7.0 %). For all patients, 8-year actuarial rates for local control, metastases-free survival, disease-specific survival, and overall survival amounted to 89, 75, 80, and 69 %, respectively. All local recurrences occurred in grade 3 (G3) tumors irrespective of their specific immunohistochemical phenotype; thus, the local control rate for grades 1/2 (G1/2) was 100 % for both 5NP and CB, while for G3 it was 88 % for 5NP and 90 % for CB (p = 0.65 and 0.82, respectively, n.s.). For disease-specific survival, only the difference of the best-prognosis group 5-NP/G3 vs. the worst-prognosis cohort CB/G1/2 was statistically significant: 90 % vs. 54 % (p = 0.03). Boost-IOERT provides acceptable long-term in-breast control in triple negative breast cancer. The best subgroup in terms of disease-specific survival was represented by 5NP in combination with tumor grading G3. (orig.) [German] Ziel der Studie war es, im Rahmen einer retrospektiven Analyse Ueberlebens- und Lokalkontrollraten bei triple-negativen Mammakarzinomen zu untersuchen. Die Tumoren waren in 5NP(5-Marker-negative)- und CB(core basal)-Subtypen klassifiziert und die Patientinnen hatten nach brusterhaltender Operation und

  20. A rotating annulus driven by localized convective forcing: a new atmosphere-like experiment

    Science.gov (United States)

    Scolan, Hélène; Read, Peter L.

    2017-06-01

    We present an experimental study of flows in a cylindrical rotating annulus convectively forced by local heating in an annular ring at the bottom near the external wall and via a cooled circular disk near the axis at the top surface of the annulus. This new configuration is distinct from the classical thermally driven annulus analogue of the atmosphere circulation, in which thermal forcing is applied uniformly on the sidewalls, but with a similar aim to investigate the baroclinic instability of a rotating, stratified flow subjected to zonally symmetric forcing. Two vertically and horizontally displaced heat sources/sinks are arranged, so that in the absence of background rotation, statically unstable Rayleigh-Bénard convection would be induced above the source and beneath the sink, thereby relaxing strong constraints placed on background temperature gradients in previous experimental configurations based on the conventional rotating annulus. This better emulates local vigorous convection in the tropics and polar regions of the atmosphere while also allowing stably-stratified baroclinic motion in the central zone of the annulus, as in mid-latitude regions in the Earth's atmosphere. Regimes of flow are identified, depending mainly upon control parameters that in turn depend on rotation rate and the strength of differential heating. Several regimes exhibit baroclinically unstable flows which are qualitatively similar to those previously observed in the classical thermally driven annulus. However, in contrast to the classical configuration, they typically exhibit more spatio-temporal complexity. Thus, several regimes of flow demonstrate the equilibrated co-existence of, and interaction between, free convection and baroclinic wave modes. These new features were not previously observed in the classical annulus and validate the new setup as a tool for exploring fundamental atmosphere-like dynamics in a more realistic framework. Thermal structure in the fluid is

  1. EMC3-EIRENE modeling of toroidally-localized divertor gas injection experiments on Alcator C-Mod

    Energy Technology Data Exchange (ETDEWEB)

    Lore, J.D., E-mail: lorejd@ornl.gov [Oak Ridge National Laboratory, Oak Ridge, TN 37831 (United States); Reinke, M.L. [York Plasma Institute, Department of Physics, University of York, Heslington, York YO10 5DD (United Kingdom); LaBombard, B. [Plasma Science and Fusion Center, MIT, Cambridge, MA 02139 (United States); Lipschultz, B. [York Plasma Institute, Department of Physics, University of York, Heslington, York YO10 5DD (United Kingdom); Churchill, R.M. [Plasma Science and Fusion Center, MIT, Cambridge, MA 02139 (United States); Pitts, R.A. [ITER Organization, Route de Vinon sur Verdon, 13115 Saint Paul Lez Durance (France); Feng, Y. [Max Planck Institute for Plasma Physics, Greifswald (Germany)

    2015-08-15

    Experiments on Alcator C-Mod with toroidally and poloidally localized divertor nitrogen injection have been modeled using the three-dimensional edge transport code EMC3-EIRENE to elucidate the mechanisms driving measured toroidal asymmetries. In these experiments five toroidally distributed gas injectors in the private flux region were sequentially activated in separate discharges resulting in clear evidence of toroidal asymmetries in radiated power and nitrogen line emission as well as a ∼50% toroidal modulation in electron pressure at the divertor target. The pressure modulation is qualitatively reproduced by the modeling, with the simulation yielding a toroidal asymmetry in the heat flow to the outer strike point. Toroidal variation in impurity line emission is qualitatively matched in the scrape-off layer above the strike point, however kinetic corrections and cross-field drifts are likely required to quantitatively reproduce impurity behavior in the private flux region and electron temperatures and densities directly in front of the target.

  2. Importance of Local Control in Early-Stage Prostate Cancer: Outcomes of Patients With Positive Post-Radiation Therapy Biopsy Results Treated in RTOG 9408

    Energy Technology Data Exchange (ETDEWEB)

    Krauss, Daniel J., E-mail: dkrauss@beaumont.edu [Department of Radiation Oncology, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan (United States); Hu, Chen [NRG Statistics and Data Management Center, Philadelphia, Pennsylvania (United States); Bahary, Jean-Paul [Centre Hospitalier de l' Université de Montréal-Notre Dame, Montreal, Quebec (Canada); Souhami, Luis [McGill University, Montreal, Quebec (Canada); Gore, Elizabeth M. [Medical College of Wisconsin, Milwaukee, Wisconsin (United States); Chafe, Susan Maria Jacinta [Cross Cancer Institute, Edmonton, Alberta (Canada); Leibenhaut, Mark H. [Sutter General Hospital, Sacramento, California (United States); Narayan, Samir [Michigan Cancer Research Consortium CCOP (United States); Torres-Roca, Javier [H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida (United States); Michalski, Jeff [Washington University, St. Louis, Missouri (United States); Zeitzer, Kenneth L. [Albert Einstein Medical Center, Bronx, New York, New York (United States); Donavanik, Viroon [Christiana Care Health Services Inc CCOP, Newark, Delaware (United States); Sandler, Howard [Cedars-Sinai Medical Center, Los Angeles, California (United States); McGowan, David G. [Cross Cancer Institute, Edmonton, Alberta (Canada); Jones, Christopher U. [Sutter General Hospital, Sacramento, California (United States); Shipley, William U. [Dana-Farber Cancer Institute, Boston, Massachusetts (United States)

    2015-07-15

    Purpose: The purpose of this study was to assess the association between positive post-radiation therapy (RT) biopsy results and subsequent clinical outcomes in males with localized prostate cancer. Methods and Materials: Radiation Therapy Oncology Group study 94-08 analyzed 1979 males with prostate cancer, stage T1b-T2b and prostate-specific antigen concentrations of ≤20 ng/dL, to investigate whether 4 months of total androgen suppression (TAS) added to RT improved survival compared to RT alone. Patients randomized to receive TAS received flutamide with luteinizing hormone releasing hormone (LHRH) agonist. According to protocol, patients without evidence of clinical recurrence or initiation of additional endocrine therapy underwent repeat prostate biopsy 2 years after RT completion. Statistical analysis was performed to evaluate the impact of positive post-RT biopsy results on clinical outcomes. Results: A total of 831 patients underwent post-RT biopsy, 398 were treated with RT alone and 433 with RT plus TAS. Patients with positive post-RT biopsy results had higher rates of biochemical failure (hazard ratio [HR] = 1.7; 95% confidence interval [CI] = 1.3-2.1) and distant metastasis (HR = 2.4; 95% CI = 1.3-4.4) and inferior disease-specific survival (HR = 3.8; 95% CI = 1.9-7.5). Positive biopsy results remained predictive of such outcomes after correction for potential confounders such as Gleason score, tumor stage, and TAS administration. Prior TAS therapy did not prevent elevated risk of adverse outcome in the setting of post-RT positive biopsy results. Patients with Gleason score ≥7 with a positive biopsy result additionally had inferior overall survival compared to those with a negative biopsy result (HR = 1.56; 95% CI = 1.04-2.35). Conclusions: Positive post-RT biopsy is associated with increased rates of distant metastases and inferior disease-specific survival in patients treated with definitive RT and was associated with inferior overall

  3. Experiments on Linear and Nonlinear Localization of Optical Vortices in Optically Induced Photonic Lattices

    Directory of Open Access Journals (Sweden)

    Daohong Song

    2012-01-01

    Full Text Available We provide a brief overview on our recent experimental work on linear and nonlinear localization of singly charged vortices (SCVs and doubly charged vortices (DCVs in two-dimensional optically induced photonic lattices. In the nonlinear case, vortex propagation at the lattice surface as well as inside the uniform square-shaped photonic lattices is considered. It is shown that, apart from the fundamental (semi-infinite gap discrete vortex solitons demonstrated earlier, the SCVs can self-trap into stable gap vortex solitons under the normal four-site excitation with a self-defocusing nonlinearity, while the DCVs can be stable only under an eight-site excitation inside the photonic lattices. Moreover, the SCVs can also turn into stable surface vortex solitons under the four-site excitation at the surface of a semi-infinite photonics lattice with a self-focusing nonlinearity. In the linear case, bandgap guidance of both SCVs and DCVs in photonic lattices with a tunable negative defect is investigated. It is found that the SCVs can be guided at the negative defect as linear vortex defect modes, while the DCVs tend to turn into quadrupole-like defect modes provided that the defect strength is not too strong.

  4. Fostering EFL learners´ literacies through local inquiry in a multimodal experience

    Directory of Open Access Journals (Sweden)

    July Rincon

    2016-07-01

    Full Text Available Addressing students’ social reality through the exploration of community inquiries in the English language class can create learning environments for developing students´ language and literacies. This paper addresses the question in what ways community inquiries create opportunities for students to explore social and cultural issues in their neighborhoods using multimodality. It discusses the role community inquiries play in the development of literacy practices of a group of 10th graders in their EFL class. This descriptive qualitative project carried out at a public institution in the south of Bogotá, Colombia involved 40 participants. The goal of the institutional project is to transform the way students relate to the community in order to create local knowledge. Data was collected through videotape recordings of students´ presentations, teacher´s journal, students´ interactions in Facebook and students´ blogs in a 2-year period. The findings reveal that teachers and students enacted a critical pedagogy through an inquiry curriculum that explored community issues and allowed participants to become inquirers of their own realities. Students´ language learning was evident in multimodal texts in English in their blogs, in the use of EFL in their oral presentations and in their comments in response to peers in Facebook and their blogs.

  5. Locally advanced head and neck cancer treated with accelerated radiotherapy, the hypoxic modifier nimorazole and weekly cisplatin. Results from the DAHANCA 18 phase II study.

    Science.gov (United States)

    Bentzen, Jens; Toustrup, Kasper; Eriksen, Jesper Grau; Primdahl, Hanne; Andersen, Lisbeth Juhler; Overgaard, Jens

    2015-07-01

    A phase II clinical trial evaluating the feasibility and outcome of treating locally advanced head and neck squamous cell carcinoma (HNSCC) with accelerated radiotherapy, the hypoxic modifier nimorazole and weekly cisplatin. A total of 227 patients with stage III or IV HNSCC of the larynx, oropharynx, hypopharynx, or oral cavity where included between January 2007 and December 2010. The prescribed radiotherapy (RT) dose was 66-68 Gy in 2 Gy fractions, 6 F/W. The hypoxic radiosensitiser nimorazole was given orally at a dose of 1200 mg/m(2) before each fraction. Concomitant cisplatin (40 mg/m(2)) i.v. was given once a week for a maximum of six cycles. Outcome data were evaluated in terms of loco-regional tumour control (LRC), event-free survival (EFS) and overall survival (OS). Morbidity data were evaluated based on the DAHANCA routine registration. Human papillomavirus (HPV)-status was estimated by immunohistochemical staining of p16. Included were 178 (78%) men and 49 (22%) women with a median age of 57 years. All except five patients received RT as prescribed. At least five series of cisplatin was given to 164 (72%) of the patients, and 149 patients (66%) received the full dose of nimorazole. The five-year actuarial LRC, EFS and OS rates were 80%, 67% and 72%, respectively. The LRC rates according to site were: oropharynx: 88%, larynx: 77%, hypopharynx 72% and oral cavity 49%, respectively. HPV/p16 staining was obtained in 141 of the 150 oropharyngeal cancers. Of these, 112 (79%) were p16 pos and 29 (21%) were p16 neg. LRC for the p16 neg oropharyngeal cancers was poorer than for the p16 pos (74% vs. 91%; p = 0.02). Tube feeding during treatment was necessary for 146 (64%) patients. At 12 months this number was reduced to 6%. The treatment was tolerable in this cohort of locally advanced HNSCC patients. Acute and late toxicity was comparable to similar studies of chemoradiotherapy, and the outcome superior to the data reported in the literature. This strongly

  6. Focal laser ablation for localized prostate cancer: principles, clinical trials, and our initial experience.

    Science.gov (United States)

    Lee, Ted; Mendhiratta, Neil; Sperling, Dan; Lepor, Herbert

    2014-01-01

    Focal therapy of prostate cancer is an evolving treatment strategy that destroys a predefined region of the prostate gland that harbors clinically significant disease. Although long-term oncologic control has yet to be demonstrated, focal therapy is associated with a marked decrease in treatment-related morbidity. Focal laser ablation is an emerging modality that has several advantages, most notably real-time magnetic resonance imaging (MRI) compatibility. This review presents the principles of laser ablation, the role of multiparametric MRI for delineating the site of significant prostate cancer, a summary of published clinical studies, and our initial experience with 23 patients, criteria for selecting candidates for focal prostate ablation, and speculation regarding future directions.

  7. Experience with local lymph node assay performance standards using standard radioactivity and nonradioactive cell count measurements.

    Science.gov (United States)

    Basketter, David; Kolle, Susanne N; Schrage, Arnhild; Honarvar, Naveed; Gamer, Armin O; van Ravenzwaay, Bennard; Landsiedel, Robert

    2012-08-01

    The local lymph node assay (LLNA) is the preferred test for identification of skin-sensitizing substances by measuring radioactive thymidine incorporation into the lymph node. To facilitate acceptance of nonradioactive variants, validation authorities have published harmonized minimum performance standards (PS) that the alternative endpoint assay must meet. In the present work, these standards were applied to a variant of the LLNA based on lymph node cell counts (LNCC) run in parallel as a control with the standard LLNA with radioactivity measurements, with threshold concentrations (EC3) being determined for the sensitizers. Of the 22 PS chemicals tested in this study, 21 yielded the same results from standard radioactivity and cell count measurements; only 2-mercaptobenzothiazole was positive by LLNA but negative by LNCC. Of the 16 PS positives, 15 were positive by LLNA and 14 by LNCC; methylmethacrylate was not identified as sensitizer by either of the measurements. Two of the six PS negatives tested negative in our study by both LLNA and LNCC. Of the four PS negatives which were positive in our study, chlorobenzene and methyl salicylate were tested at higher concentrations than the published PS, whereas the corresponding concentrations resulted in consistent negative results. Methylmethacrylate and nickel chloride tested positive within the concentration range used for the published PS. The results indicate cell counts and radioactive measurements are in good accordance within the same LLNA using the 22 PS test substances. Comparisons with the published PS results may, however, require balanced analysis rather than a simple checklist approach. Copyright © 2011 John Wiley & Sons, Ltd.

  8. Initial Thomson Scattering Survey of Local Helicity Injection and Ohmic Plasmas at the Pegasus Toroidal Experiment

    Science.gov (United States)

    Schlossberg, D. J.; Bodner, G. M.; Bongard, M. W.; Fonck, R. J.; Winz, G. R.

    2014-10-01

    A multipoint Thomson scattering diagnostic has recently been installed on the Pegasus ST. The system utilizes a frequency-doubled Nd:YAG laser (λ0 ~ 532 nm), spectrometers with volume phase holographic gratings, and a gated, intensified CCD camera. It provides measurements of Te and ne at 8 spatial locations for each spectrometer once per discharge. A new multiple aperture and beam dump system has been implemented to mitigate interference from stray light. This system has provided initial measurements in the core region of plasmas initiated by local helicity injection (LHI), as well as conventional Ohmic L- and H-mode discharges. Multi-shot averages of low-density (ne ~ 3 ×1018 m-3) , Ip ~ 0 . 1 MA LHI discharges show central Te ~ 75 eV at the end of the helicity injection phase. Ip ~ 0 . 13 MA Ohmic plasmas at moderate densities (ne ~ 2 ×1019 m-3) have core Te ~ 150 eV in L-mode. Generally, these plasmas do not reach transport equilibrium in the short 25 ms pulse length available. After an L-H transition, strong spectral broadening indicates increasing Te, to values above the range of the present spectrometer system with a high-dispersion VPH grating. Near-term system upgrades will focus on deploying a second spectrometer, with a lower-dispersion grating capable of measuring the 0.1-1.0 keV range. The second spectrometer system will also increase the available number of spatial channels, enabling study of H-mode pedestal structure. Work supported by US DOE Grant DE-FG02-96ER54375.

  9. Fanconi's anemia and clinical radiosensitivity. Report on two adult patients with locally advanced solid tumors treated by radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Bremer, M.; Karstens, J.H. [Hannover Medical School, Hannover (Germany). Dept. of Radiation Oncology; Schindler, D.; Gross, M. [Univ. Wuerzburg (Germany). Inst. of Human Genetics; Doerk, T. [Hannover Medical School, Hannover (Germany). Dept. of Obstetrics and Gynecology; Morlot, S. [Hannover Medical School, Hannover (Germany). Inst. of Human Genetics

    2003-11-01

    Background: Patients with Fanconi's anemia (FA) may exhibit an increased clinical radiosensitivity of various degree, although detailed clinical data are scarce. We report on two cases to underline the possible challenges in the radiotherapy of FA patients. Case Report and Results: Two 24- and 32-year-old male patients with FA were treated by definitive radiotherapy for locally advanced squamous cell head and neck cancers. In the first patient, long-term tumor control could be achieved after delivery of 67 Gy with a - in part - hyperfractionated split-course treatment regimen and, concurrently, one course of carboplatin followed by salvage neck dissection. Acute toxicity was marked, but no severe treatment-related late effects occurred. 5 years later, additional radiotherapy was administered due to a second (squamous cell carcinoma of the anus) and third (squamous cell carcinoma of the head and neck) primary, which the patient succumbed to. By contrast, the second patient experienced fatal acute hematologic toxicity after delivery of only 8 Gy of hyperfractionated radiotherapy. While the diagnosis FA could be based on flow cytometric analysis of a lymphocyte culture in the second patient, the diagnosis in the first patient had to be confirmed by hypersensitivity to mitomycin of a fibroblast cell line due to complete somatic lymphohematopoietic mosaicism. In this patient, phenotype complementation and molecular genetic analysis revealed a pathogenic mutation in the FANCA gene. The first patient has not been considered to have FA until he presented with his second tumor. Conclusion: FA has to be considered in patients presenting at young age with squamous cell carcinoma of the head and neck or anus. The diagnosis FA is of immediate importance for guiding the optimal choice of treatment. Radiotherapy or even radiochemotherapy seems to be feasible and effective in individual cases. (orig.)

  10. A Biopsy-based 17-gene Genomic Prostate Score as a Predictor of Metastases and Prostate Cancer Death in Surgically Treated Men with Clinically Localized Disease.

    Science.gov (United States)

    Van Den Eeden, Stephen K; Lu, Ruixiao; Zhang, Nan; Quesenberry, Charles P; Shan, Jun; Han, Jeong S; Tsiatis, Athanasios C; Leimpeter, Amethyst D; Lawrence, H Jeffrey; Febbo, Phillip G; Presti, Joseph C

    2017-10-05

    A 17-gene biopsy-based reverse transcription polymerase chain reaction assay, which provides a Genomic Prostate Score (GPS-scale 0-100), has been validated as an independent predictor of adverse pathology and biochemical recurrence after radical prostatectomy (RP) in men with low- and intermediate-risk prostate cancer (PCa). To evaluate GPS as a predictor of PCa metastasis and PCa-specific death (PCD) in a large cohort of men with localized PCa and long-term follow-up. A retrospective study using a stratified cohort sampling design was performed in a cohort of men treated with RP within Kaiser Permanente Northern California. RNA from archival diagnostic biopsies was assayed to generate GPS results. We assessed the association between GPS and time to metastasis and PCD in prespecified uni- and multivariable statistical analyses, based on Cox proportional hazard models accounting for sampling weights. The final study population consisted of 279 men with low-, intermediate-, and high-risk PCa between 1995 and 2010 (median follow-up 9.8 yr), and included 64 PCD and 79 metastases. Valid GPS results were obtained for 259 (93%). In univariable analysis, GPS was strongly associated with time to PCD, hazard ratio (HR)/20 GPS units=3.23 (95% confidence interval [CI] 1.84-5.65; passociation between GPS and both end points remained significant after adjusting for National Comprehensive Cancer Network, American Urological Association, and Cancer of the Prostate Risk Assessment (CAPRA) risks (pcourse of management of their disease. Copyright © 2017 European Association of Urology. Published by Elsevier B.V. All rights reserved.

  11. Enhancing health service delivery through a university-local governemnt partnership model, issues and experiences from Uganda

    Directory of Open Access Journals (Sweden)

    Gad Razaaza Ndaruhutse

    2013-12-01

    Full Text Available A number of approaches have been adopted in medical education geared towards training health professionals that can improve access to health care by communities most vulnerable to inequalities and injustices in health systems. Relevant health professions education is vital for improvements in health and health care access. A symbiotic medical education can improve the quality of health care and impact on career choice, yet the challenge to sustain equitable access to improved health and healthcare particularly for those most in need remains a major global challenge ( Ssewankambo, 2012. Within a decentralized system, such as in Uganda, Local Governments are mandated to ensure health promotion and equitable healthcare for the population under their jurisdiction. Whereas public service reforms have mainly focused on decentralization and good governance (Mamdani, 2012, Stiglitz, 2012, the role of curriculum reforms in addressing health and health care challenges through needs-based education of health professionals has been largely ignored. Through an analysis of the challenges of health care within a decentralized Local Government setting, this paper, by presenting experiences from one public university in Uganda, reveals how a partnership between Universities and Local Government can go a long way in addressing health disparities and reduction of morbidity and mortality.

  12. FOLFIRI in patients with locally advanced or metastatic pancreatic or biliary tract carcinoma: a monoinstitutional experience.

    Science.gov (United States)

    Moretto, Roberto; Raimondo, Lucia; De Stefano, Alfonso; Cella, Chiara A; Matano, Elide; De Placido, Sabino; Carlomagno, Chiara

    2013-10-01

    Pancreatic and biliary tract carcinomas are very chemoresistant. After a first-line treatment with a gemcitabine-based regimen, no second-line scheme is consolidated in clinical practice. The aim of this study was to evaluate the toxicity and the activity of the FOLFIRI regimen as first-line or second-line chemotherapy in patients with pancreatic or biliary tract tumors. Fifty-four patients (30 with pancreatic tumor, nine with gallbladder tumor, and 15 with biliary tract tumor) were treated with FOLFIRI (irinotecan 180 mg/m², day 1; leucovorin 100 mg/m² intravenously, days 1 and 2; 5-fluorouracil 400 mg/m² intravenous bolus, days 1 and 2; and 600 mg/m² in 22 h intravenously, continuous infusion days 1 and 2; every 14 days). Toxicity was recorded at each cycle according to the NCI-CTC V3.0 criteria, the response rate was verified each four cycles according to the RECIST criteria, and the progression-free survival rates as well as the overall survival rates were calculated according to the Kaplan-Meier method. Overall, the toxicity was mild. Grade 3-4 neutropenia occurred in 42.6% of patients. Grade 3-4 gastrointestinal toxicity was rare. FOLFIRI as a first-line treatment produced a response rate of 25%. In the second-line group, 9/21 patients (42.9%) obtained a stable disease as best response. In the entire population, the median progression-free survival rates were 3.1 months [95% confidence interval (CI), 1.9-4.4] and 3.5 months (95% CI, 2.6-4.4), respectively, in the first-line and the second-line cohort of patients. The median overall survival rates were 14.5 months (95% CI, 7.0-22.1) and 6.2 months (95% CI, 5.4-7.0), respectively, in the first-line and the second-line cohort of patients. FOLFIRI is feasible and well tolerated in patients with pancreatic or biliary tract tumors; it has a good activity in first line and mostly in patients with pancreatic cancer.

  13. Managed Aquifer Recharge: from Local Research and Experiences to Regional Aquifer Storage and Recovery

    Science.gov (United States)

    Hendriks, D.; Faneca, M.; Oude Essink, G.; van Baaren, E.; Stuurman, R.; Delsman, J. R.; van Kempen, C.; de Louw, P.

    2016-12-01

    Many areas in the world experience periodic water shortages due to meteorological drought, salt water intrusion or over-exploitation of the water resources. Recently, it was established that the depletion of aquifers in many areas of the world is in an advanced state (Gleeson et al, 2012). This poses enormous challenges as 2.5 billion people and many companies depend on groundwater now and in the future (UN, 2015; ESG, 2016). A solution to increase robustness of water systems and prevent water shortage is subsurface storage of water during wet periods using Managed Aquifer Research (MAR). In addition to mitigation of water shortage, MAR can also reduce the occurrence and degree of flooding. Here, we present an overview of Deltares MAR expertise and available tools for up-scaling MAR. Deltares has experience with both research and implementation of MAR in different parts of the world under various hydro(geo)logical, climatic and socio-economic conditions. Various MAR techniques were assessed/tested in coastal areas of the Netherlands, Spain, New York, New Orleans and in Bangladesh. In some of these areas specific groundwater shortage related issues occur, such as salt water intrusion or subsidence. In Singapore, monitoring campaigns and modeling were done to design MAR by infiltration of water in over-exploited aquifers. In Abu Dhabi, geophysical methods were used to detect the optimal conditions for MAR systems. To effectively increase the robustness of groundwater systems up-scaling of MAR is required. For this purpose, Deltares developed tools that provide insight in the potential demand, possibilities and effectiveness of MAR at larger scales. The Quick scan tool for Fresh Groundwater Buffering provides insight on regional to national scale and is based on GIS-information of water demand, water resources, and subsurface properties. This quick scan tool has been applied for Mozambique, Kenya, India and Bangladesh. The Fresh Water Optimizer assesses the

  14. Twelve years' experience with high-intensity focused ultrasound (HIFU) using sonablate™ devices for the treatment of localized prostate cancer

    Science.gov (United States)

    Uchida, Toyoaki; Nakano, Muyura; Shoji, Sunao; Nagata, Yoshihiro; Usui, Yukio; Terachi, Toshiro

    2012-10-01

    To report on the long-term results of high-intensity focused ultrasound (HIFU) in the treatment of localized prostate cancer. Patients with clinical Stage T1c-T3N0M0, biopsy proven, localized prostate cancer, with a serum prostate specific antigen (PSA) level of Gleason score were included. All patients underwent HIFU using the Sonablate™ (S) device and were required to have a minimal follow-up of 2 years after the last HIFU session to be included in this analysis. Four different generation HIFU devices, S200, S500, S500 version 4 and S500 TCM, have been used for this study. Biochemical failure was defined according to the Phoenix definition (PSA nadir+2ng/ml). Seven hundred and fifty-three men with prostate cancer were included. The patients were divided into two groups: in the Former group, 421 patients were treated with S200 and 500 from 1990 to 2005; in the Latter group, 332 patients were treated with S500 ver. 4 and TCM from 2005 to 2009. The mean age, PSA, Gleason score, operation time, and follow-up period in the Former and Latter groups were 68 and 67 years, 11.3 and 9.7 ng/ml, 6.2 and 6.6, 167 and 101 min, and 49 and 38 months, respectively. The biochemical disease-free rate (BDFR) in the groups at 5 years was, respectively, 67% and 53%, and was 50% at 10 years in the Former group (p<0.0001). The BDFR in patients in the low-, intermediate-, and high-risk groups in the Former group at 5 and 10 years were 68% and 65%, 52% and 48%, and 43% and 40%, respectively (p<0.0001). The BDFR in patients in the low-, intermediate-, and high-risk groups in the Latter group at 5 years were 83%, 76%, and 42% (p<0.0001). The negative prostate biopsy rate in the Former and Latter groups was 81% and 93%, respectively. Postoperative erectile dysfunction was noted in 45%, 38%, and 24% of patients at 6 months, 12 months, and 2 years after HIFU. The results after long-term follow-up have indicated that HIFU is an efficient and safe treatment for patients with localized prostate

  15. Hemorrhagic cystitis in children treated with alkylating agent cyclophosphamide: The experience of a medical center in Taiwan

    Directory of Open Access Journals (Sweden)

    Ching-Chia Wang

    2015-08-01

    Conclusion: Alteration serum uric acid level and BMT could be indicators for severe hemorrhagic cystitis. The elevated levels of urinary nitrite/nitrate and 8-iso-prostaglandin F2α may indicate the essential roles played by nitric oxide syntheses and reactive oxidative stress in cyclophosphamide-induced hemorrhagic cystitis. These findings may help clinicians formulate a better strategy for treating cyclophosphamide-induced hemorrhagic cystitis.

  16. Should lower limb fractures be treated surgically in patients with chronic spinal injuries? Experience in a reference centre.

    Science.gov (United States)

    Barrera-Ochoa, S; Haddad, S; Rodríguez-Alabau, S; Teixidor, J; Tomás, J; Molero, V

    To report the outcomes of surgical treatment of lower limb fractures in patients with chronic spinal cord injuries. A total of 37 lower limb fractures were treated from 2003 to 2010, of which 25 fractures were treated surgically and 12 orthopaedically. Patients of the surgical group had better clinical results, range of motion, bone consolidation, and less pressure ulcers and radiological misalignment. No differences were detected between groups in terms of pain, hospital stay, and medical complications. There is no currently consensus regarding the management of lower limb fractures in patients with chronic spinal cord injuries, but the trend has been conservative treatment due to the high rate of complications in surgical treatment. Chronic spinal cord injuries patients with lower limb fractures who are treated surgically achieved a more reliable consolidation, practically a free range of motion, low rate of cutaneous complications, and pain associated with the fracture. This allows a quick return to the previous standard of living, and should be considered as an alternative to orthopaedic treatment in these patients. Copyright © 2016 SECOT. Publicado por Elsevier España, S.L.U. All rights reserved.

  17. Analytical and Radio-Histo-Chemical Experiments of Plants and Tissue Culture Cells Treated with Lunar and Terrestrial Materials

    Science.gov (United States)

    Halliwell, R. S.

    1973-01-01

    The nature and mechanisms of the apparent simulation of growth originally observed in plants growing in contact with lunar soil during the Apollo project quarantine are examined. Preliminary experiments employing neutron activated lunar soil indicate uptake of a few elements by plants. It was found that while the preliminary neutron activation technique allowed demonstration of uptake of minerals it presented numerous disadvantages for use in critical experiments directed at elucidating possible mechanisms of stimulation.

  18. Multi-Institutional Experience of Ductal Carcinoma In Situ in Black vs White Patients Treated With Breast-Conserving Surgery and Whole Breast Radiation Therapy

    Energy Technology Data Exchange (ETDEWEB)

    Nelson, Carl [Robert Wood Johnson Medical School, New Brunswick, New Jersey (United States); Bai, Harrison [Yale University School of Medicine, New Haven, Connecticut (United States); Neboori, Hanmanth [Drexel Medical College, Philadelphia, Pennsylvania (United States); Takita, Cristiane [University of Miami, Miami, Florida (United States); Motwani, Sabin [Robert Wood Johnson Medical School, New Brunswick, New Jersey (United States); Wright, Jean L.; Hobeika, Georges [University of Miami, Miami, Florida (United States); Haffty, Bruce G. [Robert Wood Johnson Medical School, New Brunswick, New Jersey (United States); Jones, Tiffanie [Yale University School of Medicine, New Haven, Connecticut (United States); Goyal, Sharad [Robert Wood Johnson Medical School, New Brunswick, New Jersey (United States); Moran, Meena S., E-mail: meena.moran@yale.edu [Yale University School of Medicine, New Haven, Connecticut (United States)

    2012-11-01

    Purpose: Given the paucity of data on racial disparities in ductal carcinoma in situ (DCIS), the data from a multi-institutional cohort of DCIS patients treated with breast-conserving surgery and whole breast radiation therapy (RT) were analyzed to determine whether racial disparities or differences exist. Methods and Materials: A total of 533 white and 76 black DCIS patients from 3 university-based cancer centers were uniformly treated with breast-conserving surgery and RT. All patient data were collected and analyzed as a function of race. Results: The median follow-up was 5.2 years. No significant racial differences were seen in tumor size, age at diagnosis, estrogen receptor status, necrosis, or grade (all P>.05). Of the treatment parameters, the RT dose delivered, boost, positive margin rates, frequency of hormone receptor status assessment, and receipt of hormonal therapy for the 2 cohorts did not significantly differ (all P>.05). The local relapse-free survival was similar at 5 years (96.1% and 98.1%, P=.399) and 10 years (92.8% vs 95.8%, P=.360), with no significant overall survival difference at 10 years (94.0% vs 88.9%, P=.290) between the white and black patients, respectively. On multivariate analysis, race was not an independent predictor of local relapse-free survival or overall survival when accounting for age, grade, and margin status. Conclusion: In our large cohort of DCIS patients uniformly treated at 3 institutions with breast conservation without any apparent differences in treatment delivery parameters, we demonstrated that the clinical and pathologic features and local survival outcomes did not differ as a function of race. Our results suggest that when black patients with DCIS are appropriately selected for breast conservation and receive adjuvant RT without racial disparities in the treatment parameters, differences in the outcomes as a function of race do not exist.

  19. Analysis of Dosimetric Parameters Associated With Acute Gastrointestinal Toxicity and Upper Gastrointestinal Bleeding in Locally Advanced Pancreatic Cancer Patients Treated With Gemcitabine-Based Concurrent Chemoradiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Nakamura, Akira [Department of Radiation Oncology and Image-Applied Therapy, Kyoto University Graduate School of Medicine, Kyoto (Japan); Shibuya, Keiko, E-mail: kei@kuhp.kyoto-u.ac.jp [Department of Radiation Oncology and Image-Applied Therapy, Kyoto University Graduate School of Medicine, Kyoto (Japan); Matsuo, Yukinori; Nakamura, Mitsuhiro; Shiinoki, Takehiro; Mizowaki, Takashi; Hiraoka, Masahiro [Department of Radiation Oncology and Image-Applied Therapy, Kyoto University Graduate School of Medicine, Kyoto (Japan)

    2012-10-01

    Purpose: To identify the dosimetric parameters associated with gastrointestinal (GI) toxicity in patients with locally advanced pancreatic cancer (LAPC) treated with gemcitabine-based chemoradiotherapy. Methods and Materials: The data from 40 patients were analyzed retrospectively. Chemoradiotherapy consisted of conventional fractionated three-dimensional radiotherapy and weekly gemcitabine. Treatment-related acute GI toxicity and upper GI bleeding (UGB) were graded according to the Common Toxicity Criteria Adverse Events, version 4.0. The dosimetric parameters (mean dose, maximal absolute dose which covers 2 cm{sup 3} of the organ, and absolute volume receiving 10-50 Gy [V{sub 10-50}]) of the stomach, duodenum, small intestine, and a composite structure of the stomach and duodenum (StoDuo) were obtained. The planning target volume was also obtained. Univariate analyses were performed to identify the predictive factors for the risk of grade 2 or greater acute GI toxicity and grade 3 or greater UGB, respectively. Results: The median follow-up period was 15.7 months (range, 4-37). The actual incidence of acute GI toxicity was 33%. The estimated incidence of UGB at 1 year was 20%. Regarding acute GI toxicity, a V{sub 50} of {>=}16 cm{sup 3} of the stomach was the best predictor, and the actual incidence in patients with V{sub 50} <16 cm{sup 3} of the stomach vs. those with V{sub 50} of {>=}16 cm{sup 3} was 9% vs. 61%, respectively (p = 0.001). Regarding UGB, V{sub 50} of {>=}33 cm{sup 3} of the StoDuo was the best predictor, and the estimated incidence at 1 year in patients with V{sub 50} <33 cm{sup 3} of the StoDuo vs. those with V{sub 50} {>=}33 cm{sup 3} was 0% vs. 44%, respectively (p = 0.002). The dosimetric parameters correlated highly with one another. Conclusion: The irradiated absolute volume of the stomach and duodenum are important for the risk of acute GI toxicity and UGB. These results could be helpful in escalating the radiation doses using novel

  20. Factors Associated With Early Mortality in Patients Treated With Concurrent Chemoradiation Therapy for Locally Advanced Non-Small Cell Lung Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Warner, Andrew [Department of Radiation Oncology, London Health Sciences Centre, London, Ontario (Canada); Dahele, Max [Department of Radiation Oncology, VU University Medical Center, Amsterdam (Netherlands); Hu, Bo; Palma, David A. [Department of Radiation Oncology, London Health Sciences Centre, London, Ontario (Canada); Senan, Suresh [Department of Radiation Oncology, VU University Medical Center, Amsterdam (Netherlands); Oberije, Cary [Department of Radiation Oncology, MAASTRO Clinic, Maastricht (Netherlands); Tsujino, Kayoko [Department of Radiation Oncology, Hyogo Cancer Center, Akashi (Japan); Moreno-Jimenez, Marta [Department of Oncology, Clínica Universidad, Universidad de Navarra, Pamplona (Spain); Kim, Tae Hyun [Department of Radiation Oncology, National Cancer Center, Goyang-si, Gyeonggi (Korea, Republic of); Marks, Lawrence B. [Department of Radiation Oncology, University of North Carolina Chapel Hill, Chapel Hill, North Carolina (United States); Rengan, Ramesh [Department of Radiation Oncology, University of Washington, Seattle, Washington (United States); De Petris, Luigi [Department of Oncology and Pathology, Karolinska University Hospital, Stockholm (Sweden); Ramella, Sara [Department of Radiation Oncology, Campus Bio-Medico University, Rome (Italy); De Ruyck, Kim [Department of Basic Medical Sciences, Ghent University, Ghent (Belgium); De Dios, Núria Rodriguez [Department of Radiation Oncology, Hospital de la Esperanza, Parc de Salut Mar, Barcelona (Spain); Bradley, Jeffrey D. [Department of Radiation Oncology, Washington University School of Medicine, St Louis, Missouri (United States); Rodrigues, George, E-mail: George.Rodrigues@lhsc.on.ca [Department of Radiation Oncology, London Health Sciences Centre, London, Ontario (Canada)

    2016-03-01

    Purpose: Concurrent chemoradiation therapy (con-CRT) is recommended for fit patients with locally advanced non-small cell lung cancer (LA-NSCLC) but is associated with toxicity, and observed survival continues to be limited. Identifying factors associated with early mortality could improve patient selection and identify strategies to improve prognosis. Methods and Materials: Analysis of a multi-institutional LA-NSCLC database consisting of 1245 patients treated with con-CRT in 13 institutions was performed to identify factors predictive of 180-day survival. Recursive partitioning analysis (RPA) was performed to identify prognostic groups for 180-day survival. Multivariate logistic regression analysis was used to create a clinical nomogram predicting 180-day survival based on important predictors from RPA. Results: Median follow-up was 43.5 months (95% confidence interval [CI]: 40.3-48.8) and 127 patients (10%) died within 180 days of treatment. Median, 180-day, and 1- to 5-year (by yearly increments) actuarial survival rates were 20.9 months, 90%, 71%, 45%, 32%, 27%, and 22% respectively. Multivariate analysis adjusted by region identified gross tumor volume (GTV) (odds ratio [OR] ≥100 cm{sup 3}: 2.61; 95% CI: 1.10-6.20; P=.029) and pulmonary function (forced expiratory volume in 1 second [FEV{sub 1}], defined as the ratio of FEV{sub 1} to forced vital capacity [FVC]) (OR <80%: 2.53; 95% CI: 1.09-5.88; P=.030) as significant predictors of 180-day survival. RPA resulted in a 2-class risk stratification system: low-risk (GTV <100 cm{sup 3} or GTV ≥100 cm{sup 3} and FEV{sub 1} ≥80%) and high-risk (GTV ≥100 cm{sup 3} and FEV{sub 1} <80%). The 180-day survival rates were 93% for low risk and 79% for high risk, with an OR of 4.43 (95% CI: 2.07-9.51; P<.001), adjusted by region. A clinical nomogram predictive of 180-day survival, incorporating FEV{sub 1}, GTV, N stage, and maximum esophagus dose yielded favorable calibration (R{sup 2} = 0

  1. Quantitative Analysis of {sup 18}F-Fluorodeoxyglucose Positron Emission Tomography Identifies Novel Prognostic Imaging Biomarkers in Locally Advanced Pancreatic Cancer Patients Treated With Stereotactic Body Radiation Therapy

    Energy Technology Data Exchange (ETDEWEB)

    Cui, Yi [Department of Radiation Oncology, Stanford University, Palo Alto, California (United States); Global Institution for Collaborative Research and Education, Hokkaido University, Sapporo (Japan); Song, Jie; Pollom, Erqi; Alagappan, Muthuraman [Department of Radiation Oncology, Stanford University, Palo Alto, California (United States); Shirato, Hiroki [Global Institution for Collaborative Research and Education, Hokkaido University, Sapporo (Japan); Chang, Daniel T.; Koong, Albert C. [Department of Radiation Oncology, Stanford University, Palo Alto, California (United States); Stanford Cancer Institute, Stanford, California (United States); Li, Ruijiang, E-mail: rli2@stanford.edu [Department of Radiation Oncology, Stanford University, Palo Alto, California (United States); Global Institution for Collaborative Research and Education, Hokkaido University, Sapporo (Japan); Stanford Cancer Institute, Stanford, California (United States)

    2016-09-01

    Purpose: To identify prognostic biomarkers in pancreatic cancer using high-throughput quantitative image analysis. Methods and Materials: In this institutional review board–approved study, we retrospectively analyzed images and outcomes for 139 locally advanced pancreatic cancer patients treated with stereotactic body radiation therapy (SBRT). The overall population was split into a training cohort (n=90) and a validation cohort (n=49) according to the time of treatment. We extracted quantitative imaging characteristics from pre-SBRT {sup 18}F-fluorodeoxyglucose positron emission tomography, including statistical, morphologic, and texture features. A Cox proportional hazard regression model was built to predict overall survival (OS) in the training cohort using 162 robust image features. To avoid over-fitting, we applied the elastic net to obtain a sparse set of image features, whose linear combination constitutes a prognostic imaging signature. Univariate and multivariate Cox regression analyses were used to evaluate the association with OS, and concordance index (CI) was used to evaluate the survival prediction accuracy. Results: The prognostic imaging signature included 7 features characterizing different tumor phenotypes, including shape, intensity, and texture. On the validation cohort, univariate analysis showed that this prognostic signature was significantly associated with OS (P=.002, hazard ratio 2.74), which improved upon conventional imaging predictors including tumor volume, maximum standardized uptake value, and total legion glycolysis (P=.018-.028, hazard ratio 1.51-1.57). On multivariate analysis, the proposed signature was the only significant prognostic index (P=.037, hazard ratio 3.72) when adjusted for conventional imaging and clinical factors (P=.123-.870, hazard ratio 0.53-1.30). In terms of CI, the proposed signature scored 0.66 and was significantly better than competing prognostic indices (CI 0.48-0.64, Wilcoxon rank sum test P<1e-6

  2. Is Ki-67 Expression Prognostic for Local Relapse in Early-Stage Breast Cancer Patients Treated With Breast Conservation Therapy (BCT)?

    Energy Technology Data Exchange (ETDEWEB)

    Hafeez, Farhaan [Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, Connecticut (United States); Neboori, Hanmanth J. [Drexel Medical College, Philadelphia, Pennsylvania (United States); Harigopal, Malini [Department of Pathology, Yale University School of Medicine, New Haven, Connecticut (United States); Wu, Hao; Haffty, Bruce G. [Department of Radiation Oncology, University of Medicine and Dentistry of New Jersey–Robert Wood Johnson School of Medicine, New Brunswick, New Jersey (United States); Yang, Qifeng [Department of Breast Surgery, Shandong University School of Medicine, Shanghai (China); Schiff, Devora [Department of Radiation Oncology, University of Medicine and Dentistry of New Jersey–Robert Wood Johnson School of Medicine, New Brunswick, New Jersey (United States); Moran, Meena S., E-mail: meena.moran@yale.edu [Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, Connecticut (United States)

    2013-10-01

    Purpose: Ki-67 is a human nuclear protein whose expression is strongly up-regulated in proliferating cells and can be used to determine the growth fraction in clonal cell populations. Although there are some data to suggest that Ki-67 overexpression may be prognostic for endpoints such as survival or postmastectomy recurrence, further elucidation of its prognostic significance is warranted. Specifically after breast conservation therapy (BCT) (defined in this setting as breast-conserving surgery and adjuvant radiation therapy), whether Ki-67 predicts for locoregional recurrence has not been investigated. The purpose of this study was to assess Ki-67 expression in a cohort of early-stage breast cancer patients to determine whether a significant independent association between Ki-67 and locoregional relapse exists. Methods and Materials: Ki-67 staining was conducted on a tissue microarray of 438 patients previously treated with BCT, and expression was analyzed with clinicopathologic features and outcomes from our database. Results: Ki-67 expression was more prevalent in black patients (37% of black patients vs 17% of white patients, P<.01), younger patients (27% of patients aged ≤50 years vs 15% of patients aged >50 years, P<.01), estrogen receptor (ER)–negative tumors (25% of ER-negative tumors vs 17% of ER-positive tumors, P=.04), human epidermal growth factor receptor 2 (HER2)/neu–positive tumors (35% of HER2-positive tumors vs 18% of HER2-negative tumors, P=.01), and larger tumors (26% of T2 tumors vs 16% of T1 tumors, P=.03). On univariate/multivariate analysis, Ki-67 did not predict for overall survival (74.4% vs 72.6%), cause-specific survival (82.9% vs 82.1%), local relapse-free survival (83.6% vs 88.5%), distant metastasis-free survival (76.1% vs 81.4%), recurrence-free survival (65.5% vs 74.6%), and locoregional recurrence-free survival (81.6% vs 84.7%): P>.05 for all. Conclusions: Ki-67 appears to be a surrogate marker for aggressive disease and

  3. Parents' experiences of their premature infants' transportation from a university hospital NICU to the NICU at two local hospitals.

    Science.gov (United States)

    Granrud, Marie Dahlen; Ludvigsen, Elin; Andershed, Birgitta

    2014-01-01

    The aim of this study was to describe how the parents of premature infants experience the transportation of their baby from the neonatal intensive care unit at a university hospital (NICU-U) to such a unit at a local hospital (NICU-L). This descriptive qualitative study comprises interviews with nine sets of parents and two mothers. The qualitative content analysis resulted in one theme: living in uncertainty about whether the baby will survive, and three categories: being distanced from the baby; fearing that something would happen to the baby during transportation; and experiencing closeness to the baby. The results also revealed that the parents experienced developmental, situational and health-illness transitions. Copyright © 2014 Elsevier Inc. All rights reserved.

  4. Nutritive Value of Grasses in Semi-arid Rangelands of Ethiopia: Local Experience Based Herbage Preference Evaluation versus Laboratory Analysis

    Science.gov (United States)

    Keba, Habtamu T.; Madakadze, I. C.; Angassa, A.; Hassen, A.

    2013-01-01

    We examined the nutritive value of common grass species in the semi-arid rangelands of Borana in southern Ethiopia using local experience based herbage preference (LEBHP) perception and laboratory techniques. Local pastoralists in the study area were asked to identify common grass species and rank them according to the species’ preferences and palatability to cattle. The pastoralists listed a total of 15 common grass species which were then sampled during the main rain and cold dry seasons and analyzed for crude protein (CP), Neutral Detergent Fiber (NDF), Acid Detergent Fiber (ADF) and ash content to verify pastoralists’ claim regarding the quality of individual species. The relative feed value (RFV) and dry matter digestibility (DMD) were also calculated using NDF and ADF contents. Spearman’s rank correlation was used to examine possible relationships between laboratory results and pastoralists’ experience on grass quality. Cenchrus ciliaris, Chrysopogon aucheri, Digitaria milanjiana, Eragrostis papposa and Panicum maximum were the top five species based on LEBHP perception. There were indications of inconsistency in terms of LEBHP perception among the different pastoral communities. The chemical composition of all grass species showed significant (prangelands were in the range of 8.7% in the main rain season to 5.1% for the cold dry season. The fiber constituents were relatively low in the main rain season compared to the cold dry season. Overall, Digitaria milanjiana had the highest CP (16.5%) content, while the least was recorded with Heteropogon contortus (10.8) and Aristida adoensis (9.8%) during the main rain season. It seems that the spatial variability of landscapes within the wider geographical regions, soil properties and texture, and land-use patterns probably contributed to site differences in species quality. Generally, the RFV of individual grass species was significantly (prangeland forage species for sustainable animal production. PMID

  5. Long-term regional shifts in plant community composition are largely explained by local deer impact experiments.

    Directory of Open Access Journals (Sweden)

    Katie Frerker

    Full Text Available The fact that herbivores and predators exert top-down effects to alter community composition and dynamics at lower trophic levels is no longer controversial, yet we still lack evidence of the full nature, extent, and longer-term effects of these impacts. Here, we use results from a set of replicated experiments on the local impacts of white-tailed deer to evaluate the extent to which such impacts could account for half-century shifts in forest plant communities across the upper Midwest, USA. We measured species' responses to deer at four sites using 10-20 year-old deer exclosures. Among common species, eight were more abundant outside the exclosures, seven were commoner inside, and 16 had similar abundances in- and outside. Deer herbivory greatly increased the abundance of ferns and graminoids and doubled the abundance of exotic plants. In contrast, deer greatly reduced tree regeneration, shrub cover (100-200 fold in two species, plant height, plant reproduction, and the abundance of forbs. None of 36 focal species increased in reproduction or grew taller in the presence of deer, contrary to expectations. We compared these results to data on 50-year regional shifts in species abundances across 62 sites. The effects of herbivory by white-tailed deer accurately account for many of the long-term regional shifts observed in species' abundances (R2 = 0.41. These results support the conjecture that deer impacts have driven many of the regional shifts in forest understory cover and composition observed in recent decades. Our ability to link results from shorter-term, local experiments to regional long-term studies of ecological change strengthens the inferences we can draw from both approaches.

  6. THE FREEDOM IN VIDEO GAME LOCALIZATION (How Indonesian Game Translator applied Carte Blanche of Translation to Preserve Game Experience

    Directory of Open Access Journals (Sweden)

    Agung Prasetyo Wibowo

    2017-12-01

    Full Text Available This paper addresses the issue of video game localisation in MMORPG video game that focusing on the freedom of the translator in transferring meaning in the in-game text assets of video games. Games, regardless of their forms, are the media of entertainments. Foreign audiences may have different expectations on how they wish to be entertained. They most certainly have their own canon of cultural references that they will put into relation to any content of the game. Localization has to take all these things into account, and subsequently the localization process can involve the addition, removal or replacement of elements of the product. Game localisation allows translators to transcreate the things that are necessary to preserve the game experience and to produce a fresh and engaging translation. In this paper, the writers cast a spotlight on translators, progressing from our analysis focused on games as translation texts and as products. The result of this paper shows about how the translator used the freedom of the translator or the degree of creativity that they may have when adapting the game. Concisely, the more complex and creative a storyline, the more useful transcreation may turn in the translation process.

  7. Hemorrhagic cystitis in children treated with alkylating agent cyclophosphamide: The experience of a medical center in Taiwan.

    Science.gov (United States)

    Wang, Ching-Chia; Weng, Te-I; Lu, Meng-Yao; Yang, Rong-Sen; Lin, Kai-Hsin; Wu, Mei-Hwan; Liu, Shing-Hwa

    2015-08-01

    Hemorrhagic cystitis is a common complication with chemotherapeutic alkylating agents. We investigated the possible prognostic factors of cyclophosphamide-induced hemorrhagic cystitis in children. Medical records of children (hemorrhagic cystitis were collected retrospectively from January 2000 to December 2010 in a tertiary care center. We also prospectively enrolled children (hemorrhagic cystitis than those who did not receive BMT (p hemorrhage cystitis, was significantly lower after the development of hemorrhagic cystitis (p hemorrhagic cystitis. The elevated levels of urinary nitrite/nitrate and 8-iso-prostaglandin F2α may indicate the essential roles played by nitric oxide syntheses and reactive oxidative stress in cyclophosphamide-induced hemorrhagic cystitis. These findings may help clinicians formulate a better strategy for treating cyclophosphamide-induced hemorrhagic cystitis. Copyright © 2013. Published by Elsevier B.V.

  8. Improving quantitative precipitation nowcasting with a local ensemble transform Kalman filter radar data assimilation system: observing system simulation experiments

    Directory of Open Access Journals (Sweden)

    Chih-Chien Tsai

    2014-03-01

    Full Text Available This study develops a Doppler radar data assimilation system, which couples the local ensemble transform Kalman filter with the Weather Research and Forecasting model. The benefits of this system to quantitative precipitation nowcasting (QPN are evaluated with observing system simulation experiments on Typhoon Morakot (2009, which brought record-breaking rainfall and extensive damage to central and southern Taiwan. The results indicate that the assimilation of radial velocity and reflectivity observations improves the three-dimensional winds and rain-mixing ratio most significantly because of the direct relations in the observation operator. The patterns of spiral rainbands become more consistent between different ensemble members after radar data assimilation. The rainfall intensity and distribution during the 6-hour deterministic nowcast are also improved, especially for the first 3 hours. The nowcasts with and without radar data assimilation have similar evolution trends driven by synoptic-scale conditions. Furthermore, we carry out a series of sensitivity experiments to develop proper assimilation strategies, in which a mixed localisation method is proposed for the first time and found to give further QPN improvement in this typhoon case.

  9. The Scary World in Your Living Room and Neighborhood: Using Local Broadcast News, Neighborhood Crime Rates, and Personal Experience to Test Agenda Setting and Cultivation.

    Science.gov (United States)

    Gross, Kimberly; Aday, Sean

    2003-01-01

    Tests two important theories in the history of mass communication research, agenda setting and cultivation, by comparing the effects of watching local television news with direct experience measures of crime on issue salience and fear of victimization. Finds that direct experience had no agenda-setting effect but did predict fear. (SG)

  10. A Single-Institutional Experience of 15 Years of Treating T3 Laryngeal Cancer With Primary Radiotherapy, With or Without Chemotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Al-Mamgani, Abrahim, E-mail: a.al-mamgani@erasmusmc.nl [Department of Radiation Oncology, Erasmus MC-Daniel den Hoed Cancer Center, Rotterdam (Netherlands); Tans, Lisa; Rooij, Peter van; Levendag, Peter C. [Department of Radiation Oncology, Erasmus MC-Daniel den Hoed Cancer Center, Rotterdam (Netherlands)

    2012-07-01

    Purpose: To retrospectively analyze the outcomes, toxicity, quality of life, and voice quality of patients with T3 laryngeal cancer treated with radiotherapy and to identify subgroups of patients in whom the addition of chemotherapy to radiotherapy is necessary. Methods and Materials: Between March 1996 and November 2009, 170 consecutive patients with T3 tumor were treated with (chemo)radiotherapy. Endpoints of the study were local control (LC), locoregional control (LRC), disease-free survival (DFS), overall survival (OS), late toxicity, quality of life, and voice handicap index. Results: After a median follow-up time of 32 months (range, 7-172), the 3-year actuarial rates of LC, LRC, DFS, and OS were 73%, 70%, 64%, and 61%, respectively, and the 5-year figures were 68%, 65%, 60%, and 49%, respectively. At last follow-up, 84 patients (49.5%) were still alive, 65 of them (77.3%) without local progression. Laryngectomy was performed in 16 patients, leaving 49 patients with anatomic organ preservation, corresponding to an actuarial laryngectomy-free survival of 58.3% at 3 years. The figures for patients treated with chemoradiotherapy and radiotherapy alone were 76.8% and 53.5%, respectively (p = 0.001). Chemoradiotherapy was the only significant predictor for LC on multivariate analysis. The overall 5-year cumulative incidence of late Grade {>=}2 toxicity was 28.2%. Chemoradiotherapy, compared with radiotherapy alone, resulted in slight increase in late toxicity and slight deterioration of quality of life and voice-handicap-index scores. However, the differences were statistically not significant. Conclusion: The addition of chemotherapy to radiotherapy in T3 laryngeal cancer significantly improved LC and laryngectomy-free survival without statistically significant increases in late toxicity or deterioration of quality of life or voice handicap index.

  11. Gaining perspective on own illness - the lived experiences of a patient education programme for women with treated coeliac disease.

    Science.gov (United States)

    Ring Jacobsson, Lisa; Milberg, Anna; Hjelm, Katarina; Friedrichsen, Maria

    2016-05-01

    To explore the lived experiences of women with coeliac disease after attending a patient education programme, to gain a broader perspective of its influence. Adults, particularly women, with coeliac disease report suffering from poor well-being and reduced quality of life in terms of health. Patient education programmes might support and encourage them in the search for possible improvements in lifestyle and in their approach to the disease. A qualitative phenomenological study. Personal narrative interviews with 14 women suffering from coeliac disease who had participated in an educational programme. Data analysis in accordance with Giorgi was performed. The essential structure of women's lived experiences following their participation in the patient education programme was found to be an interaction with others with the same disease, which left the women feeling individually strengthened. The interaction enabled the participants to acquire a broader view of their life with coeliac disease. As a result, this realigned their sense of self in relation to their own disease. In coping with coeliac disease, it seems that women need interaction with others with the disease to experience togetherness within a group, get the opportunity to compare themselves with others and to exchange knowledge. The interaction appears to result in that women acquire an overview of life with the disease, develop a greater confidence and dare to try new things in life. When designing a patient education programme it seems important to consider the needs of persons to meet others with the same disease, and to ask them about their need for knowledge, rather than simply assuming that health care professionals know what they need. © 2016 John Wiley & Sons Ltd.

  12. Women Treated for Breast Cancer Experiences of Chemotherapy-Induced Pain: Memories, Any Present Pain, and Future Reflections.

    Science.gov (United States)

    Hellerstedt-Börjesson, Susanne; Nordin, Karin; Fjällskog, Marie-Louise; Holmström, Inger K; Arving, Cecilia

    Breast cancer survivors make up a growing population facing treatment that poses long-standing adverse effects including chemotherapy-related body function changes and/or pain. There is limited knowledge of patients' lived experiences of chemotherapy-induced pain (CHIP). The aim of this study was to explore CHIP and any long-standing pain experiences in the lifeworld of breast cancer survivors. Fifteen women participated in a follow-up interview a year after having experienced CHIP. They were interviewed from a lifeworld perspective; the interviews were analyzed through guided phenomenology reflection. A past perspective: CHIP is often described in metaphors, leads to changes in a patient's lifeworld, and impacts lived time. The women become entirely dependent on others but at the same time feel isolated and alone. Existential pain was experienced as increased vulnerability. Present perspective: Pain engages same parts of the body, but at a lower intensity than during CHIP. The pain creates time awareness. Expected normality in relationships/daily life has not yet been achieved, and a painful existence emerges in-between health and illness. Future perspective: There are expectations of pain continuing, and there is insecurity regarding whom to turn to in such cases. A painful awareness emerges about one's own and others' fragile existence. Experiencing CHIP can impact the lifeworld of women with a history of breast cancer. After CHIP, there are continued experiences of pain that trigger insecurity about whether one is healthy. Cancer survivors would likely benefit from communication and information about and evaluation of CHIP.

  13. COMPLICATIONS OF ENDONASAL ENDOSCOPIC TRANSSPHENOIDAL APPROACH FOR PITUITARY ADENOMAS: OUR EXPERIENCE IN 50 PATIENTS TREATED AT OUR TERTIARY CENTRE

    Directory of Open Access Journals (Sweden)

    Mani Ram

    2015-12-01

    Full Text Available INTRODUCTION Between September 2013 and October 2014, we conducted a retrospective analysis to assess the complications related to endoscopic pituitary surgery in a series of 50 patients. We analysed the complications in preoperative, postoperative and endocrinological categories. We had a follow up of 1-2 years. Endonasal endoscopic transsphenoidal surgery (ETSS is an effective option for pituitary tumors. Complications do occur, but they can be reduced with experience & expertise and there is a steep learning curve. It demands a multidisciplinary approach.

  14. Biliary drainage by teflon endoprosthesis in obstructive jaundice - experiences in 69 patients treated by PTCD or ERCD

    Energy Technology Data Exchange (ETDEWEB)

    Rupp, N.; Kramann, B.; Gullotta, U.; Reiser, M.

    1983-02-01

    In 69 patients with extrahepatic biliary obstruction a specially designed teflon tube, the endoprosthesis, was inserted across the ductal stenosis either by percutaneous or by endoscopic route to reduce jaundice. After gaining experience our success rate of stent placement was more than 90%. Compared with catheter drainage the endoprosthesis worked faster and more efficiently, while in palliative treatment the quality of life of the patient improved and secondary cholangitis was prevented. The rate of significant long-term stent obstruction can be tolerated in view of the expected life span of four months as an average in our material.

  15. Osteonecrosis of the jaw in oncology patients treated with bisphosphonates: prospective experience of a dental oncology referral center.

    Science.gov (United States)

    Nicolatou-Galitis, Ourania; Papadopoulou, Erofili; Sarri, Triantafyllia; Boziari, Polyxeni; Karayianni, Aikaterini; Kyrtsonis, Marie-Christine; Repousis, Panagiotis; Barbounis, Vassilios; Migliorati, Cesar A

    2011-08-01

    The objectives of this study were to define the incidence, pain, and healing in cancer patients treated with intravenous bisphosphonates. The study included long-term follow-up of 99 bisphosphonate-using patients (group A) and conservative treatment of 67 patients with bisphosphonate-related osteonecrosis of the jaw (BRONJ, group B) using 3 antibiotic schemes and oral hygiene. The frequency of zoledronic acid single-agent use was 85.9% and 69.8% in group A and B, respectively. Median follow-up was 13 months (group A) and 16 months (group B). Two patients in group A developed BRONJ (2%). Of those with BRONJ in group B who completed follow-up, healing occurred in 14.9% (7/47) and pain subsided in 80.9% (38/47). Healing was significant in patients who received pamidronate followed by zoledronic acid (P = .023) and with BRONJ stages 0 and stage I (P = .003). This case series suggests that oral hygiene and conservative antibiotic therapy play a role in healing and pain alleviation in BRONJ. Oral hygiene and follow-up may decrease incidence of BRONJ. Copyright © 2011 Mosby, Inc. All rights reserved.

  16. Red blood cell alloimmunization in 184 patients with myeloid neoplasms treated with azacitidine - A retrospective single center experience.

    Science.gov (United States)

    Leisch, M; Weiss, L; Lindlbauer, N; Jungbauer, C; Egle, A; Rohde, E; Greil, R; Grabmer, C; Pleyer, L

    2017-08-01

    Alloimmunization to Red Blood Cell (RBC) antigens frequently occurs in patients with myeloid neoplasms (AML, MDS and CMML) and potentially poses the patient at risk for delayed hemolytic transfusion reactions and limited supply of compatible RBC-units. However, there is comparatively little data on transfusion associated characteristics in this patient cohort. We therefore retrospectively analyzed transfusion requirements and clinical outcomes of 184 patients with myloid neoplasms treated with azacitidine at the Paracelsus Medical University Salzburg, which were included in the Austrian Registry of Hypomethylating Agents. The mean blood component requirements for AML, MDS and CMML were 39.8, 67.4 and 31.4 RBC units and 31.7, 27.6 and 19.1 platelet (PLT) units respectively. In spite of an extended and stringent RBC unit matching policy (ABO, RhD, RhCcEe and K antigens), 20 (11%) patients formed at least one alloantibody ("allo-group"), whereas 164 patients (89%) did not ("non-allo-group"). The most frequent antibody specificity was anti-E, followed by anti-Wra -Lua, -D, -C and -Jka. Alloimmunization was associated with higher numbers of transfused RBC units (68 vs. 38; p=0.001), as well as with longer time under transfusion (16.7 vs. 9.4 months; p=0.014). Median overall survival (OS) did not differ significantly between the "allo"- and "non-allo-group". Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

  17. Effectiveness of Botox in Treating Chronic Anal Fissure: A Clinical Experience with Mid-Term Follow Up

    Directory of Open Access Journals (Sweden)

    Tawfiq JM Al-Marzooq

    2017-03-01

    Full Text Available Chronic anal fissure (CAF is a common distressing problem with high recurrence rates. For many years, lateral internal sphincterotomy was the main treatment for CAF. Recently, intrasphincteric injection of botulinum toxin (BT seems to be a good alternative option. The aim of this study was to evaluate the effectiveness and safety of BT type-A (botox injection in the treatment of CAF. A total of 62 patients (45 males, 17 females; mean age of 41.3 years with CAF who presented to surgical outpatient clinic at my hospital in the period between January 2014 and September 2015 were treated with BT injections of 20-30 units in the internal sphincter. They were followed up for one year to evaluate the effects of this treatment. The results of this study revealed that all patients had significant symptomatic relief with high rates of fissure healing reaching 74.2% (46 patients after the first treatment session and 87.1% (54 patients after the second session. During injections, no complications or side effects were reported. After injections, 19 patients experienced minor incontinence in the form of a fecal and gas soiling which solved spontaneously later. There were 3 relapses during 12 months of follow-up. I conclude that BT therapy can be considered effective, safe and without significant complication. It can be proposed to the patient as first line treatment before surgery

  18. Patients' experiences of a computerised self-help program for treating depression - a qualitative study of Internet mediated cognitive behavioural therapy in primary care.

    Science.gov (United States)

    Holst, Anna; Nejati, Shabnam; Björkelund, Cecilia; Eriksson, Maria C M; Hange, Dominique; Kivi, Marie; Wikberg, Carl; Petersson, Eva-Lisa

    2017-03-01

    The objective of this study was to explore primary care patients' experiences of Internet mediated cognitive behavioural therapy (iCBT) depression treatment. Qualitative study. Data were collected from focus group discussions and individual interviews. Primary care. Data were analysed by systematic text condensation by Malterud. Thirteen patients having received iCBT for depression within the PRIM-NET study. Analysis presented different aspects of patients' experiences of iCBT. The informants described a need for face-to-face meetings with a therapist. A therapist who performed check-ups and supported the iCBT process seemed important. iCBT implies that a responsibility for the treatment is taken by the patient, and some patients felt left alone, while others felt well and secure. This was a way to work in privacy and freedom with a smoothly working technology although there was a lack of confidence and a feeling of risk regarding iCBT. iCBT is an attractive alternative to some patients with depression in primary care, but not to all. An individual treatment design seems to be preferred, and elements of iCBT could be included as a complement when treating depression in primary care. Such a procedure could relieve the overall treatment burden of depression. Key points Internet mediated cognitive behavioural therapy (iCBT) can be effective in treating depression in primary care, but patients' experiences of iCBT are rarely studied • Most patients express a need for human contact, real-time interaction, dialogue and guidance when treated for depression. • The patient's opportunity to influence the practical circumstances about iCBT is a success factor, though this freedom brings a large responsibility upon the receiver. • An individual treatment design seems to be crucial, and elements of iCBT could be included as a complement to face-to-face meetings.

  19. Experiences of Women With Gestational Trophoblastic Neoplasia Treated With High-Dose Chemotherapy and Stem Cell Transplantation: A Qualitative Study.

    Science.gov (United States)

    Singh, Kam; Warnock, Clare; Ireson, Jane; Strickland, Sarah; Short, Delia; Seckl, Michael J; Hancock, Barry W

    2017-05-01

    To explore the experiences of women with gestational trophoblastic neoplasia during and after treatment to understand their perspectives, priorities, and concerns.
. A descriptive, exploratory study using in-depth semistructured interviews.
. All interviews were conducted in a quiet, designated room at Weston Park Hospital in Sheffield, South Yorkshire.
. Women with gestational trophoblastic neoplasia who had received stem cell transplantation from 2003 to 2013. Ten patients were eligible, and eight agreed to participate.
. Interviews were carried out over the phone and were recorded and transcribed verbatim. Framework analysis was carried out to generate in-depth descriptions of participants' experiences.
. Participants described significant physical, psychological, and social effects during and following treatment. Recovery was slow, and treatment had long-term effects on sexuality and body image. The impact of the women's diagnosis and treatment on their children was a primary concern.
. The study provided insight into the multidimensional impact of stem cell transplantation, which can continue after treatment. The need for family-centered services for patients with dependent children was identified.
. Nurses need to develop services that effectively communicate the challenges of stem cell transplantation to patients and provide family-centered care and late effects and rehabilitation services.

  20. Treat Me But Don't Judge Me: A Qualitative Examination of Health Care Experiences of Pregnant and Parenting Youth.

    Science.gov (United States)

    Harrison, Megan E; Clarkin, Chantalle; Rohde, Kristina; Worth, Kerry; Fleming, Nathalie

    2017-04-01

    To share pregnant and parenting youth's experiences with health care to inform recommendations for promoting youth-friendly medical encounters. This exploratory study used a qualitative descriptive approach. Three urban centers that service pregnant youth and young parents in a large Canadian city. A convenience sample of 26 participants (mean age of 18.7 years) was recruited across sites. Five focus groups were conducted. Focus groups were audio recorded, transcribed verbatim, and analyzed thematically. Analysis involved the independent, open coding of data by 2 qualitative researchers to identify and compare emerging themes. Three major themes emerged regarding their experiences with health care providers: characteristics of negative health care encounters, the emergence of contemporary stereotypes during these encounters, and characteristics of positive health care encounters. Negative encounters often resulted from perceived judgmental attitudes of providers and were shown to contribute to a general sense of mistrust and fear. Positive health care encounters tended to feature mutual respect, support, open dialogue, and nonjudgmental attitudes. Pregnant and parenting youth in our study have experienced many negative health care encounters that have contributed to disengagement and mistrust of the health care system. To engage this high-risk population in health care, practitioners are encouraged to consider their own biases when servicing this population and work toward fostering positive, nonjudgmental interactions, and supportive environments. Copyright © 2016 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

  1. The use of data from national and other large-scale user experience surveys in local quality work: a systematic review.

    Science.gov (United States)

    Haugum, Mona; Danielsen, Kirsten; Iversen, Hilde Hestad; Bjertnaes, Oyvind

    2014-12-01

    An important goal for national and large-scale surveys of user experiences is quality improvement. However, large-scale surveys are normally conducted by a professional external surveyor, creating an institutionalized division between the measurement of user experiences and the quality work that is performed locally. The aim of this study was to identify and describe scientific studies related to the use of national and large-scale surveys of user experiences in local quality work. Ovid EMBASE, Ovid MEDLINE, Ovid PsycINFO and the Cochrane Database of Systematic Reviews. Scientific publications about user experiences and satisfaction about the extent to which data from national and other large-scale user experience surveys are used for local quality work in the health services. Themes of interest were identified and a narrative analysis was undertaken. Thirteen publications were included, all differed substantially in several characteristics. The results show that large-scale surveys of user experiences are used in local quality work. The types of follow-up activity varied considerably from conducting a follow-up analysis of user experience survey data to information sharing and more-systematic efforts to use the data as a basis for improving the quality of care. This review shows that large-scale surveys of user experiences are used in local quality work. However, there is a need for more, better and standardized research in this field. The considerable variation in follow-up activities points to the need for systematic guidance on how to use data in local quality work. © The Author 2014. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved.

  2. Treating Infertility

    Science.gov (United States)

    ... Education & Events Advocacy For Patients About ACOG Treating Infertility Home For Patients Search FAQs Treating Infertility Page ... Treating Infertility FAQ137, October 2017 PDF Format Treating Infertility Gynecologic Problems What is infertility? What causes infertility ...

  3. Acute Promyelocytic Leukemia: an Experience on 95 Greek Patients Treated in the All-Trans-Retinoic Acid Era

    Science.gov (United States)

    Pagoni, Maria; Garofalaki, Maria; Panitsas, Fotios; Manola, Kalliopi; Psarra, Katerina; Economopoulos, Panagiotis; Vourtsi, Aggeliki; Antoniades, Marios; Gkirkas, Kostas; Tzouvara, Evangelia; Katis, Fotis; Prokopiou, Chrystalla; Tziotziou, Irene; Balta, Artemis; Lemissiou, Eleni; Tsirigotis, Panagiotis; Repoussis, Panagiotis; Harhalakis, Nicolas

    2011-01-01

    Acute promyelocytic leukemia (APL) is highly curable with the combination of all-transretinoic acid (ATRA) and anthracycline based chemotherapy, but the percentage of early deaths remains high. In the present study, we report the clinical, immunophenotypic, cytogenetic and molecular characteristics and outcome of APL patients diagnosed and treated in various Hospitals of Greece and Cyprus. We describe the data of ninety-five APL patients who were diagnosed during the last 15 years. Seven (7.4%) newly diagnosed APL patients died due to intracranial hemorrhage within 72 hours of presentation. All but two patients were induced with ATRA alone or ATRA plus chemotherapy. The early death rate was 14.9%. After induction all 80 evaluable patients achieved complete hematologic remission. The cumulative incidence of relapse was 18.3%. Eight of the ten relapsed patients were successfully salvaged, while both patients with molecularly resistant disease died during salvage treatment. Overall survival (OS) at 5 years was 78.4% and disease free survival (DFS) 73.6%. In multivariate analysis of OS age over 60 years, DIC at diagnosis and marginally major hemorrhage at presentation were identified as adverse prognostic factors. In the subgroup of patients with available data on FLT3 mutation status (49 out of 94), ITD positivity also remained as an independent prognostic factor in the final model of OS, together with major hemorrhage and marginally high Sanz score. We found a close correlation between the CD2 expression and the development of the differentiation syndrome (DS). In conclusion, the main problem in managing patients with APL is still the high early death rate. PMID:22220250

  4. "One step procedure" local anaesthesia for inguinal hernia repair in ambulatory surgery conditions--district general hospital experience.

    Science.gov (United States)

    Dabić, Dejan; Perunicić, Vladan; Marić, Biljana

    2012-01-01

    , or perspiration. The complications during the mean follow-up of 31 months (1-60) was: 1.4% (6 patients)--a hematoma, 1.87% (8 patients)--seroma, 0.47% (2 patients)--wound infection, 0.23% (1 patient)--chronic pain, and 0.47% (2 patients)--recurrence. Revision due to active bleeding was conducted in two patients (0.47%), after using PHS and Lichtenstein techniques. These were the only patients who were rehospitalized due to complications. In hernia repairs on an outpatient basis, "one-step procedure" in local anaesthetic administration is reliable, easy, safe, effective, and the type of the surgical technique is not a determining factor. The success rate and treatment outcome depend on the surgical technique and the surgeon's experience in using local anaesthesia in ambulatory surgery.

  5. Nutritive Value of Grasses in Semi-arid Rangelands of Ethiopia: Local Experience Based Herbage Preference Evaluation versus Laboratory Analysis

    Directory of Open Access Journals (Sweden)

    Habtamu T. Keba

    2013-03-01

    Full Text Available We examined the nutritive value of common grass species in the semi-arid rangelands of Borana in southern Ethiopia using local experience based herbage preference (LEBHP perception and laboratory techniques. Local pastoralists in the study area were asked to identify common grass species and rank them according to the species’ preferences and palatability to cattle. The pastoralists listed a total of 15 common grass species which were then sampled during the main rain and cold dry seasons and analyzed for crude protein (CP, Neutral Detergent Fiber (NDF, Acid Detergent Fiber (ADF and ash content to verify pastoralists’ claim regarding the quality of individual species. The relative feed value (RFV and dry matter digestibility (DMD were also calculated using NDF and ADF contents. Spearman’s rank correlation was used to examine possible relationships between laboratory results and pastoralists’ experience on grass quality. Cenchrus ciliaris, Chrysopogon aucheri, Digitaria milanjiana, Eragrostis papposa and Panicum maximum were the top five species based on LEBHP perception. There were indications of inconsistency in terms of LEBHP perception among the different pastoral communities. The chemical composition of all grass species showed significant (p<0.05 variation between sites, seasons and species. The results showed that the CP values for the Borana rangelands were in the range of 8.7% in the main rain season to 5.1% for the cold dry season. The fiber constituents were relatively low in the main rain season compared to the cold dry season. Overall, Digitaria milanjiana had the highest CP (16.5% content, while the least was recorded with Heteropogon contortus (10.8 and Aristida adoensis (9.8% during the main rain season. It seems that the spatial variability of landscapes within the wider geographical regions, soil properties and texture, and land-use patterns probably contributed to site differences in species quality. Generally, the RFV

  6. Implementing a hypertension management programme in a rural area: local approaches and experiences from Ba-Vi district, Vietnam

    Directory of Open Access Journals (Sweden)

    Nguyen Viet

    2011-05-01

    Full Text Available Abstract Background Costly efforts have been invested to control and prevent cardiovascular diseases (CVD and their risk factors but the ideal solutions for low resource settings remain unclear. This paper aims at summarising our approaches to implementing a programme on hypertension management in a rural commune of Vietnam. Methods In a rural commune, a programme has been implemented since 2006 to manage hypertensive people at the commune health station and to deliver health education on CVD risk factors to the entire community. An initial cross-sectional survey was used to screen for hypertensives who might enter the management programme. During 17 months of implementation, other people with hypertension were also followed up and treated. Data were collected from all individual medical records, including demographic factors, behavioural CVD risk factors, blood pressure levels, and number of check-ups. These data were analysed to identify factors relating to adherence to the management programme. Results Both top-down and bottom-up approaches were applied to implement a hypertension management programme. The programme was able to run independently at the commune health station after 17 months. During the implementation phase, 497 people were followed up with an overall regular follow-up of 65.6% and a dropout of 14.3%. Severity of hypertension and effectiveness of treatment were the main factors influencing the decision of people to adhere to the management programme, while being female, having several behavioural CVD risk factors or a history of chronic disease were the predictors for deviating from the programme. Conclusion Our model showed the feasibility, applicability and future potential of a community-based model of comprehensive hypertension care in a low resource context using both top-down and bottom-up approaches to engage all involved partners. This success also highlighted the important roles of both local authorities and a cardiac

  7. Sevelamer is an Effective Drug in Treating Hyperphosphatemia Due to Tumor Lysis Syndrome in Children: A Developing World Experience.

    Science.gov (United States)

    Kahlon, Dilraj Kaur; Dinand, Veronique; Yadav, Satya Prakash; Sachdeva, Anupam

    2016-03-01

    We report here a study on efficacy of sevelamer hydrochloride in treating hyperphosphatemia due to tumor lysis syndrome (TLS) in a developing world setting. Twenty one children with hyperphosphatemia due to TLS were included. All received hyper-hydration, allopurinol and sevelamer. Efficacy was assessed by decrease in serum phosphate level, calcium-phosphate product and TLS score as per Cairo Bishop definition. Four children who underwent dialysis were excluded from analysis. Among the remaining 17 patients with hyperphosphatemia, laboratory TLS was recorded in 15 patients and clinical TLS in five. Sevelamer was given according to weight, most often 400 mg twice to thrice daily. Mean phosphatemia decreased from 8.3 ± 3.0 to 6.7 ± 2.1 mg/dl within 24 h of starting sevelamer (p = 0.02), 6.0 ± 2.1 mg/dl at 48 h, 4.9 ± 1.5 mg/dl at 72 h and 4.39 ± 1.7 mg/dl at 96 h. TLS was corrected in 72 h in 14 patients, 96 h in 1 and 120 h in another patient. Mean calcium-phosphate product decreased from 63.0 ± 14.0 to 49.2 ± 9.7 mg/dl (p = 0.002) at 24 h, 46.1 ± 17.0 mg/dl at 48 h and 39.7 ± 13.5 mg/dl at 72 h. There was no mortality due to hyperphosphatemia. Sevelamer is efficacious in children with malignancy-associated hyperphosphatemia in the developing world.

  8. Local Scale Radiobrightness Modeling During the Intensive Observing Period-4 of the Cold Land Processes Experiment-1

    Science.gov (United States)

    Kim, Edward J.; Tedesco, Marco; deRoo, Roger; England, Anthony W.; Gu, Hao-Yu; Pham, Hanh; Boprie, David; Graf, Tobias; Koike, Toshio; Armstrong, Richard

    2005-01-01

    The NASA Cold Land Processes Field Experiment (CLPX-1) was designed to provide microwave remote sensing observations and ground truth for studies of snow and frozen ground remote sensing, particularly issues related to scaling. CLPX-1 was conducted in 2002 and 2003 in Colorado, USA. One of the goals of the experiment was to test the capabilities of microwave emission models at different scales. Initial forward model validation work has concentrated on the Local-Scale Observation Site (LSOS), a 0.8 ha study site consisting of open meadows separated by trees where the most detailed measurements were made of snow depth and temperature, density, and grain size profiles. Results obtained in the case of the 3& Intensive Observing Period (IOP3) period (Feb., 2003, dry snow) suggest that a model based on Dense Medium Radiative Transfer (DMRT) theory is able to model the recorded brightness temperatures using snow parameters derived from field measurements. This paper focuses on the ability of forward DMRT modelling, combined with snowpack measurements, to reproduce the radiobrightness signatures observed by the University of Michigan s Truck-Mounted Radiometer System (TMRS) at 19 and 37 GHz during the 4th IOP (IOP4) in March, 2003. Unlike IOP3, conditions during IOP4 include both wet and dry periods, providing a valuable test of DMRT model performance. In addition, a comparison will be made for the one day of coincident observations by the University of Tokyo's Ground-Based Microwave Radiometer-7 (GBMR-7) and the TMRS. The plot-scale study in this paper establishes a baseline of DMRT performance for later studies at successively larger scales. And these scaling studies will help guide the choice of future snow retrieval algorithms and the design of future Cold Lands observing systems.

  9. Public health response systems in-action: learning from local health departments' experiences with acute and emergency incidents.

    Directory of Open Access Journals (Sweden)

    Jennifer C Hunter

    Full Text Available As part of their core mission, public health agencies attend to a wide range of disease and health threats, including those that require routine, acute, and emergency responses. While each incident is unique, the number and type of response activities are finite; therefore, through comparative analysis, we can learn about commonalities in the response patterns that could improve predictions and expectations regarding the resources and capabilities required to respond to future acute events. In this study, we interviewed representatives from more than 120 local health departments regarding their recent experiences with real-world acute public health incidents, such as infectious disease outbreaks, severe weather events, chemical spills, and bioterrorism threats. We collected highly structured data on key aspects of the incident and the public health response, particularly focusing on the public health activities initiated and community partners engaged in the response efforts. As a result, we are able to make comparisons across event types, create response profiles, and identify functional and structural response patterns that have import for future public health preparedness and response. Our study contributes to clarifying the complexity of public health response systems and our analysis reveals the ways in which these systems are adaptive to the character of the threat, resulting in differential activation of functions and partners based on the type of incident. Continued and rigorous examination of the experiences of health departments throughout the nation will refine our very understanding of what the public health response system is, will enable the identification of organizational and event inputs to performance, and will allow for the construction of rich, relevant, and practical models of response operations that can be employed to strengthen public health systems.

  10. Public Health Response Systems In-Action: Learning from Local Health Departments’ Experiences with Acute and Emergency Incidents

    Science.gov (United States)

    Hunter, Jennifer C.; Yang, Jane E.; Crawley, Adam W.; Biesiadecki, Laura; Aragón, Tomás J.

    2013-01-01

    As part of their core mission, public health agencies attend to a wide range of disease and health threats, including those that require routine, acute, and emergency responses. While each incident is unique, the number and type of response activities are finite; therefore, through comparative analysis, we can learn about commonalities in the response patterns that could improve predictions and expectations regarding the resources and capabilities required to respond to future acute events. In this study, we interviewed representatives from more than 120 local health departments regarding their recent experiences with real-world acute public health incidents, such as infectious disease outbreaks, severe weather events, chemical spills, and bioterrorism threats. We collected highly structured data on key aspects of the incident and the public health response, particularly focusing on the public health activities initiated and community partners engaged in the response efforts. As a result, we are able to make comparisons across event types, create response profiles, and identify functional and structural response patterns that have import for future public health preparedness and response. Our study contributes to clarifying the complexity of public health response systems and our analysis reveals the ways in which these systems are adaptive to the character of the threat, resulting in differential activation of functions and partners based on the type of incident. Continued and rigorous examination of the experiences of health departments throughout the nation will refine our very understanding of what the public health response system is, will enable the identification of organizational and event inputs to performance, and will allow for the construction of rich, relevant, and practical models of response operations that can be employed to strengthen public health systems. PMID:24236137

  11. Is Satisfaction with the Acute-Care Experience Higher amongst Consumers Treated in the Private Sector? A Survey of Public and Private Sector Arthroplasty Recipients.

    Science.gov (United States)

    Naylor, Justine M; Descallar, Joseph; Grootemaat, Mechteld; Badge, Helen; Harris, Ian A; Simpson, Grahame; Jenkin, Deanne

    2016-01-01

    Consumer satisfaction with the acute-care experience could reasonably be expected to be higher amongst those treated in the private sector compared to those treated in the public sector given the former relies on high-level satisfaction of its consumers and their subsequent recommendations to thrive. The primary aims of this study were to determine, in a knee or hip arthroplasty cohort, if surgery in the private sector predicts greater overall satisfaction with the acute-care experience and greater likelihood to recommend the same hospital. A secondary aim was to determine whether satisfaction across a range of service domains is also higher in the private sector. A telephone survey was conducted 35 days post-surgery. The hospital cohort comprised eight public and seven private high-volume arthroplasty providers. Consumers rated overall satisfaction with care out of 100 and likeliness to recommend their hospital on a 5-point Likert scale. Additional Likert-style questions were asked covering specific service domains. Generalized estimating equation models were used to analyse overall satisfaction (dichotomised as ≥ 90 or hospital. The only care domains where the private out-performed the public sector were hospitality (46.7 vs 35.6%, p hospital provider. Rather, avoidance of complications in either sector appears to result in improved satisfaction as well as a greater likelihood that patients would recommend their hospital provider.

  12. HIV Testing and Counselling in Colombia: Local Experience on Two Different Recruitment Strategies to Better Reach Low Socioeconomic Status Communities

    Science.gov (United States)

    Galindo-Quintero, Jaime; Mueses-Marin, Hector Fabio; Montaño-Agudelo, David; Pinzón-Fernández, María Virginia; Tello-Bolívar, Inés Constanza; Alvarado-Llano, Beatriz Eugenia; Martinez-Cajas, Jorge Luis

    2014-01-01

    HIV testing rates remain very low in Colombia, with only 20% of individuals at risk ever tested. In order to tackle this issue, the Corporacion de Lucha Contra el Sida (CLS) has implemented a multidisciplinary, provider-initiated, population-based HIV testing/counselling strategy named BAFI. In this report, we describe the experience of CLS at reaching populations from low socioeconomic backgrounds in 2008-2009. Two different approaches were used: one led by CLS and local health care providers (BAFI-1) and the other by CLS and community leaders (BAFI-2). Both approaches included the following: consented HIV screening test, a demographic questionnaire, self-reported HIV knowledge and behaviour questionnaires, pre- and posttest counselling, confirmatory HIV tests, clinical follow-up, access to comprehensive care and antiretroviral treatment. A total of 2085 individuals were enrolled in BAFI-1 and 363 in BAFI-2. The effectiveness indicators for BAFI-1 and BAFI-2, respectively, were HIV positive-confirmed prevalence = 0.29% and 3.86%, return rate for confirmatory results = 62.5% and 93.7%, return rate for comprehensive care = 83.3% and 92.8%, and ART initiation rate = 20% and 76.9%. Although more people were reached with BAFI-1, the community-led BAFI-2 was more effective at reaching individuals with a higher prevalence of behavioural risk factors for HIV infection. PMID:24592330

  13. HIV Testing and Counselling in Colombia: Local Experience on Two Different Recruitment Strategies to Better Reach Low Socioeconomic Status Communities.

    Science.gov (United States)

    Galindo-Quintero, Jaime; Mueses-Marin, Hector Fabio; Montaño-Agudelo, David; Pinzón-Fernández, María Virginia; Tello-Bolívar, Inés Constanza; Alvarado-Llano, Beatriz Eugenia; Martinez-Cajas, Jorge Luis

    2014-01-01

    HIV testing rates remain very low in Colombia, with only 20% of individuals at risk ever tested. In order to tackle this issue, the Corporacion de Lucha Contra el Sida (CLS) has implemented a multidisciplinary, provider-initiated, population-based HIV testing/counselling strategy named BAFI. In this report, we describe the experience of CLS at reaching populations from low socioeconomic backgrounds in 2008-2009. Two different approaches were used: one led by CLS and local health care providers (BAFI-1) and the other by CLS and community leaders (BAFI-2). Both approaches included the following: consented HIV screening test, a demographic questionnaire, self-reported HIV knowledge and behaviour questionnaires, pre- and posttest counselling, confirmatory HIV tests, clinical follow-up, access to comprehensive care and antiretroviral treatment. A total of 2085 individuals were enrolled in BAFI-1 and 363 in BAFI-2. The effectiveness indicators for BAFI-1 and BAFI-2, respectively, were HIV positive-confirmed prevalence = 0.29% and 3.86%, return rate for confirmatory results = 62.5% and 93.7%, return rate for comprehensive care = 83.3% and 92.8%, and ART initiation rate = 20% and 76.9%. Although more people were reached with BAFI-1, the community-led BAFI-2 was more effective at reaching individuals with a higher prevalence of behavioural risk factors for HIV infection.

  14. A Community-Based Sensory Training Program Leads to Improved Experience at a Local Zoo for Children with Sensory Challenges

    Directory of Open Access Journals (Sweden)

    Michele Kong

    2017-09-01

    Full Text Available Sensory processing difficulties are common among many special needs children, especially those with autism spectrum disorder (ASD. The sensory sensitivities often result in interference of daily functioning and can lead to social isolation for both the individual and family unit. A quality improvement (QI project was undertaken within a local zoo to systematically implement a sensory training program targeted at helping special needs individuals with sensory challenges, including those with ASD, Down’s syndrome, attention-deficit/hyperactivity disorder, and speech delay. We piloted the program over a 2-year period. The program consisted of staff training, provision of sensory bags and specific social stories, as well as creation of quiet zones. Two hundred family units were surveyed before and after implementation of the sensory training program. In this pilot QI study, families reported increased visitation to the zoo, improved interactions with staff members, and the overall quality of their experience. In conclusion, we are able to demonstrate that a sensory training program within the community zoo is feasible, impactful, and has the potential to decrease social isolation for special needs individuals and their families.

  15. HIV Testing and Counselling in Colombia: Local Experience on Two Different Recruitment Strategies to Better Reach Low Socioeconomic Status Communities

    Directory of Open Access Journals (Sweden)

    Jaime Galindo-Quintero

    2014-01-01

    Full Text Available HIV testing rates remain very low in Colombia, with only 20% of individuals at risk ever tested. In order to tackle this issue, the Corporacion de Lucha Contra el Sida (CLS has implemented a multidisciplinary, provider-initiated, population-based HIV testing/counselling strategy named BAFI. In this report, we describe the experience of CLS at reaching populations from low socioeconomic backgrounds in 2008-2009. Two different approaches were used: one led by CLS and local health care providers (BAFI-1 and the other by CLS and community leaders (BAFI-2. Both approaches included the following: consented HIV screening test, a demographic questionnaire, self-reported HIV knowledge and behaviour questionnaires, pre- and posttest counselling, confirmatory HIV tests, clinical follow-up, access to comprehensive care and antiretroviral treatment. A total of 2085 individuals were enrolled in BAFI-1 and 363 in BAFI-2. The effectiveness indicators for BAFI-1 and BAFI-2, respectively, were HIV positive-confirmed prevalence = 0.29% and 3.86%, return rate for confirmatory results = 62.5% and 93.7%, return rate for comprehensive care = 83.3% and 92.8%, and ART initiation rate = 20% and 76.9%. Although more people were reached with BAFI-1, the community-led BAFI-2 was more effective at reaching individuals with a higher prevalence of behavioural risk factors for HIV infection.

  16. Commercial Function as a Treat to the Monument - 25 Years of Experience in the Commercialization of Monuments in Gdansk, Poland

    Science.gov (United States)

    Ratajczyk – Piatkowska, Elzbieta

    2017-10-01

    The principles of the market economy adopted in Poland in the nineties have significantly touched the resources of immovable monuments. As a result, monuments have become a product of culture subject to the rules of the free market; and state ownership, patronage and decision-making practice has now been replaced by private interest. Practical monument use has also changed with the shift in ownership of objects after privatization and further advances in technology and the economy. Accordingly, the subject of this research addresses the issue of ensuring protection as well as the profitability of monumental objects of heritage under private investment in association with municipal and state ownership. The nineties of the twentieth century in Poland marked a period of rapid revival in trade based on market principles and openness to contemporary global trends in the design of commercial facilities. Thus, commercial function as a new use has been used for the commercialization of the monument. After 25 years of experience, it turns out that this new use may pose a threat to the conditions of monument preservation. The spatial and location specifics of the monument are poorly matched to the organizational form of trade and product range, despite the huge variety of these forms; the result is bankruptcy of the commercial operation and the consequent loss of use for the monument. Unused objects will eventually be destroyed. Studies have shown that functions supporting the creation of culture, especially museums, are optimal for the use of monuments. The museum function provides sufficiently high prestige and spatial stability, and allows for the maximum preservation of authentic elements, thus performing an additional role as museum piece.

  17. A Pulmonary Embolism Response Team's initial 20 month experience treating 87 patients with submassive and massive pulmonary embolism.

    Science.gov (United States)

    Sista, Akhilesh K; Friedman, Oren A; Dou, Eda; Denvir, Brendan; Askin, Gulce; Stern, Jamie; Estes, Jaclyn; Salemi, Arash; Winokur, Ronald S; Horowitz, James M

    2017-09-01

    Pulmonary Embolism Response Teams (PERTs) have emerged to provide rapid multidisciplinary assessment and treatment of PE patients. However, descriptive institutional experience and preliminary outcomes data from such teams are sparse. PERT activations were identified through a retrospective review. Only confirmed submassive or massive PEs were included in the data analysis. In addition to baseline variables, the therapeutic intervention, length of stay (LOS), in-hospital mortality, and bleeding rate/severity were recorded. A total of 124 PERT activations occurred over 20 months: 43 in the first 10 months and 81 in the next 10. A total of 87 submassive (90.8%) and massive (9.2%) PE patients were included. The median age was 65 (51-75 IQR) years. Catheter-directed thrombolysis (CDT) was administered to 25 patients, systemic thrombolysis (ST) to six, and anticoagulation alone (AC) to 54. The median ICU stay and overall LOS were 6 (3-10 IQR) and 7 (4-14 IQR) days, respectively, with no association with any variables except a brain natriuretic peptide (BNP) >100 pg/mL ( p=0.008 ICU LOS; p=0.047 overall LOS). Twelve patients (13.7%) died in the hospital, nine of whom had metastatic or brain cancer, with a median overall LOS of 13 (11-17 IQR) days. There were five major bleeds: one in the CDT group, one in the ST group, and three in the AC group. Overall, (1) PERT activations increased after the first 10 months; (2) BNP >100 pg/mL was associated with a longer LOS; (3) rates of mortality and bleeding did not correlate with treatment; and (4) the majority of in-hospital deaths occurred in patients with advanced cancer.

  18. Effect of Whole Pelvic Radiotherapy for Patients With Locally Advanced Prostate Cancer Treated With Radiotherapy and Long-Term Androgen Deprivation Therapy

    Energy Technology Data Exchange (ETDEWEB)

    Mantini, Giovanna [Department of Radiotherapy, Policlinico Universitario A. Gemelli, Catholic University, Rome (Italy); Tagliaferri, Luca, E-mail: luca.tagliaferri@rm.unicatt.it [Department of Radiotherapy, Policlinico Universitario A. Gemelli, Catholic University, Rome (Italy); Mattiucci, Gian Carlo; Balducci, Mario; Frascino, Vincenzo; Dinapoli, Nicola [Department of Radiotherapy, Policlinico Universitario A. Gemelli, Catholic University, Rome (Italy); Di Gesu, Cinzia; Ippolito, Edy; Morganti, Alessio G. [Department of Radiotherapy, John Paul II Center for High Technology Research and Education in Biomedical Sciences, Catholic University, Campobasso (Italy); Cellini, Numa [Department of Radiotherapy, Policlinico Universitario A. Gemelli, Catholic University, Rome (Italy)

    2011-12-01

    Purpose: To evaluate the effect of whole pelvic radiotherapy (WPRT) in prostate cancer patients treated with RT and long-term (>1 year) androgen deprivation therapy (ADT). Methods and materials: Prostate cancer patients with high-risk features (Stage T3-T4 and/or Gleason score {>=}7 and/or prostate-specific antigen level {>=}20 ng/mL) who had undergone RT and long-term ADT were included in the present analysis. Patients with bowel inflammatory disease, colon diverticula, and colon diverticulitis were excluded from WPRT and treated with prostate-only radiotherapy (PORT). Patients were grouped according to nodal risk involvement as assessed by the Roach formula using different cutoff levels (15%, 20%, 25%, and 30%). Biochemical disease-free survival (bDFS) was analyzed in each group according to the RT type (WPRT or PORT). Results: A total of 358 patients treated between 1994 and 2007 were included in the analysis (46.9% with WPRT and 53.1% with PORT). The median duration of ADT was 24 months (range, 12-38). With a median follow-up of 52 months (range, 20-150), the overall 4-year bDFS rate was 90.5%. The 4-year bDFS rate was similar between the patients who had undergone WPRT or PORT (90.4% vs. 90.5%; p = NS). However, in the group of patients with the greatest nodal risk (>30%), a significant bDFS improvement was recorded for the patients who had undergone WPRT (p = .03). No differences were seen in acute toxicity among the patients treated with WPRT or PORT. The late gastrointestinal toxicity was similar in patients treated with PORT or WPRT (p = NS). Conclusions: Our analysis has supported the use of WPRT in association with long-term ADT for patients with high-risk nodal involvement (>30%), although a definitive recommendation should be confirmed by a randomized trial.

  19. A Comment on ‘Democracy Promotion at a Local Level : Experiences, Perspectives and Policy of Swiss International Cooperation’ by Martin Dahinden

    Directory of Open Access Journals (Sweden)

    Olivier Roy

    2013-11-01

    Full Text Available The article ‘Democracy Promotion at a Local Level : Experiences, Perspectives and Policy of Swiss International Cooperation’ by Martin Dahinden presents a fine and complex analysis of what could constitute a concrete and efficient democratisation aid policy; it highlights possible limitations of such a policy, the complexity of levels of intervention and the need to implement this policy within the context of a given civil society and local power dynamics.Such democratisation aid clearly aris...

  20. Women's experiences of using vaginal trainers (dilators) to treat vaginal penetration difficulties diagnosed as vaginismus: a qualitative interview study.

    Science.gov (United States)

    Macey, Kat; Gregory, Angela; Nunns, David; das Nair, Roshan

    2015-06-20

    Recent research has highlighted controversies in the conceptualisation, diagnosis and treatment of vaginismus. Vaginal trainers are currently the most widely used treatment. Critiques have highlighted concerns that the evidence-base of its effectiveness is limited, with controlled trials reporting disappointing results, and its prescription promotes 'performance-based' sexuality which may be detrimental. Despite this, little has been done to seek women's views about their treatment. This study set out to explore women's experiences of vaginismus treatment with vaginal trainers, and to use their voices to propose guidelines for improving treatment. 13 women who had used vaginal trainers for vaginal penetration difficulties diagnosed as vaginismus were recruited through a specialist clinic, university campuses, and online forums. The women took part in semi-structured individual interviews (face-to-face/telephone/Skype), which were audio-recorded, transcribed verbatim and analysed using Thematic Analysis. Four superordinate themes were elicited and used to draft 'better treatment' guidelines. Themes were: (1) Lack of knowledge, (2) Invalidation of suffering by professionals, (3) Difficult journey, and (4) Making the journey easier. This paper describes themes (3) and (4). Difficult Journey describes the long and arduous 'Journey into treatment', including difficulties asking for help, undergoing physical investigations and negotiating 'the system' of medical referrals. It also describes the sometimes demoralising process of 'being in treatment', which includes emotional and practical demands of treatment. Making the journey easier highlights the importance of and limits to 'partner support'. 'Professional support' comprises personal qualities of professionals/therapeutic relationship, the value of specialist skills and knowledge and the need for facilitating couple communication about vaginismus. 'Peer support/helping each other' describes the importance of

  1. Prevalence of the middle mesial canal in non surgical root canal treated mandibular first and second molars in a local military population

    Science.gov (United States)

    2016-06-13

    Vertucci F, Williams R. Root canal anatomy of the mandibular first molar. J NJ Dent Assoc. 1974; Spring:27-28. 3. Weine F. endodontic therapy...Kane AW, et al. Analysis of reasons for extraction of endodontically treated teeth: a prospective study. J Endod 2011;37:1512–5. 7. Selden H. The...after guided troughing under high magnification : an in vivo investigation. J Endod 2015; 41(2): 164-167. 10. Nosrat A, et al. Middle mesial canals

  2. Local adaptations to frost in marginal and central populations of the dominant forest tree Fagus sylvatica L. as affected by temperature and extreme drought in common garden experiments

    Science.gov (United States)

    Kreyling, Juergen; Buhk, Constanze; Backhaus, Sabrina; Hallinger, Martin; Huber, Gerhard; Huber, Lukas; Jentsch, Anke; Konnert, Monika; Thiel, Daniel; Wilmking, Martin; Beierkuhnlein, Carl

    2014-01-01

    Local adaptations to environmental conditions are of high ecological importance as they determine distribution ranges and likely affect species responses to climate change. Increased environmental stress (warming, extreme drought) due to climate change in combination with decreased genetic mixing due to isolation may lead to stronger local adaptations of geographically marginal than central populations. We experimentally observed local adaptations of three marginal and four central populations of Fagus sylvaticaL., the dominant native forest tree, to frost over winter and in spring (late frost). We determined frost hardiness of buds and roots by the relative electrolyte leakage in two common garden experiments. The experiment at the cold site included a continuous warming treatment; the experiment at the warm site included a preceding summer drought manipulation. In both experiments, we found evidence for local adaptation to frost, with stronger signs of local adaptation in marginal populations. Winter frost killed many of the potted individuals at the cold site, with higher survival in the warming treatment and in those populations originating from colder environments. However, we found no difference in winter frost tolerance of buds among populations, implying that bud survival was not the main cue for mortality. Bud late frost tolerance in April differed between populations at the warm site, mainly because of phenological differences in bud break. Increased spring frost tolerance of plants which had experienced drought stress in the preceding summer could also be explained by shifts in phenology. Stronger local adaptations to climate in geographically marginal than central populations imply the potential for adaptation to climate at range edges. In times of climate change, however, it needs to be tested whether locally adapted populations at range margins can successfully adapt further to changing conditions. PMID:25035801

  3. Local control and survival in patients with soft tissue sarcomas treated with limb sparing surgery in combination with interstitial brachytherapy and external radiation

    DEFF Research Database (Denmark)

    Muhic, A.; Hovgaard, D.; Mork, Petersen M.

    2008-01-01

    %. Nineteen (49%) patients suffered from some degree of decreased force or function of the affected extremity, 16 (41%) suffered from oedema, 12 (31%) had persistent pain, 8 (21%) suffered from wound complications, and in 4 (10%) of these patients plastic surgery were required. CONCLUSION: Limb sparing......PURPOSE: The purpose of this study was to evaluate local control, survival and complication rate after treatment of soft tissue sarcoma (STS) with limb-sparing surgery combined with pulsed-dose rate (PDR) interstitial brachytherapy (BRT) and external beam radiotherapy (EBRT). PATIENTS AND METHODS......: A retrospective review of 39 adult patients (female/male=25/14, mean age 51(range 21-78) years) with STS who underwent primary limb-sparing surgery combined with PDR BRT (20Gy) and additional post-operative EBRT (50Gy) during the years 1995-2004. RESULTS: Five patients developed local recurrence after a mean...

  4. Computed tomographic evaluation of thickness of perirectal fascia in rectal cancer treated by preoperative radiotherapy; Diagnostic value for prediction of local recurrence

    Energy Technology Data Exchange (ETDEWEB)

    Okumura, Toshiyuki (Ibaraki Prefectural Central Hospital, Tomobe (Japan)); Ohara, Kiyoshi; Saida, Yukihisa; Tatsuzaki, Hideo; Sugahara, Shinji; Yoshida, Tsuguo; Itai, Yuji; Orii, Kazuo; Todoroki, Takeshi

    1991-05-01

    Perirectal fascia was examined by computed tomography before and after preoperative radiotherapy in thirty-six patients with rectal cancer. CT measurement showed that perirectal fascia tend to increase in thickness during preoperative radiotherapy in proportion to tumor extension into perirectal fat tissue. The fascial thickening more than 7 mm after preoperative radiotherapy was suggestive of local recurrence to develop. Preoperative or intraoperative boost irradiation would be recommended for such high-risk patients. (author).

  5. Role of chymase in the local renin-angiotensin system in keloids: inhibition of chymase may be an effective therapeutic approach to treat keloids

    Science.gov (United States)

    Wang, Ru; Chen, Junjie; Zhang, Zhenyu; Cen, Ying

    2015-01-01

    Background Histologically, keloids contain excess fibroblasts and an overabundance of dermal collagen. Recently, it was reported that chymase induced a profibrotic response via transforming growth factor-β1 (TGF-β1)/Smad activation in keloid fibroblasts (KFs). However, the role of chymase in the local renin-angiotensin system (RAS) in keloids has not been elucidated. This study aims to determine whether chymase plays an important role in the local RAS in keloids. Methods We compared the expression and activity of chymase in keloids and normal skin tissues using Western blotting and radioimmunoassay, and studied the expression of TGF-β1, interleukin-1β, collagen I, hydroxyproline, and angiotensin II in KFs after chymase and inhibitors’ treatment. Results The results revealed an increased activity of chymase in keloid tissues, and that chymase enhanced the expression of angiotensin II, collagen I, TGF-β1, and interleukin-1β in KFs. Blockade of the chymase pathway involved in the local RAS lowered the expression of these signaling factors. Conclusion This research suggests that inhibition of chymase might be an effective therapeutic approach to improve the clinical treatment of keloids. PMID:26357464

  6. No increase of local recurrence rate in breast cancer patients treated with skin-sparing mastectomy followed by immediate breast reconstruction.

    Science.gov (United States)

    van Mierlo, D R J; Lopez Penha, T R; Schipper, R J; Martens, M H; Serroyen, J; Lobbes, M B I; Heuts, E M; Tuinder, S; Smidt, M L

    2013-12-01

    The aim of this study was to evaluate the incidence of local recurrence after SSM with IBR and to determine whether complications lead to postponement of adjuvant therapy. Patients that underwent IBR after SSM between 2004 and 2011 were included. A total of 157 reconstruction procedures were performed in 147 patients for invasive breast cancer (n = 117) and ductal carcinoma in situ (n = 40). The median follow-up was 39 months [range 6-97]. Estimated 5-year local recurrence rate was 2.9% (95% CI 0.1-5.7). The median time to start adjuvant therapy was 27.5 days [range 19-92] in 18 patients with complications, and 23.5 days [range 8-54] in 46 patients without complications (p = 0.025). In our single-institution cohort, IBR after SSM carried an acceptable local recurrence rate. Complications caused a delay of adjuvant treatment but this was within guidelines and therefore not clinically relevant. Copyright © 2013 Elsevier Ltd. All rights reserved.

  7. The role of local food in the touristic experience : A focus on Visit Tampere All Bright! Marketing Program

    OpenAIRE

    Reza Monroy, Alberto

    2014-01-01

    In an age where the population is being encouraged to think about eating more healthily, and celebrity chefs are highlighting the often unsavory side of mass farming, local food is a valuable resource which makes a significant contribution to local economies and encourages diversification amongst rural communities, not to mention the big opportu-nities that can bring to the tourism industry. This thesis tries to define the role local food plays in tourism promotion by analyzing the promot...

  8. Adnexal Masses Treated Using a Combination of the SILS Port and Noncurved Straight Laparoscopic Instruments: Turkish Experience and Review of the Literature

    Directory of Open Access Journals (Sweden)

    Polat Dursun

    2013-01-01

    Full Text Available Objective. To report our experience treating adnexal masses using a combination of the SILS port and straight nonroticulating laparoscopic instruments. Study Design. This prospective feasibility study included 14 women with symptomatic and persistent adnexal masses. Removal of adnexal masses via single-incision laparoscopic surgery using a combination of the SILS port and straight nonroticulating laparoscopic instruments was performed. Results. All of the patients had symptomatic complex adnexal masses. Mean age of the patients was 38.4 years (range: 21–61 years and mean duration of surgery was 71 min (range: 45–130 min. All surgeries were performed using nonroticulating straight laparoscopic instruments. Mean tumor diameter was 6 cm (range: 5–12 cm. All patient pathology reports were benign. None of the patients converted to laparotomy. All the patients were discharged on postoperative d1. Postoperatively, all the patients were satisfied with their incision and cosmetic results. Conclusion. All 14 patients were successfully treated using standard, straight nonroticulating laparoscopic instruments via the SILS port. This procedure can reduce the cost of treatment, which may eventually lead to more widespread use of the SILS port approach. Furthermore, concomitant surgical procedures are possible using this approach. However, properly designed comparative studies with single port and classic laparoscopic surgery are urgently needed.

  9. Asians with localized prostate cancer treated with 3-dimensional conformal radiation therapy and adjuvant hormonal therapy: comparing Phoenix and American Society of Therapeutic Radiology and Oncology (ASTRO) definitions in an Asian population.

    Science.gov (United States)

    Ramalingam, Mohan; Lau, Weber; Tan, Terence; Fook, Stephanie; Ngoi, Francis; Cheng, Christopher

    2008-03-01

    Conformal radiotherapy with adjuvant androgen suppression is used in our center to treat localized prostate cancer. We compare Phoenix as an alternative to American Society of Therapeutic Radiology and Oncology (ASTRO) for defining biochemical failure. Our primary aim was to assess the Phoenix and ASTRO definitions of biochemical failure in a population of mainly Asian men with early localized prostate cancer treated with conformal radiotherapy with and without androgen ablation. We retrospectively analyzed 141 patients who were treated for T1/T2 cancer of the prostate in our center from January 1997 to June 2002 with a mean duration of follow-up of 62 months. Outcomes were analyzed by using both Phoenix and ASTRO definitions of biochemical failure as well as clinical failure. The Phoenix definition of biochemical failure was superior as measured by sensitivity, specificity, positive and negative predictive values, accuracy, and a greater concordance with clinical outcome as measured by Kappa analysis. The ASTRO definition helped to standardize reporting of biochemical failures post-radiotherapy but inadequacies have been identified especially when adjuvant hormone therapy has been given. The Phoenix definition has been noted to be a more accurate and precise description of biochemical failure in international series, and we find this to be true in our Asian population as well.

  10. Subcellular localization of a PhoE-LacZ fusion protein in E. coli by protease accessibility experiments reveals an inner-membrane-spanning form of the protein

    NARCIS (Netherlands)

    Tommassen, J.P.M.; Kroon, T. de

    1987-01-01

    Protease accessibility experiments were employed to localize a PhoE-LacZ hybrid protein, encompassing a large N-terminal fragment of the outer membrane PhoE protein of E. coli, fused to β-galactosidase, at the subcellular level. In previous studies, this protein was shown to co-fractionate with the

  11. Oncogene mutation profile predicts tumor regression and survival in locally advanced rectal cancer patients treated with preoperative chemoradiotherapy and radical surgery.

    Science.gov (United States)

    Peng, Jianhong; Lin, Junzhong; Qiu, Miaozhen; Zhao, Yujie; Deng, Yuxiang; Shao, Jianyong; Ding, Peirong; Zhang, Huizhong; Wan, Desen; Lu, Zhenhai; Pan, Zhizhong

    2017-07-01

    Tumor response to preoperative chemoradiotherapy and postoperative survival differs among patients with locally advanced rectal cancer. The objective was to find correlations of mutated oncogenes and clinical outcomes in locally advanced rectal cancer. A total of 70 patients with preoperative preoperative chemoradiotherapy followed by radical surgery at a single cancer center between 2006 and 2012 were enrolled. Pretreatment tumor biopsy samples were assayed for 238 mutation hotspots harboring 19 oncogenes by time-of-flight mass spectrometry and OncoCarta Array. Oncogene mutations were found in 48.6% of patients (34/70). KRAS was the most frequent driver mutation, found in 35.7% of patients (25/70), followed by PIK3CA (14.3%), NRAS (5.7%), FLT3 (2.9%), and BRAF (1.4%). Multiple gene mutations were observed in eight patients (11.4%). Tumors with KRAS mutations responded poorly to preoperative chemoradiotherapy (p = 0.044). Patients with oncogene mutations had worse 3-year disease-free survival than those without mutations (67.2% vs 94.2%, p = 0.010). Patients with KRAS or RAS mutations had lower 3-year disease-free survival (68% vs 88.3%, p = 0.016; 65.5% vs 92.3%, p = 0.004, respectively) and 3-year overall survival (88% vs 95.4%, p = 0.020; 89.7% vs 94.9%, p = 0.036, respectively) than those without KRAS or RAS mutations. Oncogene mutation status affected tumor response to treatment and long-term survival in locally advanced rectal cancer.

  12. Do Local Food Networks Foster Socio-Ecological Transitions towards Food Sovereignty? Learning from Real Place Experiences

    Directory of Open Access Journals (Sweden)

    Juliana Lutz

    2013-11-01

    Full Text Available Drawing on transition theory, we conceptualize local food networks as innovations that initially function and develop in local niches within a given food regime. As niche-innovations local food networks induce socio-ecological changes on the local level and they have the potential to foster wider transformations of the dominant food regime. Many local food networks adopt the concept of food sovereignty as a kind of “leitmotif”. At the core of this concept lies the question of how to create an agro-food system that, (i allows for democratic participation and civic engagement in food production, and (ii sets up new relationships that avoid social inequity and the exploitation of both humans and nature. In this paper we shed light on how the Austrian local food network “SpeiseLokal” addresses the challenge of operationalizing the concept of food sovereignty. The case study captures the strategies which local food networks embark on and depicts the difficulties they encounter. The paper aims to identify critical points of intersection that either strengthen or constrain local food networks from becoming established, operating, and up-scaling in the ways they wish; that is, in accordance with the principles and aims of food sovereignty, while avoiding a later assimilation into the dominant food regime.

  13. The Rise and Fall of the Concept of The Experience Economy in the Local Economic Development of Denmark

    DEFF Research Database (Denmark)

    Freire-Gibb, L. Carlos

    2011-01-01

    in the late 1990s, while in Denmark, it evolved as a multifaceted idea with notable effects for economic development at the local level. The concept is related to the cultural or creative economy, but in the Danish case, it became more diffuse. This article does not intend to be a critique of these two lines......, nor to tourist attractions, which are also linked to TEE. However, it criticizes the implementation of an unorthodox idea to Local Economic Development, even though it may have useful principles to other disciplines. This article reflects the line of recent research which has questioned its...... applications in Local Economic Development. Local governments have supported this strategy because of the national government's key role. Also, academics and consultants contributed to the process. The article also investigates the reasons Denmark had for developing the concept of TEE in Danish local planning...

  14. Using ESSEA Modules, Local Event Studies and Personal Learning Experiences in an Earth Systems Science Course for Preservice Middle School Teachers

    Science.gov (United States)

    Slattery, W.; Brown, D.

    2008-12-01

    Most science courses, including courses that provide preparation for pre-service K-12 teachers are only taught from a deductive big picture perspective. This method is fine for most abstract learners, but pre- service classroom educators that are being prepared to teach in middle school classrooms will be faced with the challenge of building science content knowledge in students that are concrete learners. For these K-12 students a better pedagogical practice is to use local real-world familiar places, issues and personal experience to connect student learning with more abstract concepts. To make it more likely that teachers have the requisite skills and pedagogical content knowledge to build K- 12 student science concept knowledge and science process skills we have integrated ESSEA modules that connect worldwide issues such as global climate change with local event studies chosen by learners. Some recent examples include how such local events such as landfill fires and suburban sprawl impact the local area's air, land, water and life. Course participants are able to choose a more personal route to understanding how their habits impact the global environment by participating in a three week learning experience called the Lifestyle Project. This experience asks students to incrementally reduce their use of heating or air-conditioning, the amount of waste going to landfills, to conserve electricity, drive less and eat less energy intensively. Pre-post content assessments indicate that students in this course scored significantly higher on post course content assessments and reported that by engaging in personal experience to global scale learning experiences they have a new appreciation for how personal choices impact the global environment and how to use local artifacts and issues to enhance K-12 student learning.

  15. Locally aggressive aneurysmal bone cyst of C4 vertebra treated by total en bloc excision and anterior plus posterior cervical instrumentation

    Directory of Open Access Journals (Sweden)

    Himanshu N Parmar

    2015-01-01

    Full Text Available We are presenting a case of cervical (C4 aneurysmal bone cyst in a 13-year-old girl, came to the outpatient department with neck pain and stiffness since 6 months and normal neurology. We did an en bloc excision of locally aggressive tumor through anterior plus posterior approach and stabilization by lateral mass screw fixation and anterior cervical instrumentation. Involvement of several adjacent cervical vertebrae by an aneurysmal bone cyst is rare, and conventional treatment with curettage and bone grafting is most likely to carry a high rate of recurrence and spinal instability. We recommend complete excision of the tumor and instrumentation in a single stage to avoid instability.

  16. From the Experience of Revitalization of Ecological and Local Lore Student Initiatives of Izmail State University for Humanities

    Directory of Open Access Journals (Sweden)

    Gramatik N.V.

    2016-08-01

    Full Text Available The urgency of the problem of ecological education of students of local lore is its connection with the decision of the major problems of pedagogy, as the problem of the formation of personality, all its moral side, and including - a responsible attitude to nature. Ecological and local history education in the vocational training system, opens the future specialist the world with all the versatility of the complex nature of the relationship, it promotes the formation of personal qualities and values. In this regard, the main objective of the educational process in higher education is study ways to enhance eco-initiatives of local history students.

  17. High frequency of radiation pneumonitis in patients with locally advanced non-small cell lung cancer treated with concurrent radiotherapy and gemcitabine after induction with gemcitabine and carboplatin.

    Science.gov (United States)

    Arrieta, Oscar; Gallardo-Rincón, Dolores; Villarreal-Garza, Cynthia; Michel, Rosa M; Astorga-Ramos, Alma M; Martínez-Barrera, Luis; de la Garza, Jaime

    2009-07-01

    The combination of chemotherapy and thoracic radiation is the standard treatment for locally advanced non-small cell lung cancer (NSCLC). However, most favorable chemotherapy regimen, timing of full-dose chemotherapy, and optimal combination of chemotherapy with radiation remain to be determined. Our primary objective was to evaluate the efficacy and safety of gemcitabine concurrent with radiotherapy after induction chemotherapy with gemcitabine plus carboplatin for locally advanced NSCLC. Patients with histologically proven NSCLC stage IIIA and -B received carboplatin (area under the curve of 2.5) and gemcitabine (800 mg/m) on days 1 and 8, every 21 days for two cycles, followed by conventional fractioned thoracic radiotherapy and concomitant weekly gemcitabine 200 mg/m, and finally, consolidation chemotherapy. Inclusion was discontinued because of high-grade 3 to 5 radiation-pneumonitis events (6 of 19 patients, 31.6%), including one treatment-related death associated with radiation pneumonitis. Median follow-up was 11.9 months. Most common grades 3/4 hematological side effects comprised anemia, neutropenia 3 of 19 patients, each (15.8%), and thrombocytopenia (4 of 19, 21.1%) during induction. Partial response was observed in 10 patients (52.6%) following induction chemotherapy. After concurrent chemo-radiotherapy, overall response was 68.4%. Four patients (21.1%) underwent surgical resection. Median progression-free survival and overall survival were 12 +/- 1 month (95% confidence interval [CI], 9.8-14.1) and 21 +/- 3.5 months (95% CI, 14-27.9 months), respectively. Concurrent radiotherapy with gemcitabine after induction with gemcitabine and carboplatin showed a high-response rate; however, it is associated with excessive pulmonary toxicity. Adjustments in gemcitabine dosage during radiotherapy or changes in radiotherapy planning could reduce toxicity.

  18. A Phase I trial using local regional treatment, nonlethal irradiation, intratumoral and systemic polyinosinic-polycytidylic acid polylysine carboxymethylcellulose to treat liver cancer: in search of the abscopal effect.

    Science.gov (United States)

    de la Torre, Andrew N; Contractor, Sohail; Castaneda, Ismael; Cathcart, Charles S; Razdan, Dolly; Klyde, David; Kisza, Piotr; Gonzales, Sharon F; Salazar, Andres M

    2017-01-01

    To determine the safety of an approach to immunologically enhance local treatment of hepatocellular cancer (HCC) by combining nonlethal radiation, local regional therapy with intratumoral injection, and systemic administration of a potent Toll-like receptor (TLR) immune adjuvant. Patients with HCC not eligible for liver transplant or surgery were subject to: 1) 3 fractions of 2-Gy focal nonlethal radiation to increase tumor antigen expression, 2) intra-/peri-tumoral (IT) injection of the TLR3 agonist, polyinosinic-polycytidylic acid polylysine carboxymethylcellulose (poly-ICLC), to induce an immunologic "danger" response in the tumor microenvironment with local regional therapy, and 3) systemic boosting of immunity with intramuscular poly-ICLC. Primary end points were safety and tolerability; secondary end points were progression-free survival (PFS) and overall survival (OS) at 6 months, 1 year, and 2 years. Eighteen patients with HCC not eligible for surgery or liver transplant were treated. Aside from 1 embolization-related severe adverse event, all events were ≤grade II. PFS was 66% at 6 months, 39% at 12 months, and 28% at 24 months. Overall 1-year survival was 69%, and 2-year survival 38%. In patients 60 years (P<0.05). Several patients had prolonged PFS and OS. Intra-tumoral injection of the TLR3 agonist poly-ICLC in patients with HCC is safe and tolerable when combined with local nonlethal radiation and local regional treatment. Further work is in progress to evaluate if this approach improves survival compared to local regional treatment alone and characterize changes in anticancer immunity.

  19. Tolerance of local anesthetic for transrectal ultrasound-guided prostate biopsy: our experience and a literature review

    Energy Technology Data Exchange (ETDEWEB)

    Buckley, M.R.E.; Bryant, N.J.; Brown, J.A.; Tiwari, P.; Cooperberg, P.L.; Wong, A.D. [St Paul' s Hospital, Ultrasound Dept., Vancouver, British Columbia (Canada)]. E-mail: twong@providcencehealth.bc.ca

    2006-06-15

    To determine whether local anesthetic injection or gel reduced pain during transrectal ultrasound-guided prostate biopsies and whether there was significant difference between quadrant and apex-only anesthesia. Between September 2001 and May 2002, 240 male patients with elevated prostate-specific antigen and (or) abnormal digital rectal examination were randomized into 1 of 4 groups: 1) transrectal lidocaine gel, 2) quadrant lidocaine injections, 3) apex-only lidocaine injections, or 4) no local anesthetic. Patients scored their pain on a numerical rating scale where 0 indicated no pain and 10 indicated worst pain. We analyzed mean and standard deviations of scores, using a 1-way analysis of variance (ANOVA) and post hoc multiple comparisons with Tukey's honestly significant difference (HSD) studentized range test to determine whether there were significant differences across the groups. There was no significant difference between local anesthetic gel (mean 3.1, SD 1.9) and no anesthetic (mean 3.5, SD 1.9) or between quadrant (mean 1.7, SD 1.7) and apex-only (mean 2.0, SD 1.8) local anesthetic injections. There was significant difference between quadrant injections (mean 1.7, SD 1.7) and no local anesthetic (mean 3.5, SD 1.9) and between apex-only injections (mean 2.0, SD 1.8) and no local anesthetic (mean 3.5, SD 1.9). There was significant pain reduction with local anesthetic injections but not with gel, and since there was no significant difference in efficacy between quadrant and apex-only injections, we recommend apex-only local anesthetic injections for transrectal ultrasound-guided prostate biopsies because it simplifies the injection procedure. (author)

  20. The "inside out" transforaminal technique to treat lumbar spinal pain in an awake and aware patient under local anesthesia: results and a review of the literature.

    Science.gov (United States)

    Gore, Satishchandra; Yeung, Anthony

    2014-01-01

    Surgical management of back and leg pain is evolving and changing due to a better understanding of the patho-anatomy well correlated with its pathophysiology. Pain is better understood with in vivo visualization and probing of the pain generators using an endoscopic access rather than just relying on symptoms diagram and image correlation. This has resulted in a shared decision making involving patient and surgeon, focused on a broader spectrum of surgical as well as non-surgical treatments, and not just masking the pain generator. It has moved away from decisions based on diagnostic images alone, that, while noting the image alterations, cannot explain the pain experienced by each individual as images do not always show variations in nerve supply and patho-anatomy. The ability to isolate and visualize "pain" generators in the foramen and treating persistent pain by visualizing inflammation and compression of nerves, serves as the basis for transforaminal endoscopic (TFE) surgery. This has also resulted in better pre surgical planning with more specific and defined goals in mind. The "Inside out" philosophy of TFE surgery is safe and precise. It provides basic access to the disc and foramen to cover a large spectrum of painful pathologies.

  1. Screening for local and regional cancer recurrence in patients curatively treated for laryngeal cancer: definition of a high-risk group and estimation of the lead time.

    Science.gov (United States)

    Ritoe, Savitri C; Verbeek, André L M; Krabbe, Paul F M; Kaanders, Johannes H A M; van den Hoogen, Frank J A; Marres, Henri A M

    2007-05-01

    All patients treated for laryngeal cancer are offered the same follow-up schedule to detect asymptomatic locoregional recurrences. In this study, we evaluated the prognostic profile of patients for cancer recurrence and estimated the lead time. A cohort study was performed between 1990 and 1995. Cox proportional hazards model was used to analyze the prognostic factors. The effect of altering the follow-up for asymptomatic recurrence detection was determined after estimating the lead time. The variables cT classification, smoking, and histologic grade proved to be prognostic factors. The risk of locoregional failure was 15% in the low-risk group versus 29% in the high-risk group. The estimated lead time was 2 to 4 weeks. Risk profiles for locoregional relapse were defined. Intensifying the follow-up schedule is not advisable because the lead time is very short. An excessively high number of routine visits would have to be performed to increase the detection rate for asymptomatic recurrences. (c) 2006 Wiley Periodicals, Inc.

  2. The newer aspect of dexmedetomidine use in dentistry: As an additive to local anesthesia, initial experience, and review of literature.

    Science.gov (United States)

    Kumar, Prashant; Thepra, Manju; Bhagol, Amrish; Priya, Kannu; Singh, Virendra

    2016-01-01

    Despite the availability of a wide variety of pharmacological agents in the field of anesthesia, there has always been a continuous search for newer local anesthetic agents with improved efficacy, potency, and better handling properties. Dexmedetomidine, a selective alpha-2 adrenergic receptor agonist, is an emerging agent for provision of additive local anesthetic effect if used with conventional local anesthetics, which can be implicated in dentistry for performing many minor oral surgical procedures. The present paper reports a pilot study comparing clinical efficacy and potency of this newer emerging drug in combination with lignocaine. Ten patients undergoing orthodontic extraction for correction of malocclusion and other dentofacial deformities requiring orthodontic treatment were locally infiltrated with 2% lignocaine plus dexmedetomidine 1μ/ml and 2% lignocaine plus adrenaline in 1:200,000 dilution at two different appointments. The onset of action, duration of action, and pain threshold were assessed. Onset of action was found to be faster with longer duration of action with the newer drug dexmedetomidine and lignocaine combination when compared with combination of lignocaine and adrenaline. The study demonstrated that the combination of dexmedetomidine with lignocaine enhances the local anesthetic potency of lignocaine without significant systemic effects when locally injected into oral mucosa.

  3. The Influence of Local Bone Density on the Outcome of One Hundred and Fifty Proximal Humeral Fractures Treated with a Locking Plate.

    Science.gov (United States)

    Kralinger, Franz; Blauth, Michael; Goldhahn, Jörg; Käch, Kurt; Voigt, Christine; Platz, Andreas; Hanson, Beate

    2014-06-18

    There is biomechanical evidence that bone density predicts the mechanical failure of implants. The aim of this prospective study was to evaluate the influence of local bone mineral density on the rate of mechanical failure after locking plate fixation of proximal humeral fractures. We enrolled 150 patients who were from fifty to ninety years old with a closed, displaced proximal humeral fracture fixed with use of a locking plate from July 2007 to April 2010. There were 118 women and thirty-two men who had a mean age of sixty-nine years. Preoperative computed tomography (CT) scans were done to assess bone mineral density of the contralateral humerus, and dual x-ray absorptiometry of the distal end of the radius of the unaffected arm was conducted within the first six weeks postoperatively. At follow-up evaluations at six weeks, three months, and one year postoperatively, pain, shoulder mobility, strength, and multiple functional and quality-of-life outcome measures (Disabilities of the Arm, Shoulder and Hand [DASH] questionnaire; Shoulder Pain and Disability Index [SPADI]; Constant score; and EuroQuol-5D [EQ-5D]) were done and standard radiographs were made. We defined mechanical failure as all complications related to bone quality experienced within one year. After locking plate fixation, fifty-three (35%) of 150 patients had mechanical failure; loss of reduction and secondary screw loosening with perforation were common. CT assessments of local bone mineral density showed no difference between patients with and without mechanical failure (89.82 versus 91.51 mg/cm3, respectively; p = 0.670). One-year DASH, SPADI, and Constant scores were significantly better for patients without mechanical failure (p ≤ 0.05). We did not find evidence of an association between bone mineral density and the rate of mechanical failures, which may suggest that patients with normal bone mineral density are less prone to sustain a proximal humeral fracture. Future studies should target

  4. TU-CD-BRB-08: Radiomic Analysis of FDG-PET Identifies Novel Prognostic Imaging Biomarkers in Locally Advanced Pancreatic Cancer Patients Treated with SBRT

    Energy Technology Data Exchange (ETDEWEB)

    Cui, Y; Shirato, H [Hokkaido University, Global Institute for Collaborative Research and Educat, Sapporo, Hokkaido (Japan); Song, J; Pollom, E; Chang, D; Koong, A [Stanford University, Palo Alto, CA (United States); Li, R [Hokkaido University, Global Institute for Collaborative Research and Educat, Sapporo, Hokkaido (Japan); Stanford University, Palo Alto, CA (United States)

    2015-06-15

    Purpose: This study aims to identify novel prognostic imaging biomarkers in locally advanced pancreatic cancer (LAPC) using quantitative, high-throughput image analysis. Methods: 86 patients with LAPC receiving chemotherapy followed by SBRT were retrospectively studied. All patients had a baseline FDG-PET scan prior to SBRT. For each patient, we extracted 435 PET imaging features of five types: statistical, morphological, textural, histogram, and wavelet. These features went through redundancy checks, robustness analysis, as well as a prescreening process based on their concordance indices with respect to the relevant outcomes. We then performed principle component analysis on the remaining features (number ranged from 10 to 16), and fitted a Cox proportional hazard regression model using the first 3 principle components. Kaplan-Meier analysis was used to assess the ability to distinguish high versus low-risk patients separated by median predicted survival. To avoid overfitting, all evaluations were based on leave-one-out cross validation (LOOCV), in which each holdout patient was assigned to a risk group according to the model obtained from a separate training set. Results: For predicting overall survival (OS), the most dominant imaging features were wavelet coefficients. There was a statistically significant difference in OS between patients with predicted high and low-risk based on LOOCV (hazard ratio: 2.26, p<0.001). Similar imaging features were also strongly associated with local progression-free survival (LPFS) (hazard ratio: 1.53, p=0.026) on LOOCV. In comparison, neither SUVmax nor TLG was associated with LPFS (p=0.103, p=0.433) (Table 1). Results for progression-free survival and distant progression-free survival showed similar trends. Conclusion: Radiomic analysis identified novel imaging features that showed improved prognostic value over conventional methods. These features characterize the degree of intra-tumor heterogeneity reflected on FDG

  5. SU-F-T-123: The Simulated Effect of the Breath-Hold Reproducibility Treating Locally-Advanced Lung Cancer with Pencil Beam Scanned Proton Therapy

    Energy Technology Data Exchange (ETDEWEB)

    Dueck, J [Paul Scherrer Institut, Villigen PSI (Switzerland); Department of Oncology, Rigshospitalet, Copenhagen (Denmark); Niels Bohr Institute, University of Copenhagen, Copenhagen (Denmark); Perrin, R [Paul Scherrer Institut, Villigen PSI (Switzerland); Persson, G F; Engelholm, S A [Department of Oncology, Rigshospitalet, Copenhagen (Denmark); Lomax, A [Paul Scherrer Institut, Villigen PSI (Switzerland); Department of Physics, ETH, Zürich (Switzerland); Josipovic, M; Rosenschöld, AF [Department of Oncology, Rigshospitalet, Copenhagen (Denmark); Niels Bohr Institute, University of Copenhagen, Copenhagen (Denmark); Weber, D C [Paul Scherrer Institut, Villigen PSI (Switzerland); University of Zürich, Zürich (Switzerland); Munck, P

    2016-06-15

    Purpose: The breath-hold (BH) technique has been suggested to mitigate motion and reduce target coverage degradation due to motion effects. The aim of this study was to investigate the effect of inter-BH residual motion on the dose distribution for pencil beam scanned (PBS) proton therapy of locally-advanced lung cancer patients. Methods: A dataset of visually-guided BH CT scans was acquired (10 scans per patient) taken from five lung cancer patients: three intra-fractionally repeated CT scans on treatment days 2,16 and 31, in addition to the day 0 planning CT scan. Three field intensity-modulated proton therapy (IMPT) plans were constructed on the planning CT scan. Dose delivery on fraction 2, 16 and 31 were simulated on the three consecutive CT scans, assuming BH duration of 20s and soft tissue match. The dose was accumulated in the planning CT using deformable image registration, and scaled to simulate the full treatment of 66Gy(RBE) in 33 fractions. Results: The mean dose to the lungs and heart, and maximum dose to the spinal cord and esophagus were within 1% of the planned dose. The CTV V95% decreased and the inhomogeneity (D5%–D95%) increased on average 4.1% (0.4–12.2%) and 5.8% (2.2–13.4%), respectively, over the five patient cases. Conclusion: The results showed that the BH technique seems to spare the OARs in spite of inter-BH residual motion. However, small degradation of target coverage occurred for all patients, with 3/5 patients having a decrease in V95% ≤1%. For the remaining two patients, where V95% decreased up to 12%, the cause could be related to treatment related anatomical changes and, as in photon therapy, plan adaptation may be necessary to ensure target coverage. This study showed that BH could be a potential treatment option to reliably mitigate motion for the treatment of locally-advanced lung cancer using PBS proton therapy.

  6. Second primary cancer in survivors of locally advanced non-small cell lung cancer treated with concurrent chemoradiation followed by surgery.

    Science.gov (United States)

    Makimoto, Go; Kubo, Toshio; Oze, Isao; Ohashi, Kadoaki; Hotta, Katsuyuki; Tabata, Masahiro; Soh, Junichi; Toyooka, Shinichi; Katsui, Kuniaki; Takigawa, Nagio; Tanimoto, Mitsune; Kiura, Katsuyuki

    2018-02-02

    The standard treatment for patients with locally advanced non-small-cell lung cancer (LA-NSCLC) is chemoradiotherapy (CRT), but surgical resection following induction CRT can extend overall survival in a select population. However, patients who survive longer are at risk of developing a second primary cancer (SPC). This is the first report to determine the incidence of SPC in survivors with LA-NSCLC after trimodal therapy. Between October 1997 and October 2013, 112 Stage III NSCLC patients underwent trimodal therapy in our hospital. The 5-year overall survival rate was 71.8%. SPC developed in 10 of the 112 patients 0.60-15.0 (median 5.49) years after initiating CRT. The observed incidence of SPC was 1.8 per 100 patient-years. Although trimodal therapy can prolong patient survival, the estimated incidence of SPC does not increase. A large prospective study with a longer follow-up time is required to determine the effects of trimodal therapy, including the development of SPC. © The Author(s) 2018. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  7. Phase I/II clinical trial of encapsulated, cytochrome P450 expressing cells as local activators of cyclophosphamide to treat spontaneous canine tumours.

    Directory of Open Access Journals (Sweden)

    Monika Michałowska

    Full Text Available Based upon promising preclinical studies, a clinical trial was performed in which encapsulated cells overexpressing cytochrome P450 enzyme isoform 2B1 were implanted around malignant mammary tumours arising spontaneously in dogs. The dogs were then given cyclophosphamide, one of the standard chemotherapeutic agents used for the treatment of mammary tumours. The dogs were assessed for a number of clinical parameters as well as for reduction in tumour size. The treatment was well tolerated with no evidence of adverse reactions or side effects being associated with the administration of the encapsulated cells. Reductions in tumour size of more than 50% were observed for 6 out of the 11 tumours analysed while 5 tumours showing minor responses, i.e. stable disease. In contrast, the tumours that received cyclophosphamide alone showed only stable disease. Taken together, this data suggests that encapsulated cytochrome P450 expressing cells combined with chemotherapy may be useful in the local treatment of a number of dog mammary tumours and support the performance of further clinical studies to evaluate this new treatment.

  8. Air quality management: evolution of policy and practice in the UK as exemplified by the experience of English local government

    Science.gov (United States)

    Beattie, C. I.; Longhurst, J. W. S.; Woodfield, N. K.

    The air quality management (AQM) framework in the UK is designed to be an effects-based solution to air pollutants currently affecting human health. The AQM process has been legislated through The Environment Act 1995, which required the National Air Quality Strategy (NAQS) to be published. AQM practice and capability within local authorities has flourished since the publication of the NAQS in March 1997. This paper outlines the policy framework within which the UK operates, both at a domestic and European level, and reviews the air quality management process relating to current UK policy and EU policy. Data from questionnaire surveys are used to indicate the involvement of various sectors of local government in the air quality management process. These data indicate an increasing use of monitoring, and use of air dispersion modelling by English local authorities. Data relating to the management of air quality, for example, the existence and work of air quality groups, dissemination of information to the public and policy measures in place on a local scale to improve air quality, have also been reported. The UK NAQS has been reviewed in 1999 to reflect developments in European legislation, technological and scientific advances, improved air pollution modelling techniques and an increasingly better understanding of the socio-economic issues involved. The AQM process, as implemented by UK local authorities, provides an effective model for other European member states with regards to the implementation of the Air Quality Framework Directive. The future direction of air quality policy in the UK is also discussed.

  9. Analysis and experiments on Fano interference using a 2D metamaterial cavity for field localized wireless power transfer

    Science.gov (United States)

    Son Pham, Thanh; Kumara Ranaweera, Aruna; Viet Ngo, Duc; Lee, Jong-Wook

    2017-08-01

    To meet both safety and efficiency demands of future wireless power transfer (WPT) systems, field leakage to the nearby environment should be controlled below a certain level. Therefore, field localization is one of the key issues in advanced WPT systems. Recently, metamaterials have shown great potential for enhanced control of electromagnetic propagation in various environments. In this work, we investigate a locally modified metamaterial to create a two-dimensional (2D) cavity for field localization at a sub-wavelength scale. We also show that the field localization in the cavity can be explained using Fano-type interference. We believe that this is one of the first works demonstrating that Fano-type interference can be applied for resonance-coupled mid-range WPT. Using the proposed approach, we achieve a localized WPT in a region that is eight times smaller than that of a transmit coil. At a distance of 0.6 meters, the measured efficiency is 56.5%, which represents a six-fold and two-fold enhancement compared to free space and uniform metamaterial slabs, respectively.

  10. HIV testing experiences and their implications for patient engagement with HIV care and treatment on the eve of 'test and treat': findings from a multicountry qualitative study.

    Science.gov (United States)

    Wringe, Alison; Moshabela, Mosa; Nyamukapa, Constance; Bukenya, Dominic; Ondenge, Ken; Ddaaki, William; Wamoyi, Joyce; Seeley, Janet; Church, Kathryn; Zaba, Basia; Hosegood, Victoria; Bonnington, Oliver; Skovdal, Morten; Renju, Jenny

    2017-07-01

    In view of expanding 'test and treat' initiatives, we sought to elicit how the experience of HIV testing influenced subsequent engagement in HIV care among people diagnosed with HIV. As part of a multisite qualitative study, we conducted in-depth interviews in Uganda, South Africa, Tanzania, Kenya, Malawi and Zimbabwe with 5-10 health workers and 28-59 people living with HIV, per country. Topic guides covered patient and provider experiences of HIV testing and treatment services. Themes were derived through deductive and inductive coding. Various practices and techniques were employed by health workers to increase HIV testing uptake in line with national policies, some of which affected patients' subsequent engagement with HIV services. Provider-initiated testing was generally appreciated, but rarely considered voluntary, with instances of coercion and testing without consent, which could lead to disengagement from care.Conflicting rationalities for HIV testing between health workers and their clients caused tensions that undermined engagement in HIV care among people living with HIV. Although many health workers helped clients to accept their diagnosis and engage in care, some delivered static, morally charged messages regarding sexual behaviours and expectations of clinic use which discouraged future care seeking. Repeat testing was commonly reported, reflecting patients' doubts over the accuracy of prior results and beliefs that antiretroviral therapy may cure HIV. Repeat testing provided an opportunity to develop familiarity with clinical procedures, address concerns about HIV services and build trust with health workers. The principles of consent and confidentiality that should underlie HIV testing and counselling practices may be modified or omitted by health workers to achieve perceived public health benefits and policy expectations. While such actions can increase HIV testing rates, they may also jeopardise efforts to connect people diagnosed with HIV to

  11. The impact of body mass index on rectal dose in locally advanced cervical cancer treated with high-dose-rate brachytherapy.

    Science.gov (United States)

    Lim, Jihoon; Durbin-Johnson, Blythe; Valicenti, Richard; Mathai, Matthew; Stern, Robin L; Mayadev, Jyoti

    2013-01-01

    The impact of body mass index (BMI) on rectal dose in brachytherapy for cervical cancer is unknown. We assessed the association of BMI on rectal dose and lower gastrointestinal (GI) toxicity. Between 2007 and 2010, 51 patients with 97 brachytherapy planning images were reviewed. Volumetric measurements of the maximum percentage, mean percentage, dose to 2cc (D2cc), and dose to 1cc (D1cc) of the rectum, and the Internal Commission on Radiation Units and Measurement (ICRU) rectal point were recorded. Linear mixed effect models, analysis of variance, and regression analyses were used to determine the correlation between multiple observations or to detect a difference in the mean. The GI acute and late toxicity were prospectively recorded and retrospectively analyzed. The average BMI (kg/m(2)) was 27.7 with a range of 17.4-46.6. Among the patients, 8% were morbidly obese, 25% obese, 25% overweight, 40% normal weight, and 2% underweight. The mean D1cc, D2cc, mean rectal dose (%), maximum rectal dose (%), and ICRU rectum was 3.03 Gy, 2.78 Gy, 20%, 60%, and 2.99 Gy, respectively. On multivariate analysis, there was a significant decrease in the D1cc and D2cc rectal dose (p=0.016), ICRU rectal point dose (p=0.022), and mean rectal dose percentage (p=0.021) with an increase in BMI. There was, however, no statistically significant relationship between BMI and GI toxicity. Obesity decreases the rectal dose given in high-dose-rate brachytherapy for locally advanced cervical cancer because of an increase in fatty tissue in the recto-uterine space. There is no significant correlation between BMI and acute or late GI toxicity. Published by Elsevier Inc.

  12. Predictors of grade {>=}2 and grade {>=}3 radiation pneumonitis in patients with locally advanced non-small cell lung cancer treated with three-dimensional conformal radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Dang, Jun; Li, Guang; Ma, Lianghua; Han, Chong; Zhang, Shuo; Yao, Lei [Dept. of Radiation Oncology, The First Hospital of China Medical Univ., Shenyang (China)], e-mail: gl1963516@yahoo.cn; Diao, Rao [Dept. of Experimental Technology Center, China Medical Univ., Shenyang (China); Zang, Shuang [Dept. of Nursing, China Medical Univ., Shenyang (China)

    2013-08-15

    Grade {>=}3 radiation pneumonitis (RP) is generally severe and life-threatening. Predictors of grade {>=}2 are usually used for grade {>=}3 RP prediction, but it is unclear whether these predictors are appropriate. In this study, predictors of grade {>=}2 and grade {>=}3 RP were investigated separately. The increased risk of severe RP in elderly patients compared with younger patients was also evaluated. Material and methods: A total of 176 consecutive patients with locally advanced non-small cell lung cancer were followed up prospectively after three-dimensional conformal radiotherapy. RP was graded according to Common Terminology Criteria for Adverse Events version 3.0. Results: Mean lung dose (MLD), mean heart dose, ratio of planning target volume to total lung volume (PTV/Lung), and dose-volume histogram comprehensive value of both heart and lung were associated with both grade {>=}2 and grade {>=}3 RP in univariate analysis. In multivariate logistic regression analysis, age and MLD were predictors of both grade {>=}2 RP and grade {>=}3 RP; receipt of chemotherapy predicted grade {>=}3 RP only; and sex and PTV/Lung predicted grade {>=}2 RP only. Among patients who developed high-grade RP, MLD and PTV/Lung were significantly lower in patients aged {>=}70 years than in younger patients (p<0.05 for both comparisons). Conclusions: The predictors were not completely consistent between grade {>=}2 RP and grade {>=}3 RP. Elderly patients had a higher risk of severe RP than younger patients did, possibly due to lower tolerance of radiation to the lung.

  13. PET/CT Response Criteria (European Organization for Research and Treatment of Cancer) Predict Survival Better Than Response Evaluation Criteria in Solid Tumors in Locally Advanced Cervical Cancer Treated With Chemoradiation.

    Science.gov (United States)

    Yoon, Jung Won; Kim, Sunghoon; Kim, Sang Wun; Kim, Young Tae; Kang, Won Jun; Nam, Eun Ji

    2016-09-01

    To investigate whether the ratio of SUVs measured with F-FDG PET/CT between pretreatment and posttreatment has prognostic value in patients with locally advanced cervical cancer treated with primary chemoradiation therapy. Cases of locally advanced cervical cancer (International Federation of Gynecology and Obstetrics stages IB1 to IVA) treated with a nonsurgical curative modality (172 cases including chemoradiation or radiation therapy) were reviewed. F-FDG PET/CT parameters, including SUVmax and SUVmean, were evaluated by F-FDG PET/CT performed prior to treatment and 6 weeks after the end of treatment. Metabolic response was evaluated according to the European Organization for Research and Treatment of Cancer guidelines and was compared with radiologic response measured according to the Response Evaluation Criteria In Solid Tumours (RECIST). In total, 142 patients receiving chemoradiation showed radiologic responses (median 56% decrease in maximal diameter), whereas 160 and 146 patients showed metabolic responses measured with SUVmax and SUVmean, respectively (73% decrease in SUVmax; 48% decrease in SUVmean). Radiologic response and metabolic response were significantly correlated for SUVmax and SUVmean (P = 0.0009; P = 0.0457, respectively). Kaplan-Meier analysis revealed significant differences in overall survival and progression-free survival between the responder and nonresponder groups, based on the European Organization for Research and Treatment of Cancer criteria (both P PET/CT parameters are good prognostic markers for the response of cervical cancer patients to concurrent chemoradiation therapy, as compared with the RECIST criteria.

  14. Preliminary experience in treatment of papillary and macular retinoblastoma: evaluation of local control and local complications after treatment with linear accelerator-based stereotactic radiotherapy with micromultileaf collimator as second-line or salvage treatment after chemotherapy.

    Science.gov (United States)

    Pica, Alessia; Moeckli, Raphael; Balmer, Aubin; Beck-Popovic, Maja; Chollet-Rivier, Madeleine; Do, Huu-Phuoc; Weber, Damien C; Munier, Francis L

    2011-12-01

    To determine the local control and complication rates for children with papillary and/or macular retinoblastoma progressing after chemotherapy and undergoing stereotactic radiotherapy (SRT) with a micromultileaf collimator. Between 2004 and 2008, 11 children (15 eyes) with macular and/or papillary retinoblastoma were treated with SRT. The mean age was 19 months (range, 2-111). Of the 15 eyes, 7, 6, and 2 were classified as International Classification of Intraocular Retinoblastoma Group B, C, and E, respectively. The delivered dose of SRT was 50.4 Gy in 28 fractions using a dedicated micromultileaf collimator linear accelerator. The median follow-up was 20 months (range, 13-39). Local control was achieved in 13 eyes (87%). The actuarial 1- and 2-year local control rates were both 82%. SRT was well tolerated. Late adverse events were reported in 4 patients. Of the 4 patients, 2 had developed focal microangiopathy 20 months after SRT; 1 had developed a transient recurrence of retinal detachment; and 1 had developed bilateral cataracts. No optic neuropathy was observed. Linear accelerator-based SRT for papillary and/or macular retinoblastoma in children resulted in excellent tumor control rates with acceptable toxicity. Additional research regarding SRT and its intrinsic organ-at-risk sparing capability is justified in the framework of prospective trials. Copyright © 2011 Elsevier Inc. All rights reserved.

  15. Preliminary Experience in Treatment of Papillary and Macular Retinoblastoma: Evaluation of Local Control and Local Complications After Treatment With Linear Accelerator-Based Stereotactic Radiotherapy With Micromultileaf Collimator as Second-Line or Salvage Treatment After Chemotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Pica, Alessia, E-mail: Alessia.Pica@chuv.ch [Department of Radiation Oncology, Centre Hospitalier Universitaire Vaudois, Lausanne (Switzerland); Moeckli, Raphael [University Institute for Radiation Physics, Centre Hospitalier Universitaire Vaudois, Lausanne (Switzerland); Balmer, Aubin [Department of Radiation Oncology, Jules Gonin Eye Hospital, Lausanne (Switzerland); Beck-Popovic, Maja [Unit of Pediatric Oncology, University of Lausanne, Lausanne (Switzerland); Chollet-Rivier, Madeleine [Department of Anesthesiology, University of Lausanne, Lausanne (Switzerland); Do, Huu-Phuoc [University Institute for Radiation Physics, Centre Hospitalier Universitaire Vaudois, Lausanne (Switzerland); Weber, Damien C. [Department of Radiation Oncology, Geneva University Hospital, University of Geneva, Geneva (Switzerland); Munier, Francis L. [Department of Radiation Oncology, Jules Gonin Eye Hospital, Lausanne (Switzerland)

    2011-12-01

    Purpose: To determine the local control and complication rates for children with papillary and/or macular retinoblastoma progressing after chemotherapy and undergoing stereotactic radiotherapy (SRT) with a micromultileaf collimator. Methods and Materials: Between 2004 and 2008, 11 children (15 eyes) with macular and/or papillary retinoblastoma were treated with SRT. The mean age was 19 months (range, 2-111). Of the 15 eyes, 7, 6, and 2 were classified as International Classification of Intraocular Retinoblastoma Group B, C, and E, respectively. The delivered dose of SRT was 50.4 Gy in 28 fractions using a dedicated micromultileaf collimator linear accelerator. Results: The median follow-up was 20 months (range, 13-39). Local control was achieved in 13 eyes (87%). The actuarial 1- and 2-year local control rates were both 82%. SRT was well tolerated. Late adverse events were reported in 4 patients. Of the 4 patients, 2 had developed focal microangiopathy 20 months after SRT; 1 had developed a transient recurrence of retinal detachment; and 1 had developed bilateral cataracts. No optic neuropathy was observed. Conclusions: Linear accelerator-based SRT for papillary and/or macular retinoblastoma in children resulted in excellent tumor control rates with acceptable toxicity. Additional research regarding SRT and its intrinsic organ-at-risk sparing capability is justified in the framework of prospective trials.

  16. Risk factors for local recurrence in Wilms tumour and the potential influence of biopsy - the United Kingdom experience.

    Science.gov (United States)

    Irtan, S; Jitlal, M; Bate, J; Powis, M; Vujanic, G; Kelsey, A; Walker, J; Mitchell, C; Machin, D; Pritchard-Jones, K

    2015-01-01

    The UKW3 trial compared biopsy/pre-operative chemotherapy versus immediate nephrectomy and afforded the opportunity to examine the influence of percutaneous retroperitoneal biopsy and other factors on local and distant relapse of Wilms tumour (WT). Patients with unilateral WT (stages I-IV) excluding metachronous relapse or early progressive disease were eligible. Metastatic and 'inoperable' tumours were biopsied electively. 'Local' was defined as relapse within the abdomen, except for liver metastases considered as 'distant' relapse, together with other haematogenous routes. Uni- and multivariable analyses estimated the risk factors for relapse. Overall, 285/635 (44.9%) patients had a biopsy. With a median follow-up of 10.1 years, 35 (5.5%) patients experienced a 'local', 15 a combined (2.4%) and 60 (9.4%) a 'distant' relapse. On univariate analysis, biopsy, anaplasia and tumour size were associated with an increased risk of local relapse. On multivariable analysis, anaplasia and tumour size remained significant for local relapse whereas the elevated risk of biopsy (hazards ratio (HR) = 1.80: 95% confidence interval (CI) 0.97-3.32, p = 0.060) was marginal. Age, anaplasia, tumour size, lymph nodes metastases and stage, but not biopsy, were individually associated with increased risk of distant relapse but only age and anaplasia remained significant following multivariable analysis. The UKW3 trial provides some reassurance that biopsy should not automatically lead to 'upstaging' of WT. Further assessment of this controversial area is required. Comparison of local relapse rates in a multinational trial in which the United Kingdom (UK) continued the practice of routinely biopsying all patients in contrast to the standard European approach will afford this opportunity and is planned. Copyright © 2014 Elsevier Ltd. All rights reserved.

  17. Understanding agency and developing historical thinking through labour history in elementary school: A local history learning experience

    Directory of Open Access Journals (Sweden)

    Stéphanie Demers

    2015-05-01

    Full Text Available Local history has been much neglected in many social studies curricula, in spite of its potential for providing students with authentic and proximal objects of study for the development of historical thinking and understanding of historical agency. This paper presents the results of a collaborative research endeavor, conducted with two teachers and their fifth grade students, and centered around a local history learning unit. The unit included a field enquiry and role-play based on the use of primary source evidence. The unit proved favorable for the development of some structural concepts of historical thinking (Seixas, 1996 and helped students see themselves as historical agents.

  18. A river-scale Lagrangian experiment examining controls on phytoplankton dynamics in the presence and absence of treated wastewater effluent high in ammonium

    Science.gov (United States)

    Kraus, Tamara; Carpenter, Kurt; Bergamaschi, Brian; Parker, Alexander; Stumpner, Elizabeth; Downing, Bryan D.; Travis, Nicole; Wilkerson, Frances; Kendall, Carol; Mussen, Timothy

    2017-01-01

    Phytoplankton are critical component of the food web in most large rivers and estuaries, and thus identifying dominant controls on phytoplankton abundance and species composition is important to scientists, managers, and policymakers. Recent studies from a variety of systems indicate that ammonium ( NH+4) in treated wastewater effluent decreases primary production and alters phytoplankton species composition. However, these findings are based mainly on laboratory and enclosure studies, which may not adequately represent natural systems. To test effects of effluent high in ammonium on phytoplankton at the ecosystem scale, we conducted whole-river–scale experiments by halting discharges to the Sacramento River from the regional wastewater treatment plant (WWTP), and used a Lagrangian approach to compare changes in phytoplankton abundance and species composition in the presence (+EFF) and absence (−EFF) of effluent. Over 5 d of downstream travel from 20 km above to 50 km below the WWTP, chlorophyll concentrations declined from 15–25 to ∼2.5 μg L−1, irrespective of effluent addition. Benthic diatoms were dominant in most samples. We found no significant difference in phytoplankton abundance or species composition between +EFF and −EFF conditions. Moreover, greatest declines in chlorophyll occurred upstream of the WWTP where NH+4 concentrations were low. Grazing by clams and zooplankton could not account for observed losses, suggesting other factors such as hydrodynamics and light limitation were responsible for phytoplankton declines. These results highlight the advantages of conducting ecosystem-scale, Lagrangian-based experiments to understand the dynamic and complex interplay between physical, chemical, and biological factors that control phytoplankton populations.

  19. The learning curve in treating coronary chronic total occlusion early in the experience of an operator at a tertiary medical center: The role of the hybrid approach.

    Science.gov (United States)

    Shammas, Nicolas W; Shammas, Gail A; Robken, Jon; Harris, Thomas; Madison, Ashley; Dinklenburg, Catherine; Shammas, Andrew N; Harb, Christine; Jerin, Michael

    2016-01-01

    Treatment of chronic total occlusion (CTO) is complex and has a low adoption rate by interventional cardiologists. The introduction of the hybrid approach has provided a systematic step-by-step approach to treat complex CTO lesions with a high success rate. We describe the overall experience with the use of the hybrid approach of a non-CTO operator and analyze differences in the procedural and long term outcomes before and after the initial 30 cases performed. A total of 67 unselected, consecutive patients (68 lesions) underwent PCI of a CTO between January 2012 and June 2013 by a non-CTO operator. Patients were followed up for 1year using office and hospital medical records and death certificates. Cases were divided into the first consecutive 30 patients and compared to the subsequent 37 patients. The primary endpoint was acute procedural success defined as residual narrowing of ≤30% with no major adverse events. Secondary endpoints included the independent outcomes of death, major bleeding, perforations with cardiac tamponade, acute stent thrombosis (ST), target lesion revascularization (TLR) and target vessel revascularization (TVR). Descriptive analysis was performed on all variables. Univariate analysis was used to compare both groups. Baseline characteristics were as follows: mean age 63.9±10.6years, males 80.6%, diabetes 41.8%, de novo lesions 100%, ejection fraction 49.9±13.8%, CTO length 76.9±45.7mm, number of drug eluting stents per CTO 2.8±1.6 (median 3), contrast use 397±161.3ml, fluoroscopy time 51±32min and procedure time 134.3±74.7min. Lesions were crossed using an antegrade approach in 70.6% and a combined retrograde/antegrade approach in 29.4%. Crossing was intraluminal in 83.8% and subintimal in 16.2%. Acute procedural success was 95.5%. MAE included pericardial effusion with tamponade in 4.5%. On follow-up, TLR occurred in 6.6% of patients and TVR in 13.1%. There were no definite ST, one (1.6%) probable ST and one (1.6%) possible ST

  20. Prognostic Value of External Beam Radiation Therapy in Patients Treated With Surgical Resection and Intraoperative Electron Beam Radiation Therapy for Locally Recurrent Soft Tissue Sarcoma: A Multicentric Long-Term Outcome Analysis

    Energy Technology Data Exchange (ETDEWEB)

    Calvo, Felipe A. [Department of Oncology, Hospital General Universitario Gregorio Marañón, Madrid (Spain); School of Medicine, Complutense University, Madrid (Spain); Sole, Claudio V., E-mail: cvsole@uc.cl [Department of Oncology, Hospital General Universitario Gregorio Marañón, Madrid (Spain); School of Medicine, Complutense University, Madrid (Spain); Service of Radiation Oncology, Instituto de Radiomedicina, Santiago (Chile); Cambeiro, Mauricio [Service of Radiation Oncology, Clínica Universitaria, Universidad de Navarra, Pamplona (Spain); Montero, Angel; Polo, Alfredo [Service of Radiation Oncology, Hospital Universitario Ramón y Cajal, Universidad de Alcala, Madrid (Spain); Gonzalez, Carmen [School of Medicine, Complutense University, Madrid (Spain); Service of Radiation Oncology, Instituto de Radiomedicina, Santiago (Chile); Service of Radiation Oncology, Clínica Universitaria, Universidad de Navarra, Pamplona (Spain); Service of Radiation Oncology, Hospital Universitario Ramón y Cajal, Universidad de Alcala, Madrid (Spain); Service of Radiation Oncology, Hospital General Universitario Gregorio Marañón, Madrid (Spain); Cuervo, Miguel [Service of Orthopedics and Traumatology, Hospital General Universitario Gregorio Marañón, Madrid (Spain); San Julian, Mikel [Service of Orthopedics and Traumatology, Clínica Universitaria, Universidad de Navarra, Pamplona (Spain); and others

    2014-01-01

    Background: A joint analysis of data from centers involved in the Spanish Cooperative Initiative for Intraoperative Electron Radiotherapy was performed to investigate long-term outcomes of locally recurrent soft tissue sarcoma (LR-STS) patients treated with a multidisciplinary approach. Methods and Materials: Patients with a histologic diagnosis of LR-STS (extremity, 43%; trunk wall, 24%; retroperitoneum, 33%) and no distant metastases who underwent radical surgery and intraoperative electron radiation therapy (IOERT; median dose, 12.5 Gy) were considered eligible for participation in this study. In addition, 62% received external beam radiation therapy (EBRT; median dose, 50 Gy). Results: From 1986 to 2012, a total of 103 patients from 3 Spanish expert IOERT institutions were analyzed. With a median follow-up of 57 months (range, 2-311 months), 5-year local control (LC) was 60%. The 5-year IORT in-field control, disease-free survival (DFS), and overall survival were 73%, 43%, and 52%, respectively. In the multivariate analysis, no EBRT to treat the LR-STS (P=.02) and microscopically involved margin resection status (P=.04) retained significance in relation to LC. With regard to IORT in-field control, only not delivering EBRT to the LR-STS retained significance in the multivariate analysis (P=.03). Conclusion: This joint analysis revealed that surgical margin and EBRT affect LC but that, given the high risk of distant metastases, DFS remains modest. Intensified local treatment needs to be further tested in the context of more efficient concurrent, neoadjuvant, and adjuvant systemic therapy.

  1. Selecting, training and supervising nurses to treat depression in the medically ill: experience and recommendations from the SMaRT oncology collaborative care trials.

    Science.gov (United States)

    Wanat, Marta; Walker, Jane; Hodges, Laura; Richardson, Alison; Sharpe, Michael

    2015-01-01

    Collaborative care programs to treat comorbid depression in the medically ill often have general (nonpsychiatric) nurses care managers. In this paper, we aim to provide practical recommendations for their selection, training and supervision. Based on more than 10 years of experience of selecting, training and supervising general nurses to deliver a highly effective collaborative care programme called "Depression Care for People with Cancer," we describe the problems encountered and the solutions adopted to optimize the selection, training and supervision of nurse care managers. To select nurses for the role of care manager, we found that role plays enabled us to assess nurses' ability to interact with distressed patients and their capacity for self-reflection better than simple interviews. To train the nurses, we found that a structured program that mirrored the treatment manual and included simulated practice was best. To achieve effective supervision, we found that having sessions led by senior psychiatrists facilitated both constructive feedback to the nurses and effective review of the management of cases. We recommend that the selection, training and supervision of general nurses use the strategies outlined if they are to maximize the benefit that patients achieve from collaborative care programs. Copyright © 2015 Elsevier Inc. All rights reserved.

  2. Central coordination as an alternative for local coordination in a multicenter randomized controlled trial: the FAITH trial experience

    NARCIS (Netherlands)

    Zielinski, Stephanie M.; Viveiros, Helena; Heetveld, Martin J.; Swiontkowski, Marc F.; Bhandari, Mohit; Patka, Peter; van Lieshout, Esther M. M.; Devereaux, Philip J.; Guyatt, Gordon; Jeray, Kyle; Liew, Susan; Richardson, Martin J.; Schemitsch, Emil H.; Swiontkowski, Marc; Tornetta, Paul; Walter, Stephen; Sprague, Sheila; Simunovic, Helena Viveiros Nicole; Heels-Ansdell, Diane; Buckingham, Lisa; Duraikannan, Aravin; Agel, Julie; Goslings, J. Carel; Haverlag, Robert; Ponsen, Kees Jan; Eversdijk, Martin G.; Peters, Rolf; den Hartog, Dennis; van Waes, Oscar J. F.; Oprel, Pim; de Rijcke, Piet A. R.; Koppert, C. L.; Buijk, Steven E.; Groenendijk, Richard P. R.; Dawson, I.; Tetteroo, G. W. M.; Bruijninckx, Milko M. M.; Doornebosch, Pascal G.; deGraaf, E. J. R.; Visser, Gijs A.; Stockmann, Heyn; Silvis, Rob; Snellen, J. P.; Rijbroek, A.; Scheepers, Joris J. G.; Vermeulen, Erik G. J.; Siroen, M. P. C.; Vuylsteke, Ronald; Brom, H. L. F.; Ryna, H.; Rhemrev, Steven J.; Bosman, C. H. R.; de Mol van Otterloo, Alexander; Hoogendoorn, Jochem; de Vries, Alexander C.; Meylaerts, Sven A. G.; Roukema, Gert R.; Josaputra, H.; Keller, Paul; de Rooij, P. P.; Kuiken, H.; Boxma, Han; Cleffken, B. I.; Liem, Ronald; Poolman, Rudolf W.; Simons, Maarten P.; van der Heijden, Frank H. W. M.; Willems, W. J.; de Meulemeester, Frank R. A. J.; van der Hart, Cor P.; Turckan, Kahn; Festen, Sebastiaan; de Nies, F.; Out, Nico J. M.; Bosma, J.; van der Elst, Maarten; van der Pol, Carmen C.; van 't Riet, Martijne; Karsten, T. M.; de Vries, M. R.; Stassen, Laurents P. S.; Schep, Niels W. L.; Schmidt, G. B.; Hoffman, W. H.; Segers, Michiel J. M.; Zijl, Jacco A. C.; Verhoeven, Bart; Smits, Anke B.; de Vries, J. P. P. M.; Fioole, Bram; van der Hoeven, H.; Theunissen, Evert B. M.; de Vries Reilingh, Tammo S.; Govaert, Lonneke; Wittich, Philippe; de Brauw, Maurits; Wille, Jan; Go, Peter M. N. Y. M.; Ritchie, Ewan D.; Wessel, R. N.; Hammacher, Eric R.; Verhofstad, Michiel H. J.; Meijer, Joost; van Egmond, Teun; van der Brand, Igor; van der Vis, Harm M.; Campo, Martin; Verhagen, Ronald; Albers, G. H. R.; Zurcher, A.; van Kampen, A.; Biert, Jan; van Vugt, Arie B.; Edwards, Michael J. R.; Blokhuis, Taco J.; Froelke, Jan Paul M.; Geeraedts, M. G.; Gardeniers, J. W. M.; Tan, Edward T. C. H.; Poelhekke, L. M. S. J.; Malefijt, Waal; Schreurs, Bart; Simmermacher, Rogier K. J.; van Mulken, Jeroen; van Wessem, Karlijn; van Gaalen, Steven M.; Leenen, Luke P. H.; Bronkhorst, Maarten W. G. A.; Guicherit, O. R.; Frihagen, Frede; Nordsletten, Lars; Stoen, Oydna; Brekke, Kine; Tetsworth, Kevin; Weinrauch, Patrick; Pincus, Paul; Donald, Geoff; yang, Steven; Halliday, Brett; Gervais, Trevor; Holt, Michael; Flynn, Annette; Pirpiris, Marinis; Love, David; Bucknill, Andrew; Farrugia, Richard J.; Dowrick, Adam; Donohue, Craig; Bedi, Harvinder; Li, Doug; Edwards, Elton; Csongvay, Steven; Miller, Russell; Wang, Otis; Chia, Andrew; Jain, Arvind; Mammen, Mathan; Murdoch, Zoe; Sage, Claire; Jain, Anil Kumar; Pankaj, Amite; Singh, Ajay Pal; Pesantez, Rodrigo; Martinez, Adriana; Novoa, Catherine; Buckley, Richard E.; Duffy, Paul; Korley, Robert; Johnston, Kelly; Puloski, Shannon; Carcary, Kimberly; Avram, Victoria; Bicknell, Ryan; Yach, Jeff; Bardana, Davide; Lambert, Sue; Sanders, David W.; Howard, Jamie; Macleod, Mark; Bartly, C. T.; Tieszer, Christina; Peterson, Devin; Zalzal, Paul; Maumetz, Victor; Brien, Heather; Weening, Brad; Wai, Eugene K.; Roffey, Darren; McCormack, Robert; Stone, Trevor; Perey, Bertrand; Viskontas, Darius; Boyer, Dory; Perey, Bert; Zomar, Mauri; Moon, Karyn; Oatt, Amber; McKee, Michael; Hall, Jeremy; Ahn, Henry; Vicente, Milena R.; Wild, Lisa M.; Kreder, Hans J.; Stephen, David J. G.; Nousianinen, Markku; Cagaanan, Ria; Kunz, Monica; Syed, Khalid; Azad, Tania; Coles, Chad; Leighton, Ross; Johnstone, David; Glazebrook, Mark; Alexander, David; Trask, Kelly; Dobbin, Gwendolyn; Oliver, Todd M.; Jones, Vicky; Ronan, James; Brown, Desmond T.; Carlilse, Hope; Shaughnessy, Lisa; Schwappach, John; Davis, Craig A.; Weingarten, Peter; Weinerman, Stewart; Newman, Heike; Baker, Janell; Browner, Kieran; Hurley, Meghan; Zura, Robert; Manson, Maria J.; Goetz, David; Broderick, Scott J.; Porter, Scott; Pace, Thomas; Tanner, Stephanie L.; Snider, Becky; Schmidt, Andrew H.; Haas, Jonathan; Templeman, David; Westberg, Jerald R.; Mullis, Brian; Ertl, J. P.; Shively, Karl; Frizzel, Valda; Marcantonio, Andrew J.; Iorio, Richard; Lobo, Margaret; Kain, Michael; Specht, Lawrence; Garfi, John; Prayson, Michael J.; Davis, Craig; Laughlin, Richard; Rubino, Joe; Lawless, Mathew; DiPaola, Matt; Gaydon, Chris; Dulaney, Liz; Vallier, Heather A.; Wilber, John; Sontich, John; Patterson, Brendan; Dolenc, Andrea; Robinson, Chalitha; Wilber, Roger; DePaolo, Charles J.; Alosky, Rachel; Shell, E. Leslie; Keeve, Jonathan P.; Anderson, Chris; McDonald, Michael; Hoffman, Jodi; Baele, Joseph; Weber, Tim; Edison, Matt; Musapatika, Dana; Jones, Clifford; Ringler, James; Endres, Terrance; Gelbke, Martin; Jabara, Michael; Sietsema, Debra L.; Engerman, Susan M.; Switzer, Julie A.; Li, Mangnai; Marston, Scott; Cole, Peter; Vang, Sandy X.; Foley, Amy; McBeth, Jessica; Comstock, Curt; Ziran, Navid; Shaer, James; Hileman, Barbara; Karges, David; Cannada, Lisa; Watson, John Tracy; Mills, Emily; Simon, Tiffany; Abdelgawad, Amr; Shunia, Juan; Jenkins, Mark; Zumwalt, Mimi; Romero, Amanda West; Lowe, Jason; Goldstein, Jessica; Zamorano, David P.; Lawson, Deanna; Archdeacon, Michael; Wyrick, John; Hampton, Shelley; Lewis, Courtland G.; Ademi, Arben; Sullivan, Raymond; Caminiti, Stephanie; Graves, Matthew; Smith, Lori; Della Rocca, Gregory J.; Crist, Brett D.; Murtha, Yvonne; Anderson, Linda K.; Kliewer, Toni K.; McPherson, Melinda K.; Sullivan, Kelly M.; Sagebien, Carlos; Seuffert, Patricia; Mehta, Samir; Esterhai, John; Ahn, Jaimo; Tjoumakaris, Fotios; Horan, Annamarie D.; Kaminski, Christine; Tarkin, Ivan; Siska, Peter; Luther, Arlene; Irrgang, James; Farrell, Dana; Gorczyca, John T.; Gross, Jonathan M.; Kates, Stephen Lloyd; Colosi, Jen; Hibsch, Nancy; Noble, Krista; Agarwal, Animesh; Wright, Rebecca; Houston, Sam; Hsu, Joseph R.; Ficke, James R.; Napierala, Matthew A.; Charlton, Michael T.; Fan, Mary K.; Obremskey, William T.; Richards, Justin E.; Robinson, Kenya

    2012-01-01

    Surgeons in the Netherlands, Canada and the US participate in the FAITH trial (Fixation using Alternative Implants for the Treatment of Hip fractures). Dutch sites are managed and visited by a financed central trial coordinator, whereas most Canadian and US sites have local study coordinators and

  3. Exploring Partnerships between Local Communities and Timber Companies: An Experiment Using the Role-Playing Games Approach

    Directory of Open Access Journals (Sweden)

    Herry Purnomo

    2009-01-01

    Full Text Available Cooperation among stakeholders is widely accepted as an effective management strategy. This paper describes an experimental study that explores this cooperation using role-playing games, which is formulated within a multiagent simulation framework. This framework enables participants to take active roles in mimicking the collaborative decision environment and the behaviors and attitudes of the different stakeholders. The paper examines a forest plantation company in South Sumatra, Indonesia, which has cooperated with local communities since 2000. The experimental pilot study described in this paper explored the role of communication in partnership relationships between the company and the local communities living within and around the surroundings of the company's plantation. These partnerships were explored and analyzed using the gaming approach involving university students taking the role of forest stakeholders, from both the timber company and the local communities. Lessons learned from the game provided the rationale for the establishment of a communication institution called “Forum Sebahu Sejalan.” This formal forum was constituted after a facilitated ex-postinteraction between representatives from the timber company and local communities. Results and observations drawn from the interactions show the potentials of the RPG approach and the formal forum in crafting resilient partnerships among stakeholders.

  4. Central coordination as an alternative for local coordination in a multicenter randomized controlled trial: the FAITH trial experience.

    NARCIS (Netherlands)

    Zielinski, S.M.; Viveiros, H.; Heetveld, M.J.; Swiontkowski, M.F.; Bhandari, M.; Patka, P.; Lieshout, E.M. van; Kampen, A. van; Gardeniers, J.W.; Biert, J.; Poelhekke, L.M.S.J.

    2012-01-01

    BACKGROUND: Surgeons in the Netherlands, Canada and the US participate in the FAITH trial (Fixation using Alternative Implants for the Treatment of Hip fractures). Dutch sites are managed and visited by a financed central trial coordinator, whereas most Canadian and US sites have local study

  5. Central coordination as an alternative for local coordination in a multicenter randomized controlled trial: The FAITH trial experience

    NARCIS (Netherlands)

    S.M. Zielinski (Stephanie); H. Viveiros (Helena); M.J. Heetveld (Martin); M.F. Swiontkowski (Marc ); M. Bhandari (Mohit); P. Patka (Peter); E.M.M. van Lieshout (Esther)

    2012-01-01

    textabstractBackground: Surgeons in the Netherlands, Canada and the US participate in the FAITH trial (Fixation using Alternative Implants for the Treatment of Hip fractures). Dutch sites are managed and visited by a financed central trial coordinator, whereas most Canadian and US sites have local

  6. Local gene targeting and cell positioning using magnetic nanoparticles and magnetic tips: comparison of mathematical simulations with experiments.

    Science.gov (United States)

    Kilgus, Carsten; Heidsieck, Alexandra; Ottersbach, Annika; Roell, Wilhelm; Trueck, Christina; Fleischmann, Bernd K; Gleich, Bernhard; Sasse, Philipp

    2012-05-01

    Magnetic nanoparticles (MNPs) and magnets can be used to enhance gene transfer or cell attachment but gene or cell delivery to confined areas has not been addressed. We therefore searched for an optimal method to simulate and perform local gene targeting and cell delivery in vitro. Localized gene transfer or cell positioning was achieved using permanent magnets with newly designed soft iron tips and MNP/lentivirus complexes or MNP-loaded cells, respectively. Their distribution was simulated with a mathematical model calculating magnetic flux density gradients and particle trajectories. Soft iron tips generated strong confined magnetic fields and could be reliably used for local (~500 μm diameter) gene targeting and positioning of bone marrow cells or cardiomyocytes. The calculated distribution of MNP/lentivirus complexes and MNP-loaded cells concurred very well with the experimental results of local gene expression and cell attachment, respectively. MNP-based gene targeting and cell positioning can be reliably performed in vitro using magnetic soft iron tips, and computer simulations are effective methods to predict and optimize experimental results.

  7. A experiência barroca e a identidade local na Semana Santa de Campanha, Minas Gerais The baroque experience and local Identity in the Holy Week of Campanha, Minas Gerais

    Directory of Open Access Journals (Sweden)

    Suzel Ana Reily

    2011-12-01

    Full Text Available Este trabalho analisa a formação de uma sensibilidade barroca em Minas Gerais a partir da orientação participativa e altamente emotiva das festas coloniais, cujo legado se mantem presente nas festas religiosas de muitas antigas cidades mineradoras do estado. Enfocando as celebrações da Semana Santa na cidade sul-mineira de Campanha, o texto mostra como este evento anual era organizado pela Irmandade do Santíssimo Sacramento, passando então às mãos de uma comissão local após a extinção da irmandade. Se até meados do século XIX, havia músicos semi-profissionais contratados para tocar e cantar nas celebrações, a música foi assumida progressivamente por grupos de amadores. Assim, a festa passou a ser entendida como uma produção local e a cada ano a população renova o seu orgulho campanhense, ao contemplar sua capacidade de produzir um evento tão 'maravilhoso'.This paper analyses the formation of a baroque sensibility in the State of Minas Gerais (Brazil that derives from the participatory and highly emotive orientation of the colonial festivals, the legacy of which is still present in many former mining towns in the region. By focusing upon the Holy Week celebrations in Campanha, a small town in southern Minas Gerais, the text shows how this annual event was organized by the Confraternity of the Holy Sacrament, but was then transferred to a local committee after the confraternity was made extinct. If up to the mid 19th century there were semi-professional musicians to perform for the celebrations, responsibility for the music was slowly taken over by amateur groups. In this way the festival came to be understood as a local affair, and each year the population renews its pride in itself for its capacity to stage such a 'marvelous' event.

  8. Solar Wind Charge Exchange and Local Hot Bubble X-Ray Emission with the DXL Sounding Rocket Experiment

    Science.gov (United States)

    Galeazzi, M.; Collier, M. R.; Cravens, T.; Koutroumpa, D.; Kuntz, K. D.; Lepri, S.; McCammon, D.; Porter, F. S.; Prasai, K.; Robertson, I.; hide

    2012-01-01

    The Diffuse X-ray emission from the Local Galaxy (DXL) sounding rocket is a NASA approved mission with a scheduled first launch in December 2012. Its goal is to identify and separate the X-ray emission of the SWCX from that of the Local Hot Bubble (LHB) to improve our understanding of both. To separate the SWCX contribution from the LHB. DXL will use the SWCX signature due to the helium focusing cone at 1=185 deg, b=-18 deg, DXL uses large area propostionai counters, with an area of 1.000 sq cm and grasp of about 10 sq cm sr both in the 1/4 and 3/4 keY bands. Thanks to the large grasp, DXL will achieve in a 5 minule flight what cannot be achieved by current and future X-ray satellites.

  9. The effect of the introduction of a nationwide DUR system where local DUR systems are operating--The Korean experience.

    Science.gov (United States)

    Yang, Ju-Hyun; Kim, Mira; Park, Young-Taek; Lee, Eui-Kyung; Jung, Chai Young; Kim, Sukil

    2015-11-01

    Outpatient clinics in Korea usually have local DUR (drug utilisation review) systems, which are integrated with EMRs or health insurance claims submission systems. Whenever, the government announces a list of drug contraindications, each local DUR system loads the list and applies it in practice. In December 2010, a nationwide DUR system was introduced. This study is to investigate the impact of the nationwide DUR system on prescribing practices where local DUR systems are already operating. Between January 2009 and December 2012 the monthly number of drugs per prescription was retrieved from the health insurance claims data warehouse at the Health Insurance Review and Assessment (HIRA). The monthly proportions of 3 DDI (drug-drug interaction) pairs, 6 drug-age contraindications, and 3 drug-pregnancy contraindications from January 2007 to December 2012, at the outpatient clinic level, were also retrieved. An interrupted time series analysis was used for controlling government announcements of drug contraindications. There was no difference in the number of drugs per prescription before and after the introduction of the nationwide DUR system. Most proportions of the 3 DDI pairs, 6 drug-age contraindications, and 3 drug-pregnancy contraindications, were significantly reduced following the government announcement of drug contraindications in the short term and/or long term. The number of drugs per prescription was not related to the nationwide DUR introduction in places where local DUR systems are operating. The introduction of duplicate guidelines, in locations where the guidelines were already well followed, is considered to be the main reason for this. Furthermore, the Doctor's ignorance of alerts, and their continued substitution of regulated drugs, for non-regulated drugs, likely played a role in nullifying the effectiveness of the nationwide DUR system. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  10. HIFU therapy for local recurrence of prostate cancer after external beam radiotherapy and radical prostatectomy - 5,5 years experience

    Science.gov (United States)

    Solovov, V. A.; Vozdvizhenskiy, M. O.; Matysh, Y. S.

    2017-03-01

    Objectives. To evaluate the clinical efficacy of high-intensity focused ultrasound ablation (HIFU) for local recurrence of prostate cancer after external beam radiotherapy (EBRT) and radical prostatectomy (RPE). Materials and Methods: During 2007-2013 years 47 patients with local recurrence of prostate cancer after EBRT and RPE undertook HIFU therapy on the system "Ablaterm» (EDAP, France). Relapse arose after an average of 2 years after EBRT and RPE. Median follow-up after HIFU therapy was 38 (12-60) months. The mean age was 68.5 ± 5.8 years. The median PSA level before HIFU - 15.4 (7-48) ng / mL. Results: In 34 patients (72.3%) at six months after treatment the median PSA was 0.4 (0-3.2) ng / mL, in 48 months - 0.9 (0.4-7.5) ng / mL. In 13 patients (27.7%) at 6 months was observed progression of the disease. In general, after a 5-year follow-up 72.3% of the patients had no data for the progression and recurrence. Conclusion: HIFU therapy in patients with local recurrence of prostate cancer after EBRT and RPE is minimally invasive and effective technology.

  11. Lazer, esporte e cultura na agenda local: a experiência de promoção da saúde em Manguinhos Leisure, sports and culture on the local agenda: the Manguinhos’ health promotion experience

    Directory of Open Access Journals (Sweden)

    Fabio de Faria Peres

    2005-09-01

    Full Text Available Localizada na Zona Norte da cidade do Rio de Janeiro e composta por 11 favelas, a região de Manguinhos é marcada pela pobreza e pela desigualdade, demonstrando o estado de omissão de políticas públicas. Constituiu-se naquela região uma política de Desenvolvimento Local (DL e de Promoção da Saúde que provocou uma revitalização da vida associativa e um intenso debate acerca das demandas presentes nas comunidades. Lazer, cultura e esporte apareceram como forte demanda das lideranças comunitárias. Este artigo trata da compreensão dos significados e valores que os líderes comunitários atribuem ao lazer, à cultura e ao esporte. Buscamos entender a prática e a ação dessas lideranças e seus conflitos internos no papel de mediadores culturais. Foram identificadas diferenças na prática política entre os líderes comunitários. Trata-se de um cenário permeado por clivagens e desconfianças que representam consideráveis "dilemas da ação coletiva". Assim, a baixa capacidade de ação cooperativa entre as diversas lideranças locais acaba por prejudicar a elaboração de uma agenda comum a ser negociada com o poder público e demais organizações sociais do local, dificultando o encaminhamento das demandas, em particular, aquelas em torno de lazer, esporte e cultura.Located in the north zone of Rio de Janeiro City and consisting of eleven slums, Manguinhos is marked by poverty and social inequalities, showing a lack of public policies. The constitution of a Local Development (DL and Health Promotion policy in the region revitalized the association life and raised a heated debate about the present demands. The main focus is to understand the meanings and values that the community leaders attribute to leisure, sport and culture and the political practice and relation between these leaderships, and their internal conflicts. Differences in the everyday political practice of the community leaders were identified. This creates a

  12. Role of radiotherapy in local control of non-AIDS associated Kaposi's sarcoma patients in Korea: a single institution experience

    Energy Technology Data Exchange (ETDEWEB)

    Chang, Ji Hyun; Kim, Il Han [Seoul National University College of Medicine, Seoul (Korea, Republic of)

    2012-12-15

    There has been no definite consensus on standard treatment, either local or systemic, for the Kaposi's sarcoma (KS). Radiotherapy (RT) can be a good local therapeutic choice especially in non-AIDS associated KS (NAKS) for its indolent behavior. Medical records of 17 KS patients treated with RT at the Seoul National University Hospital from February 1998 to January 2012 were retrospectively reviewed. One human immunodeficiency virus (HIV)+ patient with 3 lesions was excluded. The total number of the lesion was 23 among the 16 patients. The median follow-up period was 27.9 months. Correlation between response and variables was analyzed using the logistic regression model. Median age of the patients was 75 years. All the 23 lesions were located at the extremities. Fourteen (61%) of those had pain or local swelling as the initial presentation. Ten patients had possible causes of immunodeficiency and were regarded as iatrogenic, and other 6 were classic KS. Median dose of RT was 36 Gy. No KS-related death was observed. Excluding 2 with short-term follow-up only, complete response and partial response were obtained in 2 (9%) and 19 (73%) lesions, respectively. Of those, 3 lesions underwent local progression. Six had out-of-field recurrence after RT. Symptom improvement was achieved in 13 (93%) of 14 patients. Grade 2 skin toxicities were found in 9 lesions but all got improvement after treatment. When divided into responsive and progressive group, free from progression was not related to any of the possible variables. RT is effective in local control of NAKS resulting great response rate.

  13. Local Foods, Local Places

    Science.gov (United States)

    The Local Foods, Local Places technical assistance program protects human health and the environment, spurs revitalization, increases access to healthy foods, and creates economic opportunities by promoting local foods.

  14. 张晓丹教授运用两地汤治疗月经先期量少的临床经验%Clinical experience of Prof. ZHANG Xiao-dan for treating menstruation with the Liangdi decoction

    Institute of Scientific and Technical Information of China (English)

    范道艳; 张晓丹

    2014-01-01

    张晓丹教授有着丰富的临床经验,尤其擅长治疗月经不调。本文从病因病机、临床选方、用药指导和病案举例四个方面介绍张晓丹教授运用两地汤治疗月经先期量少的临床经验。%Prof. ZHANG Xiao-dan gained rich experience for treating menstruation. The experience for treating menstruation with the Liangdi decoction was introduced from four aspects, including pathogenesis, prescription, medication guide and medical records.

  15. {sup 18}F-Choline Positron Emission Tomography/Computed Tomography and Multiparametric Magnetic Resonance Imaging for the Detection of Early Local Recurrence of Prostate Cancer Initially Treated by Radiation Therapy: Comparison With Systematic 3-Dimensional Transperineal Mapping Biopsy

    Energy Technology Data Exchange (ETDEWEB)

    Kanoun, Salim, E-mail: Salim.kanoun@gmail.com [Department of Nuclear Medicine, Centre Georges-François Leclerc, Dijon (France); LE2I UMR6306, Centre national de la recherche scientifique, Arts et Métiers, Université Bourgogne Franche-Comté, Dijon (France); MRI Unit, Centre Hospitalier Régional Universitaire, Hôpital François Mitterrand, Dijon (France); Walker, Paul [LE2I UMR6306, Centre national de la recherche scientifique, Arts et Métiers, Université Bourgogne Franche-Comté, Dijon (France); MRI Unit, Centre Hospitalier Régional Universitaire, Hôpital François Mitterrand, Dijon (France); Vrigneaud, Jean-Marc; Depardon, Edouard [Department of Nuclear Medicine, Centre Georges-François Leclerc, Dijon (France); Barbier, Vincent [Department of Urology, Centre Hospitalier Régional Universitaire, Hôpital François Mitterrand, Dijon (France); Humbert, Olivier [Department of Nuclear Medicine, Centre Georges-François Leclerc, Dijon (France); Moulin, Morgan [Department of Urology, Centre Hospitalier Régional Universitaire, Hôpital François Mitterrand, Dijon (France); and others

    2017-04-01

    Purpose: To compare the diagnostic performance of {sup 18}F-fluorocholine positron emission tomography/computed tomography (FCH-PET/CT), multiparametric prostate magnetic resonance imaging (mpMRI), and a combination of both techniques for the detection of local recurrence of prostate cancer initially treated by radiation therapy. Methods and Materials: This was a retrospective, single-institution study of 32 patients with suspected prostate cancer recurrence who underwent both FCH-PET/CT and 3T mpMRI within 3 months of one another for the detection of recurrence. All included patients had to be cleared for metastatic recurrence. The reference procedure was systematic 3-dimensional (3D)-transperineal prostate biopsy for the final assessment of local recurrence. Both imaging modalities were analyzed by 2 experienced readers blinded to clinical data. The analysis was made per-patient and per-segment using a 4-segment model. Results: The median prostate-specific antigen value at the time of imaging was 2.92 ng/mL. The mean prostate-specific antigen doubling time was 14 months. Of the 32 patients, 31 had a positive 3D-transperineal mapping biopsy for a local relapse. On a patient-based analysis, the detection rate was 71% (22 of 31) for mpMRI and 74% (23 of 31) for FCH-PET/CT. On a segment-based analysis, the sensitivity and specificity were, respectively, 32% and 87% for mpMRI, 34% and 87% for FCH-PET/CT, and 43% and 83% for the combined analysis of both techniques. Accuracy was 64%, 65%, and 66%, respectively. The interobserver agreement was κ = 0.92 for FCH-PET/CT and κ = 0.74 for mpMRI. Conclusions: Both mpMRI and FCH-PET/CT show limited sensitivity but good specificity for the detection of local cancer recurrence after radiation therapy, when compared with 3D-transperineal mapping biopsy. Prostate biopsy still seems to be mandatory to diagnose local relapse and select patients who could benefit from local salvage therapy.

  16. Experience of weekly cisplatin concurrent with intensity-modulated radiotherapy for locally advanced nasopharyngeal carcinoma patients with resistance to neoadjuvant chemotherapy.

    Science.gov (United States)

    Chen, Chuanben; Chen, Taojun; Huang, Chaoxiong; Wang, Jing; Fei, Zhaodong

    2017-11-01

    Nasopharyngeal carcinoma (NPC) is highly sensitive to radiotherapy. Locally advanced NPC has a relatively poor prognosis if treated with radiotherapy alone. Several studies have demonstrated that chemoradiotherapy confers survival benefit in locally advanced NPC. However, a small proportion of patients are resistant to chemotherapy based on cisplatin. So, it is important to make a valuable and inexpensive schedule for these patients. After 2 cycles of neoadjuvant chemotherapy that consisted of gemcitabine and cisplatin (80 mg/m, every 3 weeks) or paclitaxel and cisplatin (80 mg/m, every 3 weeks), magnetic resonance imaging (MRI) was used to evaluate efficacy. A total of 13 patients with extensive nodal disease or/and bulky tumors volume were determined with a stable disease (SD) and enrolled in this study. Cisplatin at a dose of 30 mg/m administered weekly concurrent with intensity-modulated radiotherapy (IMRT) was used to treat these patients resistant to neoadjuvant chemotherapy. The efficacy was evaluated by tumor response and the change of tumor volume. After the completion of concurrent chemoradiotherapy (CCRT), the overall tumor response was a complete response (CR) for 4 of 13 (30.8%) patients and partial response (PR) for 9 of 13 (69.2%) patients. The mean primary tumor volume was reduced by 59.7% and 89.8% at the 24th fraction of IMRT and after the completion of IMRT, respectively. The mean nodal volume was reduced by 63.8% and 93.5% at the 24th fraction of IMRT and after completion of IMRT, respectively. The study showed that weekly cisplatin concurrent with IMRT improved the treatment parameters for locally advanced NPC with resistance to neoadjuvant chemotherapy based on cisplatin. It was a valuable and relatively inexpensive schedule to improve the prognosis for these patients.

  17. The Saudi experience with neutron therapy in locally advanced head and neck cancers; L`experience saoudienne de neutrontherapie dans des cas de cancers localement avances de la tete et du cou

    Energy Technology Data Exchange (ETDEWEB)

    Flores, A.D.; Kandil, A.; Jamshed, A.; Khafaga, Y.; Schultz, H.; Rostom, A.; El Houssainy, G.; Abdallah, H.; El-Akkad, S.; Vol, E.B. de; El Beteri, A. [King Faisal Specialist Hospital, Riyadh (Saudi Arabia)

    1996-12-31

    The neutron therapy program at King Faisal Specialist Hospital and Research Center conducted a phase II study to evaluate the toxicity and efficacy of neutrons against conventional external megavoltage irradiation in patients with locally advanced head and neck malignancy. One hundred and nineteen patients were allocated to receive either photons (46/119) or neutrons (73/119). Radiation effects were scored according to the EORTC/RTOG criteria; data was collected weekly during treatment, once a month for the first year and at 6-month intervals subsequently. While acute effects were scored in all patients, only 59 were evaluable for late effects and locoregional control. A composite of the average reaction results were obtained using this information, to compare them in time, for acute and late effects in both arms of the study. The maximum acute reactions in the two groups were similar. In the majority of the patients (80 %) acute skin and mucosal reactions occurred during the last week of treatment. The changes in the subcutaneous tissues and salivary glands became clinically apparent at 3 months or later. Salivary gland toxicity was more severe in the photon arm and the difference was statistically significant at 3 months (P + 0.04) but this was lost at 12 months. Late effects for skin and subcutaneous tissues were significantly more severe in the neutron arm with P values of 0.04 and 0.01 respectively. Three patients in the neutron arm died of grade 4 radiation complications. The local control and survival were similar in both groups. (author). 5 refs.

  18. Integrating watershed hydrology and economics to establish a local market for water quality improvement: A field experiment

    Science.gov (United States)

    Innovative market mechanisms are being increasingly recognized as effective decision-making institutions to incorporate the value of ecosystem services into the economy. We present a field experiment that integrates an economic auction and a biophysical water flux model to develo...

  19. Retrospective cohort study comparing neonatal outcomes of women treated with glyburide or insulin in gestational diabetes: a 5-year experience in a South Indian teaching hospital.

    Science.gov (United States)

    Mathews, Jiji Elizabeth; Biswas, Biwas; Samuel, Prasanna; Jana, Atanu Kumar; Muliyil, Jaya Prakash; Mathai, Matthews

    2011-11-01

    To assess the effectiveness of glyburide in preventing complications of gestational diabetes in neonates as compared to insulin. Information from birth register, maternal and neonatal records were obtained. Five hundred and seventy-seven gestational diabetics with moderate hyperglycemia i.e., with highest fasting plasma glucose value of ≤130 mg/dl and/or highest post-prandial value of ≤250 mg/dl treated with insulin or glyburide were included from a cohort of 769 women needing additional therapy to initial diet therapy during a 5-year period. Thus neonatal outcomes of 303 women treated with insulin and 274 women treated with glyburide were compared. Baseline plasma glucose levels in the group treated with insulin were higher. The mean birth weight (SD) of the neonates in women treated with insulin was 3021.3 g (604.19) as compared to 3104.6 g (499.35, P = 0.07) in the group treated with glyburide. Neonatal outcomes such as hypoglycemia (4.9%, 3.6%, P = 0.44), hypocalcemia (1.3%, 0.7%, P = 0.48), polycythemia (1.7%, 0.7%, P = 0.31), macrosomia (11.6%, 8.7%, P = 0.26), congenital anomalies (2.1%, 2.3%, P = 0.87), birth trauma (1.4%, 1.2%, P = 0.79) were similar in both groups. Neonates of women treated with insulin were more likely to have hyperbilirubinemia (11.5%, 6.5%, P = 0.03). Neonatal outcomes of women treated with glyburide were comparable to those in women treated with insulin. More number of neonates of mothers treated with insulin had hyperbilirubinemia compared to neonates of mothers treated with glyburide (11.5%, 6.5% P = 0.03).

  20. Does radiation dose matter in thyroid cancer?: Patterns of local-regional failure in recurrent and metastatic well-differentiated thyroid cancers treated with dose-painted intensity-modulated radiation therapy.

    Science.gov (United States)

    Shugard, Erin; Chen, Josephine; Quivey, Jeanne M; Glastonbury, Christine M; Khanafshar, Elham; Garsa, Adam A; George, Jonathan R; Yom, Sue S

    2016-08-01

    Due to complex multimodal treatments and a lengthy natural history of disease, the impact of radiation therapy for well-differentiated thyroid cancer (WDTC) is challenging to evaluate. We analysed the effect of dose escalation, as enabled by intensity-modulated radiation therapy (IMRT), on preventing local-regional failure (LRF) of microscopic and macroscopic WDTC. We performed a retrospective review of WDTC patients treated with IMRT from 1998-2011. Diagnostic imaging demonstrating first LRF was registered to the simulation CT containing the treated radiation isodose volumes. Areas of disease progression were contoured and the relationships of LRFs with isodose volumes were recorded. Thirty patients had a median follow-up of 56 months (range = 1-139). Seventeen (57%) had gross residual, five (17%) had microscopic residual and eight (27%) had clear margins at the time of IMRT. Nine patients (30%) developed LRF, at a median time of 44 months (range = 0-116). Of these, six (67%) had been radiated to gross disease and one (11%) had microscopic residual. In the seven analysable cases, only one (14%) LRF occurred within the 70 Gy isodose volume. Marginal LRFs were: four (57%) outside 70 Gy, one (14%) outside 60 Gy and one (14%) outside 50 Gy. All but one recurrence (86%) occurred in the perioesophageal region. Local-regional failure was seen most in patients who had gross disease at the time of IMRT, almost always occurred outside of the 70 Gy volume and was frequently in the area of oesophageal sparing. Meticulous surgical dissection, especially in the perioesophageal region, should be prioritised to prevent long-term LRF. © 2016 The Royal Australian and New Zealand College of Radiologists.

  1. The Italian experience for the recovery of the housing market. An economic model applied to the management of local governments

    Directory of Open Access Journals (Sweden)

    Gianluigi De Mare

    2013-08-01

    Full Text Available Following the crisis generated by the financialization of private real-estate, construction prices have gradually decreased depriving the housing market of the necessary growth stimuli. Many countries have set up measures to revive this highly strategic area for the national economy. With reference to the Campania Region Law n. 19 dated 28 December 2009, known Housing Plan, this work has two objectives: to recognize the fundamental estimation problems that need to be solved in the implementation of the Campania Housing Plan; in addition, predict the effects of the regulations on the regional economy, both in overall terms as well as for each production sector, with particular attention being given to the construction industry. Regarding the first objective, the contents of the law are analysed on the basis of the principles that govern the appraisal. The consequences of the Campania Housing Plan on the economic system are then evaluated using input-output matrices, which are able to capture the structural relationships that exist among the various productive sectors. The numerical calculations require a preliminary investigation aimed at collecting a list of interventions approved by local governments in accordance to the Housing Plan. The cost of the works, as proposed in the applications submitted to the local administrations, is the input data for the implementation of the Social Accounting Matrix 2010 of the Campania Region.

  2. Analysis of clinical and dosimetric factors associated with severe acute radiation pneumonitis in patients with locally advanced non-small cell lung cancer treated with concurrent chemotherapy and intensity-modulated radiotherapy

    Directory of Open Access Journals (Sweden)

    Xu Bo

    2010-05-01

    Full Text Available Abstract Background To evaluate the association between the clinical, dosimetric factors and severe acute radiation pneumonitis (SARP in patients with locally advanced non-small cell lung cancer (LANSCLC treated with concurrent chemotherapy and intensity-modulated radiotherapy (IMRT. Methods We analyzed 94 LANSCLC patients treated with concurrent chemotherapy and IMRT between May 2005 and September 2006. SARP was defined as greater than or equal 3 side effects and graded according to Common Terminology Criteria for Adverse Events (CTCAE version 3.0. The clinical and dosimetric factors were analyzed. Univariate and multivariate logistic regression analyses were performed to evaluate the relationship between clinical, dosimetric factors and SARP. Results Median follow-up was 10.5 months (range 6.5-24. Of 94 patients, 11 (11.7% developed SARP. Univariate analyses showed that the normal tissue complication probability (NTCP, mean lung dose (MLD, relative volumes of lung receiving more than a threshold dose of 5-60 Gy at increments of 5 Gy (V5-V60, chronic obstructive pulmonary disease (COPD and Forced Expiratory Volume in the first second (FEV1 were associated with SARP (p p = 0.001 and V10 (p = 0.015 were the most significant factors associated with SARP. The incidences of SARP in the group with NTCP > 4.2% and NTCP ≤4.2% were 43.5% and 1.4%, respectively (p 50% were 5.7% and 29.2%, respectively (p Conclusions NTCP value and V10 are the useful indicators for predicting SARP in NSCLC patients treated with concurrent chemotherapy and IMRT.

  3. The prognostic value of expression of HIF1α, EGFR and VEGF-A, in localized prostate cancer for intermediate- and high-risk patients treated with radiation therapy with or without androgen deprivation therapy

    Directory of Open Access Journals (Sweden)

    Weber Damien C

    2012-04-01

    Full Text Available Abstract Purpose Androgens stimulate the production of hypoxia-inducible factor (HIF1α and ultimately vascular endothelial growth factor (VEGF-A. Additionally, epithelial growth factor (EGF mediates HIF1α production. Carbonic anhydrase IX (CAIX expression is associated with tumor cell hypoxia in a variety of malignancies. This study assesses the prognostic relation between HIF1α, VEGF-A, EGF Receptor and CAIX expression by immunochemistry in diagnostic samples of patients with intermediate- and high-risk localized prostate cancer treated with radiation therapy, with or without androgen deprivation therapy (ADT. Materials and methods Between 1994 and 2004, 103 prostate cancer patients (mean age, 68.7 ± 6.2, with prostate cancer (mean PSA, 13.3 ± 3.7, were treated with radiation therapy (RT, median dose, 74 Gy. Fifty seven (55.3% patients received ADT (median duration, 6 months; range, 0 – 24. Median follow-up was 97.6 months (range, 5.9 – 206.8. Results Higher EGFR expression was significantly (p = 0.04 correlated with higher Gleason scores. On univariate analysis, HIF1α nuclear expression was a significant (p = 0.02 prognostic factor for biological progression-free survival (bPFS. A trend towards significance (p = 0.05 was observed with EGFR expression and bPFS. On multivariate analysis, low HIF1α nuclear (p = 0.01 and high EGFR (p = 0.04 expression remained significant adverse prognostic factors. Conclusions Our study suggests that high nuclear expression of HIF1α and low EGFR expression in diagnostic biopsies of prostate cancer patients treated with RT ± ADT is associated with a good prognosis.

  4. Municipis contra la segregació escolar: sis experiències de política educativa local

    NARCIS (Netherlands)

    Bonal i Sarró, X.

    2012-01-01

    Municipis contra la segregació escolar recull les experiències de sis municipis catalans (Mataró, Olot, Manlleu, Terrassa, Girona i Valls) que han desplegat polítiques educatives de lluita contra la segregació escolar efectives. És el resultat del treball col·lectiu d’un grup d’experts de l’àmbit

  5. Experiência de 65 anos no tratamento da acne e de 26 anos com isotretinoína oral A 65-year experience treating acne, including 26 years with oral isotretinoin

    Directory of Open Access Journals (Sweden)

    Sebastião de Almeida Prado Sampaio

    2008-08-01

    Full Text Available Este artigo especial foi extraído de uma palestra proferida pelo Prof. Sebastião Sampaio e elaborado em conjunto com a Profa Edileia Bagatin. Reflete a experiência dos autores no tratamento das principais formas de acne nos períodos pré e pós a introdução da isotretinoína oral que revolucionou a abordagem da doença. Esta droga representa a única opção capaz de levar à remissão prolongada ou cura da acne por atuar em todos os mecanismos etiopatogênicos conhecidos até o momento. Evidentemente, deve ser prescrita de acordo com as recomendações vigentes e reservada para casos de difícil controle, com tendência a cicatrizes e com sérias repercussões psico-sociais. Outras modalidades terapêuticas, tópicas e/ou sistêmicas, devem ser consideradas no início do tratamento e nos casos de intensidade leve a moderada.This special article is based on the contents of a lecture given by Sampaio and was written together with Bagatin. It is a summary of the authors’ experience treating various forms of acne before and after the introduction of oral isotretinoin, which revolutionized the management of the disease. Nowadays, this drug is considered the unique option to obtain a prolonged remission or cure of acne due to its action in all etiopathogenic factors involved in the disease. Therefore it should be prescribed in accordance to current recommendations, as well as for difficult cases, including those showing tendency to scars or serious psychological and social repercussions. Other topical and/or systemic therapeutic modalities should be considered in the initial approach and for mild and moderate cases.

  6. Single step therapy for abscess foci localized at different parts of the body using trocar type catheter: Results of two year-experience

    Directory of Open Access Journals (Sweden)

    Orhan Özbek

    2011-12-01

    Full Text Available Objectives: The aim of this study was to emphasize the feasibility and cost effectiveness of trocar type catheter in percutaneous abscess drainage under imaging guidance and to determine the clinical efficacy of the method.Materials and methods: From June 2008 to December 2010, 48 patients who were referred to interventional radiology unit, in order to undergo percutaneous abscess drainage. All was data including age, the organ or the part of the body where the abscess was localized and size of abscess were recorded. Forty-two (87% patients underwent drainage with ultrasonographic guidance, while 6 (13% underwent with computed tomography guidance. One pediatric patient underwent systemic sedation anesthesia (with remiphentanyl and midazolam and the rest of the patient with local anesthesia (with prilocain hydrochlorid. Catheterization procedure with which abscess drainage was done accepted as technically successful.Results: Imaging guided percutaneous abscess drainage procedures were performed with trocar type catheter to localized abscesses in different organs or systems in 48 patients (25 men, 23 women, mean age 52 years, range 2-82 years. Technical success was 100% in all cases. No patient had a complication during the procedure. Time to extraction of percutaneous catheter after drainage procedure was 5-28 days (mean 11.2 days. There was no recurrence except for a case, in which an abscess at the splenectomy site was successfully drained.Conclusion: Percutaneous drainage with imaging guidance using the trocar type catheter should be preferred because of its feasibility, cost-effectiveness, and reduced rate of complications in treating abscesses, which localized at different organ systems.

  7. High-intensity focused ultrasound (HIFU) using Sonablate{trade mark, serif} devices for the treatment of localized prostate cancer: 13-year experience

    Science.gov (United States)

    Uchida, Toyoaki; Tomonaga, Tetsuro; Shoji, Sunao; Kim, Hakushi; Nagata, Yoshihiro

    2012-11-01

    To report on the long-term results of high-intensity focused ultrasound (HIFU) in the treatment of localized prostate cancer. Eight hundred and eighty-four men with prostate cancer treated with Sonablate® (SB) devices were included. All patients were followed for more than 2 years. The patients were divided into three groups: in the first group, 419 patients were treated with SB200/500 from 1999 to 2006; in the second group, 263 patients were treated with SB 500 ver. 4 from 2005 to 2009: in the third group, 202 patients were treated with SB 500 TCM from 2007 up to present. Biochemical failure was defined according to the Phoenix definition (PSA nadir + 2 ng/ml). The mean age, PSA, Gleason score, operation time, and follow-up period in each group were 68, 66 and 67 years, 11.2, 9.7 and 9.3 ng/ml, 6.2, 6.6 and 6.7, 167, 101 and 106 min, and 56, 48 and 36 months, respectively. The biochemical disease-free rate (bDFR) in each group at 5 years was, respectively, 54%, 61% and 84%, and was 50% at 10 years in the SB200/500 group (p<0.0001). The bDFR in patients in the low-, intermediate-, and high-risk groups in all patients at 10 years were 72% and 58%, 44%, respectively (p<0.0001). The BDFR in patients in the low-, intermediate-, and high-risk groups in the SB500 TCM group at 5 years were 97%, 83%, and 74% (p=0.0056). The negative prostate biopsy rates in 3 groups were 81%, 92% and 88%, respectively. As post HIFU complications, urethral stricture, acute epididymitis and urinary incontinence were noted in 18.0%, 6.2% and 1.9%, respectively. Rectourethral fistula was occurred in 0.6% in the first HIFU cases, Postoperative erectile dysfunction was noted in 27% of patients at 2 years after HIFU. HIFU therapy appears to be minimally invasive, efficacious, and safe for patients with localized prostate cancer. Technological advances as well as cultural and economic vectors have caused a shift from to minimally invasive techniques.

  8. Adapting Free, Prior, and Informed Consent (FPIC to Local Contexts in REDD+: Lessons from Three Experiments in Vietnam

    Directory of Open Access Journals (Sweden)

    Thuy Thu Pham

    2015-07-01

    Full Text Available Free, prior, and informed consent (FPIC is a means of ensuring that people’s rights are respected when reducing emissions from deforestation and forest degradation, and enhancing forest carbon stocks (REDD+ projects are established in developing countries. This paper examines how FPIC has been applied in three projects in Vietnam and highlights two key lessons learnt. First, as human rights and democracy are seen as politically sensitive issues in Vietnam, FPIC is likely to be more accepted by the government if it is built upon the national legal framework on citizen rights. Applying FPIC in this context can ensure that both government and citizen’s interests are achieved within the permitted political space. Second, FPIC activities should be seen as a learning process and designed based on local needs and preferences, with accountability of facilitators, two-way and multiple communication strategies, flexibility, and collective action in mind.

  9. Iridium-192 implants for primary breast cancer: experience with placement at the time of wide local excision

    Energy Technology Data Exchange (ETDEWEB)

    McCormick, B.; Wesson, M.F.; Cox, L.; Osborne, M.P.; Petrek, J.A.; Kinne, D.W.

    1988-09-01

    An Ir-192 boost is a technique frequently used to deliver an additional dose of radiation therapy to the tumor bed following breast conserving surgery and combined with external beam radiation therapy to the entire breast for patients with early breast cancer. Traditionally these catheters are placed following completion of 4500-5000 cGy, as a separate procedure. This paper described a Pilot Study identifying placement of the catheters at the time of primary wide local excision, or re-excision in 52 patients. The key to the success of this technique is the achievement of complete hemostasis in the primary cavity, the presence of the radiation oncologist during the surgical procedure itself, and closure of the wound prior to placement of the catheters. Details of the technique, and preliminary patient results are presented.

  10. Enhancing the resilience of local communities threated by natural disaster: the experience of the Project "Shkoder", (Albania)

    Science.gov (United States)

    Pazzi, Veronica; Morelli, Stefano; Fidolini, Francesco; Fanti, Riccardo; Vannocci, Pietro; Krymbi, Ervis; Centoducati, Carlo; Ghini, Alessandro

    2013-04-01

    scenarios can be obtained using relatively simple and low-cost technologies and methods, whose easy accessibility is fundamental for government and academic institutions of poorly developed countries; b) training of the local community (public administrations and volunteers) on the themes of natural risk, disaster prevention and emergency management; c) creating an efficient Civil Protection volunteer system, able to cooperate with the local governmental and scientific institutions in case of natural disasters. The evaluation of the flooding risk in the study area has been carried out by means of HEC-RAS software, while the seismic vulnerability of strategic buildings has been estimated by microtremors analysis. A two-days course has been performed to expose the main results of the field survey and to train the beneficiaries on local vulnerabilities, emergency behaviours and roles. Finally the local authorities and the volunteers, by working together under the supervision of the Italian institutions (National Civil Protection Department and University of Firenze), promoted and realized the first national civil protection relief drill in Albania.

  11. Poly(methyl methacrylate) particles for local drug delivery using shock wave lithotripsy: In vitro proof of concept experiment.

    Science.gov (United States)

    Shaked, Eliav; Shani, Yoav; Zilberman, Meital; Scheinowitz, Mickey

    2015-08-01

    To leverage current local drug delivery systems methodology, there is vast use of polymeric particles serving as drug carriers to assure minimal invasive therapy with little systemic distribution of the released drug. There is an increasing interest in poly(methyl methacrylate) (PMMA) serving as carriers in drug delivery. The study aims to develop PMMA carriers for localized drug delivery and release system, combining innovative biomaterial technology and shock wave lithotripsy (SWL), and to study the effect of SWL on various concentrations of PMMA particles. We prepared PMMA particles that contain horseradish peroxidase (HRP) using a double emulsion technique, and investigated the mechanism of in vitro drug release from the carriers following exposure to SWL. We investigated the correlation between production method modifications, concentrations of the carriers subjected to SWL, and shock wave patterns. We successfully produced PMMA particles as drug carriers and stimulated the release of their contents by SWL; their polymeric shell can be shattered externally by SWL treatment, leading to release of the encapsulated drug. HRP enzyme activity was maintained following the encapsulation process and exposure to high dose of SWL pulses. Increased shock wave number results in increased shattering and greater fragmentation of PMMA particles. The results demonstrate a dose-response release of HRP; quantitation of the encapsulated HRP from the carriers rises with the number of SWL. Moreover, increased concentration of particles subjected to the same dose of SWL results in a significant increase of the total HRP release. Our research offers novel technique and insights into new, site-specific drug delivery and release systems. © 2014 Wiley Periodicals, Inc.

  12. Immunofluorescence localization of levopimaradiene/abietadiene synthase in methyl jasmonate treated stems of Sitka spruce (Picea sitchensis) shows activation of diterpenoid biosynthesis in cortical and developing traumatic resin ducts.

    Science.gov (United States)

    Zulak, Katherine G; Dullat, Harpreet K; Keeling, Christopher I; Lippert, Dustin; Bohlmann, Jörg

    2010-10-01

    Conifers produce terpenoid-rich oleoresin in specialized resin ducts as a main line of defence against pests and pathogens. In spruce species (Picea spp.), axial resin ducts are either present constitutively in the cortex tissue (cortical resin ducts, CRDs) or are formed de novo as traumatic resin ducts (TRDs) in the cambial zone upon attack by insects, fungi or treatment with methyl jasmonate (MeJA). Using immunofluorescence localization we tested if previously formed CRDs respond to MeJA treatment with increased capacity for diterpenoid biosynthesis. We also tested the dynamics of diterpene synthase localization in the cambial zone. Immunofluorescence localization was performed using an antibody against a diterpene synthase, levopimaradiene/abietadiene synthase (LAS), in stem cross-sections of untreated and 0.1% MeJA-treated 4-year old Sitka spruce (P. sitchensis) trees. No fluorescence signal was observed in untreated stem cross-sections; however, signal was present 2 days after treatment with MeJA exclusively in the epithelial cells of CRDs. Fluorescence steadily increased in the CRD epithelial cells 4 and 8 days after treatment. At 8days, additional fluorescence was observed in developing epithelial cells of traumatic resin ducts TRDs in the cambial zone. These results confirm that resin duct epithelial cells are the main site of diterpene biosynthesis in Sitka spruce, diterpenoid biosynthesis is induced in CRD epithelial cells early upon treatment with MeJA, and immature developing TRD epithelial cells produce diterpene synthase enzyme. Overall, the results of this work improve our understanding of spatial and temporal patterns of induced diterpene resin acid biosynthesis in conifers. Copyright © 2010 Elsevier Ltd. All rights reserved.

  13. Intervening in the local health system to improve diabetes care: lessons from a health service experiment in a poor urban neighborhood in India

    Directory of Open Access Journals (Sweden)

    Upendra Bhojani

    2015-11-01

    intervention, particularly with regard to the use of generic medications and the standard treatment guidelines. Doctors’ concerns about the efficacy, quality, availability, and acceptability by patients of generic medications explained limited prescriptions of generic medications. The patients’ perception that ailments should be treated through medications limited the use of non-medical management by the doctors in early stages of diabetes. The other reason for the limited use of the standard treatment guidelines was that these doctors mainly provided follow-up care to patients who were previously put on a given treatment plan by specialists. Maintenance: The intervention facilities continued using posters and television monitors for health education after the intervention period. The use of generic medications and standard treatment guidelines for diabetes management remained very limited. Conclusions: Implementing efficacious health service intervention in a real-world resource-constrained setting is challenging and may not prove effective in improving patient outcomes. Interventions need to consider patients’ and healthcare providers’ experiences and perceptions and how macro-level policies translate into practice within local health systems.

  14. Prognostic Significance of Carbohydrate Antigen 19-9 in Unresectable Locally Advanced Pancreatic Cancer Treated With Dose-Escalated Intensity Modulated Radiation Therapy and Concurrent Full-Dose Gemcitabine: Analysis of a Prospective Phase 1/2 Dose Escalation Study

    Energy Technology Data Exchange (ETDEWEB)

    Vainshtein, Jeffrey M., E-mail: jvainsh@med.umich.edu [Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan (United States); Schipper, Matthew [Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan (United States); Zalupski, Mark M. [Division of Hematology Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan (United States); Lawrence, Theodore S. [Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan (United States); Abrams, Ross [Department of Radiation Oncology, Rush Medical Center, Chicago, Illinois (United States); Francis, Isaac R. [Department of Radiology, University of Michigan, Ann Arbor, Michigan (United States); Khan, Gazala [Division of Hematology Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan (United States); Leslie, William [Division of Hematology Oncology, Department of Internal Medicine, Rush Medical Center, Chicago, Illinois (United States); Ben-Josef, Edgar [Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania (United States)

    2013-05-01

    Purpose: Although established in the postresection setting, the prognostic value of carbohydrate antigen 19-9 (CA19-9) in unresectable locally advanced pancreatic cancer (LAPC) is less clear. We examined the prognostic utility of CA19-9 in patients with unresectable LAPC treated on a prospective trial of intensity modulated radiation therapy (IMRT) dose escalation with concurrent gemcitabine. Methods and Materials: Forty-six patients with unresectable LAPC were treated at the University of Michigan on a phase 1/2 trial of IMRT dose escalation with concurrent gemcitabine. CA19-9 was obtained at baseline and during routine follow-up. Cox models were used to assess the effect of baseline factors on freedom from local progression (FFLP), distant progression (FFDP), progression-free survival (PFS), and overall survival (OS). Stepwise forward regression was used to build multivariate predictive models for each endpoint. Results: Thirty-eight patients were eligible for the present analysis. On univariate analysis, baseline CA19-9 and age predicted OS, CA19-9 at baseline and 3 months predicted PFS, gross tumor volume (GTV) and black race predicted FFLP, and CA19-9 at 3 months predicted FFDP. On stepwise multivariate regression modeling, baseline CA19-9, age, and female sex predicted OS; baseline CA19-9 and female sex predicted both PFS and FFDP; and GTV predicted FFLP. Patients with baseline CA19-9 ≤90 U/mL had improved OS (median 23.0 vs 11.1 months, HR 2.88, P<.01) and PFS (14.4 vs 7.0 months, HR 3.61, P=.001). CA19-9 progression over 90 U/mL was prognostic for both OS (HR 3.65, P=.001) and PFS (HR 3.04, P=.001), and it was a stronger predictor of death than either local progression (HR 1.46, P=.42) or distant progression (HR 3.31, P=.004). Conclusions: In patients with unresectable LAPC undergoing definitive chemoradiation therapy, baseline CA19-9 was independently prognostic even after established prognostic factors were controlled for, whereas CA19-9 progression

  15. Breast conservation surgery and interstitial brachytherapy in the management of locally recurrent carcinoma of the breast: the Allegheny General Hospital experience.

    Science.gov (United States)

    Trombetta, Mark; Julian, Thomas; Bhandari, Tanuja; Werts, E Day; Miften, Moyed; Parda, David

    2008-01-01

    To evaluate lumpectomy followed by interstitial brachytherapy as an acceptable salvage therapy for women who have developed localized recurrence of breast cancer after conservation surgery and postoperative external radiotherapy. Between 1/1998 and 10/2006, 21 patients with T0 or T1 in-breast recurrence of carcinoma were offered interstitial low-dose rate brachytherapy after tumor re-excision as an alternative to salvage mastectomy. All patients had failed lumpectomy followed by standard postoperative external beam radiotherapy (range, 5000-6040cGy) as treatment for the initial breast carcinoma. Seven recurred as ductal carcinoma in situ, 2 as infiltrating lobular carcinoma, and 12 as recurrent invasive carcinoma. The recurrent tumors were excised with final margins of resection free of residual disease per National Surgical Adjuvant Breast and Bowel Project definition. Tumor bed implantation was then carried out with an interstitial technique using (192)Ir with the target volume consisting of the tumor bed plus a minimum 1.0-cm clinical margin. The required minimum dose delivered to the target volume was 4500-5000cGy (range, 4500-5530). Twenty of 21 patients were free of local disease with a median observation time of 40 months (range, 3-69). The single patient who developed a second local recurrence was treated successfully with simple mastectomy. Two patients succumbed to systemic disease at 17 and 24 months after salvage implant therapy. One patient developed a contralateral breast cancer. Cosmetic results defined by the National Surgical Adjuvant Breast and Bowel Project cosmesis scale were acceptable. One patient developed a localized seroma requiring multiple needle aspirations before complete resolution. Two patients developed localized skin breakdown in the tumor bed. One healed after 6 months of conservative treatment. The other healed 9 months later with Grade II cosmesis. This patient also developed a concurrent postoperative wound infection. Repeat

  16. experience

    Directory of Open Access Journals (Sweden)

    Fernanda da R. Becker

    2007-01-01

    Full Text Available La Educación Infantil es un derecho reconocido en la Convención de Derechos de los Niños (2005. Sin embargo, este derecho ha sido pasado por alto, pues muchos países no tienen programas oficiales para los primeros años de infancia, o si tienen algunos programas, éstos no son efectivos. En 1966, el gobierno brasileño adoptó la política de integrar dentro del sector educativo la responsabilidad administrativa de las sala-cunas de niños y niñas de cero a tres años y de los preescolares de cuatro a seis años, lo cual fue un primer paso para la expansión de la provisión de Educación Inicial. Diez años más tarde, todavía hay una carencia de establecimientos públicos y los gobiernos locales no le dan alta prioridad en sus presupuestos a esta fase de la educación. Este artículo se dirige a analizar la experiencia brasileña de Educación Inicial, con el fin de identificar los obstáculos que todavía impiden lograr las metas establecidas. El análisis empírico se enfoca hacia las diferencias entre las regiones del país y entre las etapas de expansión de la Educación Inicial, para medir la brecha existente entre el número de matrículas y la demanda por cupos. Se evalúan los datos oficiales, como el número de establecimientos y de matrículas desde 1996 hasta 2006. El análisis señala algunos obstáculos que deberían superar los gobiernos locales para poder mejorar la provisión y la calidad de la Educación Inicial

  17. Professor Ma’s Experience in Treating Headache in Menstruation%马大正老师治疗经行头痛经验介绍

    Institute of Scientific and Technical Information of China (English)

    李婷; 马大正

    2014-01-01

    [目的]探讨马大正老师治疗各型经行头痛的经验。[方法]通过分析马大正老师对经行头痛病因病机的认识、总结马老的临证思路和典型案例,来阐述马大正老师治疗妇科经行头痛的临床经验。[结果]经过马大正老师的中医辨证方法拟方,分别以外感风邪、肝火上逆、血虚生风、痰浊内阻、肝胃不和、气滞血瘀等治疗各型经行头痛,临床取得良好的效果。[结论]引起经行头痛的病因很多,但马老根据患者的特点辨证论治选方用药精准能取得很好的疗效,对临床治疗经行头痛有很好的指导作用。%Objective To study the traditional Chinese medicine treatment in headache in menstruation of Ma Dazheng professor. [Methods]The paper expounds Professor Ma’s experience in treating headache in menstruation by analyzing the etiology, pathology, summaring the clinical thoughts and citing some typical cases. [Results]After the syndrome differentiation methods fitting which were from Ma Dazheng professor of TCM, good resulets have been achieved in the each model headache of dialectical classification. [Conclusion]The causes of headache have a lot, but according to the characteristics of the patients with the clinical syndrome differentiation, choosing precision wil get very good curative effect, it is a good guide for clinical treatment in a headach in menstruation.

  18. Treating Meningitis

    Science.gov (United States)

    ... David C. Spencer, MD Steven Karceski, MD Treating meningitis Steven Karceski, MD WHAT DID THE AUTHORS STUDY? ... study, “ Dexamethasone and long-term survival in bacterial meningitis, ” Dr. Fritz and his colleagues carefully evaluated 2 ...

  19. LA ENSEÑANZA DEL PASADO LOCAL EN EDUCACIÓN INICIAL: UNA EXPERIENCIA CON ROMPECABEZAS / THE TEACHING OF THE LOCAL PAST IN PRESCHOOL EDUCATION: AN EXPERIENCE WITH PUZZLES

    Directory of Open Access Journals (Sweden)

    Graciela Beatriz Yáñez

    2017-06-01

    Full Text Available La ausencia de material didáctico para la enseñanza del pasado local en la Educación Inicial, particularmente en el caso de la Ciudad de San Luis, es algo notorio y de una preocupación importante para quienes trabajamos en la formación de formadores del nivel y desarrollamos procesos de investigación sobre la temática de la historia y la memoria local. En esta línea de interés, presentamos algunos resultados obtenidos de una experiencia en salas del Nivel Inicial cuyo objeto fue la validación de un equipo de rompecabezas construidos a partir de imágenes del pasado y del presente de hitos arquitectónicos de la Ciudad de San Luis. Este conjunto de rompecabezas es parte de una serie de materiales didácticos diseñados y producidos a partir del conocimiento histórico construido en el proceso de investigación sobre la historia y memoria local a partir del Patrimonio Cultural Arquitectónico de la Ciudad de San Luis para ser utilizado en distintas instancias del sistema educativo y para el público en general. Los resultados nos permiten mirar los procesos generados por las/os niñas y niños para el armado y para el análisis de las imágenes, así como determinar las potencialidades didácticas de los rompecabezas para abordar el pasado local. / The absence of teaching materials for the teaching of the local past in Preschool Education, particularly in the case of the city of San Luis, is a notorious and important concern for those who work in the training of preschool teachers and develop research processes about local history and memory. In this regard, we present some results obtained from an experience in Preschool Education classrooms whose objective was the validation of a set of puzzles built from images of past and present architectural landmarks of the city of San Luis. This set of puzzles is part of a series of didactic materials designed and produced from the historical knowledge built in the research process about local

  20. Centralized Analysis of Local Data, With Dollars and Lives on the Line: Lessons From The Home Radon Experience

    Energy Technology Data Exchange (ETDEWEB)

    Price, PhillipN.; Gelman, Andrew

    2014-11-24

    In this chapter we elucidate four main themes. The first is that modern data analyses, including "Big Data" analyses, often rely on data from different sources, which can present challenges in constructing statistical models that can make effective use of all of the data. The second theme is that although data analysis is usually centralized, frequently the final outcome is to provide information or allow decision-making for individuals. Third, data analyses often have multiple uses by design: the outcomes of the analysis are intended to be used by more than one person or group, for more than one purpose. Finally, issues of privacy and confidentiality can cause problems in more subtle ways than are usually considered; we will illustrate this point by discussing a case in which there is substantial and effective political opposition to simply acknowledging the geographic distribution of a health hazard. A researcher analyzes some data and learns something important. What happens next? What does it take for the results to make a difference in people's lives? In this chapter we tell a story - a true story - about a statistical analysis that should have changed government policy, but didn't. The project was a research success that did not make its way into policy, and we think it provides some useful insights into the interplay between locally-collected data, statistical analysis, and individual decision making.

  1. Local coupling (LoCo) vs. large-scale coupled (LsCo) land-atmosphere interactions in idealized experiments

    Science.gov (United States)

    Gentine, P.; Lintner, B. R.; Findell, K. L.; Rochetin, N.; Sobel, A. H.; Anber, U. M.

    2014-12-01

    We will present two idealized epxeriments/methodologies to investigate local (LoCo) and large-scale (LsCo) coupling between the surface and the atmsophere: the contiental Radiative-Convective Equilibrium (RCE) and the continental Weak Temperature Gradient (WTG). The RCE defines an equilibrium state of coupling between the surafce and the atmosphere isolated from any large-scale dependence, which were investigated within the single column model of the Laboratoire de Meteorologie Dynamique (LMD) coupled to a simple bucket land model. This studies emphasizes the role of low-level cloud and the diurnal cylce of the boundary layer on the final state of the system. In the WTG we investigate the coupling between the surface and the atmosphere during the dry and wet season of the Amazon with the WRF model coupled to the NOAH land-surface model. Large-scale coupling is obtained with the WTG. The dry and wet season demonstrate very fundamental behavior: in the dry season deep convection is generated by radiative cooling in the higher troposhere and is disconnected from the surface. In the wet season the coupling between the surface and the atmosphere is much tighter. We suggest that the WTG is a powerful tool to investigate the coupling between the surface and the atmosphere, which solves two major issues: the limited resolution of convection in GCMs and the lack of large-scale coupling in CRM. Later investigation will look at the effect of deforestation, water table and distance from the ocean.

  2. A Importância dos PCTs para o desenvolvimento local e territorial: a experiência do Parque Tecnológico da Paraíba

    Directory of Open Access Journals (Sweden)

    Elis Regina Neves Barreiro

    2016-01-01

    Full Text Available Ambientes de inovação implantados em países desenvolvidos e em desenvolvimento para dinamizar economias regionais e nacionais, os Parques Científicos e Tecnológicos (PCTs, através da relação Governo-Universidade-Empresa, podem desempenhar o papel de impulsionador do desenvolvimento cientifico e tecnológico local e territorial, tornando as localidades mais competitivas, gerando empregos de qualidade e bem-estar social. O objetivo deste artigo é analisar a relevância dos PCTs para o desenvolvimento local e territorial e apresentar a experiência do Parque Tecnológico da Paraíba. A metodologia utilizada foi a pesquisa bibliográfica, documental e de campo. Os resultados obtidos apontam que a instituição tornou-se uma peça importante no fomento à Ciência e Tecnologia no Estado e para a criação de empresas inovadoras. Apoiado nas sinergias das relações entre o Governo, a Universidade e Empresa, tornou-se uma alternativa viável para promoção do desenvolvimento científico e tecnológico local e territorial, apontam-se, assim, contribuições singulares e relevantes em seu entorno.

  3. carcinomes nasopharynges localement avances locally advanced ...

    African Journals Online (AJOL)

    East Asia and North Africa. The prognosis remains poor for locally advanced stages (IIB -IVB), more than one third of cases presented locally recurrent and ..... Lee A.W.M, Poon Y.F, Foo W et al. Retrospective analysis of 5 037 patients with nasopharyngeal carcinoma treated during 1976-85: ove- rall survival and patterns of ...

  4. Prostatic fiducial markers implantation by transrectal ultrasound for adaptive image guided radiotherapy in localized cancer: 7-years experience

    Directory of Open Access Journals (Sweden)

    Vito Lacetera

    2014-12-01

    Full Text Available Objective: we present our 7-years’ experience with fiducial gold markers inserted before Image-Guided Radiotherapy (IGRT focusing on our echo-guided technique reporting early and late complications. Material and methods: 78 prostate cancer (PCA patients who underwent fiducial markers placement for adaptive IGRT (period 2007-2014 were selected. Mean patient age was 75 years (range 60-81, mean PSA 7.8 ng/ml (range 3.1-10, clinical stage < T3, mean Gleason Score 6.4 (range 6-7. We recorded early and late complications. Maximum distance between the Clinical Target Volume (CTV and Planning Target Volume (PTV was assessed for each direction and the mean PTV reduction was estimated. Results: we describe in details our echo-guided technique of intraprostatic gold fiducial markers insertion prior to adaptative IGRT. We report rare early toxicity (5-7% grade 1-2, a mean PTV reduction of 37% and a very low late toxicity (only 3.4% bladder G3 and 8% rectal G2 side effects. Conclusion: Our technique of fiducial gold markers implantation for adaptative IGRT is safe and well-tolerated and it resulted helpful to reduce CTV-PTV margin in all cases; the effects on clinical practice seem significant in terms of late toxicity but further investigations are needed with longer follow-up.

  5. Locally advanced non inflammatory breast cancer treated by combined chemotherapy and preoperative irradiation: updated results in a series of 120 patients; Cancer du sein localement evolue non inflammatoire traite par association de chimiotherapie et de radiotherapie a dose preoperatoire: reactualisation des resultats d'une serie de 120 patientes

    Energy Technology Data Exchange (ETDEWEB)

    Lerouge, D.; Touboul, E.; Moureau-Zabotto, L. [Hopital Tenon AP-HP, Service d' oncologie-radiotherapie, 75 - Paris (France); Lefran, J.P.; Blondon, J. [Hopital Pitie-Salpetriere AP-HP, Service de chirurgie generale et gynecologique, 75 - Paris (France); Genestie, C. [Hopital Pitie-Salpetriere AP-HP, Service d' anatomopathologie, 75 - Paris (France)

    2004-06-01

    Purpose. - To evaluate our updated data concerning survival and locoregional control in a study of locally advanced non inflammatory breast cancer after primary chemotherapy followed by external preoperative irradiation. Patients and methods. - Between 1982 and 1998, 120 patients (75 stage IIIA, 41 stage IIIB, and 4 stage IIIC according to AJCC staging system 2002) were consecutively treated by four courses of induction chemotherapy with anthracycline-containing combinations followed by preoperative irradiation (45 Gy to the breast and nodal areas) and a fifth course of chemotherapy. Three different locoregional approaches were proposed, depending on tumour characteristics and tumour response. After completion of local therapy, all patients received a sixth course of chemotherapy and a maintenance adjuvant chemotherapy regimen without anthracycline. The median follow-up from the beginning of treatment was 140 months. Results. - Mastectomy and axillary dissection were performed in 49 patients (with residual tumour larger than 3 cm in diameter or located behind the nipple or with bifocal tumour), and conservative treatment in 71 patients (39 achieved clinical complete response or partial response >90% and received additional radiation boost to initial tumour bed; 32 had residual mass {<=}3 cm in diameter and were treated by wide excision and axillary dissection followed by a boost to the excision site). Ten-year actuarial local failure rate was 13% after irradiation alone, 23% after wide excision and irradiation, and 4% after mastectomy (p =0.1). After multivariate analysis, possibility of breast-conserving therapy was related to initial tumour size (<6 vs. {>=}6 cm in diameter, p =0.002). Ten-year overall metastatic disease-free survival rate was 61%. After multivariate analysis, metastatic disease-free survival rates were significantly influenced by clinical stage (stage IIIA-B vs. IIIC, p =0.0003), N-stage (N0 vs. N1-2a, and 3c, p = 0.017), initial tumour size (<6

  6. Predictive and prognostic value of CT based radiomics signature in locally advanced head and neck cancers patients treated with concurrent chemoradiotherapy or bioradiotherapy and its added value to Human Papillomavirus status.

    Science.gov (United States)

    Ou, Dan; Blanchard, Pierre; Rosellini, Silvia; Levy, Antonin; Nguyen, France; Leijenaar, Ralph T H; Garberis, Ingrid; Gorphe, Philippe; Bidault, François; Ferté, Charles; Robert, Charlotte; Casiraghi, Odile; Scoazec, Jean-Yves; Lambin, Philippe; Temam, Stephane; Deutsch, Eric; Tao, Yungan

    2017-08-01

    To explore prognostic and predictive value of radiomics in patients with locally advanced head and neck squamous cell carcinomas (LAHNSCC) treated with concurrent chemoradiotherapy (CRT) or bioradiotherapy (BRT). Data of 120 patients (CRT vs. BRT matched 2:1) were retrospectively analyzed. A total of 544 radiomics features of the primary tumor were extracted from radiotherapy planning computed tomography scans. Cox proportional hazards models were used to examine the association between survival and radiomics features with false discovery rate correction. The discriminatory performance was evaluated using receiver operating characteristic curve analysis. Multivariate analysis showed a 24-feature based signature significantly predicted for OS (HR=0.3, P=0.02) and progression-free survival (PFS) (HR=0.3, P=0.01). Combining the radiomics signature with p16 status showed a significant improvement of prognostic performance compared with p16 (AUC=0.78vs. AUC=0.64 at 5years, P=0.01) or radiomics signature (AUC=0.78vs. AUC=0.67, P=0.01) alone. When patients were stratified according to this combination, OS and PFS were significantly different according to the 4 sub-types (p16+ with low/high signature score; p16- with low/high signature score) (Padded value of radiomics features as prognostic and predictive biomarker in HNSCC treated with CRT/BRT. Moreover, the radiomics signature provided additional information to HPV/p16 status to further stratify patients. External validation of such findings is mandatory given the risk of overfitting. Copyright © 2017 Elsevier Ltd. All rights reserved.

  7. Long- and/or short-range transportation of local Asian aerosols in DRAGON-Osaka Experiment

    Science.gov (United States)

    Nakata, M.; Sano, I.; Mukai, S.; Holben, B. N.

    2013-12-01

    This work intends to demonstrate the spatial and temporal variation of atmospheric particles in East Asia, especially around AERONET (Aerosol Robotics Network) -Osaka site during Dragon Asia period in the spring of 2012, named Dragon-Osaka. It is known that the air pollution in East Asia becomes to be severe due to both