WorldWideScience

Sample records for international adventure therapy

  1. Gestalt and Adventure Therapy: Parallels and Perspectives.

    Science.gov (United States)

    Gilsdorf, Rudiger

    This paper calls attention to parallels in the literature of adventure education and that of Gestalt therapy, demonstrating that both are rooted in an experiential tradition. The philosophies of adventure or experiential education and Gestalt therapy have the following areas in common: (1) emphasis on personal growth and the development of present…

  2. Emotional Safety in Adventure Therapy Programs: Can It Be Defined?

    Science.gov (United States)

    Vincent, Suzanne M.

    1995-01-01

    Ninety-eight adventure therapy professionals analyzed a proposed definition of emotional safety and rated 26 factors hypothesized to affect an individual's level of emotional safety during adventure activities. Factors were related to specific techniques used by instructors, instructor skills and abilities, the physical environment, and group…

  3. Cultural Bridging through Shared Adventure: Cross-Cultural Perspectives on Adventure Therapy

    Science.gov (United States)

    Norton, Christine L.; Hsieh, Chi-Mou

    2011-01-01

    This paper examines the importance of the therapeutic relationship and the need for cultural competence in adventure therapy. Cultural differences between therapist and client can sometimes result in possible misinterpretation and conflict, which can lead to problems in the therapeutic relationship and negatively affect treatment outcomes. This…

  4. An Environmental Scan of Adventure Therapy in Canada

    Science.gov (United States)

    Ritchie, Stephen D.; Patrick, Krysten; Corbould, Gordon Marcus; Harper, Nevin J.; Oddson, Bruce E.

    2016-01-01

    We report on an environmental scan (ES) of adventure therapy (AT) literature, organizations, and activities in Canada. The ES methodology involved (a) an examination of final reports related to a series of national symposiums on AT in Canada, (b) a review of academic literature related to AT in Canada, and (c) a summary of AT programs and courses…

  5. Re-Examining Group Development in Adventure Therapy Groups.

    Science.gov (United States)

    DeGraaf, Don; Ashby, Jeff

    1998-01-01

    Small-group development is an important aspect of adventure therapy. Supplementing knowledge of sequential stages of group development with knowledge concerning within-stage nonsequential development yields a richer understanding of groups. Integrating elements of the individual counseling relationship (working alliance, transference, and real…

  6. Pathway to Efficacy: Recognizing Cognitive Behavioral Therapy as an Underlying Theory for Adventure Therapy.

    Science.gov (United States)

    Gillen, Mark C.

    2003-01-01

    Adventure therapy and cognitive behavioral therapy share elements, including transformation of distorted thinking patterns, a focus on current and future functioning, consideration of the counselor-client relationship, and the use of stress in the change process. Recognizing cognitive behavioral therapy as an empirically sound theory underlying…

  7. An International Polar Year Adventure in the Arctic

    Science.gov (United States)

    Wartes, D.

    2008-12-01

    Native students in the UA system who participated in RAHI are nearly twice as likely to earn a bachelor's degree, than those who did not attend RAHI. The past two summers, in celebration of the International Polar Year, in collaboration with Ilisagvik College, at the completion of the traditional RAHI program, ten RAHI students flew to Barrow for an additional two weeks of study. Five students participated in an archaeological dig and five students performed research with the Barrow Arctic Science Consortium scientists studying climate change. And another student was the Alaskan delegate to the Students on Ice, a 2-week ship-based adventure in northern Canada. In addition, ten students from Greenland visited the program, with plans to more fully participate next summer. This added dimension to the program has proved successful, allowing the students to compare and contrast between their own countries and indigenous perspectives. Global warming was an issue that was hotly debated, as its effects are so evident in the Polar Regions. In the Arctic, one's life is directly tied to the ice and snow. As the ice disappears and/or changes, the Indigenous people have to adapt. RAHI would like to share with you some of the results of this past summer's IPY activities.

  8. Wilderness adventure therapy effects on the mental health of youth participants.

    Science.gov (United States)

    Bowen, Daniel J; Neill, James T; Crisp, Simon J R

    2016-10-01

    Adventure therapy offers a prevention, early intervention, and treatment modality for people with behavioural, psychological, and psychosocial issues. It can appeal to youth-at-risk who are often less responsive to traditional psychotherapeutic interventions. This study evaluated Wilderness Adventure Therapy (WAT) outcomes based on participants' pre-program, post-program, and follow-up responses to self-report questionnaires. The sample consisted of 36 adolescent out-patients with mixed mental health issues who completed a 10-week, manualised WAT intervention. The overall short-term standardised mean effect size was small, positive, and statistically significant (0.26), with moderate, statistically significant improvements in psychological resilience and social self-esteem. Total short-term effects were within age-based adventure therapy meta-analytic benchmark 90% confidence intervals, except for the change in suicidality which was lower than the comparable benchmark. The short-term changes were retained at the three-month follow-up, except for family functioning (significant reduction) and suicidality (significant improvement). For participants in clinical ranges pre-program, there was a large, statistically significant reduction in depressive symptomology, and large to very large, statistically significant improvements in behavioural and emotional functioning. These changes were retained at the three-month follow-up. These findings indicate that WAT is as effective as traditional psychotherapy techniques for clinically symptomatic people. Future research utilising a comparison or wait-list control group, multiple sources of data, and a larger sample, could help to qualify and extend these findings. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

  9. The Use of Adventure Therapy in Community-Based Mental Health: Decreases in Problem Severity among Youth Clients

    Science.gov (United States)

    Tucker, Anita R.; Javorski, Steve; Tracy, Julie; Beale, Bobbi

    2013-01-01

    Background: There is an increasing need to identify effective mental health treatment practices for children and adolescents in community-based settings, due to current mixed findings of existing interventions. This study looked at adventure therapy (AT) as a viable option to meet this need. Objective: Using a sample of 1,135 youth from a…

  10. Adventure-Based Experiential Therapy with Inpatients in Child and Adolescent Psychiatry: An Approach to Practicability and Evaluation

    Science.gov (United States)

    Eckstein, Florian; Rüth, Ulrich

    2015-01-01

    This article examines the use of adventure-based experiential therapy (AET) with child and adolescent psychiatry inpatients. AET environments, indications, practicality, therapeutic effects and research are outlined and clinical findings are reported. Activities such as rock-climbing, exploring a creek and caving are discussed and the limitations…

  11. Adventure tourism

    DEFF Research Database (Denmark)

    Løseth, Kristin

    In a rapidly changing tourism industry, the international competition is strong and the well-travelled tourists have high expectations. This has led to an increasing emphasis on the development of new services and experiences to attract tourists’ attention. Innovation has become a “buzz-word”, seen...... as essential for survival and growth. With cases from Norway and NZ this thesis examines what innovation means in the context of adventure tourism businesses, and explore relations between such change processes and the available knowledge resources of the business. Several factors influence the knowledge...... resources of a given business, and this study looks specifically at how the size of the business, its location, and the maturity of the specific adventure tourism activity shapes processes of knowledge development and innovation. The study takes it starting point in research on small businesses and tourism...

  12. Modeling Internal Radiation Therapy

    NARCIS (Netherlands)

    van den Broek, Egon; Schouten, Theo E.; Pellegrini, M.; Fred, A.; Filipe, J.; Gamboa, H.

    2011-01-01

    A new technique is described to model (internal) radiation therapy. It is founded on morphological processing, in particular distance transforms. Its formal basis is presented as well as its implementation via the Fast Exact Euclidean Distance (FEED) transform. Its use for all variations of internal

  13. Toward an Ecological Paradigm in Adventure Programming

    Science.gov (United States)

    Beringer, Almut

    2004-01-01

    Many forms of adventure therapy, in particular wilderness therapy, rely on challenges in the outdoors to achieve objectives of client change. While nature is drawn on as a medium for therapy and healing, some adventure therapists give nature little if any mention when it comes to explaining therapeutic success. The dominant paradigm in psychology…

  14. Data Adventures

    DEFF Research Database (Denmark)

    A B Barros, Gabriella; Liapis, Antonios; Togelius, Julian

    2015-01-01

    This paper outlines a system for generating adventure games based on open data, and describes a sketch of the system im- plementation at its current state. The adventure game genre has been popular for a long time and diers signicantly in design priorities from game genres which are commonly ad......- dressed in PCG research. In order to create believable and engaging content, we use data from DBpedia to generate the game's non-playable characters locations and plot, and OpenStreetMaps to create the game's levels...

  15. The Volvo Ocean Adventure

    Science.gov (United States)

    Boxall, S. R.; Flechter, S.; Byfield, Y.

    2003-04-01

    The Volvo Ocean Adventure is a web-based international programme for schools and young scientists in the 10-16 age range which was established in June 2001 (www.volvooceanadventure.org). Using the Volvo Ocean Race as its focus it made use of environmental data colletced from the yachts in the round the World race to introduce the public to a wide range of marine environmental topics including pollution, global climate change and fisheries. As well as web-based activities for the class room a variety of "road" shows were established with the race along with an international competition to encourage active participation by young people. The Adventure involved input from over 50 scientists form around the World with the first phase finishing in September 2002. The successes and lessons learned will be presented by the science co-ordinators of the project.

  16. Internal Radiation Therapy for Cancer

    Science.gov (United States)

    When getting internal radiation therapy, a source of radiation is put inside your body, in either liquid or solid form. It can be used treat different kinds of cancer, including thyroid, head and neck, breast, cervix, prostate, and eye. Learn more about how what to expect when getting internal radiation therapy.

  17. International Occupational Therapy Research Priorities.

    Science.gov (United States)

    Mackenzie, Lynette; Coppola, Susan; Alvarez, Liliana; Cibule, Lolita; Maltsev, Sergey; Loh, Siew Yim; Mlambo, Tecla; Ikiugu, Moses N; Pihlar, Zdenka; Sriphetcharawut, Sarinya; Baptiste, Sue; Ledgerd, Richard

    2017-04-01

    Occupational therapy is a global profession represented by the World Federation of Occupational Therapists (WFOT). International research priorities are needed for strategic guidance on global occupational therapy practice. The objective of this study was to develop international research priorities to reflect global occupational therapy practice. A Delphi study using three rounds of electronic surveys, distributed to WFOT member organizations and WFOT accredited universities, was conducted. Data were analyzed after each round, and priorities were presented for rating and ranking in order of importance. Forty-six (53%) out of 87 WFOT member countries participated in the Delphi process. Eight research priorities were confirmed by the final electronic survey round. Differences were observed in rankings given by member organizations and university respondents. Despite attrition at Round 3, the final research priorities will help to focus research efforts in occupational therapy globally. Follow-up research is needed to determine how the research priorities are being adopted internationally.

  18. Bromélia Filminhos and the international adventures of Lottie Dottie Chicken

    Directory of Open Access Journals (Sweden)

    Maria Luiza Carvalho de Aguillar Pinho

    2015-09-01

    Full Text Available This case study examines the trajectory of a company in the audiovisual industry, founded in 2006, responsible for the first Brazilian animated series whose artistic and authorial design was produced entirely in Brazil, to reach the one billion views milestone on YouTube. Created in 2007, the series became a massive hit with children by using the internet as a launching platform and so breaking with the established paradigm of using only traditional media (television and cinema to introduce an animated character. In just 18 months, the company had its brand licensed to more than 600 products, achieving almost 50% of its revenues from licensing in Brazil. In 2012, Bromélia Filminhos began their internationalization process. Management expected that international activities would soon account for 10% of the company revenues. This case study aims to discuss the internationalization of a small animation studio and the business potential for the licensing of Brazilian characters and brands at the national and international levels.

  19. The South African Adventure Tourism Economy: An urban phenomenon

    Directory of Open Access Journals (Sweden)

    McKay Tracey

    2017-09-01

    Full Text Available The international adventure tourism literature is remarkably silent on the geographical nature of the industry. This study seeks to provide a geographical analysis of the sector within the context of South Africa. The spatial analysis was undertaken by metropolitan area, secondary towns and small towns, using a dataset of adventure tourism enterprises. It was found that the sector is spatially concentrated and highly urbanised, despite the perception that adventure tourism requires ‘wild’ and outdoor spaces. With many adventure tourism enterprises located in South Africa’s metropolitan areas, it is a hither too unknown sub-sector of the South African urban tourism market. Urban settlements with large populations and a strong general tourism sector form a significant support base for adventure tourism operators. Cape Town is the dominant adventure tourism destination, making it the adventure capital of South Africa. A few small settlements were found to be highly dependent upon the sector for survival.

  20. Adventure Education: Redux

    Science.gov (United States)

    Brown, Mike; Beames, Simon

    2017-01-01

    This article discusses the meanings of adventure and its role in learning. An analysis of literature from the fields of education, recreation and tourism suggests that definitions of adventure are constantly undergoing reinterpretation. We highlight how "narrow" views of adventure, which appeal to notions of risk and danger, are…

  1. The South African Adventure Tourism Economy: An urban phenomenon

    OpenAIRE

    McKay Tracey

    2017-01-01

    The international adventure tourism literature is remarkably silent on the geographical nature of the industry. This study seeks to provide a geographical analysis of the sector within the context of South Africa. The spatial analysis was undertaken by metropolitan area, secondary towns and small towns, using a dataset of adventure tourism enterprises. It was found that the sector is spatially concentrated and highly urbanised, despite the perception that adventure tourism requires ‘wild’ and...

  2. Fermilab Education Office: Science Adventures

    Science.gov (United States)

    Search The Education Office: Science Adventures Adventure Catalog Search for Adventures Calendar Class Facebook Group. Contact: Science Adventures Registrar, Education Office Fermilab, MS 777, P.O. Box 500 it again." Opportunities for Instructors The Education Office has openings for instructors who

  3. Adventures in Manipulation

    Science.gov (United States)

    Christensen, Bonniejean

    1971-01-01

    Objects to an alleged misrepresentation and inaccurate presentation of a J. R. R. Tolkien quotation in "Adventures in Reading" (Harcourt, Brace & World, 1969), a ninth grade literature anthology. (RD)

  4. Outdoor Adventure er mulighedernes læringslandskab

    DEFF Research Database (Denmark)

    Pedersen, Sune Ib Schou

    2014-01-01

    Global Nutrition and Health er en ny international uddannelse for ernærings- og sundhedsstuderende ved Professionshøjskolen Metropol. De tilbydes Outdoor Adventure, som bryder de vante rammer for undervisning.......Global Nutrition and Health er en ny international uddannelse for ernærings- og sundhedsstuderende ved Professionshøjskolen Metropol. De tilbydes Outdoor Adventure, som bryder de vante rammer for undervisning....

  5. Outdoor Adventure er mulighedernes læringslandskab

    DEFF Research Database (Denmark)

    Pedersen, Sune

    2015-01-01

    Global Nutrition and Health er en ny international uddannelse for ernærings- og sundhedsstuderende ved Professionshøjskolen Metropol. De tilbydes Outdoor Adventure, som bryder de vante rammer for undervisning.......Global Nutrition and Health er en ny international uddannelse for ernærings- og sundhedsstuderende ved Professionshøjskolen Metropol. De tilbydes Outdoor Adventure, som bryder de vante rammer for undervisning....

  6. Nursing care update: Internal radiation therapy

    International Nuclear Information System (INIS)

    Lowdermilk, D.L.

    1990-01-01

    Internal radiation therapy has been used in treating gynecological cancers for over 100 years. A variety of radioactive sources are currently used alone and in combination with other cancer treatments. Nurses need to be able to provide safe, comprehensive care to patients receiving internal radiation therapy while using precautions to keep the risks of exposure to a minimum. This article discusses current trends and issues related to such treatment for gynecological cancers.20 references

  7. The adventure of numbers

    CERN Document Server

    Godefroy, Gilles

    2004-01-01

    Numbers are fascinating. The fascination begins in childhood, when we first learn to count. It continues as we learn arithmetic, algebra, geometry, and so on. Eventually, we learn that numbers not only help us to measure the world, but also to understand it and, to some extent, to control it. In The Adventure of Numbers, Gilles Godefroy follows the thread of our expanding understanding of numbers to lead us through the history of mathematics. His goal is to share the joy of discovering and understanding this great adventure of the mind. The development of mathematics has been punctuated by a n

  8. Adventure and Extreme Sports.

    Science.gov (United States)

    Gomez, Andrew Thomas; Rao, Ashwin

    2016-03-01

    Adventure and extreme sports often involve unpredictable and inhospitable environments, high velocities, and stunts. These activities vary widely and include sports like BASE jumping, snowboarding, kayaking, and surfing. Increasing interest and participation in adventure and extreme sports warrants understanding by clinicians to facilitate prevention, identification, and treatment of injuries unique to each sport. This article covers alpine skiing and snowboarding, skateboarding, surfing, bungee jumping, BASE jumping, and whitewater sports with emphasis on epidemiology, demographics, general injury mechanisms, specific injuries, chronic injuries, fatality data, and prevention. Overall, most injuries are related to overuse, trauma, and environmental or microbial exposure. Copyright © 2016 Elsevier Inc. All rights reserved.

  9. Teamwork in adventure racing

    OpenAIRE

    Šavrňák, Ondřej

    2011-01-01

    Title: Teamwork in Adventure racing Goals: The main goal is to make up the chapter about an ideal teamwork in Adventure racing. And so, to help starting teams but also help experienced teams to learn about their lacks in cooperation and to shift teamwork level above. Method: We used the method of literature retrieval from books, articles and researches. Results: It is very hard task to define ideal teamwork, we would not find same two teams in the world and therefore each team suits something...

  10. Adventure in a Bun.

    Science.gov (United States)

    Loynes, Chris

    1998-01-01

    Aspects of outdoor adventure education such as sport and risk are increasingly commercialized, whereas the core value of connection--to community, the environment, or other people--is being lost. A shift from providing challenge to encouraging exploration may enable programs emphasizing connection to find a home in the "third sector"…

  11. Migration as Adventure

    DEFF Research Database (Denmark)

    Olwig, Karen Fog

    2018-01-01

    Narratives of adventure constitute a well-established convention of describing travel experiences, yet the significance of this narrative genre in individuals’ accounts of their migration and life abroad has been little investigated. Drawing on Simmel and Bakhtin, among others, this article...

  12. Adventure tourism and adventure sports injury: the New Zealand experience.

    Science.gov (United States)

    Bentley, Tim A; Page, Stephen J; Macky, Keith A

    2007-11-01

    The primary aims of this study were to establish a client injury baseline for the New Zealand adventure tourism and adventure sport sector, and to examine patterns and trends in claims for injury during participation in adventure activities. Content analysis of narrative text data for compensated injuries occurring in a place for recreation and sport over a 12-month period produced over 15,000 cases involving adventure tourism and adventure sport. As found in previous studies in New Zealand, highest claim counts were observed for activities that are often undertaken independently, rather than commercially. Horse riding, tramping, surfing and mountain biking were found to have highest claim counts, while hang gliding/paragliding/parasailing and jet boating injuries had highest claim costs, suggesting greatest injury severity. Highest claim incidence was observed for horse riding, with female claimants over-represented for this activity. Younger male claimants comprised the largest proportion of adventure injuries, and falls were the most common injury mechanism.

  13. The Implementation of an Integrative Model of Adventure-Based Counseling and Adlerian Play Therapy Value-Based Taught by Parents to Children to Increase Adjustment Ability of Preschool Children

    Directory of Open Access Journals (Sweden)

    Rita Eka Izzaty

    2016-11-01

    Full Text Available This study was conducted for two reasons. First, pre-school age is the foundation for the subsequent development. Second, the previous research findings show that there are behavioral problems which affect the development of subsequent development. This study aims to increase children’s social ability by employing An Integrative Model of Adventure-Based Counseling and Adlerian Play Therapy, a counseling model emphasizing the importance of play providing opportunity for children to express their feelings in natural situation and insight toward personality and environment by modifying teaching cultural values by parents to children. This study employed an action study. The prior data collection techniques were conducting literary study, surveying on cultural values taught, and selecting a counseling model. The subjects were four preschool children (4-6 years old with behavioral problems. The study was conducted in 2 cycles with several steps: planning, action, evaluation, and reflection. The finding of this research shows that an Integrative Model of Adventure-Based Counseling and Adlerian Play Therapy can increase children social ability and decrease non adaptive behavior. The reflection of employing counseling model modified with cultural values taught by parents to children is when using this model, counselors truly examine the duration of the implementation, the children’s condition, the counselors’ condition, the type of play, and the purpose of each steps which must be detailed.

  14. Connecting to the Good Life through Outdoor Adventure Leadership Experiences Designed for Indigenous Youth

    Science.gov (United States)

    Ritchie, Stephen D.; Wabano, Mary Jo; Corbiere, Rita G.; Restoule, Brenda M.; Russell, Keith C.; Young, Nancy L.

    2015-01-01

    Indigenous voices are largely silent in the outdoor education and adventure therapy literature. The purpose of this research collaboration was to understand how a 10-day outdoor adventure leadership experience (OALE) may promote resilience and well-being for Indigenous youth through their participation in the program. The process was examined…

  15. A Review of Adventure Learning

    Directory of Open Access Journals (Sweden)

    George Veletsianos

    2009-12-01

    Full Text Available Adventure learning (AL is an approach for the design of digitally-enhanced teaching and learning environments driven by a framework of guidelines grounded on experiential and inquiry-based education. The purpose of this paper is to review the adventure learning literature and to describe the status quo of the practice by identifying the current knowledge, misconceptions, and future opportunities in adventure learning. Specifically, the authors present an integrative analysis of the adventure learning literature, identify knowledge gaps, present future research directions, and discuss research methods and approaches that may improve the AL approach.The authors engaged in a systematic search strategy to identify adventure learning studies then applied a set of criteria to decide whether to include or exclude each study. Results from the systematic review were combined, analyzed, and critiqued inductively using the constant comparative method and weaved together using the qualitative metasynthesis approach.Results indicate the appeal and promise of the adventure learning approach. Nevertheless, the authors recommend further investigation of the approach. Along with studies that investigate learning outcomes, aspects of the AL approach that are engaging, and the nature of expert-learner collaboration, future adventure learning projects that focus on higher education and are (a small and (b diverse can yield significant knowledge into adventure learning. Research and design in this area will benefit by taking an activity theory and design-based research perspective.

  16. The international implementation of multisystemic therapy.

    Science.gov (United States)

    Schoenwald, Sonja K; Heiblum, Naamith; Saldana, Lisa; Henggeler, Scott W

    2008-06-01

    The purpose of this article is to consider, through the lenses of theory and research on technology transfer and the adoption and implementation of innovation, the international transport of evidence-based psychosocial treatments for youth, using Multisystemic Therapy (MST) as an example. MST is a well-validated family and community-based approach originally developed in the United States to treat serious juvenile offenders. This article describes challenges to MST transport internationally by virtue of the political, legal, economic, and cultural contexts in different nations. Modifications used to address these challenges and facilitate the international implementation of MST are described and pertain to pre-implementation processes, clinical staff, training materials and procedures, and clinical service delivery.

  17. Adventures in Python

    CERN Document Server

    Richardson, Craig

    2015-01-01

    The complete beginner's guide to Python, for young people whowant to start today Adventures in Python is designed for 11-to 15-year oldswho want to teach themselves Python programming, but don't knowwhere to start. Even if you have no programming experience at all,this easy to follow format and clear, simple instruction will getyou up and running quickly. The book walks you through nineprojects that teach you the fundamentals of programming in general,and Python in particular, gradually building your skills until youhave the confidence and ability to tackle your own projects. Videoclips accom

  18. Adventures in Raspberry Pi

    CERN Document Server

    Philbin, Carrie Anne

    2015-01-01

    Start programming quickly with this super-fun guide to Raspberry Pi Adventures in Raspberry Pi, 2nd Edition includes 9 cool projects that show you how to set up and start developing on your Raspberry Pi. Updated for the release of the Rev 3 board, this second edition covers all the latest features and tells you everything you need to know. Written specifically for 11-15 year-olds, this book uses the wildly successful, Raspberry Pi to explain the fundamentals of computing. You'll have a blast learning basic programming and system administration skills, beginning with the very basics of how to p

  19. The Adventurous Gene

    DEFF Research Database (Denmark)

    Blomkvist, Katarina; Cantwell, John A.; Kappen, Philip

    2014-01-01

    In this paper we explore the notion of imprinting in the multinational corporation (MNC), specifically how during the brief period when foreign subsidiaries turn into technologically advanced units they are influenced by the technological activities carried out at headquarters and home country...... units. We hypothesize and empirically show that during that period of transition the degree of adventurousness or explorative intensity of home country units is replicated and has a long-lasting effect on the type of technological work carried out by the foreign subsidiaries. The results suggest...

  20. Adventures in Celestial Mechanics

    CERN Document Server

    Szebehely, Victor G

    1998-01-01

    A fascinating introduction to the basic principles of orbital mechanics. It has been three hundred years since Isaac Newton first formulated laws to explain the orbits of the Moon and the planets of our solar system. In so doing he laid the groundwork for modern science's understanding of the workings of the cosmos and helped pave the way to the age of space exploration. Adventures in Celestial Mechanics offers students an enjoyable way to become acquainted with the basic principles involved in the motions of natural and human-made bodies in space. Packed with examples in which these principle

  1. Dose distribution following selective internal radiation therapy

    International Nuclear Information System (INIS)

    Fox, R.A.; Klemp, P.F.; Egan, G.; Mina, L.L.; Burton, M.A.; Gray, B.N.

    1991-01-01

    Selective Internal Radiation Therapy is the intrahepatic arterial injection of microspheres labelled with 90Y. The microspheres lodge in the precapillary circulation of tumor resulting in internal radiation therapy. The activity of the 90Y injected is managed by successive administrations of labelled microspheres and after each injection probing the liver with a calibrated beta probe to assess the dose to the superficial layers of normal tissue. Predicted doses of 75 Gy have been delivered without subsequent evidence of radiation damage to normal cells. This contrasts with the complications resulting from doses in excess of 30 Gy delivered from external beam radiotherapy. Detailed analysis of microsphere distribution in a cubic centimeter of normal liver and the calculation of dose to a 3-dimensional fine grid has shown that the radiation distribution created by the finite size and distribution of the microspheres results in an highly heterogeneous dose pattern. It has been shown that a third of normal liver will receive less than 33.7% of the dose predicted by assuming an homogeneous distribution of 90Y

  2. Fostering Experiential Self-Regulation through Outdoor Adventure Education

    Science.gov (United States)

    Sibthorp, Jim; Collins, Rachel; Rathunde, Kevin; Paisley, Karen; Schumann, Scott; Pohja, Mandy; Gookin, John; Baynes, Sheila

    2015-01-01

    Learners thrive when they have the capacity to regulate interest and goal direction. Through direct experiences that are interesting and goal-relevant, learners can internalize and better understand their own agency in the learning process. This article further examines this premise in an outdoor adventure education (OAE) context through two…

  3. DEMOGRAPHIC PROFILE OF ADVENTURE TOURISTS IN PRETORIA

    OpenAIRE

    Melissa Jeanette Lötter; Sue Geldenhuys; Marius Potgieter

    2012-01-01

    It is difficult to examine different motivations and segment differentiations in niche markets such as adventure tourism seeing that it is not a well-defined segment in the discipline of tourism studies. In order to assist adventure tourism companies towards identifying and developing effective marketing strategies to attract or penetrate the adventure niche market, this study aims to contribute towards the current understanding of adventure tourists in Pretoria by compiling a demographic pro...

  4. Marketing of adventure tourism destination in Nepal

    OpenAIRE

    Baral, Nirajan

    2016-01-01

    Adventure tourism is one of the key factors of the Nepalese tourism industry. The main aim of this bachelor’s thesis was to clarify the current situation and challenges for developing adventure tourism in Nepal and to evaluate the importance of appropriate marketing strategies. The thesis also focuses on promoting adventure tourism activities and rural tourism destinations. The objective of the thesis was to explore Dhorpatan Hunting Reserve as an adventure tourism destination at internationa...

  5. External and internal radiation therapy: Past and future directions

    Directory of Open Access Journals (Sweden)

    Sadeghi Mahdi

    2010-01-01

    Full Text Available Cancer is a leading cause of morbidity and mortality in the modern world. Treatment modalities comprise radiation therapy, surgery, chemotherapy and hormonal therapy. Radiation therapy can be performed by using external or internal radiation therapy. However, each method has its unique properties which undertakes special role in cancer treatment, this question is brought up that: For cancer treatment, whether external radiation therapy is more efficient or internal radiation therapy one? To answer this question, we need to consider principles and structure of individual methods. In this review, principles and application of each method are considered and finally these two methods are compared with each other.

  6. Outdoor Adventure Programs Fulfilling Heroic Archetypal Patterns.

    Science.gov (United States)

    Lee, Johnny

    The experiences found in adventure programs often parallel the archetypes depicted in mythological quests. Drawing on the work of Joseph Campbell, the stages and trials of adventure participants are compared to similar rites of passage and epic adventures experienced by heroes and heroines in epic literature and mythology. The basic pattern of…

  7. Adventures in graph theory

    CERN Document Server

    Joyner, W David

    2017-01-01

    This textbook acts as a pathway to higher mathematics by seeking and illuminating the connections between graph theory and diverse fields of mathematics, such as calculus on manifolds, group theory, algebraic curves, Fourier analysis, cryptography and other areas of combinatorics. An overview of graph theory definitions and polynomial invariants for graphs prepares the reader for the subsequent dive into the applications of graph theory. To pique the reader’s interest in areas of possible exploration, recent results in mathematics appear throughout the book, accompanied with examples of related graphs, how they arise, and what their valuable uses are. The consequences of graph theory covered by the authors are complicated and far-reaching, so topics are always exhibited in a user-friendly manner with copious graphs, exercises, and Sage code for the computation of equations. Samples of the book’s source code can be found at github.com/springer-math/adventures-in-graph-theory. The text is geared towards ad...

  8. Liver cancer and selective internal radiation therapy

    International Nuclear Information System (INIS)

    Sutton, C.

    2002-01-01

    Liver cancer is the biggest cancer-related killer of adults in the world. Liver cancer can be considered as two types: primary and secondary (metastatic). Selective Internal Radiation Therapy (SIRT) is a revolutionary treatment for advanced liver cancer that utilises new technologies designed to deliver radiation directly to the site of tumours. SIRT, on the other hand, involves the delivery of millions of microscopic radioactive spheres called SIR-Spheres directly to the site of the liver tumour/s, where they selectively irradiate the tumours. The anti-cancer effect is concentrated in the liver and there is little effect on cancer at other sites such as the lungs or bones. The SIR-Spheres are delivered through a catheter placed in the femoral artery of the upper thigh and threaded through the hepatic artery (the major blood vessel of the liver) to the site of the tumour. The microscopic spheres, each approximately 35 microns (the size of four red blood cells or one-third the diameter of a strand of hair), are bonded to yttrium-90 (Y-90), a pure beta emitter with a physical half-life of 64.1 hours (about 2.67 days). The microspheres are trapped in the tumour's vascular bed, where they destroy the tumour from inside. The average range of the radiation is only 2.5 mm, so it is wholly contained within the patient's body; after 14 days, only 2.5 percent of the radioactive activity remains. The microspheres are suspended in water for injection. The vials are shipped in lead shields for radiation protection. Treatment with SIR-Spheres is generally not regarded as a cure, but has been shown to shrink the cancer more than chemotherapy alone. This can increase life expectancy and improve quality of life. On occasion, patients treated with SIR-Spheres have had such marked shrinkage of the liver cancer that the cancer can be surgically removed at a later date. This has resulted in a long-term cure for some patients. SIRTeX Medical Limited has developed three separate cancer

  9. Adventures in public data.

    Science.gov (United States)

    Zaharevitz, Dan W

    2011-10-14

    This article contains the slides and transcript of a talk given by Dan Zaharevitz at the "Visions of a Semantic Molecular Future" symposium held at the University of Cambridge Department of Chemistry on 2011-01-19. A recording of the talk is available on the University Computing Service's Streaming Media Service archive at http://sms.cam.ac.uk/media/1095515 (unfortunately the first part of the recording was corrupted, so the talk appears to begin at slide 6, 'At a critical time'). We believe that Dan's message comes over extremely well in the textual transcript and that it would be poorer for serious editing. In addition we have added some explanations and references of some of the concepts in the slides and text. (Charlotte Bolton; Peter Murray-Rust, University of Cambridge) EDITORIAL PREFACE: The following paper is part of a series of publications which arose from a Symposium held at the Unilever Centre for Molecular Informatics at the University of Cambridge to celebrate the lifetime achievements of Peter Murray-Rust. One of the motives of Peter's work was and is a better transport and preservation of data and information in scientific publications. In both respects the following publication is relevant: it is about public data and their representation, and the publication represents a non-standard experiment of transporting the content of the scientific presentation. As you will see, it consists of the original slides used by Dan Zaharevitz in his talk "Adventures in Public Data" at the Unilever Centre together with a diligent transcript of his speech. The transcribers have gone through great effort to preserve the original spirit of the talk by preserving colloquial language as it is used at such occasions. For reasons known to us, the original speaker was unable to submit the manuscript in a more conventional form. We, the Editors, have discussed in depth whether such a format is suitable for a scientific journal. We have eventually decided to publish this

  10. Adventures in public data

    Directory of Open Access Journals (Sweden)

    Zaharevitz Dan W

    2011-10-01

    Full Text Available Abstract This article contains the slides and transcript of a talk given by Dan Zaharevitz at the "Visions of a Semantic Molecular Future" symposium held at the University of Cambridge Department of Chemistry on 2011-01-19. A recording of the talk is available on the University Computing Service's Streaming Media Service archive at http://sms.cam.ac.uk/media/1095515 (unfortunately the first part of the recording was corrupted, so the talk appears to begin at slide 6, 'At a critical time'. We believe that Dan's message comes over extremely well in the textual transcript and that it would be poorer for serious editing. In addition we have added some explanations and references of some of the concepts in the slides and text. (Charlotte Bolton; Peter Murray-Rust, University of Cambridge Editorial preface The following paper is part of a series of publications which arose from a Symposium held at the Unilever Centre for Molecular Informatics at the University of Cambridge to celebrate the lifetime achievements of Peter Murray-Rust. One of the motives of Peter's work was and is a better transport and preservation of data and information in scientific publications. In both respects the following publication is relevant: it is about public data and their representation, and the publication represents a non-standard experiment of transporting the content of the scientific presentation. As you will see, it consists of the original slides used by Dan Zaharevitz in his talk "Adventures in Public Data" at the Unilever Centre together with a diligent transcript of his speech. The transcribers have gone through great effort to preserve the original spirit of the talk by preserving colloquial language as it is used at such occasions. For reasons known to us, the original speaker was unable to submit the manuscript in a more conventional form. We, the Editors, have discussed in depth whether such a format is suitable for a scientific journal. We have eventually

  11. Postoperative internal iliac artery embolisation as salvage therapy ...

    African Journals Online (AJOL)

    Postoperative internal iliac artery embolisation as salvage therapy for ... of blood products. Damage control surgery was performed, and bleeding was ultimately only ... abdomen was packed with adrenalin-soaked swabs. Coagulation.

  12. Internal Dosimetry in therapy with 90Y

    International Nuclear Information System (INIS)

    Torres, Leonel; Vergara, Alex; García, Leonardo

    2016-01-01

    Introduction: 90 Y has shown satisfactory results in the therapy of multiple oncological diseases. This radionuclide has been widely used in therapy of diseases such as NHL (Zevalin), TNE ( 90 Y-DOTATOC), liver cancer, etc. Its safe and effective use presupposes the availability of accurate dosimetry methods and reproducible.El objective of this work is to standardize and optimize images use procedures that allow for dosimetric estimates braking during therapy of malignant diseases 90 Y. Materials and Methods: To quantify the activity in absolute units from scans correction methods that consider the peculiarities of the bremsstrahlung of 90 Y were proposed. acquisition parameters such as the selection of the collimator and the definition of energy windows as well as methods of scatter correction, attenuation, interactions of radiation with the collimator (septal penetration and degradation of information with distance) were considered and sensitivity or calibration factor was estimated. They were evaluated and calibrated parameters for dosimetry at the level of organ and estimates of distributions 3D dose, using experimental measurements with SPECT Mediso Nucline ™ Spirit DH-V system and simulations were performed using the Monte Carlo method, using the SIMIND v5 software .0. Results: The optimum position-energy window width and collimator to be used is determined from the relationship between total photons and primary photons (T / P), calculated with SIMIND. The results were favorable to employ HEGP collimator and energy window between 90-170kev. the sensitivity of the system for the selected collimator (HEGP for 90 Y) was estimated. He was evaluated and determined the MTF order to correct dispersive plane images, the source-detector and interactions of radiation with the collimator distance, using filtering methods (Wiener filter), including empirical estimates of the SNR component. Similarly the procedure for the use of transmission maps obtained from

  13. Our Heroic Adventure: Creating a Personal Mythology

    Science.gov (United States)

    Rubin, Lawrence C.

    2009-01-01

    Utilizing Joseph Campbell's concept of the hero's adventure, this article provides a technique through which clients can story their lives and challenges as an unfolding personal myth or epic adventure. The use of personal narrative and storytelling has found efficacy in the counseling field and, as such, forms a useful foundation for clinical…

  14. Learning in Action and Adventure Sports

    Science.gov (United States)

    Ellmer, Eva; Rynne, Steven

    2016-01-01

    The exponential growth in action and adventure sport (e.g. snowboarding, bicycle motorcross (BMX), surfing, parkour) participation over the past two decades has been showcased in world championship events and the inclusion in Olympic programs. Yet, by virtue of their alternative, escapist and/or adventure-based origins, these sports do not fully…

  15. HAE international home therapy consensus document

    Directory of Open Access Journals (Sweden)

    Longhurst Hilary J

    2010-07-01

    Full Text Available Abstract Hereditary angioedema (C1 inhibitor deficiency, HAE is associated with intermittent swellings which are disabling and may be fatal. Effective treatments are available and these are most useful when given early in the course of the swelling. The requirement to attend a medical facility for parenteral treatment results in delays. Home therapy offers the possibility of earlier treatment and better symptom control, enabling patients to live more healthy, productive lives. This paper examines the evidence for patient-controlled home treatment of acute attacks ('self or assisted administration' and suggests a framework for patients and physicians interested in participating in home or self-administration programmes. It represents the opinion of the authors who have a wide range of expert experience in the management of HAE.

  16. Internal radiation dosimetry using nuclear medicine imaging in radionuclide therapy

    International Nuclear Information System (INIS)

    Kim, Kyeong Min; Byun, Byun Hyun; Cheon, Gi Jeong; Lim, Sang Moo

    2007-01-01

    Radionuclide therapy has been an important field in nuclear medicine. In radionuclide therapy, relevant evaluation of internally absorbed dose is essential for the achievement of efficient and sufficient treatment of incurable disease, and can be accomplished by means of accurate measurement of radioactivity in body and its changes with time. Recently, the advances of nuclear medicine imaging and multi modality imaging processing techniques can provide chance of more accurate and easier measurement of the measures commented above, in cooperation of conventional imaging based approaches. In this review, basic concept for internal dosimetry using nuclear medicine imaging is summarized with several check points which should be considered in real practice

  17. Building International Sustainable Partnerships in Occupational Therapy: A Case Study.

    Science.gov (United States)

    Tupe, Debra Ann; Kern, Stephen B; Salvant, Sabrina; Talero, Pamela

    2015-09-01

    Occupational therapy practitioners frequently identify opportunities for international practice. The World Health Organization and the World Federation of Occupational Therapists have encouraged occupational therapists to address transnational issues, social inclusion, and equal access to opportunities grounded in meaningful occupation (WFOT, 2012). This case study describes a partnership between two U.S. schools of occupational therapy and a Cuban community based pediatric clinic. It examines the dynamics that have sustained the partnership despite political, economic, and logistical barriers. The literature is scrutinized to show how this case study fits into other accounts of collaborative international partnerships. Particularly, it investigates structural and institutional conditions that shape international sustainable partnerships. In doing so, we answer the following questions: (1) Under which circumstances do international partnerships emerge and flourish? (2) What structural and institutional conditions shape international sustainable partnerships? And (3) How do partners perceive and experience the bilateral international partnership? It also discusses and illustrates the foundations and development of international partnerships that succeed. Through the use of a case study we illustrate the development of this partnership. Finally, we consider the next steps of this particular sustainable and collaborative international partnership. © 2015 John Wiley & Sons, Ltd.

  18. Radiation therapy. 1990-2001. International Atomic Energy Agency publications

    International Nuclear Information System (INIS)

    2001-04-01

    This catalog lists all sales publications of the International Atomic Energy Agency dealing with Radiation Therapy, and issued during the period 1 January 1990 - 30 April 2001. Most publications are issued in English, though some are also available in other languages. These are noted in the catalogue

  19. An international intercomparison of absorbed dose measurements for radiation therapy

    International Nuclear Information System (INIS)

    Taiman Kadni; Noriah Mod Ali

    2002-01-01

    Dose intercomparison on an international basis has become an important component of quality assurance measurement i.e. to check the performance of absorbed dose measurements in radiation therapy. The absorbed dose to water measurements for radiation therapy at the SSDL, MINT have been regularly compared through international intercomparison programmes organised by the IAEA Dosimetry Laboratory, Seibersdorf, Austria such as IAEA/WHO TLD postal dose quality audits and the Intercomparison of therapy level ionisation chamber calibration factors in terms of air kerma and absorbed dose to water calibration factors. The results of these intercomparison in terms of percentage deviations for Cobalt 60 gamma radiation and megavoltage x-ray from medical linear accelerators participated by the SSDL-MINT during the year 1985-2001 are within the acceptance limit. (Author)

  20. A collaborative adventure

    CERN Multimedia

    2014-01-01

    At the start of a new year, I’d like to wish all of you and your families a happy, successful and peaceful 2014. It’s a year that holds particular significance for CERN, as on 29 September it will be 60 years since the Organization was founded.   As CERN turns 60, it is still going strong, maintaining its underlying attraction of international collaboration for basic science. Since its foundation in 1954, it has grown steadily and this year begins well as we welcome a new Member State, Israel. CERN and Israel already have a long history of mutual collaboration and now we can look forward to increasingly fruitful scientific cooperation. Israel’s accession brings the total number of Member States to 21, and other countries are in the stages leading up to becoming Members or Associates, while still others are expressing interest. CERN is becoming a global success, while retaining its original, European flavour. This year’s events for the 60th anniversary ...

  1. The adventure of atom. Vol.1

    International Nuclear Information System (INIS)

    La Gorce, P.M. de; Bacher, P.; Bourgeois, J.; Bussac, J.; Cauquais, C.; Gauvenet, A.; Goldschmidt, B.; Le Baut, Y.; Mezin, M.

    1992-01-01

    In the first volume on the ambiguous adventure of atom, the authors present the history of atom conquest with the discoveries of natural and artificial radioactivity and chain reactions, before to explain the first military uses

  2. CERN, an adventure in international scientific cooperation

    CERN Document Server

    Bannier, J H

    1977-01-01

    Outlines the history of the Conseil European pour la Recherche Nucleaire (CERN) from its origins in 1951-53 and its establishment on a site on the Swiss-French border near Geneva. Describes the structure of the organisation and discusses the more important policy decisions of the 1960s and 1970s. Concludes by considering future prospects. (0 refs).

  3. The Analysis of Fourth Adventure of Seven-Adventures of Iranian National Epic based on Myth

    Directory of Open Access Journals (Sweden)

    GH Ebrahimi

    2012-08-01

    Full Text Available The seven-adventures of Rostam, in particular, and other Iranian seven-adventures such as Esfandyar seven-adventures or Gorshasp pseudo-seven-adventures are a kind of eternity search, a kind of battle with selfhood that aims to facilitate the problems, the difficulties of evolution way and human ascent. By discussing and analyzing Iranian seven-adventures, this research aims to study the fourth adventure of all the seven-adventures, which is, at the surface, the battle between man (hero, champion and woman but, in essence, it is the battle between fire and water. Fire is the son of Ahura Mazda and water is its enemy. Water, which was at one time the symbol of holiness and purity of Ahura, became a satanic element during Sassanid era and following the dominance of Zorvani thoughts on religious system of that time. By analyzing Rostam, Esfandyar, Gorshasp, Heracles fourth adventure and looking at Zal and Roodabe stories, Khajavi Kermani’s Sam-Nameh, Nezemi’s Khosro and Shirin and Mahmoud Dolatabadi’s Kalidar, we try to prove this hypothesis.

  4. Adventure Learning: Theory and Implementation of Hybrid Learning

    Science.gov (United States)

    Doering, A.

    2008-12-01

    Adventure Learning (AL), a hybrid distance education approach, provides students and teachers with the opportunity to learn about authentic curricular content areas while interacting with adventurers, students, and content experts at various locations throughout the world within an online learning environment (Doering, 2006). An AL curriculum and online environment provides collaborative community spaces where traditional hierarchical classroom roles are blurred and learning is transformed. AL has most recently become popular in K-12 classrooms nationally and internationally with millions of students participating online. However, in the literature, the term "adventure learning" many times gets confused with phrases such as "virtual fieldtrip" and activities where someone "exploring" is posting photos and text. This type of "adventure learning" is not "Adventure Learning" (AL), but merely a slideshow of their activities. The learning environment may not have any curricular and/or social goals, and if it does, the environment design many times does not support these objectives. AL, on the other hand, is designed so that both teachers and students understand that their online and curriculum activities are in synch and supportive of the curricular goals. In AL environments, there are no disparate activities as the design considers the educational, social, and technological affordances (Kirschner, Strijbos, Kreijns, & Beers, 2004); in other words, the artifacts of the learning environment encourage and support the instructional goals, social interactions, collaborative efforts, and ultimately learning. AL is grounded in two major theoretical approaches to learning - experiential and inquiry-based learning. As Kolb (1984) noted, in experiential learning, a learner creates meaning from direct experiences and reflections. Such is the goal of AL within the classroom. Additionally, AL affords learners a real-time authentic online learning experience concurrently as they

  5. Analysis of supply adventure tourism in the South Bohemian Region

    OpenAIRE

    Klečacká, Simona

    2009-01-01

    The thesis, entitled "Analysis of supply adventure tourism in the South Bohemian Region" is to describe and analyze the options and instruments of tourism in selected destination. Work processes typology adventure tourism and also defines key terms related to this topic. It then focuses on identifying different types of adventure tourism, cooperation in the design of an appropriate design and implementation of a new product in the field of adventure tourism.

  6. Empowerment and women in adventure tourism : a negotiated journey

    OpenAIRE

    Doran, Adele

    2016-01-01

    Women’s participation in adventure tourism is growing, yet few studies have explored this group of tourists. This conceptual paper seeks to extend our understanding of female adventure tourists by examining the empowering journey women can take through constraint negotiation to enjoy the benefits of adventure tourism. Using content analysis to review the literature on women’s adventure experiences in tourism and recreation settings reveals prominent themes that have been consolidated to propo...

  7. All-Girls Adventure Programmes: What Are the Benefits?

    Science.gov (United States)

    Whittington, Anja; Mack, Erica Nixon; Budbill, Nadine W.; McKenney, Priscilla

    2011-01-01

    This study examined the benefits of all-girls adventure programmes from the perspective of adolescent girls. Participants included 361 girls aged 10-17 years from diverse ethnic and socio-economic backgrounds who completed a variety of adventure programmes. Adventure activities included rock climbing, sea kayaking, mountaineering, backpacking,…

  8. Here Be Dragons: voorgeschiedenis en ontstaan van Adventure Games

    NARCIS (Netherlands)

    Veugen, Connie

    2004-01-01

    The article traces the history of adventure games from the birth of the fantasy genre in William Morris' work and the origins of the Kriegspiel, through Tolkien's fantasy world and Dungeons and Dragons to the early text adventures and the first graphical adventures.

  9. Safety in New Zealand's adventure tourism industry: the client accident experience of adventure tourism operators.

    Science.gov (United States)

    Bentley , T A; Page, S J; Laird, I S

    2000-01-01

    Injuries and fatalities among participants of adventure tourism activities have the potential to seriously impact on New Zealand's tourism industry. However, the absence of statistics for tourist accidents in New Zealand, and the lack of detailed academic research into adventure tourism safety, means the extent of the problem is unknown. The aims of the present study were to determine the incidence of client injuries across a range of adventure tourism activity sectors, and to identify common accident events and contributory risk factors. A postal questionnaire survey of New Zealand adventure tourism operators was used. Operators were asked to provide information related to their business; the number of recorded client injuries during the preceding 12 month period, January to December 1998; common accident and injury events associated with their activity; and perceived risk factors for accidents in their sector of the adventure tourism industry. The survey was responded to by 142 New Zealand adventure tourism operators. The operators' reported client injury experience suggests the incidence of serious client injuries is very low. Highest client injury incidence rates were found for activities that involved the risk of falling from a moving vehicle or animal (e.g., cycle tours, quad biking, horse riding, and white-water rafting). Slips, trips, and falls on the level were common accident events across most sectors of the industry. Perceived accident/incident causes were most commonly related to the client, and in particular, failure to attend to and follow instructions. The prevalence of client injuries in activity sectors not presently covered by government regulation, suggests policy makers should look again at extending codes of practice to a wider range of adventure tourism activities. Further research considering adventure tourism involvement in overseas visitor hospitalized injuries in New Zealand, is currently in progress. This will provide supporting evidence

  10. Participating in Paintball: Adventure or extreme sport?

    Directory of Open Access Journals (Sweden)

    Dewald Venter

    2014-01-01

    Full Text Available According to Jessica (2012 paintball is recognised as one of the world's most exciting outdoor participation sports. Paintball is played in over 104 countries by millions of men and women of all ages and lifestyles. Whether homemakers or high-school students, professionals or retirees, all paintball players share in common a love for adventure and a strong competitive spirit. Some confusion exists in industry and amongst players on whether paintball is and adventure or extreme sport as well as terminologies used. The article serves to analyse and clarify the unique terminologies used in paintball and debate classification of paintball as either an adventure or extreme sport. A detailed description of equipment used, player categories as well as formats that are employed are discussed so as to elucidate for readers who are unfamiliar with paintball.

  11. Side effects of cancer therapies. International classification and documentation systems

    International Nuclear Information System (INIS)

    Seegenschmiedt, M.H.

    1998-01-01

    The publication presents and explains verified, international classification and documentation systems for side effects induced by cancer treatments, applicable in general and clinical practice and clinical research, and covers in a clearly arranged manner the whole range of treatments, including acute and chronic side effects of chemotherapy and radiotherapy, surgery, or combined therapies. The book fills a long-felt need in tumor documentation and is a major contribution to quality assurance in clinical oncology in German-speaking countries. As most parts of the book are bilingual, presenting German and English texts and terminology, it satisfies the principles of interdisciplinarity and internationality. The tabulated form chosen for presentation of classification systems and criteria facilitate the user's approach as well as application in daily work. (orig./CB) [de

  12. ADVENTURE TOURISM AN INSUFFICENTLY EXPLOITED OPPORTUNITY IN BIHOR COUNTY, ROMANIA

    Directory of Open Access Journals (Sweden)

    Anamaria Liana LĂZURAN (GIURĂU

    2014-06-01

    Full Text Available The routine of everyday life, the stifling society, the desire of novel and unexpected alongside the unlimited access to information got the modern man on the threshold of a new experience: adventure. Within this context in the tourism industry one type of tourism seems to gain more and more followers: adventure tourism. The adventure tourism is a nature-based tourism involving challenging outdoors activities with a great potential of thrill and excitement. Thus, this paper aims to emphasise the potential for adventure tourism in Bihor County by highlighting the areas where activities related to adventure tourism are developed and to propose new itineraries.

  13. Arduino adventures escape from Gemini station

    CERN Document Server

    Kelly, James Floyd

    2013-01-01

    Arduino Adventures: Escape from Gemini Station provides a fun introduction to the Arduino microcontroller by putting you (the reader) into the action of a science fiction adventure story.  You'll find yourself following along as Cade and Elle explore Gemini Station-an orbiting museum dedicated to preserving and sharing technology throughout the centuries. Trouble ensues. The station is evacuated, including Cade and Elle's class that was visiting the station on a field trip. Cade and Elle don't make it aboard their shuttle and are trapped on the station along with a friendly artificial intellig

  14. Newton's laws through a science adventure

    OpenAIRE

    Šuštar, Sara

    2013-01-01

    The main purpose of my diploma thesis is to create a scientific adventure based on the Newton's laws. My aim has been to introduce this topic to the kids in elementary school as well as the general public. That is why the adventure will take place in the House of Experiments. The first part is dedicated to theory and various experiments, which lead to deeper understanding of the laws. I implemented experiments on rollerblades, such as free movement, movement with the help of springs which wer...

  15. It's Time for an Adventure

    Science.gov (United States)

    Eldam Pommer, R.

    2017-12-01

    In recent years, studies have repeatedly illustrated the significance of children seeing themselves reflected in careers and cultures that they may not typically identify with. The current lack of diversity in accessible media, however, limits the potential for self-reflection from children of different socioeconomic, racial, and gender identity backgrounds. This isolates substantial sections of our population from experiencing these moments of recognition and inspiration. As scientists in a rapidly evolving field that requires diversity in perspective and ideas, it is incumbent upon us to innovate new ways to engage with these future generations in the pursuit of inspiring future earth scientists. Inspired by the work of others (e.g. Doc McStuffins, The Sandwich Swap) and through a successful crowdfunding campaign, I was able to develop a project which integrates children's love of adventure with foundational critical thinking skills. That project is MD and Finn. MD and Finn is a self-written/published children's book series which was developed to address the lack of diversity in children's literature. MD is a little girl who continuously explores, discovers, and builds the world around her with her best friend, Finn the fox. They encourage one another to ask questions, brainstorm, make mistakes, and learn from absolutely everything. While the primary goal of the series is to create a character in which young girls can see themselves solving problems, learning from mistakes, and enjoying the little pieces of science in daily life, as the project progresses, characters from different races, ethnicities, gender identities, religions, and disabilities are purposefully introduced. In bringing these books to life, I have been given the unique opportunity to regularly engage with classrooms and families who may be meeting an actual scientist for the very first time. For a few young girls, they may also finally be seeing just a little bit of themselves - in a lab coat

  16. Safe adventures. An ethnographic study of safety and adventure guides in Arctic Norway

    OpenAIRE

    Johannessen, Mats Hoel

    2016-01-01

    With numerous entrepreneurs already established within the area, adventure tourism is a growing industry within Arctic Norway. The continuously expanding interest for the phenomenon has gained universities’ attention with recent education programs for guides being established. A cultural change involving a more professionalized approach to adventure tourism has also been noticed. At the forefront of ensuring tourists’ safety are the guides, who work in the area. In former research on safety i...

  17. Advances in neutron capture therapy 2006. Proceedings of 12th international congress on neutron capture therapy

    International Nuclear Information System (INIS)

    Nakagawa, Yoshinobu; Kobayashi, Tooru; Fukuda, Hiroshi

    2006-01-01

    The Twelfth International Congress on Neutron Capture Therapy (ICNCT-12) is being held from October 9th to 13th, 2006 at the Kagawa International Congress Hall in Takamatsu, Kagawa, Japan. The main theme of the congress is From the past to the Future'. Five symposiums were organized to accommodate all the contributions from the international scientific committees of the International Society for Neutron Capture Therapy (ISNCT), and two symposiums were added to balance the number of fields of specialties. The seven symposiums for ICNCT-12 are as follows: 1) Clinical Results of BNCT for Brain Tumors, 2) Dosimetry, 3) Treatment Planning system, 4) Drug Delivery System, 5) Biomedical and General Matters, 6) BNCT Systems using Accelerators, 7) New Applications and Protocols for BNCT. There are a total of 195 presentations in this congress: 3 special lectures, 34 symposium presentations, 10 presentations in two special sessions from the recipients of the Ralph G. Fairchild Award, 70 presentations in the oral parallel sessions and 78 presentations in the poster sessions. A compilation of 169 papers are published in this proceedings. The 165 of the presented papers are indexed individually. (J.P.N.)

  18. Interventional therapy of traumatic pseudoaneurysms in internal carotid artery siphon

    International Nuclear Information System (INIS)

    Tang Jun; Shang Jianqiang; Chen Jie; Li Fengxin; Liu Yanjun

    2007-01-01

    Objective: To determine the methods and results of treating traumatic pseudoaneurysms in siphon segment of internal carotid artery (ICA)by interventional therapy. Methods: Twelve cases of traumatic pseudoaneurysms in siphon segment of internal carotid artery were treated. The collateral circulation of Willis circle was observed after DSA. Different methods of treatment were applied according to the collateral circulation of Willis circle. Ten cases were treated by occlusion of ICA completely, 1 case was embolized by guglielmi detachable coil (GDC) only. Results: Nine of 12 treated by occlusion of ICA were cured. In the 3 cases who had poor collateral of Willis circle, one was cured by GDC embolization alone; one died 48 hours later after ICA occlusion though his consciousness and the activity of extremities were normal during the temporary balloon test occlusion (BTO) of ICA. One died during the training to improve the collateral of the Willis circle. Conclusion: ICA embolization is feasible for treatment of traumatic pseudoaneurysms in siphon segment of internal carotid artery after evaluating the collateral circulation of Willis circle. (authors)

  19. Biophysical and biomathematical adventures in radiobiology

    International Nuclear Information System (INIS)

    Scott, B.R.

    1991-01-01

    Highlights of my biophysical and biomathematical adventures in radiobiology is presented. Early adventures involved developing ''state-vector models'' for specific harmful effects (cell killing, life shortening) of exposure to radiation. More recent adventures led to developing ''hazard-function models'' for predicting biological effects (e.g., cell killing, mutations, tumor induction) of combined exposure to different toxicants. Hazard-function models were also developed for predicting harm to man from exposure to large radiation doses. Major conclusions derived from the modeling adventures are as follows: (1) synergistic effects of different genotoxic agents should not occur at low doses; (2) for exposure of the lung or bone marrow to large doses of photon radiation, low rates of exposure should be better tolerated than high rates; and (3) for some types of radiation (e.g., alpha particles and fission neutrons), moderate doses delivered at a low rate may be more harmful than the same dose given at a high rate. 53 refs., 7 figs

  20. The Tipping Point and the Adventure Advantage.

    Science.gov (United States)

    Prouty, Dick

    1998-01-01

    Insights from chaos theory--the interconnectedness of everything, nonlinear cause and effect, leverage and the "tipping point," and the importance of aligning interventions within a system--are applied to social action and illustrated via the role of adventure education in school and community interventions in the Brattleboro (Vermont) Leadership…

  1. The Universe Adventure - The Beginnings of Cosmology

    Science.gov (United States)

    The Universe Adventure [ next ] [ home ] Go The Beginnings of Cosmology Since the beginning of of stars? What do the stars tell us about the future? Where did the Universe come from? Cosmology is will introduce you to Cosmology and the study of the structure, history, and fate of the Universe. In

  2. Adventure tourists in Pretoria, South Africa: A demographic profile

    Directory of Open Access Journals (Sweden)

    MJ Lötter

    2014-01-01

    Full Text Available Adventure activities and experiences constantly evolve because individuals, motives, behaviours, and experiences differ and change over time. In order to assist adventure tourism companies to promote and sell specific activities and experiences that will meet the specific needs and wants of their identified target markets, this paper focuses on the demographic profile of adventure tourists who used the products/services of adventure tourism companies within Pretoria, South Africa. The realised sample was 234, providing a 93.6% response rate. The research instrument used was a self-completing questionnaire. Based on the results, these adventure tourists were Afrikaans speaking individuals between the ages of twenty-eight and forty-nine years. Their households consisted of two to four people and there were generally two income earners per household. This study established that there is a need for further researching of comprehensive adventure tourist profiles.

  3. Adventure tourism in South Africa: Challenges and prospects

    OpenAIRE

    Giddy, Julia Kathryn

    2016-01-01

    There is great potential for the development of adventure tourism in Southern Africa for a number of reasons. One is the variety of landscapes provided by South Africa's natural environment that are suitable for adventure tourism activities, many of which remain relatively pristine. In addition, the development of adventure tourism has significant potential to uplift local communities through local economic development strategies due to the relatively low capital needed to establish many acti...

  4. ADVENTURE TOURISM AN INSUFFICENTLY EXPLOITED OPPORTUNITY IN BIHOR COUNTY, ROMANIA

    OpenAIRE

    Anamaria Liana LĂZURAN (GIURĂU); Mihaela UNGUREANU

    2014-01-01

    The routine of everyday life, the stifling society, the desire of novel and unexpected alongside the unlimited access to information got the modern man on the threshold of a new experience: adventure. Within this context in the tourism industry one type of tourism seems to gain more and more followers: adventure tourism. The adventure tourism is a nature-based tourism involving challenging outdoors activities with a great potential of thrill and excitement. Thus, this paper aim...

  5. Adventure Tourism Benchmark – Analyzing the Case of Suesca, Cundinamarca

    Directory of Open Access Journals (Sweden)

    Juan Felipe Tsao Borrero

    2012-11-01

    Full Text Available Adventure tourism is a growing sector within the tourism industry and understanding its dynamics is fundamental for adventure tourism destinations and their local authorities. Destination benchmarking is a strong tool to identify the performance of tourism services offered at the destination in order to design appropriate policies to improve its competitiveness. The benchmarking study of Suesca, an adventure tourism destination in Colombia, helps to identify the gaps compared with successful adventure tourism destinations around the world, and provides valuable information to local policy-makers on the features to be improved. The lack of available information to tourists and financial facilities hinders the capability of Suesca to improve its competitiveness.

  6. The Andean Geotrail (1): A scientific adventure

    Science.gov (United States)

    Sassier, C.; Galland, O.; Raufaste, C.; Mair, K.

    2009-12-01

    The role of Geosciences in our society is of primary importance. Its implications for humanity relate to major challenges such as climate change, managing energy resources, natural hazard mitigation, and water scarcity. Despite these issues being familiar to specialists, this is in general not the case for the public. In a world, where the impact of human activity is beginning to be seen on the environment, knowledge of the Earth and its history is paramount to make informed decisions that will influence our future. The necessity to educate the global population and raise awareness of Geosciences has led UNESCO to designate 2009 the International Year of the Planet Earth. In this context and with the label of the UNESCO, we organized and performed a popular science adventure that was followed in real time by both school children and many adults around the world. The Andean Geotrail consisted of a cycling expedition through a spectacular geological environment, the Andean Cordillera. During the nine month expedition, we cycled 8000 km and walked 400 km from Ushuaia in the Southern tip of Argentina to Nazca in Peru to encounter a rich variety of geological environments: active volcanoes, earthquakes, mineral and hydrocarbon deposits, and fantastic geological scenery. All this makes the Andes a great pedagogical natural laboratory. During the expedition, we visited spectacular geological localities that illustrate key Earth Science phenomena (such as mines and hydrocarbon deposits, erupting volcanoes and seismogenically active areas, and national parks) and discovered their implications for the local people. Along the way, we interviewed local geologists and scientists who helped us understand the geology of their areas. We gathered our own observations with those of the local specialists and published essays, articles and photographs on our website and blog (www.georouteandine.fr/English, http://georouteandine.blogspot.com). Seventeen schools in France and Norway

  7. A History of Adventure in Children's Literature

    DEFF Research Database (Denmark)

    McCausland, Elly

    2017-01-01

    with popular medievalism and the figure of the bold chivalric knight intersected with bourgeois forms of venture capitalism; the resulting children’s adventure narratives attempt to negotiate and even combine these two very different forms of risk-taking. Next, I will explore the rise of fantasy literature......This project will examine representations of risk in children’s literature from the mid-nineteenth century to the present day. It will explore how issues of risk and trust have been mediated through children’s narratives, and how the adventurous child has served, and continues to serve...... for children following the Second World War. There are numerous overviews of trends within children’s literature during this period, but little exists that links these trends with their immediate sociocultural context and with changing attitudes towards childhood during the aftermath of the war...

  8. Inside/outside the Western 'Bubble': The nexus of adventure, adventure sports and perceptions of risk in UK and Mauritius

    OpenAIRE

    Humberstone, Barbara

    2009-01-01

    Globalization can be thought of as the widening, deepening and quickening of the worldwide interconnections in social, cultural, political and economic life (Held et al., 1999). For adventure sports enthusiasts from the West, this has opened up the world for them to pursue their activities in more ‘exotic’ natural locations. Marketing of adventure holidays has increased with the greater ease of travelling to suitable geographical locations, providing apparently ‘authentic’ adventure experienc...

  9. ADVENTURE TOURISM IN THE SURVEYED POLISH ADVENTURE TOURISTS’ OPINION – OUTLINE OF THE PROBLEM

    Directory of Open Access Journals (Sweden)

    Ewa Cieślik

    2014-12-01

    Full Text Available Tourism is a kind of human activity, which has the ability to simultaneously satisfy a wide human needs’ range and develop people’s personality. Adventure tourism term is a type of tourism able to fulfill these types of human needs. The aim of the study was to know the Polish tourists opinion about the adventure tourism in Poland. The study involved 50 people, taking into account their gender, age, education and occupational status. The research tool was a survey questionnaire. The study indicated that it is not a popular form of tourism in Poland. Its proponents, the information about places and facilities derive mainly from the Internet. The most popular forms are trekking, tramping, caves exploration, paintball, windsurfing, bungejumping and rafting. Rather average possibility of practicing the adventure tourism in Poland is associated with multitude barriers, mainly financial investments, lack of free time, as well as fear and general fear of some of its forms.

  10. Injuries to New Zealanders participating in adventure tourism and adventure sports: an analysis of Accident Compensation Corporation (ACC) claims.

    Science.gov (United States)

    Bentley, Tim; Macky, Keith; Edwards, Jo

    2006-12-15

    The aim of this study was to examine the involvement of adventure tourism and adventure sports activity in injury claims made to the Accident Compensation Corporation (ACC). Epidemiological analysis of ACC claims for the period, July 2004 to June 2005, where adventure activities were involved in the injury. 18,697 adventure tourism and adventure sports injury claims were identified from the data, representing 28 activity sectors. Injuries were most common during the summer months, and were most frequently located in the major population centres. The majority of injuries were incurred by claimants in the 20-50 years age groups, although claimants over 50 years of age had highest claims costs. Males incurred 60% of all claims. Four activities (horse riding, mountain biking, tramping/hiking, and surfing) were responsible for approximately 60% of all adventure tourism and adventure sports-related injuries. Slips, trips, and falls were the most common injury initiating events, and injuries were most often to the back/spine, shoulder, and knee. These findings suggest the need to investigate whether regulatory intervention in the form of codes of practice for high injury count activities such as horse riding and mountain biking may be necessary. Health promotion messages and education programs should focus on these and other high-injury risk areas. Improved risk management practices are required for commercial adventure tourism and adventure sports operators in New Zealand if safety is to be improved across this sector.

  11. Going Pro: Point of View Cameras in Adventure Sports Research

    Science.gov (United States)

    French, Graham

    2016-01-01

    The role of the adventure sports coach was first identified by Collins and Collins (2012) who suggested that the sports coaching process is significantly different in an adventurous context. Whilst there is a growing body of literature surrounding coaching pedagogy (Hay, Dickens, Crudginton, & Engstrom, 2012), investigation of coaching…

  12. Promoting Resiliency in Adolescent Girls through Adventure Programming

    Science.gov (United States)

    Whittington, Anja; Aspelmeier, Jeffery E.; Budbill, Nadine W.

    2016-01-01

    This study examined whether participation in an adventure program increased the resiliency of adolescent girls. Eighty-seven girls who participated in Dirt Divas, a non-profit, adventure program, completed the Resiliency Scale for Children and Adolescents® before and after their experience. Means-comparison tests for within-subjects designs were…

  13. Outdoor Recreation and Adventure Tourism: Unique but Allied Industries

    Science.gov (United States)

    Bailey, Andrew W.; Kang, H. K.; Lewis, T. Grant

    2017-01-01

    Outdoor recreation and adventure tourism are overlapping industries serving similar clientele. While descriptive marketing research exists for both industries (George Washington University School of Business [GW], Adventure Travel Trade Association [ATTA], & Xola Consulting [XC], 2010; Outdoor Foundation [OF], 2014), there is no clear…

  14. Mitigating Litigation for Adventure Recreation Operators: The Ski Safety Act

    Science.gov (United States)

    Brgoch, Shea; Lower, Leeann M.

    2017-01-01

    Adventure tourism is a rapidly growing segment of the tourism industry, which can be regarded as specific activities that are alluring for their uncertain and potentially dangerous outcomes. Risk-taking attitudes and behaviors may be common among adventure recreationists and increase the potential for litigation against recreation operators. In…

  15. Colonial adventures in tropical agriculture

    NARCIS (Netherlands)

    Buelens, Frans; Frankema, Ewout

    2016-01-01

    How profitable were foreign investments in plantation agriculture in the Netherlands Indies during the late colonial era? We use a new dataset of monthly quoted stock prices and dividends of international companies at the Brussels stock exchange to estimate the returns to investment in tropical

  16. Outdoor Program Models: Placing Cooperative Adventure and Adventure Education Models on the Continuum.

    Science.gov (United States)

    Guthrie, Steven P.

    In two articles on outdoor programming models, Watters distinguished four models on a continuum ranging from the common adventure model, with minimal organizational structure and leadership control, to the guide service model, in which leaders are autocratic and trips are highly structured. Club programs and instructional programs were in between,…

  17. Negative-pressure wound therapy with instillation: international consensus guidelines.

    Science.gov (United States)

    Kim, Paul J; Attinger, Christopher E; Steinberg, John S; Evans, Karen K; Lehner, Burkhard; Willy, Christian; Lavery, Larry; Wolvos, Tom; Orgill, Dennis; Ennis, William; Lantis, John; Gabriel, Allen; Schultz, Gregory

    2013-12-01

    Negative-pressure wound therapy with instillation is increasingly utilized as an adjunct therapy for a wide variety of wounds. Despite its growing popularity, there is a paucity of evidence and lack of guidance to provide effective use of this therapy. A panel of experts was convened to provide guidance regarding the appropriate use of negative-pressure wound therapy with instillation. A face-to-face meeting was held where the available evidence was discussed and individual clinical experience with this therapy was shared. Follow-up communication among the panelists continued until consensus was achieved. The final consensus recommendations were derived through more than 80 percent agreement among the panelists. Nine consensus statements were generated that address the appropriate use of negative-pressure wound therapy with instillation. The question of clinical effectiveness of this therapy was not directly addressed by the consensus panel. This document serves as preliminary guidelines until more robust evidence emerges that will support or modify these consensus recommendations.

  18. Adventures in human population biology.

    Science.gov (United States)

    Baker, P T

    1996-01-01

    This article is a memoir of anthropologist Paul Baker's professional life. The introduction notes that the field of anthropology was altered by the impact of World War II when physical anthropologists provided vital information to the military. After the war, the GI bill supported the undergraduate and graduate studies of veterans, including Baker. After describing his academic training at the University of New Mexico and Harvard, Baker details his research training and field work in the desert for the US Climatic Research Laboratory and his work identifying the dead in Japan for the Quartermaster unit. Baker then traces his academic career at the Pennsylvania State University during which he directed two multidisciplinary research efforts for the International Biological Programme, one that sought to understand human adaptability at high altitude in Peru and another that studied migration and modernization in Samoa. Baker's last administrative positions were as staff consultant to the Man and the Biosphere (MAB) program and as chair of the US MAB committee. Baker retired from academic life at age 60 in 1987 and has devoted his time to reading and to helping organize professional associations in anthropology, especially those devoted to furthering internationally organized scientific efforts. Baker concludes this memoir by acknowledging the growth and development of the discipline of human population biology.

  19. The safety experience of New Zealand adventure tourism operators.

    Science.gov (United States)

    Bentley, Tim A; Page, Stephen; Walker, Linda

    2004-01-01

    This survey examined parameters of the New Zealand adventure tourism industry client injury risk. The research also sought to establish priorities for intervention to reduce adventure tourism risk, and identify client injury control measures currently in place (or absent) in the New Zealand adventure tourism industry, with a view to establishing guidelines for the development of effective adventure tourism safety management systems. This 2003 survey builds upon an exploratory study of New Zealand adventure tourism safety conducted by us during 1999. A postal questionnaire was used to survey all identifiable New Zealand adventure tourism operators. The questionnaire asked respondents about their recorded client injury experience, perceptions of client injury risk factors, safety management practices, and barriers to safety. Some 27 adventure tourism activities were represented among the responding sample (n=96). The highest client injury risk was reported in the snow sports, bungee jumping and horse riding sectors, although serious underreporting of minor injuries was evident across the industry. Slips, trips and falls (STF) were the major client injury mechanisms, and a range of risk factors for client injuries were identified. Safety management measures were inconsistently applied across the industry. The industry should consider the implications of poor injury reporting standards and safety management practices generally. Specifically, the industry should consider risk management that focuses on minor (e.g., STF) as well as catastrophic events.

  20. Reactions of Internal and External Test-Anxious Students to Counseling and Behavior Therapies

    Science.gov (United States)

    Friedman, Meredith L.; Dies, Robert R.

    1974-01-01

    Results from this study showed that external subjects provided with counseling and systematic desensitization felt that they retained too much control of therapy, while internals generally indicated an optional amount of control in counseling. (Author)

  1. Proceedings of the first international symposium on neutron capture therapy

    International Nuclear Information System (INIS)

    Fairchild, R.G.; Brownell, G.L.

    1982-01-01

    This meeting was arranged jointly by MIT and BNL in order to illuminate progress in the synthesis and targeting of boron compounds and to evaluate and document progress in radiobiological and dosimetric aspects of neutron capture therapy. It is hoped that this meeting will facilitate transfer of information between groups working in these fields, and encourage synergistic collaboration

  2. Proceedings of the first international symposium on neutron capture therapy

    Energy Technology Data Exchange (ETDEWEB)

    Fairchild, R.G.; Brownell, G.L. (eds.)

    1982-01-01

    This meeting was arranged jointly by MIT and BNL in order to illuminate progress in the synthesis and targeting of boron compounds and to evaluate and document progress in radiobiological and dosimetric aspects of neutron capture therapy. It is hoped that this meeting will facilitate transfer of information between groups working in these fields, and encourage synergistic collaboration.

  3. Transformative Learning through International Immersion: Building Multicultural Competence in Family Therapy and Counseling

    Science.gov (United States)

    McDowell, Teresa; Goessling, Kristen; Melendez, Tatiana

    2012-01-01

    This study explores the experiences of graduate students who completed one of two international courses facilitated by family therapy faculty in a U.S. master's-level counseling psychology department. Participants reported that international courses were personally and professionally transformative. Spending time in a foreign country gave them…

  4. Radiobiology of Proton Therapy - Results of an international expert workshop

    DEFF Research Database (Denmark)

    Lühr, Armin; von Neubeck, Cläre; Pawelke, Jörg

    2018-01-01

    The physical properties of proton beams offer the potential to reduce toxicity in tumor-adjacent normal tissues. Toward this end, the number of proton radiotherapy facilities has steeply increased over the last 10-15 years to currently around 70 operational centers worldwide. However, taking full...... in proton therapy combined with systemic treatments, and (4) testing biological effects of protons in clinical trials. Finally, important research avenues for improvement of proton radiotherapy based on radiobiological knowledge are identified. The clinical distribution of radiobiological effectiveness...... of protons alone or in combination with systemic chemo- or immunotherapies as well as patient stratification based on biomarker expressions are key to reach the full potential of proton beam therapy. Dedicated preclinical experiments, innovative clinical trial designs, and large high-quality data...

  5. The Chemical Adventures of Sherlock Holmes: The Baker Street Burning.

    Science.gov (United States)

    Waddell, Thomas G.; Rybolt, Thomas R.

    1998-01-01

    Presents the ninth story in a series of chemical mysteries with emphasis on forensic chemistry, physical properties, and qualitative organic analysis. The mystery centers around the adventures of Sherlock Holmes. (DDR)

  6. Nuclear deterrence - The French nuclear adventure - The cockerel's spurs

    International Nuclear Information System (INIS)

    Valensi, Edouard

    2013-01-01

    This book reveals the secrets of the French strike force: the formidable adventure which provided France with first ranking strategic forces, the incredible fight given by Europe and the European Commission states to prohibit France from acquiring nuclear weapons, the US ambiguous game of accompanying France in her nuclear adventure in order to better monitor her, the core of deterrence with its doctrine of use, and for the future, the measures which will make French deterrence a decisive tool for worldwide peace

  7. Optimizing the use of intravenous therapy in internal medicine.

    Science.gov (United States)

    Champion, Karine; Mouly, Stéphane; Lloret-Linares, Celia; Lopes, Amanda; Vicaut, Eric; Bergmann, Jean-François

    2013-10-01

    We aimed to evaluate the impact of physicians' educational programs in the reduction of inappropriate intravenous lines in internal medicine. Fifty-six French internal medicine units were enrolled in a nationwide, prospective, blinded, randomized controlled trial. Forms describing the patients with an intravenous line and internal medicine department characteristics were filled out on 2 separate days in January and April 2007. Following the first visit, all units were randomly assigned to either a specific education program on the appropriate indications of an intravenous line, during February and March 2007, or no training (control group). The Investigators' Committee then blindly evaluated the clinical relevance of the intravenous line according to pre-established criteria. The primary outcome was the percentage of inappropriate intravenous lines. During January 2007, intravenous lines were used in 475 (24.9%) of the 1910 hospitalized patients. Of these, 80 (16.8%) were considered inappropriate. In April 2007, 416 (22.8%) of the 1823 hospitalized patients received an intravenous line, which was considered in 10.2% (21/205) of patients managed by trained physicians, versus 16.6% (35/211) of patients in the control group (relative difference 39%; 95% confidence interval, -0.6-13.3; P = .05). Reduced intravenous administration of fluids, antibiotics, and analgesics accounted for the observed decrease. The use of a simple education program reduced the rate of inappropriate intravenous lines by almost 40% in an internal medicine setting (NCT01633307). Copyright © 2013 Elsevier Inc. All rights reserved.

  8. The LHIN adventure: The journey continues.

    Science.gov (United States)

    Huras, Paul; Switzer, Gary; Eliasoph, Hy

    2015-11-01

    The Local Health Integration Network (LHIN) adventure began 10 years ago with the intent of transforming the Ontario health system by providing system-based leadership and building collaborative capacity among health service providers. The LHIN construct has continued its evolution during this time and is still in the midst of testing and reshaping the boundaries of its mandate and authority. Working closely and in tandem with the Ministry of Health and Long-Term Care, LHINs have grappled with governance, funding, integration, and engagement, changing the nature of relationships and the dynamics inherent across the health system. The next decade holds considerable promise for LHINs and the health system in Ontario as a whole. © 2015 The Canadian College of Health Leaders.

  9. Autistic phenomena in The Adventures of Pinocchio.

    Science.gov (United States)

    Smith, Adrian

    2017-04-01

    This paper seeks to demonstrate that the protagonist of Carlo Collodi's The Adventures of Pinocchio illustrates numerous autistic phenomena such as communication difficulties, sensory and perceptual distortions and mindblindness. While Pinocchio is viewed as a literary construct with contraindications of autism, it will be argued that his autistic traits are sufficient to suggest the possibility that Collodi had a partial intuition of the syndrome 60 years before it was identified by Leo Kanner. Approaching Collodi's text in this manner is taken as an opportunity to survey and reflect upon the psychoanalytic literature on autism and to position it in relation to contemporary theories from cognitive neuroscience. © 2017, The Society of Analytical Psychology.

  10. KEMASAN PAKET WISATA JATILUWIH SIGHTSEEING AND ADVENTURE

    Directory of Open Access Journals (Sweden)

    Renita Sri Lestari

    2017-01-01

    Full Text Available This study discusses and examines potential identification and package tour in Tabanan regency. Qualitative approaches were applied in this research. The data were collected by using observation techniques, in-depths interviews, and documentation technique. Informant and key informant techniques were used to determine the informantion. This study used descriptive qualitative data analysis techniques with three steps which are data reduction, data display and conclusion drawing. In this study, showed potential identifications taken place in Alas Kedaton, Jatiluwih, Batukaru Temple, Subak Museum, and Tengkudak Village. The packaging of this package tour with itinerary such as visit the Subak Museum, Tengkudak village adventure, visit Jatiluwih, sightseeing in Batukaru temple, sightseeing in Alas Kedaton and shopping in Krisna oleh-oleh. This package tour was presented in tabulated style, Graphic style as well as the calculation of travel costs.

  11. Stem Cell Gene Therapy for Fanconi Anemia: Report from the 1st International Fanconi Anemia Gene Therapy Working Group Meeting

    Science.gov (United States)

    Tolar, Jakub; Adair, Jennifer E; Antoniou, Michael; Bartholomae, Cynthia C; Becker, Pamela S; Blazar, Bruce R; Bueren, Juan; Carroll, Thomas; Cavazzana-Calvo, Marina; Clapp, D Wade; Dalgleish, Robert; Galy, Anne; Gaspar, H Bobby; Hanenberg, Helmut; Von Kalle, Christof; Kiem, Hans-Peter; Lindeman, Dirk; Naldini, Luigi; Navarro, Susana; Renella, Raffaele; Rio, Paula; Sevilla, Julián; Schmidt, Manfred; Verhoeyen, Els; Wagner, John E; Williams, David A; Thrasher, Adrian J

    2011-01-01

    Survival rates after allogeneic hematopoietic cell transplantation (HCT) for Fanconi anemia (FA) have increased dramatically since 2000. However, the use of autologous stem cell gene therapy, whereby the patient's own blood stem cells are modified to express the wild-type gene product, could potentially avoid the early and late complications of allogeneic HCT. Over the last decades, gene therapy has experienced a high degree of optimism interrupted by periods of diminished expectation. Optimism stems from recent examples of successful gene correction in several congenital immunodeficiencies, whereas diminished expectations come from the realization that gene therapy will not be free of side effects. The goal of the 1st International Fanconi Anemia Gene Therapy Working Group Meeting was to determine the optimal strategy for moving stem cell gene therapy into clinical trials for individuals with FA. To this end, key investigators examined vector design, transduction method, criteria for large-scale clinical-grade vector manufacture, hematopoietic cell preparation, and eligibility criteria for FA patients most likely to benefit. The report summarizes the roadmap for the development of gene therapy for FA. PMID:21540837

  12. Adventures in supercomputing: An innovative program for high school teachers

    Energy Technology Data Exchange (ETDEWEB)

    Oliver, C.E.; Hicks, H.R.; Summers, B.G. [Oak Ridge National Lab., TN (United States); Staten, D.G. [Wartburg Central High School, TN (United States)

    1994-12-31

    Within the realm of education, seldom does an innovative program become available with the potential to change an educator`s teaching methodology. Adventures in Supercomputing (AiS), sponsored by the U.S. Department of Energy (DOE), is such a program. It is a program for high school teachers that changes the teacher paradigm from a teacher-directed approach of teaching to a student-centered approach. {open_quotes}A student-centered classroom offers better opportunities for development of internal motivation, planning skills, goal setting and perseverance than does the traditional teacher-directed mode{close_quotes}. Not only is the process of teaching changed, but the cross-curricula integration within the AiS materials is remarkable. Written from a teacher`s perspective, this paper will describe the AiS program and its effects on teachers and students, primarily at Wartburg Central High School, in Wartburg, Tennessee. The AiS program in Tennessee is sponsored by Oak Ridge National Laboratory (ORNL).

  13. A marketing plan for the ice cream brand Max Adventures in food service

    OpenAIRE

    Carbó, Marina Cercós

    2013-01-01

    A Work Project, presented as part of the requirements for the Award of a Masters Degree in Management from the NOVA – School of Business and Economics This project consists on developing a marketing plan in the Spanish market for the ice cream brand Max Adventures in the food service sector. The objective of the plan is to increase current level of sales and distribution. For this reason an external and internal audit is done in order to understand the context, observe what competitors are...

  14. Proceedings of the international heavy particle therapy workshop (PTCOG/EORTC/ECNEU)

    International Nuclear Information System (INIS)

    Blattmann, H.

    1990-07-01

    The International Heavy Particle Therapy Workshop at PSI was an experiment in several ways. For the PTCOG it was the first meeting outside the American continent. It was also the first meeting of PRCOG in conjunction with the EORTC Heavy Particle Therapy Group, which up to now has been dominated by discussion on neutron therapy. A common goal for radiotherapy as well as neutron therapy are all aiming at this goal by improved dose distribution and/or higher biological effectiveness. The meeting at Villigen was an attempt to stimulate discussion between the different groups and to strengthen international collaboration. The large number of proffered oral papers and posters was certainly a sign that the meeting served a need and that particle radiotherapy enjoys growing interest worldwide. 89 tabs., 164 figs., 441 refs

  15. A constraints-based approach to the acquisition of expertise in outdoor adventure sports

    NARCIS (Netherlands)

    Davids, Keith; Brymer, Eric; Seifert, Ludovic; Orth, Dominic

    2013-01-01

    A constraints-based framework enables a new understanding of expertise in outdoor adventure sports by considering performer-environment couplings through emergent and self-organizing behaviours in relation to interacting constraints. Expert adventure athletes, conceptualized as complex, dynamical

  16. The entry-level occupational therapy clinical doctorate: advantages, challenges, and international issues to consider.

    Science.gov (United States)

    Brown, Ted; Crabtree, Jeffrey L; Mu, Keli; Wells, Joe

    2015-04-01

    Internationally, occupational therapy education has gone through several paradigm shifts during the last few decades, moving from certificate to diploma to bachelors to masters and now in some instances to clinical doctorate as the entry-level professional credential to practice. In the United States there is a recommendation under consideration by the American Occupational Therapy Association (AOTA) that by 2025, all occupational therapy university programs will move to the clinical doctorate level. It should be noted, however, that the AOTA Board can only make recommendations and it is the Accreditation Council for Occupational Therapy Education (ACOTE) who has regulatory authority to approve such a change. What are the potential implications for the profession, our clients, and funders of occupational therapy services? What are the primary drivers for the move towards the clinical doctorate being the educational entry point? Is the next step in the evolution of occupational therapy education globally a shift to the entry-level clinical doctorate? This article reviews current literature and discusses issues about the occupational therapy entry-level clinical doctorate. The published evidence available about the occupational therapy entry-level clinical doctorate is summarized and the perceived or frequently cited pros and cons of moving to the clinical doctorate as the singular entry point to occupational therapy practice are considered. The potential impacts of the introduction of the clinical doctorate as the entry-to-practice qualification across the United States on the occupational therapy community internationally will be briefly discussed. If the United States moves toward the entry-level clinical doctorate as the only educational starting point for the profession, will other jurisdictions follow suit? Further discourse and investigation of this issue both inside and outside of the United States is needed so that informed decisions can be made.

  17. The Eustress Paradigm: A Strategy for Decreasing Stress in Wilderness Adventure Programming.

    Science.gov (United States)

    Estrellas, Anjanette

    This essay proposes that stress has been misused in traditional adventure education and presents a new model of risk taking based on the literature on stress and feminist perspectives in adventure education. Proponents of the traditional adventure perspective state that the intentional use of stress is central to the change process in wilderness…

  18. Adolescent Girls and Body Image: Influence of Outdoor Adventure on Healthy Living

    Science.gov (United States)

    Barr-Wilson, Susie K.; Roberts, Nina S.

    2016-01-01

    Outdoor adventure may improve body image. However, minimal research exists on the effect outdoor adventure has on body image in adolescent girls, a demographic continually plagued by negative body image. In response, this exploratory study considered the influence of one outdoor adventure program in the San Francisco Bay Area. Through…

  19. Adventures with cyanobacteria: a personal perspective

    Directory of Open Access Journals (Sweden)

    Govindjee e

    2011-07-01

    Full Text Available Cyanobacteria, or the blue-green algae as they used to be called until 1974, are the oldest oxygenic photosynthesizers. We summarize here adventures with them since the early 1960s. This includes studies on light absorption by cyanobacteria, excitation energy transfer at room temperature down to liquid helium temperature, fluorescence (kinetics as well as spectra and its relationship to photosynthesis, and afterglow (or thermoluminescence from them. Further, we summarize experiments on their two-light reaction - two-pigment system, as well as the unique role of bicarbonate (hydrogen carbonate on the electron acceptor side of their photosystem II, PSII. This review, in addition, includes a discussion on the regulation of changes in phycobilins (mostly in PSII and chlorophyll a (Chl a; mostly in photosystem I, PSI under oscillating light, on the relationship of the slow fluorescence increase (the so-called S to M rise, especially in the presence of diuron in minute time scale with the so-called state-changes, and on the possibility of limited oxygen evolution in mixotrophic PSI (minus mutants, up to 30 minutes, in the presence of glucose. We end this review with a brief discussion on the position of cyanobacteria in the evolution of photosynthetic systems.

  20. SOTUNKI: An Island Of Education and Adventure

    Directory of Open Access Journals (Sweden)

    Heidi HEIKKILÄ

    2011-08-01

    Full Text Available Last year some of the teachers of Sotunki Distance Learning Centre set out to find a new approach to teaching different subjects in Upper Secondary School. We wanted to do this by using social media and finally decided on using Second Life. I think social media like Second Life can offer a lot to our students who study via internet and rarely meet each other or their teachers. In Second Life students can meet their teachers, guidance counselors and fellow students face to face and in real time. This brings more interaction to the learning process and gives the students a chance to get to know each other. Also the interaction in Second Life is slightly different – it gives us teachers a different kind of chance to get to know our students better in a more informal way. There were many decisions to make when we first started building our school. We started by deciding on whether we wanted to have a traditional school building with traditional classrooms in it – and decided against it. Why repeat the real world in Second Life? What is the point of using a virtual world if not to benefit from the possibilities that the real world does not have? So we set out to do something new and extraordinary: instead of a school house we have a mountainous jungle waiting for explorers, and instead of classrooms we have lots of different innovations customized to fit the virtual world. It is important to us that students want to explore our island and learn while exploring it: learning can be a real adventure.I chose the course of history of literature as my project because Second Life has wonderful tools for creating historical settings. Building a pathway came naturally too: the history of literature is linear by nature; a pathway is its natural form. There are plenty of time periods in literature that have distinctive styles but I could not include them all. Finally I decided to build information points for eight different stylistic periods

  1. 2010 International consensus algorithm for the diagnosis, therapy and management of hereditary angioedema

    DEFF Research Database (Denmark)

    Bowen, Tom; Cicardi, Marco; Farkas, Henriette

    2010-01-01

    ABSTRACT: BACKGROUND: We published the Canadian 2003 International Consensus Algorithm for the Diagnosis, Therapy, and Management of Hereditary Angioedema (HAE; C1 inhibitor [C1-INH] deficiency) and updated this as Hereditary angioedema: a current state-of-the-art review: Canadian Hungarian 2007 ...

  2. 2010 International consensus algorithm for the diagnosis, therapy and management of hereditary angioedema

    Directory of Open Access Journals (Sweden)

    Bowen Tom

    2010-07-01

    Full Text Available Abstract Background We published the Canadian 2003 International Consensus Algorithm for the Diagnosis, Therapy, and Management of Hereditary Angioedema (HAE; C1 inhibitor [C1-INH] deficiency and updated this as Hereditary angioedema: a current state-of-the-art review: Canadian Hungarian 2007 International Consensus Algorithm for the Diagnosis, Therapy, and Management of Hereditary Angioedema. Objective To update the International Consensus Algorithm for the Diagnosis, Therapy and Management of Hereditary Angioedema (circa 2010. Methods The Canadian Hereditary Angioedema Network (CHAEN/Réseau Canadien d'angioédème héréditaire (RCAH http://www.haecanada.com and cosponsors University of Calgary and the Canadian Society of Allergy and Clinical Immunology (with an unrestricted educational grant from CSL Behring held our third Conference May 15th to 16th, 2010 in Toronto Canada to update our consensus approach. The Consensus document was reviewed at the meeting and then circulated for review. Results This manuscript is the 2010 International Consensus Algorithm for the Diagnosis, Therapy and Management of Hereditary Angioedema that resulted from that conference. Conclusions Consensus approach is only an interim guide to a complex disorder such as HAE and should be replaced as soon as possible with large phase III and IV clinical trials, meta analyses, and using data base registry validation of approaches including quality of life and cost benefit analyses, followed by large head-to-head clinical trials and then evidence-based guidelines and standards for HAE disease management.

  3. [Corticosteroid therapy and therapeutic education: experience of an internal medicine department

    NARCIS (Netherlands)

    Simon, A.; Ane, A.M.; Afroun, A.

    2013-01-01

    In 2003, we sought to determine what were the needs of patients prescribed with long-term glucocorticoid therapy in our internal medicine department. Following this inventory, we decided to homogenize the medical practices regarding glucocorticoid prescriptions in our institution. We also set up a

  4. Matołek Broda. Creative and publishing adventures

    Directory of Open Access Journals (Sweden)

    Justyna Staroń

    2016-03-01

    Full Text Available The article discusses issues related to the creative process and the editorial fate of The Adventures of Matołek the Billy-Goat by Kornel Makuszyński. It contains collected informations on the appearance of an idea for a book-comic for children (as told by Makuszyński’s wife – Janina, Marian Walentynowicz, Jan Gebethner, through the actual process of writing, the first edition and post-war issue. Also it discusses drawings from The 120 adventures of Matołek the Billy-Goat which sometimes differ quite significantly depending on the edition.

  5. Psychological implications of outdoor adventure model of education

    Directory of Open Access Journals (Sweden)

    Paulina Kida

    2017-07-01

    Full Text Available The article is a synthetic analysis of the Outdoor Adventure Education model in the context of three elementary components: the environment – in relation to the theory of space from the perspective of sociological and pedagogical theory of space; personal perspective and growth as well as social development – in relation to psychological phenomena that accompany the individual and group involved in the process of Outdoor Adventure Education. The aim is to present how these processes determine the effects of education and what personalities’ elements are involved.

  6. Significant profile differences among male and female adventure tourists in Pretoria, South Africa

    Directory of Open Access Journals (Sweden)

    Melissa Jeanette Lötter

    2014-01-01

    Full Text Available Different adventure activities/experiences evolve because individuals, their motives, behaviours, and experiences differ and change over time. This notion illustrates the broad nature of adventure tourism and its links with other forms of tourism. In turn, adventure tourism companies are compelled to promote/sell an array of activities/experiences to a diverse range of markets as novel and exclusive experiences to facilitate the growth of adventure holidays (Swarbrooke et al., 2003. To assist adventure tourism companies in achieving effective marketing strategies, the study’s objective is to identify significant sociopsychological profile differences among male and female adventure tourists in Pretoria, South Africa. Furthermore, to facilitate the comparison of adventure tourists’ profiles, an equal number of respondents were male (117 and female (117, which provided a 93.6% response rate. In comparison to female respondents, male respondents prefer winter as a season to participate in hard/high-risk adventure activities when they are with or without their family, and they participate in adventure activities for travelling and socialising purposes. Whereas, female respondents predominantly regard scuba-diving, abseiling, and helicopter flights as a hard/high-risk adventure activity, although these activities are generally regarded by the overall sample as being soft/low-risk adventure activities. Furthermore, even though females’ participation in adventure activities is sponsored, they did not participate or only participated in adventure activities once over the past year due to fear/risk and/or lack of skill. This study established that there is a need to further research adventure tourists’ profiles before it could be equally accepted and interpreted.

  7. Making an impact: an adventure into international pharmacy.

    Science.gov (United States)

    Hitch, William; Ransom, Matthew

    2009-01-01

    To support a medical team, organized by Shoulder to Shoulder, with pharmacy services in an effort to expand ongoing health care to a rural community in Honduras. Pharmacy services in a temporary medical clinic in a schoolhouse in Colomarigua, a small mountain village in Honduras. Pharmacy services and medical care to address acute care needs of the people of Colomarigua, Honduras, during a week-long clinic. Interpreters assisted with patient counseling. Medication labels with pictures that connected doses to mealtimes increased patient understanding and the potential for medications to be dosed correctly. Fill lines were drawn on delivery devices for pediatric suspensions. An effort was made to avoid polypharmacy by communicating with physicians about the different prescriptions that were being prescribed in each household. Not applicable. Not applicable. We created a temporary clinic with a pharmacy and provided medical care to more than 600 children and adults in the surrounding regions. The medical team identified need for a feeding program, and local Shoulder to Shoulder teams began activities to support the community's development. Education programs were initiated to allow promising local children access to higher education. Challenges to providing optimal pharmaceutical care included language barriers, space and flow of the pharmacy, and a limited formulary. Benefits included gaining a whole new perspective on pharmacotherapy, health, and the importance of service to those in need whether abroad or at home.

  8. International Patterns of Practice in the Management of Radiation Therapy-induced Nausea and Vomiting

    Energy Technology Data Exchange (ETDEWEB)

    Dennis, Kristopher; Zhang Liying [Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario (Canada); Lutz, Stephen [Blanchard Valley Health Systems, Findlay, Ohio (United States); Baardwijk, Angela van [Department of Radiation Oncology (MAASTRO Clinic), GROW-School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht (Netherlands); Linden, Yvette van der [Leiden University Medical Center, Leiden (Netherlands); Holt, Tanya [Radiation Oncology Mater Centre, Princess Alexandra Hospital, Brisbane (Australia); Arnalot, Palmira Foro [Parc de Salut Mar. Universitat Pompeu Fabra Barcelona (Spain); Lagrange, Jean-Leon [AP-HP Hopital Henri-Mondor, Universite Paris Est Creteil, Creteil (France); Maranzano, Ernesto [' S. Maria' Hospital, Terni (Italy); Liu, Rico [Queen Mary Hospital, Hong Kong (China); Wong, Kam-Hung [Queen Elizabeth Hospital, Hong Kong (Hong Kong); Wong, Lea-Choung [National University Cancer Institute (Singapore); Vassiliou, Vassilios [Bank of Cyprus Oncology Centre, Nicosia (Cyprus); Corn, Benjamin W. [Tel Aviv Medical Center, Tel Aviv (Israel); De Angelis, Carlo; Holden, Lori; Wong, C. Shun [Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario (Canada); Chow, Edward, E-mail: Edward.Chow@sunnybrook.ca [Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario (Canada)

    2012-09-01

    Purpose: To investigate international patterns of practice in the management of radiation therapy-induced nausea and vomiting (RINV). Methods and Materials: Oncologists prescribing radiation therapy in the United States, Canada, The Netherlands, Australia, New Zealand, Spain, Italy, France, Hong Kong, Singapore, Cyprus, and Israel completed a Web-based survey that was based on 6 radiation therapy-only clinical cases modeled after the minimal-, low-, moderate-, and high-emetic risk levels defined in the antiemetic guidelines of the American Society of Clinical Oncology and the Multinational Association of Supportive Care in Cancer. For each case, respondents estimated the risks of nausea and vomiting separately and committed to an initial management approach. Results: In total, 1022 responses were received. Risk estimates and management decisions for the minimal- and high-risk cases varied little and were in line with guideline standards, whereas those for the low- and moderate-risk cases varied greatly. The most common initial management strategies were as follows: rescue therapy for a minimal-risk case (63% of respondents), 2 low-risk cases (56% and 80%), and 1 moderate-risk case (66%); and prophylactic therapy for a second moderate-risk case (75%) and a high-risk case (95%). The serotonin (5-HT){sub 3} receptor antagonists were the most commonly recommended prophylactic agents. On multivariate analysis, factors predictive of a decision for prophylactic or rescue therapy were risk estimates of nausea and vomiting, awareness of the American Society of Clinical Oncology antiemetic guideline, and European Society for Therapeutic Radiology and Oncology membership. Conclusions: Risk estimates and management strategies for RINV varied, especially for low- and moderate-risk radiation therapy cases. Radiation therapy-induced nausea and vomiting are under-studied treatment sequelae. New observational and translational studies are needed to allow for individual patient risk

  9. International Patterns of Practice in the Management of Radiation Therapy-induced Nausea and Vomiting

    International Nuclear Information System (INIS)

    Dennis, Kristopher; Zhang Liying; Lutz, Stephen; Baardwijk, Angela van; Linden, Yvette van der; Holt, Tanya; Arnalot, Palmira Foro; Lagrange, Jean-Léon; Maranzano, Ernesto; Liu, Rico; Wong, Kam-Hung; Wong, Lea-Choung; Vassiliou, Vassilios; Corn, Benjamin W.; De Angelis, Carlo; Holden, Lori; Wong, C. Shun; Chow, Edward

    2012-01-01

    Purpose: To investigate international patterns of practice in the management of radiation therapy-induced nausea and vomiting (RINV). Methods and Materials: Oncologists prescribing radiation therapy in the United States, Canada, The Netherlands, Australia, New Zealand, Spain, Italy, France, Hong Kong, Singapore, Cyprus, and Israel completed a Web-based survey that was based on 6 radiation therapy-only clinical cases modeled after the minimal-, low-, moderate-, and high-emetic risk levels defined in the antiemetic guidelines of the American Society of Clinical Oncology and the Multinational Association of Supportive Care in Cancer. For each case, respondents estimated the risks of nausea and vomiting separately and committed to an initial management approach. Results: In total, 1022 responses were received. Risk estimates and management decisions for the minimal- and high-risk cases varied little and were in line with guideline standards, whereas those for the low- and moderate-risk cases varied greatly. The most common initial management strategies were as follows: rescue therapy for a minimal-risk case (63% of respondents), 2 low-risk cases (56% and 80%), and 1 moderate-risk case (66%); and prophylactic therapy for a second moderate-risk case (75%) and a high-risk case (95%). The serotonin (5-HT) 3 receptor antagonists were the most commonly recommended prophylactic agents. On multivariate analysis, factors predictive of a decision for prophylactic or rescue therapy were risk estimates of nausea and vomiting, awareness of the American Society of Clinical Oncology antiemetic guideline, and European Society for Therapeutic Radiology and Oncology membership. Conclusions: Risk estimates and management strategies for RINV varied, especially for low- and moderate-risk radiation therapy cases. Radiation therapy-induced nausea and vomiting are under-studied treatment sequelae. New observational and translational studies are needed to allow for individual patient risk

  10. The impact of an adventure based experiential learning programme ...

    African Journals Online (AJOL)

    The aim of this study was to determine the effect of an adventure based experiential learning programme (AEP) in developing the life effectiveness of black high school learners. “Life Effectiveness” reflects the psychological and behavioural aspects of human functioning which determine the proficiency of a person in society.

  11. Understanding Groups in Outdoor Adventure Education through Social Network Analysis

    Science.gov (United States)

    Jostad, Jeremy; Sibthorp, Jim; Paisley, Karen

    2013-01-01

    Relationships are a critical component to the experience of an outdoor adventure education (OAE) program, therefore, more fruitful ways of investigating groups is needed. Social network analysis (SNA) is an effective tool to study the relationship structure of small groups. This paper provides an explanation of SNA and shows how it was used by the…

  12. Resurgent Military Political Adventurism in West Africa: Implications ...

    African Journals Online (AJOL)

    The democratization efforts of the 1990s in West Africa appeared to have put paid to military political adventurism which had been the plague of that region since independence in the 1960s. But since the year 2000 there has been a resurgence of military intervention in the politics of some West African states and this calls ...

  13. Conceptualizing Skill within a Participatory Ecological Approach to Outdoor Adventure

    Science.gov (United States)

    Mullins, Philip M.

    2014-01-01

    To answer calls for an ecological approach to outdoor adventure that can respond to the crisis of sustainability, this paper suggests greater theoretical and empirical attention to skill and skill development as shaping participant interactions with and experiences of environments, landscapes, places, and inhabitants. The paper reviews calls for…

  14. Factors that Influence Women's Technical Skill Development in Outdoor Adventure

    Science.gov (United States)

    Warren, Karen; Loeffler, TA

    2006-01-01

    This article provides a theoretical foundation for understanding women's technical skill development (TSD) in outdoor adventure. An examination of societal and biological factors influencing women's TSD focuses on gender role socialization, sense of competence, technical conditioning, sexism, spatial ability, and risk-taking. The article suggests…

  15. The Spirit of Adventure and the Art of Creation

    Indian Academy of Sciences (India)

    Home; Journals; Resonance – Journal of Science Education; Volume 19; Issue 7. The Spirit of Adventure and the Art of Creation: Camphor to Vitamin B12. Setty Mallikarjuna Babu Subramania Ranganathan. General Article Volume 19 Issue 7 July 2014 pp 593-623 ... Keywords. Camphor; vitamin B12; art of creation.

  16. A Socio-Environmental Case for Skill in Outdoor Adventure

    Science.gov (United States)

    Mullins, Philip M.

    2014-01-01

    In response to the crisis of sustainability, this paper revisits understandings of human--environment relations established through skill-based outdoor activities that are used commonly among adventure recreation, education, and tourism. Reconsidering a predominant focus on risk and a persistent tension between technical and environmental…

  17. “Soldiers of paint”: Relationship between leisure adventure combat ...

    African Journals Online (AJOL)

    Adventure sports tourism has shown consistent growth during the last several decades as a leisure activity that stands as an antithesis of traditional leisure tourism. ... An exploratory factor analysis on the leisure aspects of paintball, positive sport lifestyle, leisure and recreation life domain positive/negative effect and quality ...

  18. The Sweat Lodge Ceremony in Challenge/Adventure Programming.

    Science.gov (United States)

    Quinn, William J.; Smith, Thomas E.

    This paper advocates the potentials of "sweat lodge" rituals for adventure education programs. Historically, rituals and ceremonies have been instrumental in passing major philosophical and sociological paradigms from one generation to the next. However, there is little theory and research about how ritual and ceremony results in the…

  19. Artificial Intelligence in a German Adventure Game: Spion in PROLOG.

    Science.gov (United States)

    Molla, Steven R.; And Others

    1988-01-01

    Spion, an adventure game for intermediate and advanced college German students, requires players to communicate with a fictitious agent in complete, correct German sentences. The spy game was written in PROLOG, runs on an IBM-PC, and is available at no cost for noncommercial purposes. (Author/CB)

  20. Cardiovascular disease in the Adventures of Sherlock Holmes.

    Science.gov (United States)

    Ramanan, S V

    2001-03-12

    The Adventures of Sherlock Holmes by Sir Arthur Conan Doyle contains many incidents of medical interest. While disorders of the cardiovascular system do not play an important role in these tales, there are, nevertheless, some illnesses that invite speculation. Eleven such incidents are reviewed and discussed in light of the times in which they occurred and in light of current medical knowledge.

  1. Challenges in the delivery of adventure education: The case of ...

    African Journals Online (AJOL)

    This qualitative study explored the substantive issues and challenges faced by Physical Education teachers in delivering adventure education in the context of Botswana junior secondary schools. In the first stage of the study, 22 respondents completed a semi-structured questionnaire requesting information pertaining to the ...

  2. The effect of adventure-based experiential learning on personal ...

    African Journals Online (AJOL)

    The purpose of the study was to determine the effectiveness of Adventure-based Experiential Learning (AEL) in developing the personal effectiveness of adolescents. Twenty three adolescents, currently enrolled in a post-matriculation development centre were studied. The study consisted of an experimental (n=12) and ...

  3. The Writing Process for "Edutaining" CD-ROM Adventures.

    Science.gov (United States)

    Mountain, Lee

    2000-01-01

    Describes a CD-ROM adventure story written by the author to educate her students about the word relationships of synonyms and antonyms. Discusses how this interactive medium put a different twist on each of the stages of the writing process itself. Relates how two students enthusiastically used the program, and were inspired to write one of their…

  4. Evaluation of Team Development in a Corporate Adventure Training Program.

    Science.gov (United States)

    Bronson, Jim; And Others

    1992-01-01

    An intact work unit of 17 corporate managers participated in a 3-day adventure training program to develop teamwork and group unity. The unit improved significantly on 8 of 10 items of the Team Development Inventory, administered before and 2 months after training, relative to an intact control group. (SV)

  5. Locating opportunities for outdoor action and adventure recreation ...

    African Journals Online (AJOL)

    This paper indicates how modern spatial computing technology can be used for developing spatial policy for, and planning of outdoor action and adventure recreation and tourism (OAART). An application was performed in the Western Cape Province of South Africa. The research overviews spatial recreation and tourism ...

  6. The Censorship of the "Adventures of Huckleberry Finn": An Investigation.

    Science.gov (United States)

    Cloonan, Michele V.

    1984-01-01

    Explores reasons why "Adventures of Huckleberry Finn" has been continuously censored from its publication in 1885 to present. Historical precedents for censorship of library materials in the United States and specific censorship attempts are discussed. Controversial passages are examined in light of both praise and criticism.…

  7. Decision Making and Risk Management in Adventure Sports Coaching

    Science.gov (United States)

    Collins, Loel; Collins, Dave

    2013-01-01

    Adventure sport coaches practice in environments that are dynamic and high in risk, both perceived and actual. The inherent risks associated with these activities, individuals' responses and the optimal exploitation of both combine to make the processes of risk management more complex and hazardous than the traditional sports where risk management…

  8. The Social System in Outdoor Adventure Education Programs

    Science.gov (United States)

    Sibthorp, Jim; Jostad, Jeremy

    2014-01-01

    Many components of the social system interact with one another to produce group-level behavior that determines the functionality of the small group in outdoor adventure education (OAE). This article synthesizes the contemporary literature and theory regarding eight aspects of the OAE social system: (a) Macro Contextual Factors, (b) Student…

  9. Sustaining International Partnerships: The European Master of Science Program In Occupational Therapy: A Case Study

    DEFF Research Database (Denmark)

    Ilott, Irene; Kottorp, Anders; la Cour, Karen

    2013-01-01

    Abstract International partnerships are a mechanism for supporting the academic development of occupational therapy and promoting cultural competence. This case study describes the factors that have helped to sustain a post-qualifying programme implemented by five higher education institutions...... comprises students from an average of eight countries to optimize inter-cultural dialogue. Four factors support sustainability. These are 1) supportive professional European networks; 2) timeliness and alignment with European higher education policy; 3) partnership structures and processes that emphasize...

  10. Internal and External Triggering Mechanism of "Smart" Nanoparticle-Based DDSs in Targeted Tumor Therapy.

    Science.gov (United States)

    Qiana, Xian-Ling; Li, Jun; Wei, Ran; Lin, Hui; Xiong, Li-Xia

    2018-05-09

    Anticancer chemotherapeutics have a lot of problems via conventional drug delivery systems (DDSs), including non-specificity, burst release, severe side-effects, and damage to normal cells. Owing to its potential to circumventing these problems, nanotechnology has gained increasing attention in targeted tumor therapy. Chemotherapeutic drugs or genes encapsulated in nanoparticles could be used to target therapies to the tumor site in three ways: "passive", "active", and "smart" targeting. To summarize the mechanisms of various internal and external "smart" stimulating factors on the basis of findings from in vivo and in vitro studies. A thorough search of PubMed was conducted in order to identify the majority of trials, studies and novel articles related to the subject. Activated by internal triggering factors (pH, redox, enzyme, hypoxia, etc.) or external triggering factors (temperature, light of different wavelengths, ultrasound, magnetic fields, etc.), "smart" DDSs exhibit targeted delivery to the tumor site, and controlled release of chemotherapeutic drugs or genes. In this review article, we summarize and classify the internal and external triggering mechanism of "smart" nanoparticle-based DDSs in targeted tumor therapy, and the most recent research advances are illustrated for better understanding. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

  11. Adventures in Evaluation: Reviewing a CD-ROM Based Adventure Game Designed for Young People Recovering from Psychosis

    Science.gov (United States)

    Shrimpton, Bradley; Hurworth, Rosalind

    2005-01-01

    Recently the Centre for Program Evaluation (CPE) at the University of Melbourne was approached by a mental health agency to undertake the unique and challenging task of evaluating a prototype CD-ROM based adventure game designed for young people recovering from psychosis. This unusual and inventive game, titled Pogo's Pledge, used…

  12. How safe is adventure tourism in New Zealand? An exploratory analysis.

    Science.gov (United States)

    Bentley, T; Page, S; Meyer, D; Chalmers, D; Laird, I

    2001-08-01

    The paper reports findings from a multidisciplinary programme of research, the major aims of which were to determine the nature and extent of the New Zealand adventure tourism injury problem. Analysis of hospital discharge and mortality data for a 15-year period identified adventure tourism-related activities as contributing to approximately 20% of overseas visitor injuries, and 22% of fatalities. Activities that commonly involve independent-unguided adventure tourism, notably mountaineering, skiing and tramping, contributed most to injury and fatality incidence. Horse riding and cycling activities were identified from hospital discharge data and adventure tourism operators' reported client injury-incidence, as the commercial adventure tourism activities most frequently involved in client injuries. Falls were the most common injury events, and a range of client, equipment, environmental and organisational risk factors were identified. Possible interventions to reduce injury risk among overseas and domestic adventure tourists are discussed.

  13. The Paediatric Rheumatology International Trials Organisation provisional criteria for the evaluation of response to therapy in juvenile dermatomyositis

    DEFF Research Database (Denmark)

    Ruperto, Nicolino; Pistorio, Angela; Ravelli, Angelo

    2010-01-01

    To develop a provisional definition for the evaluation of response to therapy in juvenile dermatomyositis (DM) based on the Paediatric Rheumatology International Trials Organisation juvenile DM core set of variables....

  14. International collaboration including patients is essential to develop new therapies for patients with myositis.

    Science.gov (United States)

    Lundberg, Ingrid E; Vencovsky, Jiri

    2017-05-01

    To discuss the needs for international collaborations between investigators in different disciplines working with myositis and with patients with myositis. Recent advances in detection of several myositis-specific autoantibodies that are associated with distinct clinical phenotypes, will enable studies in new well defined clinically homogenous subgroups of myositis This is likely to lead to development of new information on molecular pathogenesis that might be different in different myositis subgroups. Subgrouping patients according to autoantibody profile may also be important to assess outcome, to identify prognostic biomarkers and in clinical trials. As these are rare disorders international collaboration is essential to enrol large enough cohorts of the subgroups. To facilitate such collaboration we have developed a web-based international myositis register, www.euromyositis.eu, which includes validated outcome measures and patient reported outcome measures. This register is to support research but also to support decision-making in the clinic. We welcome investigators to join the Euromyositis register. Myositis is a heterogeneous disorder with varying treatment response and outcome. There is a high unmet need for new therapies which can only be achieved by increased knowledge on molecular disease mechanisms. Subgrouping patients according to autoantibody profile may be a new way forward to get a better understanding on disease mechanisms and to develop novel therapies.

  15. International experts' practice in the antibiotic therapy of infective endocarditis is not following the guidelines.

    Science.gov (United States)

    Tissot-Dupont, H; Casalta, J P; Gouriet, F; Hubert, S; Salaun, E; Habib, G; Fernandez-Gerlinger, M P; Mainardi, J L; Tattevin, P; Revest, M; Lucht, F; Botelho-Nevers, E; Gagneux-Brunon, A; Snygg-Martin, U; Chan, K L; Bishara, J; Vilacosta, I; Olmos, C; San Román, J A; López, J; Tornos, P; Fernández-Hidalgo, N; Durante-Mangoni, E; Utili, R; Paul, M; Baddour, L M; DeSimone, D C; Sohail, M R; Steckelberg, J M; Wilson, W R; Raoult, D

    2017-10-01

    The management of infective endocarditis (IE) may differ from international guidelines, even in reference centres. This is probably because most recommendations are not based on hard evidence, so the consensus obtained for the guidelines does not represent actual practices. For this reason, we aimed to evaluate this question in the particular field of antibiotic therapy. Thirteen international centres specialized in the management of IE were selected, according to their reputation, clinical results, original research publications and quotations. They were asked to detail their actual practice in terms of IE antibiotic treatment in various bacteriological and clinical situations. They were also asked to declare their IE-related in-hospital mortality for the year 2015. The global compliance with guidelines concerning antibiotic therapy was 58%, revealing the differences between theoretical 'consensus', local recommendations and actual practice. Some conflicts of interest were also probably expressed. The adherence to guidelines was 100% when the protocol was simple, and decreased with the seriousness of the situation (Staphylococus spp. 54%-62%) or in blood-culture-negative endocarditis (0%-15%) that requires adaptation to clinical and epidemiological data. Worldwide experts in IE management, although the majority of them were involved and co-signed the guidelines, do not follow international consensus guidelines on the particular point of the use of antibiotics. Copyright © 2017 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

  16. EGF Functionalized Polymer-Coated Gold Nanoparticles Promote EGF Photostability and EGFR Internalization for Photothermal Therapy.

    Directory of Open Access Journals (Sweden)

    Catarina Oliveira Silva

    Full Text Available The application of functionalized nanocarriers on photothermal therapy for cancer ablation has wide interest. The success of this application depends on the therapeutic efficiency and biocompatibility of the system, but also on the stability and biorecognition of the conjugated protein. This study aims at investigating the hypothesis that EGF functionalized polymer-coated gold nanoparticles promote EGF photostability and EGFR internalization, making these conjugated particles suitable for photothermal therapy. The conjugated gold nanoparticles (100-200 nm showed a plasmon absorption band located within the near-infrared range (650-900 nm, optimal for photothermal therapy applications. The effects of temperature, of polymer-coated gold nanoparticles and of UVB light (295nm on the fluorescence properties of EGF have been investigated with steady-state and time-resolved fluorescence spectroscopy. The fluorescence properties of EGF, including the formation of Trp and Tyr photoproducts, is modulated by temperature and by the intensity of the excitation light. The presence of polymeric-coated gold nanoparticles reduced or even avoided the formation of Trp and Tyr photoproducts when EGF is exposed to UVB light, protecting this way the structure and function of EGF. Cytotoxicity studies of conjugated nanoparticles carried out in normal-like human keratinocytes showed small, concentration dependent decreases in cell viability (0-25%. Moreover, conjugated nanoparticles could activate and induce the internalization of overexpressed Epidermal Growth Factor Receptor in human lung carcinoma cells. In conclusion, the gold nanoparticles conjugated with Epidermal Growth Factor and coated with biopolymers developed in this work, show a potential application for near infrared photothermal therapy, which may efficiently destroy solid tumours, reducing the damage of the healthy tissue.

  17. EGF Functionalized Polymer-Coated Gold Nanoparticles Promote EGF Photostability and EGFR Internalization for Photothermal Therapy

    Science.gov (United States)

    Silva, Catarina Oliveira; Petersen, Steffen B.; Reis, Catarina Pinto; Rijo, Patrícia; Molpeceres, Jesús; Fernandes, Ana Sofia; Gonçalves, Odete; Gomes, Andreia C.; Correia, Isabel; Vorum, Henrik; Neves-Petersen, Maria Teresa

    2016-01-01

    The application of functionalized nanocarriers on photothermal therapy for cancer ablation has wide interest. The success of this application depends on the therapeutic efficiency and biocompatibility of the system, but also on the stability and biorecognition of the conjugated protein. This study aims at investigating the hypothesis that EGF functionalized polymer-coated gold nanoparticles promote EGF photostability and EGFR internalization, making these conjugated particles suitable for photothermal therapy. The conjugated gold nanoparticles (100–200 nm) showed a plasmon absorption band located within the near-infrared range (650–900 nm), optimal for photothermal therapy applications. The effects of temperature, of polymer-coated gold nanoparticles and of UVB light (295nm) on the fluorescence properties of EGF have been investigated with steady-state and time-resolved fluorescence spectroscopy. The fluorescence properties of EGF, including the formation of Trp and Tyr photoproducts, is modulated by temperature and by the intensity of the excitation light. The presence of polymeric-coated gold nanoparticles reduced or even avoided the formation of Trp and Tyr photoproducts when EGF is exposed to UVB light, protecting this way the structure and function of EGF. Cytotoxicity studies of conjugated nanoparticles carried out in normal-like human keratinocytes showed small, concentration dependent decreases in cell viability (0–25%). Moreover, conjugated nanoparticles could activate and induce the internalization of overexpressed Epidermal Growth Factor Receptor in human lung carcinoma cells. In conclusion, the gold nanoparticles conjugated with Epidermal Growth Factor and coated with biopolymers developed in this work, show a potential application for near infrared photothermal therapy, which may efficiently destroy solid tumours, reducing the damage of the healthy tissue. PMID:27788212

  18. Is ecotourism an alternative to adventure tourism in El Chaco?

    Directory of Open Access Journals (Sweden)

    Daniela Polanco

    2017-07-01

    Full Text Available El Chaco is one of the cantons has excelled in adventure tourism. However, since 2006 this activity has not broken and tourism has been separated from the local development. The objective of the present investigation is to find out the issues that affect the adventure tourism in El Chaco and to propose a new tourism product regarding the zone possibilities. In order to obtain the results, it has been developed a theoretical and methodological investigation focused in interviews and social cartography in Gonzalo Díaz de Pineda and in the cantonal head El Chaco. The main results denote the lack of organization, the high costs and the impacts generated by the construction of the Coca Codo Sinclair hydroelectric power plant. These results make visible the problems and support the suggestion of practicing ecotourism as a new choice of local development in the region.

  19. Mythic Frodo and his Predestinate Call to Adventure

    Directory of Open Access Journals (Sweden)

    Farid Mohammadi

    2013-09-01

    Full Text Available One of the most interesting aspects of J.R.R. Tolkien’s stories, especially The Lord of the Rings is the presentation of the multidimensional characters; therefore, the complexity of interpretations concerning their actions, motives, and aims will be manifested from the beginning of the story, until the end. Following the study of a mythic hero’s adventure, initiation, and psychological aspects, the present paper focuses on the investigation of Predestinate Call to Adventure. The researcher has benefited the theories of Joseph Campbell, presented in his renowned book The Hero with a Thousand Faces and the supplementary comments of Christopher Vogler. In fact, the researcher’s motivation for the work initiated in this regard is to improve the very few previous attempts studied by others, concerning Frodo Baggins’ role as the main and the most tragic hero of The Lord of the Rings.

  20. A Prospective Cohort Study of Gated Stereotactic Liver Radiation Therapy Using Continuous Internal Electromagnetic Motion Monitoring

    DEFF Research Database (Denmark)

    Worm, Esben S; Høyer, Morten; Hansen, Rune

    2018-01-01

    PURPOSE: Intrafraction motion can compromise the treatment accuracy in liver stereotactic body radiation therapy (SBRT). Respiratory gating can improve treatment delivery; however, gating based on external motion surrogates is inaccurate. The present study reports the use of Calypso-based internal...... electromagnetic motion monitoring for gated liver SBRT. METHODS AND MATERIALS: Fifteen patients were included in a study of 3-fraction respiratory gated liver SBRT guided by 3 implanted electromagnetic transponders. The planning target volume was created by a 5-mm axial and 7-mm (n = 12) or 10-mm (n = 3...

  1. Split, Croatia - Educational, Adventurous and Sustainable Tourism Destination

    OpenAIRE

    Chabik, Szymon; Imran, Md. Azim

    2015-01-01

    The purpose of this Bachelor’s thesis is to create an audio-visual documentation about an educational trip to Split, Croatia. The trip took place in April, 2014. The educational tour was organized by Laurea University of Applied Sciences. The destination, Split, were chosen by participants’ vote. The tour was arranged and planned by a group of students and the theme of the tour was Educational Tourism. The entire trip was taken into consideration from sustainable, Adventure and educational po...

  2. CREATING NEW MARKETING STRATEGY FOR CASE COMPANY ADVENTURE NET

    OpenAIRE

    Koleva, Hristina

    2017-01-01

    The purpose of this thesis was to create new, more successful marketing strategy for case company Adventure Net through analyzing the current marketing strategy and market environment of the company. The tools included in the theoretical part were used to analyze the market environment and marketing strategy. The analyzing tools included were PESTEL (Political, Economic, Social, Technological, Ecologic, Legal) analysis, SWOT (Strengths, Weaknesses, Threats, Opportunities) analysis and com...

  3. Is Endoscopic Therapy Safe for Upper Gastrointestinal Bleeding in Anticoagulated Patients With Supratherapeutic International Normalized Ratios?

    Science.gov (United States)

    Shim, Choong Nam; Chung, Hyun Soo; Park, Jun Chul; Shin, Sung Kwan; Lee, Sang Kil; Lee, Yong Chan; Kim, Ha Yan; Kim, Dong Wook; Lee, Hyuk

    2016-01-01

    The management of upper gastrointestinal bleeding (UGIB) in anticoagulated patients with supratherapeutic international normalized ratios (INRs) presents a challenge. The purpose of the study was to evaluate the safety of endoscopic therapy for UGIB in anticoagulated patients with supratherapeutic INR in terms of rebleeding and therapeutic outcomes. One hundred ninety-two anticoagulated patients who underwent endoscopic treatment for UGIB were enrolled in the study. Patients were divided into 2 groups based on the occurrence of rebleeding within 30 days of the initial therapeutic endoscopy: no-rebleeding group (n = 168) and rebleeding group (n = 24). The overall rebleeding rate was 12.5%. Bleeding from gastric cancer and bleeding at the duodenum were significantly related to rebleeding in a univariate analysis. Multivariate analysis determined that presenting symptoms other than melena (hematemesis, hematochezia, or others) (odds ratio, 3.93; 95% confidence interval, 1.44-10.76) and bleeding from gastric cancer (odds ratio, 6.10; 95% confidence interval, 1.27-29.25) were significant factors predictive of rebleeding. Supratherapeutic INR at the time of endoscopic therapy was not significantly associated with rebleeding in either univariate or multivariate analysis. Significant differences in bleeding-related mortality, additional intervention to control bleeding, length of hospital stay, and transfusion requirements were revealed between the rebleeding and no-rebleeding groups. There were no significant differences in therapeutic outcomes between patients with INR within the therapeutic range and those with supratherapeutic INR. Supratherapeutic INR at the time of endoscopic therapy did not change rebleeding and therapeutic outcomes. Thus, we should consider endoscopic therapy for UGIB in anticoagulated patients, irrespective of INR at the time of endoscopic therapy.

  4. The Process for the Formulation of the International Telehealth Position Statement for Occupational Therapy

    Science.gov (United States)

    JACOBS, KAREN; CASON, JANA; MCCULLOUGH, ANN

    2015-01-01

    The World Federation of Occupational Therapists (WFOT) consists of 84 member organizations representing over 420,000 occupational therapists internationally (WFOT, 2014). In 2014, WFOT published the WFOT Telehealth Position Statement on the use of telehealth in occupational therapy. The process for the formulation of the official document involved reviewing WFOT member organizations’ telehealth position statements and data collected from a survey sent to member organizations’ delegates in April 2014. Qualitative data from 39 countries yielded factors to consider in five key areas: licensure/registration requirements, the cost of technology, privacy and security, reimbursement/payment models, and other issues (e.g., need for collaboration/transfer of knowledge, client selection, provider competencies, standard of care). The WFOT Telehealth Position Statement addressed each of these areas. The collaborative effort resulting in the development of the WFOT Telehealth Position Statement serves as a model for other international organizations. PMID:27563380

  5. Relation of psychological distress to the international normalized ratio in patients with venous thromboembolism with and without oral anticoagulant therapy.

    Science.gov (United States)

    Von Känel, R; Vökt, F; Biasiutti, F Demarmels; Stauber, S; Wuillemin, W A; Lukas, P S

    2012-08-01

    Psychological distress might affect the international normalized ratio (INR), but effects might vary depending on oral anticoagulant (OAC) therapy. To investigate the association of psychological distress with INR and clotting factors of the extrinsic pathway in patients with and without OAC therapy. We studied 190 patients with a previous venous thromboembolism (VTE); 148 had discontinued OAC therapy and 42 had ongoing OAC therapy. To assess psychological distress, all patients completed validated questionnaires to measure symptoms of depression, anxiety, worrying, anger and hostility. INR, fibrinogen, factor (F)II:C, FV:C, FVII:C and FX:C were measured as part of outpatient thrombophilia work-up. In VTE patients without OAC therapy, the odds of a reduced INR (therapy, INR was unrelated to a negative affect; however, lower FVII:C related to anxiety and worrying as well as lower FX:C related to anger and hostility were observed in patients with OAC therapy compared with those without OAC therapy. Psychological distress was associated with a reduced INR in VTE patients without OAC therapy. The direction of the association between psychological distress and activity in some clotting factors of the extrinsic coagulation pathway might differ depending on whether VTE patients are under OAC therapy or not. © 2012 International Society on Thrombosis and Haemostasis.

  6. Internal dosimetry for the radiological protection of the patient in the therapy with I-131

    International Nuclear Information System (INIS)

    Deluca, G.M.; Rojo, A.M.

    2006-01-01

    In the patients with differentiated thyroid cancer (CADIT) subjected to therapy with radiopharmaceuticals should be considered the possible risk of sharp depression of the bone marrow like consequence of the intolerance to the quantity of administered activity. The manifestation of the myelotoxicity can limit in a substantial way the future treatments and to deteriorate the predict of resolution of the illness. In this work it shows the physical-mathematical mark of a methodology for the estimated absorbed dose in bone marrow based in the MIRD scheme whose objective is to protect the one patient of the noxious and undesirable effects of the internal radiotherapy in organs that are not target of the same one. The formalism incorporates specific information of the patient and also peculiar characteristics of the internal therapy in patient with CADIT. The considerations are the following ones: (1) the main organ to protect is the bone marrow: (2) the accumulated activity, in bone marrow, it is obtained starting from measurements in blood: (3) the used isotope almost exclusively in this type of therapies is the 131 I; (4) it is used as radiopharmaceutical at the 131 INa that it is characterized to be a simple, inorganic and small molecule: (5) the statistical incidence of the CADIT is bigger in women than in men. It is explained for that it was selected the formalism that is presented, the principles on which it is sustained which are their reaches and their limitations. They are also presented future innovations that can be implemented to effects of improving the estimates. The work is framed inside the thematic of the medical applications of open radioactive sources and it constitutes a contribution to the invigoration of the internal therapy with radiopharmaceuticals. This is due to that the methodology of dose estimation presented supplements with a theoretical biophysics base the protocols of empiric prescription broadly used in this practice. For these reasons

  7. Selective internal radiation therapy (SIRT) for liver metastases secondary to colorectal adenocarcinoma

    International Nuclear Information System (INIS)

    Welsh, James S.; Kennedy, Andrew S.; Thomadsen, Bruce

    2006-01-01

    Introduction: Selective internal radiation therapy (SIRT) is a relatively new commercially available microbrachytherapy technique for treatment of malignant hepatic lesions using 9 Y embedded in resin microspheres, which are infused directly into the hepatic arterial circulation. It is FDA approved for liver metastases secondary to colorectal carcinoma and is under investigation for treatment of other liver malignancies, such as hepatocellular carcinoma and neuroendocrine malignancies. Materials/Methods: A modest number of clinical trials, preclinical animal studies, and dosimetric studies have been reported. Here we review several of the more important results. Results: High doses of beta radiation can be selectively delivered to tumors, resulting in impressive local control and survival rates. Ex vivo analyses have shown that microspheres preferentially cluster around the periphery of tumor nodules with a high tumor:normal tissue ratio of up to 200:1. Toxicity is usually mild, featuring fatigue, anorexia, nausea, abdominal discomfort, and slight elevations of liver function tests. Conclusions: Selective internal radiation therapy represents an effective means of controlling liver metastases from colorectal adenocarcinoma. Clinical trials have demonstrated improved local control of disease and survival with relatively low toxicity. Investigations of SIRT for other hepatic malignancies and in combination with newer chemotherapy agents and targeted biologic therapies are under way or in planning. A well-integrated team involving interventional radiology, nuclear medicine, medical oncology, surgical oncology, medical physics, and radiation oncology is essential for a successful program. Careful selection of patients through the combined expertise of the team can maximize therapeutic efficacy and reduce the potential for adverse effects

  8. Music Therapy Practice Status and Trends Worldwide: An International Survey Study.

    Science.gov (United States)

    Kern, Petra; Tague, Daniel B

    2017-11-01

    The field of music therapy is growing worldwide. While there is a wealth of country-specific information available, only a few have databased workforce censuses. Currently, little to no descriptive data exists about the global development of the profession. The purpose of this study was to obtain descriptive data about current demographics, practice status, and clinical trends to inform worldwide advocacy efforts, training needs, and the sustainable development of the field. Music therapists (N = 2,495) who were professional members of organizations affiliated with the World Federation of Music Therapy (WFMT) served as a sample for this international cross-sectional survey study. A 30-item online questionnaire was designed, pilot tested by key partners, and translated into seven languages. Researchers and key partners distributed the online survey through e-mail invitations and social media announcements. Professional music therapists worldwide are well-educated, mature professionals with adequate work experience, who are confident in providing high-quality services primarily in mental health, school, and geriatric settings. Due to ongoing challenges related to recognition and government regulation of the field as an evidence-based and well-funded healthcare profession, most individuals work part-time music therapy jobs and feel underpaid. Yet, many music therapists have a positive outlook on the field's future. Continued research and advocacy efforts, as well as collaborations with lobbyists, business consultants, and credentialing/licensure experts to develop progressive strategies, will be crucial for global development and sustainability of the field. © the American Music Therapy Association 2017. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

  9. The Meaning Associated with the Experience of a Sea Kayaking Adventure among Adults with Visual Impairment

    Science.gov (United States)

    Nancy Eagan

    2004-01-01

    What is the meaning associated with participation in an outdoor adventure for a person with a disability? A number of studies have investigated the topic of adventure program outcomes for people with and without disabilities. The author located two studies about kayaking with individuals with disabilities: 1) Siegel Taylor and Evans McGruder (1995) found “subjects...

  10. Adventure Counseling as an Adjunct to Group Counseling in Hospital and Clinical Settings

    Science.gov (United States)

    Gillen, Mark C.; Balkin, Richard S.

    2006-01-01

    Adventure counseling has been thought of as a highly specialized application of group counseling skills in a wilderness environment. In fact, adventure counseling is based on a developmental theory of group, can be useful for a variety of clients, and can be thoughtfully integrated into clinical and hospital settings. This article describes the…

  11. Outdoor Education Opportunities for Middle School Students: Academic and Social Impacts of Adventure Programs

    Science.gov (United States)

    Gordon, Lisa

    2011-01-01

    This study examines components of outdoor adventure programs for middle school students, using a school with a successful program as a model. Outdoor education is often left out of these years for financial and safety reasons, however the benefits of adventure programs are both measurable and profound to self-concept, confidence, identity growth,…

  12. Effects of a Developmental Adventure on the Self-Esteem of College Students

    Science.gov (United States)

    Paquette, Linda; Brassard, Audrey; Guérin, Audrey; Fortin-Chevalier, Justine; Tanguay-Beaudoin, Laurence

    2014-01-01

    This study examines the effects of outdoor developmental adventure programming (ODA) on college students' self-esteem. Although some previous studies have shown that outdoor adventure programming has positive effects on self-esteem, others did not find any effect. A quasi-experimental study was conducted over 5 months, which included two pretests…

  13. The Romance of Risk: Adventure's Incorporation in Risk Society

    Science.gov (United States)

    Bell, Martha

    2017-01-01

    Adventure has outgrown its use as a metaphor and motive for educational journeys into the cultural outdoors. Self-reliance cannot counter the mechanisation of everyday life. "Adventure" is produced and serviced by the very people who felt its worth to their own individualisation and now advance its professionalisation for their own…

  14. Second International Conference on Near-Field Optical Analysis: Photodynamic Therapy and Photobiology Effects

    Science.gov (United States)

    Bulgher, Debra L. (Editor); Morrison, Dennis

    2002-01-01

    The International NASA/DARPA Photobiology Conference held at the Johnson Space Center in Houston/TX demonstrated where low level laser therapy (LLLT), respectively low intensity light activated biostimulation (LILAB) and nanotechnological applications employing photobiomodulation techniques will presumably go in the next ten years. The conference was a continuation of the 1st International Conference on Nearfield Optical Analysis organized by Andrei Sommer (ENSOMA Lab, University of Ulm, Germany) in November 2000 at Castle Reisenburg, Germany, which started with a group of ten scientists from eight different countries. The 1st conference was co-sponsored by the American Chemical Society to evaluate the molecular mechanism of accelerated and normal wound healing processes. The 2nd conference was co-sponsored by DARPA, NASA-JSC and the Medical College of Wisconsin. Despite the short time between events, the 2nd conference hosted 40 international experts form universities, research institutes, agencies and the industry. The materials published here are expected to become milestones forming a novel platform in biomedical photobiology. The multidisciplinary group of researchers focused on LLLT/LILAB-applications under extreme conditions expected to have beneficial effects particularly in space, on submarines, and under severe battlefield conditions. The group also focused on novel technologies with possibilities allowing investigating the interaction of light with biological systems, molecular mechanisms of wound healing, bone regeneration, nerve regeneration, pain modulation, as well as biomineralization and biofilm formulation processes induced by nanobacteria.

  15. Roads to Learning: Adventures in Education.

    Science.gov (United States)

    Eyster, John W.; Griffin, Michael C.

    The booklet describes a social studies field study seminar which utilizes a direct experiential approach to increase high school student comprehension of federal and international politics. The first chapter explains the objectives of the seminars; the second and third chapters discuss the two major seminars which build upon previously taught…

  16. Risk Stratification for Athletes and Adventurers in High-Altitude Environments: Recommendations for Preparticipation Evaluation.

    Science.gov (United States)

    Campbell, Aaron D; McIntosh, Scott E; Nyberg, Andy; Powell, Amy P; Schoene, Robert B; Hackett, Peter

    2015-12-01

    High-altitude athletes and adventurers face a number of environmental and medical risks. Clinicians often advise participants or guiding agencies before or during these experiences. Preparticipation evaluation (PPE) has the potential to reduce risk of high-altitude illnesses in athletes and adventurers. Specific conditions susceptible to high-altitude exacerbation also important to evaluate include cardiovascular and lung diseases. Recommendations by which to counsel individuals before participation in altitude sports and adventures are few and of limited focus. We reviewed the literature, collected expert opinion, and augmented principles of a traditional sport PPE to accommodate the high-altitude wilderness athlete/adventurer. We present our findings with specific recommendations on risk stratification during a PPE for the high-altitude athlete/adventurer. Copyright © 2015. Published by Elsevier Inc.

  17. Design of an international multicentre RCT on group schema therapy for borderline personality disorder.

    Science.gov (United States)

    Wetzelaer, Pim; Farrell, Joan; Evers, Silvia M A A; Jacob, Gitta A; Lee, Christopher W; Brand, Odette; van Breukelen, Gerard; Fassbinder, Eva; Fretwell, Heather; Harper, R Patrick; Lavender, Anna; Lockwood, George; Malogiannis, Ioannis A; Schweiger, Ulrich; Startup, Helen; Stevenson, Teresa; Zarbock, Gerhard; Arntz, Arnoud

    2014-11-18

    Borderline personality disorder (BPD) is a severe and highly prevalent mental disorder. Schema therapy (ST) has been found effective in the treatment of BPD and is commonly delivered through an individual format. A group format (group schema therapy, GST) has also been developed. GST has been found to speed up and amplify the treatment effects found for individual ST. Delivery in a group format may lead to improved cost-effectiveness. An important question is how GST compares to treatment as usual (TAU) and what format for delivery of schema therapy (format A; intensive group therapy only, or format B; a combination of group and individual therapy) produces the best outcomes. An international, multicentre randomized controlled trial (RCT) will be conducted with a minimum of fourteen participating centres. Each centre will recruit multiple cohorts of at least sixteen patients. GST formats as well as the orders in which they are delivered to successive cohorts will be balanced. Within countries that contribute an uneven number of sites, the orders of GST formats will be balanced within a difference of one. The RCT is designed to include a minimum of 448 patients with BPD. The primary clinical outcome measure will be BPD severity. Secondary clinical outcome measures will include measures of BPD and general psychiatric symptoms, schemas and schema modes, social functioning and quality of life. Furthermore, an economic evaluation that consists of cost-effectiveness and cost-utility analyses will be performed using a societal perspective. Lastly, additional investigations will be carried out that include an assessment of the integrity of GST, a qualitative study on patients' and therapists' experiences with GST, and studies on variables that might influence the effectiveness of GST. This trial will compare GST to TAU for patients with BPD as well as two different formats for the delivery of GST. By combining an evaluation of clinical effectiveness, an economic evaluation

  18. Conditional internalization of PEGylated nanomedicines by PEG engagers for triple negative breast cancer therapy

    Science.gov (United States)

    Su, Yu-Cheng; Burnouf, Pierre-Alain; Chuang, Kuo-Hsiang; Chen, Bing-Mae; Cheng, Tian-Lu; Roffler, Steve R.

    2017-06-01

    Triple-negative breast cancer (TNBC) lacks effective treatment options due to the absence of traditional therapeutic targets. The epidermal growth factor receptor (EGFR) has emerged as a promising target for TNBC therapy because it is overexpressed in about 50% of TNBC patients. Here we describe a PEG engager that simultaneously binds polyethylene glycol and EGFR to deliver PEGylated nanomedicines to EGFR+ TNBC. The PEG engager displays conditional internalization by remaining on the surface of TNBC cells until contact with PEGylated nanocarriers triggers rapid engulfment of nanocargos. PEG engager enhances the anti-proliferative activity of PEG-liposomal doxorubicin to EGFR+ TNBC cells by up to 100-fold with potency dependent on EGFR expression levels. The PEG engager significantly increases retention of fluorescent PEG probes and enhances the antitumour activity of PEGylated liposomal doxorubicin in human TNBC xenografts. PEG engagers with specificity for EGFR are promising for improved treatment of EGFR+ TNBC patients.

  19. Adventure sports and tourism at the beginning of the construction of Europe in the Pyrenees

    Directory of Open Access Journals (Sweden)

    André Suchet

    2011-12-01

    Full Text Available Organised in the spring of 1993 on the border between France and Spain, the Pyrenees Adventure Games (les Jeux Pyrénéens de l’Aventure or los Juegos Pirenaicos de la Aventura, brought together more than 1,000 athletes from 26 countries and were attended by 21,000 visitors. An alternative Olympics of adventure and outdoor sports patronised by the IOC, the events took place in the Aure Valley in France (Hautes-Pyrénées and in the Sobrarbe in Spain (Huesca province. This article analyses the governance of this international sports competition. More specifically, this case study will enable us to find out more about the conditions of organisation of a cross-border project in the early 1990s. What were the various political, social and cultural exchanges between the valleys in terms of sports and tourism in the Pyrenees? The results show that the French organisation and the Spanish organisation functioned side by side instead of working together on the field. This division in working enabled them to bypass the language problem. The cross-border dimension of these adventure Olympics in 1993 stemmed from pressure from the French regional planning agency, DATAR right from the beginning of the project, i.e. in October 1989, to be exact. This dimension made the 1993 Pyrenees Adventure Games a testimony to the new political Europe that was being built after 1989. This period was marked by the proactiveness of institutions, which far exceeded the motivations of the populations of the Union.Organisés au printemps 1993 sur la frontière entre la France et l’Espagne, les Jeux Pyrénéens de l’Aventure, ou los Juegos Pirenaicos de la Aventura, réunirent plus de 1 000 athlètes venus de 26 pays du monde sous les yeux de 21 000 visiteurs. Olympiade des sports d’aventure et de nature patronnée par le CIO, les épreuves se déroulèrent dans la vallée d’Aure en France (département des Hautes-Pyrénées et le Sobrarbe en Espagne (province de

  20. Practice Patterns Analysis of Ocular Proton Therapy Centers: The International OPTIC Survey

    International Nuclear Information System (INIS)

    Hrbacek, Jan; Mishra, Kavita K.; Kacperek, Andrzej; Dendale, Remi; Nauraye, Catherine; Auger, Michel; Herault, Joel; Daftari, Inder K.; Trofimov, Alexei V.; Shih, Helen A.; Chen, Yen-Lin E.; Denker, Andrea; Heufelder, Jens; Horwacik, Tomasz; Swakoń, Jan; Hoehr, Cornelia; Duzenli, Cheryl; Pica, Alessia; Goudjil, Farid; Mazal, Alejandro

    2016-01-01

    Purpose: To assess the planning, treatment, and follow-up strategies worldwide in dedicated proton therapy ocular programs. Methods and Materials: Ten centers from 7 countries completed a questionnaire survey with 109 queries on the eye treatment planning system (TPS), hardware/software equipment, image acquisition/registration, patient positioning, eye surveillance, beam delivery, quality assurance (QA), clinical management, and workflow. Results: Worldwide, 28,891 eye patients were treated with protons at the 10 centers as of the end of 2014. Most centers treated a vast number of ocular patients (1729 to 6369). Three centers treated fewer than 200 ocular patients. Most commonly, the centers treated uveal melanoma (UM) and other primary ocular malignancies, benign ocular tumors, conjunctival lesions, choroidal metastases, and retinoblastomas. The UM dose fractionation was generally within a standard range, whereas dosing for other ocular conditions was not standardized. The majority (80%) of centers used in common a specific ocular TPS. Variability existed in imaging registration, with magnetic resonance imaging (MRI) rarely being used in routine planning (20%). Increased patient to full-time equivalent ratios were observed by higher accruing centers (P=.0161). Generally, ophthalmologists followed up the post–radiation therapy patients, though in 40% of centers radiation oncologists also followed up the patients. Seven centers had a prospective outcomes database. All centers used a cyclotron to accelerate protons with dedicated horizontal beam lines only. QA checks (range, modulation) varied substantially across centers. Conclusions: The first worldwide multi-institutional ophthalmic proton therapy survey of the clinical and technical approach shows areas of substantial overlap and areas of progress needed to achieve sustainable and systematic management. Future international efforts include research and development for imaging and planning software upgrades

  1. Practice Patterns Analysis of Ocular Proton Therapy Centers: The International OPTIC Survey

    Energy Technology Data Exchange (ETDEWEB)

    Hrbacek, Jan, E-mail: Jan.hrbacek@psi.ch [Center for Proton Therapy, Paul Scherrer Institute, Villigen (Switzerland); Mishra, Kavita K. [Ocular Tumor Proton Therapy Program, University of California San Francisco, San Francisco, California (United States); Kacperek, Andrzej [National Proton Therapy Centre, Clatterbridge Cancer Centre, Bebington (United Kingdom); Dendale, Remi; Nauraye, Catherine; Auger, Michel [Centre de Protonthérapie d' Orsay, Institut Curie, Orsay (France); Herault, Joel [Centre Lacassagne, Nice (France); Daftari, Inder K. [Ocular Tumor Proton Therapy Program, University of California San Francisco, San Francisco, California (United States); Trofimov, Alexei V.; Shih, Helen A.; Chen, Yen-Lin E. [F. H. Burr Proton Therapy Center, Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts (United States); Denker, Andrea [Protons for Therapy, Helmholtz-Zentrum Berlin, Berlin (Germany); Heufelder, Jens [BerlinProtonen am HZB, Charité – Universitätsmedizin Berlin, Berlin (Germany); Horwacik, Tomasz; Swakoń, Jan [Institute of Nuclear Physic, Polish Academy of Sciences, Krakow (Poland); Hoehr, Cornelia; Duzenli, Cheryl [BC Cancer Agency – TRIUMF, Vancouver (Canada); Pica, Alessia [Center for Proton Therapy, Paul Scherrer Institute, Villigen (Switzerland); Goudjil, Farid; Mazal, Alejandro [Centre de Protonthérapie d' Orsay, Institut Curie, Orsay (France); and others

    2016-05-01

    Purpose: To assess the planning, treatment, and follow-up strategies worldwide in dedicated proton therapy ocular programs. Methods and Materials: Ten centers from 7 countries completed a questionnaire survey with 109 queries on the eye treatment planning system (TPS), hardware/software equipment, image acquisition/registration, patient positioning, eye surveillance, beam delivery, quality assurance (QA), clinical management, and workflow. Results: Worldwide, 28,891 eye patients were treated with protons at the 10 centers as of the end of 2014. Most centers treated a vast number of ocular patients (1729 to 6369). Three centers treated fewer than 200 ocular patients. Most commonly, the centers treated uveal melanoma (UM) and other primary ocular malignancies, benign ocular tumors, conjunctival lesions, choroidal metastases, and retinoblastomas. The UM dose fractionation was generally within a standard range, whereas dosing for other ocular conditions was not standardized. The majority (80%) of centers used in common a specific ocular TPS. Variability existed in imaging registration, with magnetic resonance imaging (MRI) rarely being used in routine planning (20%). Increased patient to full-time equivalent ratios were observed by higher accruing centers (P=.0161). Generally, ophthalmologists followed up the post–radiation therapy patients, though in 40% of centers radiation oncologists also followed up the patients. Seven centers had a prospective outcomes database. All centers used a cyclotron to accelerate protons with dedicated horizontal beam lines only. QA checks (range, modulation) varied substantially across centers. Conclusions: The first worldwide multi-institutional ophthalmic proton therapy survey of the clinical and technical approach shows areas of substantial overlap and areas of progress needed to achieve sustainable and systematic management. Future international efforts include research and development for imaging and planning software upgrades

  2. Final Report: 8th International Symposium on Neutron Capture Therapy (NCT) for Cancer, May 15, 1998 - May 15, 1999

    International Nuclear Information System (INIS)

    Hawthorne, M.F.

    1999-01-01

    The 8th International Symposium on Neutron Capture Therapy for Cancer (8th ISNCTC) was held in La Jolla, CA on Sept. 13-18, 1998. This biennial meeting of the International Society for Neutron Capture Therapy (ISNCT) was hosted by Society President M.F. Hawthorne (UCLA Dept. of Chemistry and Biochemistry). The Symposium brought together scientists (300 registrants from 21 countries) from diverse fields to report the latest developments in NCT. Topics of the 275 papers presented (30 plenary lectures, 81 oral presentations, and 164 posters) included the physics of neutron sources, chemistry of tumor-targeting agents, dosimetry, radiobiological studies, and clinical applications

  3. A medical perspective on the adventures of Sherlock Holmes.

    Science.gov (United States)

    Reed, J

    2001-12-01

    The adventures of Sherlock Holmes, although primarily famous as stories of detection of crime, offer a considerable amount to interest the medical reader. There are many medical references in the stories, and the influence of Conan Doyle's medical background is clearly seen in the main characters. Aspects of the stories also reflect Conan Doyle's medical career, and also something of his attitude towards the profession. From Holmes's sayings and accounts of his methods, parallels can be drawn between Holmesian deduction and the diagnostic process. It is concluded, however, that deduction cannot be used as a direct paradigm since medical problems are rarely soluble through a process of logic alone.

  4. International students of speech and language therapy in the UK: do we meet their needs?

    Science.gov (United States)

    Marshall, Julie; Goldbart, Juliet; Evans, Ruth

    2004-01-01

    Informal evidence suggests that many Speech and Language Therapy (SLT) students from outside of the UK and/or Republic of Ireland who come to the UK either do not return to their home country on qualification or do not practise as SLTs in the public sector. Many factors may contribute to this situation. Concern that it may result in part from a poor match between UK SLT education and the demands of the role in other countries led the Royal College of Speech and Language Therapists (RCSLT) to fund a study of international SLT students' experiences of UK qualifying courses. To discover and describe the experiences, views and expectations of current and past international students studying SLT in the UK and past international students' experiences, views and expectations of practising as SLTS, both inside and outside the UK. To consider the implications of the findings for (1) international students planning to work as SLTs; (2) UK SLT students planning to practise outside the UK; and (3) all those involved in SLT education: educational institutions; supervising SLTs; RCSLT. The study involved distributing 166 postal questionnaires (some directly to (ex)students and some to their Higher Education Institutes, or HEIs) and carrying out 23 interviews, with both current students and those qualifying since May 1994. Quantitative analysis was carried out using SPSS using descriptive statistics. Qualitative analysis used content and thematic analyses. Seventy-one questionnaires were received from current and past students, representing a minimum response rate of 43%. (It was not possible to verify exactly how many questionnaires were distributed by HEIs.) The results describe the diverse range of respondents' experiences of studying and working in the UK, their views of working in their home countries and the UK, and their suggestions about strategies that might be adopted to support them further. The results revealed that students come from a wide diversity of countries

  5. Aging Adventure Athletes Assess Achievements and Alter Aspirations to Maintain Self-Esteem.

    Science.gov (United States)

    Buckley, Ralf C

    2018-01-01

    Achievements and capabilities influence the self-esteem of skilled adventure athletes. Self-esteem affects individual mental health. Aging commonly reduces adventure capabilities. To avoid loss in self-esteem, aging adventure athletes are forced to adjust their aspirations. Here, I examine this process using participant observation, ethnographic and autoethnographic approaches. The qualitative data for this analysis are derived from 60 years' experience in outdoor adventure activities, and ∼30,000 person-hours of participant observation. I argue that individuals assess their own capabilities against a set of specific feats. For some activities, successful completion of a specific feat is known as nailing it. The selection of these feats depends on factors such as activity and geographic location, as well as individual experience and peer comparisons. I examine the detailed process using a single feat repeated over a period of decades, the bubble-line kayak run through Lava Falls on the Grand Canyon of the Colorado River. I compare other examples of nail or fail to construct a general framework for self-esteem in aging adventure athletes, with both physical and psychological feedback loops. I also identify two key thresholds, as aging adventure athletes recognize their declining skills. These may apply to aging more broadly, beyond outdoor adventure.

  6. Aging Adventure Athletes Assess Achievements and Alter Aspirations to Maintain Self-Esteem

    Directory of Open Access Journals (Sweden)

    Ralf C. Buckley

    2018-02-01

    Full Text Available Achievements and capabilities influence the self-esteem of skilled adventure athletes. Self-esteem affects individual mental health. Aging commonly reduces adventure capabilities. To avoid loss in self-esteem, aging adventure athletes are forced to adjust their aspirations. Here, I examine this process using participant observation, ethnographic and autoethnographic approaches. The qualitative data for this analysis are derived from 60 years’ experience in outdoor adventure activities, and ∼30,000 person-hours of participant observation. I argue that individuals assess their own capabilities against a set of specific feats. For some activities, successful completion of a specific feat is known as nailing it. The selection of these feats depends on factors such as activity and geographic location, as well as individual experience and peer comparisons. I examine the detailed process using a single feat repeated over a period of decades, the bubble-line kayak run through Lava Falls on the Grand Canyon of the Colorado River. I compare other examples of nail or fail to construct a general framework for self-esteem in aging adventure athletes, with both physical and psychological feedback loops. I also identify two key thresholds, as aging adventure athletes recognize their declining skills. These may apply to aging more broadly, beyond outdoor adventure.

  7. When does atopic dermatitis warrant systemic therapy? Recommendations from an expert panel of the International Eczema Council.

    Science.gov (United States)

    Simpson, Eric L; Bruin-Weller, Marjolein; Flohr, Carsten; Ardern-Jones, Michael R; Barbarot, Sebastien; Deleuran, Mette; Bieber, Thomas; Vestergaard, Christian; Brown, Sara J; Cork, Michael J; Drucker, Aaron M; Eichenfield, Lawrence F; Foelster-Holst, Regina; Guttman-Yassky, Emma; Nosbaum, Audrey; Reynolds, Nick J; Silverberg, Jonathan I; Schmitt, Jochen; Seyger, Marieke M B; Spuls, Phyllis I; Stalder, Jean-Francois; Su, John C; Takaoka, Roberto; Traidl-Hoffmann, Claudia; Thyssen, Jacob P; van der Schaft, Jorien; Wollenberg, Andreas; Irvine, Alan D; Paller, Amy S

    2017-10-01

    Although most patients with atopic dermatitis (AD) are effectively managed with topical medication, a significant minority require systemic therapy. Guidelines for decision making about advancement to systemic therapy are lacking. To guide those considering use of systemic therapy in AD and provide a framework for evaluation before making this therapeutic decision with the patient. A subgroup of the International Eczema Council determined aspects to consider before prescribing systemic therapy. Topics were assigned to expert reviewers who performed a topic-specific literature review, referred to guidelines when available, and provided interpretation and expert opinion. We recommend a systematic and holistic approach to assess patients with severe signs and symptoms of AD and impact on quality of life before systemic therapy. Steps taken before commencing systemic therapy include considering alternate or concomitant diagnoses, avoiding trigger factors, optimizing topical therapy, ensuring adequate patient/caregiver education, treating coexistent infection, assessing the impact on quality of life, and considering phototherapy. Our work is a consensus statement, not a systematic review. The decision to start systemic medication should include assessment of severity and quality of life while considering the individual's general health status, psychologic needs, and personal attitudes toward systemic therapies. Copyright © 2017 American Academy of Dermatology, Inc. All rights reserved.

  8. XVII International Conference on the Use of Computers in Radiation Therapy (ICCR 2013)

    Science.gov (United States)

    2014-03-01

    Editorial Dear colleagues, From a professional perspective there is nothing quite as enjoyable as attending a good conference with colleagues that share not only interest for the same topic but also a similar vision for their field of work. Proceedings cannot replace the direct contact and lively conversations between participants who are at the same time at the same place sharing ideas and discussion. However, proceedings complement the actual conference by 1. giving the ideas, research findings and debates which characterise the conference lasting presence 2. giving participants an opportunity to refresh their memory about issues they would like to follow up on and 3. providing an opportunity for others who were not able to attend the meeting to share in the thoughts and issues discussed at the conference. For the proceedings of the International Conferences on the Use of Computers in Radiation Therapy (ICCR) all this has been important in the past as the high citation rates for ICCR proceedings show. We hope that also the present proceedings will appeal to participants and others who are interested in cancer and ways to treat patients affected by it. It is exciting to note that what sounded like a small niche field (''Computers in Radiation Therapy'') has become a very broad forum to discuss all aspects of cancer diagnosis and therapy. Of particular interest for the 17th ICCR have been data and how to collect, organise and use it effectively. This is relevant for most areas in medicine and we believe that radiation therapy with its focus on evidence based practice and measurable and standardised activities has an important and possibly leading role to play. The 100 manuscripts combined in the present proceedings can hopefully contribute to this. The proceedings are organised into five different streams which reflect the foci of the conference: • Dose Calculation • Imaging for treatment planning and Motion Management • Treatment planning and optimisation

  9. Circumvention of resistance to photodynamic therapy in doxorubicin-resistant sarcoma by photochemical internalization of gelonin.

    Science.gov (United States)

    Olsen, Cathrine Elisabeth; Berg, Kristian; Selbo, Pål Kristian; Weyergang, Anette

    2013-12-01

    A wide range of anti-cancer therapies have been shown to induce resistance upon repetitive treatment and such adapted resistance may also cause cross-resistance to other treatment modalities. We here show that MES-SA/Dx5 cells with adapted resistance to doxorubicin (DOX) are cross-resistant to photodynamic therapy (PDT). A DOX-induced increased expression of the reactive oxygen species (ROS)-scavenging proteins glutathione peroxidase (GPx) 1 and GPx4 in MES-SA/Dx5 cells was indicated as the mechanism of resistance to PDT in line with the reduction in PDT-generated ROS observed in this cell line. ROS-induced p38 activation was, in addition, shown to be reduced to one-third of the signal of the parental MES-SA cells 2h after PDT, and addition of the p38 inhibitor SB203580 confirmed p38 activation as a death signal after PDT in the MES-SA cells. The MES-SA/Dx5 cells were also cross-resistant to ionizing radiation in agreement with the increased GPx1 and GPx4 expression. Surprisingly, PDT-induced endo/lysosomal release of the ribosome-inactivating protein gelonin (photochemical internalization (PCI)) was more effective in the PDT-resistant MES-SA/Dx5 cells, as measured by synergy calculations in both cell lines. Analysis of death-inducing signaling indicated a low activation of caspase-3 and a strong PARP I cleavage after PDT and PCI in both cell lines. The PARP I activation was, however, stronger after PCI than after PDT in the MES-SA cells, but not in the MES-SA/Dx5 cells, and therefore cannot explain the strong PCI effect in the MES-SA/Dx5 cells. In conclusion PCI of recombinant gelonin circumvents ROS resistance in an apoptosis-independent manner. © 2013 Elsevier Inc. All rights reserved.

  10. Effectiveness of Group Activity Play Therapy on Internalizing and Externalizing Behavior Problems of Preadolescent Orphans in Uganda

    Science.gov (United States)

    Ojiambo, Deborah

    2011-01-01

    This pilot study investigated the impact of group activity play therapy (GAPT) on displaced orphans aged 10 to 12 years living in a large children's village in Uganda. Teachers and housemothers identified 60 preadolescents exhibiting clinical levels of internalizing and externalizing behavior problems. The participants' ethnicity was African and…

  11. Treatment Guidelines for Preoperative Radiation Therapy for Retroperitoneal Sarcoma: Preliminary Consensus of an International Expert Panel

    Energy Technology Data Exchange (ETDEWEB)

    Baldini, Elizabeth H., E-mail: ebaldini@partners.org [Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women' s Hospital, Boston, Massachusetts (United States); Wang, Dian [Department of Radiation Oncology, Rush University Medical Center, Chicago, Illinois (United States); Haas, Rick L.M. [Department of Radiotherapy, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam (Netherlands); Catton, Charles N. [Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, Ontario (Canada); Indelicato, Daniel J. [Department of Radiation Oncology, University of Florida Medical Center, Jacksonville, Florida (United States); Kirsch, David G. [Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina (United States); Roberge, David [Department of Radiation Oncology, Centre Hospitalier de l' Université de Montreal, Montreal, Quebec (Canada); Salerno, Kilian [Department of Radiation Oncology, Roswell Park Cancer Institute, Buffalo, New York (United States); Deville, Curtiland [Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins Sidney Kimmel Cancer Center, Washington, DC (United States); Guadagnolo, B. Ashleigh [Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas (United States); O' Sullivan, Brian [Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, Ontario (Canada); Petersen, Ivy A. [Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota (United States); Le Pechoux, Cecile [Department of Radiotherapy, Institut Gustave-Roussy, Villejuif (France); Abrams, Ross A. [Department of Radiation Oncology, Rush University Medical Center, Chicago, Illinois (United States); DeLaney, Thomas F. [Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts (United States)

    2015-07-01

    Purpose: Evidence for external beam radiation therapy (RT) as part of treatment for retroperitoneal sarcoma (RPS) is limited. Preoperative RT is the subject of a current randomized trial, but the results will not be available for many years. In the meantime, many practitioners use preoperative RT for RPS, and although this approach is used in practice, there are no radiation treatment guidelines. An international expert panel was convened to develop consensus treatment guidelines for preoperative RT for RPS. Methods and Materials: An expert panel of 15 academic radiation oncologists who specialize in the treatment of sarcoma was assembled. A systematic review of reports related to RT for RPS, RT for extremity sarcoma, and RT-related toxicities for organs at risk was performed. Due to the paucity of high-quality published data on the subject of RT for RPS, consensus recommendations were based largely on expert opinion derived from clinical experience and extrapolation of relevant published reports. It is intended that these clinical practice guidelines be updated as pertinent data become available. Results: Treatment guidelines for preoperative RT for RPS are presented. Conclusions: An international panel of radiation oncologists who specialize in sarcoma reached consensus guidelines for preoperative RT for RPS. Many of the recommendations are based on expert opinion because of the absence of higher level evidence and, thus, are best regarded as preliminary. We emphasize that the role of preoperative RT for RPS has not been proven, and we await data from the European Organization for Research and Treatment of Cancer (EORTC) study of preoperative radiotherapy plus surgery versus surgery alone for patients with RPS. Further data are also anticipated pertaining to normal tissue dose constraints, particularly for bowel tolerance. Nonetheless, as we await these data, the guidelines herein can be used to establish treatment uniformity to aid future assessments of efficacy

  12. Delineation of Internal Mammary Nodal Target Volumes in Breast Cancer Radiation Therapy

    Energy Technology Data Exchange (ETDEWEB)

    Jethwa, Krishan R.; Kahila, Mohamed M. [Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota (United States); Hunt, Katie N. [Department of Radiology, Mayo Clinic, Rochester, Minnesota (United States); Brown, Lindsay C.; Corbin, Kimberly S.; Park, Sean S.; Yan, Elizabeth S. [Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota (United States); Boughey, Judy C. [Department of Surgery, Mayo Clinic, Rochester, Minnesota (United States); Mutter, Robert W., E-mail: mutter.robert@mayo.edu [Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota (United States)

    2017-03-15

    Purpose: The optimal clinical target volume for internal mammary (IM) node irradiation is uncertain in an era of increasingly conformal volume-based treatment planning for breast cancer. We mapped the location of gross internal mammary lymph node (IMN) metastases to identify areas at highest risk of harboring occult disease. Methods and Materials: Patients with axial imaging of IMN disease were identified from a breast cancer registry. The IMN location was transferred onto the corresponding anatomic position on representative axial computed tomography images of a patient in the treatment position and compared with consensus group guidelines of IMN target delineation. Results: The IMN location in 67 patients with 130 IMN metastases was mapped. The location was in the first 3 intercostal spaces in 102 of 130 nodal metastases (78%), whereas 18 of 130 IMNs (14%) were located caudal to the third intercostal space and 10 of 130 IMNs (8%) were located cranial to the first intercostal space. Of the 102 nodal metastases within the first 3 intercostal spaces, 54 (53%) were located within the Radiation Therapy Oncology Group consensus volume. Relative to the IM vessels, 19 nodal metastases (19%) were located medially with a mean distance of 2.2 mm (SD, 2.9 mm) whereas 29 (28%) were located laterally with a mean distance of 3.6 mm (SD, 2.5 mm). Ninety percent of lymph nodes within the first 3 intercostal spaces would have been encompassed within a 4-mm medial and lateral expansion on the IM vessels. Conclusions: In women with indications for elective IMN irradiation, a 4-mm medial and lateral expansion on the IM vessels may be appropriate. In women with known IMN involvement, cranial extension to the confluence of the IM vein with the brachiocephalic vein with or without caudal extension to the fourth or fifth interspace may be considered provided that normal tissue constraints are met.

  13. Tumor-Triggered Geometrical Shape Switch of Chimeric Peptide for Enhanced in Vivo Tumor Internalization and Photodynamic Therapy.

    Science.gov (United States)

    Han, Kai; Zhang, Jin; Zhang, Weiyun; Wang, Shibo; Xu, Luming; Zhang, Chi; Zhang, Xianzheng; Han, Heyou

    2017-03-28

    Geometrical shape of nanoparticles plays an important role in cellular internalization. However, the applicability in tumor selective therapeutics is still scarcely reported. In this article, we designed a tumor extracellular acidity-responsive chimeric peptide with geometrical shape switch for enhanced tumor internalization and photodynamic therapy. This chimeric peptide could self-assemble into spherical nanoparticles at physiological condition. While at tumor extracellular acidic microenvironment, chimeric peptide underwent detachment of acidity-sensitive 2,3-dimethylmaleic anhydride groups. The subsequent recovery of ionic complementarity between chimeric peptides resulted in formation of rod-like nanoparticles. Both in vitro and in vivo studies demonstrated that this acidity-triggered geometrical shape switch endowed chimeric peptide with accelerated internalization in tumor cells, prolonged accumulation in tumor tissue, enhanced photodynamic therapy, and minimal side effects. Our results suggested that fusing tumor microenvironment with geometrical shape switch should be a promising strategy for targeted drug delivery.

  14. Theranostic Nanoseeds for Efficacious Internal Radiation Therapy of Unresectable Solid Tumors

    Science.gov (United States)

    Moeendarbari, Sina; Tekade, Rakesh; Mulgaonkar, Aditi; Christensen, Preston; Ramezani, Saleh; Hassan, Gedaa; Jiang, Ruiqian; Öz, Orhan K.; Hao, Yaowu; Sun, Xiankai

    2016-02-01

    Malignant tumors are considered “unresectable” if they are adhere to vital structures or the surgery would cause irreversible damages to the patients. Though a variety of cytotoxic drugs and radiation therapies are currently available in clinical practice to treat such tumor masses, these therapeutic modalities are always associated with substantial side effects. Here, we report an injectable nanoparticle-based internal radiation source that potentially offers more efficacious treatment of unresectable solid tumors without significant adverse side effects. Using a highly efficient incorporation procedure, palladium-103, a brachytherapy radioisotope in clinical practice, was coated to monodispersed hollow gold nanoparticles with a diameter about 120 nm, to form 103Pd@Au nanoseeds. The therapeutic efficacy of 103Pd@Au nanoseeds were assessed when intratumorally injected into a prostate cancer xenograft model. Five weeks after a single-dose treatment, a significant tumor burden reduction (>80%) was observed without noticeable side effects on the liver, spleen and other organs. Impressively, >95% nanoseeds were retained inside the tumors as monitored by Single Photon Emission Computed Tomography (SPECT) with the gamma emissions of 103Pd. These findings show that this nanoseed-based brachytherapy has the potential to provide a theranostic solution to unresectable solid tumors.

  15. Impact of International Collaborative Project on Cultural Competence among Occupational Therapy Students

    Directory of Open Access Journals (Sweden)

    Divya Sood OTD, OTR/L

    2014-07-01

    Full Text Available Occupational therapy (OT educators recognize a need to ensure that OT students are culturally competent. The researchers developed the International Collaborative Project on Cultural Competence (ICPCC to help students understand the impact of cultural context on client care. Entry-level MOT students from a university in the US (N = 18 collaborated with BOT students (N = 4 and advanced MOT students (N = 9 from two universities in India using an online course management system WebCT. The study explored the impact of the ICPCC on OT students’ cultural competence and discusses students’ perceptions of culture on the OT process. The Inventory for Assessing the Process of Cultural Competence Among Health Care Professionals Revised© measured students’ cultural competence at baseline and immediately after participation in the ICPCC. Qualitative data was collected using a Self-Reflection Form. There was an increase in the cultural competence scores among all three groups of students after participating in the ICPCC at p value < .05. Three themes emerged from the qualitative data analysis: meaning of the term culture, impact of cultural on client- centered practice, and impact of cultural on OT outcomes. OT students recognized the role that cultural differences play in OT evaluation and intervention.

  16. Density overwrites of internal tumor volumes in intensity modulated proton therapy plans for mobile lung tumors

    Science.gov (United States)

    Botas, Pablo; Grassberger, Clemens; Sharp, Gregory; Paganetti, Harald

    2018-02-01

    The purpose of this study was to investigate internal tumor volume density overwrite strategies to minimize intensity modulated proton therapy (IMPT) plan degradation of mobile lung tumors. Four planning paradigms were compared for nine lung cancer patients. Internal gross tumor volume (IGTV) and internal clinical target volume (ICTV) structures were defined encompassing their respective volumes in every 4DCT phase. The paradigms use different planning CT (pCT) created from the average intensity projection (AIP) of the 4DCT, overwriting the density within the IGTV to account for movement. The density overwrites were: (a) constant filling with 100 HU (C100) or (b) 50 HU (C50), (c) maximum intensity projection (MIP) across phases, and (d) water equivalent path length (WEPL) consideration from beam’s-eye-view. Plans were created optimizing dose-influence matrices calculated with fast GPU Monte Carlo (MC) simulations in each pCT. Plans were evaluated with MC on the 4DCTs using a model of the beam delivery time structure. Dose accumulation was performed using deformable image registration. Interplay effect was addressed applying 10 times rescanning. Significantly less DVH metrics degradation occurred when using MIP and WEPL approaches. Target coverage (D99≥slant 70 Gy(RBE)) was fulfilled in most cases with MIP and WEPL (D{{99}WEPL}=69.2+/- 4.0 Gy (RBE)), keeping dose heterogeneity low (D5-D{{95}WEPL}=3.9+/- 2.0 Gy(RBE)). The mean lung dose was kept lowest by the WEPL strategy, as well as the maximum dose to organs at risk (OARs). The impact on dose levels in the heart, spinal cord and esophagus were patient specific. Overall, the WEPL strategy gives the best performance and should be preferred when using a 3D static geometry for lung cancer IMPT treatment planning. Newly available fast MC methods make it possible to handle long simulations based on 4D data sets to perform studies with high accuracy and efficiency, even prior to individual treatment planning.

  17. Postgraduate Training in Music Therapy Research in Aalborg University: An International Enterprise

    DEFF Research Database (Denmark)

    Bonde, Lars Ole

    2011-01-01

    Short report on dissemination and careers of PhD candidates in Music Therapy from Aalborg University 1998-2006......Short report on dissemination and careers of PhD candidates in Music Therapy from Aalborg University 1998-2006...

  18. Smart pH-responsive upconversion nanoparticles for enhanced tumor cellular internalization and near-infrared light-triggered photodynamic therapy.

    Science.gov (United States)

    Wang, Sheng; Zhang, Lei; Dong, Chunhong; Su, Lin; Wang, Hanjie; Chang, Jin

    2015-01-01

    A smart pH-responsive photodynamic therapy system based on upconversion nanoparticle loaded PEG coated polymeric lipid vesicles (RB-UPPLVs) was designed and prepared. These RB-UPPLVs which are promising agents for deep cancer photodynamic therapy applications can achieve enhanced tumor cellular internalization and near-infrared light-triggered photodynamic therapy.

  19. Release of patients after radionuclide therapy. With contributions from the [International Commission on Radiological Protection] ICRP

    International Nuclear Information System (INIS)

    2009-01-01

    The use of unsealed radiopharmaceuticals for treatment of disease is common practice worldwide. This approach was widely employed some years ago and, following a decline, there has recently been a resurgence of interest in it. The combination of newly accessible radionuclides, improved labelling technology and developments in biotechnology has resulted in more enthusiasm and a wider range of applications for this form of therapy. Radionuclide treatments are performed with either the patient admitted to hospital or as an outpatient only. The criteria to determine which approach is best vary considerably, and are not always closely linked with the well established standards of radiation protection practice. Safety issues for the patient, their family, associated carers, staff and the general public arise with either approach. The potential risks are from both external irradiation and contamination. The International Basic Safety Standards for Protection against Ionizing Radiation and for the Safety of Radiation Sources (BSS) specify the dose constraints and limits for all of these groups, and their more general provisions with respect to the as low as reasonably achievable principle and justification also apply. One way of managing exposures of the various groups is to control when patients are released from hospital. While they are in hospital, it is relatively easy to control exposure. Once they have returned to their family in the community, they must be advised on how to restrict the exposure of those people that they will come into contact with. Until recently, the International Commission on Radiological Protection (ICRP) did not provide specific advice in this area, and relied on the application of dose limits and constraints. However, regulators in some countries took a prescriptive approach, often using estimates of retained activity as a release criterion. These only loosely relate to dose limits. This publication attempts to bring newly available advice

  20. GoNorth! - An Adventure Learning Case Study

    Science.gov (United States)

    Porsild, M.; Doering, A.; Pregont, P.

    2008-12-01

    GoNorth! is an adventure learning series developed at the University of Minnesota in collaboration with NOMADS Online Expeditions. GoNorth! uses real-time experiences of dogsled expeditions on a multimedia saturated website at http://www.PolarHusky.com to motivate and engage millions of K-12 students and teachers. The program is free and research (Doering & Veletsianos, 2007) shows that it can be adopted by any teacher who signs up to use the program. It is currently utilized in 3400+ classrooms across the 50 US States and in 29 countries worldwide. Research (Doering & Veletsianos, 2007; 2008) notes that students working with GoNorth! are excited, motivated, and eager to engage with authentic tasks, solve real-world problems, collaborate with colleagues and experts, and initiate actions in their own community. Our team of educators, scientists and explorers circumnavigate the Arctic traveling by dog team to a new Arctic locale every year. Driven by an environmental question of particular relevance to the given Arctic region, each year a comprehensive natural and social science GoNorth! Curriculum & Activity Guide (450+ pages) is developed reflecting the expedition's current Arctic locale and its indigenous culture. The associated online learning environment delivers comprehensive resources about the region of travel, collaborative opportunities, live field updates and field research findings synched real-time to the curriculum. Field research relevant to understanding patterns of climate change and polar science is conducted with independent researchers featured as "Cool GoNorth! Scientists." Collaborations span from scientists at NASA and the United States Department of Agriculture to student observers in pan-Arctic communities as part of the NSF-supported initiative "What Is Climate Change to You?." This scientific research and fieldwork in turn coincides with the curriculum. The result is a community of learners on the Internet gaining knowledge from Arctic

  1. Improving student understanding in web programming material through multimedia adventure games

    Science.gov (United States)

    Fitriasari, N. S.; Ashiddiqi, M. F.; Nurdin, E. A.

    2018-05-01

    This study aims to make multimedia adventure games and find out the improvement of learners’ understanding after being given treatment of using multimedia adventure game in learning Web Programming. Participants of this study are students of class X (ten) in one of the Vocational Schools (SMK) in Indonesia. The material of web programming is a material that difficult enough to be understood by the participant therefore needed tools to facilitate the participants to understand the material. Solutions offered in this study is by using multimedia adventures game. Multimedia has been created using Construct2 and measured understood with method Non-equivalent Control Group Design. Pre-test and post-test has given to learners who received treatment using the multimedia adventure showed increase in understanding web programming material.

  2. Promoting international mobility in The Degree of Speech and Language Therapy: a case of an educational good practice

    Directory of Open Access Journals (Sweden)

    Nieves Mendizábal de la Cruz

    2015-05-01

    Full Text Available The constant modification of teaching and learning methods require the design of innovative strategies and the identification of educational good practices. The Degree of Speech and Language Therapy at theUniversityofValladolidhas developed various actions to promote international mobility of students and staff members, within the framework of interuniversity innovative educational projects. The objectives are: to make students aware of the role of the international dimension to increase the quality of their training; to expose innovative educational strategies to promote the international mobility; to foster internationalization of studies as a driver of research in this field; to establish Spanish as the language of reference in speech and language therapy. Descriptive methodology of performed actions was used. Results included: questionnaire sent to speech and language therapists in order to know their language skills and to enhance their importance, participation in courses, workshops and meetings, as well as in international mobility programs and exchange of experiences, teaching of subjects in English, publication of multilingual educational materials, contacts with American and European institutions and participation in international networks, blogging. It is concluded that the whole educative community should help to provide university programs of an international identity, and mobility should be provided of a social sense promoting equal opportunities for all groups.

  3. Hoarseness in School-Aged Children and Effectiveness of Voice Therapy in International Classification of Functioning Framework.

    Science.gov (United States)

    Akın Şenkal, Özgül; Özer, Cem

    2015-09-01

    The hoarseness in school-aged children disrupts the educational process because it affects the social progress, communication skills, and self-esteem of children. Besides otorhinolaryngological examination, the first treatment option is voice therapy when hoarseness occurs. The aim of the study was to determine the factors increasing the hoarseness in school-aged children by parental interview and to know preferable voice therapy on school-aged children within the frame of International Classification of Functioning (ICF). Retrospective analysis of data gathered from patient files. A total of 75 children (56 boys and 19 girls) were examined retrospectively. The age range of school-aged children is 7-14 years and average is 10.86 ± 2.51. A detailed history was taken from parents of children involved in this study. Information about vocal habits of children was gathered within the frame of ICF and then the voice therapies of children were started by scheduling appointments by an experienced speech-language pathologist. The differences between before and after voice therapy according to applied voice therapy methods, statistically significant differences were determined between maximum phonation time values and s/z rate. The relationship between voice therapy sessions and s/z rate with middle degree significance was found with physiological voice therapy sessions. According to ICF labels, most of voice complaints are matching with "body functions" and "activity and limitations." The appropriate voice therapy methods for hoarseness in school-aged children must be chosen and applied by speech-language therapists. The detailed history, which is received from family during the examination, within the frame of ICF affects the processes of choosing the voice therapy method and application of them positively. Child's family is very important for a successful management. Copyright © 2015 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

  4. Uranium mines and French mining companies: a magnificent adventure

    International Nuclear Information System (INIS)

    Blanc, J.

    2008-01-01

    The French mining adventure still arouses enthusiasm. The search for uranium began in 1945 with the creation of the Cea (Atomic Energy Board) whose one mission was to supply the nascent French nuclear programme with the necessary materials. Prospecting works were then led throughout France, Madagascar, the Ivory Coast and the French equatorial Africa. More than 60 years later the only surviving actor of this quest for uranium has become the mining department of Areva Nuclear Cycle which is itself a sub-company of Areva. The author, who was an ancient high executive of Cogema draws a detailed history of the French uranium mining industry with with its ups and downs, by analysing the impact of the 2 oil crisis and of the decline of nuclear energy in the decade following the Chernobyl accident. (A.C.)

  5. A grande aventura urbana The great urban adventure

    Directory of Open Access Journals (Sweden)

    Ângela Freire Prysthon

    2008-11-01

    Full Text Available Caiafa, Janice (2007. Aventura das cidades. ensaios e etnografias. Rio de Janeiro: Editora FGV. Em Aventura das cidades, Janice Caiafa reúne oito ensaios apresentados e publicados nos últimos anos. O tema central de sete deles é justamente a experiência urbana e a errância pelas metrópoles contemporâneas, o último traz à tona as questões metodológicas que permeiam as etnografias das cidades feitas pela autora. In Adventure of the Cities, Janice Caiafa compiles eight essays presented and published in recent years. The central theme of seven of these essays is, as indicated by the title, the urban experience and wandering through contemporary metropolises. The eighth essay broaches methodological issues that permeate the author's ethnographies of the city.

  6. To Capture Student Interest in Geosciences, Plan an Adventure

    Science.gov (United States)

    Sassier, Caroline; Galland, Olivier; Mair, Karen

    2011-01-01

    It is dawn, -17°C, and 4700 meters above sea level, and two young scientists are alone in a tiny tent in the middle of the immense desert of the Bolivian Altiplano. Their bicycles and sleeping bags are coated with a thin layer of ice. Muscles aching, as they did yesterday and probably will tomorrow, they shrug off their sleepiness as the sunrise heats up their tent. After a simple breakfast, the researchers peek out and feast their eyes on a stunning view of high volcanic peaks and salt lakes. They are on the Andean Geotrail, a 9-month bike adventure through the Andes mountains, from Ushuaia in Argentinean Tierra del Fuego to Nazca, Peru (see Figure 1). Their goal is to share this spectacular geological setting with primary-, secondary- and high-school students.

  7. Dynamic Music and Immersion in the Action-Adventure

    DEFF Research Database (Denmark)

    Gasselseder, Hans-Peter

    2014-01-01

    in the context of dynamic and non-dynamic music. 60 subjects answered self-report questionnaires each time after playing a 3rd-person action-adventure in one of three conditions accounting for (1) dynamic music, (2) non-dynamic music/low arousal potential and (3) non-dynamic music/high arousal potential......Aiming to immerse players into a new realm of drama experience, a growing number of video games utilize interactive, ‘dynamic’ music that reacts adaptively to game events. Though little is known about the involved perceptual processes, the design rationale of enhanced immersive experiences is taken...... over by public discussion including scientific accounts, despite lacking empirical validation. The present paper intends to fill this gap by hypothesizing facilitatory effects of dynamic music on attention allocation in the matching of expected and incoming expressive characteristics of concurrent...

  8. Maps to the other side adventures of a bipolar cartographer

    CERN Document Server

    DuBrul, Sascha Altman

    2013-01-01

    Part mad manifesto, part revolutionary love letter, part freight train adventure story — Maps to the Other Side is a self-reflective shattered mirror, a twist on the classic punk rock travel narrative that searches for authenticity and connection in the lives of strangers and the solidarity and limitations of underground community. Beginning at the edge of the internet age, a time when radical zine culture prefigured social networking sites, these timely writings paint an illuminated trail through a complex labyrinth of undocumented migrants, anarchist community organizers, brilliant visionary artists, revolutionary seed savers, punk rock historians, social justice farmers, radical mental health activists, and iconoclastic bridge builders. This book is a document of one person's odyssey to transform his experiences navigating the psychiatric system by building community in the face of adversity; a set of maps for how rebels and dreamers can survive and thrive in a crazy world.

  9. Modern Radiation Therapy for Hodgkin Lymphoma: Field and Dose Guidelines From the International Lymphoma Radiation Oncology Group (ILROG)

    International Nuclear Information System (INIS)

    Specht, Lena; Yahalom, Joachim; Illidge, Tim; Berthelsen, Anne Kiil; Constine, Louis S.; Eich, Hans Theodor; Girinsky, Theodore; Hoppe, Richard T.; Mauch, Peter; Mikhaeel, N. George; Ng, Andrea

    2014-01-01

    Radiation therapy (RT) is the most effective single modality for local control of Hodgkin lymphoma (HL) and an important component of therapy for many patients. These guidelines have been developed to address the use of RT in HL in the modern era of combined modality treatment. The role of reduced volumes and doses is addressed, integrating modern imaging with 3-dimensional (3D) planning and advanced techniques of treatment delivery. The previously applied extended field (EF) and original involved field (IF) techniques, which treated larger volumes based on nodal stations, have now been replaced by the use of limited volumes, based solely on detectable nodal (and extranodal extension) involvement at presentation, using contrast-enhanced computed tomography, positron emission tomography/computed tomography, magnetic resonance imaging, or a combination of these techniques. The International Commission on Radiation Units and Measurements concepts of gross tumor volume, clinical target volume, internal target volume, and planning target volume are used for defining the targeted volumes. Newer treatment techniques, including intensity modulated radiation therapy, breath-hold, image guided radiation therapy, and 4-dimensional imaging, should be implemented when their use is expected to decrease significantly the risk for normal tissue damage while still achieving the primary goal of local tumor control. The highly conformal involved node radiation therapy (INRT), recently introduced for patients for whom optimal imaging is available, is explained. A new concept, involved site radiation therapy (ISRT), is introduced as the standard conformal therapy for the scenario, commonly encountered, wherein optimal imaging is not available. There is increasing evidence that RT doses used in the past are higher than necessary for disease control in this era of combined modality therapy. The use of INRT and of lower doses in early-stage HL is supported by available data. Although the

  10. Stakeholders willingness to apply sustainable adventure tourism indicators: a case of Waterval Boven in South Africa

    Directory of Open Access Journals (Sweden)

    NN Tshipala

    2014-01-01

    Full Text Available In South Africa and across the globe, the development of adventure tourism industry has resulted in a multitude of different types of activities, destinations, risks, impacts and unsustainable practices. The development of adventure tourism in many destinations has boosted many economies across rural communities and countries. The added benefits of developing adventure tourism in a sustainable manner include the promotion of responsible investment, infrastructure development and a host of other positive economic, social and environmental impacts. This study investigates the stakeholders will to utilise sustainable adventure tourism indicators from residents, tourists, business owners and government employees at Waterval Boven if made available. Descriptive statistics were presented; Cronbach Alpha and Chi-square tests were also applied. In general, the respondents perceived the indicators positively and felt they could assist in the sustainable development of adventure tourism. The study contributes towards the development of sustainable adventure tourism destinations that can make a significant contribution towards poverty alleviation by maximising social and economic benefits for locals, enhancing cultural heritage and reducing any negative impacts on the environment.

  11. Adventurous activities, embodiment and nature: spiritual, sensual and sustainable? Embodying environmental justice

    Directory of Open Access Journals (Sweden)

    Barbara Humberstone

    2013-09-01

    Full Text Available This paper examines research on adventurous physical activities in nature from the perspective of the sentient body. Drawing upon ethnographic and autoethnographic research, I examine what has been termed 'peak' happenings or 'flow' which many who practise adventurous activities claim to experience through their whole body when in the 'zone'. I consider the concept of 'edgework', voluntary risk-taking, and insightful mobile and social understanding of the relationships between body, emotions and the elements, where the adventurous activity is experienced and interpreted as oneness with nature or expressed as 'spiritual' not only in high but also low risk nature-based sport. I then consider if and in what ways these knowledges may bring about greater understanding and action in relation to social and environmental justice. I argue that adventurous activities/nature-based sport may provide processes and practices that are alternative or complementary to traditional sporting 'body techniques' or 'body pedagogics'. I suggest that modern embodied adventurous practices in nature challenge dominant narratives of body/mind separation and potentially provide a pedagogic process fostering kinetic empathy. Finally I draw attention to the paradox of (re-presenting sensorial experiences of sport in nature and ask for consideration on how we interconnect with the environment when we participate in adventureous nature-based sports.

  12. Respiratory gating based on internal electromagnetic motion monitoring during stereotactic liver radiation therapy: First results.

    Science.gov (United States)

    Poulsen, Per Rugaard; Worm, Esben Schjødt; Hansen, Rune; Larsen, Lars Peter; Grau, Cai; Høyer, Morten

    2015-01-01

    Intrafraction motion may compromise the target dose in stereotactic body radiation therapy (SBRT) of tumors in the liver. Respiratory gating can improve the treatment delivery, but gating based on an external surrogate signal may be inaccurate. This is the first paper reporting on respiratory gating based on internal electromagnetic monitoring during liver SBRT. Two patients with solitary liver metastases were treated with respiratory-gated SBRT guided by three implanted electromagnetic transponders. The treatment was delivered in end-exhale with beam-on when the centroid of the three transponders deviated less than 3 mm [left-right (LR) and anterior-posterior (AP) directions] and 4mm [cranio-caudal (CC)] from the planned position. For each treatment fraction, log files were used to determine the transponder motion during beam-on in the actual gated treatments and in simulated treatments without gating. The motion was used to reconstruct the dose to the clinical target volume (CTV) with and without gating. The reduction in D95 (minimum dose to 95% of the CTV) relative to the plan was calculated for both treatment courses. With gating the maximum course mean (standard deviation) geometrical error in any direction was 1.2 mm (1.8 mm). Without gating the course mean error would mainly increase for Patient 1 [to -2.8 mm (1.6 mm) (LR), 7.1 mm (5.8 mm) (CC), -2.6 mm (2.8mm) (AP)] due to a large systematic cranial baseline drift at each fraction. The errors without gating increased only slightly for Patient 2. The reduction in CTV D95 was 0.5% (gating) and 12.1% (non-gating) for Patient 1 and 0.3% (gating) and 1.7% (non-gating) for Patient 2. The mean duty cycle was 55%. Respiratory gating based on internal electromagnetic motion monitoring was performed for two liver SBRT patients. The gating added robustness to the dose delivery and ensured a high CTV dose even in the presence of large intrafraction motion.

  13. Selective internal radiation therapy compared with sorafenib for hepatocellular carcinoma with portal vein thrombosis

    Energy Technology Data Exchange (ETDEWEB)

    Edeline, Julien [Centre Eugene Marquis, Medical Oncology Department, Rennes (France); Inserm UMR991, Rennes (France); Crouzet, Laurence; Pracht, Marc; Boucher, Eveline [Centre Eugene Marquis, Medical Oncology Department, Rennes (France); Campillo-Gimenez, Boris [Centre Eugene Marquis, Clinical Research Department, Rennes (France); Rolland, Yan; Rohou, Tanguy [Centre Eugene Marquis, Imaging Department, Rennes (France); Guillygomarc' h, Anne [CHU Pontchaillou, Hepatology Department, Rennes (France); Boudjema, Karim [CHU Pontchaillou, Hepatobiliary Surgery, Rennes (France); Lenoir, Laurence [Centre Eugene Marquis, Nuclear Medicine Department, Rennes (France); Adhoute, Xavier [Hopital Saint-Joseph, Hepato-Gastroenterology Department, Marseille (France); Clement, Bruno [Inserm UMR991, Rennes (France); Blanc, Jean-Frederic [Hopital Saint-Andre, Hepato-Gastroenterology Department, Bordeaux (France); Garin, Etienne [Inserm UMR991, Rennes (France); Centre Eugene Marquis, Nuclear Medicine Department, Rennes (France)

    2016-04-15

    Tumoural portal vein thrombosis (PVT) is a major prognostic factor in hepatocellular carcinoma (HCC). The efficacy of sorafenib, the only treatment approved at an advanced stage, is limited. Based on previous data, selective internal radiation therapy (SIRT), or {sup 90}Y radioembolization, seems an interesting option. We aimed to compare both treatments in this population. We retrospectively compared patients treated in two centres for HCC with tumoural PVT. We compared overall survival (OS) between patients treated with SIRT and patients treated with sorafenib. Analyses were performed before and after 1:1 matching with a propensity score for controlling indication bias, using a Cox proportional hazards model. A total of 151 patients were analysed, 34 patients treated with SIRT and 117 patients treated with sorafenib only. In the whole population, SIRT was associated with a higher median OS as compared with sorafenib: 18.8 vs 6.5 months (log-rank p < 0.001). There was an imbalance of baseline characteristics between patients treated by SIRT and sorafenib, which justified patient matching with use of a propensity score: 24 patients treated with SIRT could be matched with 24 patients treated with sorafenib. OS was estimated with a median of 26.2 vs 8.7 months in patients treated with SIRT vs sorafenib, respectively (log-rank p = 0.054). Before and after patient matching, the adjusted hazard ratio related to treatment by SIRT was estimated at 0.62 [95 % confidence interval (CI) 0.39-0.97] (p = 0.037) and 0.40 (95 % CI 0.19-0.82) (p = 0.013), respectively. SIRT seems more effective than sorafenib in patients presenting with HCC and tumoural PVT. This hypothesis is being tested in prospective randomized trials. (orig.)

  14. Selective internal radiation therapy compared with sorafenib for hepatocellular carcinoma with portal vein thrombosis

    International Nuclear Information System (INIS)

    Edeline, Julien; Crouzet, Laurence; Pracht, Marc; Boucher, Eveline; Campillo-Gimenez, Boris; Rolland, Yan; Rohou, Tanguy; Guillygomarc'h, Anne; Boudjema, Karim; Lenoir, Laurence; Adhoute, Xavier; Clement, Bruno; Blanc, Jean-Frederic; Garin, Etienne

    2016-01-01

    Tumoural portal vein thrombosis (PVT) is a major prognostic factor in hepatocellular carcinoma (HCC). The efficacy of sorafenib, the only treatment approved at an advanced stage, is limited. Based on previous data, selective internal radiation therapy (SIRT), or 90 Y radioembolization, seems an interesting option. We aimed to compare both treatments in this population. We retrospectively compared patients treated in two centres for HCC with tumoural PVT. We compared overall survival (OS) between patients treated with SIRT and patients treated with sorafenib. Analyses were performed before and after 1:1 matching with a propensity score for controlling indication bias, using a Cox proportional hazards model. A total of 151 patients were analysed, 34 patients treated with SIRT and 117 patients treated with sorafenib only. In the whole population, SIRT was associated with a higher median OS as compared with sorafenib: 18.8 vs 6.5 months (log-rank p < 0.001). There was an imbalance of baseline characteristics between patients treated by SIRT and sorafenib, which justified patient matching with use of a propensity score: 24 patients treated with SIRT could be matched with 24 patients treated with sorafenib. OS was estimated with a median of 26.2 vs 8.7 months in patients treated with SIRT vs sorafenib, respectively (log-rank p = 0.054). Before and after patient matching, the adjusted hazard ratio related to treatment by SIRT was estimated at 0.62 [95 % confidence interval (CI) 0.39-0.97] (p = 0.037) and 0.40 (95 % CI 0.19-0.82) (p = 0.013), respectively. SIRT seems more effective than sorafenib in patients presenting with HCC and tumoural PVT. This hypothesis is being tested in prospective randomized trials. (orig.)

  15. Dosimetric Advantages of Midventilation Compared With Internal Target Volume for Radiation Therapy of Pancreatic Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Lens, Eelco, E-mail: e.lens@amc.uva.nl; Horst, Astrid van der; Versteijne, Eva; Tienhoven, Geertjan van; Bel, Arjan

    2015-07-01

    Purpose: The midventilation (midV) approach can be used to take respiratory-induced pancreatic tumor motion into account during radiation therapy. In this study, the dosimetric consequences for organs at risk and tumor coverage of using a midV approach compared with using an internal target volume (ITV) were investigated. Methods and Materials: For each of the 18 patients, 2 treatment plans (25 × 2.0 Gy) were created, 1 using an ITV and 1 using a midV approach. The midV dose distribution was blurred using the respiratory-induced motion from 4-dimensional computed tomography. The resulting planning target volume (PTV) coverage for this blurred dose distribution was analyzed; PTV coverage was required to be at least V{sub 95%} >98%. In addition, the change in PTV size and the changes in V{sub 10Gy}, V{sub 20Gy}, V{sub 30Gy}, V{sub 40Gy}, D{sub mean} and D{sub 2cc} for the stomach and for the duodenum were analyzed; differences were tested for significance using the Wilcoxon signed-rank test. Results: Using a midV approach resulted in sufficient target coverage. A highly significant PTV size reduction of 13.9% (P<.001) was observed. Also, all dose parameters for the stomach and duodenum, except the D{sub 2cc} of the duodenum, improved significantly (P≤.002). Conclusions: By using the midV approach to account for respiratory-induced tumor motion, a significant PTV reduction and significant dose reductions to the stomach and to the duodenum can be achieved when irradiating pancreatic tumors.

  16. Dosimetric Advantages of Midventilation Compared With Internal Target Volume for Radiation Therapy of Pancreatic Cancer

    International Nuclear Information System (INIS)

    Lens, Eelco; Horst, Astrid van der; Versteijne, Eva; Tienhoven, Geertjan van; Bel, Arjan

    2015-01-01

    Purpose: The midventilation (midV) approach can be used to take respiratory-induced pancreatic tumor motion into account during radiation therapy. In this study, the dosimetric consequences for organs at risk and tumor coverage of using a midV approach compared with using an internal target volume (ITV) were investigated. Methods and Materials: For each of the 18 patients, 2 treatment plans (25 × 2.0 Gy) were created, 1 using an ITV and 1 using a midV approach. The midV dose distribution was blurred using the respiratory-induced motion from 4-dimensional computed tomography. The resulting planning target volume (PTV) coverage for this blurred dose distribution was analyzed; PTV coverage was required to be at least V 95% >98%. In addition, the change in PTV size and the changes in V 10Gy , V 20Gy , V 30Gy , V 40Gy , D mean and D 2cc for the stomach and for the duodenum were analyzed; differences were tested for significance using the Wilcoxon signed-rank test. Results: Using a midV approach resulted in sufficient target coverage. A highly significant PTV size reduction of 13.9% (P<.001) was observed. Also, all dose parameters for the stomach and duodenum, except the D 2cc of the duodenum, improved significantly (P≤.002). Conclusions: By using the midV approach to account for respiratory-induced tumor motion, a significant PTV reduction and significant dose reductions to the stomach and to the duodenum can be achieved when irradiating pancreatic tumors

  17. [Development and Effects of a Cognitive-behavioral Therapy Based Program in Reducing Internalized Stigma in Patients with Schizophrenia].

    Science.gov (United States)

    Kim, Mi Young; Jun, Seong Sook

    2016-06-01

    This study was done to develop a internalized stigma reducing program based on cognitive-behavioral therapy and appropriate for patients with schizophrenia and to evaluate its effectiveness. The study design was a mixed method research. Qualitative study, 13 patients with schizophrenia who had experience in overcoming stigma were purposively chosen for interviews and data were analyzed using Giorgi method. Quantitative study, 64 patients with schizophrenia (experimental group=32, control group=32) were recruited. The cognitive-behavioral therapy-based program for reducing internalized stigma in patients with schizophrenia was provided for 8 weeks (12 sessions). Data were collected from June. 20, 2013 to Feb. 14, 2014. Quantitative data were analyzed using χ²-test, t-test, repeated measures ANOVA with the SPSS program. Qualitative results, from the experience of coping with stigma in patients with schizophrenia seventeen themes and five themes-clusters were drawn up. Quantitative results showed that internalized stigma, self-esteem, mental health recovery and quality of life were significantly better in the experimental group compared to the control group. Study findings indicate that this program for reducing internalized stigma in patients with schizophrenia is effective and can be recommended as a rehabilitation program intervention to help patients with schizophrenia to cope with internalized stigma.

  18. Proceedings from an international conference on ablation therapy for Barrett's mucosa: Brittany, France, 31 August - 2 September 1997.

    Science.gov (United States)

    Bremner, C G; Demeester, T R

    2017-11-01

    The increasing incidence of adenocarcinoma of the lower esophagus and cardia arising in Barrett's metaplastic epithelium continues to be of great concern because medical and surgical efforts to reverse the process have been disappointing. A potential answer to the problem is removal of the metaplastic epithelium. Modern technology has introduced physical and chemical modalities which facilitate ablation of the neo-epithelium endoscopically. These techniques have been used in several centers, and preliminary results are encouraging. This report summarizes the proceedings of an international symposium on ablative therapy held in Brittany, France in August 1997.Twenty-eight speakers contributed to the talks on the pathology, pathogenesis, current therapy experimental studies and clinical experience of ablation of Barrett's esophagus. © 1998 International Society for Diseases of the Esophagus/Harcourt Brace & Co. Ltd.

  19. Dr. S. Donald (Don) Stookey (1915-2014): Pioneering Researcher and Adventurer

    Science.gov (United States)

    Beall, George H.

    2016-07-01

    Don Stookey, the father of glass-ceramics, was a pioneer in inducing and understanding internal nucleation phenomena in glass. His early work on dense opal glasses and photosensitive precipitation of gold and silver in glass led to an amazing series of inventions: Fotalite, a photosensitive opal, chemically machined Fotoform and Fotoceram, and TiO2-nucleated Pyroceram products including missile nosecones and oven-proof cookware. He received a basic patent on glass-ceramics, which was contested and affirmed in court. Don was able to demonstrate a clear photochromic glass that showed reversible darkening for thousands of cycles. This material became a fixture in the ophthalmic industry. He went on to invent a full-color polychromatic glass, capable of yielding a permanent patterned and monolithic stained glass. In his life outside science, Don chaired an interfaith group that founded a home for the elderly in Corning. He was also a wilderness enthusiast, surviving a plane crash in the Arctic and two boat capsizings. Even in his later years, he continued fishing off the coast of Florida and on Lake Ontario and went solo on a trip to the Patagonian Andes. Don Stookey was a special person by any measure: an unassuming optimist, eminent scientist and inventor, adventurer, and a beloved family man. Introduction

  20. Dr. S. Donald (Don Stookey: (1915-2014: Pioneering Researcher and Adventurer

    Directory of Open Access Journals (Sweden)

    George Halsey Beall

    2016-08-01

    Full Text Available Don Stookey was a special person by any measure: an unassuming optimist, eminent scientist and inventor, adventurer, and a beloved family man. Don Stookey, the father of glass-ceramics, was a pioneer in inducing and understanding internal nucleation phenomena in glass. His early work on dense opal glasses and photosensitive precipitation of gold and silver in glass led to an amazing series of inventions: Fotalite®, a photosensitive opal, chemically machined Fotoform® and Fotoceram®, and TiO2-nucleated Pyroceram™ products including missile nosecones and oven-proof cookware. He received a basic patent on glass-ceramics which was contested and affirmed in court.Don was able to demonstrate a clear photochromic glass that showed reversible darkening for thousands of cycles. This material became a fixture in the ophthalmic industry. He went on to invent a full-color polychromatic glass capable of yielding a permanent patterned and monolithic stained glass.In his life outside science, Don chaired an interfaith group that founded a home for the elderly in Corning. He was also a wilderness enthusiast, surviving a plane crash in the Arctic and two boat capsizings. Even In his later years, he continued fishing off the coast of Florida and on Lake Ontario, and went solo on a trip to the Patagonian Andes.

  1. Modern Radiation Therapy for Extranodal Lymphomas: Field and Dose Guidelines From the International Lymphoma Radiation Oncology Group

    Energy Technology Data Exchange (ETDEWEB)

    Yahalom, Joachim, E-mail: yahalomj@mskcc.org [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Illidge, Tim [Institute of Cancer Sciences, University of Manchester, Manchester Academic Health Sciences Centre, The Christie National Health Service Foundation Trust, Manchester (United Kingdom); Specht, Lena [Department of Oncology and Hematology, Rigshospitalet, University of Copenhagen, Copenhagen (Denmark); Hoppe, Richard T. [Department of Radiation Oncology, Stanford University, Palo Alto, California (United States); Li, Ye-Xiong [Department of Radiation Oncology, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (China); Tsang, Richard [Department of Radiation Oncology, Princess Margaret Hospital, University of Toronto, Toronto, Ontario (Canada); Wirth, Andrew [Division of Radiation Oncology, Peter MacCallum Cancer Institute, St. Andrews Place, East Melbourne (Australia)

    2015-05-01

    Extranodal lymphomas (ENLs) comprise about a third of all non-Hodgkin lymphomas (NHL). Radiation therapy (RT) is frequently used as either primary therapy (particularly for indolent ENL), consolidation after systemic therapy, salvage treatment, or palliation. The wide range of presentations of ENL, involving any organ in the body and the spectrum of histological sub-types, poses a challenge both for routine clinical care and for the conduct of prospective and retrospective studies. This has led to uncertainty and lack of consistency in RT approaches between centers and clinicians. Thus far there is a lack of guidelines for the use of RT in the management of ENL. This report presents an effort by the International Lymphoma Radiation Oncology Group (ILROG) to harmonize and standardize the principles of treatment of ENL, and to address the technical challenges of simulation, volume definition and treatment planning for the most frequently involved organs. Specifically, detailed recommendations for RT volumes are provided. We have applied the same modern principles of involved site radiation therapy as previously developed and published as guidelines for Hodgkin lymphoma and nodal NHL. We have adopted RT volume definitions based on the International Commission on Radiation Units and Measurements (ICRU), as has been widely adopted by the field of radiation oncology for solid tumors. Organ-specific recommendations take into account histological subtype, anatomy, the treatment intent, and other treatment modalities that may be have been used before RT.

  2. Modern Radiation Therapy for Extranodal Lymphomas: Field and Dose Guidelines From the International Lymphoma Radiation Oncology Group

    International Nuclear Information System (INIS)

    Yahalom, Joachim; Illidge, Tim; Specht, Lena; Hoppe, Richard T.; Li, Ye-Xiong; Tsang, Richard; Wirth, Andrew

    2015-01-01

    Extranodal lymphomas (ENLs) comprise about a third of all non-Hodgkin lymphomas (NHL). Radiation therapy (RT) is frequently used as either primary therapy (particularly for indolent ENL), consolidation after systemic therapy, salvage treatment, or palliation. The wide range of presentations of ENL, involving any organ in the body and the spectrum of histological sub-types, poses a challenge both for routine clinical care and for the conduct of prospective and retrospective studies. This has led to uncertainty and lack of consistency in RT approaches between centers and clinicians. Thus far there is a lack of guidelines for the use of RT in the management of ENL. This report presents an effort by the International Lymphoma Radiation Oncology Group (ILROG) to harmonize and standardize the principles of treatment of ENL, and to address the technical challenges of simulation, volume definition and treatment planning for the most frequently involved organs. Specifically, detailed recommendations for RT volumes are provided. We have applied the same modern principles of involved site radiation therapy as previously developed and published as guidelines for Hodgkin lymphoma and nodal NHL. We have adopted RT volume definitions based on the International Commission on Radiation Units and Measurements (ICRU), as has been widely adopted by the field of radiation oncology for solid tumors. Organ-specific recommendations take into account histological subtype, anatomy, the treatment intent, and other treatment modalities that may be have been used before RT

  3. Design of an international multicentre RCT on group schema therapy for borderline personality disorder

    NARCIS (Netherlands)

    Wetzelaer, P.; Farrell, J.; Evers, S.M.A.A.; Jacob, G.A.; Lee, C.W.; Brand, O.; van Breukelen, G.; Fassbinder, E.; Fretwell, H.; Harper, R.P.; Lavender, A.; Lockwood, G.; Malogiannis, I.A.; Schweiger, U.; Startup, H.; Stevenson, T.; Zarbock, G.; Arntz, A.

    2014-01-01

    Background: Borderline personality disorder (BPD) is a severe and highly prevalent mental disorder. Schema therapy (ST) has been found effective in the treatment of BPD and is commonly delivered through an individual format. A group format (group schema therapy, GST) has also been developed. GST has

  4. Gaps in Radiation Therapy Awareness: Results From an Educational Multi-institutional Survey of US Internal Medicine Residents.

    Science.gov (United States)

    Shaverdian, Narek; Yoo, Sun Mi; Cook, Ryan; Chang, Eric M; Jiang, Naomi; Yuan, Ye; Sandler, Kiri; Steinberg, Michael; Lee, Percy

    2017-08-01

    Internists and primary care providers play a growing role in cancer care. We therefore evaluated the awareness of radiation therapy in general and specifically the clinical utility of stereotactic body radiation therapy (SBRT) for early-stage non-small cell lung cancer (NSCLC) among current US internal medicine residents. A web-based institutional review board-approved multi-institutional survey was distributed to US internal medicine residency programs. The survey evaluated trainee demographic characteristics, baseline radiation oncology awareness, knowledge of the role of SBRT for early-stage NSCLC, and whether the survey successfully improved awareness. Thirty US internal medicine programs participated, with an overall participant response rate of 46% (1177 of 2551). Of the trainees, 93% (n=1076) reported no radiation oncology education in their residency, 39% (n=452) reported confidence in knowing when to consult radiation oncology in an oncologic emergency, and 26% (n=293) reported confidence in knowing when to consult radiation oncology in the setting of a newly diagnosed cancer. Of the participants, 76% (n=850) correctly identified that surgical resection is the standard treatment in operable early-stage NSCLC, but only 50% (n=559) of participants would recommend SBRT to a medically inoperable patient, followed by 31% of participants (n=347) who were unsure of the most appropriate treatment, and 10% (n=117) who recommended waiting to offer palliative therapy. Ninety percent of participants (n=1029) agreed that they would benefit from further training on when to consult radiation oncology. Overall, 96% (n=1072) indicated that the survey increased their knowledge and awareness of the role of SBRT. The majority of participating trainees received no education in radiation oncology in their residency, reported a lack of confidence regarding when to consult radiation oncology, and overwhelmingly agreed that they would benefit from further training. These findings

  5. Third-line Targeted Therapy in Metastatic Renal Cell Carcinoma: Results from the International Metastatic Renal Cell Carcinoma Database Consortium.

    Science.gov (United States)

    Wells, J Connor; Stukalin, Igor; Norton, Craig; Srinivas, Sandy; Lee, Jae Lyun; Donskov, Frede; Bjarnason, Georg A; Yamamoto, Haru; Beuselinck, Benoit; Rini, Brian I; Knox, Jennifer J; Agarwal, Neeraj; Ernst, D Scott; Pal, Sumanta K; Wood, Lori A; Bamias, Aristotelis; Alva, Ajjai S; Kanesvaran, Ravindran; Choueiri, Toni K; Heng, Daniel Y C

    2017-02-01

    The use of third-line targeted therapy (TTT) in metastatic renal cell carcinoma (mRCC) is not well characterized and varies due to the lack of robust data to guide treatment decisions. This study examined the use of third-line therapy in a large international population. To evaluate the use and efficacy of targeted therapy in a third-line setting. Twenty-five international cancer centers provided consecutive data on 4824 mRCC patients who were treated with an approved targeted therapy. One thousand and twelve patients (21%) received TTT and were included in the analysis. Patients were analyzed for overall survival (OS) and progression-free survival using Kaplan-Meier curves, and were evaluated for overall response. Cox regression analyses were used to determine the statistical association between OS and the six factors included in the International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) prognostic model. Subgroup analysis was performed on patients stratified by their IMDC prognostic risk status. Everolimus was the most prevalent third-line therapy (27.5%), but sunitinib, sorafenib, pazopanib, temsirolimus, and axitinib were all utilized in over ≥9% of patients. Patients receiving any TTT had an OS of 12.4 mo, a progression-free survival of 3.9 mo, and 61.1% of patients experienced an overall response of stable disease or better. Patients not receiving TTT had an OS of 2.1 mo. Patients with favorable- (7.2%) or intermediate-risk (65.3%) disease had the highest OS with TTT, 29.9 mo and 15.5 mo, respectively, while poor-risk (27.5%) patients survived 5.5 mo. Results are limited by the retrospective nature of the study. TTT remains highly heterogeneous. The IMDC prognostic criteria can be used to stratify third-line patients. TTT use in favorable- and intermediate-risk patients was associated with the greatest OS. Patients with favorable- and intermediate-prognostic criteria disease treated with third-line targeted therapy have an associated

  6. The natural-geographical basics for the development of the adventure tourism in Serbia

    Directory of Open Access Journals (Sweden)

    Spalević Aleksandra

    2011-01-01

    Full Text Available Adventure tourism represents traveling motivated by the wish to be in the nature. It includes both physical and cultural interaction between the nature and a tourist. The concept of “adventure” includes the wish of a guest for unusual activities and experience. This is also followed by excitement. The natural and tourist potentials of Serbia are analyzed in this work. The types of adventure tourism, for which there are favorable conditions in our country, are sorted out. Among different adventure activities the most important are: hiking, speleo tourism, rafting, cannoning, paragliding and mountain biking. Nevertheless, due to many problems this branch of tourism is undeveloped. In the analysis of the tourist space of Serbia, the beginning point is the mountain documents from the section about the development of tourism. In accordance with them and based on natural and anthropogenic resources and the potentials of Serbia, the possible ways of development of adventure tourism in Serbia are defined. The aim of this work is to draw attention to adventure tourism of Serbia and to point out the possibilities of its development based on the characteristics of the natural values. It also aims to suggest the potential areas-centers of development of this tourist branch.

  7. MO-A-BRB-01: Review of TG-262 Internal Survey of Practices in EMR for External Beam Therapy

    International Nuclear Information System (INIS)

    Mechalakos, J.

    2015-01-01

    The process of converting to an electronic chart for radiation therapy can be daunting. It requires a dedicated committee to first research and choose appropriate software, to review the entire documentation policy and flow of the clinic, to convert this system to electronic form or if necessary, redesign the system to more easily conform to the electronic process. Those making the conversion and those who already use electronic charting would benefit from the shared experience of those who have been through the process in the past. Therefore TG262 was convened to provide guidance on electronic charting for external beam radiation therapy and brachytherapy. This course will present the results of an internal survey of task group members on EMR practices in External Beam Radiation Therapy as well as discuss important issues in EMR development and structure for both EBRT and brachytherapy. Learning Objectives: Be familiarized with common practices and pitfalls in development and maintenance of an electronic chart in Radiation Oncology Be familiarized with important issues related to electronic charting in External Beam Radiation Therapy Be familiarized with important issues related to electronic charting in Brachytherapy

  8. The adventure of nuclear energy: a scientifical and industrial history

    International Nuclear Information System (INIS)

    Reuss, P.

    2007-01-01

    The nuclear energy history is one of the most exciting scientifical and industrial adventure. In France, in a few decades, nuclear energy has become the main energy source for power generation. The aim of this book is to present the stakes of this challenge, to better outline the difficulties that have been encountered all along its development in order to better understand the complexness of such a development. After an overview of the successive advances of atomic and nuclear physics since more than a century, the book describes the genesis of nuclear energy, its industrial developments and its still wide open perspectives. The conclusions makes a status of the advantages and risks linked with this energy source. The book contains also the testimonies of two French nuclear actors: P. Benoist and S. David. The forewords by H. Langevin, daughter of F. and I. Joliot-Curie, stresses on the past and future role of nuclear energy in the live synergy between research and industry. (J.S.)

  9. Pre-Participation Medical Evaluation for Adventure and Wilderness Watersports.

    Science.gov (United States)

    Nathanson, Andrew T; Young, Justin Mark J; Young, Craig

    2015-12-01

    A request for a preparticipation medical evaluation for wilderness watersports may be made by guiding agencies, instructional camps, or by patients presenting for an annual visit. Although guidelines have been published regarding preparticipation physical evaluation for traditional competitive high school and collegiate sports, little has been written about medical evaluations for those wishing to engage in wilderness and adventure watersports. in this article, we offer guidance based on literature review and expert opinion. Watersports are among the most common recreational activities in the United states and are generally safe. Drowning, however, is a significant risk, particularly in small, self-propelled craft, and among children. Medical counseling before participation in watersports should include screening for medical conditions which may impair swimming ability, including a history of seizures, heart disease, and lung disease. Physicians should also promote preventive health measures such as use of lifejackets and sun protection, as well as alcohol avoidance. Swim testing tailored to specific activities should be strongly considered for children and those with questionable swimming ability. Copyright © 2015. Published by Elsevier Inc.

  10. "My petticoat encumbrances"; the 'female adventurer' and the north

    Directory of Open Access Journals (Sweden)

    Kathryn Walchester

    2014-08-01

    Full Text Available Focussing on the northern travelogues of two women travellers from the late nineteenth century, Ethel Brilliana Tweedie’s A Winter Jaunt to Norway: with Accounts of Nansen, Ibsen, Bjornson, Brandes, and Many Others and Polar Gleams; an Account of a Voyage on the Yacht ‘Blencathra’ by Helen Peel, this article suggests that rather than presenting a polarized gendered perspective of Arctic travel, in their writing Peel and Tweedie negotiate between masculine and feminine-coded associations in order to legitimate and popularize their travels, whilst remaining within the conventions of Victorian femininity.  Of the strategies for ensuring the apparent propriety of their text, the references to clothing are highly significant on several levels. Not only could Peel and Tweedie show their adherence (or not to conventional feminine dress through their descriptions of their clothing, they could also illustrate their relationship to other travellers and the Norwegians they encountered. Thus the ‘petticoat encumbrances’ have a double function in the text. Symbolic of Victorian conventions of femininity and their limitations on women, the adherence to sartorial norms at least indicated to readers and critics of the woman traveller’s compliance with gender conventions. This achieved, the woman travel writer had more scope to embark on her remarkable journey and to write about its potential adventures with enthusiasm as a ‘female adventurer’ and still remain within the acceptable boundaries of late-Victorian femininity.

  11. 'The adventure': Charles-Ferdinand Ramuz's extraordinary stroke diary.

    Science.gov (United States)

    Bogousslavsky, J

    2010-01-01

    The famous Swiss writer Charles-Ferdinand Ramuz suffered a stroke at 65 years, which he called 'the adventure' or 'the accident'. He developed language disturbances suggesting crossed aphasia in a right hander with left hemiparesis. This uncommon pattern allowed him to continue to write his diary and to report his disturbances, with a unique depth and precision, especially for cognitive-emotional changes. Language and motor dysfunction recovered within a few weeks, but Ramuz complained of persisting emotional flattening alternating with irritability, fatigue, depression, anxiety, and concentration difficulty, which gave him the feeling to have become another person and to be inhabited by a stranger, whom he compared with devils. Ramuz fought several months to resume his literary activity, having the impression to have lost inspiration and creativity. However, the novels he wrote less than 6 months after stroke show no stylistic changes and have been found to be of the same quality as his previous production. Ramuz even 'used' his stroke experience in his work, in particular in a novel depicting an old man who has a stroke and dies of it. Ramuz's diary, with his own daily description of stroke features and consequences during acute and recovery phases, is a unique document in a writer of his importance, and provides invaluable information on subjective emotional and cognitive experience of stroke. Copyright (c) 2010 S. Karger AG, Basel.

  12. Adventures of Geo: Using comics as a learning tool

    Science.gov (United States)

    Lee, K. K. M.; Wallenta, A.

    2015-12-01

    Illustrations are a good way to visualize what is not readily seen. To take this medium a step further, we use illustrations in the form of comics as a way to teach Earth science concepts. The comic book format lends itself to engaging reading for young and old alike and has been used recently by the American Physical Society (APS) and by NASA as an outreach teaching tool. Due to their sequential nature, comic books make it easy for readers to follow a story and grasp concepts that are covered. The limited text in each panel can also help those where reading is a challenge or for those who become nervous and/or discouraged with long text passages. The illustrations also add visual clues that can aid in understanding the concepts being laid out. In the second installment of "Adventures of Geo," we use the comic book format to introduce the Moon, its formation, evolution, orbit and its interplay with Earth. The exploration of such faraway places is readily disseminated to the public through such a graphical approach. The comic books are aimed at middle school students in the New Haven Public Schools (NHPS) where Earth Science topics are covered in the curriculum.

  13. A qualitative study of intimate partner violence universal screening by family therapy interns: implications for practice, research, training, and supervision.

    Science.gov (United States)

    Todahl, Jeffrey L; Linville, Deanna; Chou, Liang-Ying; Maher-Cosenza, Patricia

    2008-01-01

    Although a few family therapy researchers and clinicians have urged universal screening for intimate partner violence (IPV), how screening is implemented-and, in particular, client and therapist response to screening-is vaguely defined and largely untested. This qualitative study examined the dilemmas experienced by couples and family therapy interns when implementing universal screening for IPV in an outpatient clinic setting. Twenty-two graduate students in a COAMFTE-accredited program were interviewed using qualitative research methods grounded in phenomenology. Three domains, 7 main themes, and 26 subthemes were identified. The three domains that emerged in this study include (a) therapist practice of universal screening, (b) client response to universal screening, and (c) therapist response to universal screening. Implications for practice, research, training, and supervision are discussed.

  14. TIME-A - an international RCT on the effectiveness of music therapy in ASD

    DEFF Research Database (Denmark)

    Geretsegger, Monika

    2014-01-01

    disorders (ASD). However, generalisability of previous findings has been restricted, as studies were limited in either methodological accuracy or the clinical relevance of their approach. TIME-A is hosted by the Grieg Academy Music Therapy Research Centre, Bergen/Norway, and sets out to examine whether...... improvisational music therapy is superior to standard care in improving social communication in children with ASD over a 5-month treatment period. Funded by the Research Council of Norway, and building upon a collaboration of nine countries worldwide, TIME-A aims to include a total of 300 children with ASD aged...

  15. Designing and Building of 3D Adventure Game “Tetuko: Childhood of Ghatotkacha” Using Kinect

    Directory of Open Access Journals (Sweden)

    Achmad Basuki

    2014-06-01

    Full Text Available Nowadays, the young people are not interested in the local culture as a “wayang” puppet. This condition threatens the extinction of some of the local culture that should be a mainstay of the industry entering an era of creative industries. On the other hand, theyare more interested in playing computer games as changing of people's lifestyles. It becomes our basic idea to produce a game as a creative product. The genre of this game is fighting-adventure. This game depictures a story of fighting between the baby Tetuko and giant Kala Pracona. The game uses Kinect and 3D platform technology to attract more players to feel their adventures. With Kinect technology, the player can control the character with his gesture. Thus, this game will increase the awareness of young people about the culture of Wayang. Keywords : 3D game, kinect,adventure, local culture, creative industry.

  16. Integration of professional judgement and decision-making in high-level adventure sports coaching practice.

    Science.gov (United States)

    Collins, Loel; Collins, Dave

    2015-01-01

    This study examined the integration of professional judgement and decision-making processes in adventure sports coaching. The study utilised a thematic analysis approach to investigate the decision-making practices of a sample of high-level adventure sports coaches over a series of sessions. Results revealed that, in order to make judgements and decisions in practice, expert coaches employ a range of practical and pedagogic management strategies to create and opportunistically use time for decision-making. These approaches include span of control and time management strategies to facilitate the decision-making process regarding risk management, venue selection, aims, objectives, session content, and differentiation of the coaching process. The implication for coaches, coach education, and accreditation is the recognition and training of the approaches that "create time" for the judgements in practice, namely "creating space to think". The paper concludes by offering a template for a more expertise-focused progression in adventure sports coaching.

  17. An internationally generalizable risk index for mortality after one year of antiretroviral therapy

    NARCIS (Netherlands)

    Tate, Janet P.; Justice, Amy C.; Hughes, Michael D.; Bonnet, Fabrice; Reiss, Peter; Mocroft, Amanda; Nattermann, Jacob; Lampe, Fiona C.; Bucher, Heiner C.; Sterling, Timothy R.; Crane, Heidi M.; Kitahata, Mari M.; May, Margaret; Sterne, Jonathan A. C.

    2013-01-01

    Despite the success of antiretroviral therapy (ART), excess mortality continues for those with HIV infection. A comprehensive approach to risk assessment, addressing multiorgan system injury on ART, is needed. We sought to develop and validate a practical and generalizable mortality risk index for

  18. Follow-up after focal therapy in renal masses: an international multidisciplinary Delphi consensus project

    NARCIS (Netherlands)

    Zondervan, P. J.; Wagstaff, P. G. K.; Desai, M. M.; de Bruin, D. M.; Fraga, A. F.; Hadaschik, B. A.; Köllermann, J.; Liehr, U. B.; Pahernik, S. A.; Schlemmer, H. P.; Wendler, J. J.; Algaba, F.; de la Rosette, J. J. M. C. H.; Laguna Pes, M. P.

    2016-01-01

    To establish consensus on follow-up (FU) after focal therapy (FT) in renal masses. To formulate recommendations to aid in clinical practice and research. Key topics and questions for consensus were identified from a systematic literature research. A Web-based questionnaire was distributed among

  19. Adjuvant therapy of Dukes' C colon cancer by intra-arterial P-32 colloid for internal radiation therapy of the liver

    Energy Technology Data Exchange (ETDEWEB)

    Grady, E.D.

    1984-09-01

    To prevent probable occult metastatic liver cancer from progressing to clinical disease, the author used internal radiation therapy as an effective adjuvant to surgical excision of primary Dukes' C colonic cancer. A calculated radiation dose of 5000 rads was delivered to the liver by injecting radioactive 32-P chromic phosphate colloid through the superior mesenteric and celiac arteries. When this was done, the colloid passed through the intestines and was mixed thoroughly with the blood and delivered to the liver by the portal vein. The Kupffer cells in the liver trapped the colloid, and a minimum amount passed through the liver and got into the general circulation. This kept the amount of colloid deposited in the bone marrow to a minimum. In a phase-I pilot study in which nine patients were treated, no serious side effects were noted. In eight patients, the liver has remained free of cancer for more than 1 year.

  20. Understanding Action and Adventure Sports Participation-An Ecological Dynamics Perspective.

    Science.gov (United States)

    Immonen, Tuomas; Brymer, Eric; Orth, Dominic; Davids, Keith; Feletti, Francesco; Liukkonen, Jarmo; Jaakkola, Timo

    2017-12-01

    Previous research has considered action and adventure sports using a variety of associated terms and definitions which has led to confusing discourse and contradictory research findings. Traditional narratives have typically considered participation exclusively as the pastime of young people with abnormal characteristics or personalities having unhealthy and pathological tendencies to take risks because of the need for thrill, excitement or an adrenaline 'rush'. Conversely, recent research has linked even the most extreme forms of action and adventure sports to positive physical and psychological health and well-being outcomes. Here, we argue that traditional frameworks have led to definitions, which, as currently used by researchers, ignore key elements constituting the essential merit of these sports. In this paper, we suggest that this lack of conceptual clarity in understanding cognitions, perception and action in action and adventure sports requires a comprehensive explanatory framework, ecological dynamics which considers person-environment interactions from a multidisciplinary perspective. Action and adventure sports can be fundamentally conceptualized as activities which flourish through creative exploration of novel movement experiences, continuously expanding and evolving beyond predetermined environmental, physical, psychological or sociocultural boundaries. The outcome is the emergence of a rich variety of participation styles and philosophical differences within and across activities. The purpose of this paper is twofold: (a) to point out some limitations of existing research on action and adventure sports; (b) based on key ideas from emerging research and an ecological dynamics approach, to propose a holistic multidisciplinary model for defining and understanding action and adventure sports that may better guide future research and practical implications.

  1. An integrated service digital network (ISDN)-based international telecommunication between Samsung Medical Center and Hokkaido University using telecommunication helped radiotherapy planning and information system (THERAPIS).

    Science.gov (United States)

    Huh, S J; Shirato, H; Hashimoto, S; Shimizu, S; Kim, D Y; Ahn, Y C; Choi, D; Miyasaka, K; Mizuno, J

    2000-07-01

    This study introduces the integrated service digital network (ISDN)-based international teleradiotherapy system (THERAPIS) in radiation oncology between hospitals in Seoul, South Korea and in Sapporo, Japan. THERAPIS has the following functions: (1) exchange of patient's image data, (2) real-time teleconference, and (3) communication of the treatment planning, dose calculation and distribution, and of portal verification images between the remote hospitals. Our preliminary results of applications on eight patients demonstrated that the international telecommunication using THERAPIS was clinically useful and satisfactory with sufficient bandwidth for the transfer of patient data for clinical use in radiation oncology.

  2. An integrated service digital network (ISDN)-based international telecommunication between Samsung Medical Center and Hokkaido University using telecommunication helped radiotherapy planning and information system (THERAPIS)

    International Nuclear Information System (INIS)

    Huh, S.J.; Kim, D.Y.; Ahn, Y.C.; Choi, D.; Shirato, H.; Hashimoto, S.; Shimizu, S.; Miyasaka, K.; Mizuno, J.

    2000-01-01

    This study introduces the integrated service digital network (ISDN)-based international teleradiotherapy system (THERAPIS) in radiation oncology between hospitals in Seoul, South Korea and in Sapporo, Japan. THERAPIS has the following functions: (1) exchange of patient's image data, (2) real-time teleconference, and (3) communication of the treatment planning, dose calculation and distribution, and of portal verification images between the remote hospitals. Our preliminary results of applications on eight patients demonstrated that the international telecommunication using THERAPIS was clinically useful and satisfactory with sufficient bandwidth for the transfer of patient data for clinical use in radiation oncology. (author)

  3. A conceptual framework for international service-learning course planning: promoting a foundation for ethical practice in the physical therapy and occupational therapy professions.

    Science.gov (United States)

    Lattanzi, Jill Black; Pechak, Celia

    2011-01-01

    As physical therapy (PT) and occupational therapy (OT) educational programs endeavor to foster core values of social responsibility, justice, and altruism in an increasingly global community, the incorporation of local and international service-learning (ISL) into the curriculum is growing. Much of the research has focused on the measurement of student learning, with little written about the impact on the host community. Proponents of global health initiatives are calling for consideration of all stakeholders to ensure ethical practice. This paper explores the current literature related to PT and OT ISL and builds a conceptual framework for ISL course planning. The essential phases in the framework include: 1) pre-experience planning/preparation stage, 2) field immersion experience stage, and 3) postexperience stage. The essential elements are: 1) cultural competency training, 2) communication and coordination with community, 3) comprehensive assessment, and 4) strategic planning. The authors suggest this framework as a practical tool to structure ISL courses with an explicit emphasis on ethical concerns. Additionally, they seek to foster more dialogue and action related to the promotion of ethical practices in ISL in PT and OT education programs.

  4. Comparison of international guideline programs to evaluate and update the Dutch program for clinical guideline development in physical therapy.

    Science.gov (United States)

    Van der Wees, Philip J; Hendriks, Erik J M; Custers, Jan W H; Burgers, Jako S; Dekker, Joost; de Bie, Rob A

    2007-11-23

    Clinical guidelines are considered important instruments to improve quality in health care. Since 1998 the Royal Dutch Society for Physical Therapy (KNGF) produced evidence-based clinical guidelines, based on a standardized program. New developments in the field of guideline research raised the need to evaluate and update the KNGF guideline program. Purpose of this study is to compare different guideline development programs and review the KNGF guideline program for physical therapy in the Netherlands, in order to update the program. Six international guideline development programs were selected, and the 23 criteria of the AGREE Instrument were used to evaluate the guideline programs. Information about the programs was retrieved from published handbooks of the organizations. Also, the Dutch program for guideline development in physical therapy was evaluated using the AGREE criteria. Further comparison the six guideline programs was carried out using the following elements of the guideline development processes: Structure and organization; Preparation and initiation; Development; Validation; Dissemination and implementation; Evaluation and update. Compliance with the AGREE criteria of the guideline programs was high. Four programs addressed 22 AGREE criteria, and two programs addressed 20 AGREE criteria. The previous Dutch program for guideline development in physical therapy lacked in compliance with the AGREE criteria, meeting only 13 criteria. Further comparison showed that all guideline programs perform systematic literature searches to identify the available evidence. Recommendations are formulated and graded, based on evidence and other relevant factors. It is not clear how decisions in the development process are made. In particular, the process of translating evidence into practice recommendations can be improved. As a result of international developments and consensus, the described processes for developing clinical practice guidelines have much in common

  5. Comparison of international guideline programs to evaluate and update the Dutch program for clinical guideline development in physical therapy

    Directory of Open Access Journals (Sweden)

    Burgers Jako S

    2007-11-01

    Full Text Available Abstract Background Clinical guidelines are considered important instruments to improve quality in health care. Since 1998 the Royal Dutch Society for Physical Therapy (KNGF produced evidence-based clinical guidelines, based on a standardized program. New developments in the field of guideline research raised the need to evaluate and update the KNGF guideline program. Purpose of this study is to compare different guideline development programs and review the KNGF guideline program for physical therapy in the Netherlands, in order to update the program. Method Six international guideline development programs were selected, and the 23 criteria of the AGREE Instrument were used to evaluate the guideline programs. Information about the programs was retrieved from published handbooks of the organizations. Also, the Dutch program for guideline development in physical therapy was evaluated using the AGREE criteria. Further comparison the six guideline programs was carried out using the following elements of the guideline development processes: Structure and organization; Preparation and initiation; Development; Validation; Dissemination and implementation; Evaluation and update. Results Compliance with the AGREE criteria of the guideline programs was high. Four programs addressed 22 AGREE criteria, and two programs addressed 20 AGREE criteria. The previous Dutch program for guideline development in physical therapy lacked in compliance with the AGREE criteria, meeting only 13 criteria. Further comparison showed that all guideline programs perform systematic literature searches to identify the available evidence. Recommendations are formulated and graded, based on evidence and other relevant factors. It is not clear how decisions in the development process are made. In particular, the process of translating evidence into practice recommendations can be improved. Conclusion As a result of international developments and consensus, the described processes

  6. Yttrium-90 Selective Internal Radiation Therapy with Glass Microspheres for Hepatocellular Carcinoma: Current and Updated Literature Review

    International Nuclear Information System (INIS)

    Lee, Edward Wolfgang; Alanis, Lourdes; Cho, Sung-Ki; Saab, Sammy

    2016-01-01

    Hepatocellular carcinoma is the most common primary liver cancer and it represents the majority of cancer-related deaths in the world. More than 70% of patients present at an advanced stage, beyond potentially curative options. Ytrrium-90 selective internal radiation therapy (Y90-SIRT) with glass microspheres is rapidly gaining acceptance as a potential therapy for intermediate and advanced stage primary hepatocellular carcinoma and liver metastases. The technique involves delivery of Y90 infused glass microspheres via the hepatic arterial blood flow to the appropriate tumor. The liver tumor receives a highly concentrated radiation dose while sparing the healthy liver parenchyma due to its preferential blood supply from portal venous blood. There are two commercially available devices: TheraSphere® and SIR-Spheres®. Although, Y90-SIRT with glass microspheres improves median survival in patients with intermediate and advanced hepatocellular carcinoma and has the potential to downstage hepatocellular carcinoma so that the selected candidates meet the transplantable criteria, it has not gained widespread acceptance due to the lack of large randomized controlled trials. Currently, there are various clinical trials investigating the use of Y90-SIRT with glass microspheres for treatment of hepatocellular carcinoma and the outcomes of these trials may result in the incorporation of Y90-SIRT with glass microspheres into the treatment guidelines as a standard therapy option for patients with intermediate and advanced stage hepatocellular carcinoma

  7. Yttrium-90 selective internal radiation therapy with glass microspheres for hepatocellular carcinoma: Current and updated literature review

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Edward Wolfgang; Alanic, Lourdes [Div. of Interventional Radiology, Dept. of Radiology, UCLA Medical Center, David Geffen School of Medicine at UCLA, Los Angeles (United States); Cho, Sung Ki [Div. of Interventional Radiology, Dept. of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of); Saab, Sammy [Div. of Hepatology, Dept. of Medicine, Pfleger Liver Institute, University of California at Los Angeles, Los Angeles (United States)

    2016-07-15

    Hepatocellular carcinoma is the most common primary liver cancer and it represents the majority of cancer-related deaths in the world. More than 70% of patients present at an advanced stage, beyond potentially curative options. Ytrrium-90 selective internal radiation therapy (Y90-SIRT) with glass microspheres is rapidly gaining acceptance as a potential therapy for intermediate and advanced stage primary hepatocellular carcinoma and liver metastases. The technique involves delivery of Y90 infused glass microspheres via the hepatic arterial blood flow to the appropriate tumor. The liver tumor receives a highly concentrated radiation dose while sparing the healthy liver parenchyma due to its preferential blood supply from portal venous blood. There are two commercially available devices: TheraSphere® and SIR-Spheres®. Although, Y90-SIRT with glass microspheres improves median survival in patients with intermediate and advanced hepatocellular carcinoma and has the potential to downstage hepatocellular carcinoma so that the selected candidates meet the transplantable criteria, it has not gained widespread acceptance due to the lack of large randomized controlled trials. Currently, there are various clinical trials investigating the use of Y90-SIRT with glass microspheres for treatment of hepatocellular carcinoma and the outcomes of these trials may result in the incorporation of Y90-SIRT with glass microspheres into the treatment guidelines as a standard therapy option for patients with intermediate and advanced stage hepatocellular carcinoma.

  8. Yttrium-90 Selective Internal Radiation Therapy with Glass Microspheres for Hepatocellular Carcinoma: Current and Updated Literature Review

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Edward Wolfgang; Alanis, Lourdes [Division of Interventional Radiology, Department of Radiology, UCLA Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095 (United States); Cho, Sung-Ki [Division of Interventional Radiology, Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351 (Korea, Republic of); Saab, Sammy [Division of Hepatology, Department of Medicine, Pfleger Liver Institute, University of California at Los Angeles, Los Angeles, CA 90024 (United States)

    2016-11-01

    Hepatocellular carcinoma is the most common primary liver cancer and it represents the majority of cancer-related deaths in the world. More than 70% of patients present at an advanced stage, beyond potentially curative options. Ytrrium-90 selective internal radiation therapy (Y90-SIRT) with glass microspheres is rapidly gaining acceptance as a potential therapy for intermediate and advanced stage primary hepatocellular carcinoma and liver metastases. The technique involves delivery of Y90 infused glass microspheres via the hepatic arterial blood flow to the appropriate tumor. The liver tumor receives a highly concentrated radiation dose while sparing the healthy liver parenchyma due to its preferential blood supply from portal venous blood. There are two commercially available devices: TheraSphere® and SIR-Spheres®. Although, Y90-SIRT with glass microspheres improves median survival in patients with intermediate and advanced hepatocellular carcinoma and has the potential to downstage hepatocellular carcinoma so that the selected candidates meet the transplantable criteria, it has not gained widespread acceptance due to the lack of large randomized controlled trials. Currently, there are various clinical trials investigating the use of Y90-SIRT with glass microspheres for treatment of hepatocellular carcinoma and the outcomes of these trials may result in the incorporation of Y90-SIRT with glass microspheres into the treatment guidelines as a standard therapy option for patients with intermediate and advanced stage hepatocellular carcinoma.

  9. Yttrium-90 selective internal radiation therapy with glass microspheres for hepatocellular carcinoma: Current and updated literature review

    International Nuclear Information System (INIS)

    Lee, Edward Wolfgang; Alanic, Lourdes; Cho, Sung Ki; Saab, Sammy

    2016-01-01

    Hepatocellular carcinoma is the most common primary liver cancer and it represents the majority of cancer-related deaths in the world. More than 70% of patients present at an advanced stage, beyond potentially curative options. Ytrrium-90 selective internal radiation therapy (Y90-SIRT) with glass microspheres is rapidly gaining acceptance as a potential therapy for intermediate and advanced stage primary hepatocellular carcinoma and liver metastases. The technique involves delivery of Y90 infused glass microspheres via the hepatic arterial blood flow to the appropriate tumor. The liver tumor receives a highly concentrated radiation dose while sparing the healthy liver parenchyma due to its preferential blood supply from portal venous blood. There are two commercially available devices: TheraSphere® and SIR-Spheres®. Although, Y90-SIRT with glass microspheres improves median survival in patients with intermediate and advanced hepatocellular carcinoma and has the potential to downstage hepatocellular carcinoma so that the selected candidates meet the transplantable criteria, it has not gained widespread acceptance due to the lack of large randomized controlled trials. Currently, there are various clinical trials investigating the use of Y90-SIRT with glass microspheres for treatment of hepatocellular carcinoma and the outcomes of these trials may result in the incorporation of Y90-SIRT with glass microspheres into the treatment guidelines as a standard therapy option for patients with intermediate and advanced stage hepatocellular carcinoma

  10. Yttrium-90 Selective Internal Radiation Therapy with Glass Microspheres for Hepatocellular Carcinoma: Current and Updated Literature Review.

    Science.gov (United States)

    Lee, Edward Wolfgang; Alanis, Lourdes; Cho, Sung-Ki; Saab, Sammy

    2016-01-01

    Hepatocellular carcinoma is the most common primary liver cancer and it represents the majority of cancer-related deaths in the world. More than 70% of patients present at an advanced stage, beyond potentially curative options. Ytrrium-90 selective internal radiation therapy (Y90-SIRT) with glass microspheres is rapidly gaining acceptance as a potential therapy for intermediate and advanced stage primary hepatocellular carcinoma and liver metastases. The technique involves delivery of Y90 infused glass microspheres via the hepatic arterial blood flow to the appropriate tumor. The liver tumor receives a highly concentrated radiation dose while sparing the healthy liver parenchyma due to its preferential blood supply from portal venous blood. There are two commercially available devices: TheraSphere® and SIR-Spheres®. Although, Y90-SIRT with glass microspheres improves median survival in patients with intermediate and advanced hepatocellular carcinoma and has the potential to downstage hepatocellular carcinoma so that the selected candidates meet the transplantable criteria, it has not gained widespread acceptance due to the lack of large randomized controlled trials. Currently, there are various clinical trials investigating the use of Y90-SIRT with glass microspheres for treatment of hepatocellular carcinoma and the outcomes of these trials may result in the incorporation of Y90-SIRT with glass microspheres into the treatment guidelines as a standard therapy option for patients with intermediate and advanced stage hepatocellular carcinoma.

  11. Engineering thermal engine rocket adventurer for space nuclear application

    International Nuclear Information System (INIS)

    Nam, Seung H.; Suh, Kune Y.; Kang, Seong G.

    2008-01-01

    The conceptual design for the first-of-a-kind engineering of Thermal Engine Rocket Adventure (TERA) is described. TERA comprising the Battery Omnibus Reactor Integral System (BORIS) as the heat resource and the Space Propulsion Reactor Integral System (SPRIS) as the propulsion system, is one of the advanced Nuclear Thermal Rocket (NTR) engine utilizing hydrogen (H 2 ) propellant being developed at present time. BORIS in this application is an open cycle high temperature gas cooled reactor that has eighteen fuel elements for propulsion and one fuel element for electricity generation and propellant pumping. Each fuel element for propulsion has its own small nozzle. The nineteen fuel elements are arranged into hexagonal prism shape in the core and surrounded by outer Be reflector. The TERA maximum power is 1,000 MW th , specific impulse 1,000 s, thrust 250,000 N, and the total mass is 550 kg including the reactor, turbo pump and auxiliaries. Each fuel element comprises the fuel assembly, moderators, pressure tube and small nozzle. The TERA fuel assembly is fabricated of 93% enriched 1.5 mm (U, Zr, Nb)C wafers in 25.3% voided Square Lattice Honeycomb (SLHC). The H 2 propellant passes through these flow channels. This study is concerned with thermohydrodynamic analysis of the fuel element for propulsion with hypothetical axial power distribution because nuclear analysis of TERA has not been performed yet. As a result, when the power distribution of INSPI's M-SLHC is applied to the fuel assembly, the local heat concentration of fuel is more serious and the pressure of the initial inlet H 2 is higher than those of constant average power distribution applied. This means the fuel assembly geometry of 1.5 mm fuel wafers and 25.3% voided SLHC needs to be changed in order to reduce thermal and mechanical shocks. (author)

  12. [Focal hyperhidrosis.Quality of life, socioeconomic importance and use of internal medicinal therapy].

    Science.gov (United States)

    Rzany, B; Müller, C; Hund, M

    2012-06-01

    Focal hyperhidrosis can have a substantial influence on the professional, physical, emotional and social life of those affected. This becomes clear when the results of quality of life studies and Health Service Research studies are reviewed, e.g. affected patients were prepared to contribute additional money for treatment of hyperhidrosis. The systemic therapy of focal hyperhidrosis with oral anticholinergic agents is a quite economical treatment strategy. These products can be administered continuously or sporadically. However, only good clinical date for the continous treatment exists. Focal hyperhidrosis is a disease which requires our full attention. It should be discussed whether e.g. QoL questionnaires should be used routinelly.

  13. Fast-neutron therapy in advanced head and neck cancer: a collaborative international randomized trial

    Energy Technology Data Exchange (ETDEWEB)

    Maor, Moshe H; Errington, R Douglas; Caplan, Richard J; Griffin, Thomas W; Laramore, George E; Parker, Robert G; Burnison, Michele; Stetz, Joann; Zink, Sandra; Davis, Lawrence W; Peters, Lester J

    1995-06-15

    Purpose: To compare the efficacy of fast-neutron radiotherapy with that of conventionally fractionated photon therapy in the management of patients with locally advanced squamous cell carcinoma of the head and neck. Methods and Materials: Patients with Stage III or IV disease were randomized to receive either 20.4 Gy/12 fractions/4 weeks of neutrons or 70 Gy/35 fractions/7 weeks of photons (control). Between April 1986 and March 1991, 178 patients were entered, 169 of whom were eligible for analysis. The treatment arms were balanced for age, stage, and performance status, but not for primary site of origin. Results: Complete response occurred in 70 and 52% with neutrons and photons, respectively (p = 0.006). Local regional failure at 3 years for all patients was 63% for neutrons and 68% for photons. Actuarial overall survival curves were virtually identical in both study arms, falling to 27% at 3 years. Acute toxicity was similar in the two arms, but late grade 3-5 toxicity was 40% with neutrons compared to 18% with photons (p = 0.008). Conclusion: Although the initial response rate was higher with neutrons, permanent local control and survival were not improved, and the incidence of late normal tissue toxicity was increased. As a result, fast-neutron therapy for advanced squamous cell carcinoma of the head and neck can only be recommended for patients in whom the logistic benefit of treatment in 12 sessions over 4 weeks outweighs the increased risk of late toxicity.

  14. Fast-neutron therapy in advanced head and neck cancer: a collaborative international randomized trial

    International Nuclear Information System (INIS)

    Maor, Moshe H.; Errington, R. Douglas; Caplan, Richard J.; Griffin, Thomas W.; Laramore, George E.; Parker, Robert G.; Burnison, Michele; Stetz, Joann; Zink, Sandra; Davis, Lawrence W.; Peters, Lester J.

    1995-01-01

    Purpose: To compare the efficacy of fast-neutron radiotherapy with that of conventionally fractionated photon therapy in the management of patients with locally advanced squamous cell carcinoma of the head and neck. Methods and Materials: Patients with Stage III or IV disease were randomized to receive either 20.4 Gy/12 fractions/4 weeks of neutrons or 70 Gy/35 fractions/7 weeks of photons (control). Between April 1986 and March 1991, 178 patients were entered, 169 of whom were eligible for analysis. The treatment arms were balanced for age, stage, and performance status, but not for primary site of origin. Results: Complete response occurred in 70 and 52% with neutrons and photons, respectively (p = 0.006). Local regional failure at 3 years for all patients was 63% for neutrons and 68% for photons. Actuarial overall survival curves were virtually identical in both study arms, falling to 27% at 3 years. Acute toxicity was similar in the two arms, but late grade 3-5 toxicity was 40% with neutrons compared to 18% with photons (p = 0.008). Conclusion: Although the initial response rate was higher with neutrons, permanent local control and survival were not improved, and the incidence of late normal tissue toxicity was increased. As a result, fast-neutron therapy for advanced squamous cell carcinoma of the head and neck can only be recommended for patients in whom the logistic benefit of treatment in 12 sessions over 4 weeks outweighs the increased risk of late toxicity

  15. Citizenship and Children's Identity in "The Wonderful Adventures of Nils" and "Scouting for Boys"

    Science.gov (United States)

    Sundmark, Bjorn

    2009-01-01

    "The Wonderful Adventures of Nils" (1906-1907) by Selma Lagerlof and "Scouting for Boys" (1908) by Robert Baden-Powell are characteristic of their time and their respective national and cultural contexts--the Swedish nation state of the early twentieth century and the British Empire. Taking its cue from recent theories on…

  16. Using text adventure games to entice learners to practice arithmetic skills over Mxit

    CSIR Research Space (South Africa)

    Butgereit, L

    2009-01-01

    Full Text Available examines a project where text adventure games with a mathematical twist are deployed over Mxit which participants can play on their cell phones. In order to complete the puzzles laid out in the game, participants must do various arithmetic calculations....

  17. Caverns Measureless to Man: Subterranean Rivers and Adventurous Masculinities in the Victorian Lost World Novel

    DEFF Research Database (Denmark)

    McCausland, Elly

    2018-01-01

    This article examines a recurring trope in late Victorian ‘lost world’ adventure novels: the terrifying descent down a subterranean river into the bowels of the earth. More than simply an exciting episode, the subterranean river journey reflects narrative strategies and thematic concerns key to b...

  18. Adventure Education and the Acculturation of First-Generation Chinese Canadians in Vancouver, Canada

    Science.gov (United States)

    Lo, Simon; Gidlow, Bob; Cushman, Grant

    2014-01-01

    This article reports on research that demonstrates how parents in first-generation Chinese families in Vancouver, Canada, most of them from Hong Kong, control their children's involvement in local adventure education (AE) programs and in so doing minimize the likelihood of intergenerational culture conflict involving those children. The research…

  19. Judgment and Decision Making in Outdoor Adventure Leadership: A Dual-Process Model

    Science.gov (United States)

    Culp, Clinton A.

    2016-01-01

    From an examination of the current textbooks and literature concerning judgment and decision-making models used in outdoor adventure leadership, it is easy to see that they are still deeply rooted in the classical decision-making theory. In this article, I will (a) outline the importance of good judgment and decision making in an outdoor adventure…

  20. More than Activities: Using a "Sense of Place" to Enrich Student Experience in Adventure Sport

    Science.gov (United States)

    Leather, Mark; Nicholls, Fiona

    2016-01-01

    There has been increasing interest in recent years in the significance of a sense of place in the literature of outdoor adventure education. In the UK relationships between outdoor education and the environment still appear largely focused on the science of the natural environment and the activity in question. In this paper, we present empirical…

  1. Outdoor Adventure Education in East Asia: Interpreting Data from Outward Bound Hong Kong

    Science.gov (United States)

    Sibthorp, Jim; Funnell, Aaron; Riley, Mike; Chan, Bacon; Meerts-Brandsma, Lisa

    2018-01-01

    Outdoor adventure education (OAE) is philosophically rooted in Western values, yet it has been implemented in non-Western cultures, such as East Asia. This paper examines how OAE functions in East Asia, through data from Hong Kong. Although some cultural differences are clear, there is no compelling evidence that OAE cannot provide benefits in…

  2. The value of outdoor adventure activities as part of the enviro course ...

    African Journals Online (AJOL)

    The value of outdoor adventure activities as part of the enviro course at Golden Gate Highlands National Park. Garth Johnson. Abstract. No Abstract. Full Text: EMAIL FREE FULL TEXT EMAIL FREE FULL TEXT · DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT · Creative Commons License This work is licensed under a ...

  3. Using Outdoor Adventure Education to Develop Students' Groupwork Skills: A Quantitative Exploration of Reaction and Learning

    Science.gov (United States)

    Cooley, Sam J.; Burns, Victoria E.; Cumming, Jennifer

    2016-01-01

    This study investigates the initial development of groupwork skills through outdoor adventure education (OAE) and the factors that predict the extent of this development, using the first two levels of Kirkpatrick's model of training evaluation. University students (N = 238) completed questionnaires measuring their initial reactions to OAE (Level 1…

  4. The Role of Outdoor Adventure Education in Facilitating Groupwork in Higher Education

    Science.gov (United States)

    Cooley, Sam J.; Burns, Victoria E.; Cumming, Jennifer

    2015-01-01

    Groupwork is an increasingly popular method of learning in higher education and the ability to work effectively with others is important for academic success and employability. This systematic review investigated the use of outdoor adventure education (OAE) in facilitating the development of transferable groupwork skills in higher education. The…

  5. First Steps to the Last Frontier: Programming Suggestions for Alaskan Adventures.

    Science.gov (United States)

    Miner, Todd

    This article provides an overview of trip programming in Alaska for those seeking a low-cost wilderness adventure. Alaska is a land of glaciers, mountains, lakes, rivers, forests, and wildlife. Safety is a major concern when traveling in Alaska. A local guide or outdoor educator can assist with safety and logistical planning. Travelers should plan…

  6. Adlerian Adventure-Based Counseling to Enhance Self-Esteem in School Children

    Science.gov (United States)

    Wagner, Holly H.; Elliott, Anna

    2014-01-01

    This article provides a rationale for using adventure-based counseling (ABC) principles to promote children's self-esteem through group work within the school setting. The effectiveness of combining Adlerian theory with ABC to promote self-esteem is established. The process that would allow a school counselor to plan, organize, facilitate,…

  7. Conceptual Design of Electrical Propulsion System for Nuclear Operated Vessel Adventurer

    International Nuclear Information System (INIS)

    Halimi, B.; Suh, K. Y.

    2009-01-01

    A design concept of the electric propulsion system for the Nuclear Operated Vessel Adventure (NOVA) is presented. NOVA employs Battery Omnibus Reactor Integral System (BORIS), a liquid metal cooled small fast integral reactor, and Modular Optimized Brayton Integral System (MOBIS), a supercritical CO 2 (SCO 2 ) Brayton cycle as power converter to Naval Application Vessel Integral System (NAVIS)

  8. Kultuurilaev "Adventure" Tallinna ja Kotka sadamas / Juta Kivimäe

    Index Scriptorium Estoniae

    Kivimäe, Juta, 1952-

    2005-01-01

    Eesti kirjanikud, muusikud ja kunstnikud Kotkas kultuuriüritusel "Adventure". Jaan Elkeni kureeritud kolmest kunstinäitusest üldnimega "Tallinn-Kotka. Kaksteist Tallinna kunstnikku Kotkas" (osalejad loetletud), Matti Variku tehtud Lenini monumendist Kotkas, meenutusi eesti kunstnike varasematest Kotka-näitustest

  9. CSI Web Adventures: A Forensics Virtual Apprenticeship for Teaching Science and Inspiring STEM Careers

    Science.gov (United States)

    Miller, Leslie; Chang, Ching-I; Hoyt, Daniel

    2010-01-01

    CSI: The Experience, a traveling museum exhibit and a companion web adventure, was created through a grant from the National Science Foundation as a potential model for informal learning. The website was designed to enrich and complement the exhibit by modeling the forensic process. Substantive science, real-world lab techniques, and higher-level…

  10. Thrill and adventure seeking in risky driving at work: The moderating role of safety climate.

    Science.gov (United States)

    Wishart, Darren; Somoray, Klaire; Evenhuis, Amanda

    2017-12-01

    Introduction Within many industrialized countries, the leading cause of worker fatalities and serious injuries can be attributed to road trauma. In non-occupational research, high levels of sensation seeking personality, and specifically thrill and adventure seeking, have been associated with risky driving behaviors. In work driving literature, high organizational safety climate has been associated with reduced risky driving in work drivers. However, the extent that factors such as safety climate and thrill seeking interact in regard to work driving safety remains unclear, and the current research examined this interaction. Methods A total of 1,011 work drivers from four organizations participated in the research. Surveys were distributed online and hardcopies were sent via mail. The survey included measures of thrill and adventure seeking, safety climate and work-related driving behaviors, as well as questions relating to participant demographics and information about their work driving. Results The results demonstrated that safety climate significantly moderated the effect of thrill and adventure seeking trait on driving errors, driving violations, and driving while fatigued. Conclusion These results suggest that the development of a strong safety climate has the potential to improve work driving safety outcomes by reducing the impact of particular personality traits such as thrill seeking within an organizational context. Practical application To improve work driving safety, organizations and management need to develop strategies to encourage and foster positive work driving safety climate, particularly within work settings that may attract thrill and adventure seeking employees. Copyright © 2017. Published by Elsevier Ltd.

  11. Constructing the Runaway Youth Problem: Boy Adventurers to Girl Prostitutes, 1960-1978.

    Science.gov (United States)

    Staller, Karen M.

    2003-01-01

    Examines, using a qualitative case study of stories printed in "The New York Times," the social construction of "runaway youth" in print media during 1960-1978. Finds that running away was an unconstructed problem (or simmering social condition) in the early 1960s and featured harmless adventures. Contributes to the…

  12. Revisiting the Common Adventure Concept: An Annotated Review of the Literature, Misconceptions and Contemporary Perspectives.

    Science.gov (United States)

    Watters, Ron

    In the 1970s a new form of outdoor trip programming appeared. Known as "common adventure," its best known trait is the absence of a designated leader. In 1970, Gary Grimm, the University of Oregon's first outdoor program coordinator, laid out the key principles: self-directed learning, formation of groups of people with similar interests…

  13. Cranking Out Adventure: A Bike Leader's Guide to Trial and Error Touring.

    Science.gov (United States)

    Rohnke, Karl

    The product of a 3,355 mile bicycle trip involving a co-ed group of teenagers and a leader (N=12), this guide to bike riding trips presents practical and philosophical insights gained by the Project Adventure leader who conducted the trip. Detailed lists of pre- and on-trip requirements are presented. Specifically, there are sections devoted to…

  14. New Perspectives for Teaching Physical Education: Preservice Teachers' Reflections on Outdoor and Adventure Education

    Science.gov (United States)

    Timken, Gay L.; McNamee, Jeff

    2012-01-01

    The purpose of this study was to gauge preservice physical education teachers' perspectives during one physical activity pedagogy course, teaching outdoor and adventure education. Teacher belief, occupational socialization and experiential learning theories overlaid this work. Over three years 57 students (37 males; 20 females) participated in the…

  15. The "Nature" of Leadership Philosophy in Outdoor and Adventure Education: Partnership or Predation

    Science.gov (United States)

    Uhlik, Kim S.

    2006-01-01

    Nature continually impresses humans in its role as an omnipresent, if not ultimate, source of power. One hallmark of outdoor and adventure education (OAE) has been its presumption that humans' interaction with aspects of Nature's "power" promotes the antecedents of leadership: measurable, persistent psychological effects and behavioral…

  16. Breaking Down the Stigma of Mental Illness through an Adventure Camp: A Collaborative Education Initiative.

    Science.gov (United States)

    Stuhlmiller, Cynthia M.

    2003-01-01

    Describes an outdoor adventure camp to help mental health consumers and nursing students explore the issues of mental health and illness through experiential and perceived risk challenges. Evaluation data reveals a breakdown in the stigma of mental illness as consumers and students came to know, trust, and count on each other in order to succeed…

  17. Exercise therapy for treatment of supraspinatus tears does not alter glenohumeral kinematics during internal/external rotation with the arm at the side.

    Science.gov (United States)

    Ferrer, Gerald A; Miller, R Matthew; Zlotnicki, Jason P; Tashman, Scott; Irrgang, James J; Musahl, Volker; Debski, Richard E

    2018-01-01

    Rotator cuff tears are a significant clinical problem, with exercise therapy being a common treatment option for patients. Failure rates of exercise therapy may be due to the failure to improve glenohumeral kinematics. Tears involving the supraspinatus may result in altered glenohumeral kinematics and joint instability for internal/external rotation with the arm at the side because not all muscles used to stabilize the glenohumeral joint are functioning normally. The objective of the study is to assess in vivo glenohumeral kinematic changes for internal/external rotation motions with the arm at the side of patients with a symptomatic full-thickness supraspinatus tear before and after a 12-week exercise therapy programme. Five patients underwent dynamic stereoradiography analysis before and after a 12-week exercise therapy protocol to measure changes in glenohumeral kinematics during transverse plane internal/external rotation with the arm at the side. Patient-reported outcomes and shoulder strength were also evaluated. No patient sought surgery immediately following exercise therapy. Significant improvements in isometric shoulder strength and patient-reported outcomes were observed (p internal/external rotation with the arm at the side. Despite satisfactory clinical outcomes following exercise therapy, glenohumeral kinematics did not change. The lack of changes may be due to the motion studied or the focus of current exercise therapy protocols being increasing shoulder strength and restoring range of motion. Current exercise therapy protocols should be adapted to also focus on restoring glenohumeral kinematics to improve joint stability since exercise therapy may have different effects depending on the motions of daily living. Prognostic study, Level II.

  18. Development of a real-time internal and external marker tracking system for particle therapy: a phantom study using patient tumor trajectory data.

    Science.gov (United States)

    Cho, Junsang; Cheon, Wonjoong; Ahn, Sanghee; Jung, Hyunuk; Sheen, Heesoon; Park, Hee Chul; Han, Youngyih

    2017-09-01

    Target motion-induced uncertainty in particle therapy is more complicated than that in X-ray therapy, requiring more accurate motion management. Therefore, a hybrid motion-tracking system that can track internal tumor motion and as well as an external surrogate of tumor motion was developed. Recently, many correlation tests between internal and external markers in X-ray therapy have been developed; however, the accuracy of such internal/external marker tracking systems, especially in particle therapy, has not yet been sufficiently tested. In this article, the process of installing an in-house hybrid internal/external motion-tracking system is described and the accuracy level of tracking system was acquired. Our results demonstrated that the developed in-house external/internal combined tracking system has submillimeter accuracy, and can be clinically used as a particle therapy system as well as a simulation system for moving tumor treatment. © The Author 2017. Published by Oxford University Press on behalf of The Japan Radiation Research Society and Japanese Society for Radiation Oncology.

  19. Wilderness medicine: strategies for provision of medical support for adventure racing.

    Science.gov (United States)

    Townes, David A

    2005-01-01

    In adventure racing, or multisporting, athletes perform multiple disciplines over a course in rugged, often remote, wilderness terrain. Disciplines may include, but are not limited to, hiking, trail running, mountain biking, caving, technical climbing, fixed-line mountaineering, flat- and white-water boating, and orienteering. While sprint races may be as short as 6 hours, expedition-length adventure races last a minimum of 36 hours up to 10 days or more and may cover hundreds of kilometres. Over the past decade, adventure racing has grown in popularity throughout the world with increasing numbers of events and participants each year. The provision of on-site medical care during these events is essential to ensure the health and safety of the athletes and thus the success of the sport. At present, there are no formal guidelines and a relatively small amount of literature to assist in the development of medical support plans for these events. This article provides an introduction to the provision of medical support for adventure races. Since a wide variety of illness and injury occur during these events, the medical support plan should provide for proper personnel, equipment and supplies to provide care for a wide range of illness and injury. Foot-related problems are the most common reasons for athletes to require medical attention during these events. This article also highlights some of the controversies involved in the provision of medical support for these events. Suggested penalties for acceptance of medical care during the event and strategies for removal of an athlete from the event for medical reasons are offered. In addition, some of the challenges involved in the provision of medical support, including communication, logistics and liability are discussed. This information should prove useful for medical directors of future, similar events. Because of their extreme nature, expedition-length adventure races represent a new and unique area of wilderness and

  20. Adventure sports and sexual freedom hip replacement: the tripolar hip.

    Science.gov (United States)

    Pritchett, James W

    2018-01-01

    Certain athletic activities and lifestyles require a completely stable and very mobile hip. Total hip replacement with a natural femoral head size and two mobile-bearing surfaces (i.e., a "tripolar" prosthesis) is the most stable prosthesis. Elegant design and wear-resistant bearing surfaces are the keys to long-term implant survivorship. The hypothesis is that a ceramic-coated tripolar prosthesis using highly cross-linked polyethylene can provide full function and complete stability with low wear. This study sought to determine: (1) patient-reported outcomes, (2) functional outcomes, (3) implant survivorship and complications, and (4) postoperative sexual limitations. Between 1998 and 2011, the author performed 160 primary total hip replacements using tripolar prostheses in patients participating in adventure sports and other physically demanding activities. The institutional review board approved this study. The inclusion criteria were patients who needed unrestricted activity and who were not candidates for or did not choose hip resurfacing. Patients were followed every second year and assessed with radiographs, Harris Hip Score, WOMAC, SF-12, and UCLA functional outcome scores. Patients were asked about symptoms of instability and satisfaction with their hip replacement. Patients were asked both preoperatively and 2 years postoperatively four questions about their sexual activity. Mean follow-up was 11 years. At 2 years' postoperatively, 98% of patients reported their satisfaction as excellent or good and 99% were not limited for sexual activity following surgery. Seventy-four percent of patients reported they were recovered within 6 weeks of surgery. There were no dislocations. There were three revision procedures for implant loosening, infection, and periprosthetic fracture, but there were no failures of the tripolar articulation. The mean postoperative UCLA score was the highly athletic score of 8. There were no signs of osteolysis, wear, or metal

  1. Fifty-four Years of Adventures in Infrared Astronomy

    Science.gov (United States)

    Becklin, Eric Eric

    2018-01-01

    My adventures in infrared astronomy started when I was a grad student in 1965 with the discovery of an infrared-bright object (now known as the Becklin-Neugebauer Object) in the Orion Nebula. In 1966, I made the first measurements of the infrared radiation from the center of the Milky Way Galaxy. I was fortunate enough to be able to take advantage of the 2.2 micron sky survey carried out by Neugebauer and Leighton (1969), which produced many remarkable discoveries, the most spectacular being the heavily dust-embedded carbon star IRC+10216, thebrightest object in the sky at 5 microns outside the solar system. In the 1970’s there was a growth in Infrared astronomy with the availability of many new facilities such as the Kuiper Airborne Observatory, (KAO) which I used extensively with Mike Werner and Ian Gatley for many unique observations. In 1977, I moved to Hawaii to work on the NASA IRTF 3- meter telescope. Many discoveries were made, including the first direct measurements of the rings of Jupiter at 2.2 microns (with Gareth Wynn-Williams) and the discovery of the first L dwarf star around a white dwarf (with Ben Zuckerman). In the 1980’s the introduction of large format arrays changed the way we did infrared astronomy. With Ian McLean, I moved to UCLA in 1990 to start the IR lab and get involved in Keck development and science. In 1995, Andrea, Ghez, Mark Morris and I started looking for evidence of a possible massive Black Hole in the Galactic Center. Spectacular observations using the Keck10 meter telescopes with large format near-infrared arrays and adaptive optics led to the confirmation of the presence of such a black hole and an estimate of its mass (4xE6 M (Sun)). In 1996, I began working on the Stratospheric Observatory For Infrared Astronomy (SOFIA) and I will finish my talk by discussing SOFIA observations of the ring of dust and gas orbiting the massive black hole in the center

  2. Extending Parent–Child Interaction Therapy for Early Childhood Internalizing Problems: New Advances for an Overlooked Population

    Science.gov (United States)

    Puliafico, Anthony C.; Kurtz, Steven M. S.; Pincus, Donna B.; Comer, Jonathan S.

    2014-01-01

    Although efficacious psychological treatments for internalizing disorders are now well established for school-aged children, until recently there have regrettably been limited empirical efforts to clarify indicated psychological intervention methods for the treatment of mood and anxiety disorders presenting in early childhood. Young children lack many of the developmental capacities required to effectively participate in established treatments for mood and anxiety problems presenting in older children, making simple downward extensions of these treatments for the management of preschool internalizing problems misguided. In recent years, a number of research groups have successfully adapted and modified parent–child interaction therapy (PCIT), originally developed to treat externalizing problems in young children, to treat various early internalizing problems with a set of neighboring protocols. As in traditional PCIT, these extensions target child symptoms by directly reshaping parent–child interaction patterns associated with the maintenance of symptoms. The present review outlines this emerging set of novel PCIT adaptations and modifications for mood and anxiety problems in young children and reviews preliminary evidence supporting their use. Specifically, we cover (a) PCIT for early separation anxiety disorder; (b) the PCIT-CALM (Coaching Approach behavior and Leading by Modeling) Program for the full range of early anxiety disorders; (c) the group Turtle Program for behavioral inhibition; and (d) the PCIT-ED (Emotional Development) Program for preschool depression. In addition, emerging PCIT-related protocols in need of empirical attention—such as the PCIT-SM (selective mutism) Program for young children with SM—are also considered. Implications of these protocols are discussed with regard to their unique potential to address the clinical needs of young children with internalizing problems. Obstacles to broad dissemination are addressed, and we consider

  3. Extending parent-child interaction therapy for early childhood internalizing problems: new advances for an overlooked population.

    Science.gov (United States)

    Carpenter, Aubrey L; Puliafico, Anthony C; Kurtz, Steven M S; Pincus, Donna B; Comer, Jonathan S

    2014-12-01

    Although efficacious psychological treatments for internalizing disorders are now well established for school-aged children, until recently there have regrettably been limited empirical efforts to clarify indicated psychological intervention methods for the treatment of mood and anxiety disorders presenting in early childhood. Young children lack many of the developmental capacities required to effectively participate in established treatments for mood and anxiety problems presenting in older children, making simple downward extensions of these treatments for the management of preschool internalizing problems misguided. In recent years, a number of research groups have successfully adapted and modified parent-child interaction therapy (PCIT), originally developed to treat externalizing problems in young children, to treat various early internalizing problems with a set of neighboring protocols. As in traditional PCIT, these extensions target child symptoms by directly reshaping parent-child interaction patterns associated with the maintenance of symptoms. The present review outlines this emerging set of novel PCIT adaptations and modifications for mood and anxiety problems in young children and reviews preliminary evidence supporting their use. Specifically, we cover (a) PCIT for early separation anxiety disorder; (b) the PCIT-CALM (Coaching Approach behavior and Leading by Modeling) Program for the full range of early anxiety disorders; (c) the group Turtle Program for behavioral inhibition; and (d) the PCIT-ED (Emotional Development) Program for preschool depression. In addition, emerging PCIT-related protocols in need of empirical attention--such as the PCIT-SM (selective mutism) Program for young children with SM--are also considered. Implications of these protocols are discussed with regard to their unique potential to address the clinical needs of young children with internalizing problems. Obstacles to broad dissemination are addressed, and we consider

  4. Guidelines on the medical therapy of persons accidentally overexposed to ionizing radiations. Internal contamination

    International Nuclear Information System (INIS)

    Di Trano, J.L.; Perez, M.R.; Gisone, P.

    1999-01-01

    This work represent a guide for the treatment of accidental intakes of radionuclides. The different phases of radioactive contamination, the transfer and non-transfer of radioisotopes, the general principles in the treatment of internal contamination and the follow-up are determined. The in vivo monitoring and the evaluation of activity level are specified in this document. The applied treatment depends on the via of intake, that is: inhalation, ingestion, and through skin. The decontamination procedures that reduce the radionuclide transfer are specified. The different drugs, used to enhance radionuclides elimination, are enumerated in this work. Considerations about the iodine prophylaxis in radiologic als accidents are considered. (author)

  5. Vital Pulp Therapy of a Mature Molar with Concurrent Hyperplastic Pulpitis, Internal Root Resorption and Periradicular Periodontitis: A Case Report.

    Science.gov (United States)

    Asgary, Saeed; Kemal Çalışkan, Mehmet

    2015-01-01

    Vital pulp therapy (VPT) of permanent mature teeth is continuously ascertaining to be a more reliable endodontic treatment. The purpose of this case report was to describe successful VPT of a mature mandibular left first molar with concurrent hyperplastic pulpitis, internal root resorption and periradicular periodontitis in a 35-year-old male patient. After complete caries removal and access cavity preparation, the dental pulp was removed from the coronal third of the roots. To protect the remaining pulp, calcium-enriched mixture (CEM) cement was placed and adapted into the cavities; the tooth was then restored with amalgam. Six months after VPT, radiographic examination showed evidence of periradicular healing. Clinically, the tooth was functional without signs and symptoms of infection/inflammation. The successful outcome of this case suggests that diseased dental pulp (i.e. irreversible pulpitis) has the potential to heal after pulp protection with CEM biocement.

  6. Vital Pulp Therapy of a Mature Molar with Concurrent Hyperplastic Pulpitis, Internal Root Resorption and Periradicular Periodontitis: A Case Report

    Science.gov (United States)

    Asgary, Saeed; Kemal Çalışkan, Mehmet

    2015-01-01

    Vital pulp therapy (VPT) of permanent mature teeth is continuously ascertaining to be a more reliable endodontic treatment. The purpose of this case report was to describe successful VPT of a mature mandibular left first molar with concurrent hyperplastic pulpitis, internal root resorption and periradicular periodontitis in a 35-year-old male patient. After complete caries removal and access cavity preparation, the dental pulp was removed from the coronal third of the roots. To protect the remaining pulp, calcium-enriched mixture (CEM) cement was placed and adapted into the cavities; the tooth was then restored with amalgam. Six months after VPT, radiographic examination showed evidence of periradicular healing. Clinically, the tooth was functional without signs and symptoms of infection/inflammation. The successful outcome of this case suggests that diseased dental pulp (i.e. irreversible pulpitis) has the potential to heal after pulp protection with CEM biocement. PMID:26523145

  7. Panoramic view of the Fifth International Symposium on Stem Cell Therapy and Applied Cardiovascular Biotechnology, April 2008, Madrid (Spain).

    Science.gov (United States)

    Villa, Adolfo; Sanz, Ricardo; Fernandez, M Eugenia; Elizaga, Jaime; Ludwig, Indrig; Sanchez, Pedro L; Fernandez-Aviles, Francisco

    2009-03-01

    The Fifth International Symposium on Stem Cell Therapy and Applied Cardiovascular Biotechnology was held on April 24th-25th, 2008, at the Auditorium of the High Council of Scientific Research of Spain (CSIC) in Madrid, as a continuation of a series of yearly meetings, organized in an attempt to encourage translational research in this field and facilitate a positive interaction among experts from several countries, along with industry representatives and journalists. In addition, members of the Task Force of the European Society concerning the clinical investigation of the use of autologous adult stem cells for repair of the heart gathered and discussed an update of the previous consensus, still pending of publication. In this article, we summarize some of the main topics of discussion, the state-of-the-art and latest advances in this field, and new challenges brought up for the near future.

  8. The Paediatric Rheumatology International Trials Organisation provisional criteria for the evaluation of response to therapy in juvenile dermatomyositis.

    Science.gov (United States)

    Ruperto, Nicolino; Pistorio, Angela; Ravelli, Angelo; Rider, Lisa G; Pilkington, Clarissa; Oliveira, Sheila; Wulffraat, Nico; Espada, Graciela; Garay, Stella; Cuttica, Ruben; Hofer, Michael; Quartier, Pierre; Melo-Gomes, Jose; Reed, Ann M; Wierzbowska, Malgorzata; Feldman, Brian M; Harjacek, Miroslav; Huppertz, Hans-Iko; Nielsen, Susan; Flato, Berit; Lahdenne, Pekka; Michels, Harmut; Murray, Kevin J; Punaro, Lynn; Rennebohm, Robert; Russo, Ricardo; Balogh, Zsolt; Rooney, Madeleine; Pachman, Lauren M; Wallace, Carol; Hashkes, Philip; Lovell, Daniel J; Giannini, Edward H; Gare, Boel Andersson; Martini, Alberto

    2010-11-01

    To develop a provisional definition for the evaluation of response to therapy in juvenile dermatomyositis (DM) based on the Paediatric Rheumatology International Trials Organisation juvenile DM core set of variables. Thirty-seven experienced pediatric rheumatologists from 27 countries achieved consensus on 128 difficult patient profiles as clinically improved or not improved using a stepwise approach (patient's rating, statistical analysis, definition selection). Using the physicians' consensus ratings as the "gold standard measure," chi-square, sensitivity, specificity, false-positive and-negative rates, area under the receiver operating characteristic curve, and kappa agreement for candidate definitions of improvement were calculated. Definitions with kappa values >0.8 were multiplied by the face validity score to select the top definitions. The top definition of improvement was at least 20% improvement from baseline in 3 of 6 core set variables with no more than 1 of the remaining worsening by more than 30%, which cannot be muscle strength. The second-highest scoring definition was at least 20% improvement from baseline in 3 of 6 core set variables with no more than 2 of the remaining worsening by more than 25%, which cannot be muscle strength (definition P1 selected by the International Myositis Assessment and Clinical Studies group). The third is similar to the second with the maximum amount of worsening set to 30%. This indicates convergent validity of the process. We propose a provisional data-driven definition of improvement that reflects well the consensus rating of experienced clinicians, which incorporates clinically meaningful change in core set variables in a composite end point for the evaluation of global response to therapy in juvenile DM. Copyright © 2010 by the American College of Rheumatology.

  9. Radiation Therapy for Primary Cutaneous Anaplastic Large Cell Lymphoma: An International Lymphoma Radiation Oncology Group Multi-institutional Experience

    Energy Technology Data Exchange (ETDEWEB)

    Million, Lynn, E-mail: lmillion@stanford.edu [Stanford Cancer Institute, Stanford, California (United States); Yi, Esther J.; Wu, Frank; Von Eyben, Rie [Stanford Cancer Institute, Stanford, California (United States); Campbell, Belinda A. [Department of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, East Melbourne (Australia); Dabaja, Bouthaina [The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Tsang, Richard W. [Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, Ontario (Canada); Ng, Andrea [Department of Radiation Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts (United States); Wilson, Lynn D. [Department of Therapeutic Radiology/Radiation Oncology, Yale School of Medicine, Yale Cancer Center, New Haven, Connecticut (United States); Ricardi, Umberto [Department of Oncology, University of Turin, Turin (Italy); Kirova, Youlia [Institut Curie, Paris (France); Hoppe, Richard T. [Stanford Cancer Institute, Stanford, California (United States)

    2016-08-01

    Purpose: To collect response rates of primary cutaneous anaplastic large cell lymphoma, a rare cutaneous T-cell lymphoma, to radiation therapy (RT), and to determine potential prognostic factors predictive of outcome. Methods and Materials: The study was a retrospective analysis of patients with primary cutaneous anaplastic large cell lymphoma who received RT as primary therapy or after surgical excision. Data collected include initial stage of disease, RT modality (electron/photon), total dose, fractionation, response to treatment, and local recurrence. Radiation therapy was delivered at 8 participating International Lymphoma Radiation Oncology Group institutions worldwide. Results: Fifty-six patients met the eligibility criteria, and 63 tumors were treated: head and neck (27%), trunk (14%), upper extremities (27%), and lower extremities (32%). Median tumor size was 2.25 cm (range, 0.6-12 cm). T classification included T1, 40 patients (71%); T2, 12 patients (21%); and T3, 4 patients (7%). The median radiation dose was 35 Gy (range, 6-45 Gy). Complete clinical response (CCR) was achieved in 60 of 63 tumors (95%) and partial response in 3 tumors (5%). After CCR, 1 tumor recurred locally (1.7%) after 36 Gy and 7 months after RT. This was the only patient to die of disease. Conclusions: Primary cutaneous anaplastic large cell lymphoma is a rare, indolent cutaneous lymphoma with a low death rate. This analysis, which was restricted to patients selected for treatment with radiation, indicates that achieving CCR was independent of radiation dose. Because there were too few failures (<2%) for statistical analysis on dose response, 30 Gy seems to be adequate for local control, and even lower doses may suffice.

  10. Present developments in reaching an international consensus for a model-based approach to particle beam therapy.

    Science.gov (United States)

    Prayongrat, Anussara; Umegaki, Kikuo; van der Schaaf, Arjen; Koong, Albert C; Lin, Steven H; Whitaker, Thomas; McNutt, Todd; Matsufuji, Naruhiro; Graves, Edward; Mizuta, Masahiko; Ogawa, Kazuhiko; Date, Hiroyuki; Moriwaki, Kensuke; Ito, Yoichi M; Kobashi, Keiji; Dekura, Yasuhiro; Shimizu, Shinichi; Shirato, Hiroki

    2018-03-01

    Particle beam therapy (PBT), including proton and carbon ion therapy, is an emerging innovative treatment for cancer patients. Due to the high cost of and limited access to treatment, meticulous selection of patients who would benefit most from PBT, when compared with standard X-ray therapy (XRT), is necessary. Due to the cost and labor involved in randomized controlled trials, the model-based approach (MBA) is used as an alternative means of establishing scientific evidence in medicine, and it can be improved continuously. Good databases and reasonable models are crucial for the reliability of this approach. The tumor control probability and normal tissue complication probability models are good illustrations of the advantages of PBT, but pre-existing NTCP models have been derived from historical patient treatments from the XRT era. This highlights the necessity of prospectively analyzing specific treatment-related toxicities in order to develop PBT-compatible models. An international consensus has been reached at the Global Institution for Collaborative Research and Education (GI-CoRE) joint symposium, concluding that a systematically developed model is required for model accuracy and performance. Six important steps that need to be observed in these considerations include patient selection, treatment planning, beam delivery, dose verification, response assessment, and data analysis. Advanced technologies in radiotherapy and computer science can be integrated to improve the efficacy of a treatment. Model validation and appropriately defined thresholds in a cost-effectiveness centered manner, together with quality assurance in the treatment planning, have to be achieved prior to clinical implementation.

  11. 'Adventurous' judgments
    A comparative exploration into human rights as a moral-political force in judicial law development

    Directory of Open Access Journals (Sweden)

    Bas de Gaay Fortman

    2006-12-01

    Full Text Available This article looks at the development of law by the judiciary in the sense of judgments taking the law beyond the point of what was hitherto regarded as ius positivum. Its main perspective, however, is not the creation of law by the courts as such, but rather the ways and means in which the human rights idea has encouraged judges to deliver decisions that imply an overturning of 'settled' law. In the comparative exploration of 'adventurous' judgments that we shall embark on, our focus will be on the political morality of human rights as a driving force in judicial activism. It is assumed, in other words, that where the judiciary is 'active', human rights may play a part as general principles of law as distinct from rules already incorporated in positive law. Notably then, human rights in this way affect positive law in a manner other than through processes of international, regional and national standard setting connected with the establishment of new supervisory institutions and mechanisms. For this reason, the article does not so much consider typical human rights cases; instead the focus is on major decisions by national courts that were not in the first place regarded as human rights cases at all. In this endeavour, the article aims to be no more than an initial comparative exploration, intended to illustrate a function of human rights that is not normally highlighted, namely its function as an inspirational force towards 'adventurous' judgments. Yet, the judicial potential illustrated here is of great significance, as it may lead to law development inspired by the two principal pillars underpinning the international quest for the realization of human rights: universality and human dignity. After reviewing a variety of characteristic cases from such diverse legal backgrounds as the United Kingdom, the Netherlands, the United States of America, India, South Africa and Nigeria, some conclusions are drawn as to the ways in which human rights

  12. An international systematic mapping review of fieldwork education in occupational therapy.

    Science.gov (United States)

    Roberts, Michael E; Hooper, Barbara R; Wood, Wendy H; King, Robin M

    2015-04-01

    Owing to its importance in preparing occupational therapists, fieldwork education has generated numerous studies. These have not been collected and reviewed, leaving researchers without a map for growing a science of fieldwork education. This study aimed to systematically categorize the topics, research designs, methods, levels of impact, and themes that have and have not been addressed in fieldwork education scholarship. Guided by a systematic mapping review design, 124 articles, identified through database searches and inclusion coding, were studied. Data were collected using a data extraction instrument and analyzed using Microsoft Access queries. Papers primarily addressed curriculum (n = 51) and students (n = 32). Conceptual/descriptive inquiry methods (n = 57) were predominant. Qualitative (n = 48) and quantitative methods (n = 49) were used equally. Research outcomes mainly targeted perceived participation in fieldwork. Recurring themes included student perceptions, external influences, and transition to practice. Three recommendations were identified: strengthen procedures for studying singular fieldwork experiences, broaden rationales for studying fieldwork, and translate educational concepts for occupational therapy.

  13. World Radiopharmaceutical Therapy Council: A report on the 5th International Radiopharmaceutical Therapy Colloquium and the Final Planning Meeting of the World Radiopharmaceutical Therapy Council held at Santiago, Chile, 29 September, 2002

    International Nuclear Information System (INIS)

    Turner, J.V.

    2003-01-01

    Full text: The 5th International Radiopharmaceutical Therapy Colloquium was held on 29th October 2002 as a pre-congress meeting of the World Federation of Nuclear Medicine and Biology Congress in Santiago, Chile. Work-in-Progress research papers were presented by leaders in the field of therapeutic nuclear oncology. Speakers gave untitled presentations without abstracts and reported data from studies performed only days or weeks before the meeting. Such cutting edge research presentations stimulated lively discussion which also addressed the problems encountered and ways in which they may be circumvented. Radioimmunotherapy of haematological malignancy was discussed by Greg Wiseman of the Mayo Clinic, and Thomas Behr of the University of Marburg. Radiopeptide therapy of neuroendocrine tumours was presented by Larry Kvols from the University of Florida, and locoregional therapy of glioma was presented by John Buscombe of the Royal Free Hospital, London. All speakers reported encouraging clinical results with objective tumour responses, increased survival and improved quality of life, which encourages wider clinical application of these novel radiopharmaceutical therapies. The Round Table Discussion on clinical applications of Rhenium-188 radiopharmaceuticals was chaired by Russ Knapp from Oak Ridge National Laboratory and Hans Biersack of the University of Bonn. Following an outline of current developments by Russ Knapp preliminary results of clinical trials were presented for discussion. Hans Biersack, Javier Gaudiano from Montevideo and Achim Kropp from Dresden reported effective palliation of painful skeletal metastases with 188Re-HEDP. Ajit Padhy gave an update of the IAEA multicentre trial of intrahepatic arterial 188Re-Lipiodol therapy of hepatocellular carcinoma and Harvey Turner reported preliminary results in hepatoma patients using an alternative kit formulation of 188Re-Lipiodol in Fremantle. Early experience with Rhenium 188 in the prevention of re

  14. International multicentre randomised controlled trial of improvisational music therapy for children with autism spectrum disorder: TIME-A study.

    Science.gov (United States)

    Crawford, Mike J; Gold, Christian; Odell-Miller, Helen; Thana, Lavanya; Faber, Sarah; Assmus, Jörg; Bieleninik, Łucja; Geretsegger, Monika; Grant, Claire; Maratos, Anna; Sandford, Stephan; Claringbold, Amy; McConachie, Helen; Maskey, Morag; Mössler, Karin Antonia; Ramchandani, Paul; Hassiotis, Angela

    2017-10-01

    Preliminary studies have indicated that music therapy may benefit children with autism spectrum disorders (ASD). To examine the effects of improvisational music therapy (IMT) on social affect and responsiveness of children with ASD. International, multicentre, three-arm, single-masked randomised controlled trial, including a National Institute for Health Research (NIHR)-funded centre that recruited in London and the east of England. Randomisation was via a remote service using permuted blocks, stratified by study site. Schools and private, voluntary and state-funded health-care services. Children aged between 4 and 7 years with a confirmed diagnosis of ASD and a parent or guardian who provided written informed consent. We excluded children with serious sensory disorder and those who had received music therapy within the past 12 months. All parents and children received enhanced standard care (ESC), which involved three 60-minute sessions of advice and support in addition to treatment as usual. In addition, they were randomised to either one (low-frequency) or three (high-frequency) sessions of IMT per week, or to ESC alone, over 5 months in a ratio of 1 : 1 : 2. The primary outcome was measured using the social affect score derived from the Autism Diagnostic Observation Schedule (ADOS) at 5 months: higher scores indicated greater impairment. Secondary outcomes included social affect at 12 months and parent-rated social responsiveness at 5 and 12 months (higher scores indicated greater impairment). A total of 364 participants were randomised between 2011 and 2015. A total of 182 children were allocated to IMT (90 to high-frequency sessions and 92 to low-frequency sessions), and 182 were allocated to ESC alone. A total of 314 (86.3%) of the total sample were followed up at 5 months [165 (90.7%) in the intervention group and 149 (81.9%) in the control group]. Among those randomised to IMT, 171 (94.0%) received it. From baseline to 5 months, mean scores of ADOS

  15. The Effect of Bad Human Activities on Marine Life as Portrayed in Sammy's Adventure: the Secret Passage

    OpenAIRE

    LATHIFAH, ISNA NUR

    2015-01-01

    Keywords: ecocriticism, bad humans activities, marine life, Sammy's Adventure: the Secret Passage movie. The balance of marine life is often damaged by irresponsible humans who do not care about their environment. This problem has inspired some works to criticize humans' reckless behavior toward environment, especially ocean. Sammy's Adventure: the Secret Passage is one of the examples that have been created to criticize the bad human activities in the ocean. This research applies ecocritici...

  16. Sodium oxybate therapy provides multidimensional improvement in fibromyalgia: results of an international phase 3 trial

    Science.gov (United States)

    Spaeth, Michael; Bennett, Robert M; Benson, Beverly A; Wang, Y Grace; Lai, Chinglin; Choy, Ernest H

    2012-01-01

    Background Fibromyalgia is characterised by chronic musculoskeletal pain and multiple symptoms including fatigue, multidimensional function impairment, sleep disturbance and tenderness. Along with pain and fatigue, non-restorative sleep is a core symptom of fibromyalgia. Sodium oxybate (SXB) is thought to reduce non-restorative sleep abnormalities. This study evaluated effects of SXB on fibromyalgia-related pain and other symptoms. Methods 573 patients with fibromyalgia according to 1990 American College of Rheumatology criteria were enrolled at 108 centres in eight countries. Subjects were randomly assigned to placebo, SXB 4.5 g/night or SXB 6 g/night. The primary efficacy endpoint was the proportion of subjects with ≥30% reduction in pain visual analogue scale from baseline to treatment end. Other efficacy assessments included function, sleep quality, effect of sleep on function, fatigue, tenderness, health-related quality of life and subject's impression of change in overall wellbeing. Results Significant improvements in pain, sleep and other symptoms associated with fibromyalgia were seen in SXB treated subjects compared with placebo. The proportion of subjects with ≥30% pain reduction was 42.0% for SXB4.5 g/night (p=0.002) and 51.4% for SXB6 g/night (pQuality of sleep (Jenkins sleep scale) improved by 20% for SXB4.5 g/night (p≤0.001) and 25% for SXB6 g/night (p≤0.001) versus 0.5% for placebo. Adverse events with an incidence ≥5% and twice placebo were nausea, dizziness, vomiting, insomnia, anxiety, somnolence, fatigue, muscle spasms and peripheral oedema. Conclusion These results, combined with findings from previous phase 2 and 3 studies, provide supportive evidence that SXB therapy affordsimportant benefits across multiple symptoms in subjects with fibromyalgia. PMID:22294641

  17. External Validation and Optimization of International Consensus Clinical Target Volumes for Adjuvant Radiation Therapy in Bladder Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Reddy, Abhinav V. [Department of Radiation and Cellular Oncology, University of Chicago Pritzker School of Medicine, Chicago, Illinois (United States); Christodouleas, John P. [Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania (United States); Wu, Tianming [Department of Radiation and Cellular Oncology, University of Chicago Pritzker School of Medicine, Chicago, Illinois (United States); Smith, Norman D.; Steinberg, Gary D. [Section of Urology, Department of Surgery, University of Chicago Pritzker School of Medicine, Chicago, Illinois (United States); Liauw, Stanley L., E-mail: sliauw@radonc.uchicago.edu [Department of Radiation and Cellular Oncology, University of Chicago Pritzker School of Medicine, Chicago, Illinois (United States)

    2017-03-15

    Purpose: International consensus (IC) clinical target volumes (CTVs) have been proposed to standardize radiation field design in the treatment of patients at high risk of locoregional failure (LRF) after radical cystectomy. The purpose of this study was to externally validate the IC CTVs in a cohort of postsurgical patients followed up for LRF and identify revisions that might improve the IC CTVs' performance. Methods and Materials: Among 334 patients with pT3 to pT4 bladder cancer treated with radical cystectomy, LRF developed in 58 (17%), of whom 52 had computed tomography scans available for review. Images with LRF were exported into a treatment planning system, and IC CTVs were contoured and evaluated for adequacy of coverage of each LRF with respect to both the patient and each of 6 pelvic subsites: common iliac (CI) region, obturator region (OR), external and internal iliac region, presacral region, cystectomy bed, or other pelvic site. Revisions to the IC contours were proposed based on the findings. Results: Of the 52 patients with documented LRF, 13 (25%) had LRFs that were outside of the IC CTV involving 17 pelvic subsites: 5 near the CI CTV, 5 near the OR CTV, 1 near the external and internal iliac region, and 6 near the cystectomy bed. The 5 CI failures were located superior to the CTV, and the 5 OR failures were located medial to the CTV. Increasing the superior boundary of the CI to a vessel-based definition of the aortic bifurcation, as well as increasing the medial extension of the OR by an additional 9 mm, decreased the number of patients with LRF outside of the IC CTV to 7 (13%). Conclusions: Modified IC CTVs inclusive of a slight adjustment superiorly for the CI region and medially for the OR may reduce the risk of pelvic failure in patients treated with adjuvant radiation therapy.

  18. International

    International Nuclear Information System (INIS)

    Anon.

    1997-01-01

    This rubric reports on 10 short notes about international economical facts about nuclear power: Electricite de France (EdF) and its assistance and management contracts with Eastern Europe countries (Poland, Hungary, Bulgaria); Transnuclear Inc. company (a 100% Cogema daughter company) acquired the US Vectra Technologies company; the construction of the Khumo nuclear power plant in Northern Korea plays in favour of the reconciliation between Northern and Southern Korea; the delivery of two VVER 1000 Russian reactors to China; the enforcement of the cooperation agreement between Euratom and Argentina; Japan requested for the financing of a Russian fast breeder reactor; Russia has planned to sell a floating barge-type nuclear power plant to Indonesia; the control of the Swedish reactor vessels of Sydkraft AB company committed to Tractebel (Belgium); the renewal of the nuclear cooperation agreement between Swiss and USA; the call for bids from the Turkish TEAS electric power company for the building of the Akkuyu nuclear power plant answered by three candidates: Atomic Energy of Canada Limited (AECL), Westinghouse (US) and the French-German NPI company. (J.S.)

  19. Review of the 25th annual scientific meeting of the International Society for Biological Therapy of Cancer

    Directory of Open Access Journals (Sweden)

    Jaffee Elizabeth M

    2011-05-01

    Full Text Available Abstract Led by key opinion leaders in the field, the 25th Annual Meeting of the International Society for Biological Therapy of Cancer (iSBTc, recently renamed the Society for Immunotherapy of Cancer, SITC provided a scientific platform for ~500 attendees to exchange cutting-edge information on basic, clinical, and translational research in cancer immunology and immunotherapy. The meeting included keynote addresses on checkpoint blockade in cancer therapy and recent advances in therapeutic vaccination against cancer induced by Human Papilloma Virus 16. Participants from 29 countries interacted through oral presentations, panel discussions, and posters on topics that included dendritic cells and cancer, targeted therapeutics and immunotherapy, innate/adaptive immune interplay in cancer, clinical trial endpoints, vaccine combinations, countering negative regulation, immune cell trafficking to tumor microenvironment, and adoptive T cell transfer. In addition to the 50 oral presentations and >180 posters on these topics, a new SITC/iSBTc initiative to create evidence-based Cancer Immunotherapy Guidelines was announced. The SITC/iSBTc Biomarkers Taskforce announced the release of recommendations on immunotherapy biomarkers and a highly successful symposium on Immuno-Oncology Biomarkers that took place on the campus of the National Institutes of Health (NIH immediately prior to the Annual Meeting. At the Annual Meeting, the NIH took the opportunity to publicly announce the award of the U01 grant that will fund the Cancer Immunotherapy Trials Network (CITN. In summary, the Annual Meeting gathered clinicians and scientists from academia, industry, and regulatory agencies from around the globe to interact and exchange important scientific advances related to tumor immunobiology and cancer immunotherapy.

  20. Review of the 25th annual scientific meeting of the International Society for Biological Therapy of Cancer.

    Science.gov (United States)

    Balwit, James M; Kalinski, Pawel; Sondak, Vernon K; Coulie, Pierre G; Jaffee, Elizabeth M; Gajewski, Thomas F; Marincola, Francesco M

    2011-05-12

    Led by key opinion leaders in the field, the 25th Annual Meeting of the International Society for Biological Therapy of Cancer (iSBTc, recently renamed the Society for Immunotherapy of Cancer, SITC) provided a scientific platform for ~500 attendees to exchange cutting-edge information on basic, clinical, and translational research in cancer immunology and immunotherapy. The meeting included keynote addresses on checkpoint blockade in cancer therapy and recent advances in therapeutic vaccination against cancer induced by Human Papilloma Virus 16. Participants from 29 countries interacted through oral presentations, panel discussions, and posters on topics that included dendritic cells and cancer, targeted therapeutics and immunotherapy, innate/adaptive immune interplay in cancer, clinical trial endpoints, vaccine combinations, countering negative regulation, immune cell trafficking to tumor microenvironment, and adoptive T cell transfer. In addition to the 50 oral presentations and >180 posters on these topics, a new SITC/iSBTc initiative to create evidence-based Cancer Immunotherapy Guidelines was announced. The SITC/iSBTc Biomarkers Taskforce announced the release of recommendations on immunotherapy biomarkers and a highly successful symposium on Immuno-Oncology Biomarkers that took place on the campus of the National Institutes of Health (NIH) immediately prior to the Annual Meeting. At the Annual Meeting, the NIH took the opportunity to publicly announce the award of the U01 grant that will fund the Cancer Immunotherapy Trials Network (CITN). In summary, the Annual Meeting gathered clinicians and scientists from academia, industry, and regulatory agencies from around the globe to interact and exchange important scientific advances related to tumor immunobiology and cancer immunotherapy.

  1. Radiation Therapy Planning for Early-Stage Hodgkin Lymphoma: Experience of the International Lymphoma Radiation Oncology Group

    International Nuclear Information System (INIS)

    Maraldo, Maja V.; Dabaja, Bouthaina S.; Filippi, Andrea R.; Illidge, Tim; Tsang, Richard; Ricardi, Umberto; Petersen, Peter M.; Schut, Deborah A.; Garcia, John; Headley, Jayne; Parent, Amy; Guibord, Benoit; Ragona, Riccardo; Specht, Lena

    2015-01-01

    Purpose: Early-stage Hodgkin lymphoma (HL) is a rare disease, and the location of lymphoma varies considerably between patients. Here, we evaluate the variability of radiation therapy (RT) plans among 5 International Lymphoma Radiation Oncology Group (ILROG) centers with regard to beam arrangements, planning parameters, and estimated doses to the critical organs at risk (OARs). Methods: Ten patients with stage I-II classic HL with masses of different sizes and locations were selected. On the basis of the clinical information, 5 ILROG centers were asked to create RT plans to a prescribed dose of 30.6 Gy. A postchemotherapy computed tomography scan with precontoured clinical target volume (CTV) and OARs was provided for each patient. The treatment technique and planning methods were chosen according to each center's best practice in 2013. Results: Seven patients had mediastinal disease, 2 had axillary disease, and 1 had disease in the neck only. The median age at diagnosis was 34 years (range, 21-74 years), and 5 patients were male. Of the resulting 50 treatment plans, 15 were planned with volumetric modulated arc therapy (1-4 arcs), 16 with intensity modulated RT (3-9 fields), and 19 with 3-dimensional conformal RT (2-4 fields). The variations in CTV-to-planning target volume margins (5-15 mm), maximum tolerated dose (31.4-40 Gy), and plan conformity (conformity index 0-3.6) were significant. However, estimated doses to OARs were comparable between centers for each patient. Conclusions: RT planning for HL is challenging because of the heterogeneity in size and location of disease and, additionally, to the variation in choice of treatment techniques and field arrangements. Adopting ILROG guidelines and implementing universal dose objectives could further standardize treatment techniques and contribute to lowering the dose to the surrounding OARs

  2. A Weekend in the Country: The Outdoors, the Earth & Drama Therapy.

    Science.gov (United States)

    Reed, Chris

    1999-01-01

    A group of British graduate students in drama and movement therapy spent a weekend outdoors engaging in adventure, dramatic, and creative activities that focused on the symbolism of the Earth and increasing awareness of the self, the environment, and spirituality. (SV)

  3. A Journey of Freedom-seeking-A Character Analysis of The Adventure of Huckleberry Finn

    Institute of Scientific and Technical Information of China (English)

    谭险峰

    2013-01-01

    The thesis analyzes and comments on the two main characters in The Adventure of Huckleberry Finn so as to reveal the truth that to win both physical and psychological freedom in the society, we must learn to stand on ourselves. It begins with a brief introduction to the author, the novel and the paper thesis. Then, the author discloses the freedom-fighting process of the two main characters and the functions of Mississippi River and the raft in The Adventure of Huckleberry Finn: On the hegira, Huck realizes the cruelty, greed, murder, trickery, hypocrisy, racism, and a general lack of morality of the society;Jim, with his in-telligence and compassion, wins his freedom;the Mississippi River and the raft are symbols of freedom. Finally, the author reveals that to win both physical and psychological freedom, one must rely on his or her own efforts.

  4. The effects of brief individual cognitive behavioural therapy for depression and homesickness among international students in Malaysia.

    Science.gov (United States)

    Saravanan, Coumaravelou; Alias, Alizi; Mohamad, Mardiana

    2017-10-01

    Students who go to other countries for higher education face various psychological problems, particularly homesickness and depression. The objectives of this study were to: (a) identify differences between students who did and did not receive brief individual cognitive behavioural therapy (CBT) for depression to reduce homesickness; (b) identify whether brief individual CBT for depression reduces the level of homesickness in students between pre-, post- and follow-up assessment; and (c) compare the scores of students experiencing only homesickness and those experiencing both homesickness and depression. The sample consisted of 520 first-year undergraduate international students. The experimental group contained students who were diagnosed with depression and homesickness and received seven sessions of brief individual CBT for depression to reduce homesickness. The control group contained students who were diagnosed with depression and homesickness and received one session of advice and suggestions. The comparison group contained students who experienced only homesickness and did not receive any interventions. The study used the comparison group to determine if an interaction effect existed between students experiencing only homesickness and students experiencing both homesickness and depression. Students who received brief individual CBT displayed a significant reduction in their homesickness and depression scores compared to the scores of students in the control group. Students who experienced only homesickness exhibited a significant reduction in the scores on homesickness in the post-assessment compared to the control group's post-assessment homesickness scores. The results of this study cannot be generalized as data were collected from three universities in Malaysia. The follow-up assessment was conducted six months after the post-assessment, which also limits generalizability beyond six months. Overall, homesickness is considered a normal reaction. Brief

  5. Implementasi Sistem Informasi Crm (Customer Relationship Management) (Studi Pada Ud. Iwek-p Adventure Kota Malang)

    OpenAIRE

    Randy, Muhammad Iqbal Dimasz

    2014-01-01

    The purpose of this minor thesis is to describe the customer relationship management of information system, to analize the problem of customer relationship management information system, and to give an alternative solution or a new customer relationship management information system recommendation to UD. Iwek-P Adventure. Through Customer Relationship Management, companies can improve interaction with customers, not only interact directly but also at the time online, and Customer Relationship...

  6. A biomedical adventurers' guide to navigating between careers in academia and industry.

    Science.gov (United States)

    Superti-Furga, Giulio

    2009-12-01

    An explosion of scientific and technological advances has broadened the field of biomedicine. Traditional boundaries between the public and private research sectors are now blurred by multidisciplinary projects and the necessity for new and more efficient models of the translational process. This allows the adventurous scientist to boldly and consciously sample selected skills during periods of secondment in different institutions and organizations, and to assemble a personal and unique blend of competences to help them manage their career.

  7. Green and Gold: Promoting Eco-Adventure and Cultural Tourism for Inclusive and Sustainable Growth

    OpenAIRE

    Picazo, Oscar F.

    2015-01-01

    This paper briefly reviews the literature on the emerging concept of eco-adventure and cultural tourism, dubbed "green and gold tourism," respectively. It provides the rationale for conducting such a study in the Philippines (why the concern for inclusivity and environmental sustainability in tourism). It then establishes the feasible scope of such study and lists illustrative activities of inclusive and sustainable green and gold tourism. It also identifies concerns and issues about green an...

  8. Monitoring injury in the New Zealand adventure tourism sector: an operator survey.

    Science.gov (United States)

    Bentley, Tim A; Page, Stephen; Edwards, Joanna

    2008-01-01

    Client safety is a major risk management concern for the commercial adventure tourism sector in New Zealand. This study built on previous exploratory analyses of New Zealand adventure tourism safety, including industry surveys conducted by these authors in 1999 and 2003. The aims of the study were to provide a continuation of injury monitoring across the sector through data collected from self-reported injury incidence by industry operators and to compare findings with those from other primary and secondary research studies conducted by the authors. A postal questionnaire was used to survey all identifiable New Zealand adventure tourism operators during 2006. The questionnaire asked respondents about their recorded client injury experience, perceptions of client injury risk factors, and safety management practices. Some 21 adventure tourism activities were represented among the responding sample (n = 127), with most operations being very small in terms of staff numbers, although responding operators catered to nearly 1 million clients in total annually. Highest ranked risk factors for client injury included clients not following instructions; level of client skill, ability, and fitness; and changeable/unpredictable weather conditions. Highest client injury was reported for horse riding, ecotourism, and white water rafting sectors, although serious underreporting of minor injuries was evidenced across the sector. Slips, trips, and falls were the most frequently reported injury mechanism, while safety management measures were inconsistently applied across the sector. The industry should address reporting culture issues and safety management practices generally. Specifically, the industry should consider risk management that focuses on minor (eg, falls) as well as catastrophic events.

  9. Pembuatan Aplikasi Permainan Pengenalan Provinsi di Indonesia Melalui Game “Adventure Indonesia” Berbasis Android

    Directory of Open Access Journals (Sweden)

    Yusuf Ashari

    2016-04-01

    Full Text Available Indonesia adalah Negara yang luas dan kaya akan keanekaragaman aspek keruangan. Secara administratif menurut UU RI Nomor 20 Tahun 2012 Indonesia tentang pembentukan provinsi Kalimantan Utara yang menjadikan Indonesia terdiri dari 34 Provinsi. Hal ini berdampak terhadap aspek kehidupan terutama pada aspek pendidikan. Pada tingkat sekolah dasar siswa telah diajarkan untuk mengenal wilayah Indonesia. untuk mempermudah siswa sekolah dasar dalam memahami dan mengenal provinsi dibutuhkan suatu aplikasi edukasi yang dapat mengenalkan karakteristik dan nama ibukota dari provinsi di Indonesia oleh karena itu muncul sebuah ide untuk merancang dan membangun aplikasi permainan “Adventure Indonesia” ini diharapkan menjadi sarana permainan tentang pengenalan provinsi di Indonesia. Aplikasi permainan 'Adventure Indonesia' dibuat menggunakan perangkat lunak Unity versi 5. Pengembangan multimedia yang digunakan adalah Multimedia Development Life Cycle (MDLC yang memiliki enam tahap, yaitu tahap konsep (Concept, tahap perancangan (Design, tahap pengumpulan materi (Material Collecting, tahap pembuatan (Assembly, tahap pengujian (testing, dan tahap distribusi (Distribution. Pengujian black-box juga digunakan pada aplikasi ini. Hasil dari penelitian adalah berupa aplikasi permainan “Adventure Indonesia” yang dapat berjalan pada perangkat berbasis android. Aplikasi ini berisi pengenalan karakteristik dan ibukota dari provinsi di Indonesia. Berdasarkan pengujian dengan menggunakan metode black-box, seluruh fungsi yang ada dalam aplikasi permainan telah berhasil dan berjalan sesuai dengan fungsinya masing-masing.

  10. Professional judgement and decision-making in adventure sports coaching: the role of interaction.

    Science.gov (United States)

    Collins, Loel; Collins, Dave

    2016-01-01

    This qualitative study presents the view that coaching practice places demands on the coach's adaptability and flexibility. These requirements for being adaptive and flexible are met through a careful process of professional judgement and decision-making based on context-appropriate bodies of knowledge. Adventure sports coaches were selected for study on the basis that adventure sports create a hyper-dynamic environment in which these features can be examined. Thematic analysis revealed that coaches were generally well informed and practised with respect to the technical aspects of their sporting disciplines. Less positively, however, they often relied on ad hoc contextualisation of generalised theories of coaching practice to respond to the hyper-dynamic environments encountered in adventure sports. We propose that coaching practice reflects the demands of the environment, individual learning needs of the students and the task at hand. Together, these factors outwardly resemble a constraints-led approach but, we suggest, actually reflect manipulation of these parameters from a cognitive rather than an ecological perspective. This process is facilitated by a refined judgement and decision-making process, sophisticated epistemology and an explicit interaction of coaching components.

  11. Chronic pelvic pain syndrome: reduction of medication use after pelvic floor physical therapy with an internal myofascial trigger point wand.

    Science.gov (United States)

    Anderson, Rodney U; Harvey, Richard H; Wise, David; Nevin Smith, J; Nathanson, Brian H; Sawyer, Tim

    2015-03-01

    This study documents the voluntary reduction in medication use in patients with refractory chronic pelvic pain syndrome utilizing a protocol of pelvic floor myofascial trigger point release with an FDA approved internal trigger point wand and paradoxical relaxation therapy. Self-referred patients were enrolled in a 6-day training clinic from October, 2008 to May, 2011 and followed the protocol for 6 months. Medication usage and symptom scores on a 1-10 scale (10 = most severe) were collected at baseline, and 1 and 6 months. All changes in medication use were at the patient's discretion. Changes in medication use were assessed by McNemar's test in both complete case and modified intention to treat (mITT) analyses. 374 out of 396 patients met inclusion criteria; 79.7 % were male, median age of 43 years and median symptom duration of 5 years. In the complete case analysis, the percent of patients using medications at baseline was 63.6 %. After 6 months of treatment the percentage was 40.1 %, a 36.9 % reduction (p < 0.001). In the mITT analysis, there was a 22.7 % overall reduction from baseline (p < 0.001). Medication cessation at 6 months was significantly associated with a reduction in total symptoms (p = 0.03).

  12. Adventure-Based Counseling: An Adlerian "Natural High."

    Science.gov (United States)

    Gillis, H. Lee; Dagley, John

    Special characteristics of action-oriented approaches to therapy, cautions and tips for using these approaches, and sample activities are provided in this guide. An introductory section explains the relationship of action-based counseling to the traditional action-oriented methods and principles of Adlerian psychology and emphasizes the merit of…

  13. Counseling for the Wilderness Athlete and Adventurer During a Preparticipation Evaluation for Preparation, Safety, and Injury Prevention.

    Science.gov (United States)

    Young, Justin Mark J; Campbell, Aaron D; Raastad, Kate K

    2015-12-01

    Wilderness sports and adventures continue to increase in popularity. Counseling is an essential element of the preparticipation evaluation (PPE) for athletes in traditional sports. This approach can be applied to and augmented for the wilderness athlete and adventurer. The authors reviewed the literature on counseling during PPEs and gathered expert opinion from medical professionals who perform such PPEs for wilderness sports enthusiasts. The objective was to present findings of this review and make recommendations on the counseling component of a wilderness sports/adventure PPE. The counseling component of a PPE for wilderness sports/adventures should take place after a basic medical evaluation, and include a discussion on sport or activity-specific injury prevention, personal health, travel recommendations, and emergency event planning. Counseling should be individualized and thorough, and involve shared decision making. This should take place early enough to allow ample time for the athlete or adventurer to further prepare as needed based on the recommendations. Resources may be recommended for individuals desiring more information on selected topics. Copyright © 2015. Published by Elsevier Inc.

  14. Alignment of Outcome Instruments Used in Hand Therapy With the Occupational Therapy Practice Framework: Domain and Process and the International Classification of Functioning, Disability and Health: A Scoping Review.

    Science.gov (United States)

    Lesher, Danielle Ann-Marie; Mulcahey, M J; Hershey, Peter; Stanton, Donna Breger; Tiedgen, Andrea C

    We sought to identify outcome instruments used in rehabilitation of the hand and upper extremity; to determine their alignment with the constructs of the International Classification of Functioning, Disability and Health (ICF) and the Occupational Therapy Practice Framework: Domain and Process; and to report gaps in the constructs measured by outcome instruments as a basis for future research. We searched CINAHL, MEDLINE, OTseeker, and the Cochrane Central Register of Controlled Trials using scoping review methodology and evaluated outcome instruments for concordance with the ICF and the Framework. We identified 18 outcome instruments for analysis. The findings pertain to occupational therapists' focus on body functions, body structures, client factors, and activities of daily living; a gap in practice patterns in use of instruments; and overestimation of the degree to which instruments used are occupationally based. Occupational therapy practitioners should use outcome instruments that embody conceptual frameworks for classifying function and activity. Copyright © 2017 by the American Occupational Therapy Association, Inc.

  15. Proceedings of the signature series event of the international society for cellular therapy: "Advancements in cellular therapies and regenerative medicine in digestive diseases," London, United Kingdom, May 3, 2017.

    Science.gov (United States)

    Ciccocioppo, Rachele; Dos Santos, Claudia C; Baumgart, Daniel C; Cangemi, Giuseppina C; Cardinale, Vincenzo; Ciacci, Carolina; De Coppi, Paolo; Haldar, Debashis; Klersy, Catherine; Nostro, M Cristina; Ott, Michael; Piemonti, Lorenzo; Tomei, Alice A; Uygun, Basak; Vetrano, Stefania; Orlando, Giuseppe

    2018-03-01

    A summary of the First Signature Series Event, "Advancements in Cellular Therapies and Regenerative Medicine for Digestive Diseases," held on May 3, 2017, in London, United Kingdom, is presented. Twelve speakers from three continents covered major topics in the areas of cellular therapy and regenerative medicine applied to liver and gastrointestinal medicine as well as to diabetes mellitus. Highlights from their presentations, together with an overview of the global impact of digestive diseases and a proposal for a shared online collection and data-monitoring platform tool, are included in this proceedings. Although growing evidence demonstrate the feasibility and safety of exploiting cell-based technologies for the treatment of digestive diseases, regulatory and methodological obstacles will need to be overcome before the successful implementation in the clinic of these novel attractive therapeutic strategies. Copyright © 2017 International Society for Cellular Therapy. Published by Elsevier Inc. All rights reserved.

  16. Splenomegaly and tumor marker response following selective internal radiation therapy for non-resectable liver metastases from neuroendocrine tumor

    International Nuclear Information System (INIS)

    Shehata, M.; Yan, K.; Itoh, Seiji; King, J.; Glenn, D.; Quinn, R.; Morris, D.L.

    2009-01-01

    The aim of this study was to investigate changes in spleen size, the level of chromogranin A as a tumor marker, and the relationship between these two parameters before and 3 months after selective internal radiation therapy (SIRT) for non-resectable liver metastases from neuroendocrine tumor (NET). Our first serious adverse event with this relatively new treatment is also discussed. A retrospective review of a prospective database identified patients with non-resectable liver metastases from NET who underwent SIRT between 2003 and 2007. Patients who underwent CT scans before and 3 months after treatment were included. The patients were divided into two groups: those with and without a 20% or more increase in splenic volume on the CT scans. The percentages of patients showing a tumor marker response in the two groups were then compared. Fourteen patients were included in the present analysis. A tumor marker response was seen in 6 of 7 patients (85.7%) who showed an increase in splenic volume of >20%, and in 3 of 7 patients (42.9%) without an increase in splenic volume (p=0.266). There was one death as a result of oesophageal variceal bleeding due to portal hypertension at 9 months after treatment. Splenic enlargement after SIRT may be associated with tumor marker response, although this could not be confirmed statistically in this study due to the small number of patients. Long-term splenomegaly and portal hypertension may be important complications of SIRT. This issue needs to be investigated further using a larger number of patients and longer follow-up. (author)

  17. Episodic memory following deep brain stimulation of the ventral anterior limb of the internal capsule and electroconvulsive therapy.

    Science.gov (United States)

    Bergfeld, Isidoor O; Mantione, Mariska; Hoogendoorn, Mechteld L C; Horst, Ferdinand; Notten, Peter; Schuurman, P Richard; Denys, Damiaan

    Electroconvulsive Therapy (ECT) and Deep Brain Stimulation (DBS) are effective treatments for patients with treatment-resistant depression (TRD). However, a common side effect of ECT is autobiographical memory loss (e.g., personal experiences), whereas the impact of DBS on autobiographical memories has never been established. Comparing autobiographical memories following DBS and ECT. In two hospitals in The Netherlands, we interviewed 25 TRD patients treated with DBS of the ventral anterior limb of the internal capsule (vALIC), 14 TRD patients treated with ECT and 22 healthy controls (HC) with the Autobiographical Memory Inventory - Short Form (AMI-SF) in a prospective, longitudinal study between March 2010 and August 2016. Patients treated with DBS were interviewed before surgery, after surgery, and twice during treatment over 122.7 (SD: ±22.2) weeks. Patients treated with ECT were tested before ECT, after six right unilateral (RUL) ECT sessions and twice following ECT over 65.1 (±9.3) weeks. Controls were tested four times over 81.5 (±15.6) weeks. Compared to HC, the AMI-SF score decreased faster in both TRD groups (P ECT group was larger than both the DBS and HC groups. Both ECT and vALIC DBS result in a faster autobiographical memory decline compared to HC. DBS might have a negative impact on autobiographical memories, although less so than ECT. Future work should dissect whether DBS or characteristics of TRD cause this decline. Copyright © 2017 Elsevier Inc. All rights reserved.

  18. Simultaneous occurrence of subarachnoid hemorrhage and epistaxis due to ruptured petrous internal carotid artery aneurysm. Association with transsphenoidal surgery and radiation therapy. Case report

    International Nuclear Information System (INIS)

    Endo, Hidenori; Fujimura, Miki; Inoue, Takashi; Matsumoto, Yasushi; Ogawa, Yoshikazu; Kawagishi, Jun; Jokura, Hidefumi; Shimizu, Hiroaki; Tominaga, Teiji

    2011-01-01

    A 62-year-old woman presented with simultaneous subarachnoid hemorrhage (SAH) and massive epistaxis. The patient had been treated for pituitary prolactinoma by two transsphenoidal surgeries, gamma knife radiosurgery, and conventional radiation therapy since age 43 years. Cerebral angiography showed left petrous internal carotid artery (ICA) aneurysm with slight stenosis on the adjacent left petrous ICA. She underwent superficial temporal artery-middle cerebral artery (STA-MCA) double anastomosis with endovascular internal trapping without complication the day after onset. Postoperative course was uneventful; the patient did not develop symptomatic vasospasm, recurrent epistaxis, or cerebrospinal fluid rhinorrhea. Postoperative angiography demonstrated complete disappearance of the aneurysm with patent STA-MCA anastomosis. The patient was discharged 2 months after surgery without neurological deficit. The present case is extremely rare with simultaneous onset of SAH and epistaxis caused by ruptured petrous ICA aneurysm. The transsphenoidal surgeries and radiation therapies might have been critical in the formation of the petrous ICA aneurysm. (author)

  19. What are the minimum requirements for ketogenic diet services in resource-limited regions? Recommendations from the International League Against Epilepsy Task Force for Dietary Therapy.

    Science.gov (United States)

    Kossoff, Eric H; Al-Macki, Nabil; Cervenka, Mackenzie C; Kim, Heung D; Liao, Jianxiang; Megaw, Katherine; Nathan, Janak K; Raimann, Ximena; Rivera, Rocio; Wiemer-Kruel, Adelheid; Williams, Emma; Zupec-Kania, Beth A

    2015-09-01

    Despite the increasing use of dietary therapies for children and adults with refractory epilepsy, the availability of these treatments in developing countries with limited resources remains suboptimal. One possible contributory factor may be the costs. There is often reported a significant perceived need for a large ketogenic diet team, supplements, laboratory studies, and follow-up visits to provide this treatment. The 2009 Epilepsia Consensus Statement described ideal requirements for a ketogenic diet center, but in some situations this is not feasible. As a result, the International League Against Epilepsy (ILAE) Task Force on Dietary Therapy was asked to convene and provide practical, cost-effective recommendations for new ketogenic diet centers in resource-limited regions of the world. Wiley Periodicals, Inc. © 2015 International League Against Epilepsy.

  20. [Profound meaning of acupuncture taboos in Internal Classic based on the fault of reinforcing and reducing technique by mind conduction of acupuncture therapy].

    Science.gov (United States)

    Qin, Yuge; Wang, Feng; Qin, Yuheng; Li, Li; Li, Mei

    2016-05-01

    By analyzing the acupuncture taboos in Neijing (Internal Classic) on clinical application of mind conduction of acupuncture therapy in going against the actual situation, astronomy and others, it is found that the relevant acupuncture taboo implies many subtle mysteries of human body, qi, mind and astronomy, which have not been discovered yet in modern science and are very significant in qi protection. In Neijing, the acupuncture physicians have been highly required in the mind treatment, in which, accurately regulating qi circulation is the target in the treatment. The mind conduction is used for qi circulation to accomplish accurately the reinforcing or reducing in the deficiency or excess condition. All of the taboos are provided to normalize the accuracy of reinforcing and reducing technique of acupuncture therapy and avoid the damage of qi in human body. Hence, those taboos must be obeyed so as to prevent from serious consequence and ensure the safety of this acupuncture therapy.

  1. Modern Radiation Therapy for Nodal Non-Hodgkin Lymphoma—Target Definition and Dose Guidelines From the International Lymphoma Radiation Oncology Group

    DEFF Research Database (Denmark)

    Illidge, Tim; Specht, Lena; Yahalom, Joachim

    2014-01-01

    Radiation therapy (RT) is the most effective single modality for local control of non-Hodgkin lymphoma (NHL) and is an important component of therapy for many patients. Many of the historic concepts of dose and volume have recently been challenged by the advent of modern imaging and RT planning...... tools. The International Lymphoma Radiation Oncology Group (ILROG) has developed these guidelines after multinational meetings and analysis of available evidence. The guidelines represent an agreed consensus view of the ILROG steering committee on the use of RT in NHL in the modern era. The roles...... of reduced volume and reduced doses are addressed, integrating modern imaging with 3-dimensional planning and advanced techniques of RT delivery. In the modern era, in which combined-modality treatment with systemic therapy is appropriate, the previously applied extended-field and involved-field RT...

  2. Estimated Internal and External Radiation Exposure of Caregivers of Patients With Pediatric Neuroblastoma Undergoing 131I Metaiodobenzylguanidine Therapy: A Prospective Pilot Study.

    Science.gov (United States)

    Han, Sangwon; Yoo, Seon Hee; Koh, Kyung-Nam; Lee, Jong Jin

    2017-04-01

    Current recommendations suggest that family members should participate in the care of children receiving in-hospital I metaiodobenzylguanidine (MIBG) therapy for neuroblastoma. The present study aimed to measure the external radiation exposure and estimate the internal radiation exposure of caregivers during the hospital stay for I MIBG therapy. Caregivers received radiation safety instructions and a potassium iodide solution for thyroid blockade before patient admission. External radiation exposure was determined using a personal pocket dosimeter. Serial 24-hour urine samples were collected from caregivers during the hospital stay. Estimated internal radiation exposure was calculated based on the urine activity. Twelve cases (mean age, 6.2 ± 3.5 years; range, 2-13 years) were enrolled. The mean administered activity was 233.3 ± 74.9 (range, 150.0-350.0) mCi. The mean external radiation dose was 5.8 ± 7.2 (range, 0.8-19.9) mSv. Caregivers of children older than 4 years had significantly less external radiation exposure than those of children younger than 4 years (1.9 ± 1.0 vs 16.4 ± 5.0 mSv; P = 0.012). The mean estimated internal radiation dose was 11.3 ± 10.2 (range, 1.0-29.8) μSv. Caregivers receive both external and internal radiation exposure while providing in-hospital care to children receiving I MIBG therapy for neuroblastoma. However, the internal radiation exposure was negligible compared with the external radiation exposure.

  3. The ABC's of Delivering A Research-Driven Adventure Learning Program From the Field

    Science.gov (United States)

    Pregont, P.; Porsild, M.

    2008-12-01

    A is for anchoring the delivery of your research to your audience in a standard-aligned curriculum. B is for BGAN Satellite Communication System assisting in delivering real-time authentic media. C is for a collaborative online learning environment to engage learners" Z is for the peaceful sleep you will get once your program is up and running! As part of Team GoNorth! (http://www.PolarHusky.com) it is our job to deliver adventure learning. We set out to do this back when the computer was a 4-foot, 50-lb box powered by a hand-crank where one would have a window of ten minutes in a 24-hour period to catch the satellite (before Al Gore created the Internet!). Every year we review the quantum leaps in what is now possible from the field and in the classroom, and over the years we have wrestled technical issues, solutions and numerous re-structures in the process of our of curriculum development. With this presentation we will provide some basic ABC's on how you can remained focused on your research, yet deliver an adventure learning program for learners to investigate real-world issues within your scientific research. Our scales are most likely different. The volume of our curriculum is an annual production of 4-500 pages to be used from Kindergarden through 12th grade around the world. The framework of our online learning environment must be able to supports millions of users at a time. "In the field" means on a a 3-4 month dogsled expedition - so sending out our live updates involve thawing out the computers and setting up the satellite communication system to work in a ground blizzard! But regardless of the scope and location of your field research, you can probably build on some of our experiences in the planning of an upcoming adventure learning program to engage learners of all or any ages in your scientific explorations!

  4. Predictive and prognostic value of circulating nucleosomes and serum biomarkers in patients with metastasized colorectal cancer undergoing Selective Internal Radiation Therapy

    International Nuclear Information System (INIS)

    Fahmueller, Yvonne Nadine; Nagel, Dorothea; Hoffmann, Ralf-Thorsten; Tatsch, Klaus; Jakobs, Tobias; Stieber, Petra; Holdenrieder, Stefan

    2012-01-01

    Selective Internal Radiation Therapy (SIRT) is a new and effective locoregional anticancer therapy for colorectal cancer patients with liver metastases. Markers for prediction of therapy response and prognosis are needed for the individual management of those patients undergoing SIRT. Blood samples were prospectively and consecutively taken from 49 colorectal cancer patients with extensive hepatic metastases before, three, six, 24 and 48 h after SIRT to analyze the concentrations of nucleosomes and further laboratory parameters, and to compare them with the response to therapy regularly determined 3 months after therapy and with overall survival. Circulating nucleosomes, cytokeratin-19 fragments (CYFRA 21-1), carcinoembryonic antigen (CEA), C-reactive protein (CRP) and various liver markers increased already 24 h after SIRT. Pretherapeutical levels of CYFRA 21-1, CEA, cancer antigen 19-9 (CA 19-9), asparate-aminotransferase (AST) and lactate dehydrogenase (LDH) as well as 24 h values of nucleosomes were significantly higher in patients suffering from disease progression (N = 35) than in non-progressive patients (N = 14). Concerning overall survival, CEA, CA 19-9, CYFRA 21-1, CRP, LDH, AST, choline esterase (CHE), gamma-glutamyl-transferase, alkaline phosphatase, and amylase (all 0 h, 24 h) and nucleosomes (24 h) were found to be prognostic relevant markers in univariate analyses. In multivariate Cox-Regression analysis, the best prognostic model was obtained for the combination of CRP and AST. When 24 h values were additionally included, nucleosomes (24 h) further improved the existing model. Panels of biochemical markers are helpful to stratify pretherapeutically colorectal cancer patients for SIR-therapy and to early estimate the response to SIR-therapy

  5. Stamina, speed and adventure: Australian women and competitive cycling in the 1890s.

    Science.gov (United States)

    Kinsey, Fiona

    2011-01-01

    The scholarship surrounding women's cycling in Australia during the 1890s is slim. However, a focus on female competitive cycling, just one of many diverse cycling activities that women pursued in this era, reveals a rich seam of information. Accordingly, this paper surveys endurance riding, adventure touring and racing, introducing new historical and biographical detail and highlighting the significance of competitive cycling for women in the late nineteenth century. The discussion shows that women's competitive cycling constituted a significant component of Australian cycling history, and helped to re-define women's identity in an era when feminine roles were in flux and the traditional gender order was being contested.

  6. Environmental equipment for usages of FEM software. ADVENTURE system user's guide

    International Nuclear Information System (INIS)

    Yamasaki, Ichirou; Yoshimura, Shinobu

    2003-05-01

    The community softwares, databases, and other various tools have been installed in the ITBL environment by the Office of ITBL Promotion as a common utility property for each research field. Among those softwares, Finite Element Method (FEM) code, Adventure (which was originally developed by Prof. Yoshimura, the University of Tokyo), is provided as one of structure analysis programs for ITBL users. The code is well known to possess a high performance ability for parallel processing, especially for massively parallel environments. In this report, a chain of processes for usages of the system as well as the installation method to PC cluster are described. (author)

  7. Environmental equipment for usages of FEM software. ADVENTURE system user's guide

    Energy Technology Data Exchange (ETDEWEB)

    Yamasaki, Ichirou [Japan Atomic Energy Research Inst., Center for Promotion of Computional Science and Engineering, Kizu, Kyoto (Japan); Yoshimura, Shinobu [Tokyo Univ., Tokyo (Japan)

    2003-05-01

    The community softwares, databases, and other various tools have been installed in the ITBL environment by the Office of ITBL Promotion as a common utility property for each research field. Among those softwares, Finite Element Method (FEM) code, Adventure (which was originally developed by Prof. Yoshimura, the University of Tokyo), is provided as one of structure analysis programs for ITBL users. The code is well known to possess a high performance ability for parallel processing, especially for massively parallel environments. In this report, a chain of processes for usages of the system as well as the installation method to PC cluster are described. (author)

  8. Sensation seeking in outdoor pursuits: similarities and differences in discourses on radical sports and adventure tourism / Da exacerbação dos sentidos no encontro com a natureza: contrastando esportes radicais e turismo de aventura

    Directory of Open Access Journals (Sweden)

    Mary Jane P. Spink

    2005-01-01

    Full Text Available This article is a contribution to the understanding of risk-adventure as the set of practices that recuperate the positive dimension of risk. Based on a review of the literature and on the theoretical approach of Constructionist Discursive Psychology, it proposes a model for the analysis of the dimensions of risk adventure present in adventure tourism and radical sports: risk/danger, adrenaline, adventure, training, use of equipments and relationship to nature. The data, derived from the site of a tourism agency that specialized in adventure tourism and an interview with a paraglide practitioner, was analyzed using "trees of association of ideas" and "dialogical maps". All the elements of the model were present in both modalities of risk-adventure. However, adventure tourism was characterized by the delegation of responsibility to specialists, whilst the training/experience dimension made itself more present in radical sports, along with greater emphasis on individual responsibility in the control of risks.

  9. Adventures in order and chaos a scientific autobiography

    CERN Document Server

    Contopoulos, George

    2004-01-01

    The field of Order and Chaos had a remarkable expansion in the last 50 years. The main reason was the use of computers, and the development of new theoretical methods that we call now 'the theory of chaos'. The author describes this fascinating period in a relaxed and sometimes humorous autobiographical way. He relates his interactions with many people in dynamical astronomy and he quotes several anecdotes from these interactions. He refers also to his experiences when he served in various international positions, such as general secretary of the IAU and chairman of the journal Astronomy and A

  10. OEI, GTTP and Adventurers of the Universe: training teachers and disseminating science in the South of Brazil

    Science.gov (United States)

    Pavani, D. B.; Saraiva, M. F. O.; Dottori, H.

    2014-10-01

    Itinerant Educative Observatory (OEI) is a permanent program of our Department of Astronomy since 1999. It aims to lecture Astronomy to teachers of fundamental and middle levels, using attractive resources such as telescopic observations, audiovisuals, and multimedia. The training courses are requested by different cities of Rio Grande do Sul and nearby states and are organized by a local committee of the requesting city. In 2014, with federal funds, we are uniting efforts with other extension project: the Galileo Teacher Training Program (GTTP). This is an international program developed to train teachers in the effective use of astronomy education tools and resources in their science classes. The program, that is a legacy of IYA2009, aims to create a worldwide network of Galileo Ambassadors the promoters of the training workshops and Galileo Teachers the teachers who bring the learned methodologies into classroom. To supplement these activities, we initiated a new program in 2012 called Adventurers of the Universe. University professors, undergraduates students and teachers of high-school and elementary school of social vulnerable communities develop transdiciplinary didactic sequences where Astronomy is the central focus to motivate different processes of teaching and learning, considering different learning levels, designed for direct use in the classroom. The objective of the program is to contribute to the didactic transposition through the discussion about how to relate astronomy with other science and non-science disciplines. In 2012 we collaborated with 20 teachers of one school, and 900 students. In 2013, the collaborations were expanded to include teachers and students of 3 other schools.

  11. The space adventure comes to a conference at CERN

    CERN Multimedia

    CERN Bulletin

    2012-01-01

    From 5 to 7 November, CERN will host the 4th International Conference on Particle and Fundamental Physics in Space (SpacePart12). Special talks open to the general public will be given by two of the biggest names in space exploration: Edward Stone, project scientist for the Voyager probes, and William Gerstenmaier, former Manager of the International Space Station (ISS) programme.     Launched at Isola d’Elba (Italy) in 2002, then continued in Washington D.C. (USA) in 2003 and Beijing (China) in 2006, the SpacePart conferences are an opportunity for researchers and space policy makers from across the world to exchange opinions on the developments of space-related science and technology programmes. This year, SpacePart coincides with the centenary of the discovery of cosmic rays and will be held at CERN. On 5 November, Edward Stone, professor at the California Institute of Technology and project scientist for the Voyager probes since 1972, will give a talk on the extraordin...

  12. Narrative Enhancement and Cognitive Therapy: A New Group-Based Treatment for Internalized Stigma among Persons with Severe Mental Illness

    OpenAIRE

    Yanos, Philip T.; Roe, David; Lysaker, Paul H.

    2011-01-01

    Internalized stigma has been suggested to play a major role in negative changes in identity in severe mental illness. Evidence suggests that roughly one-third of people with severe mental illness show elevated internalized stigma and that it is linked to compromised outcomes in both subjective and objective aspects of recovery. Despite substantial evidence for the impact of internalized stigma, few efforts have been made to develop professionally-led treatment to address this issue. In this a...

  13. PENGARUH CITRA MEREK (BRAND IMAGE DAN KEPUASAN WISATAWAN TERHADAP LOYALITAS WISATAWAN PADA BALI ADVENTURE RAFTING

    Directory of Open Access Journals (Sweden)

    Ardilla Nathaurisia

    2017-01-01

    Full Text Available ith loyalty and high power of buying. Research impact of brand image and guest satisfaction on customer loyalty is important to do in order to obtain an explanation of the relationship between brand image and customer satisfaction on customer loyalty. The purpose of this study is 1 to identify the circumstance brand image on customer loyalty. 2 to identify the circumstance customer satisfaction on customer loyalty. 3 to determine the circumstance brand image and customer satisfaction on customer loyalty. This research was conducted at Bali Adventure Rafting. Result shows that branding and customer satisfaction has a significant effect on customer loyalty in Bali Adventure Rafting with result 41,7%. This result is obtained from the value of determination D x 100% = 0,417 x 100% = 41,7%. This means that the brand image and customer satisfaction contributing positively to customer loyalty of rating of 41,7% and the remaining 58,3% is influenced by others factors such as costumers satisfaction, marketing strategy.

  14. From risky behaviour to sexy adventures: reconceptualising young people's online sexual activities.

    Science.gov (United States)

    Naezer, Marijke

    2018-06-01

    Western discourses about young people and sexuality centre around the concept of risk. Anxieties have been fuelled by the increasing popularity of social media and practices such as 'sexting' and watching 'sexually explicit' materials online. Research has shown however that such risk discourses mainly serve to moralise about, pathologise and police particular behaviours and children. In order to counter such paternalism, researchers advocated a reconceptualisation of youth not as passive victims, but as active agents who actively negotiate sexual experiences and discourses. In this paper, which is based on ethnographic fieldwork among young people in The Netherlands, I argue that we need a reconceptualisation not only of youth, but also of their sexual practices, especially their online sexual practices. Mobilising an interdisciplinary interaction between critical socio-cultural studies of risk, feminist theory and adventure studies, I propose to reconceptualise these practices as 'adventures' rather than 'risky behaviour'. This opens up possibilities for a more reasoned analysis that acknowledges: (1) the distinction between risks and outcomes of an activity; (2) the constructive potential of risk; and (3) the subjective, dynamic character of risk and pleasure.

  15. Satisfying Psychological Needs on the High Seas: Explaining Increases Self-Esteem Following an Adventure Education Programme

    Science.gov (United States)

    Scarf, Damian; Kafka, Sarah; Hayhurst, Jill; Jang, Kyungho; Boyes, Mike; Thomson, Ruth; Hunter, John A.

    2018-01-01

    A number of recent studies have revealed that taking part in a sail-training-based Adventure Education Programme elevates youths' self-esteem. Across two studies, we sought to examine the extent to which youths' sense of belonging contributed to this increase in self-esteem. Study 1 revealed that participants who completed the voyage showed an…

  16. A Case Study Examining the Impact of Adventure Based Counseling on High School Adolescent Self-Esteem, Empathy, and Racism

    Science.gov (United States)

    Cale, Chris

    2010-01-01

    This study investigated the effectiveness of Adventure Based Counseling upon high school adolescents. The goals of this study were to (a) explore the effectiveness of ABC Counseling in increasing levels of self-esteem and empathy among adolescents; (b) study the efficacy of ABC counseling in reducing perceived racial discrimination, racist…

  17. R.L. Stevenson's 'Most Grim and Gloomy Tale': The Ebb-Tide as Deconstruction of Colonial Adventure Narrative

    Directory of Open Access Journals (Sweden)

    Christy Danelle Di Frances

    2012-11-01

    Full Text Available Although Edinburgh-born author Robert Louis Stevenson is best known as a writer of nineteenth-century popular adventures, his work to a great extent challenges prevailing adventure ideology of the Victorian era. This paper focuses on Stevenson's complexification of the villain trope in The Ebb-Tide, a South Seas novella published only a few months before his death in 1894. In the text, Stevenson blatantly disregards or dismantles typical colonial presentations of a simplistic villain personified through such topoi as the 'demonic male', the violent-but-beautiful female savage, or the vaguely formidable Other - all of which frequently populate adventure's exotic realm in nineteenth-century fiction. Rather than relying upon these culturally codified depictions, in The Ebb-Tide Stevenson presents villainy as embodied by a dangerous amalgamation of ordinary vice and extraordinary evil that traverses those national and ethnic boundaries that colonialism so often sought to demarcate and solidify. The portrayal of villainy within this text culminates in a nightmarish atmosphere which, in Stevenson's fiction, inevitably results from the unchecked workings of personal transgressions combined with a larger and more powerful indicator of evil. In so doing, the author succeeds in creating a dark narrative latent with culturally relevant commentary which, in turn, contributes to his broader re-navigation of an ethically-charged aesthetics of adventure for a modern audience.

  18. "A New Kind of Rule": The Subversive Narrator in "Alice's Adventures in Wonderland" and "The Pied Piper of Hamelin."

    Science.gov (United States)

    Blackburn, William

    1986-01-01

    Compares "Alice's Adventures in Wonderland" to "The Pied Piper of Hamelin," noting that both: (1) were begun for the amusement of specific children; (2) use a subterranean journey as a device; (3) are critical of social authority; and (4) have problematic endings. (SRT)

  19. Differences in motivations over time by level of development: an examination of pre/post adventure recreation experiences

    Science.gov (United States)

    Sharon L. Todd; Lynn Anderson; Anderson Young; Dale Anderson

    2003-01-01

    The purpose of this study was to examine changes in motivations for outdoor adventure recreation pursuits over a short period of time (pre- to posttest) for participants with different levels of development. Subjects were 100 undergraduate recreation majors from separate similar summer session Outdoor Education Practicum courses, each of which included 7 days in a camp...

  20. Let's Begin Again: Sierra On-Line and the Origins of the Graphical Adventure Game

    Science.gov (United States)

    Nooney, Laine

    2017-01-01

    The author retells the origin story of Sierra On-Line and its historic first product, the graphical adventure game "Mystery House." She reviews the academic and journalistic writing that placed the story almost exclusively inside a narrative about early computer games, treating it as a saga of the competition between the graphic…

  1. Quantification and Minimization of Uncertainties of Internal Target Volume for Stereotactic Body Radiation Therapy of Lung Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Ge Hong [Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina (United States); Department of Radiation Oncology, Henan Cancer Hospital, the Affiliated Cancer Hospital of Zhengzhou University, Henan (China); Cai Jing; Kelsey, Chris R. [Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina (United States); Yin Fangfang, E-mail: fangfang.yin@duke.edu [Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina (United States)

    2013-02-01

    Purpose: To quantify uncertainties in delineating an internal target volume (ITV) and to understand how these uncertainties may be individually minimized for stereotactic body radiation therapy (SBRT) of early stage non-small cell lung cancer (NSCLC). Methods and Materials: Twenty patients with NSCLC who were undergoing SBRT were imaged with free-breathing 3-dimensional computed tomography (3DCT) and 10-phase 4-dimensional CT (4DCT) for delineating gross tumor volume (GTV){sub 3D} and ITV{sub 10Phase} (ITV3). The maximum intensity projection (MIP) CT was also calculated from 10-phase 4DCT for contouring ITV{sub MIP} (ITV1). Then, ITV{sub COMB} (ITV2), ITV{sub 10Phase+GTV3D} (ITV4), and ITV{sub 10Phase+ITVCOMB} (ITV5) were generated by combining ITV{sub MIP} and GTV{sub 3D}, ITV{sub 10phase} and GTV{sub 3D}, and ITV{sub 10phase} and ITV{sub COMB}, respectively. All 6 volumes (GTV{sub 3D} and ITV1 to ITV5) were delineated in the same lung window by the same radiation oncologist. The percentage of volume difference (PVD) between any 2 different volumes was determined and was correlated to effective tumor diameter (ETD), tumor motion ranges, R{sub 3D}, and the amplitude variability of the recorded breathing signal (v) to assess their volume variations. Results: The mean (range) tumor motion (R{sub SI}, R{sub AP}, R{sub ML}, and R{sub 3D}) and breathing variability (v) were 7.6 mm (2-18 mm), 4.0 mm (2-8 mm), 3.3 mm (0-7.5 mm), 9.9 mm (4.1-18.7 mm), and 0.17 (0.07-0.37), respectively. The trend of volume variation was GTV{sub 3D}

  2. Current views of the risk factors, diagnosis, and therapy of Alzheimer's disease (according to the proceedings of the Alzheimer's Association International Conference, London, 2017

    Directory of Open Access Journals (Sweden)

    N. N. Koberskaya

    2017-01-01

    Full Text Available The paper presents an overview of new methods for the diagnosis, treatment, and prevention of Alzheimer's disease (AD according to the proceeding of the Alzheimer's Association International Conference that was held in London on 16 to 20 July 2017. AD is the most common cause of dementia, especially in the elderly. The data of epidemiological and genetic studies and risk factors for AD were considered. Great attention was paid to the relationship of AD to cerebrovascular disorders, the differential diagnosis of AD with dementia in other nosological entities (dementia with Lewy bodies, frontotemporal dementia, cerebrovascular disease. New approaches to managing patients with AD were discussed. Current ideas about therapy for BA, symptomatic and pathogenetic methods for its treatment, combined therapy were outlined.

  3. Mechanisms for the Negative Effects of Internalized HIV-Related Stigma on Antiretroviral Therapy Adherence in Women: The Mediating Roles of Social Isolation and Depression.

    Science.gov (United States)

    Turan, Bulent; Smith, Whitney; Cohen, Mardge H; Wilson, Tracey E; Adimora, Adaora A; Merenstein, Daniel; Adedimeji, Adebola; Wentz, Eryka L; Foster, Antonina G; Metsch, Lisa; Tien, Phyllis C; Weiser, Sheri D; Turan, Janet M

    2016-06-01

    Internalization of HIV-related stigma may inhibit a person's ability to manage HIV disease through adherence to treatment regimens. Studies, mainly with white men, have suggested an association between internalized stigma and suboptimal adherence to antiretroviral therapy (ART). However, there is a scarcity of research with women of different racial/ethnic backgrounds and on mediating mechanisms in the association between internalized stigma and ART adherence. The Women's Interagency HIV Study (WIHS) is a multicenter cohort study. Women living with HIV complete interviewer-administered questionnaires semiannually. Cross-sectional analyses for the current article included 1168 women on ART for whom data on medication adherence were available from their last study visit between April 2013 and March 2014, when the internalized stigma measure was initially introduced. The association between internalized stigma and self-reported suboptimal ART adherence was significant for those in racial/ethnic minority groups (AOR = 0.69, P = 0.009, 95% CI: 0.52 to 0.91), but not for non-Hispanic whites (AOR = 2.15, P = 0.19, 95% CI: 0.69 to 6.73). Depressive symptoms, loneliness, and low perceived social support mediated the association between internalized stigma and suboptimal adherence in the whole sample, as well as in the subsample of minority participants. In serial mediation models, internalized stigma predicted less-perceived social support (or higher loneliness), which in turn predicted more depressive symptoms, which in turn predicted suboptimal medication adherence. Findings suggest that interconnected psychosocial mechanisms affect ART adherence, and that improvements in adherence may require multifaceted interventions addressing both mental health and interpersonal factors, especially for minority women.

  4. Adventures in order and chaos : a scientific autobiography

    Science.gov (United States)

    Contopoulos, George

    The field of Order and Chaos had a remarkable expansion in the last 50 years. The main reason was the use of computers, and the development of new theoretical methods that we call now 'the theory of chaos'. The author describes this fascinating period in a relaxed and sometimes humorous autobiographical way. He relates his interactions with many people in dynamical astronomy and he quotes several anecdotes from these interactions. He refers also to his experiences when he served in various international positions, such as general secretary of the IAU and chairman of the journal Astronomy and Astrophysics. In recent years the theory of chaos has been extended to new areas, like relativity, cosmology and quantum mechanics and it continues expanding in almost all branches of physics. The book describes many important ideas in this field in a simple way. It refers also to problems of more general interest, like writing papers and giving lectures and the interaction of authors and referees. Finally it gives some useful prospects for the future of dynamical astronomy and related fields. George Contopoulos, PhD U.Athens1953; Professor of Astronomy U.Thessaloniki 1957-75; U.Athens 1975-96; Emeritus 1996-; Member, Academy of Athens 1997-. Visiting Professor Yale U., Harvard U., MIT, Cornell U., U.Chicago, U.Maryland, U. Florida, Florida State U., U. Milan; Res. Associate, Yerkes Obs., Inst.Adv.Study Princeton, Inst.Space Studies, Goddard Flight Center, Columbia U., ESO. Author or Editor of 15 books, and about 250 papers on Galactic Dynamics, Relativity and Celestial Mechanics. Positions held: Gen.Secretary of the IAU; Director General Nat.Obs.of Greece, Pres.Hellenic Astron.Soc.; Nat.Representative of Greece in NATO, etc. Distinctions: Amer. Astron.Soc. Brouwer Prize; U.Chicago, Honorary Doctor's Degree; IAU, Pres. Commission 33 (Galaxy); Member Academia Europaea; Associate Royal Astron. Soc.; Chairman of the European Journal "Astronomy and Astrophysics"; Assoc. Editor of

  5. Hydrothermal Exploration at the Chile Triple Junction - ABE's last adventure?

    Science.gov (United States)

    German, C. R.; Shank, T. M.; Lilley, M. D.; Lupton, J. E.; Blackman, D. K.; Brown, K. M.; Baumberger, T.; Früh-Green, G.; Greene, R.; Saito, M. A.; Sylva, S.; Nakamura, K.; Stanway, J.; Yoerger, D. R.; Levin, L. A.; Thurber, A. R.; Sellanes, J.; Mella, M.; Muñoz, J.; Diaz-Naveas, J. L.; Inspire Science Team

    2010-12-01

    In February and March 2010 we conducted preliminary exploration for hydrothermal plume signals along the East Chile Rise where it intersects the continental margin at the Chile Triple Junction (CTJ). This work was conducted as one component of our larger NOAA-OE funded INSPIRE project (Investigation of South Pacific Reducing Environments) aboard RV Melville cruise MV 1003 (PI: Andrew Thurber, Scripps) with all shiptime funded through an award of the State of California to Andrew Thurber and his co-PI's. Additional support came from the Census of Marine Life (ChEss and CoMarge projects). At sea, we conducted a series of CTD-rosette and ABE autonomous underwater vehicle operations to prospect for and determine the nature of any seafloor venting at, or adjacent to, the point where the the East Chile Rise subducts beneath the continental margin. Evidence from in situ sensing (optical backscatter, Eh) and water column analyses of dissolved CH4, δ3He and TDFe/TDMn concentrations document the presence of two discrete sites of venting, one right at the triple junction and the other a further 10km along axis, north of the Triple Junction, but still within the southernmost segment of the East Chile Rise. From an intercomparison of the abundance of different chemical signals we can intercompare likely characteristics of these differet source sites and also differentiate between them and the high methane concentrations released from cold seep sites further north along the Chile Margin, both with the CTJ region and also at the Concepcion Methane Seep Area (CMSA). This multi-disciplinary and international collaboration - involving scientists from Chile, the USA, Europe and Japan - can serve as an excellent and exciting launchpoint for wide-ranging future investigations of the Chile Triple Junction area - the only place on Earth where an oceanic spreading center is being actively subducted beneath a continent and also the only place on Earth where all known forms of deep

  6. Episodic memory following deep brain stimulation of the ventral anterior limb of the internal capsule and electroconvulsive therapy

    NARCIS (Netherlands)

    Bergfeld, Isidoor O; Mantione, Mariska; Hoogendoorn, Mechteld L C; Horst, Ferdinand; Notten, Peter; Schuurman, P Richard; Denys, D.

    2017-01-01

    BACKGROUND: Electroconvulsive Therapy (ECT) and Deep Brain Stimulation (DBS) are effective treatments for patients with treatment-resistant depression (TRD). However, a common side effect of ECT is autobiographical memory loss (e.g., personal experiences), whereas the impact of DBS on

  7. Episodic memory following deep brain stimulation of the ventral anterior limb of the internal capsule and electroconvulsive therapy

    NARCIS (Netherlands)

    Bergfeld, Isidoor O.; Mantione, Mariska; Hoogendoorn, Mechteld L. C.; Horst, Ferdinand; Notten, Peter; Schuurman, P. Richard; Denys, Damiaan

    2017-01-01

    Background: Electroconvulsive Therapy (ECT) and Deep Brain Stimulation (DBS) are effective treatments for patients with treatment-resistant depression (TRD). However, a common side effect of ECT is autobiographical memory loss (e.g., personal experiences), whereas the impact of DBS on

  8. International Students of Speech and Language Therapy in the UK: Choices about Where to Study and Whether to Return

    Science.gov (United States)

    Goldbart, J.; Marshall, J.; Evans, I. R.

    2005-01-01

    The qualification leading to professional practice in speech and language therapy (SLT, also known as speech and language pathology) is not evenly available across the world. Geographic mobility and the availability of information are greater than at any other time in our history. Thus, initial SLT qualification courses in many countries are…

  9. Introduction to Special Issue: A Review of the International Classification of Functioning, Disability and Health and Physical Therapy over the Years.

    Science.gov (United States)

    Escorpizo, Reuben; Bemis-Dougherty, Anita

    2015-12-01

    The International Classification of Functioning, Disability and Health (ICF) of the World Health Organization was developed as a common framework to understand health and to describe the impact of health condition on functioning. The purpose of this paper is to summarize the literature on the use of the ICF in physical therapy practice and research. We performed a scoping-narrative review and searched for relevant English language articles from 2001 to 2012 in multiple databases that included MEDLINE, PsycINFO, PubMed and Physiotherapy Evidence Database. Our keywords for the search consisted of ['physical therapy' OR 'physiotherapy'] AND ['ICF']. All types of articles were considered. We found 268 articles; out of which, 79 were reviewed. The years with most publications were 2011 (n = 16), 2008 (n = 15) and 2010 and 2012 (both with n = 13). Publications mostly came from the United States with 27% of the articles. The journal Physical Therapy leads with almost a third of ICF-related physical therapy publications. The ICF has been mostly used in studies of musculoskeletal and neuromuscular conditions. We found a wide array of application of the ICF in research, clinical practice and teaching (classroom and clinical education). Emerging topics included using the ICF in resource allocation and prevention and wellness. The use of the ICF in physical therapy practice and research is promising and continues to evolve. With recent developments in ICF-based measurement and integration in assessment tools for use in the clinics, research and teaching, the need to show the added value of using the ICF in practice and research remains. Copyright © 2013 John Wiley & Sons, Ltd.

  10. Role and liabilities of the medical physicist in the validation of oncologic treatments in internal vectorized radiation therapy. S.F.P.M. report nr 31, June 2015

    International Nuclear Information System (INIS)

    Farman, Bardia; Defez, Didier; Martineau, Antoine; Vrigneaud, Jean-Marc; Dieudonne, Arnaud; Giraud, Fabienne; Divry, Guillaume; Bardies, Manuel; Laffont, Sophie; Santoro, Lore; Ferrer, Ludovic; Guilhem, Marie-Therese; Meyer, Philippe; Simon, Luc

    2015-06-01

    According to legal arrangements and decrees, the medical physicist must validate the preparation of each treatment based on the use of radio-elements in non-sealed sources. As the medical physicist is therefore liable of this validation, this report addresses the approach to be followed to comply with the law. The authors first outline that this report only concerns oncologic internal vectorized radiation therapy, and does not address the dosimetric aspect of these treatments. After having recalled the principles of internal vectorized radiography, they describe the role of the different actors: nuclear physician, medical physicist, radio-pharmacist, radio-pharmacy dispenser, medical electro-radiology operator, state nurse. They address the various aspects of the process of validation of a treatment preparation: technical prerequisites, organisational prerequisite, validation process, traceability, dosimetry. Several examples are proposed in appendix regarding traceability, dosimetry software, examples of PRM files

  11. Narrative Enhancement and Cognitive Therapy: A New Group-Based Treatment for Internalized Stigma among Persons with Severe Mental Illness

    Science.gov (United States)

    Yanos, Philip T.; Roe, David; Lysaker, Paul H.

    2011-01-01

    Internalized stigma has been suggested to play a major role in negative changes in identity in severe mental illness. Evidence suggests that roughly one-third of people with severe mental illness show elevated internalized stigma and that it is linked to compromised outcomes in both subjective and objective aspects of recovery. Despite substantial evidence for the impact of internalized stigma, few efforts have been made to develop professionally-led treatment to address this issue. In this article, we discuss our development of a new, group-based approach to the treatment of internalized stigma which we have termed “narrative enhancement and cognitive therapy” (NECT). We describe the treatment approach and offer an illustration of it by way of a case vignette. PMID:21985260

  12. The Last Adventure: Retirement Migration, Climate and "Amenities"

    Directory of Open Access Journals (Sweden)

    Saša Božić

    2001-12-01

    Full Text Available The rising number of European retirement migrants on the Mediterranean coasts, especially in the EU countries shows that the practical and scientific relevance of the new forms of migration in Europe is on the rise. "Retirement migration" evolved from a descriptive term to a candidate for a scientific or a research concept, at least if the use of the term IRM (international retirement migration is considered. However, it is necessary to solve several problems before this term can really become a coherent concept, useful for the research and explanation of the "new" migration phenomena. The author claims that the studies usually do not distinguish clearly between the migration of the elderly and retirement migration. The naming of the concept in this case mixes the characteristics of the migrants with the reasons for migration. The author shows that the usually mentioned reasons for retirement migration cannot be clearly formulated as factors which explain retirement migration. Further on, retirement as such is not a pull, push or staying put factor. Migration rates of retired, although rising, are still lower than the migration rates of the working age population and the Mediterranean coasts are also a destination for professionals who have the means to detach the job from the working place. Only a combination of conditions that enable migration and migration decisions, as well as a combination of motives and perceptions of reasons for migration, can partially "explain" retirement migration. One of the problems that has to be solved before retirement migration is affirmed as a concept is the treatment of the temporal and spatial dimension of the mobility of the retirement migrants. The author shows that a clear positioning of retirement migration on the temporal scale of mobility is hardly possible. Retirement migration is too wide and too complex a phenomenon to be easily localised in the temporal continuum. A similar problem emerges when the

  13. Delphi-RAND consensus of the Spanish Society of Internal Medicine on the controversies in anticoagulant therapy and prophylaxis in medical diseases. INTROMBIN Project (Uncertainty in thromboprophylaxis in internal medicine).

    Science.gov (United States)

    Ruiz-Ruiz, F; Medrano, F J; Navarro-Puerto, M A; Rodríguez-Torres, P; Romero-Alonso, A; Santos-Lozano, J M; Alonso-Ortiz Del Rio, C; Varela-Aguilar, J M; Calderón, E J; Marín-León, I

    2018-05-21

    The aim of this study was to determine the opinion of internists on the management of anticoagulation and thromboembolism prophylaxis in complex clinical scenarios in which the risk-benefit ratio of surgery is narrow and to develop a consensus document on the use of drugs anticoagulant therapy in this patient group. To this end, we identified by consensus the clinical areas of greatest uncertainty, a survey was created with 20 scenarios laid out in 40 clinical questions, and we reviewed the specific literature. The survey was distributed among the internists of the Spanish Society of Internal Medicine (SEMI) and was completed by 290 of its members. The consensus process was implemented by changing the Delphi-RAND appropriateness method in an anonymous, double-round process that enabled an expert panel to identify the areas of agreement and uncertainty. In our case, we also added the survey results to the panel, a methodological innovation that helps provide additional information on the standard clinical practice. The result of the process is a set of 19 recommendations formulated by SEMI experts, which helps establish guidelines for action on anticoagulant therapy in complex scenarios (high risk or active haemorrhage, short life expectancy, coexistence of antiplatelet therapy or comorbidities such as kidney disease and liver disease), which are not uncommon in standard clinical practice. Copyright © 2018 Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI). All rights reserved.

  14. Effectiveness of Dry Cow Therapy Comprising Antibiotic Treatment, Internal Teat Sealant, and α-Tocopherol Against New Intramammary Infections in Cows

    Directory of Open Access Journals (Sweden)

    Cengiz Mehmet

    2015-04-01

    Full Text Available The aim of this study was to evaluate the preventive effectiveness of dry cow therapy based on antibiotic, internal teat sealant, and α-tocopherol administered separately or in various combinations at drying-off The study was performed on 322 uninfected quarters of 95 cows originating from three dairy herds. The new intramammary infection rates after calving were measured to evaluate the effectiveness. The quarters were divided into six groups differing in treatment, namely: control group (group C, n = 40 and five treatment groups. Treatment groups were arranged as follows: group A (antibiotic alone, n = 81, group AS (antibiotic + sealant, n = 40, group AST (antibiotic + sealant + α-tocopherol, n = 40, group T (α-tocopherol alone, n = 40, group S (sealant alone, n = 81. New infection rate amounted to 47.5% in group C. The treatment in group AST significantly prevented from the occurrence of new intramammary infections (12.5%, P 0.05, although the use of the sealant alone (group S decreased the risk of new infection (24.7%, P 0.05. Increased α-tocopherol level (P < 0.05 was detected after calving in the quarters from cows that received α-tocopherol injections. In conclusion, the combination of antibiotic, internal teat sealant, and α-tocopherol used in dry cow therapy showed a significantly better preventive effect against new intramammary infections, than the therapeutics administered separately.

  15. First on-line survey of an international multidisciplinary working group (MightyMedic) on current practice in diagnosis, therapy and follow-up of dyslipidemias.

    Science.gov (United States)

    Stefanutti, C; D'Alessandri, G; Petta, A; Harada-Shiba, M; Julius, U; Soran, H; Moriarty, P M; Romeo, S; Drogari, E; Jaeger, B R

    2015-05-01

    The MightyMedic (Multidisciplinary International Group for Hemapheresis TherapY and MEtabolic DIsturbances Contrast) Working Group has been founded in 2013. The leading idea was to establish an international network of interdisciplinary nature aimed at working to cross national borders research projects, clinical trials, educational initiatives (meetings, workshops, summer schools) in the field of metabolic diseases, namely hyperlipidemias, and diabetes, preventive cardiology, and atherosclerosis. Therapeutic apheresis, its indications and techniques, is a parallel field of investigation. The first on-line survey of the Group has been completed in the first half of 2014. The survey included # 24 Centers in Italy, Germany, Greece, UK, Sweden, Japan and USA. Relevant data have been collected on current practice in diagnosis, therapy and follow-up of dyslipidemias. 240 subjects with hyperlipidemia and treated with lipoprotein apheresis have been reported in the survey, but a large percentage of patients (35%) who could benefit from this therapeutic option are still treated by conventional drug approach. Genetic molecular diagnosis is performed in only 33% of patients while Lipoprotein(a) (Lp(a)) is included in cardiovascular disease risk assessment in 71% of participating Centers. New detailed investigations and prospective multicenter studies are needed to evaluate changes induced by the impact of updated indications and strategies, as well as new treatment options, targeting standardization of therapeutic and diagnostic approaches. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  16. Open Abdomen Therapy with Vacuum and Mesh Mediated Fascial Traction After Aortic Repair: an International Multicentre Study.

    Science.gov (United States)

    Acosta, Stefan; Seternes, Arne; Venermo, Maarit; Vikatmaa, Leena; Sörelius, Karl; Wanhainen, Anders; Svensson, Mats; Djavani, Khatereh; Björck, Martin

    2017-12-01

    Open abdomen therapy may be necessary to prevent or treat abdominal compartment syndrome (ACS). The aim of the study was to analyse the primary delayed fascial closure (PDFC) rate and complications after open abdomen therapy with vacuum and mesh mediated fascial traction (VACM) after aortic repair and to compare outcomes between those treated with open abdomen after primary versus secondary operation. This was a retrospective cohort, multicentre study in Sweden, Finland, and Norway, including consecutive patients treated with open abdomen and VACM after aortic repair at six vascular centres in 2006-2015. The primary endpoint was PDFC rate. Among 191 patients, 155 were men. The median age was 71 years (IQR 66-76). Ruptured abdominal aortic aneurysm (RAAA) occurred in 69.1%. Endovascular/hybrid and open repairs were performed in 49 and 142 patients, respectively. The indications for open abdomen were inability to close the abdomen (62%) at primary operation and ACS (80%) at secondary operation. Duration of open abdomen was 11 days (IQR 7-16) in 157 patients alive at open abdomen termination. The PDFC rate was 91.8%. Open abdomen initiated at primary (N=103), compared with secondary operation (N=88), was associated with less severe initial open abdomen status (p=.006), less intestinal ischaemia (p=.002), shorter duration of open abdomen (p=.007), and less renal replacement therapy (RRT, popen abdomen initiated at primary versus secondary operation. VACM was associated with a high PDFC rate after prolonged open abdomen therapy following aortic repair. Patient outcomes seemed better when open abdomen was initiated at primary, compared with secondary operation but a selection effect is possible. Copyright © 2017 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.

  17. Modern Radiation Therapy for Nodal Non-Hodgkin Lymphoma—Target Definition and Dose Guidelines From the International Lymphoma Radiation Oncology Group

    Energy Technology Data Exchange (ETDEWEB)

    Illidge, Tim, E-mail: Tim.Illidge@ics.manchester.ac.uk [Institute of Cancer Sciences, University of Manchester, Manchester Academic Health Sciences Centre, The Christie National Health Service Foundation Trust, Manchester (United Kingdom); Specht, Lena [Department of Oncology and Hematology, Rigshospitalet, University of Copenhagen, Copenhagen (Denmark); Yahalom, Joachim [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Aleman, Berthe [Department of Radiotherapy, The Netherlands Cancer Institute, Amsterdam (Netherlands); Berthelsen, Anne Kiil [Department of Radiation Oncology and PET Centre, Rigshospitalet, University of Copenhagen, Copenhagen (Denmark); Constine, Louis [Departments of Radiation Oncology and Pediatrics, James P. Wilmot Cancer Center, University of Rochester Medical Center, Rochester, New York (United States); Dabaja, Bouthaina [Division of Radiation Oncology, Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Dharmarajan, Kavita [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Ng, Andrea [Department of Radiation Oncology, Brigham and Women' s Hospital and Dana-Farber Cancer Institute, Harvard University, Boston, Massachusetts (United States); Ricardi, Umberto [Radiation Oncology Unit, Department of Oncology, University of Torino, Torino (Italy); Wirth, Andrew [Division of Radiation Oncology, Peter MacCallum Cancer Institute, St. Andrews Place, East Melbourne (Australia)

    2014-05-01

    Radiation therapy (RT) is the most effective single modality for local control of non-Hodgkin lymphoma (NHL) and is an important component of therapy for many patients. Many of the historic concepts of dose and volume have recently been challenged by the advent of modern imaging and RT planning tools. The International Lymphoma Radiation Oncology Group (ILROG) has developed these guidelines after multinational meetings and analysis of available evidence. The guidelines represent an agreed consensus view of the ILROG steering committee on the use of RT in NHL in the modern era. The roles of reduced volume and reduced doses are addressed, integrating modern imaging with 3-dimensional planning and advanced techniques of RT delivery. In the modern era, in which combined-modality treatment with systemic therapy is appropriate, the previously applied extended-field and involved-field RT techniques that targeted nodal regions have now been replaced by limiting the RT to smaller volumes based solely on detectable nodal involvement at presentation. A new concept, involved-site RT, defines the clinical target volume. For indolent NHL, often treated with RT alone, larger fields should be considered. Newer treatment techniques, including intensity modulated RT, breath holding, image guided RT, and 4-dimensional imaging, should be implemented, and their use is expected to decrease significantly the risk for normal tissue damage while still achieving the primary goal of local tumor control.

  18. Efficacy of Second-line Targeted Therapy for Renal Cell Carcinoma According to Change from Baseline in International Metastatic Renal Cell Carcinoma Database Consortium Prognostic Category

    DEFF Research Database (Denmark)

    Davis, Ian D; Xie, Wanling; Pezaro, Carmel

    2017-01-01

    BACKGROUND: We hypothesized that changes in International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) prognostic category at start of second-line therapy (2L) for metastatic renal cell carcinoma (mRCC) might predict response. OBJECTIVE: To assess outcomes of 2L according to type...... of therapy and change in IMDC prognostic category. DESIGN, SETTING, AND PARTICIPANTS: We performed a retrospective review of the IMDC database for mRCC patients who received first-line (1L) VEGF inhibitors (VEGFi) and then 2L with VEGFi or mTOR inhibitors (mTORi). IMDC prognostic categories were defined......% confidence interval [CI] 12.0-19.0 for VEGFi; 20.2 mo, 95% CI 14.3-26.1 for mTORi; AHR 1.53, 95% CI 1.04-2.24; adjusted p=0.03). CONCLUSIONS: Changes in IMDC prognostic category predict the subsequent clinical course for patients with mRCC and provide a rational basis for selection of subsequent therapy...

  19. Peran Layanan Jasa Search Engine Optimization untuk Meningkatkan Daya Saing pada Bisnis Startup (Studi pada Kaldera Trail and Jeep Adventure Malang)

    OpenAIRE

    Wira Bharata

    2016-01-01

    This study aimed to investigate the role of SEO as a strategic competitive advantage. This study uses a qualitative approach with case studies are used as a research design. Researchers in the interviews to the owner Caldera Trail & Jeep Adventure. The results of this study indicate that the role of SEO to optimize the website proved successful in the company’s competitive advantage strategy Caldera Trail & Jeep Adventure. The results showed online marketing is done through Facebook, ...

  20. Comparison of cephalonium alone and in combination with an internal teat sealant for dry cow therapy in seasonally calving dairy cows.

    Science.gov (United States)

    Bates, A J; Chambers, G; Laven, R A

    2016-03-01

    To assess the effect of combining an internal teat sealant (ITS) and a long-acting cephalonium-based dry cow therapy (DCT) on the prevalence of cows with a somatic cell count (SCC) >150,000 cells/mL 60-80 days after calving, and the incidence of clinical mastitis diagnosed by farm staff in the first 100 days after calving. Cows from a spring-calving, pasture-based, dairy farm in the South Canterbury region of New Zealand were randomly allocated to receive cephalonium DCT (n=289) or cephalonium and internal teat sealant (n=304) at the end of lactation. Cows were inspected twice daily by farm staff during the dry period and following calving for signs of mastitis. Individual SCC were determined from herd tests conducted in the previous lactation and following calving. Logistic regression models were used to determine relationships with the prevalence of cows with a SCC >150,000 cells/mL after calving, and survival analysis was used to model time to the first case of clinical mastitis following calving at the cow and quarter level. The OR for a cow with a SCC >150,000 cells/mL after calving, including age and individual SCC in the preceding lactation in the model, was 0.53 (95% CI=0.32-0.89) for cows treated with combination therapy compared to cows receiving cephalonium (p=0.017). At the cow level, including age and preceding SCC in the model, the hazard ratio for diagnosis of clinical mastitis by farm staff in the first 100 days of lactation was 0.60 (95% CI=0.39-0.98) for cows treated with combination therapy compared to cows receiving cephalonium (p=0.04). At the quarter level, the hazard ratio for diagnosis of clinical mastitis, with age included in the model, was 0.41 (95% CI=0.23-0.74) for the combination therapy compared to cephalonium alone (pmastitis diagnosed by farm staff in the 100 days after calving, and the prevalence of cows with a SCC >150,000 cells/mL 60-80 days after calving. This study adds to the evidence that the prevention of intra mammary

  1. Detection of Esophageal Fiducial Marker Displacement During Radiation Therapy With a 2-dimensional On-board Imager: Analysis of Internal Margin for Esophageal Cancer

    International Nuclear Information System (INIS)

    Fukada, Junichi; Hanada, Takashi; Kawaguchi, Osamu; Ohashi, Toshio; Takeuchi, Hiroya; Kitagawa, Yuko; Seki, Satoshi; Shiraishi, Yutaka; Ogata, Haruhiko; Shigematsu, Naoyuki

    2013-01-01

    Purpose: To quantify the interfraction displacement of esophageal fiducial markers for primary esophageal cancer radiation therapy. Methods and Materials: Orthogonal 2-dimensional (2D) matching records fused to vertebrae were analyzed in clinically staged T1/2N0 esophageal cancer patients undergoing endoscopic clipping as fiducial metal markers. Displacement of the markers between the digitally reconstructed radiographs and on-board kilovoltage images during radiation therapy was analyzed according to direction and esophageal site. Results: Forty-four patients, with 81 markers (10 proximal, 42 middle, and 29 distal), underwent 367 2D matching sessions during radiation therapy. The mean (SD) absolute marker displacement was 0.26 (0.30) cm in the right–left (RL), 0.50 (0.39) cm in the superior–inferior (SI), and 0.24 (0.21) cm in the anterior–posterior (AP) direction. Displacement was significantly larger in the SI than in the RL and AP directions (P<.0001). In the SI direction, mean absolute displacements of the distal, middle, and proximal esophagus were 0.67 (0.45) cm, 0.42 (0.32) cm, and 0.36 (0.30) cm, respectively. Distal esophagus displacement was significantly larger than those of the middle and proximal esophagus (P<.0001). The estimated internal margin to cover 95% of the cases was 0.75 cm in the RL and AP directions. In the SI direction, the margin was 1.25 cm for the proximal and middle esophagus and 1.75 cm for the distal esophagus. Conclusions: The magnitude of interfraction displacement of esophageal clips was larger in the SI direction, particularly in the distal esophagus, but substantial displacement was observed in other directions and at other esophageal sites. It is practical to take estimated movements into account with internal margins, even if vertebrae-based 2D matching is performed

  2. David Bowie’s Influence on JoJo’s Bizarre Adventure

    Directory of Open Access Journals (Sweden)

    Francesco-Alessio Ursini

    2017-03-01

    Full Text Available This article analyses the influence of David Bowie’s work in JoJo’s Bizarre Adventure, a manga known for its wealth of references to western popular culture. It is argued that David Bowie’s cultural reception can be attested via the presence of three narrative themes featuring in this manga series. The first theme is the exploration of diverse genres and an innovative, genre-defying attitude. The second theme is the use of avant-garde, flamboyant and gender-ambiguous aesthetics for its fictional characters. The third theme is a self-reflexive approach to the creation of fictional characters, intended as an awareness of the temporary, transient nature of their role as reluctant heroes in their own stories.

  3. CFD Analysis of Square Flow Channel in Thermal Engine Rocket Adventurer for Space Nuclear Application

    International Nuclear Information System (INIS)

    Nam, S. H.; Suh, K. Y.; Kang, S. G.

    2008-01-01

    Solar system exploration relying on chemical rockets suffers from long trip time and high cost. In this regard nuclear propulsion is an attractive option for space exploration. The performance of Nuclear Thermal Rocket (NTR) is more than twice that of the best chemical rocket. Resorting to the pure hydrogen (H 2 ) propellant the NTRs can possibly achieve as high as 1,000 s of specific impulse (I sp ) representing the ratio of the thrust over the fuel consumption rate, as compared to only 425 s of H 2 /O 2 rockets. If we reflect on the mission to Mars, NTRs would reduce the round trip time to less than 300 days, instead of over 600 days with chemical rockets. This work presents CFD analysis of one Fuel Element (FE) of Thermal Engine Rocket Adventurer (TERA). In particular, one Square Flow Channel (SFC) is analyzed in Square Lattice Honeycomb (SLHC) fuel to examine the effects of mass flow rate on rocket performance

  4. RANCANG BANGUN APLIKASI PERMAINAN ADVENTURE OF FRUNIMAL UNTUK EDUKASI BAHASA INGGRIS BERBASIS ANDROID

    Directory of Open Access Journals (Sweden)

    Muhamad Ridwan

    2017-11-01

    Full Text Available Penelitian ini bertujuan untuk membangun sebuah aplikasi permainan berjenis platformer game yang menghibur dengan tema buah dan hewan dalam bahasa inggris, dan untuk mengetahui kualitas aplikasi permainan tersebut menggunakan standar ISO 25010 dari aspek functional suitability, performance efficiency, compatibility, dan usability. Hasil dari penelitian dapat diketahui bahwa game edukasi bahasa Inggris “Adventure of Frunimal” berhasil dikembangkan dengan game engine Construct2 dengan metode pengembangan Multimedia Luther. Pengujian pada aspek functional suitability sudah memenuhi standar AQuA, pada aspek performance efficiency sudah memenuhi ambang batas aman yang ditetapkan oleh Little Eye dan tidak terjadi memory leak, pada aspek compatibility dapat berjalan pada OS Android dari versi Ice Cream Sandwich sampai Marshmallow, dan pada aspek usability secara keseluruhan didapatkan hasil baik dalam hal kegunaan, mudah digunakan dan dipelajari serta memuaskan.

  5. Outbreak of Rickettsia africae infections in participants of an adventure race in South Africa.

    Science.gov (United States)

    Fournier, P E; Roux, V; Caumes, E; Donzel, M; Raoult, D

    1998-08-01

    African tick-bite fever, caused by Rickettsia africae and transmitted by Amblyomma ticks, is an emerging rickettsiosis in southern Africa. Because of increased tourism to this area, several cases in tourists have been reported recently. We report 13 cases of R. africae infection diagnosed in France that occurred in competitors returning from an adventure race in South Africa and compare our data with previously reported findings. Most of our patients presented with fever, headache, multiple inoculation eschars, and regional lymphadenopathies, but only 15.4% had a cutaneous rash. Diagnosis was confirmed either by isolation of R. africae from an eschar biopsy specimen or by serological methods, including cross-adsorption between R. africae and Rickettsia conorii. The purpose of this study was to raise physicians' awareness of R. africae infections in an attempt to facilitate the rapid diagnosis and treatment of imported African tick-bite fever in developed countries.

  6. Sonia-Ania-Alisa, or, Alice’s Adventures in Russianland

    Directory of Open Access Journals (Sweden)

    Ilaria Sicari

    2016-02-01

    Full Text Available Lewis Carroll’s Alice’s Adventures in Wonderland (1865 is a text rich of cultural and literary references to Victorian England. This feature is one of the major obstacles to translating this work since the transfer of cultural markers from source to target text often produces partial or total loss of certain nuances of meaning. The purpose of this paper is to analyze the Russian translations of Alice through a comparative study of three translation specimens (Nabokov 1923; Olenič-Gnenenko 1940; Demurova 1967, 1978, which constitute just as many methods (domestication, foreignization, hybridization. Through the study of some difficult cases of translation – proper names with culture-specific connotations, puns and parodies – I will highlight the specificities of these different versions to understand whether and how the translator’s choices have affected the reception of Wonderland in Russia.

  7. TRANSALPINA CAN EASILY BE CONSIDERED THE DIAMOND COUNTRY LANDSCAPES, ADVENTURE AND MYSTERY

    Directory of Open Access Journals (Sweden)

    Constanta ENEA

    2014-05-01

    Full Text Available If Transfăgărăşan is pearl Romanian mountains, the road easily qill be considered the diamond country landscapes, adventure and mystery. Hell 's Kitchen has developed and evolved naturally. Have no certainty of success and money required to carry out the infrastructure first and then see if investors come, so we can not blame the local authorities find here. The difficulties encountered in implementing funding programs made for funds to obtain hard enough. In this paper, I will briefly mention some ideas that could make the two cities, the holder of administratively to Rancière, the burgeoning tourist development area of Gorj County. I sincerely hope uhat there is among us and other people with vision who want to stand up and take action to provide a decent future for our children.

  8. Radiation Dose to the Esophagus From Breast Cancer Radiation Therapy, 1943-1996: An International Population-Based Study of 414 Patients

    Energy Technology Data Exchange (ETDEWEB)

    Lamart, Stephanie, E-mail: stephanie.lamart@nih.gov [Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland (United States); Stovall, Marilyn [Department of Radiation Physics, University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Simon, Steven L. [Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland (United States); Smith, Susan A.; Weathers, Rita E.; Howell, Rebecca M. [Department of Radiation Physics, University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Curtis, Rochelle E. [Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland (United States); Aleman, Berthe M.P. [Department of Radiotherapy, The Netherlands Cancer Institute, Amsterdam (Netherlands); Travis, Lois [Rubin Center for Cancer Survivorship and Department of Radiation Oncology, University of Rochester Medical Center, Rochester, New York (United States); Kwon, Deukwoo [Sylvester Comprehensive Cancer Center, University of Miami, Miami, Florida (United States); Morton, Lindsay M. [Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland (United States)

    2013-07-15

    Purpose: To provide dosimetric data for an epidemiologic study on the risk of second primary esophageal cancer among breast cancer survivors, by reconstructing the radiation dose incidentally delivered to the esophagus of 414 women treated with radiation therapy for breast cancer during 1943-1996 in North America and Europe. Methods and Materials: We abstracted the radiation therapy treatment parameters from each patient’s radiation therapy record. Treatment fields included direct chest wall (37% of patients), medial and lateral tangentials (45%), supraclavicular (SCV, 64%), internal mammary (IM, 44%), SCV and IM together (16%), axillary (52%), and breast/chest wall boosts (7%). The beam types used were {sup 60}Co (45% of fields), orthovoltage (33%), megavoltage photons (11%), and electrons (10%). The population median prescribed dose to the target volume ranged from 21 Gy to 40 Gy. We reconstructed the doses over the length of the esophagus using abstracted patient data, water phantom measurements, and a computational model of the human body. Results: Fields that treated the SCV and/or IM lymph nodes were used for 85% of the patients and delivered the highest doses within 3 regions of the esophagus: cervical (population median 38 Gy), upper thoracic (32 Gy), and middle thoracic (25 Gy). Other fields (direct chest wall, tangential, and axillary) contributed substantially lower doses (approximately 2 Gy). The cervical to middle thoracic esophagus received the highest dose because of its close proximity to the SCV and IM fields and less overlying tissue in that part of the chest. The location of the SCV field border relative to the midline was one of the most important determinants of the dose to the esophagus. Conclusions: Breast cancer patients in this study received relatively high incidental radiation therapy doses to the esophagus when the SCV and/or IM lymph nodes were treated, whereas direct chest wall, tangentials, and axillary fields contributed lower

  9. Radiation Dose to the Esophagus From Breast Cancer Radiation Therapy, 1943-1996: An International Population-Based Study of 414 Patients

    International Nuclear Information System (INIS)

    Lamart, Stephanie; Stovall, Marilyn; Simon, Steven L.; Smith, Susan A.; Weathers, Rita E.; Howell, Rebecca M.; Curtis, Rochelle E.; Aleman, Berthe M.P.; Travis, Lois; Kwon, Deukwoo; Morton, Lindsay M.

    2013-01-01

    Purpose: To provide dosimetric data for an epidemiologic study on the risk of second primary esophageal cancer among breast cancer survivors, by reconstructing the radiation dose incidentally delivered to the esophagus of 414 women treated with radiation therapy for breast cancer during 1943-1996 in North America and Europe. Methods and Materials: We abstracted the radiation therapy treatment parameters from each patient’s radiation therapy record. Treatment fields included direct chest wall (37% of patients), medial and lateral tangentials (45%), supraclavicular (SCV, 64%), internal mammary (IM, 44%), SCV and IM together (16%), axillary (52%), and breast/chest wall boosts (7%). The beam types used were 60 Co (45% of fields), orthovoltage (33%), megavoltage photons (11%), and electrons (10%). The population median prescribed dose to the target volume ranged from 21 Gy to 40 Gy. We reconstructed the doses over the length of the esophagus using abstracted patient data, water phantom measurements, and a computational model of the human body. Results: Fields that treated the SCV and/or IM lymph nodes were used for 85% of the patients and delivered the highest doses within 3 regions of the esophagus: cervical (population median 38 Gy), upper thoracic (32 Gy), and middle thoracic (25 Gy). Other fields (direct chest wall, tangential, and axillary) contributed substantially lower doses (approximately 2 Gy). The cervical to middle thoracic esophagus received the highest dose because of its close proximity to the SCV and IM fields and less overlying tissue in that part of the chest. The location of the SCV field border relative to the midline was one of the most important determinants of the dose to the esophagus. Conclusions: Breast cancer patients in this study received relatively high incidental radiation therapy doses to the esophagus when the SCV and/or IM lymph nodes were treated, whereas direct chest wall, tangentials, and axillary fields contributed lower doses

  10. Radiation dose to the esophagus from breast cancer radiation therapy, 1943-1996: an international population-based study of 414 patients.

    Science.gov (United States)

    Lamart, Stephanie; Stovall, Marilyn; Simon, Steven L; Smith, Susan A; Weathers, Rita E; Howell, Rebecca M; Curtis, Rochelle E; Aleman, Berthe M P; Travis, Lois; Kwon, Deukwoo; Morton, Lindsay M

    2013-07-15

    To provide dosimetric data for an epidemiologic study on the risk of second primary esophageal cancer among breast cancer survivors, by reconstructing the radiation dose incidentally delivered to the esophagus of 414 women treated with radiation therapy for breast cancer during 1943-1996 in North America and Europe. We abstracted the radiation therapy treatment parameters from each patient's radiation therapy record. Treatment fields included direct chest wall (37% of patients), medial and lateral tangentials (45%), supraclavicular (SCV, 64%), internal mammary (IM, 44%), SCV and IM together (16%), axillary (52%), and breast/chest wall boosts (7%). The beam types used were (60)Co (45% of fields), orthovoltage (33%), megavoltage photons (11%), and electrons (10%). The population median prescribed dose to the target volume ranged from 21 Gy to 40 Gy. We reconstructed the doses over the length of the esophagus using abstracted patient data, water phantom measurements, and a computational model of the human body. Fields that treated the SCV and/or IM lymph nodes were used for 85% of the patients and delivered the highest doses within 3 regions of the esophagus: cervical (population median 38 Gy), upper thoracic (32 Gy), and middle thoracic (25 Gy). Other fields (direct chest wall, tangential, and axillary) contributed substantially lower doses (approximately 2 Gy). The cervical to middle thoracic esophagus received the highest dose because of its close proximity to the SCV and IM fields and less overlying tissue in that part of the chest. The location of the SCV field border relative to the midline was one of the most important determinants of the dose to the esophagus. Breast cancer patients in this study received relatively high incidental radiation therapy doses to the esophagus when the SCV and/or IM lymph nodes were treated, whereas direct chest wall, tangentials, and axillary fields contributed lower doses. Published by Elsevier Inc.

  11. Extragalactic adventure

    International Nuclear Information System (INIS)

    Heidmann, J.

    1982-01-01

    The subject is covered in chapters, entitled: our galaxy and its hundred billion stars; galaxies, population of the Universe; radioastronomy, a deeper foray in space; spectra, valuable messengers; the expansion of the Universe and the Big Bang; Einstein's General Relativity Theory or gravitation by the curvature of space; curved spaces, surprising worlds; models of the Universe; space-time; cosmological horizons, limits of the Universe; the past of the Universe, from the primeval soup to us; the future of the Universe; anomalous spectral redshifts; quasars, at the boundaries of space; the Space Telescope, a new leap in knowledge; black holes and their fantastic properties; extraterrestrials. (U.K.)

  12. Alien Adventures

    Science.gov (United States)

    Hateley, Elliott

    2010-01-01

    It has been the author's experience that children are most engaged and eager to investigate, discover and learn when immersed in creativity, be it their own or that of other people. In this article, the author describes how he created a unique way to engage his class in learning about the solar system using reality television. The theme of the…

  13. Hydro adventurers

    International Nuclear Information System (INIS)

    Wood, Janet

    2000-01-01

    Some of the changes brought about by privatisation of the hydroelectric power industry in Ecuador are discussed. At present, about 25% of the population has no electricity supply; in the remaining areas demand is increasing. Seven new facilities are presently under discussion and these are described briefly. A plant at Abitugua is to be developed as a 'merchant plant' and the meaning and implications of this are described in detail. The present financing programme for Abituaga and an alternative financing programme are detailed. By 2010, some 40% of Ecuador's electricity is expected to come from hydro

  14. The validity and internal structure of the Bipolar Depression Rating Scale: data from a clinical trial of N-acetylcysteine as adjunctive therapy in bipolar disorder.

    Science.gov (United States)

    Berk, Michael; Dodd, Seetal; Dean, Olivia M; Kohlmann, Kristy; Berk, Lesley; Malhi, Gin S

    2010-10-01

    Berk M, Dodd S, Dean OM, Kohlmann K, Berk L, Malhi GS. The validity and internal structure of the Bipolar Depression Rating Scale: data from a clinical trial of N-acetylcysteine as adjunctive therapy in bipolar disorder. The phenomenology of unipolar and bipolar disorders differ in a number of ways, such as the presence of mixed states and atypical features. Conventional depression rating instruments are designed to capture the characteristics of unipolar depression and have limitations in capturing the breadth of bipolar disorder. The Bipolar Depression Rating Scale (BDRS) was administered together with the Montgomery Asberg Rating Scale (MADRS) and Young Mania Rating Scale (YMRS) in a double-blind randomised placebo-controlled clinical trial of N-acetyl cysteine for bipolar disorder (N = 75). A factor analysis showed a two-factor solution: depression and mixed symptom clusters. The BDRS has strong internal consistency (Cronbach's alpha = 0.917), the depression cluster showed robust correlation with the MADRS (r = 0.865) and the mixed subscale correlated with the YMRS (r = 0.750). The BDRS has good internal validity and inter-rater reliability and is sensitive to change in the context of a clinical trial.

  15. Investigation of osteosarcoma genomics and its impact on targeted therapy: an international collaboration to conquer human osteosarcoma

    OpenAIRE

    Yang, Ji-Long

    2014-01-01

    Osteosarcoma is a genetically unstable malignancy that most frequently occurs in children and young adults. The lack of progress in managing this devastating disease in the clinic has prompted international researchers to collaborate to profile key genomic alterations that define osteosarcoma. A team of researchers and clinicians from China, Finland, and the United States investigated human osteosarcoma by integrating transcriptome sequencing (RNA-seq), high-density genome-wide array comparat...

  16. Treatment of Atypical Ulnar Fractures Associated with Long-Term Bisphosphonate Therapy for Osteoporosis: Autogenous Bone Graft with Internal Fixation

    Directory of Open Access Journals (Sweden)

    Yohei Shimada

    2017-01-01

    Full Text Available Long-term bisphosphonate use has been suggested to result in decreased bone remodelling and an increased risk of atypical fractures. Fractures of this nature commonly occur in the femur, and relatively few reports exist to show that they occur in other bones. Among eight previous reports of atypical ulnar fractures associated with bisphosphonate use, one report described nonunion in a patient who was treated with cast immobilization and another described ulna nonunion in one of three patients, all of whom were treated surgically with a locking plate. The remaining two surgical patients achieved bone union uneventfully following resection of the osteosclerotic lesion and iliac bone grafting before rigid fixation. We hypothesized that the discontinuation of bisphosphonate therapy, the use of teriparatide treatment, and low-intensity pulsed ultrasound (LIPUS might have been associated with fracture healing.

  17. Therapy reduction in patients with Down syndrome and myeloid leukemia: the international ML-DS 2006 trial.

    Science.gov (United States)

    Uffmann, Madita; Rasche, Mareike; Zimmermann, Martin; von Neuhoff, Christine; Creutzig, Ursula; Dworzak, Michael; Scheffers, Lenie; Hasle, Henrik; Zwaan, C Michel; Reinhardt, Dirk; Klusmann, Jan-Henning

    2017-06-22

    Children with myeloid leukemia associated with Down syndrome (ML-DS) have superior outcome compared with non-DS patients, but suffer from higher constitutional cytotoxic drug susceptibility. We analyzed the outcome of 170 pediatric patients with ML-DS enrolled in the prospective, multicenter, open-label, nonrandomized ML-DS 2006 trial by Nordic Society for Pediatric Hematology and Oncology (NOPHO), Dutch Childhood Oncology Group (DCOG), and Acute Myeloid Leukemia-Berlin-Frankfurt-Münster (AML-BFM) study group. Compared with the historical control arm (reduced-intensity protocol for ML-DS patients from the AML-BFM 98 trial), treatment intensity was reduced by lowering the cumulative dose of etoposide (950 to 450 mg/m 2 ) and intrathecal central nervous system prophylaxis while omitting maintenance therapy. Still, 5-year overall survival (89% ± 3% vs 90% ± 4%; P log-rank = .64), event-free survival (EFS; 87% ± 3% vs 89% ± 4%; P log-rank = .71), and cumulative incidence of relapse/nonresponse (CIR/NR; 6% ± 3% vs 6% ± 2%; P Gray = .03) did not significantly differ between the ML-DS 2006 trial and the historical control arm. Poor early treatment response (5-year EFS, 58% ± 16% vs 88% ± 3%; P log rank = .0008) and gain of chromosome 8 (CIR/NR, 16% ± 7% vs 3% ± 2%, P Gray = .02; 5-year EFS, 73% ± 8% vs 91% ± 4%, P log rank = .018) were identified as independent prognostic factors predicting a worse EFS. Five of 7 relapsed patients (71%) with cytogenetic data had trisomy 8. Our study reveals prognostic markers for children with ML-DS and illustrates that reducing therapy did not impair excellent outcome. The trial was registered at EudraCT as #2007-006219-2. © 2017 by The American Society of Hematology.

  18. International open trial of uniform multidrug therapy regimen for leprosy patients: Findings & implications for national leprosy programmes.

    Science.gov (United States)

    Manickam, Ponnaiah; Mehendale, Sanjay M; Nagaraju, Bathyala; Katoch, Kiran; Jamesh, Abdul; Kutaiyan, Ramalingam; Jianping, Shen; Mugudalabetta, Shivakumar; Jadhav, Vitthal; Rajkumar, Prabu; Padma, Jayasree; Kaliaperumal, Kanagasabai; Pannikar, Vijayakumar; Krishnamurthy, Padabettu; Gupte, Mohan D

    2016-10-01

    Uniform therapy for all leprosy patients will simplify leprosy treatment. In this context, we evaluated six-month multidrug therapy (MDT) currently recommended for multibacillary (MB) patients as uniform MDT (U-MDT) in a single-arm open trial under programme conditions. Primary objective was to determine efficacy to prevent five-year cumulative five per cent relapse. Secondary objectives were to assess acceptability, safety and compliance. Newly detected, treatment-naive leprosy patients were enrolled in India (six sites) and P. R. China (two sites). Primary outcome was clinically confirmed relapse of occurrence of one or more new skin patches consistent with leprosy, without evidence of reactions post-treatment. Event rates per 100 person years as well as five-year cumulative risk of relapse, were calculated. A total of 2091 paucibacillary (PB) and 1298 MB leprosy patients were recruited from the 3437 patients screened. Among PB, two relapsed (rate=0.023; risk=0.11%), eight had suspected adverse drug reactions (ADRs) (rate=0.79) and rate of new lesions due toreactions was 0.24 (n=23). Rates of neuritis, type 1 and type 2 reactions were 0.39 (n=37), 0.54 (n=51) and 0.03 (n=3), respectively. Among MB, four relapsed (rate=0.07; risk=0.37%) and 16 had suspected ADR (rate=2.64). Rate of new lesions due to reactions among MB was 1.34 (n=76) and rates of neuritis, type 1 and type 2 reactions were 1.37 (n=78), 2.01 (n=114) and 0.49 (n=28), respectively. Compliance to U-MDT was 99 per cent. Skin pigmentation due to clofazimine was of short duration and acceptable. We observed low relapse, minimal ADR and other adverse clinical events. Clofazimine-related pigmentation was acceptable. Evidence supports introduction of U-MDT in national leprosy programmes. [CTRI No: 2012/ 05/ 002696].

  19. Investigating the experience of outdoor and adventurous project work in an educational setting using a self-determination framework

    OpenAIRE

    Sproule, J.; Martindale, R.; Wang, J.; Allison, P.; Nash, C.; Gray, S.

    2013-01-01

    The purpose of this study was to carry out a preliminary investigation to explore the use ofoutdoor and adventurous project work (PW) within an educational setting. Specifically, differencesbetween the PW and normal academic school experiences were examined using a selfdeterminationtheory framework integrated with a goal orientation and psychological skills perspective.Additionally, an exploratory investigation was carried out to examine the extent to which key motivation constructs predicted...

  20. The Impact of Adventure Based Activity at Malaysian National Service Training Programme on Team Cohesion: A Demographic Analysis.

    OpenAIRE

    Jaffry Zakaria; Mazuki Mohd Yasim; Md Amin Md Taff

    2012-01-01

    The present study examines the effects of physical module elements (adventure based activity) included in the Malaysian National Service Programme and to investigate the socio-demographic variables impact on team cohesion building among the participants. In this study, the participants were selected from three different camps, namely, Tasoh camp, Guar Chenderai camp and Meranti camp, located in the state of Perlis, Malaysia. The participants were those from the second batch intake in the yea...

  1. Outdoor adventure program builds confidence and competence to help new graduate RNs become "everyday" leaders at the point of care.

    Science.gov (United States)

    Greer-Day, Susan; Medland, Jackie; Watson, Lynn; Bojak, Sarah

    2015-01-01

    A nontraditional approach to leadership development promoted successful transition of new graduate RN residents to professional nurses. Utilizing an outdoor adventure program increased nurses' feelings of competence by boosting their confidence, facilitating an environment where leadership at the bedside became an ingrained part of their nursing practice. RN residents at a Midwestern medical center represented only 17% of the nursing population but reshaped the culture of the entire organization by becoming dynamic "everyday" leaders.

  2. Highlights from the 8th International Workshop on HIV Persistence during Therapy, 12-15 December 2017, Miami, FL, USA.

    Science.gov (United States)

    Psomas, Christina K; Lafeuillade, Alain; Margolis, David; Salzwedel, Karl; Stevenson, Mario; Chomont, Nicolas; Poli, Guido; Routy, Jean-Pierre

    2018-04-01

    Over 4 days, more than 500 scientists involved in HIV persistence research shared their new unpublished data and designed future perspectives towards ART-free HIV remission. This 8th International Workshop on HIV Persistence followed the format of past conferences but further focused on encouraging participation of young investigators, especially through submission of oral and poster presentations. The topic of the workshop was HIV persistence. Consequently, issues of HIV reservoirs and HIV cure were also addressed. In this article, we report the discussions as closely as possible; however, all the workshop abstracts can be found online at www.viruseradication.com.

  3. Medical Physics Staffing Needs in Diagnostic Imaging and Radionuclide Therapy: An Activity Based Approach [Endorsed by International Organization for Medical Physics

    International Nuclear Information System (INIS)

    2018-01-01

    Over the last decades, the rapid technological development of diagnostic and interventional radiology and nuclear medicine has made them major tools of modern medicine. However, at the same time the involved risks, the growing number of procedures and the increasing complexity of the procedures require competent professional staff to ensure safe and effective patient diagnosis, treatment and management. Medical physicists (or clinically qualified medical physicists) have been recognized as vital health professionals with important and clear responsibilities related to quality and safety of applications of ionizing radiation in medicine. This publication describes an algorithm developed to determine the recommended staffing levels for clinical medical physics services in medical imaging and radionuclide therapy, based on current best practice, as described in international guidelines.

  4. Risco e aventura no esporte na percepção do instrutor Risk and adventure in sport: instructor's perception

    Directory of Open Access Journals (Sweden)

    Jairo Antônio da Paixão

    2011-08-01

    Full Text Available O presente estudo analisa o risco na percepção de instrutores de esporte de aventura. A amostra foi constituída de 121 (cento e vinte e um instrutores de diferentes modalidades de esporte de aventura praticadas em Minas Gerais, com média de idade de 31 (trinta e um anos; considerou-se o desvio-padrão com significância This study analyzes the risk perceptions of adventure sports instructors. The sample consisted of 121 (one hundred and twenty-one instructors of different types of adventure sport practiced in Minas Gerais, with a mean age of 31 (thirty-one years. It was considered the standard deviation with significance >< 0,05%. The exploratory method was used in this study. Data collection took place from a questionnaire, validated in accordance with the Delphi technique, containing 15 items based on the theoretical literature. The results express that the risk perceived by the instructors is the most genuine risk-filled adventure of the sense of play. When considering procedures and recommendations that aim to predict, calculate and minimize the risk unexpected, it was found that the perception of risk by the instructors is due to an attitude which prevails in the domain of technique and quality equipment at the time these bodily practices close to nature.

  5. The implementation of risk management in adventurous activities in Greece: The «Trekking Hellas» company

    Directory of Open Access Journals (Sweden)

    ANNA DIMITRIADI

    2006-01-01

    Full Text Available Adventurous activities can be both beneficial and perilous for health, because the circumstances differ and because of external and not always controllable factors, which may influence the outcomes. Therefore, any company, which organises adventurous activities, needs to present effective risk management and valuable safety measures in order to respond to its participants’ safety and satisfaction. This study, which was performed in the Greek company «Trekking Hellas», aimed at asserting the importance of risk management for adventure tourism. The data that were collected through personal, semi – structured interviews with the company’s managers and participants have shown that the particular company has made notable attempts to establish an organised and well-controlled risk management. This has been accomplished through implementing a methodical risk assessment and operating all necessary safety measures. The research, also, discussed the influence that the above might have had on the clients’ motivation for participation. Finally, the data have pointed out the significance that risk management has for the success of every activity and in extent, for the success and promotion of the company.

  6. Detection of esophageal fiducial marker displacement during radiation therapy with a 2-dimensional on-board imager: analysis of internal margin for esophageal cancer.

    Science.gov (United States)

    Fukada, Junichi; Hanada, Takashi; Kawaguchi, Osamu; Ohashi, Toshio; Takeuchi, Hiroya; Kitagawa, Yuko; Seki, Satoshi; Shiraishi, Yutaka; Ogata, Haruhiko; Shigematsu, Naoyuki

    2013-03-15

    To quantify the interfraction displacement of esophageal fiducial markers for primary esophageal cancer radiation therapy. Orthogonal 2-dimensional (2D) matching records fused to vertebrae were analyzed in clinically staged T1/2N0 esophageal cancer patients undergoing endoscopic clipping as fiducial metal markers. Displacement of the markers between the digitally reconstructed radiographs and on-board kilovoltage images during radiation therapy was analyzed according to direction and esophageal site. Forty-four patients, with 81 markers (10 proximal, 42 middle, and 29 distal), underwent 367 2D matching sessions during radiation therapy. The mean (SD) absolute marker displacement was 0.26 (0.30) cm in the right-left (RL), 0.50 (0.39) cm in the superior-inferior (SI), and 0.24 (0.21) cm in the anterior-posterior (AP) direction. Displacement was significantly larger in the SI than in the RL and AP directions (Pdisplacements of the distal, middle, and proximal esophagus were 0.67 (0.45) cm, 0.42 (0.32) cm, and 0.36 (0.30) cm, respectively. Distal esophagus displacement was significantly larger than those of the middle and proximal esophagus (Pinternal margin to cover 95% of the cases was 0.75 cm in the RL and AP directions. In the SI direction, the margin was 1.25 cm for the proximal and middle esophagus and 1.75 cm for the distal esophagus. The magnitude of interfraction displacement of esophageal clips was larger in the SI direction, particularly in the distal esophagus, but substantial displacement was observed in other directions and at other esophageal sites. It is practical to take estimated movements into account with internal margins, even if vertebrae-based 2D matching is performed. Copyright © 2013 Elsevier Inc. All rights reserved.

  7. Stimulant use and its impact on growth in children receiving growth hormone therapy: an analysis of the KIGS International Growth Database.

    Science.gov (United States)

    Miller, Bradley S; Aydin, Ferah; Lundgren, Frida; Lindberg, Anders; Geffner, Mitchell E

    2014-01-01

    Children receiving stimulants for attention deficit hyperactivity disorder (ADHD) frequently present to pediatric endocrinology clinics for evaluation and treatment of growth disorders. The worldwide prevalence of stimulant use in children with ADHD also receiving recombinant human growth hormone (rhGH) and the impact on response to rhGH are unknown. Data on children enrolled in the KIGS® (Pfizer International Growth Study) registry were evaluated for the associated diagnosis of ADHD prior to initiation of Genotropin® rhGH. Concomitant stimulant medications and auxological information were captured. Response to rhGH was evaluated using established growth prediction models. The prevalence of ADHD in KIGS was 2.3% (1,748/75,251), with stimulants used in 1.8% (1,326/75,251). Children with idiopathic growth hormone deficiency (IGHD) who received stimulants grew significantly less (1.1 cm) in the first year of rhGH therapy than expected for rhGH-treated non-ADHD IGHD children. After one year of rhGH, idiopathic short stature (ISS) children with ADHD were significantly shorter [0.74 cm (with stimulants) and 0.69 cm (without stimulants)] than non-ADHD ISS children. We demonstrated an impaired response to rhGH in IGHD and ISS children with ADHD. Our findings suggest that the ADHD phenotype, alone or in conjunction with stimulant therapy, may impair the short-term growth response to rhGH.

  8. Type of Referral, Dialysis Start and Choice of Renal Replacement Therapy Modality in an International Integrated Care Setting.

    Science.gov (United States)

    Marrón, Belén; Ostrowski, Janusz; Török, Marietta; Timofte, Delia; Orosz, Attila; Kosicki, Andrzej; Całka, Alicja; Moro, Daniela; Kosa, Dezider; Redl, Jenö; Qureshi, Abdul Rashid; Divino-Filho, Jose Carolino

    2016-01-01

    Integrated Care Settings (ICS) provide a holistic approach to the transition from chronic kidney disease into renal replacement therapy (RRT), offering at least both types of dialysis. To analyze which factors determine type of referral, modality provision and dialysis start on final RRT in ICS clinics. Retrospective analysis of 626 patients starting dialysis in 25 ICS clinics in Poland, Hungary and Romania during 2012. Scheduled initiation of dialysis with a permanent access was considered as planned RRT start. Modality information (80% of patients) and renal education (87%) were more frequent (pregression analysis, P start (p≤0.05) was associated with early referral, eGFR >8.2 ml/min, >2 months between information and RRT initiation and with vascular etiology after adjustment for age and gender. "Optimal care," defined as ICS follow-up >12 months plus modality information and P start, occurred in 23%. Despite the high rate of late referrals, information and education were widely provided. However, NP start was high and related to late referral and may explain the low frequency of PD.

  9. Type of Referral, Dialysis Start and Choice of Renal Replacement Therapy Modality in an International Integrated Care Setting.

    Directory of Open Access Journals (Sweden)

    Belén Marrón

    Full Text Available Integrated Care Settings (ICS provide a holistic approach to the transition from chronic kidney disease into renal replacement therapy (RRT, offering at least both types of dialysis.To analyze which factors determine type of referral, modality provision and dialysis start on final RRT in ICS clinics.Retrospective analysis of 626 patients starting dialysis in 25 ICS clinics in Poland, Hungary and Romania during 2012. Scheduled initiation of dialysis with a permanent access was considered as planned RRT start.Modality information (80% of patients and renal education (87% were more frequent (p8.2 ml/min, >2 months between information and RRT initiation and with vascular etiology after adjustment for age and gender. "Optimal care," defined as ICS follow-up >12 months plus modality information and P start, occurred in 23%.Despite the high rate of late referrals, information and education were widely provided. However, NP start was high and related to late referral and may explain the low frequency of PD.

  10. Acidity-Triggered Tumor Retention/Internalization of Chimeric Peptide for Enhanced Photodynamic Therapy and Real-Time Monitoring of Therapeutic Effects.

    Science.gov (United States)

    Han, Kai; Zhang, Wei-Yun; Ma, Zhao-Yu; Wang, Shi-Bo; Xu, Lu-Ming; Liu, Jia; Zhang, Xian-Zheng; Han, He-You

    2017-05-17

    Photodynamic therapy (PDT) holds great promise in tumor treatment. Nevertheless, it remains highly desirable to develop easy-to-fabricated PDT systems with improved tumor accumulation/internalization and timely therapeutic feedback. Here, we report a tumor-acidity-responsive chimeric peptide for enhanced PDT and noninvasive real-time apoptosis imaging. Both in vitro and in vivo studies revealed that a tumor mildly acidic microenvironment could trigger rapid protonation of carboxylate anions in chimeric peptide, which led to increased ζ potential, improved hydrophobicity, controlled size enlargement, and precise morphology switching from sphere to spherocylinder shape of the chimeric peptide. All of these factors realized superfast accumulation and prolonged retention in the tumor region, selective cellular internalization, and enhanced PDT against the tumor. Meanwhile, this chimeric peptide could further generate reactive oxygen species and initiate cell apoptosis during PDT. The subsequent formation of caspase-3 enzyme hydrolyzed the chimeric peptide, achieving a high signal/noise ratio and timely fluorescence feedback. Importantly, direct utilization of the acidity responsiveness of a biofunctional Asp-Glu-Val-Asp-Gly (DEVDG, caspase-3 enzyme substrate) peptide sequence dramatically simplified the preparation and increased the performance of the chimeric peptide furthest.

  11. Relationship between internal dosimetry and DNA double strand breaks in lymphocytes after radionuclide therapy; Zusammenhang zwischen physikalischer Dosimetrie und DNA Doppelstrangbruechen in Lymphozyten nach Radionuklidtherapie

    Energy Technology Data Exchange (ETDEWEB)

    Eberlein, Uta

    2015-09-30

    In radionuclide therapy radiopharmaceuticals are administered mostly systemically. Primarily, beta-emitters are used because of their short range in tissue. As a result the radiopharmaceutical distributes within the human body and accumulates in organs and target structures. Thus, the body is irradiated internally, in contrast to external irradiation in radiotherapy. The pattern of the activity distribution within the human body is determined by the physical and chemical properties of the radiopharmaceutical. Furthermore, the amount of activity and its accumulation in organs or tissues is essential for the calculation of the absorbed dose which defines the energy deposited in the body by ionizing radiation. During internal or external irradiation, patients are exposed to ionizing radiation which does not only destroy the malignant cells but also damages healthy tissue and cells. This is mainly caused by direct and indirect interaction of the radiation with the DNA which damages the DNA structure. Most frequently, there are single strand breaks and base damages. DNA double strand breaks (DSBs) are rare; nevertheless, they are the most critical lesions for cells as repairing the damage is difficult. Unrepaired or misrepaired DNA could cause mutations, chromosomal aberrations or lead to cell death. The formation of a DNA DSB in nuclear chromatin results in the rapid phosphorylation of the histone H2 variant H2AX, then called gamma-H2AX. Furthermore, DSBs also recruit the damage sensor 53BP1 to the chromatin surrounding the DSBs, which leads to 53BP1 and gamma-H2AX co-localization in the chromatin surrounding a DSB. By immunofluorescence staining with gamma-H2AX and 53BP1 antibodies those biomarkers can be addressed by microscopically visible DNA damage protein foci, this is also known as the DNA damage focus assay. With progression of DSB repair, gamma-H2AX and 53BP1 foci disappear. It is assumed that one focus corresponds to one DSB. Therefore, the number of foci per

  12. Registration accuracy and possible migration of internal fiducial gold marker implanted in prostate and liver treated with real-time tumor-tracking radiation therapy (RTRT)

    International Nuclear Information System (INIS)

    Kitamura, Kei; Shirato, Hiroki; Shimizu, Shinichi; Shinohara, Nobuo; Harabayashi, Toru; Shimizu, Tadashi; Kodama, Yoshihisa; Endo, Hideho; Onimaru, Rikiya; Nishioka, Seiko; Aoyama, Hidefumi; Tsuchiya, Kazuhiko; Miyasaka, Kazuo

    2002-01-01

    Background and purpose: We have developed a linear accelerator synchronized with a fluoroscopic real-time tumor-tracking system to reduce errors due to setup and organ motion. In the real-time tumor-tracking radiation therapy (RTRT) system, the accuracy of tumor tracking depends on the registration of the marker's coordinates. The registration accuracy and possible migration of the internal fiducial gold marker implanted into prostate and liver was investigated. Materials and methods: Internal fiducial gold markers were implanted in 14 patients with prostate cancer and four patients with liver tumors. Computed tomography (CT) was carried out as a part of treatment planning in the 18 patients. A total of 72 follow-up CT scans were taken. We calculated the relative relationship between the coordinates of the center of mass (CM) of the organs and those of the marker. The discrepancy in the CM coordinates during a follow-up CT compared to those recorded during the planning CT was used to study possible marker migration. Results: The standard deviation (SD) of interobserver variations in the CM coordinates was within 2.0 and 0.4 mm for the organ and the marker, respectively, in seven observers. Assuming that organs do not shrink, grow, or rotate, the maximum SD of migration error in each direction was estimated to be less than 2.5 and 2.0 mm for liver and prostate, respectively. There was no correlation between the marker position and the time after implantation. Conclusion: The degree of possible migration of the internal fiducial marker was within the limits of accuracy of the CT measurement. Most of the marker movement can be attributed to the measurement uncertainty, which also influences registration in actual treatment planning. Thus, even with the gold marker and RTRT system, a planning target volume margin should be used to account for registration uncertainty

  13. Prescription appropriateness of empiric antibiotic therapy: survey in the internal medicine departments of the Emilia Romagna region

    Directory of Open Access Journals (Sweden)

    Giovanni Pedretti

    2014-05-01

    Full Text Available The article reports the results of an observational study conducted in 53 internal medicine departments of the Emilia Romagna region based on the answers to 54 questions administered in a questionnaire, submitted electronically, based on the type of center (large >250 beds, small <250 beds, laboratory equipment, management aspects, pharmacological and clinical/economic aspects and use of antibiotics in the empirical treatment of severe infections. The result is a snapshot of the existing situation which shows a substantial availability of resources and a good level of expertise in the field of infectious disease management, despite some areas still need improvement. It also highlights some differences in terms of procedures amongst large hospitals, where infectious diseases are treated by an ad hoc specialized staff, and the small ones, where the internist is generally involved, being responsible for both direct management of severe infections and giving advice to other departments (emergency or surgery. It emerged that, both in small and large hospitals, more discussion and continuous assessment are needed to apply the appropriate protocols based on reference checklists.

  14. A comparison of the effect of short-acting and long-acting cloxacillin-based dry-cow therapy on somatic cell counts after calving in cows also given internal teat sealants.

    Science.gov (United States)

    Whitfield, L K; Laven, R A

    2018-01-01

    To compare, in cows treated with an internal teat sealant, the effect of short-acting and long-acting cloxacillin-based dry-cow therapy on somatic cell counts (SCC) after calving. Cows from a spring-calving, pasture-based dairy farm in the Manawatu-Whanganui region of New Zealand were randomly allocated to receive either a short-acting cloxacillin and ampicillin dry-cow therapy and internal teat sealant (n=291) or a long-acting cloxacillin and ampicillin dry-cow therapy and internal teat sealant (n=288) at the end of lactation. Cows were managed on-farm with routine husbandry procedures through the dry period and following calving. A multivariable logistic regression model was used to determine the association between length of action of dry-cow therapy and the proportion of cows with a SCC >150,000 cells/mL at the first herd test after calving. Age of cow, mean SCC for the preceding season and interval from calving to the first post-calving herd test were all associated with the proportion of cows with an individual SCC >150,000 cells/mL at the first herd test (pcow therapy was not associated with decreased odds of cows having a SCC >150,000 cells/mL at the first herd test compared with treatment with long-acting dry-cow therapy (OR=0.724; 95% CI=0.40-1.30). In this herd, which routinely used internal teat sealants, the use of short-acting cloxacillin-based dry-cow therapy did not result in an increased proportion of cows with elevated SSC post-calving. This was a single farm, single year study but indicates that in this herd, changing from a long-acting to a short-acting antimicrobial may have no impact on the prevalence of subclinical mastitis.

  15. Evaluation of dual energy quantitative CT for determining the spatial distributions of red marrow and bone for dosimetry in internal emitter radiation therapy

    International Nuclear Information System (INIS)

    Goodsitt, Mitchell M.; Shenoy, Apeksha; Howard, David; Christodoulou, Emmanuel; Dewaraja, Yuni K.; Shen, Jincheng; Schipper, Matthew J.; Wilderman, Scott; Chun, Se Young

    2014-01-01

    Purpose: To evaluate a three-equation three-unknown dual-energy quantitative CT (DEQCT) technique for determining region specific variations in bone spongiosa composition for improved red marrow dose estimation in radionuclide therapy. Methods: The DEQCT method was applied to 80/140 kVp images of patient-simulating lumbar sectional body phantoms of three sizes (small, medium, and large). External calibration rods of bone, red marrow, and fat-simulating materials were placed beneath the body phantoms. Similar internal calibration inserts were placed at vertebral locations within the body phantoms. Six test inserts of known volume fractions of bone, fat, and red marrow were also scanned. External-to-internal calibration correction factors were derived. The effects of body phantom size, radiation dose, spongiosa region segmentation granularity [single (∼17 × 17 mm) region of interest (ROI), 2 × 2, and 3 × 3 segmentation of that single ROI], and calibration method on the accuracy of the calculated volume fractions of red marrow (cellularity) and trabecular bone were evaluated. Results: For standard low dose DEQCT x-ray technique factors and the internal calibration method, the RMS errors of the estimated volume fractions of red marrow of the test inserts were 1.2–1.3 times greater in the medium body than in the small body phantom and 1.3–1.5 times greater in the large body than in the small body phantom. RMS errors of the calculated volume fractions of red marrow within 2 × 2 segmented subregions of the ROIs were 1.6–1.9 times greater than for no segmentation, and RMS errors for 3 × 3 segmented subregions were 2.3–2.7 times greater than those for no segmentation. Increasing the dose by a factor of 2 reduced the RMS errors of all constituent volume fractions by an average factor of 1.40 ± 0.29 for all segmentation schemes and body phantom sizes; increasing the dose by a factor of 4 reduced those RMS errors by an average factor of 1.71 ± 0.25. Results

  16. Role of Internal Mammary Node Radiation as a Part of Modern Breast Cancer Radiation Therapy: A Systematic Review

    International Nuclear Information System (INIS)

    Verma, Vivek; Vicini, Frank; Tendulkar, Rahul D.; Khan, Atif J.; Wobb, Jessica; Edwards-Bennett, Sophia; Desai, Anand; Shah, Chirag

    2016-01-01

    Purpose: Despite data from multiple randomized trials, the role of internal mammary lymph node irradiation as a part of regional nodal irradiation (IMLN RT–RNI) remains unanswered. Recent noteworthy data and modern RT techniques might identify a subset of patients who will benefit from IMLN RT–RNI, lending insight into the balance between improved outcomes and acceptable toxicity. We evaluated the current role of IMLN RT–RNI by analyzing randomized, prospective, and retrospective data. Methods and Materials: In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a review of the published data was performed using PubMed to evaluate published studies from 1994 to 2015. The information evaluated included the number of patients, follow-up period, technical aspects of RT, and outcomes (clinical outcomes, complications/toxicity). Results: We included 16 studies (4 randomized, 4 nonrandomized, 7 retrospective, and 1 meta-analysis). Although older randomized trials failed to show differences in clinical outcomes or toxicity with IMLN RT–RNI, recent randomized data suggest the potential for improved outcomes, including overall survival, with IMLN RT–RNI. Furthermore, nonrandomized data have suggested a potential benefit for central tumors with IMLN RT–RNI. Although recent data have suggested a potential increase in pulmonary complications with IMLN RT–RNI with the use of advanced radiation techniques, toxicity rates remain low with limited cardiac toxicity data available. Conclusions: Increasing data from recent randomized trials support the use of IMLN RT–RNI. IMLN RT can be considered based on the inclusion of IMLN RT as a part of RNI in recent trials and the inclusion criteria from IMLN RT–RNI trials and for patients with central or medial tumors and axillary disease.

  17. Role of Internal Mammary Node Radiation as a Part of Modern Breast Cancer Radiation Therapy: A Systematic Review

    Energy Technology Data Exchange (ETDEWEB)

    Verma, Vivek [Department of Radiation Oncology, University of Nebraska Medical Center, Omaha, Nebraska (United States); Vicini, Frank [Michigan Healthcare Professionals/21st Century Oncology, Farmington Hills, Michigan (United States); Tendulkar, Rahul D. [Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio (United States); Khan, Atif J. [Department of Radiation Oncology, Rutgers Robert Wood Johnson Medical School and the Cancer Institute of New Jersey, New Brunswick, New Jersey (United States); Wobb, Jessica [Department of Radiation Oncology, Ohio State University, Columbus, Ohio (United States); Edwards-Bennett, Sophia [21st Century Oncology, Myrtle Beach, South Carolina (United States); Desai, Anand [Department of Radiation Oncology, Summa Health System, Akron, Ohio (United States); Shah, Chirag, E-mail: csshah27@hotmail.com [Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio (United States)

    2016-06-01

    Purpose: Despite data from multiple randomized trials, the role of internal mammary lymph node irradiation as a part of regional nodal irradiation (IMLN RT–RNI) remains unanswered. Recent noteworthy data and modern RT techniques might identify a subset of patients who will benefit from IMLN RT–RNI, lending insight into the balance between improved outcomes and acceptable toxicity. We evaluated the current role of IMLN RT–RNI by analyzing randomized, prospective, and retrospective data. Methods and Materials: In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a review of the published data was performed using PubMed to evaluate published studies from 1994 to 2015. The information evaluated included the number of patients, follow-up period, technical aspects of RT, and outcomes (clinical outcomes, complications/toxicity). Results: We included 16 studies (4 randomized, 4 nonrandomized, 7 retrospective, and 1 meta-analysis). Although older randomized trials failed to show differences in clinical outcomes or toxicity with IMLN RT–RNI, recent randomized data suggest the potential for improved outcomes, including overall survival, with IMLN RT–RNI. Furthermore, nonrandomized data have suggested a potential benefit for central tumors with IMLN RT–RNI. Although recent data have suggested a potential increase in pulmonary complications with IMLN RT–RNI with the use of advanced radiation techniques, toxicity rates remain low with limited cardiac toxicity data available. Conclusions: Increasing data from recent randomized trials support the use of IMLN RT–RNI. IMLN RT can be considered based on the inclusion of IMLN RT as a part of RNI in recent trials and the inclusion criteria from IMLN RT–RNI trials and for patients with central or medial tumors and axillary disease.

  18. Gender Trouble in Conan Doyle’s “The Adventure of the Solitary Cyclist”

    Directory of Open Access Journals (Sweden)

    Kitsi-Mitakou Katerina

    2016-12-01

    Full Text Available Although the Victorian period was a time when the sexes were assigned distinct and complementary roles, these rigid gender-role divisions between the two sexes were beginning to dissolve as the nineteenth century was drawing to its close. Among the various factors that contributed to bringing the two genders closer was the cycling boom of the 1890s, and the first-wave feminists embraced the bicycle as a freedom machine and symbol of emancipation. Despite the fact, though, that cycling functioned at first as a gender equaliser, , it eventually segregated the sexes, as social norms promoted the idea of gendered cycling and enforced a model of domesticated or feminised cycling for women. This essay aims to explore how Arthur Conan Doyle’s 1895 story “The Adventure of the Solitary Cyclist” reflects this complicated impact that cycling had on gender segregation and the possibilities it offered for gender fusion as well as the alternative expressions of sexuality it enabled.

  19. Videojuegos como herramienta en Educación Primaria: caso de estudio con eAdventure

    Directory of Open Access Journals (Sweden)

    Solano Nogales, Luis

    2016-12-01

    Full Text Available Los videojuegos son herramientas interactivas y sociales de aprendizaje de la Web 2.0, con las que los usuarios pueden jugar, participar, comunicarse y aprender, creando y sacando partido de los contenidos. No obstante el profesorado necesita formación para exprimir de forma eficaz estas herramientas. Con el ánimo de comprobar la eficacia del videojuego como herramienta de enseñanza en el aula, en este artículo se presenta un estudio de caso de la adopción de los videojuegos en Educación Primaria, donde la herramienta eAdventure se ha utilizado para impartir una Unidad Didáctica de la asignatura Ciencias de la Naturaleza a alumnos de siete años. La conclusión a la que se ha llegado tras su realización es que los videojuegos pueden ser utilizados como herramientas educativas y las principales fortalezas de su uso en clase son: (i la reducción en la temporalización a la hora de impartir un contenido y (ii el incremento en la atención de los alumnos.

  20. "Once more a kingly quest": Fan games and the classic adventure genre

    Directory of Open Access Journals (Sweden)

    Anastasia Marie Salter

    2009-03-01

    Full Text Available The classic adventure games—part of the earliest traditions of interactive narrative—have not disappeared, although they no longer occupy space on the shelves at the local computer store. Even as changing hardware and operating systems render these games of the 1980s and 1990s literally unplayable without emulating the computer systems of the past, fans are keeping these stories alive. Authorship of these games has changed hands: it is now under the control of the fans, the former and current players. Through the online sharing of fan-created game design tool sets and of the fan-created games themselves, these new coauthors create a haven to revisit these decades-old games using fresh eyes and fresh systems. The products of these folk art–reminiscent efforts also offer a venue to reconsider video game fandom in light of genres. They also allow us to understand these "personal games," productions of one or more people that are not intended for commercial sale, as carrying the heritage of the classic era forward into the next generation of gaming.

  1. CFD Analysis of Square Flow Channel in Thermal Engine Rocket Adventurer for Space Nuclear Application

    Energy Technology Data Exchange (ETDEWEB)

    Nam, S. H.; Suh, K. Y. [Seoul National University, Seoul (Korea, Republic of); Kang, S. G. [PHILOSOPHIA, Inc., Seoul (Korea, Republic of)

    2008-10-15

    Solar system exploration relying on chemical rockets suffers from long trip time and high cost. In this regard nuclear propulsion is an attractive option for space exploration. The performance of Nuclear Thermal Rocket (NTR) is more than twice that of the best chemical rocket. Resorting to the pure hydrogen (H{sub 2}) propellant the NTRs can possibly achieve as high as 1,000 s of specific impulse (I{sub sp}) representing the ratio of the thrust over the fuel consumption rate, as compared to only 425 s of H{sub 2}/O{sub 2} rockets. If we reflect on the mission to Mars, NTRs would reduce the round trip time to less than 300 days, instead of over 600 days with chemical rockets. This work presents CFD analysis of one Fuel Element (FE) of Thermal Engine Rocket Adventurer (TERA). In particular, one Square Flow Channel (SFC) is analyzed in Square Lattice Honeycomb (SLHC) fuel to examine the effects of mass flow rate on rocket performance.

  2. Tourists’ Satisfaction at Trijuginarayan: An Emerging Spiritual and Adventure Tourist Destination in Garhwal Himalaya India

    Directory of Open Access Journals (Sweden)

    S.C. Bagri

    2015-10-01

    Full Text Available Tourists’ satisfaction has been acknowledged as one of the most important elements of competitive advantage and formulating effective destination management strategies because it is a reliable standard to evaluate performance of tangible and intangible elements of tourism products and services. The purpose of this study is to investigate tourists’ satisfaction by examining the relationship between destination attribute importance and performance in a tourist destination. Trijuginarayan, an emerging spiritual and adventure tourist destination located in Garhwal Himalaya in Uttarakhand state of India was selected as the study area for this research. Importance-Performance Analysis was employed to examine the relationship between importance and performance of various destination attributes. Results revealed that attributes related to tourism product of spiritual and cultural nature, atmosphere and climate, a variety of tourist activities, hospitality and safety are significant factors in determining tourist satisfaction, whereas basic facilities such as accommodation, transportation, tourism infrastructure and hygiene and sanitation at destination are of significant importance in satisfaction evaluation. Findings also reveal that tourists were satisfied with the core products, but were dissatisfied with basic tourist facilities offered at the destination. The findings alert concerned tourism stakeholders for outlining effective strategies for holistic development and improving performance of attributes in a given destination.

  3. [Efficacy of the program "Testas's (mis)adventures" to promote the deep approach to learning].

    Science.gov (United States)

    Rosário, Pedro; González-Pienda, Julio Antonio; Cerezo, Rebeca; Pinto, Ricardo; Ferreira, Pedro; Abilio, Lourenço; Paiva, Olimpia

    2010-11-01

    This paper provides information about the efficacy of a tutorial training program intended to enhance elementary fifth graders' study processes and foster their deep approaches to learning. The program "Testas's (mis)adventures" consists of a set of books in which Testas, a typical student, reveals and reflects upon his life experiences during school years. These life stories are nothing but an opportunity to present and train a wide range of learning strategies and self-regulatory processes, designed to insure students' deeper preparation for present and future learning challenges. The program has been developed along a school year, in a one hour weekly tutorial sessions. The training program had a semi-experimental design, included an experimental group (n=50) and a control one (n=50), and used pre- and posttest measures (learning strategies' declarative knowledge, learning approaches and academic achievement). Data suggest that the students enrolled in the training program, comparing with students in the control group, showed a significant improvement in their declarative knowledge of learning strategies and in their deep approach to learning, consequently lowering their use of a surface approach. In spite of this, in what concerns to academic achievement, no statistically significant differences have been found.

  4. Assessment techniques for a learning-centered curriculum: evaluation design for adventures in supercomputing

    Energy Technology Data Exchange (ETDEWEB)

    Helland, B. [Ames Lab., IA (United States); Summers, B.G. [Oak Ridge National Lab., TN (United States)

    1996-09-01

    As the classroom paradigm shifts from being teacher-centered to being learner-centered, student assessments are evolving from typical paper and pencil testing to other methods of evaluation. Students should be probed for understanding, reasoning, and critical thinking abilities rather than their ability to return memorized facts. The assessment of the Department of Energy`s pilot program, Adventures in Supercomputing (AiS), offers one example of assessment techniques developed for learner-centered curricula. This assessment has employed a variety of methods to collect student data. Methods of assessment used were traditional testing, performance testing, interviews, short questionnaires via email, and student presentations of projects. The data obtained from these sources have been analyzed by a professional assessment team at the Center for Children and Technology. The results have been used to improve the AiS curriculum and establish the quality of the overall AiS program. This paper will discuss the various methods of assessment used and the results.

  5. Oxigenoterapia en vuelos nacionales e internacionales en la Argentina Oxygen therapy during Argentine-based national and international flights

    Directory of Open Access Journals (Sweden)

    Alejandro Martínez Fraga

    2008-12-01

    Full Text Available No existe estudio que evalúe el estado de la oxigenoterapia en vuelo (OV en nuestro país. El objetivo de este estudio fue evaluar los requisitos, dificultades, sistemas y costos de la OV de las companías aéreas nacionales (N e internacionales (I que operan desde Buenos Aires. Se utilizó la misma encuesta telefónica y metodología que el estudio de Stoller y col.12. Los autores se comunicaron telefónicamente con 25 aerolíneas que operaban en los dos aeropuertos de Buenos Aires en julio de 2007, y se interrogó sobre los requisitos necesarios para viajar, sistemas y costos. Se usaron técnicas estadísticas convencionales siendo significativa pThere are no data about supplemental oxygen in flight in our country. The objective of our study was to evaluate arranging in-flight-oxygen required by a simulated traveler, system of administration and costs, and to compare the results between Argentine-based (A and international (I airlines. The questionnaire used was similar to that of Stoller et al12. Data collection consisted of telephone calls placed by one of the authors to all commercial air carriers listed in our two Buenos Aires City airports during July 2007. A structured interview with questions was addressed on issues that an oxygen-using air traveler would need to arrange in-flight oxygen. Of the 25 airlines, 6 were discarded because of lack of information (24%, three A -60%-and one I-16%-. All A allowed in-flightoxygen vs. 80% of I (p<0.05, 100% of A and 94% of I required a medical certificate (p=NS; 71% of A and 100% of I required previous notification (p<0.05; 50% of A and 87% of I provided patient interphases of oxygen administration (p=NS. Free of charge oxygen could be provided by 100% of A and 50% of I, with airline charge between 70 to 300 dollars. In conclusion, we observed different policies, rules, availability, and a pronounced lack of standardization of airline information. The cost of oxygen was very different between

  6. Evaluation of results and radiologic follow-up in detachable balloon occlusion therapy of the internal carotid artery aneurysms

    International Nuclear Information System (INIS)

    Chung, Sun Yang; Kim, Dong Ik; Lee, Kyu Chang; Huh, Seung Kon; Yoon, Pyeong Ho; Choi, Jin Young; Kim, Dong Jun

    1999-01-01

    The author has studied the clinical results of CT and MR findings of proximal carotid artery occlusion using detachable balloons in the treatement of unclippable internal carotid (IC) aneurysms. From 1987 to 1995, twenty-eight patients with IC aneurysms were treated by proximal artery occlusion with detachable balloons. Of these patients, 4 had aneurysms arising from the supraclinoid portion of the IC artery, 23 had aneuryms arising from cavernous portion of the IC artery, and one had aneurysm arising from cervical portion of the IC artery. Of the 28 patients, 7 patients without CT or MR examinations were excluded in this study. The mean follow-up period was 18.6 months. The causes of aneurysm formation were spontaneous in 17 cases and traumatic in 4 cases. Of 20 patients with aneurysms arising from supraclinoid and cavernous portion of the IC artery, 16 patients (80%) had cranial nerve symptoms by mass effect. Five patients had epistaxis (3 patient), carotid cavernous fistula (1 patient) or subarachnoid hemorrhage (1 patient) due to aneurysm rupture. Two patients, each with aneuryms arising from supraclinoid and cervical portion of carotid artery had 9th and 12th cranial nerve symptom. There were three instances of complication after permanent occlusion; two patients had subarachnoid and intracerebral hemorrhage by aneurysm rupture and expired. One patient had ischemia of posterior cerebral artery teritorry after one day. Delayed ischemic event did not occur during the follow-up period. All aneurysms of the carotid artery below the level of ophthalmic artery presented radiographic proof of complete thrombosis within two months. However, complete thrombosis of aneurysm was considerably delayed in two aneurysms arising from the supraclinoid portion of the carotid artery. In long-term follow-up study, completely thrombosed aneurysms decreased in size slowly. But incompletely thrombosed aneurysms did not decrease in size for a long time and began to contract after

  7. Evaluation of results and radiologic follow-up in detachable balloon occlusion therapy of the internal carotid artery aneurysms

    Energy Technology Data Exchange (ETDEWEB)

    Chung, Sun Yang; Kim, Dong Ik; Lee, Kyu Chang; Huh, Seung Kon; Yoon, Pyeong Ho; Choi, Jin Young; Kim, Dong Jun [Yonsei Univ. College of Medicine, Seoul (Korea, Republic of)

    1999-06-01

    The author has studied the clinical results of CT and MR findings of proximal carotid artery occlusion using detachable balloons in the treatement of unclippable internal carotid (IC) aneurysms. From 1987 to 1995, twenty-eight patients with IC aneurysms were treated by proximal artery occlusion with detachable balloons. Of these patients, 4 had aneurysms arising from the supraclinoid portion of the IC artery, 23 had aneuryms arising from cavernous portion of the IC artery, and one had aneurysm arising from cervical portion of the IC artery. Of the 28 patients, 7 patients without CT or MR examinations were excluded in this study. The mean follow-up period was 18.6 months. The causes of aneurysm formation were spontaneous in 17 cases and traumatic in 4 cases. Of 20 patients with aneurysms arising from supraclinoid and cavernous portion of the IC artery, 16 patients (80%) had cranial nerve symptoms by mass effect. Five patients had epistaxis (3 patient), carotid cavernous fistula (1 patient) or subarachnoid hemorrhage (1 patient) due to aneurysm rupture. Two patients, each with aneuryms arising from supraclinoid and cervical portion of carotid artery had 9th and 12th cranial nerve symptom. There were three instances of complication after permanent occlusion; two patients had subarachnoid and intracerebral hemorrhage by aneurysm rupture and expired. One patient had ischemia of posterior cerebral artery teritorry after one day. Delayed ischemic event did not occur during the follow-up period. All aneurysms of the carotid artery below the level of ophthalmic artery presented radiographic proof of complete thrombosis within two months. However, complete thrombosis of aneurysm was considerably delayed in two aneurysms arising from the supraclinoid portion of the carotid artery. In long-term follow-up study, completely thrombosed aneurysms decreased in size slowly. But incompletely thrombosed aneurysms did not decrease in size for a long time and began to contract after

  8. Autologous Transplantation in Follicular Lymphoma with Early Therapy Failure: A National LymphoCare Study and Center for International Blood and Marrow Transplant Research Analysis.

    Science.gov (United States)

    Casulo, Carla; Friedberg, Jonathan W; Ahn, Kwang W; Flowers, Christopher; DiGilio, Alyssa; Smith, Sonali M; Ahmed, Sairah; Inwards, David; Aljurf, Mahmoud; Chen, Andy I; Choe, Hannah; Cohen, Jonathon; Copelan, Edward; Farooq, Umar; Fenske, Timothy S; Freytes, Cesar; Gaballa, Sameh; Ganguly, Siddhartha; Jethava, Yogesh; Kamble, Rammurti T; Kenkre, Vaishalee P; Lazarus, Hillard; Lazaryan, Aleksandr; Olsson, Richard F; Rezvani, Andrew R; Rizzieri, David; Seo, Sachiko; Shah, Gunjan L; Shah, Nina; Solh, Melham; Sureda, Anna; William, Basem; Cumpston, Aaron; Zelenetz, Andrew D; Link, Brian K; Hamadani, Mehdi

    2017-12-11

    Patients with follicular lymphoma (FL) experiencing early therapy failure (ETF) within 2 years of frontline chemoimmunotherapy have poor overall survival (OS). We analyzed data from the Center for International Blood and Marrow Transplant Research (CIBMTR) and the National LymphoCare Study (NLCS) to determine whether autologous hematopoietic cell transplant (autoHCT) can improve outcomes in this high-risk FL subgroup. ETF was defined as failure to achieve at least partial response after frontline chemoimmunotherapy or lymphoma progression within 2 years of frontline chemoimmunotherapy. We identified 2 groups: the non-autoHCT cohort (patients from the NLCS with ETF not undergoing autoHCT) and the autoHCT cohort (CIBMTR patients with ETF undergoing autoHCT). All patients received rituximab-based chemotherapy as frontline treatment; 174 non-autoHCT patients and 175 autoHCT patients were identified and analyzed. There was no difference in 5-year OS between the 2 groups (60% versus 67%, respectively; P = .16). A planned subgroup analysis showed that patients with ETF receiving autoHCT soon after treatment failure (≤1 year of ETF; n = 123) had higher 5-year OS than those without autoHCT (73% versus 60%, P = .05). On multivariate analysis, early use of autoHCT was associated with significantly reduced mortality (hazard ratio, .63; 95% confidence interval, .42 to .94; P = .02). Patients with FL experiencing ETF after frontline chemoimmunotherapy lack optimal therapy. We demonstrate improved OS when receiving autoHCT within 1 year of treatment failure. Results from this unique collaboration between the NLCS and CIBMTR support consideration of early consolidation with autoHCT in select FL patients experiencing ETF. Copyright © 2017 The American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. All rights reserved.

  9. Endosonographic and manometric evaluation of internal anal sphincter in patients with chronic anal fissure and its correlation with clinical outcome after topical glyceryl trinitrate therapy.

    Science.gov (United States)

    Pascual, Marta; Pera, Miguel; Courtier, Ricard; Gil, Mariá José; Parés, David; Puig, Sonia; Andreu, Montserrat; Grande, Luis

    2007-08-01

    Anorectal pressure studies have demonstrated internal anal sphincter (IAS) hypertonia in patients with chronic anal fissure. It is unknown however, if these changes in IAS function are associated with any abnormality in sphincter morphology. The first aim was to investigate the clinical characteristics and the manometric and endosonographic findings of the IAS in a cohort of patients with chronic anal fissure. The second aim was to investigate the association between these findings and the outcome with topical Glyceryl trinitrate (GTN) therapy. All patients who presented with chronic anal fissure from November 1999 to May 2004 were included after failure of conservative therapy. Anorectal manometry and anal endosonography were performed before treatment with 0.2% GTN ointment twice daily was initiated. Patients were evaluated after 8 weeks. One hundred and twenty-four patients (66 women, mean age, 45.2 +/- 14.8 years) were included. Hypertonia of the IAS was found in 84 (68%) patients. The mean maximum IAS thickness was 3.6 +/- 0.76 mm (1.6-5.5). An abnormally thick IAS, adjusted by age, was observed in 113 (91.1%) patients. We found no correlation between resting pressure and IAS thickness (r = 0.074; p = 0.41). At 8 weeks, 52 patients (42%) had healed with complete symptoms resolution. No statistically significant differences were observed when clinical features and manometric and endosonographic findings were compared between healing and no-healing fissures. The majority of patients with chronic anal fissure present an abnormally thick IAS. Clinical, manometric and endosonographic features had no association with outcome after GTN treatment.

  10. Potential dosimetric benefits of adaptive tumor tracking over the internal target volume concept for stereotactic body radiation therapy of pancreatic cancer.

    Science.gov (United States)

    Karava, Konstantina; Ehrbar, Stefanie; Riesterer, Oliver; Roesch, Johannes; Glatz, Stefan; Klöck, Stephan; Guckenberger, Matthias; Tanadini-Lang, Stephanie

    2017-11-09

    Radiotherapy for pancreatic cancer has two major challenges: (I) the tumor is adjacent to several critical organs and, (II) the mobility of both, the tumor and its surrounding organs at risk (OARs). A treatment planning study simulating stereotactic body radiation therapy (SBRT) for pancreatic tumors with both the internal target volume (ITV) concept and the tumor tracking approach was performed. The two respiratory motion-management techniques were compared in terms of doses to the target volume and organs at risk. Two volumetric-modulated arc therapy (VMAT) treatment plans (5 × 5 Gy) were created for each of the 12 previously treated pancreatic cancer patients, one using the ITV concept and one the tumor tracking approach. To better evaluate the overall dose delivered to the moving tumor volume, 4D dose calculations were performed on four-dimensional computed tomography (4DCT) scans. The resulting planning target volume (PTV) size for each technique was analyzed. Target and OAR dose parameters were reported and analyzed for both 3D and 4D dose calculation. Tumor motion ranged from 1.3 to 11.2 mm. Tracking led to a reduction of PTV size (max. 39.2%) accompanied with significant better tumor coverage (p<0.05, paired Wilcoxon signed rank test) both in 3D and 4D dose calculations and improved organ at risk sparing. Especially for duodenum, stomach and liver, the mean dose was significantly reduced (p<0.05) with tracking for 3D and 4D dose calculations. By using an adaptive tumor tracking approach for respiratory-induced pancreatic motion management, a significant reduction in PTV size can be achieved, which subsequently facilitates treatment planning, and improves organ dose sparing. The dosimetric benefit of tumor tracking is organ and patient-specific.

  11. Good practices in health care "management experimentation models": insights from an international public-private partnership on transplantation and advanced specialized therapies.

    Science.gov (United States)

    Longo, Maria Cristina

    2015-01-01

    The research analyzes good practices in health care "management experimentation models," which fall within the broader range of the integrative public-private partnerships (PPPs). Introduced by the Italian National Healthcare System in 1991, the "management experimentation models" are based on a public governance system mixed with a private management approach, a patient-centric orientation, a shared financial risk, and payment mechanisms correlated with clinical outcomes, quality, and cost-savings. This model makes public hospitals more competitive and efficient without affecting the principles of universal coverage, solidarity, and equity of access, but requires higher financial responsibility for managers and more flexibility in operations. In Italy the experience of such experimental models is limited but successful. The study adopts the case study methodology and refers to the international collaboration started in 1997 between two Italian hospitals and the University of Pittsburgh Medical Center (UPMC - Pennsylvania, USA) in the field of organ transplants and biomedical advanced therapies. The research allows identifying what constitutes good management practices and factors associated with higher clinical performance. Thus, it allows to understand whether and how the management experimentation model can be implemented on a broader basis, both nationwide and internationally. However, the implementation of integrative PPPs requires strategic, cultural, and managerial changes in the way in which a hospital operates; these transformations are not always sustainable. The recognition of ISMETT's good management practices is useful for competitive benchmarking among hospitals specialized in organ transplants and for its insights on the strategies concerning the governance reorganization in the hospital setting. Findings can be used in the future for analyzing the cross-country differences in productivity among well-managed public hospitals.

  12. Diffusion-weighted magnetic resonance imaging predicts survival in patients with liver-predominant metastatic colorectal cancer shortly after selective internal radiation therapy

    Energy Technology Data Exchange (ETDEWEB)

    Schmeel, Frederic Carsten; Simon, Birgit; Luetkens, Julian Alexander; Traeber, Frank; Schmeel, Leonard Christopher; Schild, Hans Heinz; Hadizadeh, Dariusch Reza [University Hospital Bonn, Rheinische-Friedrich-Wilhelms-Universitaet Bonn, Department of Radiology, Bonn (Germany); Sabet, Amir [University Hospital Bonn, Rheinische-Friedrich-Wilhelms-Universitaet Bonn, Department of Nuclear Medicine, Bonn (Germany); University Hospital Essen, Universitaet Duisburg-Essen, Department of Nuclear Medicine, Essen (Germany); Ezziddin, Samer [University Hospital Bonn, Rheinische-Friedrich-Wilhelms-Universitaet Bonn, Department of Nuclear Medicine, Bonn (Germany); University Hospital Saarland, Universitaet des Saarlandes, Department of Nuclear Medicine, Homburg (Germany)

    2017-03-15

    To investigate whether quantifications of apparent diffusion coefficient (ADC) on diffusion-weighted imaging (DWI) can predict overall survival (OS) in patients with liver-predominant metastatic colorectal cancer (CRC) following selective internal radiation therapy with {sup 90}Yttrium-microspheres (SIRT). Forty-four patients underwent DWI 19 ± 16 days before and 36 ± 10 days after SIRT. Tumour-size and intratumoral minimal ADC (minADC) values were measured for 132 liver metastases on baseline and follow-up DWI. Optimal functional imaging response to treatment was determined by receiver operating characteristics and defined as ≥22 % increase in post-therapeutic minADC. Survival analysis was performed with the Kaplan-Meier method and Cox-regression comparing various variables with potential impact on OS. Median OS was 8 months. The following parameters were significantly associated with median OS: optimal functional imaging response (18 vs. 5 months; p < 0.001), hepatic tumour burden <50 % (8 vs. 5 months; p = 0.018), Eastern Cooperative Oncology Group performance scale <1 (10 vs. 4 months; p = 0.012) and progressive disease according to Response and Evaluation Criteria in Solid Tumours (8 vs. 3 months; p = 0.001). On multivariate analysis, optimal functional imaging response and hepatic tumour burden remained independent predictors of OS. Functional imaging response assessment using minADC changes on DWI may predict survival in CRC shortly after SIRT. (orig.)

  13. The Applicability of the International Staging System in Chinese Patients with Multiple Myeloma Receiving Bortezomib or Thalidomide-Based Regimens as Induction Therapy: A Multicenter Analysis

    Directory of Open Access Journals (Sweden)

    Jing Lu

    2015-01-01

    Full Text Available The International Staging System (ISS is the most important prognostic system for multiple myeloma (MM. It was identified in the era of conventional agents. The outcome of MM has significantly changed by novel agents. Thus the applicability of ISS system in the era of novel agents in Chinese patients needs to be demonstrated. We retrospectively analyzed the clinical outcomes and prognostic significance of ISS system in 1016 patients with newly diagnosed multiple myeloma in Chinese patients between 2008 and 2012, who received bortezomib- or thalidomide-based regimens as first-line therapy. The median overall survival (OS of patients for ISS stages I/II/III was not reached/55.4 months/41.7 months (p<0.001, and the median progression-free survival (PFS was 30/29.5/25 months (p=0.072, respectively. Statistically significant difference in survival was confirmed among three ISS stages in thalidomide-based group, but not between ISS stages I and II in bortezomib-based group. These findings suggest that ISS system can predict the survival in the era of novel agents in Chinese MM patients, and bortezomib may have the potential to partially overcome adverse effect of risk factors on survival, especially in higher stage of ISS system.

  14. WE-DE-201-06: Impact of Temporal Image Coregistration Methods On 3D Internal Dose Calculations in Targeted Radionuclide Therapy

    Energy Technology Data Exchange (ETDEWEB)

    Besemer, A; Marsh, I; Bednarz, B [University of Wisconsin, Madison, WI (United States)

    2016-06-15

    Purpose: The calculation of 3D internal dose calculations in targeted radionuclide therapy requires the acquisition and temporal coregistration of a serial PET/CT or SPECT/CT images. This work investigates the dosimetric impact of different temporal coregistration methods commonly used for 3D internal dosimetry. Methods: PET/CT images of four mice were acquired at 1, 24, 48, 72, 96, 144 hrs post-injection of {sup 124}I-CLR1404. The therapeutic {sup 131}I-CLR1404 absorbed dose rate (ADR) was calculated at each time point using a Geant4-based MC dosimetry platform using three temporal image coregistration Methods: (1) no coregistration (NC), whole body sequential CT-CT affine coregistration (WBAC), and individual sequential ROI-ROI affine coregistration (IRAC). For NC, only the ROI mean ADR was integrated to obtain ROI mean doses. For WBAC, the CT at each time point was coregistered to a single reference CT. The CT transformations were applied to the corresponding ADR images and the dose was calculated on a voxel-basis within the whole CT volume. For IRAC, each individual ROI was isolated and sequentially coregistered to a single reference ROI. The ROI transformations were applied to the corresponding ADR images and the dose was calculated on a voxel-basis within the ROI volumes. Results: The percent differences in the ROI mean doses were as large as 109%, 88%, and 32%, comparing the WBAC vs. IRAC, NC vs. IRAC, and NC vs. WBAC methods, respectively. The CoV in the mean dose between the all three methods ranged from 2–36%. The pronounced curvature of the spinal cord was not adequately coregistered using WBAC which resulted in large difference between the WBAC and IRAC. Conclusion: The method used for temporal image coregistration can result in large differences in 3D internal dosimetry calculations. Care must be taken to choose the most appropriate method depending on the imaging conditions, clinical site, and specific application. This work is partially funded by

  15. Evolutions of Advanced Stamping CAE -- Technology Adventures and Business Impact on Automotive Dies and Stamping

    International Nuclear Information System (INIS)

    Wang Chuantao

    2005-01-01

    In the past decade, sheet metal forming and die development has been transformed to a science-based and technology-driven engineering and manufacturing enterprise from a tryout-based craft. Stamping CAE, especially the sheet metal forming simulation, as one of the core components in digital die making and digital stamping, has played a key role in this historical transition. The stamping simulation technology and its industrial applications have greatly impacted automotive sheet metal product design, die developments, die construction and tryout, and production stamping. The stamping CAE community has successfully resolved the traditional formability problems such as splits and wrinkles. The evolution of the stamping CAE technology and business demands opens even greater opportunities and challenges to stamping CAE community in the areas of (1) continuously improving simulation accuracy, drastically reducing simulation time-in-system, and improving operationalability (friendliness) (2) resolving those historically difficult-to-resolve problems such as dimensional quality problems (springback and twist) and surface quality problems (distortion and skid/impact lines) (3) resolving total manufacturability problems in line die operations including blanking, draw/redraw, trim/piercing, and flanging, and (4) overcoming new problems in forming new sheet materials with new forming techniques. In this article, the author first provides an overview of the stamping CAE technology adventures and achievements, and industrial applications in the past decade. Then the author presents a summary of increasing manufacturability needs from the formability to total quality and total manufacturability of sheet metal stampings. Finally, the paper outlines the new needs and trends for continuous improvements and innovations to meet increasing challenges in line die formability and quality requirements in automotive stamping

  16. Pathways to designing and running an operational flood forecasting system: an adventure game!

    Science.gov (United States)

    Arnal, Louise; Pappenberger, Florian; Ramos, Maria-Helena; Cloke, Hannah; Crochemore, Louise; Giuliani, Matteo; Aalbers, Emma

    2017-04-01

    In the design and building of an operational flood forecasting system, a large number of decisions have to be taken. These include technical decisions related to the choice of the meteorological forecasts to be used as input to the hydrological model, the choice of the hydrological model itself (its structure and parameters), the selection of a data assimilation procedure to run in real-time, the use (or not) of a post-processor, and the computing environment to run the models and display the outputs. Additionally, a number of trans-disciplinary decisions are also involved in the process, such as the way the needs of the users will be considered in the modelling setup and how the forecasts (and their quality) will be efficiently communicated to ensure usefulness and build confidence in the forecasting system. We propose to reflect on the numerous, alternative pathways to designing and running an operational flood forecasting system through an adventure game. In this game, the player is the protagonist of an interactive story driven by challenges, exploration and problem-solving. For this presentation, you will have a chance to play this game, acting as the leader of a forecasting team at an operational centre. Your role is to manage the actions of your team and make sequential decisions that impact the design and running of the system in preparation to and during a flood event, and that deal with the consequences of the forecasts issued. Your actions are evaluated by how much they cost you in time, money and credibility. Your aim is to take decisions that will ultimately lead to a good balance between time and money spent, while keeping your credibility high over the whole process. This game was designed to highlight the complexities behind decision-making in an operational forecasting and emergency response context, in terms of the variety of pathways that can be selected as well as the timescale, cost and timing of effective actions.

  17. Evolutions of Advanced Stamping CAE — Technology Adventures and Business Impact on Automotive Dies and Stamping

    Science.gov (United States)

    Wang, Chuantao (C. T.)

    2005-08-01

    In the past decade, sheet metal forming and die development has been transformed to a science-based and technology-driven engineering and manufacturing enterprise from a tryout-based craft. Stamping CAE, especially the sheet metal forming simulation, as one of the core components in digital die making and digital stamping, has played a key role in this historical transition. The stamping simulation technology and its industrial applications have greatly impacted automotive sheet metal product design, die developments, die construction and tryout, and production stamping. The stamping CAE community has successfully resolved the traditional formability problems such as splits and wrinkles. The evolution of the stamping CAE technology and business demands opens even greater opportunities and challenges to stamping CAE community in the areas of (1) continuously improving simulation accuracy, drastically reducing simulation time-in-system, and improving operationalability (friendliness), (2) resolving those historically difficult-to-resolve problems such as dimensional quality problems (springback and twist) and surface quality problems (distortion and skid/impact lines), (3) resolving total manufacturability problems in line die operations including blanking, draw/redraw, trim/piercing, and flanging, and (4) overcoming new problems in forming new sheet materials with new forming techniques. In this article, the author first provides an overview of the stamping CAE technology adventures and achievements, and industrial applications in the past decade. Then the author presents a summary of increasing manufacturability needs from the formability to total quality and total manufacturability of sheet metal stampings. Finally, the paper outlines the new needs and trends for continuous improvements and innovations to meet increasing challenges in line die formability and quality requirements in automotive stamping.

  18. SU-F-J-137: Intrafractional Change of the Relationship Between Internal Fiducials and External Breathing Signal in Pancreatic Cancer Stereotactic Body Radiation Therapy

    Energy Technology Data Exchange (ETDEWEB)

    Pettersson, N; Murphy, J; Simpson, D; Cervino, L [University of California, San Diego, La Jolla, CA (United States)

    2016-06-15

    Purpose: The use of respiratory gating for management of breathing motion during stereotactic body radiation therapy (SBRT) relies on a consistent relationship between the breathing signal and the actual position of the internal target. This relationship was investigated in patients treated for pancreatic cancer. Methods: Four patients with pancreatic cancer undergoing SBRT that had implanted fiducials in the tumor were included in this study. Treatment plans were generated based on the exhale phases (30–70%) from the pre-treatment 4DCT. The margin between the internal target volume (ITV) and the planning target volume was three mm. After patient setup using cone-beam CT, simultaneous fluoroscopic imaging and breathing motion monitoring were used during at least three breathing cycles to verify the fiducial position and to optimize the gating window. After treatment, fluoroscopic images were acquired for verification purposes and exported for retrospective analyses. Fiducial positions were determined using a template-matching algorithm. For each dataset, we established a linear relationship between the fiducial position and the anterior-posterior (AP) breathing signal. The relationships before and after treatment were compared and the dose distribution impact evaluated. Results: Seven pre- and post-treatment fluoroscopic pairs were available for fiducial position analyses in the superior-inferior (SI) and left-right (LR) directions, and five in the AP direction. Time between image acquisitions was typically six to eight minutes. An average absolute change of 1.2±0.7 mm (range: 0.1–1.7) of the SI fiducial position relative to the external signal was found. Corresponding numbers for the LR and AP fiducial positions were 0.9±1.0 mm (range: 0.2–3.0) and 0.5±0.4 mm (range: 0.2–1.2), respectively. The dose distribution impact was small in both the ITV and organs-at-risk. Conclusion: The relationship change between fiducial position and external breathing

  19. SU-F-J-137: Intrafractional Change of the Relationship Between Internal Fiducials and External Breathing Signal in Pancreatic Cancer Stereotactic Body Radiation Therapy

    International Nuclear Information System (INIS)

    Pettersson, N; Murphy, J; Simpson, D; Cervino, L

    2016-01-01

    Purpose: The use of respiratory gating for management of breathing motion during stereotactic body radiation therapy (SBRT) relies on a consistent relationship between the breathing signal and the actual position of the internal target. This relationship was investigated in patients treated for pancreatic cancer. Methods: Four patients with pancreatic cancer undergoing SBRT that had implanted fiducials in the tumor were included in this study. Treatment plans were generated based on the exhale phases (30–70%) from the pre-treatment 4DCT. The margin between the internal target volume (ITV) and the planning target volume was three mm. After patient setup using cone-beam CT, simultaneous fluoroscopic imaging and breathing motion monitoring were used during at least three breathing cycles to verify the fiducial position and to optimize the gating window. After treatment, fluoroscopic images were acquired for verification purposes and exported for retrospective analyses. Fiducial positions were determined using a template-matching algorithm. For each dataset, we established a linear relationship between the fiducial position and the anterior-posterior (AP) breathing signal. The relationships before and after treatment were compared and the dose distribution impact evaluated. Results: Seven pre- and post-treatment fluoroscopic pairs were available for fiducial position analyses in the superior-inferior (SI) and left-right (LR) directions, and five in the AP direction. Time between image acquisitions was typically six to eight minutes. An average absolute change of 1.2±0.7 mm (range: 0.1–1.7) of the SI fiducial position relative to the external signal was found. Corresponding numbers for the LR and AP fiducial positions were 0.9±1.0 mm (range: 0.2–3.0) and 0.5±0.4 mm (range: 0.2–1.2), respectively. The dose distribution impact was small in both the ITV and organs-at-risk. Conclusion: The relationship change between fiducial position and external breathing

  20. Feasibility, safety and outcomes of playing Kinect Adventures!™ for people with Parkinson's disease: a pilot study.

    Science.gov (United States)

    Pompeu, J E; Arduini, L A; Botelho, A R; Fonseca, M B F; Pompeu, S M A A; Torriani-Pasin, C; Deutsch, J E

    2014-06-01

    To assess the feasibility, safety and outcomes of playing Microsoft Kinect Adventures™ for people with Parkinson's disease in order to guide the design of a randomised clinical trial. Single-group, blinded trial. Rehabilitation Center of São Camilo University, Brazil. Seven patients (six males, one female) with Parkinson's disease (Hoehn and Yahr Stages 2 and 3). Fourteen 60-minute sessions, three times per week, playing four games of Kinect Adventures! The feasibility and safety outcomes were patients' game performance and adverse events, respectively. The clinical outcomes were the 6-minute walk test, Balance Evaluation System Test, Dynamic Gait Index and Parkinson's Disease Questionnaire (PDQ-39). Patients' scores for the four games showed improvement. The mean [standard deviation (SD)] scores in the first and last sessions of the Space Pop game were 151 (36) and 198 (29), respectively [mean (SD) difference 47 (7), 95% confidence interval 15 to 79]. There were no adverse events. Improvements were also seen in the 6-minute walk test, Balance Evaluation System Test, Dynamic Gait Index and PDQ-39 following training. Kinect-based training was safe and feasible for people with Parkinson's disease (Hoehn and Yahr Stages 2 and 3). Patients improved their scores for all four games. No serious adverse events occurred during training with Kinect Adventures!, which promoted improvement in activities (balance and gait), body functions (cardiopulmonary aptitude) and participation (quality of life). Copyright © 2013 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.

  1. Going beyond: an adventure- and recreation-based group intervention promotes well-being and weight loss in schizophrenia.

    Science.gov (United States)

    Voruganti, Lakshmi N P; Whatham, Jeff; Bard, Eleanor; Parker, Gayle; Babbey, Candice; Ryan, Janet; Lee, Suganya; MacCrimmon, Duncan J

    2006-08-01

    To undertake a preliminary study to assess the feasibility of clinical implementation and evaluate the effectiveness of a novel adventure- and recreation-based group intervention in the rehabilitation of individuals with schizophrenia. In a 2-year, prospective, case-control study, 23 consecutively referred, clinically stabilized schizophrenia patients received the new intervention over an 8-month period; 31 patients on the wait list, considered the control group, received standard clinical care that included some recreational activities. Symptom severity, self-esteem, self-appraised cognitive abilities, and functioning were documented for both groups with standardized rating scales administered at baseline, on completion of treatment, and at 12 months posttreatment. Treatment adherence was 97%, and there were no dropouts. Patients in the study group showed marginal improvement in perceived cognitive abilities and on domain-specific functioning measures but experienced a significant improvement in their self-esteem and global functioning (P < 0.05), as well as a weight loss of over 12 lb. Improvement was sustained over 1 year with further occupational and social gains. In the context of overcoming barriers to providing early intervention for youth and preventing metabolic problems among older adults with schizophrenia, adventure- and recreation-based interventions could play a useful complementary role.

  2. Secrets of the Sediments: Using ANDRILL's Scientific Adventure on Ice to Transfer Climate Change Science to K-12 Audiences

    Science.gov (United States)

    Huffman, L. T.; Dahlman, L.; Frisch-Gleason, R.; Harwood, D.; Pound, K.; Rack, F.; Riesselman, C.; Trummel, E.; Tuzzi, E.; Winter, D.

    2008-12-01

    Antarctica's harsh environment and the compelling story of living and working there, provides the backdrop for hooking the interest of young learners on science research and the nature of science. By using the adventure stories of today's researcher-explorers, teachers accompanying the ANDRILL team have taken the technical science of drilling rock cores to understand the history of climate change and the advance and retreat of the Antarctic ice sheet, and translated it for non-technical audiences from K-12 school children, to adult community groups. In order to understand the important issues surrounding global climate change, members of the public need access to accurate and relevant information, high quality educational materials, and a variety of learning opportunities in different learning environments. By taking lessons learned from early virtual polar adventure learning expeditions like Will Steger's Trans-Antarctic Expedition, coupled with educators-in-the-field programs like TEA (Teachers Experiencing Antarctica and the Arctic), ARMADA and Polar Trec, ANDRILL's Education and Outreach Program has evolved into successful and far-reaching integrated education projects including 1) the ARISE (ANDRILL Research Immersion for Science Educators) Program, 2) Climate Change Student Summits, 3) the development of Flexhibit (flexible exhibit) teaching resources, 4) virtual online learning communities, and 5) partnering young researchers with teachers and classrooms. Formal evaluations indicate lasting interest in science studies on the part of students and an increase in teachers' scientific background knowledge.

  3. STUDENT’S SOFT SKILL ACQUISITION IN AN OUTDOOR ADVENTURE EDUCATION EVENT OVER TWO YEARS OF PARTICIPATION

    Directory of Open Access Journals (Sweden)

    S.J. Roos

    2016-07-01

    Full Text Available Outdoor Adventure Education can be used to develop and hone the transferable orso called soft skills such as group work and problem-solving skills in highereducation. These skills are also much needed to ensure employability. An outdooradventure activity was developed and implemented by lecturers in order to bridgethis gap between university and the industry in order to hone the transferableskills of students studying sport and recreation. Data were collected over twoyears. Two hundred students participated in the research study with a mean age of22±4 years. Data were collected qualitatively and analysed and subsequentlynumerically coded to ensure statistical analyses. Analyses indicated no statisticaldifferences between skills learned in the first and second year. Students were thendivided into first time and second time participants and statistical differences werefound. The second time participants reported mostly on leadership skills learnedand first time participants on teamwork. Implementingan outdoor AdventureEducation event was effective in developing skills in students much needed for success in higher education as well as becoming well-rounded individuals whompossess all the qualities for rewarding employment.

  4. Extreme event medicine: considerations for the organisation of out-of-hospital care during obstacle, adventure and endurance competitions.

    Science.gov (United States)

    Laskowski-Jones, Linda; Caudell, Michael J; Hawkins, Seth C; Jones, Lawrence J; Dymond, Chelsea A; Cushing, Tracy; Gupta, Sanjey; Young, David S; Starling, Jennifer M; Bounds, Richard

    2017-10-01

    Obstacle, adventure and endurance competitions in challenging or remote settings are increasing in popularity. A literature search indicates a dearth of evidence-based research on the organisation of medical care for wilderness competitions. The organisation of medical care for each event is best tailored to specific race components, participant characteristics, geography, risk assessments, legal requirements, and the availability of both local and outside resources. Considering the health risks and logistical complexities inherent in these events, there is a compelling need for guiding principles that bridge the fields of wilderness medicine and sports medicine in providing a framework for the organisation of medical care delivery during wilderness and remote obstacle, adventure and endurance competitions. This narrative review, authored by experts in wilderness and operational medicine, provides such a framework. The primary goal is to assist organisers and medical providers in planning for sporting events in which participants are in situations or locations that exceed the capacity of local emergency medical services resources. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  5. Boosted selective internal radiation therapy with 90Y-loaded glass microspheres (B-SIRT) for hepatocellular carcinoma patients: a new personalized promising concept

    International Nuclear Information System (INIS)

    Garin, E.; Lenoir, L.; Edeline, J.; Laffont, S.; Mesbah, H.; Poree, P.; Sulpice, L.; Boudjema, K.; Mesbah, M.; Guillygomarc'h, A.; Quehen, E.; Pracht, M.; Raoul, J.L.; Clement, B.; Rolland, Y.; Boucher, E.

    2013-01-01

    To evaluate the impact of dosimetry based on MAA SPECT/CT for the prediction of response, toxicity and survival, and for treatment planning in patients with hepatocellular carcinoma (HCC) treated with 90 Y-loaded glass microspheres (TheraSphere registered). TheraSphere registered was administered to 71 patients with inoperable HCC. MAA SPECT/CT quantitative analysis was used for the calculation of the tumour dose (TD), healthy injected liver dose (HILD), and total injected liver dose. Response was evaluated at 3 months using EASL criteria. Time to progression (TTP) and overall survival (OS) were evaluated using the Kaplan-Meier method. Factors potentially associated with liver toxicity were combined to construct a liver toxicity score (LTS). The response rate was 78.8 %. Median TD were 342 Gy for responding lesions and 191 Gy for nonresponding lesions (p 205 Gy (p = 0.0015 and not significant). Among patients with portal vein thrombosis (PVT) (n = 33), the median TTP and OS were 4.5 months (2-7 months) and 5 months (2-8 months), respectively, in patients with TD 205 Gy (p = 0.039 and 0.005). The median OS was 24.5 months (18-28.5 months) in PVT patients with TD >205 Gy and good PVT targeting on MAA SPECT/CT. The LTS was able to detect severe liver toxicity (n = 6) with a sensitivity of 83 % and overall accuracy of 97 %. Dosimetry based on MAA SPECT/CT was able to accurately predict response and survival in patients treated with glass microspheres. This method can be used to adapt the injected activity without increasing liver toxicity, thus defining a new concept of boosted selective internal radiation therapy (B-SIRT). This new concept and LTS enable fully personalized treatment planning with glass microspheres to be achieved. (orig.)

  6. Transformation in pretreatment manifestations of Gaucher disease type 1 during two decades of alglucerase/imiglucerase enzyme replacement therapy in the International Collaborative Gaucher Group (ICGG) Gaucher Registry.

    Science.gov (United States)

    Mistry, Pramod K; Batista, Julie L; Andersson, Hans C; Balwani, Manisha; Burrow, Thomas Andrew; Charrow, Joel; Kaplan, Paige; Khan, Aneal; Kishnani, Priya S; Kolodny, Edwin H; Rosenbloom, Barry; Scott, C Ronald; Weinreb, Neal

    2017-09-01

    This study tests the hypothesis that the prevalence of severe clinical manifestations in Gaucher disease type 1 (GD1) patients at the time of treatment initiation has changed since alglucerase/imiglucerase enzyme replacement therapy (ERT) was approved in the United States (US) in 1991. US alglucerase/imiglucerase-treated GD1 patients from the International Collaborative Gaucher Group Gaucher Registry clinicaltrials.gov NCT00358943 were stratified by age at ERT initiation (<18, 18 to <50, ≥50 years), era of ERT initiation (1991-1995, 1996-2000, 2001-2005, 2006-2009), and splenectomy status pre-ERT. Prevalence of splenectomy decreased dramatically across the eras among all age groups. Bone manifestations were more prevalent in splenectomized patients than non-splenectomized patients in all age groups. Prevalence of bone manifestations differed across eras in certain age groups: non-splenectomized patients had a lower prevalence of ischemic bone events (pediatric patients) and bone crisis (pediatric patients and adults 18 to <50 years) in later eras; splenectomized adult (18 to <50 years) patients had a lower prevalence of ischemic bone events and bone crisis in later eras. Over two decades after the introduction of ERT, the prevalence of splenectomy and associated skeletal complications has declined dramatically. Concomitantly, the interval between diagnosis and initiation of ERT has decreased, most strikingly in pediatric patients who have the most severe disease. Together, these findings suggest that since the introduction of alglucerase/imiglucerase ERT, optimal standard of care has become established in the US to prevent destructive complications of GD1. © 2017 The Authors American Journal of Hematology Published by Wiley Periodicals, Inc.

  7. Iron overload in lower international prognostic scoring system risk patients with myelodysplastic syndrome receiving red blood cell transfusions: Relation to infections and possible benefit of iron chelation therapy.

    Science.gov (United States)

    Wong, Colleen A C; Wong, Shannon A Y; Leitch, Heather A

    2018-04-01

    An increased incidence of infections and infectious mortality has been reported in myelodysplastic syndromes (MDS) patients receiving red blood cell (RBC) transfusions. We examined incidence of infections requiring antibiotics, antifungal or antiviral medications in transfused lower International Prognostic Scoring System (IPSS) risk MDS patients and whether this differed with iron chelation therapy (ICT). 138 transfused MDS patients were lower IPSS risk. 59 received ICT; median duration was 13 months. There was no significant difference between groups in neutrophil count at first RBC transfusion or first infection. Infections included: bacterial, n = 88; viral; fungal; and mycobacterial; n = 2 each. In ICT and non-ICT patients, respectively, infections were (number [%]): patients, 23 (40.0%) and 22 (27.8%); episodes (median [range]), 2 (1-6) and 2 (1-5); hospitalizations, 16 (27.1%) and 8 (10.1%); and deaths, 0 (0%) and 1 (1.3%), p = NS for all. Median overall survival (OS) from first RBC transfusion was superior in ICT patients, p = 0.01, and remained significant in a multivariate analysis (MVA), p = 0.003. Median time to first infection (TTI) was 27 and 7.8 months, respectively, p < 0.0001, and ICT remained significant for TTI in an MVA, p = 0.02, hazard ratio 0.3. For ICT patients with blast count <5%, TTI was significantly superior (p = 0.004). In this retrospective analysis, for lower IPSS risk MDS patients receiving RBC transfusions, though number and type of infections were similar between groups and despite similar neutrophil counts, time to first infection was significantly longer in ICT patients (p < 0.0001). These results should be confirmed in larger, prospective analyses. Copyright © 2018 Elsevier Ltd. All rights reserved.

  8. Boosted selective internal radiation therapy with 90Y-loaded glass microspheres (B-SIRT) for hepatocellular carcinoma patients: a new personalized promising concept.

    Science.gov (United States)

    Garin, E; Lenoir, L; Edeline, J; Laffont, S; Mesbah, H; Porée, P; Sulpice, L; Boudjema, K; Mesbah, M; Guillygomarc'h, A; Quehen, E; Pracht, M; Raoul, J L; Clement, B; Rolland, Y; Boucher, E

    2013-07-01

    To evaluate the impact of dosimetry based on MAA SPECT/CT for the prediction of response, toxicity and survival, and for treatment planning in patients with hepatocellular carcinoma (HCC) treated with (90)Y-loaded glass microspheres (TheraSphere®). TheraSphere® was administered to 71 patients with inoperable HCC. MAA SPECT/CT quantitative analysis was used for the calculation of the tumour dose (TD), healthy injected liver dose (HILD), and total injected liver dose. Response was evaluated at 3 months using EASL criteria. Time to progression (TTP) and overall survival (OS) were evaluated using the Kaplan-Meier method. Factors potentially associated with liver toxicity were combined to construct a liver toxicity score (LTS). The response rate was 78.8%. Median TD were 342 Gy for responding lesions and 191 Gy for nonresponding lesions (p 205 Gy (p = 0.0015 and not significant). Among patients with portal vein thrombosis (PVT) (n = 33), the median TTP and OS were 4.5 months (2-7 months) and 5 months (2-8 months), respectively, in patients with TD 205 Gy (p = 0.039 and 0.005). The median OS was 24.5 months (18-28.5 months) in PVT patients with TD >205 Gy and good PVT targeting on MAA SPECT/CT. The LTS was able to detect severe liver toxicity (n = 6) with a sensitivity of 83% and overall accuracy of 97%. Dosimetry based on MAA SPECT/CT was able to accurately predict response and survival in patients treated with glass microspheres. This method can be used to adapt the injected activity without increasing liver toxicity, thus defining a new concept of boosted selective internal radiation therapy (B-SIRT). This new concept and LTS enable fully personalized treatment planning with glass microspheres to be achieved.

  9. Report on outcomes of hypomethylating therapy for analyzing prognostic value of Revised International Prognostic Scoring System for patients with lower-risk myelodysplastic syndromes.

    Science.gov (United States)

    Lee, Yoo Jin; Park, Sung Woo; Lee, In Hee; Ahn, Jae Sook; Kim, Hyeoung Joon; Chung, Joo Seop; Shin, Ho Jin; Lee, Won Sik; Lee, Sang Min; Joo, Young Don; Kim, Hawk; Lee, Ho Sup; Kim, Yang Soo; Cho, Yoon Young; Moon, Joon Ho; Sohn, Sang Kyun

    2016-10-01

    The outcomes for patients with lower-risk myelodysplastic syndromes (LR-MDS) by the International Prognostic Scoring System (IPSS) vary widely. For more precise prognostication, this study evaluates the prognostic value of revised IPSS with the response to hypomethylating therapy (HMT). Using the Korean MDS Working Party database, treatment outcomes for 236 patients with HMT were retrospectively evaluated. The patients were then reclassified into very low/low (VL/L), intermediate (INT), and high (H) risk groups according to IPSS-R. According to the HMT response, the 3-year overall survival (OS) did not differ between the response group (37.9 ± 9.1 %) and the stable group (52.9 ± 6.6 %, p = 0. 782). When reclassifying according to IPSS-R, 42 patients (20.8 %) were reclassified into the H risk group. Most of them did not have benefit from continued HMT and progressed to secondary failure. The median OS was 59.0 months (range, 40.0-77.9 months) for the VL/L risk group, 31 months (range, 22.7-439.3 months) for the INT risk group, and 20.0 months (range, 15.9-24.1 months) for the H risk group (p risk group according to IPSS-R (HR = 3.054, p risk according to IPSS-R (HR = 4.912, p = 0.003), and transformation to AML (HR = 2.158, p = 0.002). If IPSS-R reclassifies LR-MDS patients as H risk, these patients should be considered for early allo-HCT, regardless of the current benefits from HMT.

  10. A comparison of initial antiretroviral therapy in the Swiss HIV Cohort Study and the recommendations of the International AIDS Society-USA.

    Directory of Open Access Journals (Sweden)

    Gilles Wandeler

    Full Text Available BACKGROUND: In order to facilitate and improve the use of antiretroviral therapy (ART, international recommendations are released and updated regularly. We aimed to study if adherence to the recommendations is associated with better treatment outcomes in the Swiss HIV Cohort Study (SHCS. METHODS: Initial ART regimens prescribed to participants between 1998 and 2007 were classified according to IAS-USA recommendations. Baseline characteristics of patients who received regimens in violation with these recommendations (violation ART were compared to other patients. Multivariable logistic and linear regression analyses were performed to identify associations between violation ART and (i virological suppression and (ii CD4 cell count increase, after one year. RESULTS: Between 1998 and 2007, 4189 SHCS participants started 241 different ART regimens. A violation ART was started in 5% of patients. Female patients (adjusted odds ratio aOR 1.83, 95%CI 1.28-2.62, those with a high education level (aOR 1.49, 95%CI 1.07-2.06 or a high CD4 count (aOR 1.53, 95%CI 1.02-2.30 were more likely to receive violation ART. The proportion of patients with an undetectable viral load (<400 copies/mL after one year was significantly lower with violation ART than with recommended regimens (aOR 0.54, 95% CI 0.37-0.80 whereas CD4 count increase after one year of treatment was similar in both groups. CONCLUSIONS: Although more than 240 different initial regimens were prescribed, violations of the IAS-USA recommendations were uncommon. Patients receiving these regimens were less likely to have an undetectable viral load after one year, which strengthens the validity of these recommendations.

  11. Cholesterol target value attainment and lipid-lowering therapy in patients with stable or acute coronary heart disease: Results from the Dyslipidemia International Study II.

    Science.gov (United States)

    Gitt, Anselm K; Lautsch, Dominik; Ferrières, Jean; De Ferrari, Gaetano M; Vyas, Ami; Baxter, Carl A; Bash, Lori D; Ashton, Veronica; Horack, Martin; Almahmeed, Wael; Chiang, Fu-Tien; Poh, Kian Keong; Brudi, Philippe; Ambegaonkar, Baishali

    2017-11-01

    Low-density lipoprotein cholesterol (LDL-C) is a major contributor to cardiovascular disease. In the Dyslipidemia International Study II (DYSIS II), we determined LDL-C target value attainment, use of lipid-lowering therapy (LLT), and cardiovascular outcomes in patients with stable coronary heart disease (CHD) and those suffering from an acute coronary syndrome (ACS). DYSIS II included patients from 18 countries. Patients with either stable CHD or an ACS were enrolled if they were ≥18 years old and had a full lipid profile available. Data were collected at a physician visit (CHD cohort) or at hospital admission and 120 days later (ACS cohort). A total of 10,661 patients were enrolled, 6794 with stable CHD and 3867 with an ACS. Mean LDL-C levels were low at 88 mg/dl and 108 mg/dl for the CHD and ACS cohorts respectively, with only 29.4% and 18.9% displaying a level below 70 mg/dl. LLT was utilized by 93.8% of the CHD cohort, with a mean daily statin dosage of 25 ± 18 mg. The proportion of the ACS cohort treated with LLT rose from 65.2% at admission to 95.6% at follow-up. LLT-treated patients, who were female, obese, or current smokers, were less likely to achieve an LDL-C level of <70 mg/dl, while those with type 2 diabetes, chronic kidney disease, or those taking a higher statin dosage were more likely. Few of these very high-risk patients achieved the LDL-C target, indicating huge potential for improving cardiovascular outcome by use of more intensive LLT. Copyright © 2017. Published by Elsevier B.V.

  12. Telling It Like It Is--And Like It Is Not: Fiction in the Service of Science in Jay Hosler's "The Sandwalk Adventures"

    Science.gov (United States)

    Porat, Michal

    2015-01-01

    Biologist and graphic novelist Jay Hosler has long been introducing young readers to biological subjects through entertaining narratives combining strongly fictional elements with nonfictional ones. Extensive application of fiction to nonfictional subject matter is uncommon, even in graphic novels, but Hosler's "The Sandwalk Adventures"…

  13. El Arte de Aprender: Una Aventura Cooperativa. Un guia de recursos para trabajar con ninos jovenes. (Learning: A Cooperative Adventure. A Resource Guide for Working with Young Children.)

    Science.gov (United States)

    Arizona State Dept. of Education, Phoenix.

    Due to the large numbers of children from Spanish-speaking homes, many districts send both English and Spanish written communication to parents and community members. Therefore this booklet, a Spanish translation of "Learning: A Cooperative Adventure" (ED 119 868), was prepared to provide parents and preschool and kindergarten staff members with…

  14. Impact of the Extended Learning Opportunities Summer Adventures in Learning (ELO SAIL) Program on Student Academic Performance: Part 1, Results from Fall 2012 to Fall 2015

    Science.gov (United States)

    Cooper-Martin, Elizabeth; Wolanin, Natalie; Jang, Seong; Modarresi, Shahpar; Zhao, Huafang

    2016-01-01

    Extended Learning Opportunities Summer Adventures in Learning (ELO SAIL) is a Montgomery County Public Schools summer program for students in all Title I elementary schools; it targets students who will be in kindergarten-Grade 2 in the fall following the program. This report analyzed demographic characteristics of attendees and the impact of the…

  15. Introducing the Use of a Semi-Structured Video Diary Room to Investigate Students' Learning Experiences during an Outdoor Adventure Education Groupwork Skills Course

    Science.gov (United States)

    Cooley, Sam J.; Holland, Mark J.; Cumming, Jennifer; Novakovic, Emily G.; Burns, Victoria E.

    2014-01-01

    Outdoor adventure education courses are used in higher education to develop transferable skills such as groupwork and problem-solving skills. There is a need for exploratory investigation into students' perceptions of this experience. This study aimed to develop an innovative qualitative data collection method, and to use it to explore…

  16. Immunosupportive therapies in aging

    Science.gov (United States)

    Fülöp, Tamas; Larbi, Anis; Hirokawa, Katsuiku; Mocchegiani, Eugenio; Lesourd, Bruno; Castle, Stephen; Wikby, Anders; Franceschi, Claudio; Pawelec, Graham

    2007-01-01

    The primary role of the immune system is to protect the organism against pathogens, but age-associated alterations to immunity increase the susceptibility of the elderly to infectious disease. The exact nature of these changes is still controversial, but the use of screening procedures, such as the SENIEUR protocol to exclude underlying illness, helped to better characterize the changes actually related to physiological aging rather than pathology. It is generally agreed that the most marked changes occur in the cellular immune response reflecting profound alterations in T cells. Much of this is due to thymic involution as well as changes in the proportions of T cell subpopulations resulting from antigen exposure, and altered T cell activation pathways. However, a body of data indicates that innate immune responses, including the critical bridge between innate and adaptive immunity, and antigen presenting capacity are not completely resistant to senescence processes. The consequences of all these alterations are an increased incidence of infections, as well as possibly cancers, autoimmune disorders, and chronic inflammatory diseases. The leading question is what, if anything, can we do to prevent these deleterious changes without dangerously dysregulating the precarious balance of productive immunity versus immunopathology? There are many potential new therapeutic means now available to modulate immunosenescence and many others are expected to be available shortly. One main problem in applying these experimental therapies is ethical: there is a common feeling that as ageing is not a disease; the elderly are not sick and therefore do not require adventurous therapies with unpredictable side-effects in mostly frail individuals. Animal models are not helpful in this context. In this chapter we will first briefly review what we think we know about human immunosenescence and its consequences for the health status of elderly individuals. We will then discuss possible

  17. International leadership in nursing

    Directory of Open Access Journals (Sweden)

    Ged F. Williams

    2013-12-01

    Full Text Available As the global community becomes overwhelmed by conflict, threat and scandal in many countries it is heartening to find that many of us can still find opportunity to give generously to the betterment of humanity.Recently we have both had our share of fun and excitement working and learning in various regions of the world, Ged in the Middle East and Africa and Wilson in the USA, The Netherlands and Brazil.We are often asked “how do you develop an international perspective”? The short answer is that it is an insidious accident sometimes, however like many things a deeper analysis reveals a journey that is often planned and other times blessed by unexpected surprises. However a sense of openness, generosity and adventure is always necessary to maximise every opportunity.Among other things, Ged allocated time to travel and to visit hospitals and nurses in other parts of Australia and the world, listening to people’s stories, dreams, and aspirations and providing reciprocal encouragement and fellowship, often through interpreters. (Rev Cuid 2013; 4(1:433-6.

  18. Results of a Quality Assurance Review of External Beam Radiation Therapy in the International Society of Paediatric Oncology (Europe) Neuroblastoma Group's High-risk Neuroblastoma Trial: A SIOPEN Study

    International Nuclear Information System (INIS)

    Gaze, Mark N.; Boterberg, Tom; Dieckmann, Karin; Hörmann, Marcus; Gains, Jennifer E.; Sullivan, Kevin P.; Ladenstein, Ruth

    2013-01-01

    Purpose: Radiation therapy is important for local control in neuroblastoma. This study reviewed the compliance of plans with the radiation therapy guidelines of the International Society of Paediatric Oncology (Europe) Neuroblastoma Group (SIOPEN) High-Risk Trial protocol. Methods and Materials: The SIOPEN trial central electronic database has sections to record diagnostic imaging and radiation therapy planning data. Individual centers may upload data remotely, but not all centers involved in the trial chose to use this system. A quality scoring system was devised based on how well the radiation therapy plan matched the protocol guidelines, to what extent deviations were justified, and whether adverse effects may result. Central review of radiation therapy planning was undertaken retrospectively in 100 patients for whom complete diagnostic and treatment sets were available. Data were reviewed and compared against protocol guidelines by an international team of radiation oncologists and radiologists. For each patient in the sample, the central review team assigned a quality assurance score. Results: It was found that in 48% of patients there was full compliance with protocol requirements. In 29%, there were deviations for justifiable reasons with no likely long-term adverse effects resulting. In 5%, deviations had occurred for justifiable reasons, but that might result in adverse effects. In 1%, there was a deviation with no discernible justification, which would not lead to long-term adverse events. In 17%, unjustified deviations were noted, with a risk of an adverse outcome resulting. Conclusions: Owing to concern over the proportion of patients in whom unjustified deviations were observed, a protocol amendment has been issued. This offers the opportunity for central review of radiation therapy plans before the start of treatment and the treating clinician a chance to modify plans.

  19. Results of a Quality Assurance Review of External Beam Radiation Therapy in the International Society of Paediatric Oncology (Europe) Neuroblastoma Group's High-risk Neuroblastoma Trial: A SIOPEN Study

    Energy Technology Data Exchange (ETDEWEB)

    Gaze, Mark N., E-mail: mark.gaze@uclh.nhs.uk [Department of Oncology, University College London Hospitals NHS Foundation Trust, London (United Kingdom); Boterberg, Tom [Department of Radiation Oncology, Ghent University Hospital, Ghent (Belgium); Dieckmann, Karin; Hoermann, Marcus [General Hospital Vienna, Medical University Vienna (Austria); Gains, Jennifer E.; Sullivan, Kevin P. [Department of Oncology, University College London Hospitals NHS Foundation Trust, London (United Kingdom); Ladenstein, Ruth [Children' s Cancer Research Institute, St. Anna Children' s Hospital, Vienna (Austria)

    2013-01-01

    Purpose: Radiation therapy is important for local control in neuroblastoma. This study reviewed the compliance of plans with the radiation therapy guidelines of the International Society of Paediatric Oncology (Europe) Neuroblastoma Group (SIOPEN) High-Risk Trial protocol. Methods and Materials: The SIOPEN trial central electronic database has sections to record diagnostic imaging and radiation therapy planning data. Individual centers may upload data remotely, but not all centers involved in the trial chose to use this system. A quality scoring system was devised based on how well the radiation therapy plan matched the protocol guidelines, to what extent deviations were justified, and whether adverse effects may result. Central review of radiation therapy planning was undertaken retrospectively in 100 patients for whom complete diagnostic and treatment sets were available. Data were reviewed and compared against protocol guidelines by an international team of radiation oncologists and radiologists. For each patient in the sample, the central review team assigned a quality assurance score. Results: It was found that in 48% of patients there was full compliance with protocol requirements. In 29%, there were deviations for justifiable reasons with no likely long-term adverse effects resulting. In 5%, deviations had occurred for justifiable reasons, but that might result in adverse effects. In 1%, there was a deviation with no discernible justification, which would not lead to long-term adverse events. In 17%, unjustified deviations were noted, with a risk of an adverse outcome resulting. Conclusions: Owing to concern over the proportion of patients in whom unjustified deviations were observed, a protocol amendment has been issued. This offers the opportunity for central review of radiation therapy plans before the start of treatment and the treating clinician a chance to modify plans.

  20. Seven day Lanzarote adventure: seven innovations in university learning and teaching

    Science.gov (United States)

    Reavey, Duncan

    2010-05-01

    An annual residential field course in Lanzarote, Canary Islands, gives university students of Environmental Science, Adventure Education, and Primary Science Education diverse opportunities for deep learning that challenges and motivates. Comments from students range from 'the best chemistry lesson ever' to 'life-changing'. Here I reflect on seven strengths from the student experience: (1) Our goal is for students to learn to ask scientific questions. Anyone can answer questions, but only the best scientists can ask questions that matter. (2) Field work fits the diverse learning styles of our diverse students. For example, students model bathymetry using sand and pebbles on a beach; students start to explore social issues around waste disposal on Lanzarote by taking part in a commando raid on a municipal rubbish tip! (3) Students learn from local experts but then learn from each other. For example, half the group explores agricultural practices while the other half explores traditional uses of plants; a student from one group is then paired with a student from the other group for them to teach each other what they have learned. (4) An overview of current research on the island (volcanic origins, indigenous species, trace elements in the wines!) comes from students reflecting on abstracts of 25 recent papers from mainstream journals and sharing their understanding with each other. (5) We replicate a real world experience. One part of the student assessment requires them to write a grant application for a scientific research project using the real-world pro forma and meeting the criteria set out by the real-world funding agency. (6) Students work as teams to write these grant applications (as they would do in the real world). They receive a single mark for their work, but the students then divide the mark among themselves according to the quality of the contributions they have made. In this way the university teachers assess the product, and the students assess the

  1. Anakinra as first-line disease-modifying therapy in systemic juvenile idiopathic arthritis: report of forty-six patients from an international multicenter series

    NARCIS (Netherlands)

    Nigrovic, Peter A.; Mannion, Melissa; Prince, Femke H. M.; Zeft, Andrew; Rabinovich, C. Egla; van Rossum, Marion A. J.; Cortis, Elisabetta; Pardeo, Manuela; Miettunen, Paivi M.; Janow, Ginger; Birmingham, James; Eggebeen, Aaron; Janssen, Erin; Shulman, Andrew I.; Son, Mary Beth; Hong, Sandy; Jones, Karla; Ilowite, Norman T.; Cron, Randy Q.; Higgins, Gloria C.

    2011-01-01

    To examine the safety and efficacy of the interleukin-1 (IL-1) receptor antagonist anakinra as first-line therapy for systemic juvenile idiopathic arthritis (JIA). Patients with systemic JIA receiving anakinra as part of initial disease-modifying antirheumatic drug (DMARD) therapy were identified

  2. Postmastectomy Radiation Therapy in Women with T1-T2 Tumors and 1 to 3 Positive Lymph Nodes: Analysis of the Breast International Group 02-98 Trial.

    Science.gov (United States)

    Zeidan, Youssef H; Habib, Joyce G; Ameye, Lieveke; Paesmans, Marianne; de Azambuja, Evandro; Gelber, Richard D; Campbell, Ian; Nordenskjöld, Bo; Gutiérez, Jorge; Anderson, Michael; Lluch, Ana; Gnant, Michael; Goldhirsch, Aron; Di Leo, Angelo; Joseph, David J; Crown, John; Piccart-Gebhart, Martine; Francis, Prudence A

    2018-06-01

    To analyze the impact of postmastectomy radiation therapy (PMRT) for patients with T1-T2 tumors and 1 to 3 positive lymph nodes enrolled on the Breast International Group (BIG) 02-98 trial. The BIG 02-98 trial randomized patients to receive adjuvant anthracycline with or without taxane chemotherapy. Delivery of PMRT was nonrandomized and performed according to institutional preferences. The present analysis was performed on participants with T1-T2 breast cancer and 1 to 3 positive lymph nodes who had undergone mastectomy and axillary nodal dissection. The primary objective of the present study was to examine the effect of PMRT on risk of locoregional recurrence (LRR), breast cancer-specific survival, and overall survival. We identified 684 patients who met the inclusion criteria and were included in the analysis, of whom 337 (49%) had received PMRT. At 10 years, LRR risk was 2.5% in the PMRT group and 6.5% in the no-PMRT group (hazard ratio 0.29, 95% confidence interval 0.12-0.73; P = .005). Lower LRR after PMRT was noted for patients randomized to receive adjuvant chemotherapy with no taxane (10-year LRR: 3.4% vs 9.1%; P = .02). No significant differences in breast cancer-specific survival (84.3% vs 83.9%) or overall survival (81.7% vs 78.3%) were observed according to receipt of PMRT. Our analysis of the BIG 02-98 trial shows excellent outcomes in women with T1-T2 tumors and 1 to 3 positive lymph nodes found in axillary dissection. Although PMRT improved LRR in this cohort, the number of events remained low at 10 years. In all groups, 10-year rates of LRR were relatively low compared with historical studies. As such, the use of PMRT in women with 1 to 3 positive nodes should be tailored to individual patient risks. Copyright © 2018 Elsevier Inc. All rights reserved.

  3. Boosted selective internal radiation therapy with {sup 90}Y-loaded glass microspheres (B-SIRT) for hepatocellular carcinoma patients: a new personalized promising concept

    Energy Technology Data Exchange (ETDEWEB)

    Garin, E.; Lenoir, L. [Comprehensive Cancer Center, Institute Eugene Marquis, Department of Nuclear Medicine, CS 44229, Rennes (France); University of Rennes 1, Rennes (France); INSERM, U-991, Liver Metabolisms and Cancer, Rennes (France); Edeline, J. [University of Rennes 1, Rennes (France); Comprehensive Cancer Center, Institute Eugene Marquis, Department of Medical Oncology, CS 44229, Rennes (France); Laffont, S. [Comprehensive Cancer Center, Institute Eugene Marquis, Department of Nuclear Medicine, CS 44229, Rennes (France); Mesbah, H.; Poree, P. [Comprehensive Cancer Center, Institute Eugene Marquis, Department of Medical Informatics, CS 44229, Rennes (France); Sulpice, L. [INSERM, U-991, Liver Metabolisms and Cancer, Rennes (France); Centre Hospitalier Universitaire Pontchaillou, Department of Digestive Surgery, Rennes (France); Boudjema, K. [University of Rennes 1, Rennes (France); INSERM, U-991, Liver Metabolisms and Cancer, Rennes (France); Centre Hospitalier Universitaire Pontchaillou, Department of Digestive Surgery, Rennes (France); Mesbah, M. [University of Pierre et Marie Curie, Paris (France); Guillygomarc' h, A. [Centre Hospitalier Universitaire Pontchaillou, Department of Hepatology, Rennes (France); Quehen, E. [Centre Hospitalier Universitaire Pontchaillou, Department of Radiology, Rennes (France); Pracht, M. [Comprehensive Cancer Center, Institute Eugene Marquis, Department of Medical Oncology, CS 44229, Rennes (France); Raoul, J.L. [Comprehensive Cancer Center, Institute Paoli Calmette, Department of Medical Oncology, Marseille (France); Clement, B. [INSERM, U-991, Liver Metabolisms and Cancer, Rennes (France); Rolland, Y. [Comprehensive Cancer Center, Institute Eugene Marquis, Department of Medical Imaging, CS 44229, Rennes (France); Boucher, E. [INSERM, U-991, Liver Metabolisms and Cancer, Rennes (France); Comprehensive Cancer Center, Institute Eugene Marquis, Department of Medical Oncology, CS 44229, Rennes (France)

    2013-07-15

    able to accurately predict response and survival in patients treated with glass microspheres. This method can be used to adapt the injected activity without increasing liver toxicity, thus defining a new concept of boosted selective internal radiation therapy (B-SIRT). This new concept and LTS enable fully personalized treatment planning with glass microspheres to be achieved. (orig.)

  4. Booted selective internal radiation therapy (B-SIRT) using 90Y-loaded glass microspheres induces prolonged overall survival for PVT patients

    International Nuclear Information System (INIS)

    Garin, E.; Lenoir, L.; Edeline, J.; Laffont, S.; Mesbah, H.; Poree, P.; Boucher, E.; Rolland, Y.

    2015-01-01

    Full text of publication follows. Goal: evaluation of the response rate and survival of hepatocellular carcinoma PVT patients treated with Therasphere using the boost concept. Material and methods: Therasphere was administered in 40 PVT hepatocellular carcinoma patients (main = 11, lobar = 23, segmental = 6). MAA SPECT/CT quantitative analysis was used for the calculation of the tumour dose (TD), the healthy injected liver dose (HLD) and the injected liver dose (LD). Response was evaluated at 3 months using EASL criterion. OS was evaluated using Kaplan and Meyer tests. Results: Mean 90 Y-loaded microspheres injected activity was 3.1 ± 1.5 GBq. Mean LD was 143 ± 49 Gy. Median TD was 316 Gy for responding lesions versus 133 Gy for non responding lesion (p<0.0001). With a threshold TD of 205 Gy, MAA-SPECT/CT was predictive of response with a sensibility of 100%, and an overall accuracy of 90% (0FN, 4FP). Knowing the TD and the HLD, 40% of the patients received an intensification of the treatment (increase of the injected activity with the goal to achieve a TD> 205 Gy with a LD > 150 Gy and a HLD<120 Gy) with a good response rate (81%) and without increased liver grade III toxicity (6.2% as against 12.5% in the non boosted patients, ns). 6 patients were put aside, 5 received a lobar hepatectomy. Median OS was 18.2 months [12-27]. It was 4 m [12-27] for patients with a TD < 205 Gy versus 21.5 m [12-28.5] for patients with a TD > 205 Gy. OS was 12 m [3-∞] for patients with main PVT versus 21.5 m [12-28.7] for patients segmental or lobar PVT (ns). Finally Os was 23.2 m for patients with a TD > 205 Gy and a good PVT targeting (n = 34). Conclusion: boosted selective internal radiation therapy using 90 Y-loaded glass microspheres induces prolonged overall survival for PVT patients without increasing liver toxicity. (authors)

  5. Pacemaker Therapy in Patients With Neurally Mediated Syncope and Documented Asystole Third International Study on Syncope of Uncertain Etiology (ISSUE-3) A Randomized Trial

    NARCIS (Netherlands)

    Brignole, Michele; Menozzi, Carlo; Moya, Angel; Andresen, Dietrich; Blanc, Jean Jacques; Krahn, Andrew D.; Wieling, Wouter; Beiras, Xulio; Deharo, Jean Claude; Russo, Vitantonio; Tomaino, Marco; Sutton, Richard; Tomaino, M.; Pescoller, F.; Donateo, P.; Oddone, D.; Russo, V.; Pierri, F.; Matino, M. G.; Vitale, E.; Massa, R.; Piccinni, G.; Melissano, D.; Menozzi, C.; Lolli, G.; Gulizia, M.; Francese, M.; Iorfida, M.; Golzio, P.; Gaggioli, G.; Laffi, M.; Rabjoli, F.; Cecchinato, C.; Ungar, A.; Rafanelli, M.; Chisciotti, V.; Morrione, A.; del Rosso, A.; Guernaccia, V.; Palella, M.; D'Agostino, C.; Campana, A.; Brigante, M.; Miracapillo, G.; Addonisio, L.; Proclemer, A.; Facchin, D.; Vado, A.; Knops, R. E.; Dekker, L. R. C.

    2012-01-01

    Background-The efficacy of cardiac pacing for prevention of syncopal recurrences in patients with neurally mediated syncope is controversial. We wanted to determine whether pacing therapy reduces syncopal recurrences in patients with severe asystolic neurally mediated syncope. Methods and

  6. Art Therapy: A Bibliography.

    Science.gov (United States)

    Gantt, Linda, Comp.; Schmal, Marilyn Strauss, Comp.

    The bibliography on art therapy presents 1175 citations (1940-1973) drawn from searches of the medical indexes, computer systems of the National Library of Medicine and the National Institute of Mental Health, other bibliographies, Centre International de Documentation Concernant les Expressions Plastiques, and the American Journal of Art Therapy.…

  7. Multivariate relationships between international normalized ratio and vitamin K-dependent coagulation-derived parameters in normal healthy donors and oral anticoagulant therapy patients

    Directory of Open Access Journals (Sweden)

    Golanski Jacek

    2003-11-01

    Full Text Available Abstract Background and objectives International Normalized Ratio (INR is a world-wide routinely used factor in the monitoring of oral anticoagulation treatment (OAT. However, it was reported that other factors, e. g. factor II, may even better reflect therapeutic efficacy of OAT and, therefore, may be potentialy useful for OAT monitoring. The primary purpose of this study was to characterize the associations of INR with other vitamin K-dependent plasma proteins in a heterogenous group of individuals, including healthy donors, patients on OAT and patients not receiving OAT. The study aimed also at establishing the influence of co-morbid conditions (incl. accompanying diseases and co-medications (incl. different intensity of OAT on INR. Design and Methods Two hundred and three subjects were involved in the study. Of these, 35 were normal healthy donors (group I, 73 were patients on medication different than OAT (group II and 95 were patients on stable oral anticoagulant (acenocoumarol therapy lasting for at least half a year prior to the study. The values of INR and activated partial thromboplastin time (APTT ratio, as well as activities of FII, FVII, FX, protein C, and concentration of prothrombin F1+2 fragments and fibrinogen were obtained for all subjects. In statistical evaluation, the uni- and multivariate analyses were employed and the regression equations describing the obtained associations were estimated. Results Of the studied parameters, three (factors II, VII and X appeared as very strong modulators of INR, protein C and prothrombin fragments F1+2 had moderate influence, whereas both APTT ratio and fibrinogen had no significant impact on INR variability. Due to collinearity and low tolerance of independent variables included in the multiple regression models, we routinely employed a ridge multiple regression model which compromises the minimal number of independent variables with the maximal overall determination coefficient. The best

  8. Effects of antibiotic dry-cow therapy and internal teat sealant on milk somatic cell counts and clinical and subclinical mastitis in early lactation.

    Science.gov (United States)

    Golder, H M; Hodge, A; Lean, I J

    2016-09-01

    The objective of this study was to determine the efficacy of an internal teat sealant (TS; Teatseal; Zoetis Australia, Silverwater, NSW, Australia), when used in combination with antibiotic dry-cow therapy (ADCT) administered at dry-off, on milk individual somatic cell count (ISCC), milk production and components, and the incidence of clinical and subclinical mastitis in dairy cows up to 60 d after calving, when compared with ADCT only. Multiparous Holstein, Jersey, or Holstein cross cows (n=2,200) from 8 farms in southern and eastern Australia were randomly assigned to treatment of all 4 quarters with ADCT alone or with ADCT plus TS (ADCT + TS) at dry-off in this randomized, multisite clinical trial. Individual milk yield, fat and protein percentages, and ISCC were measured at intervals of 14±3 d after calving for the first 60 d of lactation. The first measurement occurred between 10 and 24 d after calving. Clinical mastitis and health events were recorded from dry-off to 60 d of lactation. Milk samples were collected from first cases of clinical mastitis and subjected to bacteriology. Treatment and the interaction of treatment by time did not affect milk yield, ISCC weighted by milk yield, or fat and protein percentages. Treatment with ADCT + TS decreased geometric mean ISCC compared with treatment with ADCT alone over the first 60 d of lactation. Geometric mean ISCC (×10(3) cells/mL) was 32.0 [95% confidence interval (CI): 26.8 to 38.3] and 43.5 (95% CI: 36.2 to 52.1) for ADCT + TS and ADCT alone, respectively. The odds of at least 1 case of subclinical mastitis (ISCC ≥250,000 cells/mL) were 1.9 times higher (95% CI: 1.4 to 2.6) with ADCT alone in the first 60 d of lactation compared with ADCT + TS. Use of ADCT + TS reduced the estimated incidence of at least 1 case of subclinical mastitis on all 8 farms, compared with use of ADCT alone. Only 4 cows that calved 40 to 100 d after dry-off had a first case of clinical mastitis in the dry period. Five percent of

  9. The use of an internal teat sealant in combination with cloxacillin dry cow therapy for the prevention of clinical and subclinical mastitis in seasonal calving dairy cows.

    Science.gov (United States)

    Runciman, D J; Malmo, J; Deighton, M

    2010-10-01

    Cows (n=2,053) from 6 seasonally calving dairy herds were enrolled in a trial to compare the efficacy of 2 dry cow treatments. Cows received either a combination dry cow therapy of 600 mg of cloxacillin (CL) followed by an internal teat sealant (ITS) containing 2.6 g of bismuth subnitrate in all 4 quarters immediately following their final milking for the season, or only an intramammary infusion of 600 mg of CL. All cases of clinical mastitis were recorded and cultured during the first 150 d of lactation in each herd, and cow somatic cell count (SCC) was measured between 7 and 50 d postcalving. A large difference was found between treatment groups in the rate at which cows were diagnosed with clinical mastitis over the first 21 d of lactation, after which time the rate at which cows were diagnosed with clinical mastitis was similar between treatment groups. Analysis of the relative proportions of cows with clinical mastitis was performed at both the gland and cow levels. The relative risk (RR) of clinical mastitis diagnosed within 21, 30, and 100 d of calving in a gland treated with the ITS-CL combination was, respectively, 0.30 [95% confidence interval (CI)=0.21-0.44], 0.39 (0.28-0.53), and 0.58 (0.46-0.75) that of the CL group. An interaction between treatment and previous SCC was found when clinical mastitis was analyzed at the cow level. In a subset of cows that had low SCC in their previous lactation, the RR of mastitis in cows with the ITS-CL combination within 21, 30, and 100 d of calving was, respectively, 0.54 (95% CI=0.33-0.87), 0.57 (0.37-0.88), and 0.69 (0.50-0.99) that of cows that received only CL at drying off. In the subset of cows that had at least 1 high SCC in the previous lactation, the RR of mastitis in the ITS-CL combination group within 21, 30, and 100 d of calving was, respectively, 0.26 (95% CI=0.16-0.44), 0.37 (0.24-0.57), and 0.72 (0.55-0.96) that of the CL-only group. The ITS-CL combination of dry cow treatments was associated with a

  10. Peran Layanan Jasa Search Engine Optimization untuk Meningkatkan Daya Saing pada Bisnis Startup (Studi pada Kaldera Trail and Jeep Adventure Malang

    Directory of Open Access Journals (Sweden)

    Wira Bharata

    2016-12-01

    Full Text Available This study aimed to investigate the role of SEO as a strategic competitive advantage. This study uses a qualitative approach with case studies are used as a research design. Researchers in the interviews to the owner Caldera Trail & Jeep Adventure. The results of this study indicate that the role of SEO to optimize the website proved successful in the company’s competitive advantage strategy Caldera Trail & Jeep Adventure. The results showed online marketing is done through Facebook, Twitter, Instagram and website have a positive impact on sales in their services. Applying marketing strategies using social media-based social networks and websites are very efficient because of much greater use conventional marketing strategies. This study also emphasizes the social media as online advertising that can be used as a marketing strategy in today’s digital era.

  11. Interview with Audrey Jung, President of the International Society for Mental Health Online (ISMHO), Presented at the Online Counselling and Therapy in Action Conference, 25 April 2009

    Science.gov (United States)

    Anthony, Kate; Jung, Audrey; Rosenauer, Dominik; Nagel, Deeanna Merz; Goss, Stephen

    2010-01-01

    Counselling services provided online have become an increasingly important topic over the last decade. It is now incumbent on all practitioners at least to be aware of the impact of online living for their clients and of the options available for online counselling provision. In this article, Kate Anthony of the Online Therapy Institute interviews…

  12. LDL-cholesterol goal attainment under persistent lipid-lowering therapy in northeast China: Subgroup analysis of the dyslipidemia international study of China (DYSIS-China).

    Science.gov (United States)

    Zheng, Wen; Zhang, Yu-Jiao; Bu, Xiang-Ting; Guo, Xin-Zhu; Hu, Da-Yi; Li, Zhan-Quan; Sun, Jian

    2017-11-01

    Lipid-lowering therapy with statins reduces the risk of cardiovascular events, but the efficacy of persistent treatment in a real-world setting may vary from regions. Routine lipid-lowering therapy in the region with a high prevalence of cardiovascular disease may lead to more failures of goal attainment. We therefore performed a study to observe different lipid-lowering strategies in northeast (NE) China with respect to low-density lipoprotein-cholesterol (LDL-C) reduction and goal attainments.A cross-sectional study (DYSIS-China) was conducted in 2012, involving 25,317 patients from 122 centers across China who were diagnosed with hyperlipidemia and treated with lipid-lowering therapy for at least 3 months. Of these patients, 4559 (18.0%) were assigned to the NE group according to their residential zones.Patients in the NE group tended to be younger, female, overweight, and had more comorbidities and higher blood lipid levels than those in the non-NE group (P 24 kg/m, drinking alcohol, smoking, and being residence in NE China as independent predictors of LDL-C attainment.Despite having received persistent lipid-lowering treatments, the current situation of dyslipidemia patients in NE China is unsatisfactory. The main treatment gap might be related to the choice of statin and effective combination therapy and the control of comorbidities and obesity, especially for high-risk patients.

  13. Improving Children's Mental Health with a Digital Social Skills Development Game: A Randomized Controlled Efficacy Trial of Adventures aboard the S.S. GRIN.

    Science.gov (United States)

    Sanchez, Rebecca; Brown, Emily; Kocher, Kelly; DeRosier, Melissa

    2017-02-01

    The purpose of this study was to investigate whether a computer-based game to improve social skills and mental health in children with social skills deficits would be efficacious. The program, Adventures aboard the S.S. GRIN, translates a proven in-person intervention into a nine-episode interactive online adventure game that provides opportunity for knowledge acquisition and skill practice. Participants (children aged 7-11 years with social skills challenges) were randomly assigned to immediate treatment group (n = 33) or waitlist control group (n = 36). Children in the immediate treatment condition completed the game at home over the course of 9 weeks. Before playing the game and again within 1 week of game completion, children completed surveys about social literacy, social anxiety, bullying, social self-efficacy, and social satisfaction. Children who played Adventures improved significantly more from pretest to posttest than children who did not play the game in social literacy, social anxiety, bullying victimization, and social satisfaction. Online interactive games can be effective in improving mental health for children who struggle with social skills. For children who can access them, serious games have the potential to increase the reach of effective programs by overcoming the logistical and implementation barriers (such as cost, travel, and accessibility) that limit traditionally delivered mental health interventions.

  14. PENINGKATAN HASIL BELAJAR PERMAINAN BOLA KECIL SISWA KELAS VB TUNARUNGU DENGAN MENGGUNAKAN PERMAINAN BOLA ADVENTURE DALAM PEMBELAJARAN PENJAS DI SDLB NEGERI PURBALINGGA TAHUN AJARAN 2013 / 2014

    Directory of Open Access Journals (Sweden)

    Gallank Sasmita

    2015-04-01

    Full Text Available The purpose of this study was to determine the improvement of learning outcomes play small ball VB class deaf students using a ball game adventure in learning SDLB Purbalingga penjas in the academic year 2013/2014 . This study is an action research ( action research because of research done to solve the problem of learning in the classroom . Observations on cycle 1 , ie psychomotor aspects gained 65.47 % , 80.95 % gain cognitive and affective aspects of acquiring 100 % . In the first cycle the average value reached 78.92 class that meets both criteria . While the results of observations of cycle 2 , the psychomotor aspects of gaining 74.99 % , 90.47 % gain cognitive and affective aspects of acquiring 100 % . . In the second cycle the average value reached 84.4 classes that meet the criteria very well. Based on the above results , concluded that Ball Adventure games can improve learning outcomes of small ball . Therefore Penjasorkes teachers are advised to use the game as an alternative learning Adventure Ball Small Ball in SDLB.

  15. Drilling through the Messinian evaporites: the beginning of a new adventure?

    Science.gov (United States)

    Bassetti, M. A.; Lofi, J.

    2009-04-01

    sedimentation during the crisis? What are the vertical movements (tectonic/isostatic responses) associated to margin unloading and basin loading? - What are the present-day fluid dynamics related to the salt layer? Their impact on the deep biosphere? The response to all of these questions would only come from drilling through the complete Messinian succession. It would represent an outstanding opportunity to unravel the history of extreme environmental changes during the Messinian and a unique chance to constrain the age, nature and paleo-environment of deposition of the deep-basin Messinian sequence. For that reason, in the framework of the IODP drilling program, we propose to sample and log two different sites in the western and eastern Mediterranean basins, with the new scientific riser drillship Chikyu perfectly adapted to overcome all safety problems. In order to promote a continuous sedimentary record of the MSC since the pre-crisis paleo-environmental changes, the sites should be drilled in areas where the Messinian salt is tabular and exempted of significant tectonic influence. A complete set of integrated studies (sedimentology, geochemistry, micropaleontology, bio-and cyclostratigraphy) should be carried out. This project opens the perspective of a new intellectual and scientific adventure that we expect to be as rich and exciting as the discovery of this unusual event was.

  16. Recent progress in carcinogenesis, progression and therapy of breast cancer: the 20th Hiroshima Cancer Seminar--the 4th Three Universities' Consortium International Symposium, October 2010: 31 October 2010, International Conference Center Hiroshima.

    Science.gov (United States)

    Toi, Masakazu; Yasui, Wataru; Ito, Hisao; Tahara, Eiichi

    2011-07-01

    The 20th Hiroshima Cancer seminar focused upon breast cancer research and treatment particularly on the mechanism of tumorigenesis and drug resistance and development of novel therapeutics. Several molecules such as retinoblastoma and p16 were raised as key factors in tumorigenesis and invasiveness. Estrogen-related pathways seem to be closely involved in the process. For the tumor lacking hormone receptor and human epidermal growth factor 2, some other mechanisms could be responsible. It seems that MicroRNA 22 directing some putative targets such as SIRT1, Sp1 and CDK6 plays a crucial role in breast tumor growth and metastasis. In addition, ribophorin and the associated molecules might be engaged in breast cancer stemness. Obviously, these molecules provide potential for therapeutic targets. It was also discussed about new drug development such as anti-human epidermal growth factor 2 therapy, anti-angiogenesis, pro-tumor aspects of anti-cancer therapy and application of circulating markers for monitoring, imaging and health-care system. Furthermore, we discussed risk factors, prevention and screening to reduce invasive cancers as well. Throughout the conference, panelists and attendee indicated the importance of translational research and biomarker exploration in order to realize efficient and individualized therapy for breast cancer.

  17. Internal dosimetry for the radiological protection of the patient in the therapy with I-131; Dosimetria interna para la proteccion radiologica del paciente en la terapia con I-131

    Energy Technology Data Exchange (ETDEWEB)

    Deluca, G.M.; Rojo, A.M. [Autoridad Regulatoria Nuclear, Av. Del Libertador 8250 (C1429BNP), Buenos Aires (Argentina)]. e-mail: gdeluca@cae.arn.gov.ar

    2006-07-01

    In the patients with differentiated thyroid cancer (CADIT) subjected to therapy with radiopharmaceuticals should be considered the possible risk of sharp depression of the bone marrow like consequence of the intolerance to the quantity of administered activity. The manifestation of the myelotoxicity can limit in a substantial way the future treatments and to deteriorate the predict of resolution of the illness. In this work it shows the physical-mathematical mark of a methodology for the estimated absorbed dose in bone marrow based in the MIRD scheme whose objective is to protect the one patient of the noxious and undesirable effects of the internal radiotherapy in organs that are not target of the same one. The formalism incorporates specific information of the patient and also peculiar characteristics of the internal therapy in patient with CADIT. The considerations are the following ones: (1) the main organ to protect is the bone marrow: (2) the accumulated activity, in bone marrow, it is obtained starting from measurements in blood: (3) the used isotope almost exclusively in this type of therapies is the {sup 131}I; (4) it is used as radiopharmaceutical at the {sup 131}INa that it is characterized to be a simple, inorganic and small molecule: (5) the statistical incidence of the CADIT is bigger in women than in men. It is explained for that it was selected the formalism that is presented, the principles on which it is sustained which are their reaches and their limitations. They are also presented future innovations that can be implemented to effects of improving the estimates. The work is framed inside the thematic of the medical applications of open radioactive sources and it constitutes a contribution to the invigoration of the internal therapy with radiopharmaceuticals. This is due to that the methodology of dose estimation presented supplements with a theoretical biophysics base the protocols of empiric prescription broadly used in this practice. For these

  18. CD41 T cell recovery during suppression of HIV replication: an international comparison of the immunological efficacy of antiretroviral therapy in North America, Asia and Africa.

    Science.gov (United States)

    Geng, Elvin H; Neilands, Torsten B; Thièbaut, Rodolphe; Bwana, Mwebesa Bosco; Nash, Denis; Moore, Richard D; Wood, Robin; Zannou, Djimon Marcel; Althoff, Keri N; Lim, Poh Lian; Nachega, Jean B; Easterbrook, Philippa J; Kambugu, Andrew; Little, Francesca; Nakigozi, Gertrude; Nakanjako, Damalie; Kiggundu, Valerian; Ki Li, Patrick Chung; Bangsberg, David R; Fox, Matthew P; Prozesky, HansW; Hunt, Peter W; Davies, Mary-Ann; Reynolds, Steven J; Egger, Matthias; Yiannoutsos, Constantin T; Vittinghoff, Eric V; Deeks, Steven G; Martin, Jeffrey N

    2015-02-01

    Even among HIV-infected patients who fully suppress plasma HIV RNA replication on antiretroviral therapy, genetic (e.g. CCL3L1 copy number), viral (e.g. tropism) and environmental (e.g. chronic exposure to microbial antigens) factors influence CD4 recovery. These factors differ markedly around the world and therefore the expected CD4 recovery during HIV RNA suppression may differ globally. We evaluated HIV-infected adults from North America, West Africa, East Africa, Southern Africa and Asia starting non-nucleoside reverse transcriptase inhibitorbased regimens containing efavirenz or nevirapine, who achieved at least one HIV RNA level Africa showed diminished CD4 recovery as compared with other regions. Three years after antiretroviral therapy initiation, the mean CD4 count for a prototypical patient with a pre-therapy CD4 count of 150/ml was 529/ml [95% confidence interval (CI): 517–541] in North America, 494/ml (95% CI: 429–559) in West Africa, 515/ml (95% CI: 508–522) in Southern Africa, 503/ml (95% CI: 478–528) in Asia and 437/ml (95% CI: 425–449) in East Africa. CD4 recovery during HIV RNA suppression is diminished in East Africa as compared with other regions of the world, and observed differences are large enough to potentially influence clinical outcomes. Epidemiological analyses on a global scale can identify macroscopic effects unobservable at the clinical, national or individual regional level.

  19. Current perspectives of radiation therapy. History of radiation therapy

    International Nuclear Information System (INIS)

    Itami, Jun

    2011-01-01

    More than 100 years have passed since the discovery of X-Strahlen by Roentgen. The history of radiation therapy has evolved under mutual stimulating relationships of the external beam radiation therapy by X-ray tubes and accelerators, and the internal radiation therapy employing radium and other radionuclides. The currently employed technologies in radiation therapy have its origin already till nineteen sixties and the development of physics and engineering have realized the original concept. (author)

  20. Obesity and risk of recurrence or death after adjuvant endocrine therapy with letrozole or tamoxifen in the breast international group 1-98 trial

    DEFF Research Database (Denmark)

    Ewertz, Marianne; Gray, Kathryn P; Regan, Meredith M

    2012-01-01

    To examine the association of baseline body mass index (BMI) with the risk of recurrence or death in postmenopausal women with early-stage breast cancer receiving adjuvant tamoxifen or letrozole in the Breast International Group (BIG) 1-98 trial at 8.7 years of median follow-up....

  1. Perspectives on the International Classification of Functioning, Disability, and Health: Child and Youth Version (ICF-CY) and Occupational Therapy Practice

    Science.gov (United States)

    Cramm, Heidi; Aiken, Alice B.; Stewart, Debra

    2012-01-01

    Classifying disability for children and youth has typically meant describing a diagnosis or developmental lag. The publication of the "International Classification of Functioning, Disability and Health: Child & Youth" version (ICF-CY) marks a global paradigm shift in the conceptualization and classification of childhood disability. Knowledge and…

  2. International Trade. International Business

    OpenAIRE

    Мохнюк, А. М.; Mokhniuk, A. M.

    2015-01-01

    Work programme of the study course “International Trade. International Business” was prepared in accordance with educational and vocational training program for bachelors of training direction 6.030601 “Management”.

  3. Combination therapy with metoprolol and nifedipine versus monotherapy in patients with stable angina pectoris. Results of the International Multicenter Angina Exercise (IMAGE) Study

    DEFF Research Database (Denmark)

    Savonitto, S; Ardissiono, D; Egstrup, K

    1996-01-01

    was then added for a further 4 weeks. Exercise tests were performed at weeks 0, 6 and 10. RESULTS: At week 6, both metoprolol and nifedipine increased the mean exercise time to 1-mm ST segment depression in comparison with week 0 (both p ... 10, the groups randomized to combination therapy had a further increase in time to 1-mm ST segment depression (p ... metoprolol to nifedipine showed an increase in exercise tolerance that was greater than the 90th percentile of the distribution of the changes observed in the corresponding monotherapy + placebo groups. However, among these patients, an additive effect was observed only in 1 (14%) of the 7 patients treated...

  4. Why ghosts don’t touch: a tale of two adventurers falling one after another into a black hole

    International Nuclear Information System (INIS)

    Kassner, Klaus

    2017-01-01

    The case for the utility of Kruskal–Szekeres coordinates in the classroom made by Augousti et al in this journal (2012 Eur. J. Phys. 33 1–11) is strengthened by extending their discussion beyond the event horizon of the black hole. Observations made by two adventurers following one another into a Schwarzschild black hole are examined in terms of these nonsingular coordinates. Two scenarios are considered, the first corresponding to one observer following the other closely, the second to a significant distance between the two of them, precluding the existence of a common inertial system. In particular, the concepts of distance and temporal separation near the horizon and the redshift of the first infaller's image as seen by the second are investigated. The results show that the notion of ‘touching ghosts’ does not correspond to the local physics of two observers falling into a black hole. The story line is interesting enough and the mathematical details are sufficiently simple to use the example in a general relativity course, even at the undergraduate level. (paper)

  5. A Long Time Ago in a Library Far, Far Away ... The Adventures of the Gladiatoria Manuscript from New Haven

    Directory of Open Access Journals (Sweden)

    Hagedorn Dierk

    2015-05-01

    Full Text Available In this paper I will describe the adventurous history of an important late medieval German fechtbuch—a fighting manual—that belongs to a number of manuscripts known as the Gladiatoria group. In the beginning, the extent and the characteristics of this group of codices are explained; later on I will deal with one specific specimen that formerly belonged to a library in Germany—the Herzogliche Bibliothek in Gotha—from where it vanished during or after World War II. Until quite recently this manuscript was believed to be lost. I was able to identify a Gladiatoria manuscript from the Yale Center for British Art in New Haven, Connecticut, as that missing manuscript. The article presents a detailed description of the manuscript; it follows the path of the many places the codex passed through from the days of its creation until the present time; it offers a thorough line of argument that proves on one hand that the manuscript from New Haven is in fact identical to the one that disappeared from Gotha, and that verifies on the other hand an assumption by the renowned researcher Hans-Peter Hils that it is identical to yet another believed-to-be-lost manuscript that was sold by auction in Heidelberg in the 1950s and 1960s as single leaves; and finally it makes an attempt to reconstruct the original structure of the manuscript after it had been pulled apart.

  6. The Challenge of Translating Children’s Literature: Alice’s Adventures in Wonderland Translated by Vladimir Nabokov

    Directory of Open Access Journals (Sweden)

    Natalija Vid

    2008-06-01

    Full Text Available In the article the author focuses on Vladimir Nabokov’s translation of Lewis Carroll’s novel Alice’s Adventures in Wonderland, made in 1923. The main intention of the article is to analyze Nabokov’s translation strategies of domestication, realized in the text as substitution and localization, and to explain possible reasons for his decision in favour of almost complete Russification of the original. It is possible that Nabokov considered children’s attitude towards the final result as the most important part of the translation process. Thus, he used domesticated strategies to transfer for Russian children the humour, the originality and brightness of the paradoxical and attractive world of Lewis Carroll, his sense of the absurd and his amazing gift for games of logic and language, providing a recognizable and familiar atmosphere for the readers. Undoubtedly, his young Russian readers were able to identify themselves with the story and to comprehend the complex world created by Lewis Carroll. On the other hand, Nabokov refuses to oversimplify his translation or to patronize its young audience through simplistic translation solutions.

  7. Grado de adaptación en las traducciones de “Alice’s Adventures in Wonderland”

    Directory of Open Access Journals (Sweden)

    Ismael Lemus Montaño

    2009-01-01

    Full Text Available Resumen: La distinción entre la literatura infantil y la juvenil sigue a menudo criterios vagos o muy flexibles. A la hora de traducir obras como Alicia en el país de las maravillas, de Lewis Carroll, los traductores pueden llegar a crear dos o más textos meta diferentes, dependiendo de las características de los lectores de la lengua meta, y ello necesariamente supone una reflexión sobre la difusa frontera entre las dos categorías de literatura.Summary: The distinctions between children’s literature and young-adult literature are often flexible and loosely defined. When translating works such as Lewis Carroll’s Alice’s Adventures in Wonderland, translators must produce two or more different target texts, according to the features of the readers in the target language, and somehow it means a reflection about the fuzzy line between the two literature categories.

  8. Altjeringa and didgeridoo: Australian Identity Devices on Polyphonic Spatiality of The Adventures of Priscilla, Queen of the Desert, Stephan Elliott

    Directory of Open Access Journals (Sweden)

    Jorge Alves Santana

    2016-06-01

    Full Text Available http://dx.doi.org/10.5007/2175-8026.2016v69n2p127 The Adventures of Priscilla, Queen of the Desert (1994 is an Australian film directed by Stephan Elliott. It expresses socio- and aesthetically a perspective of devices that produce contemporary subjectivities in Australia. In this article, some aspects of the production of such subjectivities shall be discussed in terms of possible cross mobilities, present in relations strained by spatiality - in their lieux and non-lieux, lieux lisse and lieux strié (AUGÉ, 1992; 1997; 2006; Deleuze, 1997 - traveled by the trio of protagonists who, in the trip from Sydney to Alice Springs, meet an Aboriginal community in the heart of the Outback. Among Altjeringa and the didgeridoo, we will follow this meeting between homoaffective and ancestral identities, which, on a certain semantic level of this film, indicates contexts of political and cultural negotiations in the historical and imaginative nation building process (Anderson, 2006, carried out by the stratified Australian society.

  9. Playing with Light: Adventures in Optics and Spectroscopy for Honors and Majors General Chemistry

    Science.gov (United States)

    van Staveren, Marie N.; Edwards, Kimberly D.; Apkarian, V. A.

    2012-01-01

    A lab was developed for use in an undergraduate honors and majors general chemistry laboratory to introduce students to optics, spectroscopy, and the underlying principles of quantum mechanics. This lab includes four mini-experiments exploring total internal reflection, the tunneling of light, spectra of sparklers and colored candles, and emission…

  10. The prognostic value of pimonidazole and tumour pO2 in human cervix carcinomas after radiation therapy: a prospective international multi-center study

    DEFF Research Database (Denmark)

    Nordsmark, Marianne; Loncaster, Julie; Aquino-Parsons, Christina

    2006-01-01

    BACKGROUND AND PURPOSE: Hypoxia adversely affects treatment outcome in human uterine cervical cancer. Here, we present the results of a prospective international multi-centre study evaluating the prognostic value of pre-treatment tumour oxygen partial pressure (pO(2)) and the hypoxia marker pimon...... pimonidazole (pimo). MATERIALS AND METHODS: One hundred and twenty-seven patients with primary cervix cancer were entered. Pre-treatment tumour pO(2) measurements were obtained, and reported by the median tumour pO(2), the fraction of pO(2) values......BACKGROUND AND PURPOSE: Hypoxia adversely affects treatment outcome in human uterine cervical cancer. Here, we present the results of a prospective international multi-centre study evaluating the prognostic value of pre-treatment tumour oxygen partial pressure (pO(2)) and the hypoxia marker...

  11. Dose estimate for effective internal contamination in the occupationally exposed workers(OEW) that handling open sources for thyroid therapy using 131 I (3779)

    International Nuclear Information System (INIS)

    Lecuna, J.A.; Carrizales, L.I.; Dantas, B.M.

    2013-01-01

    Handling of a variety of unsealed sources in Nuclear Medicine has led a significant risk of internal exposure of workers. 131 I stands out among the radionuclides of frequent use due its wide application in diagnosis and treatment of thyroid diseases. The increasing radionuclide use for medical purposes and treatment of diseases creates a need for capable methodologies of controlling the internal contamination of work. Currently, in Venezuela, there are about 17 Nuclear Medicine Services between public and private, of which 5 are operating; however, individual monitoring is still limited in the control of internal exposure. This work presents the development of bioassay techniques 'in vivo', in order to quantify the incorporation of 131 I used in Nuclear Medicine. It also presents the research results of internal exposure of a group of workers involved in handling of therapeutic dose of 131 I . The 'in vivo' detection system was calibrated with the thyroid simulator developed at the Institute of Radiologic Protection and Dosimetry (IRD, Rio de Janeiro - Brazil) and which also has the UTN-IVIC (Caracas - Venezuela). The results showed that the bioassay method developed in this work has sufficient sensitivity for its use in routine intake survey of workers in Nuclear Medicine. Between the two workers controlled in this study, both had measurable results in terms of incorporation. Therefore, it is important to keep control of it and also gives us the possibility to evaluate the incorporations in suspected accident. The highest estimate of the effective dose was 1,28x10 -5 Sv by inhalation and 1,27x10 -5 Sv by ingestion

  12. Stromal cells from the adipose tissue-derived stromal vascular fraction and culture expanded adipose tissue-derived stromal/stem cells: a joint statement of the International Federation for Adipose Therapeutics and Science (IFATS) and the International Society for Cellular Therapy (ISCT).

    Science.gov (United States)

    Bourin, Philippe; Bunnell, Bruce A; Casteilla, Louis; Dominici, Massimo; Katz, Adam J; March, Keith L; Redl, Heinz; Rubin, J Peter; Yoshimura, Kotaro; Gimble, Jeffrey M

    2013-06-01

    Adipose tissue is a rich and very convenient source of cells for regenerative medicine therapeutic approaches. However, a characterization of the population of adipose-derived stromal and stem cells (ASCs) with the greatest therapeutic potential remains unclear. Under the authority of International Federation of Adipose Therapeutics and International Society for Cellular Therapy, this paper sets out to establish minimal definitions of stromal cells both as uncultured stromal vascular fraction (SVF) and as an adherent stromal/stem cells population. Phenotypic and functional criteria for the identification of adipose-derived cells were drawn from the literature. In the SVF, cells are identified phenotypically by the following markers: CD45-CD235a-CD31-CD34+. Added value may be provided by both a viability marker and the following surface antigens: CD13, CD73, CD90 and CD105. The fibroblastoid colony-forming unit assay permits the evaluation of progenitor frequency in the SVF population. In culture, ASCs retain markers in common with other mesenchymal stromal/stem cells (MSCs), including CD90, CD73, CD105, and CD44 and remain negative for CD45 and CD31. They can be distinguished from bone-marrow-derived MSCs by their positivity for CD36 and negativity for CD106. The CFU-F assay is recommended to calculate population doublings capacity of ASCs. The adipocytic, chondroblastic and osteoblastic differentiation assays serve to complete the cell identification and potency assessment in conjunction with a quantitative evaluation of the differentiation either biochemically or by reverse transcription polymerase chain reaction. The goal of this paper is to provide initial guidance for the scientific community working with adipose-derived cells and to facilitate development of international standards based on reproducible parameters. Copyright © 2013 International Society for Cellular Therapy. All rights reserved.

  13. Adventure travel: oilfield trucking makes highway rigs look tame and light

    Energy Technology Data Exchange (ETDEWEB)

    Collison, M.

    2000-05-01

    Oilfield trucking as a specialty, involving high stakes in property and health, are discussed. Each rig costs close to one million dollars and operating them, under the watchful eye of GPS satellite or guided by two-way radios, or cellular phones, is a specialty that comes from many years of experience, a Class I licence, special training in first aid, handling dangerous goods and workplace hazardous materials, and readiness to work in mud, slush, and sleet, navigating soft and uneven ground with unwieldy gear and high load ready to tip at any moment. The risks and challenges become even more extreme when the trucker is moving oilfield equipment internationally, where severe climatic conditions, sandstorms, extreme heat and a generally hostile environment, may be augmented by unfamiliar bureaucratic procedures, business practices, and attacks by marauding armed rebel groups. International moves involve internationally recognized shipping terms that define risk and liability between buyer and seller, ocean-safe packaging and complex inventory management. That, of course, is all additional to the trade regulations, import permits, licenses, documentation requirements and insurance procedures of each of the countries traversed during the move.

  14. Guidelines on the medical therapy of persons accidentally overexposed to ionizing radiations. Internal contamination; Guia para el tratamiento de personas accidentalmente sobreexpuestas a las radiaciones ionizantes. Contaminacion interna

    Energy Technology Data Exchange (ETDEWEB)

    Di Trano, J L; Perez, M R; Gisone, P

    1999-07-01

    This work represent a guide for the treatment of accidental intakes of radionuclides. The different phases of radioactive contamination, the transfer and non-transfer of radioisotopes, the general principles in the treatment of internal contamination and the follow-up are determined. The in vivo monitoring and the evaluation of activity level are specified in this document. The applied treatment depends on the via of intake, that is: inhalation, ingestion, and through skin. The decontamination procedures that reduce the radionuclide transfer are specified. The different drugs, used to enhance radionuclides elimination, are enumerated in this work. Considerations about the iodine prophylaxis in radiologic als accidents are considered. (author)

  15. The NordiNet® International Outcome Study and NovoNet® ANSWER Program®: rationale, design, and methodology of two international pharmacoepidemiological registry-based studies monitoring long-term clinical and safety outcomes of growth hormone therapy (Norditropin®).

    Science.gov (United States)

    Höybye, Charlotte; Sävendahl, Lars; Christesen, Henrik Thybo; Lee, Peter; Pedersen, Birgitte Tønnes; Schlumpf, Michael; Germak, John; Ross, Judith

    2013-01-01

    Randomized controlled trials have shown that growth hormone (GH) therapy has effects on growth, metabolism, and body composition. GH therapy is prescribed for children with growth failure and adults with GH deficiency. Carefully conducted observational study of GH treatment affords the opportunity to assess long-term treatment outcomes and the clinical factors and variables affecting those outcomes, in patients receiving GH therapy in routine clinical practice. The NordiNet® International Outcome Study (IOS) and the American Norditropin® Web Enabled Research (ANSWER Program®) are two complementary, non-interventional, observational studies that adhere to current guidelines for pharmacoepidemiological data. The studies include pediatric and adult patients receiving Norditropin®, as prescribed by their physicians. The studies gather long-term data on the safety and effectiveness of reallife treatment with the recombinant human GH, Norditropin®. We describe the origins, aims, objectives, and design methodology of the studies, as well as their governance and validity, strengths, and limitations. The NordiNet® IOS and ANSWER Program® studies will provide valid insights into the effectiveness and safety of GH treatment across a diverse and large patient population treated in accordance with real-world clinical practice and following the Good Pharmacoepidemiological Practice and STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) guidelines.

  16. Programme of Action for Cancer Therapy (PACT)

    International Nuclear Information System (INIS)

    2008-01-01

    This document is an informational bulletin about the problems associated with access to diagnosis and therapy of cancers in developing countries and the role of the Program of Action for Cancer Therapy (PACT) of the International Atomic Energy Agency

  17. Fetal Treatment 2017: The Evolution of Fetal Therapy Centers - A Joint Opinion from the International Fetal Medicine and Surgical Society (IFMSS) and the North American Fetal Therapy Network (NAFTNet).

    Science.gov (United States)

    Moon-Grady, Anita J; Baschat, Ahmet; Cass, Darrell; Choolani, Mahesh; Copel, Joshua A; Crombleholme, Timothy M; Deprest, Jan; Emery, Stephen P; Evans, Mark I; Luks, Francois I; Norton, Mary E; Ryan, Greg; Tsao, Kuojen; Welch, Ross; Harrison, Michael

    2017-01-01

    More than 3 decades ago, a small group of physicians and other practitioners active in what they called "fetal treatment" authored an opinion piece outlining the current status and future challenges anticipated in the field. Many advances in maternal, neonatal, and perinatal care and diagnostic and therapeutic modalities have been made in the intervening years, yet a thoughtful reassessment of the basic tenets put forth in 1982 has not been published. The present effort will aim to provide a framework for contemporary redefinition of the field of fetal treatment, with a brief discussion of the necessary minimum expertise and systems base for the provision of different types of interventions for both the mother and fetus. Our goal will be to present an opinion that encourages the advancement of thoughtful practice, ensuring that current and future patients have realistic access to centers with a range of fetal therapies with appropriate expertise, experience, and subspecialty and institutional support while remaining focused on excellence in care, collaborative scientific discovery, and maternal autonomy and safety. © 2017 S. Karger AG, Basel.

  18. Sorafenib suppresses TGF-β responses by inducing caveolae/lipid raft-mediated internalization/degradation of cell-surface type II TGF-β receptors: Implications in development of effective adjunctive therapy for hepatocellular carcinoma.

    Science.gov (United States)

    Chung, Chih-Ling; Wang, Shih-Wei; Sun, Wei-Chih; Shu, Chih-Wen; Kao, Yu-Chen; Shiao, Meng-Shin; Chen, Chun-Lin

    2018-04-18

    Sorafenib is the only FDA approved drug for the treatment of advanced hepatocellular carcinoma (HCC) and other malignancies. Studies indicate that TGF-β signalling is associated with tumour progression in HCC. Autocrine and paracrine TGF-β promotes tumour growth and malignancy by inducing epithelial-mesenchymal transition (EMT). Sorafenib is believed to antagonize tumour progression by inhibiting TGF-β-induced EMT. It improves survival of patients but HCC later develops resistance and relapses. The underlying mechanism of resistance is unknown. Understanding of the molecular mechanism of sorafenib inhibition of TGF-β-induced signalling or responses in HCC may lead to development of adjunctive effective therapy for HCC. In this study, we demonstrate that sorafenib suppresses TGF-β responsiveness in hepatoma cells, hepatocytes, and animal liver, mainly by downregulating cell-surface type II TGF-β receptors (TβRII) localized in caveolae/lipid rafts and non-lipid raft microdomains via caveolae/lipid rafts-mediated internalization and degradation. Furthermore, sorafenib-induced downregulation and degradation of cell-surface TβRII is prevented by simultaneous treatment with a caveolae disruptor or lysosomal inhibitors. On the other hand, sorafenib only downregulates cell-surface TβRII localized in caveolae/lipid rafts but not localized in non-lipid raft microdomains in hepatic stellate cells. These results suggest that sorafenib inhibits TGF-β signalling mainly by inducing caveolae/lipid raft-mediated internalization and degradation of cell-surface TβR-II in target cells. They may also imply that treatment with agents which promote formation of caveolae/lipid rafts, TGF-β receptor kinase inhibitors (e.g., LY2157299) or TGF-β peptide antagonists (by liver-targeting delivery) may be considered as effective adjunct therapy with sorafenib for HCC. Copyright © 2018 Elsevier Inc. All rights reserved.

  19. Sex Therapy

    Science.gov (United States)

    Sex therapy Overview Sex therapy is a type of psychotherapy — a general term for treating mental health problems by talking with a mental health professional. Through sex therapy, you can address concerns about sexual function, ...

  20. Family Therapy

    Science.gov (United States)

    Family therapy Overview Family therapy is a type of psychological counseling (psychotherapy) that can help family members improve communication and resolve conflicts. Family therapy is usually provided by a psychologist, ...

  1. Clinical experience with the MammoSite[reg] radiation therapy system for brachytherapy of breast cancer: Results from an international phase II trial

    International Nuclear Information System (INIS)

    Niehoff, Peter; Polgar, Csaba; Ostertag, Horst; Major, Tibor; Sulyok, Zoltan; Kimmig, Bernhard; Kovacs, Gyoergy

    2006-01-01

    Background and purpose: In a prospective multi-center phase II trial, we investigated the MammoSite[reg] Radiation Therapy System, a new device for delivering intracavitary brachytherapy following breast conserving surgery. The MammoSite[reg] is a dual lumen, closed ended catheter with a small, spherical inflatable balloon and a port for connecting a remote afterloader to the central lumen. We analyzed the surgical procedure and placement of the MammoSite[reg], treatment planning and radiation delivery complications and cosmesis, as well the comfort for the patients. Patients and methods: Between 2002 and 2004 a total of 32 patients (pts) were implanted using the MammoSite[reg]. The reference isodose was defined 1 cm from the balloon surface. We analyzed the post-implant anatomic position of the applicator and the geometric form of the balloon via ultrasound, CT and X-ray, related side effects, cosmetic outcome and patient quality of life. Results: Twenty-three out of 32 patients (72%) were eligible for MammoSite[reg] intracavitary brachytherapy. Twenty-eight percentage had to be excluded because of different reasons. Eleven patients were treated with primary brachytherapy with a total dose of 34 Gy (2x3.4 Gy) and 12 had a boost with a mean dose of 13.3 Gy (range: 7.5-15 Gy; 2x2.5 Gy) combined with EBRT and doses ranged between 46 and 50 Gy. In three cases a balloon rupture occurred. We observed two abscesses within 3 months of implantation and serious seroma development in 10 patients (39%). Skin related side effects were erythema in 21 patients (91%), hyperpigmentation in 13 patients (56%) and teleangiectasia in six patients (26%) after mean follow-up 20 months. Conclusions: The MammoSite[reg] Radiation Therapy System is a feasible treatment modality for intracavitary brachytherapy of breast cancer after breast conserving surgery. The advantage of the system is only one applicator is necessary for the delivery of a fractionated radiotherapy. In addition, patient

  2. Practicability of patient self-testing of oral anticoagulant therapy by the international normalized ratio (INR) using a portable whole blood monitor. A pilot investigation.

    Science.gov (United States)

    Hasenkam, J M; Knudsen, L; Kimose, H H; Grønnesby, H; Attermann, J; Andersen, N T; Pilegaard, H K

    1997-01-01

    The prophylactic efficacy of long-term oral anticoagulant treatment (OAT) has been demonstrated in a number of clinical conditions with increased tendency to thromboembolism, and the number of individuals subjected to OAT in the industrialised world has increased substantially in recent years. Since this therapy requires considerable resources from both the health care system and the patients, the feasibility of patients' self-monitoring and self-management of OAT has been investigated (1,2,3). The anticipated advantages of this approach include improved convenience and compliance for the patient, who may increase his apprehension for managing the treatment. In addition, self-testing allows for more frequent control compared to the conventional out-patient approach. Importantly, a prerequisite for conceiving a safe and operational concept for patient self-management (PSM) is the availability of a portable INR monitoring system with an accuracy, precision, reproducibility, and long-term reliability comparable to standard coagulometric equipment. The purpose of the present study was to evaluate the feasibility of a commercially available INR-monitor. CoaguChek, for patient self-testing, through a step-wise investigation of the performance characteristics of the equipment in the laboratory, in command of the patient, and during self-testing and self-adjustment of treatment at home. Laboratory INR values were used as reference.

  3. Next generation metronomic chemotherapy-report from the Fifth Biennial International Metronomic and Anti-angiogenic Therapy Meeting, 6-8 May 2016, Mumbai.

    Science.gov (United States)

    Pantziarka, Pan; Hutchinson, Lisa; André, Nicolas; Benzekry, Sébastien; Bertolini, Francesco; Bhattacharjee, Atanu; Chiplunkar, Shubhada; Duda, Dan G; Gota, Vikram; Gupta, Sudeep; Joshi, Amit; Kannan, Sadhana; Kerbel, Robert; Kieran, Mark; Palazzo, Antonella; Parikh, Aparna; Pasquier, Eddy; Patil, Vijay; Prabhash, Kumar; Shaked, Yuval; Sholler, Giselle Saulnier; Sterba, Jaroslav; Waxman, David J; Banavali, Shripad

    2016-01-01

    The 5 th Biennial Metronomic and Anti-angiogenic Therapy Meeting was held on 6 th - 8 th May in the Indian city of Mumbai. The meeting brought together a wide range of clinicians and researchers interested in metronomic chemotherapy, anti-angiogenics, drug repurposing and combinations thereof. Clinical experiences, including many from India, were reported and discussed in three symposia covering breast cancer, head and neck cancers and paediatrics. On the pre-clinical side research into putative mechanisms of action, and the interactions between low dose metronomic chemotherapy and angiogenesis and immune responses, were discussed in a number of presentations. Drug repurposing was discussed both in terms of clinical results, particularly with respect to angiosarcoma and high-risk neuroblastoma, and in pre-clinical settings, particularly the potential for peri-operative interventions. However, it was clear that there remain a number of key areas of challenge, particularly in terms of definitions, perceptions in the wider oncological community, mechanisms of action and predictive biomarkers. While the potential for metronomics and drug repurposing in low and middle income countries remains a key theme, it is clear that there is also considerable potential for clinically relevant improvements in patient outcomes even in high income economies.

  4. Timing of Radiation Therapy and Chemotherapy After Breast-Conserving Surgery for Node-Positive Breast Cancer: Long-Term Results From International Breast Cancer Study Group Trials VI and VII

    International Nuclear Information System (INIS)

    Karlsson, Per; Cole, Bernard F.; Price, Karen N.; Gelber, Richard D.; Coates, Alan S.; Goldhirsch, Aron; Castiglione, Monica; Colleoni, Marco; Gruber, Günther

    2016-01-01

    Purpose: To update the previous report from 2 randomized clinical trials, now with a median follow-up of 16 years, to analyze the effect of radiation therapy timing on local failure and disease-free survival. Patients and Methods: From July 1986 to April 1993, International Breast Cancer Study Group trial VI randomly assigned 1475 pre-/perimenopausal women with node-positive breast cancer to receive 3 or 6 cycles of initial chemotherapy (CT). International Breast Cancer Study Group trial VII randomly assigned 1212 postmenopausal women with node-positive breast cancer to receive tamoxifen for 5 years, or tamoxifen for 5 years with 3 early cycles of initial CT. For patients who received breast-conserving surgery (BCS), radiation therapy (RT) was delayed until initial CT was completed; 4 or 7 months after BCS for trial VI and 2 or 4 months for trial VII. We compared RT timing groups among 433 patients on trial VI and 285 patients on trial VII who received BCS plus RT. Endpoints were local failure, regional/distant failure, and disease-free survival (DFS). Results: Among pre-/perimenopausal patients there were no significant differences in disease-related outcomes. The 15-year DFS was 48.2% in the group allocated 3 months initial CT and 44.9% in the group allocated 6 months initial CT (hazard ratio [HR] 1.12; 95% confidence interval [CI] 0.87-1.45). Among postmenopausal patients, the 15-year DFS was 46.1% in the no-initial-CT group and 43.3% in the group allocated 3 months initial CT (HR 1.11; 95% CI 0.82-1.51). Corresponding HRs for local failures were 0.94 (95% CI 0.61-1.46) in trial VI and 1.51 (95% CI 0.77-2.97) in trial VII. For regional/distant failures, the respective HRs were 1.15 (95% CI 0.80-1.63) and 1.08 (95% CI 0.69-1.68). Conclusions: This study confirms that, after more than 15 years of follow-up, it is reasonable to delay radiation therapy until after the completion of standard CT.

  5. Timing of Radiation Therapy and Chemotherapy After Breast-Conserving Surgery for Node-Positive Breast Cancer: Long-Term Results From International Breast Cancer Study Group Trials VI and VII

    Energy Technology Data Exchange (ETDEWEB)

    Karlsson, Per, E-mail: per.karlsson@oncology.gu.se [Department of Oncology, Institute of Clinical Sciences, Sahgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg (Sweden); Cole, Bernard F. [Department of Mathematics and Statistics, University of Vermont, Burlington, Vermont (United States); Price, Karen N. [International Breast Cancer Study Group Statistical Center, Frontier Science and Technology Research Foundation, Boston, Massachusetts (United States); Gelber, Richard D. [International Breast Cancer Study Group Statistical Center, Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Frontier Science and Technology Research Foundation, Harvard T. F. Chan School of Public Health, Boston, Massachusetts (United States); Coates, Alan S. [International Breast Cancer Study Group and University of Sydney, Sydney (Australia); Goldhirsch, Aron [Senior Consultant Breast Cancer, European Institute of Oncology and International Breast Cancer Study Group, Milan (Italy); Castiglione, Monica [International Breast Cancer Study Group, Bern (Switzerland); Colleoni, Marco [Division of Medical Senology, European Institute of Oncology and International Breast Cancer Study Group, Milan (Italy); Gruber, Günther [Institute of Radiotherapy, Klinik Hirslanden, Zürich (Switzerland)

    2016-10-01

    Purpose: To update the previous report from 2 randomized clinical trials, now with a median follow-up of 16 years, to analyze the effect of radiation therapy timing on local failure and disease-free survival. Patients and Methods: From July 1986 to April 1993, International Breast Cancer Study Group trial VI randomly assigned 1475 pre-/perimenopausal women with node-positive breast cancer to receive 3 or 6 cycles of initial chemotherapy (CT). International Breast Cancer Study Group trial VII randomly assigned 1212 postmenopausal women with node-positive breast cancer to receive tamoxifen for 5 years, or tamoxifen for 5 years with 3 early cycles of initial CT. For patients who received breast-conserving surgery (BCS), radiation therapy (RT) was delayed until initial CT was completed; 4 or 7 months after BCS for trial VI and 2 or 4 months for trial VII. We compared RT timing groups among 433 patients on trial VI and 285 patients on trial VII who received BCS plus RT. Endpoints were local failure, regional/distant failure, and disease-free survival (DFS). Results: Among pre-/perimenopausal patients there were no significant differences in disease-related outcomes. The 15-year DFS was 48.2% in the group allocated 3 months initial CT and 44.9% in the group allocated 6 months initial CT (hazard ratio [HR] 1.12; 95% confidence interval [CI] 0.87-1.45). Among postmenopausal patients, the 15-year DFS was 46.1% in the no-initial-CT group and 43.3% in the group allocated 3 months initial CT (HR 1.11; 95% CI 0.82-1.51). Corresponding HRs for local failures were 0.94 (95% CI 0.61-1.46) in trial VI and 1.51 (95% CI 0.77-2.97) in trial VII. For regional/distant failures, the respective HRs were 1.15 (95% CI 0.80-1.63) and 1.08 (95% CI 0.69-1.68). Conclusions: This study confirms that, after more than 15 years of follow-up, it is reasonable to delay radiation therapy until after the completion of standard CT.

  6. Internal and external morphology of mandibular molars: An original micro-CT study and meta-analysis with review of implications for endodontic therapy.

    Science.gov (United States)

    Tomaszewska, Iwona M; Skinningsrud, Bendik; Jarzębska, Anna; Pękala, Jakub R; Tarasiuk, Jacek; Iwanaga, Joe

    2018-03-25

    The aim of this radiological micro-CT study and meta-analysis was to determine the morphological features of the root canal anatomy of the mandibular molars. The radiological study included micro-CT scans of 108 mandibular first, 120 mandibular second, and 146 mandibular third molars. For our meta-analysis, an extensive search was conducted through PubMed, Embase, and Web of Science to identify articles eligible for inclusion. Data extracted included investigative method (cadaveric, intraoperative, or imaging), Vertucci type of canal configuration, presence/number of canals, roots, apical foramina, apical deltas, and intercanal communications. In the mesial roots of mandibular molars, the most frequent Vertucci type of canal configuration was type IV, except for the mandibular third molar where type I was most common. Type I was most common in the distal root. There were usually two canals in the mesial root and one in the distal root. Two was the most common number of roots, and a third root was most prevalent in Asia. One apical foramen was most common in the distal root and two apical foramina in the mesial root. Intercanal communications were most frequent in the mesial root. Knowledge of the complex anatomy of the mandibular molars can make root canal therapy more likely to succeed. We recommend the use of cone-beam computed tomography before and after endodontic treatment to enable the root anatomy to be accurately described and properly diagnosed, and treatment outcome to be assessed. Clin. Anat. 00:000-000, 2018. © 2018 Wiley Periodicals, Inc. © 2018 Wiley Periodicals, Inc.

  7. Quality of Life After Palliative Radiation Therapy for Patients With Painful Bone Metastases: Results of an International Study Validating the EORTC QLQ-BM22

    Energy Technology Data Exchange (ETDEWEB)

    Zeng Liang [Department of Radiation Oncology, Odette Cancer Centre, University of Toronto, Toronto, Ontario (Canada); Chow, Edward, E-mail: edward.chow@sunnybrook.ca [Department of Radiation Oncology, Odette Cancer Centre, University of Toronto, Toronto, Ontario (Canada); Bedard, Gillian; Zhang, Liying [Department of Radiation Oncology, Odette Cancer Centre, University of Toronto, Toronto, Ontario (Canada); Fairchild, Alysa [Department of Radiation Oncology, Cross Cancer Institute, Edmonton, Alberta (Canada); Vassiliou, Vassilios [Department of Radiation Oncology, Bank of Cyprus Oncology Centre, Nicosia (Cyprus); Alm El-Din, Mohamed A. [Department of Clinical Oncology, Tanta University Hospital, Tanta Faculty of Medicine, Tanta (Egypt); Jesus-Garcia, Reynaldo [Department of Orthopedic Oncology, Federal University of Sao Paulo, Sao Paulo (Brazil); Kumar, Aswin [Division of Gynaecology and Genitourinary Oncology, Department of Radiation Oncology, Regional Cancer Center, Trivandrum (India); Forges, Fabien [Inserm CIE3, Saint Etienne University Hospital, Saint-Etienne (France); Unit of Clinical Research, Innovation, and Pharmacology, Saint Etienne University Hospital, Saint-Etienne (France); Tseng, Ling-Ming [Department of Surgery, Taipei Veterans General Hospital, National Yang-Ming University, Taipei, Taiwan (China); Hou, Ming-Feng [Department of Gastroenterologic Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan (China); Chie, Wei-Chu [Department of Public Health and Institute of Epidemiology and Preventative Medicine, National Taiwan University, Taipei, Taiwan (China); Bottomley, Andrew [European Organisation for Research and Treatment of Cancer, EORTC Headquarters, Brussels (Belgium)

    2012-11-01

    Purpose: Radiation therapy (RT) is an effective method of palliating painful bone metastases and can improve function and reduce analgesic requirements. In advanced cancer patients, quality of life (QOL) is the primary outcome of interest over traditional endpoints such as survival. The purpose of our study was to compare bone metastasis-specific QOL scores among patients who responded differently to palliative RT. Methods and Materials: Patients receiving RT for bone metastases across 6 countries were prospectively enrolled from March 2010-January 2011 in a trial validating the QLQ-BM22 and completed the QLQ-BM22 and the core measure (QLQ-C30) at baseline and after 1 month. Pain scores and analgesic intake were recorded, and response to RT was determined according to the latest published guidelines. The Kruskal-Wallis nonparametric and Wilcoxon rank sum tests compared changes in QOL among response groups. A Bonferroni-adjusted P<.003 indicated statistical significance. Results: Of 79 patients who received palliative RT, 59 were assessable. Partial response, pain progression, and indeterminate response were observed in 22, 8, and 29 patients, respectively; there were no patients with a complete response. Patients across all groups had similar baseline QOL scores apart from physical functioning (patients who progressed had better initial functioning). One month after RT, patients who responded had significant improvements in 3 of 4 QLQ-BM22 domains (painful site, P<.0001; painful characteristic, P<.0001; and functional interference, P<.0001) and 3 QLQ-C30 domains (physical functioning, P=.0006; role functioning, P=.0026; and pain, P<.0001). Patients with progression in pain had significantly worse functional interference (P=.0007) and pain (P=.0019). Conclusions: Patients who report pain relief after palliative RT also have better QOL with respect to bone metastasis-specific issues. The QLQ-BM22 and QLQ-C30 are able to discriminate among patients with varying

  8. Quality of Life After Palliative Radiation Therapy for Patients With Painful Bone Metastases: Results of an International Study Validating the EORTC QLQ-BM22

    International Nuclear Information System (INIS)

    Zeng Liang; Chow, Edward; Bedard, Gillian; Zhang, Liying; Fairchild, Alysa; Vassiliou, Vassilios; Alm El-Din, Mohamed A.; Jesus-Garcia, Reynaldo; Kumar, Aswin; Forges, Fabien; Tseng, Ling-Ming; Hou, Ming-Feng; Chie, Wei-Chu; Bottomley, Andrew

    2012-01-01

    Purpose: Radiation therapy (RT) is an effective method of palliating painful bone metastases and can improve function and reduce analgesic requirements. In advanced cancer patients, quality of life (QOL) is the primary outcome of interest over traditional endpoints such as survival. The purpose of our study was to compare bone metastasis-specific QOL scores among patients who responded differently to palliative RT. Methods and Materials: Patients receiving RT for bone metastases across 6 countries were prospectively enrolled from March 2010-January 2011 in a trial validating the QLQ-BM22 and completed the QLQ-BM22 and the core measure (QLQ-C30) at baseline and after 1 month. Pain scores and analgesic intake were recorded, and response to RT was determined according to the latest published guidelines. The Kruskal-Wallis nonparametric and Wilcoxon rank sum tests compared changes in QOL among response groups. A Bonferroni-adjusted P<.003 indicated statistical significance. Results: Of 79 patients who received palliative RT, 59 were assessable. Partial response, pain progression, and indeterminate response were observed in 22, 8, and 29 patients, respectively; there were no patients with a complete response. Patients across all groups had similar baseline QOL scores apart from physical functioning (patients who progressed had better initial functioning). One month after RT, patients who responded had significant improvements in 3 of 4 QLQ-BM22 domains (painful site, P<.0001; painful characteristic, P<.0001; and functional interference, P<.0001) and 3 QLQ-C30 domains (physical functioning, P=.0006; role functioning, P=.0026; and pain, P<.0001). Patients with progression in pain had significantly worse functional interference (P=.0007) and pain (P=.0019). Conclusions: Patients who report pain relief after palliative RT also have better QOL with respect to bone metastasis-specific issues. The QLQ-BM22 and QLQ-C30 are able to discriminate among patients with varying

  9. The internal and external responsiveness of Functional Assessment of Cancer Therapy-Prostate (FACT-P) and Short Form-12 Health Survey version 2 (SF-12 v2) in patients with prostate cancer.

    Science.gov (United States)

    Choi, Edmond P H; Wong, Carlos K H; Wan, Eric Y F; Tsu, James H L; Chin, W Y; Kung, Kenny; Yiu, M K

    2016-09-01

    To examine the responsiveness of Functional Assessment of Cancer Therapy-Prostate (FACT-P) and Short Form-12 Health Survey version 2 (SF-12 v2) in prostate cancer patients because there is a lack of evidence to support their responsiveness in this patient population. One hundred sixty-eight subjects with prostate cancer were surveyed at baseline and at 6 months using the SF-12 v2 and FACT-P version 4. Internal responsiveness was assessed using paired t test and generalized estimating equation. External responsiveness was evaluated using receiver operating characteristic curve analysis. The internal responsiveness of the FACT-P and SF-12 v2 to detect positive change was satisfactory. The FACT-P and SF-12 v2 could not detect negative change. The FACT-P and the SF-12 v2 performed the best in distinguishing between improved general health and worsened general health. The FACT-P performed better in distinguishing between unchanged general health and worsened general health. The SF-12 v2 performed better in distinguishing between unchanged general health and improved general health. Positive change detected by these measures should be interpreted with caution as they might be too responsive to detect "noise," which is not clinically significant. The ability of the FACT-P and the SF-12 v2 to detect negative change was disappointing. The internal and external responsiveness of the social well-being of the FACT-P cannot be supported, suggesting that it is not suitable to longitudinally monitor the social component of HRQOL in prostate cancer patients. The study suggested that generic and disease-specific measures should be used together to complement each other.

  10. THE COOPERATIVE INTERNATIONAL NEUROMUSCULAR RESEARCH GROUP DUCHENNE NATURAL HISTORY STUDY—A LONGITUDINAL INVESTIGATION IN THE ERA OF GLUCOCORTICOID THERAPY: DESIGN OF PROTOCOL AND THE METHODS USED

    Science.gov (United States)

    McDonald, Craig M.; Henricson, Erik K.; Abresch, R. Ted; Han, Jay J.; Escolar, Diana M.; Florence, Julaine M.; Duong, Tina; Arrieta, Adrienne; Clemens, Paula R.; Hoffman, Eric P.; Cnaan, Avital

    2014-01-01

    Contemporary natural history data in Duchenne muscular dystrophy (DMD) is needed to assess care recommendations and aid in planning future trials. Methods The Cooperative International Neuromuscular Research Group (CINRG) DMD Natural History Study (DMD-NHS) enrolled 340 individuals, aged 2–28 years, with DMD in a longitudinal, observational study at 20 centers. Assessments obtained every 3 months for 1 year, at 18 months, and annually thereafter included: clinical history; anthropometrics; goniometry; manual muscle testing; quantitative muscle strength; timed function tests; pulmonary function; and patient-reported outcomes/ health-related quality-of-life instruments. Results Glucocorticoid (GC) use at baseline was 62% present, 14% past, and 24% GC-naive. In those ≥6 years of age, 16% lost ambulation over the first 12 months (mean age 10.8 years). Conclusions Detailed information on the study methodology of the CINRG DMD-NHS lays the groundwork for future analyses of prospective longitudinal natural history data. These data will assist investigators in designing clinical trials of novel therapeutics. PMID:23677550

  11. Using four-dimensional computed tomography images to optimize the internal target volume when using volume-modulated arc therapy to treat moving targets.

    Science.gov (United States)

    Yakoumakis, Nikolaos; Winey, Brian; Killoran, Joseph; Mayo, Charles; Niedermayr, Thomas; Panayiotakis, George; Lingos, Tania; Court, Laurence

    2012-11-08

    In this work we used 4D dose calculations, which include the effects of shape deformations, to investigate an alternative approach to creating the ITV. We hypothesized that instead of needing images from all the breathing phases in the 4D CT dataset to create the outer envelope used for treatment planning, it is possible to exclude images from the phases closest to the inhale phase. We used 4D CT images from 10 patients with lung cancer. For each patient, we drew a gross tumor volume on the exhale-phase image and propagated this to the images from other phases in the 4D CT dataset using commercial image registration software. We created four different ITVs using the N phases closest to the exhale phase (where N = 10, 8, 7, 6). For each ITV contour, we created a volume-modulated arc therapy plan on the exhale-phase CT and normalized it so that the prescribed dose covered at least 95% of the ITV. Each plan was applied to CT images from each CT phase (phases 1-10), and the calculated doses were then mapped to the exhale phase using deformable registration. The effect of the motion was quantified using the dose to 95% of the target on the exhale phase (D95) and tumor control probability. For the three-dimensional and 4D dose calculations of the plan where N = 10, differences in the D95 value varied from 3% to 14%, with an average difference of 7%. For 9 of the 10 patients, the reduction in D95 was less than 5% if eight phases were used to create the ITV. For three of the 10 patients, the reduction in the D95 was less than 5% if seven phases were used to create the ITV. We were unsuccessful in creating a general rule that could be used to create the ITV. Some reduction (8/10 phases) was possible for most, but not all, of the patients, and the ITV reduction was small.

  12. Using four‐dimensional computed tomography images to optimize the internal target volume when using volume‐modulated arc therapy to treat moving targets

    Science.gov (United States)

    Yakoumakis, Nikolaos; Winey, Brian; Killoran, Joseph; Mayo, Charles; Niedermayr, Thomas; Panayiotakis, George; Lingos, Tania; Court, Laurence

    2012-01-01

    In this work we used 4D dose calculations, which include the effects of shape deformations, to investigate an alternative approach to creating the ITV. We hypothesized that instead of needing images from all the breathing phases in the 4D CT dataset to create the outer envelope used for treatment planning, it is possible to exclude images from the phases closest to the inhale phase. We used 4D CT images from 10 patients with lung cancer. For each patient, we drew a gross tumor volume on the exhale‐phase image and propagated this to the images from other phases in the 4D CT dataset using commercial image registration software. We created four different ITVs using the N phases closest to the exhale phase (where N=10, 8, 7, 6). For each ITV contour, we created a volume‐modulated arc therapy plan on the exhale‐phase CT and normalized it so that the prescribed dose covered at least 95% of the ITV. Each plan was applied to CT images from each CT phase (phases 1–10), and the calculated doses were then mapped to the exhale phase using deformable registration. The effect of the motion was quantified using the dose to 95% of the target on the exhale phase (D95) and tumor control probability. For the three‐dimensional and 4D dose calculations of the plan where N=10, differences in the D95 value varied from 3% to 14%, with an average difference of 7%. For 9 of the 10 patients, the reduction in D95 was less than 5% if eight phases were used to create the ITV. For three of the 10 patients, the reduction in the D95 was less than 5% if seven phases were used to create the ITV. We were unsuccessful in creating a general rule that could be used to create the ITV. Some reduction (8/10 phases) was possible for most, but not all, of the patients, and the ITV reduction was small. PACS number: 87.55.D‐ PMID:23149778

  13. The impact on the environment and on the population due to the release of the patients after therapy with unsealed sources: a comparison between the new international recommendations and the Italian regulations

    International Nuclear Information System (INIS)

    Russo, A.; Speranza, A.; Storto, G.; Salvatore, M.; Casale, M.; Delia, R.

    2006-01-01

    The radiopharmaceutical therapy is the administration of unsealed sources of radioactivity designed to elicit a therapeutic response as a result of irradiation of a target human tissue. Historically, radioiodine (131 I) therapy for thyroid diseases, including hyperthyroidism as well as localized and metastatic thyroid cancer, has been the most studied and successful application of radionuclide therapy. This success has largely resulted from the high, rapid, and long-retained uptake of iodide in thyroidal tissue, whereas little uptake occurs in extra-thyroidal tissues. After diagnostic nuclear medicine procedures, precautions for the public are rarely required. In the other hand, after some therapeutic procedures, exposures to the public, patients relatives, and others should be limited. The decision to hospitalise or release a patient after the therapy with unsealed radioactive sources should be determined on an individual basis, and on the factors such as the residual activity in the patient, the patients wishes, the occupational and public exposures, cost, family and environmental aspects. The ICRP Publication 94 sets a limit for the radio nuclide activities, depending on external dose to other people, that can decide if patients may be or may not be hospitalised after the therapy. The International Commission on Radiological Protection (ICRP) has relied upon the dose limit of 1 mSv/year for the public, and the dose constraint of 5 mSv/episode for relatives, visitors, and caregivers (ICRP, 1991, 1996). These recommendations have been interpreted in various Countries, and the dose constraint has often been inappropriately interpreted as a rigid annual dose limit. As iodine-131 is a frequently used high-energy gamma emitter and has an 8-days physical half-life, it results in the largest dose to medical staff, the public, and relatives after procedures involving therapeutic administration of unsealed radionuclides. If we consider 1 mSv as the dose effective for the

  14. The impact on the environment and on the population due to the release of the patients after therapy with unsealed sources: a comparison between the new international recommendations and the Italian regulations

    Energy Technology Data Exchange (ETDEWEB)

    Russo, A.; Speranza, A.; Storto, G.; Salvatore, M. [National Research Council, Institute of Biostructures and Bioimaging and Dep. of Biomorphological and Functional Sciences Federico-2 Univ., Napoli (Italy); Casale, M. [Federico-2 Univ., Dept. of Physics - Health Physics School, Napoli (Italy); Delia, R. [La Sapienza Univ., Faculty of Medicine, Rieti Section, Roma (Italy)

    2006-07-01

    The radiopharmaceutical therapy is the administration of unsealed sources of radioactivity designed to elicit a therapeutic response as a result of irradiation of a target human tissue. Historically, radioiodine (131 I) therapy for thyroid diseases, including hyperthyroidism as well as localized and metastatic thyroid cancer, has been the most studied and successful application of radionuclide therapy. This success has largely resulted from the high, rapid, and long-retained uptake of iodide in thyroidal tissue, whereas little uptake occurs in extra-thyroidal tissues. After diagnostic nuclear medicine procedures, precautions for the public are rarely required. In the other hand, after some therapeutic procedures, exposures to the public, patients relatives, and others should be limited. The decision to hospitalise or release a patient after the therapy with unsealed radioactive sources should be determined on an individual basis, and on the factors such as the residual activity in the patient, the patients wishes, the occupational and public exposures, cost, family and environmental aspects. The ICRP Publication 94 sets a limit for the radio nuclide activities, depending on external dose to other people, that can decide if patients may be or may not be hospitalised after the therapy. The International Commission on Radiological Protection (ICRP) has relied upon the dose limit of 1 mSv/year for the public, and the dose constraint of 5 mSv/episode for relatives, visitors, and caregivers (ICRP, 1991, 1996). These recommendations have been interpreted in various Countries, and the dose constraint has often been inappropriately interpreted as a rigid annual dose limit. As iodine-131 is a frequently used high-energy gamma emitter and has an 8-days physical half-life, it results in the largest dose to medical staff, the public, and relatives after procedures involving therapeutic administration of unsealed radionuclides. If we consider 1 mSv as the dose effective for the

  15. Immunosupportive therapies in aging

    Directory of Open Access Journals (Sweden)

    Tamas Fülöp

    2007-04-01

    subpopulations resulting from antigen exposure, and altered T cell activation pathways. However, a body of data indicates that innate immune responses, including the critical bridge between innate and adaptive immunity, and antigen presenting capacity are not completely resistant to senescence processes. The consequences of all these alterations are an increased incidence of infections, as well as possibly cancers, autoimmune disorders, and chronic inflammatory diseases. The leading question is what, if anything, can we do to prevent these deleterious changes without dangerously dysregulating the precarious balance of productive immunity versus immunopathology? There are many potential new therapeutic means now available to modulate immunosenescence and many others are expected to be available shortly. One main problem in applying these experimental therapies is ethical: there is a common feeling that as ageing is not a disease; the elderly are not sick and therefore do not require adventurous therapies with unpredictable side-effects in mostly frail individuals. Animal models are not helpful in this context. In this chapter we will first briefly review what we think we know about human immunosenescence and its consequences for the health status of elderly individuals. We will then discuss possible interventions that might one day become applicable in an appropriate ethical environment.Keywords: immunosenescence, T cells, phagocytic cells, nutrition, vaccination, exercise, CMV, inflammaging, IRP, immunorestorative therapies

  16. The prognostic value of pimonidazole and tumour pO2 in human cervix carcinomas after radiation therapy: A prospective international multi-center study

    International Nuclear Information System (INIS)

    Nordsmark, Marianne; Loncaster, Julie; Aquino-Parsons, Christina; Chou, S.-C.; Gebski, Val; West, Catharine; Lindegaard, Jacob C.; Havsteen, Hanne; Davidson, Susan E.; Hunter, Robin; Raleigh, James A.; Overgaard, Jens

    2006-01-01

    Background and purpose: Hypoxia adversely affects treatment outcome in human uterine cervical cancer. Here, we present the results of a prospective international multi-centre study evaluating the prognostic value of pre-treatment tumour oxygen partial pressure (pO 2 ) and the hypoxia marker pimonidazole (pimo). Materials and methods: One hundred and twenty-seven patients with primary cervix cancer were entered. Pre-treatment tumour pO 2 measurements were obtained, and reported by the median tumour pO 2 , the fraction of pO 2 values ≤10 mmHg (HP 1 ), ≤5 mmHg (HP 5 ) and ≤2.5 mmHg (HP 2.5 ). Following intravenous pimonidazole administration, biopsies were taken, stained for pimonidazole adducts, and scored for the area of labelled tumour cells on a scale from 0 to 4. Treatment modalities were surgery (11%), radiotherapy (98%), chemotherapy (33%) and carbogen (14%). Results: None of the hypoxia descriptors were statistically significant prognostic factors for loco-regional tumour control or overall survival when analyzed as continuous variables or divided by the sample median. By univariate analysis only tumour size and nodal status were significant prognostic factors for local control. Tumour size and FIGO stage were significant for overall survival. In a multivariate analysis stratified by centre, only tumour size above 5 cm and lower pre-treatment haemoglobin predicted poorer overall survival among FIGO stage, nodal involvement, tumour size, pre-treatment haemoglobin dichotomized at 12 g/dl and pimo 1, pimo 4 and HP 5 as continuous variables. Conclusion: Neither Eppendorf nor pimonidazole should be dismissed based on the current results. However, further investigations are needed to readdress the hypotheses of the current study having optimized statistical designs, and a population of sufficient size treated more homogenously following rigorous protocols

  17. Google Lunar XPRIZE: Sharing the global adventure of going 'Back to the Moon: For Good'

    Science.gov (United States)

    Heward, A.; Gonzales, C.; Ashley, C.; Hwang, P.

    2013-09-01

    The Google Lunar XPRIZE is igniting a new era of lunar exploration by offering the largest international incentive prize of all time. A total of $30 million in prizes are available to the first privately funded teams to safely land a robot on the surface of the Moon. Currently 23 teams are competing for the Google Lunar X PRIZE, with team headquarters spread across the world, including Germany, Hungary, Spain, Croatia, Denmark, Romania, Russia, India, Israel, Malaysia, Japan, Chile and Brazil as well as the USA. Building awareness and involving the public with the competition presents an outreach challenge on a global scale. A strong presence on social media is one of the core requirements for teams participating in the competition. To engage and inspire young people, Google Lunar XPRIZE has for the past three years run a junior version of the competition, MoonBots, a LEGO®MINDSTORMS® Challenge. A kit based on the competition has now been developed for use in Science Centres. In Autumn 2013, a full-dome planetarium show will be launched entitled 'Back to the Moon -For Good.' This show will be available to planetaria around the world at a no-cost lease. This suite of outreach activities aim to build excitement over the next two years as the teams prepare for launch before the Google Lunar XPRIZE expiry date of December 2015.

  18. Nopcsa, Baron Franz. 2014. Traveler, Scholar, Politician, Adventurer – A Transylvanian Baron at the Birth of Albanian Independence (ed. and trans. from German Robert Elsie. Budapest: Central European University Press. 227 pp.

    Directory of Open Access Journals (Sweden)

    David Mandler

    2015-01-01

    Full Text Available Nopcsa, Baron Franz. 2014. Traveler, Scholar, Politician, Adventurer – A Transylvanian Baron at the Birth of Albanian Independence (ed. and trans. from German Robert Elsie. Budapest: Central European University Press. 227 pp.  Reviewed by David Mandler, Independent Scholar

  19. Cone-Beam Computed Tomography Internal Motion Tracking Should Be Used to Validate 4-Dimensional Computed Tomography for Abdominal Radiation Therapy Patients

    Energy Technology Data Exchange (ETDEWEB)

    Rankine, Leith; Wan, Hanlin; Parikh, Parag; Maughan, Nichole [Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri (United States); Poulsen, Per [Department of Oncology, Aarhus University Hospital, Aarhus (Denmark); DeWees, Todd; Klein, Eric [Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri (United States); Santanam, Lakshmi, E-mail: lsantanam@radonc.wustl.edu [Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri (United States)

    2016-06-01

    Purpose: To demonstrate that fiducial tracking during pretreatment Cone-Beam CT (CBCT) can accurately measure tumor motion and that this method should be used to validate 4-dimensional CT (4DCT) margins before each treatment fraction. Methods and Materials: For 31 patients with abdominal tumors and implanted fiducial markers, tumor motion was measured daily with CBCT and fluoroscopy for 202 treatment fractions. Fiducial tracking and maximum-likelihood algorithms extracted 3-dimensional fiducial trajectories from CBCT projections. The daily internal margin (IM) (ie, range of fiducial motion) was calculated for CBCT and fluoroscopy as the 5th-95th percentiles of displacement in each cardinal direction. The planning IM from simulation 4DCT (IM{sub 4DCT}) was considered adequate when within ±1.2 mm (anterior–posterior, left–right) and ±3 mm (superior–inferior) of the daily measured IM. We validated CBCT fiducial tracking as an accurate predictive measure of intrafraction motion by comparing the daily measured IM{sub CBCT} with the daily IM measured by pretreatment fluoroscopy (IM{sub pre-fluoro}); these were compared with pre- and posttreatment fluoroscopy (IM{sub fluoro}) to identify those patients who could benefit from imaging during treatment. Results: Four-dimensional CT could not accurately predict intrafractional tumor motion for ≥80% of fractions in 94% (IM{sub CBCT}), 97% (IM{sub pre-fluoro}), and 100% (IM{sub fluoro}) of patients. The IM{sub CBCT} was significantly closer to IM{sub pre-fluoro} than IM{sub 4DCT} (P<.01). For patients with median treatment time t < 7.5 minutes, IM{sub CBCT} was in agreement with IM{sub fluoro} for 93% of fractions (superior–inferior), compared with 63% for the t > 7.5 minutes group, demonstrating the need for patient-specific intratreatment imaging. Conclusions: Tumor motion determined from 4DCT simulation does not accurately predict the daily motion observed on CBCT or fluoroscopy. Cone-beam CT could

  20. TU-AB-BRA-06: BEST IN PHYSICS (JOINT IMAGING-THERAPY): An MRI Compatible Externally and Internally Deformable Lung Motion Phantom for Multi-Modality IGRT

    Energy Technology Data Exchange (ETDEWEB)

    Sabouri, P; Sawant, A [University of Texas Southwestern Medical Center, Dallas, TX (United States); Arai, T [University of Maryland School of Medicine, Baltimore, MD (United States)

    2016-06-15

    Purpose: MRI has become an attractive tool for tumor motion management. Current MR-compatible phantoms are only capable of reproducing translational motion. This study describes the construction and validation of a more realistic, MRI-compatible lung phantom that is deformable internally as well as externally. We demonstrate a radiotherapy application of this phantom by validating the geometric accuracy of the open-source deformable image registration software NiftyReg (UCL, UK). Methods: The outer shell of a commercially-available dynamic breathing torso phantom was filled with natural latex foam with eleven water tubes. A rigid foam cut-out served as the diaphragm. A high-precision programmable, in-house, MRI-compatible motion platform was used to drive the diaphragm. The phantom was imaged on a 3T scanner (Philips, Ingenia). Twenty seven tumor traces previously recorded from lung cancer patients were programmed into the phantom and 2D+t image sequences were acquired using a sparse-sampling sequence k-t BLAST (accn=3, resolution=0.66×0.66×5mm3; acquisition-time=110ms/slice). The geometric fidelity of the MRI-derived trajectories was validated against those obtained via fluoroscopy using the on board kV imager on a Truebeam linac. NiftyReg was used to perform frame by frame deformable image registration. The location of each marker predicted by using NiftyReg was compared with the values calculated by intensity-based segmentation on each frame. Results: In all cases, MR trajectories were within 1 mm of corresponding fluoroscopy trajectories. RMSE between centroid positions obtained from segmentation with those obtained by NiftyReg varies from 0.1 to 0.21 mm in the SI direction and 0.08 to 0.13 mm in the LR direction showing the high accuracy of deformable registration. Conclusion: We have successfully designed and demonstrated a phantom that can accurately reproduce deformable motion under a variety of imaging modalities including MRI, CT and x-ray fluodoscopy